HomeMy WebLinkAbout10-18-05
217
REV-1500 EX (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21-05-0260
COUNTY CODE
YEAR
NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Catherine M. Adams
DATE OF DEATH (MM-DD-YEAR)
SOCIAL SECURITY NUMBER
195-16-2549
DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
2/4/2005 11/6/1906
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
03
05
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o 1. Original Return 0 2. Supplemental Return
o 4. Limited Estate 04a. Future Interest Compromise (date of death after 12-12-82)
o 6. Decedent Died Testate (Attach copy of Will) 0 7. Decedent Maintained a Living Trust (Attach copy of Trust) 0 8. Total Number of Safe Deposit Boxes
o 9. Litigation Proceeds Received 010. Spousal Poverty Credit (date 01 death between 12.31.91 and 1.1-95) 011. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME
Remainder Return (date of death prior to 12-13-82)
Federal Estate Tax Return Required
COMPLETE MAILING ADDRESS
5 South Hanover Street
Robert M. Fre
FIRM NAME (If Applicable)
Carlisle PA 17013
717243-5838
OFFICIAL USE ONLY
1. Real Estate (Schedule A)
(1) NONE
2. Stocks and Bonds (Schedule B)
(2)
(3) NONE
(4) NONE
49,438
')
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
(5)
(6) NONE
22,243
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6. Jointly Owned Property (Schedule F)
Dseparate Billing Requested
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G)
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7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property
(Schedule G or L)
(7)
18,791
(8)
15,589
1,245
(11)
(12)
(13)
(14)
73,638
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73,638
8. TOTAL GROSS ASSETS (total Lines 1-7)
90,472
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) :10)
12. NET VALUE OF ESTATE (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not
been made (Schedule J)
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
Z rate ,or transfers under Sec.9116 (a)(1.2)
0
i= Amount of Line 14 taxable at lineal rate
< 16.
I-
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:i! 17. Amount of Line 14 taxable at sibling rate
0
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X
< 18. Amount of Line 14 taxable at collateral rate
I-
x .0 (15) 0
73,638 x .045 (16) 3,314
x .12 (17) 0
x .15 (18) 0
(19) 3,314
19. Tax Due
200
. aH~~KiitEajf~El~"~R~!3e~jM'(N_R~.I~~~~ijl~~eR~~'(i1I~j;'
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
II.
217
Catherine M. Adams
C
Add
195-16-2549
Decedent's amp ete ress:
STREET ADDRESS
1000 West South Street
CITY I~TATE lZIP
Carlisle 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)
2,009
106
Total Credits ( A + B + C ) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 0 + 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. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
3,314
2,115
o
o
1,199
1,199
1.
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
2.
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 reversionary 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 one 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 death?
Yes
D
D
D
D
D
D
3.
4.
Did decedent own an Individual Retirement Account, annuity or other non-probate property which
contains a beneficiary designation?
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
D
No
o
o
o
o
o
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DATE
/0 -jf5.o.5
7 Bellaire Avenue Carlisle P ns Ivania 17013
SIGNATURE OF PREPARER OTHE THAN REPRESENTATIVE
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DATE
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ADDRESS
5 South Hanover Street, Carlisle, Pennsylvania 17013
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%
172 P.S. Section 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 P.S. Section 9116 (a)(1.1 )(ii)].
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 P.S. Section 9116(a)(1.2)].
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. Section 9116(1.2) [72 P.S. Section 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. Section 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.
217
REV-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Catherine M. Adams
FILE NUMBER
21-05-0260
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Stott & Stott Financial Services, Account No. 1693-1439768
(4,6643.9510 shares @10.60
VALUE AT DATE
OF DEATH
49,438
TOTAL (Also enter on line 2 Recaoitulation $
(If more space is needed, insert additional sheets of the same size)
49 438
Daniel W. Stott
157 S. Hanover St.
Carlisle,PA 17013
Phone (717) 243-8077
Fax (717) 243-1748
StottD@hdvest.net
May 5, 2005
Frey & Tiley
5 South Hanover Street
Carlisle, P A 17013
RE: Estate of Catherine M. Adams
SS# 195-16-2549
Dear Sir or Madam:
As requested, following is all of the account information for Catherine M. Adams as of
February 4, 2005.
Nuveen Mutual Funds:
Nuveen Pennsylvania Muni Bd R
Acct# 1693-1439768
Shares: 4,663.9510
Net Asset Value: $10.60
Total Value: $49,437.88
If you have any questions please feel free to contact me. Thank you.
Sincerely,
~
Daniel W. Stott
-.',.
Securities offered through H.D. Vest Investment ServicessM,
A non-bank subsidiary of Wells Fargo & Company, Member: SIPC,
6333 North State Highway 161, Fourth Floor
Irving, Texas 75038, (972) 870-6000
217
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Catherine M. Adams
Include the proceeds of litigation and the date the proceeds were received by the estate.
All orooertv iointlv-owned with right of survivorshio must be disclosed on Schedule F.
FILE NUMBER
21-05-0260
ITEM
NUMBER DESCRIPTION
Sovereign Bank, Checking Account #1671 023382(Opened 10/19/04}
Accrued Interest to Date of Death
2 M& T Bank, Checking Account #3740565258
3 PSERS
4
VALUE AT DATE
OF DEATH
20,492
15
1,678
58
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
22,243
Sovereign Bank
Catherine M. Adams
195-16-2549
February 4, 2005
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Account #: 1671023382 Type: Checking
In the name of: Catherine M. Adams or Gertrude Keller
Date of Death Balance: $23,491.51
Int.(YTD) from 1/1/2005 to 1/25/2005
Accrued interest to date of death: $15.29
Other Info:
Open date: 10/19/2004
$35.99
Page 1 of 1
r+-~
COMMONWEALTH OF PENNSYLVANIA
PUBLIC SCHOOL EMPLOYEES' RETIREMENT SYSTEM
Mailing Address
PO Box 125
Harrisburg P A 17108-0125
Toll-Free - 1-888-773-7748
( 1-888-PSERS4U)
Local-717-787-8540
Building Location
5 North 5th Street
Harrisburg PA
Web Address: www.psers.state.pa.us
May 20,2005
CAROL WERT
C/O FREY & TILEY ESQUIRE
5 S HANOVER ST
CARLISLE PA 17013
RE: Catherine Adams
S.S.# 195-16-2549
Dear Ms. Wert:
Thank you for your correspondence.
A prorated payment of $57.92 for the period of February 1, through February 4, 2005,
was due Catherine Adams, and is now payable to Gertrude E. Keller, as the designated
beneficiary.
Please provide the current address of Gertrude E. Keller.
The payments dated February 28,2005, March 31,2005, and April 29, 2005, of
$197.49 each have already been electronically transferred to Farmers Trust Co,
account #3740565258. Please reimburse PSERS for the overpayment of $592.47.
Make your check or money order payable to PSERS and send to the mailing address
shown.
Enclosed is PSERS Health Options Program information sheet which applies to any
surviving spouse or dependent(s) of the deceased member.
A 1 099-R will be sent which will report the deceased member's income for the
year 2005. This form will be necessary for the preparation of the final income tax return.
1099-R's are generated and issued at the end of the calendar year.
There will be no further benefits payable from this account.
Please include the decedent's name and social security number with all
correspondence.
f:! M&fBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
May 4, 2005
Frey & Tiley
Attorneys At Law
5 South Hanover Street
Carlisle, Pennsylvania 17013
Re: Estate of Catherine MAdams
Social Security: 195-16-2549
Date of Death: Februarv 04. 2005
Dear Sir or Madam:
Per your inquiry dated April 25, 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
3740565258
Ownership (Names of)
Catherine MAdams *
Opening Date
05/14/99
Balance on Date of Death
$1,678.48
$ 0.00
Accrued Interest
Total
$1,678.48
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 High Street Carlisle Office # 717-240-4536.
Sincerely,
1{a-P4/0'fti/
Nancy Clagett
Records Management
217
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEOENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
Catherine M. Adams
21-05-0260
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. AIG Annuity Contract #BA032090 18,791 100.00% 18,791
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL (Also enter on line 7 Recapitulation) $ 18 791
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
(If more space is needed, insert additional sheets of the same size)
-
AIG Annuity Insurance Company
PO. Box 871
Amarillo. Texas 791 OS-087I
800.424.4990
May 21,2005
Frey & Tiley
Attn: Robert M Frey
5 South Hanover Street
Carlisle, P A 17013
Re:
Deceased:
Contract #:
Catherine MAdams
BA032090
Dear Mr. Frey:
Thank you for your recent inquiry regarding the referenced annuity contract(s). It is our pleasure
to be of service to you.
The value ofthe aforementioned contract was $18,791.18 on February 4,2005.
We hope this information is helpful; however, should you have additional questions or require
further assistance, please feel free to contact our Client Care Center by using our toll free number
of 1-800-424-4990.
Sincerely,
g1ftt{)aUeL
Gayla Walker
Claims Department
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217
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Catherine M. Adams
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home, Inc., Funeral Services 11 ,456
2. Carlisle Memorials, Inscription on Headstone 184
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 3,772
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 173
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Register of Wills, (1) Short Certificate 4
TOTAL (Also enter on line 9 Recaoitulation $ 15 589
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03) 217
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Catherine M. Adams
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
DESCRIPTION
VALUE AT DATE
OF DEATH
Sarah Todd Nursing Home, Medical
Pharmerica, Medical
Central PA Imaging, Medical
Belvedere Medical Center, Medical
Sprint, Telephone
Darlene Moyer, 2005 County & Township Taxes
930
207
8
55
35
10
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,245
217
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Catherine MAdams
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)J
Gertrude E. Keller Daughter 100% residue of estate
7 Bellaire Avenue
Carlisle, Pennsylvania 17013
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 TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
I. CATHERINE M. ADAMS. of 423 "B" Street. of the Borough of
Carlisle. Cumberland County. Pennsylvania. being of sound and disposing
mind. memory and understanding. do hereby make. publish and declare this
as and for my Last Will and Testament. hereby revoking and,making void
any and all Wills by me at any time heretofore made.
1. dturect my hereinafter named Executor to pay all of my just debts
and funeral expenses as soon after my death as may be found convenient to
do so.
2. All the rest. residue and remainder of my estate. real. personal
and mixed. and wheresoever the same may be situate. I give. devise and
bequeath unto my husband. Paul L. Adams. his heirs and assigns. to the
exclusion of my chil4,ren. born and unborn. provided my said husband. Paul
L. Adams. shall survive me by a period of ninety (90) days.
3. If my said husband, Paul L. Adams. shall pre-decease me or
fail to survive me by the aforesaid period of ninety (90) days. then all the
rest. residue and remainder of my estate. real. personal and mixed. and
wheresoever the same may be situate. I give. devise and bequeath to my only
child. her heirs and assigns. she being Gertrude E. Keller.
4. I hereby nominate. constitute and appoint my said husband. Paul
L. Adams. Executor of this my Last Will and Testament. In the event my
said husban~. Paul L. Adams. shall pre-decease me or fail to qualify as
Executor. then I hereby nominate. constitute and appoint my said daughter.
Gertrude E. Keller. Executrix of this my Last Will and Testament. and I
further direct that neither my Executor or Executrix shall be required to post
any bond to secure the faithful performance of his or her duties in the
Commonwealth of Pennsylvania or in any other jurisdiction.
~ '>>1, Cd~.
I
-.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this
Last Will and Testament consisting of two pages, this1L day of October,
1964.
~.~t?~~JSEAL)
..., " .':' .d''''> ',"~;,i('~:;~.:Z~~:;;j01.k~~~:~;t:,~:r:~~~~~:~~ ~:~.~
Signed" sealed, published and declaredbY'Ca~herineM. Adams, the
testatrix above named, as and for her Last Will and Testament, in our presenc ,
who, in her presence, at her request, and in the presence of each other, have
hereunto subscribed our names as attesting witnesses.
~?r.. .?
--~;--