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Home My WebLink About12-29-05 REV . 1500 EX . 11..00) w .... ",:!i(/) 00::'" w"-O :rOO 00::-' ,,-Ill "- <( *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 05 __nQQUf'.JTXCQD~_~ YEAR SOCIAL SECURITY NUMBER 0349 NlJMB_~R .... z W Q W o W Q COMMONWEALTH OF PENNSYLVANIA I' DEPARTMENT OF REVENUE DEPT 280601 I HARRISBURG.p!'_~8:0601 ._ ul DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Cline, Gretchen B. 194-28-9078 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death priorto 12-13-82) o l'-~--~-~::::':s::~:n ! ~ o o 2. Supplemental Return o o o 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 5. Federal Estate Tax Return Required CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: COMPLETE MAILING ADDRESS I I 4811 Jonestown Rd, Suite 226 Harrisburg, P A 17109 (1 ) (2) (3) (4) , "~--- , DATE OF DEATH (MM-DD-YEAR) ~-"[)ATE-OF -BI-RTH (MM-DD-YEAR) 139,270.00 ~10NI..Y 04/02/2005 06/27/1910 C") None r~.::, ------------ .-'"-----------~---- ,(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received ..... (/)z Ww O::Q O::z 00 0,,- THIS SECTION MUST BE COMPLETED. ALL CORRESPOND AME Susan E. Lederer None \..0 FIRM NAME (If applicable) Law Offices of Susan E. Lederer TELEPHONE NUMBER 717/652-7323 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o ;::: :5 :::> .... ii: <( o W 0:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D 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) None , i 12. Net Value of Estate (Line 8 minus Line 11) (5) 4,273.44 (6) None c,.) (7) 243 , 7 1 8. 13 (8) 387,261.57 (9) 6,045.50 (10) 1,702.75 (11 ) 7,748.25 379,513 .32 (12) 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) (13) (14) 379,513.32 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) ----------- ---~------------------- z 379,513.32 .045 (16) 17,078.10 0 16.Amount of Line 14 taxable at lineal rate x ;::: ------- -----~--- -------- -~- :!' :::> "- 17.Amount of Line 14 taxable at sibling rate x .12 (17) ::l! 0 0 ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) .... 19. Tax Due (19) 17,078.10 ------- ------ ----~ ---- 20. 181 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Qt Decedent's Complete Address: STREET ADDRESS 29 Maple A venue CITY Camp Hill STATE PA I ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 17,078.10 16,300.00 -----~_. 853.91 Total Credits (A + B + C) (2) 17,153.91 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPA YMENT. (4) Checlt box on Page 1 Una 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is theBALANCE DUE. (5B) 0.00 75.81 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 No a. retain the use or income of the property transferred;............................................................................. D ~ ~: ~::::~ :h~e~;~~i:~~~s:~:~s~~~. .~~~~I. .u.~~. ~.~~. ~~~~~_~~. .~~a.n.s~~~~~.~. .o.r .i~:. ~n.c.o.~~~..............................::::::::::::: ..:..... ~ ~ 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?............................ ............................... h................................................... 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?.......................................................................................... u.................... ~ 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 I""pare'-othe'-thant~p~~onal representative is based on ",I. infc>rmat~n of which preparer has al1y knowledge. ___ SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Nancy J. Barr b s2A'2~r' '. ~.~ONSIBL~GRETl.JRN---- Jo Grove, 'v . ".c....--- SI<3- TURE.bF~EPAREROTHER THAN REPRESENTATlVE-- S a E. Lederer 162 Sloop Road Shennansdale, P A 17090 DATE JJ.l~ 7L?_r- DATE J~J0c iLoS' ----------- ----..- --- ------- D TE I :1-J~llo'S.- ADDRESS .~ 33 Wobum Abbe7 j\venue ---- _____c:~1:_Iill.....fA LilLI__ ADDRESS 4811 Jonestown Rd. Suite 226 Harrisburg, P A 17109 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. 39116 (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. 39116 (a) (1.1) (ii)]. The statutedoes not exemot 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. 39116 (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. 39116 1.2) [72 P.S. 39116 (a) (1 )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. 39116 (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. *' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT .. .------1_.,._....~___ ____________.______ ESTATE OF Cline, Gretchen B. I FILE NUMBER ! 21 - 05 - 0349 ____ ____ ____n__._,.____., __ ____._____,_.___ __._...._____.,~"____...____...__....__..___ All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be excnanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER I House and Lot located at 29 Maple A venue, Parcel # 10-21-0277-114, titled to Paul T. Cline (deceased)and Gretchen B. Cline (tax assessed value $139,270.00 X common level ratio factor 1.0 = $139,270.00) I------ VALUE AT DATE OF DEATH 139,270.00 DESCRIPTION TOTAL (Also enter on Line 1, Recapitulation) 139,270.00 *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT - ------._--_..._~--_._-_._---_._._--,--_. ---- ._-....__._,._-_.~-- - - - -----....--.----., -------....----.,---..-.--.-.....---- ESTATE OF . Chne, Gretchen B. FILE NUMBER 21 - 05 - 0349 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 I DESCRIPTION VALUE AT DATE OF DEATH 827.61 Checking Account # 536720840, held at Commerce Bank, titled to Gretchen B. Cline (accrued interest $0.06) 2 Checking Account # 536743115, held at Commerce Bank, titled to Gretchen B. Cline (accrued interest $0.08) 763.77 3 Savings Account # 626512420, held at Commerce Bank, titled to Gretchen B. Cline (accrued interest $0.03) 1,253.85 4 Restitution payment (cashed after death), Commonwealth of Pennsylvania v. Allison Marie Miller 33.99 5 Bonton Credit Card, Gretchen B. Cline (credit on account) 51.40 6 Hecht's Credit Card, Gretchen B. Cline (credit on account) 26.40 7 Capital Life Insurance (Annuity payment 3/18/2005 - cashed after death) 105.03 8 Capital Life Insurance (Annuity payment 3/24/2005 - cashed after death) 105.03 9 SunAmerica Life Insurance (Annuity payment 3/22/2005 - cashed after death) 148.68 10 SunAmerica Life Insurance (Annuity payment 4/21/2005 - cashed after death) 148.68 II Cash in safe deposit box 9.00 12 Household goods (estimate - including items in safe deposit box) 800.00 TOTAL (Also enter on Line 5, Recapitulation) 4,273.44 *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Cline, Gretchen B. FILE NUMBER 21 - 05 - 0349 un T!1is schedule must be completed and ~ed if the answer t~ any~f question~ 1 through 4 on p_age 2!s yeso__ __ DESCRIPTION OF PROPERTY ; T I % OF ITEM Include the name of the transferee, their relationship to decedent and the date of transfer 'I DAL E OFFDEA TH DECO'S EXCLUSION+ TAXABLE VALUE NUMBER Attach a copy of the deed forreal estate VA UE 0 ASSET ~APPLlCABLE) AOnu;ty-h,;ld "-"me'k.. Exp'~ss (Amerip~ise), A<<ount # ! 109'081.9f~::ST [ --, - --109,081.95 I 00000000472019595021, Gretchen B. Cline, owner, Nancy ,I ' J. Barr, Richard Cline, John P. Grove, Janine M. Grove, , , James W. Grove, Joel J. Grove, beneficiaries 2 Annuity held at American Express (Ameriprise), Account # 00000000551182447021, Gretchen B. Cline, owner, Nancy [' Barr, Richard Cline, John P. Grove, Janine M. Grove, James W. Gove, Joel J. Grove, beneficaries 85,826.46! 100% ! 1 85,826.46 3 3,093.790 shares of Tax-Free Money Fund, held at American Express (Amerprise), Account # , 00000011645969954002, Gretchen B. Cline TOD Nancy , , Barr, Richard Cline, John P. Grove, Janine M. Grove, Jamesl W. Grove, Joel J. Grove, beneficiaries 3,094.36 100% 3,094.36 4 Annuity held at American Express (Amerprise), Account # 00000930026823789004, Gretchen B. Cline, owner, Nancy J. Barr, Richard Cline, John P. Grove, Janine M. Grove, James W. Grove, Joel J. Grove, beneficiaries i 45,715.361 100% 1 1 45,715.36 TOTAL (Also enter on line 7, Recapitulation) 243,718.13 . SCHEDULE H FUNERAL.. EXPENSES & AD\lllNISlRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF . Chne, Gretchen B. Debts of decedent must be reported on Schedule I. --iTEM-, I -------- ---------- _NUMBE~ _ _ _ _ ___ _~ESCRIPTION ____ A. FUNERAL EXPENSES: 1 Zimmerman Auer Funeral Home, Inc. 2 Funeral Luncheon B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. Social Security Number(s) I EIN Number of Personal Representative(s): 2. Street Address City State Year(s) Commission paid Attorney's Fees Law Offices of Susan E. Lederer Zip I FILE NUMBER 21 - 05 - 0349 ------------.--.....__._..,....__ __n________.._____ .___ ---.--I-~-MOUNT --------,----- 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Cumberland County Register of Wills Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs Fee to obtain copy certified marriage license 2 Cumberland County Register of Wills (fee for filing Inheritance Tax Return and Inventory) Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 3,828.00 397.50 1,400.00 310.00 5.00 30.00 75.00 6,045.50 . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Cline, Gretchen B. 3 Schedule H Funeral Expenses & Aaninis1rative Costs continued Alice Souder, CPA (preparation of income tax returns) FILE NUMBER 21 - 05 - 0349 75.00 Page 2 of Schedule H ESTATE OF . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE I LIABILITIES, & LIENS I ---~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Cline, Gretchen B. Include unreimbursed medical expenses. ITEM NUMBER 1 Judy Snyder (caretaker fee) DESCRIPTION 2 Sandy Harvey (caretaker fee) 3 West Shoer EMS (ambulance bill) 4 Capital Life Insurance (annuity payment returned) 5 SunAmerica Life Insurance (annuity payment returned) 6 Holy Spirit Hospital (medical bill) 7 Verizon (phone bill) 8 Sam Bates (household maintenance bill) 9 Brown Lawn Service 10 Marie Huber, Tax Collector 11 PP&L (electric bill) 12 Ehrlich (Termite bill) 13 Com cast (cable bill) 14 Pennsylvania Water Company (water bill) 15 IRS (federal income tax) 16 Pennsylvania Department of Revenue (state income tax) I FILE NUMBER 21 - 05 - 0349 TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 30.00 45.00 134.49 105.03 148.68 18.90 24.80 70.00 77.00 322.93 53.91 145.22 45.19 47.60 135.00 299.00 1,702.75