HomeMy WebLinkAbout09-01-05
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
2-L-~~ () 2Jl~
COUNTY CODE YEAR NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Walters, Winifred V.
SOCIAL SECURITY NUMBER
182-22-9621
DATE OF DEATH (MM-DD-YEAR)
06/08/2005
DATE OF BIRTH (MM-DD-YEAR)
02/02/1921
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ 1 Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2 Supplemental Return
o 4a. Future Interest Compromise (date of death after 12.12.82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit idate of dealh between 12.31.91 and 1-1-95)
o 3. Remainder Return (date of death onor 10 12-13-R2)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11 Election to tax under Sec. 9113(A) IAttach Seh 0)
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NAME
Michael A. Scherer, Esquire
FIRM NAME (If Applicable)
O'Brien, Baric & Scherer
TELEPHONE NUMBER
(717) 249-6873
COMPLETE MAILING ADDRESS
19 West South Street
Carlisle, Pennsylvania 17013
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
0.00
0.00
0.00
0.00
14,573.08
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(8)
5,120.80
289.53
14,573.08
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0.00
(6)
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(7)
0.00
(9)
(10)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(11)
(12)
(13)
5,410.33
9,162.75
0.00
14. Net Value Subject to Tax (Line 12 minus Line 13)
9,162.75
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O ~ (15)
. 'n_ f:l,1(3?:Z~ x.O 45 (16)
412.32
16. Amount of Line 14 taxable at lineal rate
x12
(17)
17. Amount of Line 14 taxable at sibling rate
18 Amount of Line 14 taxable at collateral rate
x .15 (18)
19. Tax Due
(19)
412.32
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
1523 Shirley Avenue
CITY Carlisle
STATE
PA
ZIP
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)
412.32
20.61
Total Credits (A + B + C ) (2)
20.61
3. Interest/Penalty if applicable
D. Interest
E. Penalty
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
0.00
0.00
391.70
0.00
Total Interest/Penalty ( D + E ) (3)
4. 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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A Enter the interest on the tax due.
391.70
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: Yes No
a. retain the use or income of the property transferred;.... ...................................... D [KJ
b. retain the right to designate who shall use the property transferred or its income .. D [KJ
c. retain a reversionary interest; or......... ................. ......... D [KJ
d. receive the promise for life of either payments, benefits or care? .................. ............... ............... D [KJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................. ......................... .. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D ~
IF THE ANSWER TO ANY OF THE ABOVE 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 information of which preparer has any knowledge.
SIGy U E OF P~~LE-!O~FILlNG RETURN
ADDRESS
639 Lindsey Road, Carlisle, Pennsylvania 17013
SIGNATUtmAlrn:;..THER THAN REPRESENTATIVE
ADDRESS I
19 West South Street, Carlisle. PA 17013
---_._--------_...,--~--_..---_._----_._------ _..._-~-_._._-,.,..-_._---- .-.--..--.--------- .....- -._-~-----
DATE
~'5J .or
DATE
8.3/.0)
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 PS ~9116 (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 PS. ~9116 (a) (1.1) (il)]
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure 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 younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 PS. ~9116(a)(12}].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. !;9116(1.2) [72 PS. !;9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. !;9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF . .
WInIfred V. Walters
FILE NUMBER
Include the proceeds of litigation and the dale the proceeds were received by the estate.
All property Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
M & T Bank
checking account
Acct. No. 88665224
2,817.64
2.
Smith Barney
Acct. No. 746-13985-18
11,132.88
3.
Comcast Cable Refund
272.56
4.
Personal Property
350.00
,
TOTAL (Also enter on line 5, Recapitulation) $ 14 , 573 . 08
(If more space is needed. insert additional sheets of the same size)
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COMMONWEALTH ~ PENNSYlVANIA
INHERITANCE TAX RETURN
DENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATEOF
Winifred V. Walters
FILE NUIlBER
Debts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hoffman Roth Funeral Home 4,279.00
2. Westminister Cemetery-grave opening 595.00
B. ADMINISTRATIVE COSTS:
1. PllISOlllI\ Representative's Convnissions
Name of Personal Representative (5)
Social Security Number(s) I EIN Number of Personal Representalive(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Clahnant to Decedent
4. Probate Fees - filing fees 17.00
5. Accountanfs Fees
6. Tax Return Prepare!'s Fees
7. Flowers 90.10
8. Canopy 100.70
9. Luncheon supplies 39.00
TOTAL (Also enter on line 9, Recapitulation) $ 5,120.80
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITAt'KE TAX RETURN
RESiDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABLITIES AND LIENS
i Please Print or Type
______________________ _-L __ __.__
-------- [ FILE N-UMBER
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..____..________._____J__... _..____________________
ESTATE OF
I
--1.
winifred V. Walters
--ITEM --1---- DESCRIPTION ---------------------T---:;~OU-NT--
_~~MBER ~----------------------------------- _I
,. I Sprint II 30.72
2. Carlisle Borough-water 32.36
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3. Carlisle Tax Collection-personal tax 10.00
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4. I PP & L I 39.76
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5. I CHCS Supplemental Insurance 176.69
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TOTAL (Also enter on line 10, Recapitulation)
$ 289.53
(If more space ;s needed, insert additional sheets of same size)
'Wi. ISH EX -1'.91)
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SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER
I.
II.
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Winifred V. Walters
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DiSTRIBUTIONS (include outright spousal distributions)
1.
Hope M. Johnston
8 Furnace Hollow Road
Shippensburg, PA 17257
Donald R. Walters
639 Lindsey Road
Carlisle, PA 17013
Paul W. Walters, Jr.
754 East Walnut Street
Hanover, PA 17331
Joseph L. Walters
975 Mountain Road
Newville, PA 17241
Gerald F. Walters
1390 Poplars Road
York, PA 17404
2.
3.
4.
5.
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not list Trustee(s) OF ESTATE
daughter 1/5
son 1/5
son 1/5
son 1/5
son 1/5
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART IT - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
r
. Aug 02 05 10:03a
Hof"f"man Roth
7172433723
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Hoffman-Roth Funeral Home, Inc.
219 North Hanover StTeet
Carlisle, PA 17013
(717)243-4511
August 2, 200S
Donald Walters
639 Lindsey Rd.
Carlisle, P A 17013-
The Funeral Service for Winifred "Winnie" V. Walters
14550-104
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITE\1IZED STATEMENT OF THE SERVICES, FACILITIES, ACTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
OUR SERVICE
Basic Services of Funeral Director & Staff
Other Preparation of the Body. . .
FACILITY, 5T AFF, EQllIPMENT
$1710,00
$113.00
Graveside Services
$ I 90,00
USE OF STAFF & EQUIPMF,l'\T
Transfer of Remains to Funeral Home
Casket Coach (Hearse) . . . . .
Lead / Clergy ,I Errand Car. . . .
FU~ERAL HOME SERVICE CHARGES
$ 185.00
$230,00
$9500
$2523.00
SELECTED MERCHANDISE:
Spencer Casket . , .
Acknowledgment Cards.
Visitor Register . . .
Memorial Folders,
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
$]430,00
$20.00
$25.00
$25,00
$4023.00
Cash Advances
Newspaper Obituary Notice-Sentinel .
Certified Copies of Death Ccrtif:cate
Two Days Refndgeration . . . .
$126.00
$30.00
$100.00
TOTAL CASH ADVANCES A:\ID SPECIAL CHARGES.
$256.00
Total
Total Cost
$427'1.00
History
06/10/2005 H, Maxine Johnston . . . . . . . .
07/01/2005 CREDIT- Body preparation-hearse,Sentmel .
07/06/2005 Moumental Life Ins,Co. & Hope 1'.1, Johnston.
$-1500.00
$-241.00
$-2538.00
TOTAL AMOUNT DUE. .
$0.00
I? L%mID - m~ IPlliJ [b [b
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This statement is net and payable in full within 30 days of receipt.
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Please return this portion with your Remittance
!JM&rBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
August 9, 2005
Law Offiices
O'Brien, Baric & Scherer
19 West South Street
Carlisle, Pennsylvania 17013
Re: Estate of' Winifred V Walters
Social Security: 182-22-9621
Date of Death: June 08, 2005
Dear Sir or Madam:
Per your inquiry received August 04, 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 88665224
Ownership (Names oj) Winifred V Walters*
Hope Johnson, POA
Opening Date OS/28/73 Closed 08/04/05
Balance on Date of Death $2,817.43
Accrued Interest $ 0.21
Total
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 Carlisle West Office # 717-240-6717.
Sincerely,
2f0::~7~d;"7M
Nancy Clagett
Records Management
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. JUN.21.2005 3:50PM
SMITHHARNFY~~
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Prepared By SABRINA rN ALTERS
717-854-5553 !
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Bank ~posits
Mutu~ Furlds
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SMITH BARNEY YORK PA
NO. 548
Winifred V. Walters
1523 Shirley Ave
Carlisle PA 17013-9370
P.5
Balances
As Of 06/08/2005
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ACCoUDt]value L
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AcctNo.746-13985-18
2,532.74 Net Cash 2,532.74
8,600.14 Type 1 Market Value 8,600.14
Bank Deposits Avail 2,532.74
BDP Rate 2.547%
Last S1mt Value 11,026.28
Statement Date 5 /31/ 05
Prior Year-end Value 11,098.90
YTD Commissions 6.57
Prior Year Commissions 26.65
11,132.88/
I
l1e above summal)'/pri~qUotesf5tllJstics haVQ been obtained from sources bc1i~d reliable but are not nec:essmily complete and cannDt be guarantcod.
be information contained in monthly~ccolmt statements and confirmations re1leetB all transactions processed by Smith Barney, and lIS such 8UpcII'Sedes all
her reports for financial and tax p~ses. Smith Barney is a division and Service mark of Citigroup Global Mlirkets Inc. Member SlPC.
I
Page 1
. ,J.UN.2'l,'2005 3:50PM SMITH BRRNEY YORK PR NO. 548 P.6
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