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Home My WebLink About12-27-05 REV-1500 EX (Wl) REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 05 0459 COUNTY CODE YEAR NUMBER I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) WESTCOTT LAURENCE C SOCIAL SECURITY NUMBER I 109-18-9570 DATE OF DEATH (MM-DD-YEAR) 03/27/05 DATE OF BIRTH (MM-DD-YEAR) 03/04/16 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 193-12-8844 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) WESTCOTT CAMILLA R W I- lo::!!;Ul ua:lo: wD..U J:OO ua:..J D..al D.. el: ~ 1. Original Return o 4. Limited Estate [!] 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 3. Remainder Return (date of death priOf to 12-13-82) o 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AtlachSch0) o 2. Supplemental Return o 4a. Future Interest Compromise (dale of dealh after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) I- Z W C Z o D.. Ul W a: a: o u NAME Manufacturers and Traders Trust Company FIRM NAME (If Applicable) Attn. Jane F. Burke, Vice President TELEPHONE NUMBER (717) 240-4504 COMPLETE MAILING ADDRESS One West High Street, Carlisle, PA 17013 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 0.00 743,863.61 0.00 0.00 125,405.74 -" ~1 , . z o !c( ...J ::t !::: D.. <( U w tt:: 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 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) 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) 50,949.05 1,397,550.95 321 ,820.87 " '. rn (6) 0.00 (7) 579,230.65 1,448,500.00 (9) (10) (8) 50,090.77 858.28 (11) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) 1,075,730.08 (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::t D.. :!: o U >< ~ 15. Amount of Line 14 taxable at the spousal tax ?,gOO.OO x .045 225.00 rate, or transfers under Sec. 9116 (a)(1.2) (15) 16. Amount of Line 14 taxable at lineal rate 1,060,730.08 x .0 4? (16) 47,732.85 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate 10,000.00 x .15 (18) 1.500.00 19, Tax Due (19) 49,457.85 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 1295 Creek Road CITY Carlisle I STATE I ZIP 17013 PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 49,457.85 Total Credits (A + B + C ) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 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) 0.00 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) (5B) 49,457.85 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 49,457.85 0.00 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 a. retain the use or income of the property transferred;.......................................................................................... D b. retain the right to designate who shall use the property transferred or its income; ............................................ D c. retain a reversionary interest; or.......................................................................................................................... D d. receive the promise for life of either payments, benefits or care? ...................................................................... D 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 . b fi' d' t' ? fKJ contains a ene IClary eSlgna Ion. ........................................................................................................................ ~ No ~ ~ [iJ [iJ [iJ ~ 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. SIGNATURE Under pena~ies of pe~ury. I dedare 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. Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SPONSIBLE FOR FILING RETURN I oJ/lL, ~ I Qk rP.E51f'>c0T M&T Bank trust Depanment One West High Street Carli~le. PA 17013 ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE J ~/;l1105 DATE 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. ~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. ~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. ~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. ~9116(1.2) [72 P.S. S9116(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-1503 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF LAURENCE C. WESTCOTT FILE NUMBER 21-05-0459 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 318 shs. Barrick Gold Corp. 7,530.48 407.40 2 5 units PA Insured Muni #05-Q 3 24,662.222shs. Fidelity Spartan Muni Income Fund #37 318,265.97 4 28,051.519 shs. Fidelity Spartan PA Muni Income Fund #402 5 11,288.34 shs. T. Rowe Price Tax Free Income Fund 305,340.78 112,318.98 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 743,863.61 REV-1510 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF LAURENCE C. WESTCOTT FILE NUMBER 21-05-0459 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. AllState Life & Annuity Contract GA272469, William W. Westcott, Beneficiary 301,465.84 100 301,465.84 2 Nationwide Life & Annuity Ins. Co. Contract 071070434, Camilla R. Westcott Beneficiary 277,764.81 100 277,764.81 TOTAL (Also enter on line 7 Recapitulation) $ 579,230.65 (If more space is needed, insert additional sheets of the same size) '. REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LAURENCE C. WESTCOTT SCHEDULE J BENEFICIARIES FILE NUMBER 21-05-0459 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 Camilla R. Westcott, 1295 Creek Road, Carlisle, PA 17013 Spouse 5,000.00 2 William W. Westcott, 184 Gough Ave. Toronto, ON M4K-3P1 Canada Son 5,000.00 3 M&T Bank Trustee FBO William W. Westcott, life interest; Rensselear Polytechnic Institute, Salvation Army, American Cancer Society, Cumberland-Perry Assn. for Retarded Citizens and American Red Cross, remainder beneficiaries 478,499.43 4 Neil W. Cayey, P.O. Box 371, Galway, NY 12074 Grandnephew 1,000.00 5 Diane C. Anderson, 3220 Monarch Dr. SW, Huntsville, AL 35801-3439 Niece 1,000.00 6 Nancy Oshier, P.O. Box 160085, Big Sky, MT 59716 Niece 1,000.00 7 Vicki Cayey Ayers, P.O. Box 510 Parshville, NY 13672 Grandniece 1,000.00 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 1 Big Spring Presbyterian Church Cemetery, P.O. Box 188, Newville, PA 17241 5,000.00 2 Chasm Falls Methodist Cemetery Assn., 259 Teboville Road, Malone, NY 12953 5,000.00 3 M&T Bank Trustee Westcott Charitable Remainder Unitrust (see item 3 above) 311,820.87 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 321,820.87 (If more space is needed, insert additional sheets of the same size) I, ' '. REV-1513 EX+ (9-00) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF LAURENCE C. WESTCOTT FILE NUMBER 21-05-0459 Page # 2 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 ~nclude outright spousal distributions, and transfers under Sec. 9'116 (a) (1.2)] 8 Mary Ellen McGregor, 370 Bond St E, Oshawa, Ontario L 1 G-1 B7 Canada Niece 3,000.00 9 Vickie Westcott MacDonald, P.O. Box 183, Waddington, NY 13694 Niece 1,000.00 10 Ricky Westcott, 37 West Jefferson St., Carthage, NY 13619 Nephew 1,000.00 11 Margarette J. Lyon, 114 County Rd. 5, Ridgway, CO 81432 Niece 1,000.00 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 $ 0.00 (If more space is needed. insert additional sheets of the same size) , '. REV-1514 EX+ (12-0. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on REV.1500 Cover Sheet ESTATE OF LAURENCE C. WESTCOTT FILE NUMBER 21-05-0459 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. [!I Will 0 Intervivos Deed of Trust 0 Other LIFE ESTATE INTEREST CALCULATION NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH LIFE ESTATE IS PAYABLE William W. Westcott 06/1711948 57 III Life or o Term of Years - o Life or o Term of Years - o Life or o Term of Years - o Life or o Term of Years - o Life or o Term of Years - 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Actuarial factor per appropriate table ................................................. Interest table rate - 0 3 1/2% 0 6% 0 10% 0 Variable Rate 4.60 % 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ 790,320.30 0.60545 478,499.43 ANNUITY INTEREST CALCULATION NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH ANNUITY IS PAYABLE o Life or o Term of Years o Life or o Term of Years - o Life or o Term of Years o Life or o Term of Years - 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Check appropriate block below and enter corresponding (number) ... . . . . . . . . . . . . . . . . . . . . . . . Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( ) 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................................... 5. Annuity Factor (see instructions) Interest table rate - 031/2% 06% 0 10% 0 Variable Rate % 6. Adjustment Factor (see instructions) ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) DECEDENT: LIFE TENANT~ RATES cSt FACTORS: ONE LIFE (Table S) ****************** Date of Death..... ......[mm/dd/yyyy] 03/27/2005 Mortality Table....., ............ .Fl 90 <--Fl Help Date of Birth......, ....[mm/dd/yyyy]06/17/1948 Age at Deed Death (neares~ birthday) 57 Sec. 7520 Table S: Table S: Table S: Ra1;6. . . . . . . . . . . , . . . . . . . . Fl Remainder Factor.. ..... Life Estate Factor..... Annuity Factor. ........ 4.6% 0.39455 0.60545 13.1621 ~"':~8/?~05 13,23 499 Mitchell Road Millsboro, DE; 19966 Mail code DB-MB-12 Phone: 888-502-4349 Fax; 302-934-2955 302-934--2135 M AND T BANK RECORDS PAGE 01/02 IrlM&fBank I Fax To: Jane F Burke M&T Investment Group From: Nancy Clagett Fax: 717-240-4559 Date: June 8, 2005 Re: Estate of: Laurence C Westcott Social Security: 109-18-9570 Date of Death: March 27, 2005 Pages: 2 Dear Jane: Per your inquiIy received June 06, 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 2670019146 Ownership (Names of) Laurence C Westcott * William W Westcott, POA Opening Date 11/04/74 Closed 06/03/05 Balance on Date of Death $12,552.86 Accrued Interest $ 0.80 Total $12,553.66 2. Type of Account Savings Account Account Number 015004202072176 Ownership (Names of) Laurence C Westcott * William W Westcott, POA Opening Date 04/11/02 Closed 06/03/05 Balance on Date of Death $4,521.22 Accrued Interest $ 0.89 Total $4,522.11 09/08/2005 13:23 302-'334-2135 M AND T BANK RECORDS PAGE 02/02 3. Type of Account Box Number I Location Ownership (Nam.es of) Safe Deposit Box 00025938 I High Street Carlisle Laurence C Westcott * Camilla R Westcott* Opening Date 02107/92 This letter does DOt include any al:COUllts in which the deceased may have been listed as Power of Attomey, Custodian ofUlliform Tran.sfers. Representative Payee, or Trustee under a Written Agreement. C For further account Dlformatioll. reg&rcUng ownership, closures and/or reimbursement of funcls., etc., please call the High Street Carlisle Office ff 717-240-4536. Sincerely, ~ar Nancy Clagett Records Management AlBN~ AMERICAr& July 21,2005 Jane F. Burke, V.P. M&T Investment Group P.O. Box 220 Carlisle, PA 17013 Subject: Estate of Laurence C. Westcott Dear Ms. Burke, We recently received the request to provide you with the date-of-death balance for the below-referenced account. The information requested is as follows: Account Number Type of Account Date-of-Death Balance Accrued Interest March 27, 2005 Included in Date-of- Death Balance 403755493 Certificate of Deposit $102,669.58 $29.53 If you have any questions, please call me directly at 1-800-441-7048, extension 70937, Monday through Friday from 8 a.m. to 5 p.m. (Eastern time). If you prefer, you may write to P.O. Box 15103, Wilmington, DE 19850-5103. r:c~~ Nicole Fagan Deposit Services departmen m.. LE C@ [~ 0 tn tE w.\. Ii \ I r JUL 2 6 2005.:) U L. By = ff/nml 850-801 Life and Annuity Claims P.D. Box 94212 Palatine,'lL 60094-4212 ~ AlIstate~ You're in good hands. September 15, 2005 Jane F. Burke M& T Investment Group P.O.Box 220 Ones West High Street Carlisle PAl 7013 Re: Administrator for: Contract No: Laurence C. Westcott Allstate Life hlsurance Company GA272469 Dear Ms. Burke: We have been requested to complete Internal Revenue Service (IRS) Form 712 with regard to the referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or with its proceeds as of certain date (usually the owner's date of death or date of transfer of the contract). The contract referenced was an annuity contract, which is not reportable on IRS form 712. The following infoffilation is provided regarding the value of the annuity and other data as of the date specified: Date of Death: 03-27-2005 Annuity Value* as of Date of Death: $ 301,465.84 Cost Basis: $ 220,000.00 Named Beneficiary: Camilla R. Westcott spouse; ifno living spouse, children, if no living children, the estate. *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, or need further assistance, please contact the Customer Care Unit at 1-877-499- 6418. Sincerely, Bobbi Jo Seveska Life and Annuity Claims Overnight Address: 544 Lakeview Parkway, Vernon Hills, IL 60061 Toll Free Fax: 1-866-635-4523 NOU 22 2005 13:11 FR TO ~917172404S59 P.02/02 D 5100 Rings Road Dublin. OH 43017 On Your Side- November 22, 2005 JANE BURKE PRIVATE CLIENT SERVICES PO BOX 220 ONE WEST HIGH STREET CARLISLE PA 17013 RE: Non-Qualified Annuity Account No. 07-1070434/Laurence C. Westcott Dear Ms. Burke, Thank you tor your recent inquiry to the Nationwide Annuity Service Center. Via telephone, you requested the date of death value for the above referenced annuity account. The infonnation you requested is indicated below. ContTact Value as of 3/27/2005: S277,764.81 If you have any questions or need further assistance, please contact our Customer Service Department at 1-800-321-6064, Monday through Friday, 8:30 a.m. to 9:00 p.m. Eastern Time and an Annuity Specialist will be happy to assist you. Or, you may contact me directly at the extension listed below. ~~ Andrea @ Ext.50342 Annuity Issue Resolution Individual Annuity Service Center Nationwide Financial NationwIde Financial ** TOTAL PAGE.02 **