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HomeMy WebLinkAbout08-18-05 REV. 1500 E~(6-00) , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z UJ o UJ U UJ o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) HELMICK Ruth P. Rev-1500 FILE NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT 21 County Code OFFICIAL OIJLy 05 0364 Year Number DATE OF DEATH (MM-DD-YEAR) April 12, 2005 SOCIAL SECURITY NUMBER 185-03-6419 THIS RETURN MUST BE FILED IN DUPLICATE WITH DATE OF BIRTH (MM-DD-YEAR) July 27,1916 REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A IJ) ~~(/l ~g-TI .c:~.Q U a.m a. <( x 1. Original Return r- 4. Limited Estate r- x 6. Decedent Died Testate (Attach copy of Will) r- 9. litigation Proceeds Received '-- THIS SECTION MUST BE COMPLETED. NAME Jean D. Seibert, Esquire FIRM NAME (If Applicable) Wion, Zulli & Seibert TELEPHONE NUMBER 717-236-9301 2. Supplemental Return 3 Remainder Return (dale of death prior 10 12. '-- t-- 4a. Future Interest Comprise (date of death after 12-12-82) 5. Federal Estate Tax Return Required ,.- Lo- 7. Decedent Maintained a Living Trust (Attach a copy of Trust) 8. Total Number of Safe Deposit Boxes = 10. Spousal Poverty Credit (date of death between 12.31-91 and 1.1-95) 011. Election to tax under Sec. 9113(A) (1) (2) (3) (4) (5) (6) $70,249.96 i $0.00 j ') (:) Ob' $0.00: i; $0.00 i c: : :n $0.00 : 0 1 -0 Z (' ~ (j\ > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < c Q) -= = o =- en ~ 5 <....:> ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS 109 Locust Street Harrisburg, PA 17101 OFFICIAL USE ONLY t'~: ~ ~ 3~: 1 ~ ~f rD--~l\~ l) ? \hi be c c ;) -;::; , u'" i/\ $31,181.26 i ! , $0.001 .......................................................... (7) (9) (10) (8) $5,006.81 $9,573.05 (11) (12) (13) (14) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o I- <( .....J :J I- Q.. <( () w e::: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7 Inter-Vivos Transfers & Misc. Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 1.(\ $101,431.22 $145791\6 $86,851.36 $10000 $86,751.36 $000 $3,90381 $0.00 $000 $3,903.81 --- 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities & liens (Schedule I) 11. Total Deductions (total lines g & 10) 12. Net Value of Estate (Line 8 minus Line 11) 14. Net Value Subject to Tax (Line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) z o i= ~~ !-:) a. :::: o U 16. Amount of line 14 taxable at lineal rate 17. Amount of line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due 20. D x (15) $86,751.36 x .045 (16) x .12 (17) x .15 (18) (19) Dec~dent's'Complete Address: STREET ADDRESS Sarah Todd Home CITY I~TATE TZIP Carlisle Borough PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) $3,903.81 ~~ RSO 00 ~1~? 10 Total Credits (A + B + C) (2) $384210 3. Interest/Penalty if applicable D. Interest E. Penalty 4. Total Interest/Penalty (0 + E) (3) If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) $0.00 5. A. Enter the interest on the tax due. $61.71 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) $61.71 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; c. retain a revisionary interest; or d. receive the promise for life of either payments, benefits or care? If death occurred after December 12, 1982, did decedent transfer property within on year of death without receiving adequate consideration? Did decedent own an "in trust for" or payable upon death bank account or security at his or her Did decedent own an Individual Retirement Account, annuity, or other non-probate property which Yes No 2. ~ B ~ EB 3. 4. contains a beneficiary designation? CJ c=KJ IF THE ANSWER TO ANY OF THE AB~VE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true. correct, and complete. Declaration of preparer other than the personal representative is based on all the information of which preparer has any knowledge. DATE 8-;0-05 ADDRESS 32 Bourbon Red Drive, Mechanicsburg, PA 17050 SIGNATUR 0 PRE THER THAN REPRESENTATIVE ADDRESS 109 Locust For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P .S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statl) '---~,~ fAr rlisclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or yo' adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a) (1.2)]. NA?.D 'al parent, an The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiarie: P.S. 99116(a) (1)]. 16(1.2) [72 The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [7 Section 9102, as an individual who has at least one parent in common with the decedent, whether by I 3 RuST ld, under ~ .y 1lLcrBt Will Clno Qf~5tClmcnt OF RUTH P. HELMICK I, RUTH P. HELMICK, of the Borough ofHununelstown, Dauphin County, ","/ '-- Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby declare this as and for my Last Will and Testament, hereby revoking all Wills and Codicils previously made by me. I. I direct the payment of my debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. 2. I give and bequeath my diamond engagement ring to my granddaughter, BRENDA L. KERN. 3. I give all my remaining articles of personal or household use, including any automobiles lawn at the time of my death, to my daughter, SHIRLEY A. KNISLEY, and my granddaughters, BRENDA L. KERN, BONITA A. JOHNSON, and DEBORAH K. SUFRIN, as they can agree. Ifnone of my said daughter and granddaughters desires certain of my articles of personal or household use, I direct that these items shall be converted to cash and the proceeds therefrom added to the rest, residue and remainder of my estate. "<f' 4. I give the sum of One Hundred ($100.00) Dollars to the MOUNTAIN VIEW {/'- BIBLE CHURCH, Hummelstown, Pennsylvania. ~ 5. I direct that all the rest, residue and remainder of my estate, whether real or personal, and wherever the same may be situate or located, shall be given to my said daughter and granddaughters in the following percentage distribution: (a) Thirty-five (35%) percent to my daughter, SHIRLEY A. KNISLEY; (b) Forty-five (45%) percent to my granddaughter, BRENDA L. KERN; J ~ "--:J '~ 0si (c) Ten (10%) percent to my granddaughter, BONITA A. JOHNSON; and (d) Ten (10%) percent to my granddaughter, DEBORAH K.SUFRIN. If any of these beneficiaries should predecease me, I direct that their issue shall be in receipt of their share, per stirpes. 6. I direct that any and all inheritance, estate and transfer taxes imposed upon my estate, passing under my Will or otherwise, shall be paid as a part of the expense of administration, payable out of my residuary estate. 7. In addition to powers given her by law, my Executrix acting hereunder shall have the fullest power and authority in all matters and questions and to do all acts which I might or could do ifliving, including, without limitation, complete power and authority to invest (without restriction to investments permitted by law), sell (at public or private sale, for cash or credit, with or without security), mortgage, lease and dispose of and distribute in kind, all property, real and personal at such times and upon such terms and conditions that she may deem advisable. 8. I nominate, constitute and appoint my daughter, SHIRLEY A. KNISLEY, as Executrix of this, my Last Will and Testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said daughter, I nominate, constitute and appoint my granddaughter, BRENDA L. KERN, as Executrix of this, my Last Will and Testament. 9. I hereby relieve my personal representative from the necessity of posting security in connection with her duties as such in any jurisdiction in which she may be called upon to ~ act insofar as I am able by law to do so. 2 IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting ofthree typewritten pages, the first two of which bear my signature in the margin for the purpose of identification, this -ffiay of l~ ,2002. 11~p4iHnL~~~AL) Ruth P. Helmick Signed, sealed, published and declared by the above-named Testatrix, Ruth P. Helmick, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, and in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. p)~,Jb Name! . N~/ fd.z:u..JG:.. Address 3 Commonwealth of Pennsylvania : SS County of Dauphin We, Ruth P. Helmick , Lt'N~~ d' lk..J:..o , the Testatrix and the witnesses, respectively, ,and J6..oJ ]). ...~,' b'e/r r- whose names are signed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby declare to the undersigned authority that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence, and I, the said Testatrix, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. -&A/dU ~~:eJc Testatrix i/:.1,v)7 {)(~ Itness ~ Subscribed, sworn to and acknowledged before me by Ruth P. Helmick the Testatrix, and subscribed and sworn to before me by .L/N~ ~ and :::r-~..r D. s~r, witnesses, this ~ day of . ~ 2002. v~ X AIL"l'Lc(..C Not Public NOTARIAL SEAL _~A Y, L OWJLET 1.1(\lal' Publj I (-;l.y , ~,.t; .-'-),h, -~. J' } C V..,."" -'. ;,_.J<I..; -j;''-'''lt'f[l Count ~.~...~.~'~:~",";;m {:.~:..~~~ l~.~ mlM&TBank MAY 032005 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888)502-4349 Fax (302) 934-2955 April 27, 2005 Wion, Zulli & Seibert Attorneys At Law 109 Locust Street POBox 1121 Harrisburg, Pennsylvania 17108-1121 Re: Estate 0(: Ruth P Helmick Social Security: 185-03-6419 Date of Death: April 12, 2005 Dear Sir or Madam: Per your inquiry dated April 20, 2005, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 440362 Ownership (Names of) Ruth P A Helmick * Shirley A Knisley * Brenda L Kern, PDA Opening Date 10/28/67 Balance on Date of Death $5,643.20 $ 0.34 Accrued Interest Total $5,643.54 2. Type of Account Certificate of Deposit Account Number 031003913800768 Ownership (Names of) Ruth P A Helmick * Shirley A Knisley * Brenda L Kern, PDA Opening Date 07/25/02 Closed 04/20/05 Balance on Date of Death $46,278.68 Accrued Interest $ 429.25 Total 707.93 3. Type of Account Certificate of Deposit Account Number 031003914415904 Ownership (Names oj) Ruth P A Helmick * Shirley A Knisley * Brenda L Kern. POA Opening Date. 07/08/88 Closed 04/20/05 Balance on Date of Death $10,000.00 $ 1I.03 Accrued Interest Total $]0,0] ].03 4. Type of Account Certificate of Deposit Account Number 0310039] 441629] Ownership (Names oj) Ruth P A Helmick * Brenda L Kern, POA Opening Date 07/08/88 Closed 04/20/05 Balance on Date of Death $70,000.00 $ 23.22 Accrued Interest Total $70,023.22 Please be advised, there was no safe deposit box found for the above decedent. * For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call the Hummelstown Office # 717-566-4003. Sincerely" " ~17~r Nancy Clagett Records Management REV-150B EX. (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Ruth P. Helmick FILE NUMBER 21-05-0364 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Certificate of Deposit No. 031003914416291 at M&T Bank Interest accrued to date of death VALUE AT DATE OF DEATH $70,000.00 $23.22 2. Buse Funeral Home - refund $221.74 3. Erie Insurance Group $5.00 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) $70,249.96 REV-1509 EX + (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Ruth P. Helmick FILE NUMBER 21-05-0364 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Shirley A. Knisley 104 St. Martins Way Apollo Beach, FL 33572 Daughter B. c. JOINTLY-OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY DATE OF DEATH %OF DATE OF DEATH FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DECD'S VALUE OF NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 10-28-67 Checking account No. 440362 at M& T Bank $5,643.20 50.0% $2,821.60 Interest accrued to date of death $0.34 50.0% $0.17 2. A 7 -25-02 Certificate of Deposit No. 031003913800768 at M&T Bank $46,278.68 50.0% $23,139.34 Interest accrued to date of death $429.25 50.0% $214.63 3. A 7 -8-88 Certificate of Deposit No. 031003914415904 at M& T Bank $10,000.00 50.0% $5,000.00 Interest accrued to date of death $11.03 50.0% $5.52 TOTAL (Also enter on line 6, Recapitulation) $31,181.26 (If more space is needed, insert additional sheets of the same size) - REV-1511 EX + (1-91)(1) (', COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Ruth P. Helmick FILE NUMBER 21-05-0364 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Mountain View Bible Church - funeral luncheon and honorarium $175.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney Fees - Wion, Zulli & Seibert $4,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees $248.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Advertising - The Sentinel $158.81 Cumberland Law Journal $75.00 8. People Finder/copies/certified mailings $100.00 9. Filing fee for First and Final Accounting and notary fees $250.00 TOTAL (Also enter on line 9, Recapitulation) $5,006.81 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (1-91)(1) -, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Ruth P. Helmick FILE NUMBER 21-05-0364 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT $9,016.06 1. 4-29-05 Sarah Todd Memorial Home 2. 4-29-05 West Shore EMS - transportation 3. 5-3-05 Hershey Foods Corp. - health insurance co-pay 4_ 5-15-05 Holy Spirit Hospital 5. 5-15-05 Philhaven - doctor visit 6. 5-15-05 Pharmerica - meds. At Sarah Todd Home $115.00 $5.00 $175.00 $18.94 $242.05 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $9,573.05 REV.151: EX ~ \9.00V COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Ruth P. Helmick 21-05-0364 FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S} RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Shirley A. Knisley Daughter 35% share of residue 104 SI. Martins Way Apollo Beach, FL 33572 2 Brenda L. Kern Granddaughter 45% share of residue 32 Bourbon Red Drive Mechanicsburg, PA 17050 3. Deborah K. Sufrin Granddaughter 10% share of residue 42 Greenmont Drive Enola, PA 17025 4. Bonita A. Johnson Granddaughter 10% share of residue No Known Address ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Mountain View Bible Church $100.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $0.00 (If more space is needed, insert additional sheets of the same size) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of: Ruth P. Helmick, Deceased No.: 21-05-0364; 2005-00364 Date of Death: April 12, 2005 Social Security No.: 185-03-6419 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of the Inventory, I verify that the statements made in this Inventory are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Jean D. Seibert, Esquire Personal Representative: .~cf~ Brenda L. Kern, Executrix ID.No.: PA 41713 Address: 109 Locust Street Harrisburg, PAl 71 01 Dated: 8- 10- oS Telephone: 717-236-9301 Description Value Certificate of Deposit No. 031003914416291 at M&T Bank Interest accrued to date of death $70,000.00 23.22 Buse Funeral Home - refund 221. 74 Erie Insurance Group 5.00 Total $70,249.96 \)-. - . ~ .--======-------....--- .. . ~::;:'.~~Mit;r f., .. f:"i . .... t7":~i~'~': ~~ '~ ',-, ~.J. J-' '~ ;:: ~~ ~ \\) "- . "- .'0 .,'''; .~ ,-, ., . "- ,'-I ~ ' ~.'~ . ~ ." ~.""'. '. ,~. -~ " ~~. ':\ "-.J' -........... " ~, '.J \:j 'k~ -.....;,.,..; ,). ~~. " .}'-J , (-~-~ '~ \ .-} ..".. -,'\-I ' .'-."J ~~ ~ ~ ~;J, . >~ "'. ~ ~ "'-.;,..'~\ ~~~ "= ). ~, ~ '-' \--~'> ~,::...'. ~'" .,. ", ,. -'''. "