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HomeMy WebLinkAbout01-20-06 REV-1500 EX + (&-00) REV-1 500 OFFICIAL USE ONLY . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1 - 0 5 0 0 7 7 5 COUNTYCQiiE -vEAr- - - NUMaER- - DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z FULTZ GEORGE M. 1 9 5 - 1 6 - 5 2 5 5 W DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W REGISTER OF WILLS () 07/23/2005 07/05/1917 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C - - w IX] 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date 01 death prior to 12-13-82) I- ~ :$(1) 0 4. Limited Estate 0 4a. Future Interest Compromise (date 01 death after 12-12-82) 0 5. Federal Estate Tax Return Required (.)It:~ w~(.) :I: It: 9 IX] 6. Decedent Died Testate (Mach copy of Will) 0 7. Decedent Maintaned a Living Trust (Attach copy oITrust) 1 8. Total Number of Safe Deposit Boxes (.) R:lD < 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95) 0 11. Election to tax under Sec. 9113(A) (Attech Sch 0) I- illlii$ICTIONIU$TiafSCoMPtll$mD;~tc~~RI$$"ONDeNCeANocON~IOINII~I.Q:INEORMATION$jifOUtDiBIDlllcmDi.llllil" ~di~}fF' z NAME COMPLETE MAILING ADDRESS w Q MURREL R. WALTERS III 54 EAST MAIN STREET z 0 FIRM NAME (II Applicable) 11. II) W It: It: TELEPHONE NUMBER 0 (.) 717-697-4650 MECHANICSBURG PA 17055 69,728.33 OFICIClAL USE ONLY 1. Real Estate (Schedule A) (1) - 'n~ 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) , I 5. Cash, Bank Deposits & Miscellaneous Personal Property 78,490.85 -- (5) \ , (Schedule E) .. Z -, ' 0 6. Jointly Owned Property (Schedule F) (6) ~':w t= 0 Separate Billing Requested <C -' 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property :::) (7) I- (Schedule G or L) a:: 148,219.18 <C 8. Total Gross Assets (total Lines 1-7) (8) () 20,276.73 W 9. Fyneral Expenses & Administrative Costs (Schedule H) (9) IX: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 5,549.91 11. Total Deductions (total Lines 9 & 10) (11) 25,826.64 12. Net Value of Estate (Line 8 minus Line 11) (12) 122,392.54 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 122,392.54 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 t= rate, or transfers under Sec. 9116 (a)(1.2) X - (15) ~ 16. Amount of Line 14 taxable at lineal rate 122,392.54 X .045 (16) 5,507.66 :::) c.. 17. Amount of Line 14 taxable at sibling rate X .12 (17) :!: 0 18. Amount of Line 14 taxable at collateral rate X .15 (18) () ~ 19. Tax Due (19) 5,507.66 I- 0 ()t 20. > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < jF.' Decedent's Complete Address: STREET ADDRESS. 423 3RD STREET CITY I STATE I ZIP WEST FAIRVIEW PA 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 5,507.66 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 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. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check to: REGISTER OF WILLS, AGENT 0.00 5,507.66 5,507.66 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; ........................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00 c. retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?........................ ......... ...... ...... ............. ................ ........... ......... 0 00 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................... ....... ..... ............... ................. 0 00 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 end belief, it is true, correct and complete. Declaration of preparer other then the personal repres'Jntative is based on all information of which preparer has any knowledge. SIGNATURE OF ERSON RESPONSIBLE FOR FILING RETURN DATE C? ADDRESS PA (.1 C ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate irr:posed 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 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 99116(a)(12)J. The tax rate imposed on the net value ofcrdllsfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 PS. 99116(1.2) [72 P.S. 99116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedert's siblings is 12% [72 PS. 99116(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-1502 EX + (6-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER F L TZ GEORGE M. 21 05 77 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 exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real orooertv which is iointlv-owned with riaht of survivorshio must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 66,715.63 2. 423 3RD STREET WEST FAIRVIEW, PA 17025 NET SALE PRICE VACANT MOUNTAIN LOT FAYETTE TOWNSHIP, JUNIATA COUNTY ASSESSED 470 X 6.41 COMMON LEVAL RATIO FACTOR 3,012.70 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 69,728.33 A. SettlemQnt Statement U.S. Department of Housing and Urban Development ~ ,r B. T pe of Loan 1. 0 FHA 2. 0 FmHA 3. 0 Conv. Unins. 6. File Number 4. 0 VA 5. 0 Conv. Ins. OMB Approval No. 2502-0265 7. Loan Number 8. Mortgage Insurance Case Number C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside closing; they are shown here for informational purposes and not included in the totals D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of lender ROBERT G. RIDGWAY JEAN E. MUNDIS, EXECUTRIX WENDY TOMLINSON RIDGWAY 14 CREEKSIDE DRIVE ESTATE OF GEORGE M. FULTZ ENOLA PA 17025 G. Property Location H. Settlement Agent TAX PARCEL NO. 45-17.1044.039 MURREL R. WALTERS III, ESQUIRE 423 THIRD STREET Place of Settlement 1. Settlement Dale WEST FAIRVIEW PA 17025 54 EAST MAIN STREET 11/15/2005 MECHANICSBURG PA 17055 Disbursement Dale Lot 9.1 0 Block: 11/15/2005 J. Summary of Borrower's Transaction 100 Gross Amount Due From Borrower K. Summary of Seller's Transaction 400 Gross Amount Due To Seller 101. Contract sales price 67,000.00 401. Contract sales price 67,000.00 102. Personal propertv 402. Personal propertv 103. Settlement charaes to borrower lline 1400) 1,379.25 403. 104. 404. 105. 405. Adlustments for Items oald bv seller In advance Adlustments for Items cald by seller In advance 106. City/town taxes to 406. City/town taxes to 107. County taxes 11/15/20QS 12/3112005 35.26 407. County taxes 11/15/20116 12/3112005 35.26 108. Assessments to 408. Assessments to 109. SCHOOL 11/15/20116 6/30/2006 702.87 409. SCHOOL 11/15/20116 613012006 702.87 110. to 410. to 111. SEWER 11/15/2011612/31/2005 57.50 411. SEWER 11/15/200512/3112005 57.50 112. to 412. to 113. to 413. to 114. to 414. to 115. to 415. to 120. Gross Amount Due From Borrower 89,174.88 420. Gross Amount Due To Seller 67,795.63 200. Amounts Paid Bv Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller 201. Deoosit or earnest money 10,000.00 501. Excess deoosit (see instructions I 10,000.00 202. Principal amount of new loanis) 502. Settlement chames to seller lline 1400\ 680.00 203. Existino loanl s I taken subiect to 503. Existino loan( s \ taken sub' ect to 204. 504. Pavoff of first mortaane loan 205. 505. Pavoff of second mortaaoe loan 206. 506. 207. SELLER CREDIT FOR REFUSE REMOVAL 400.00 507. SELLER CREDIT FOR REFUSE REMOVAL 400.00 208. 508. 209. 509. AdJustments for items unnald bv seller Adlustments for Items unpaid bv seller 210. CiMown taxes to 510. City/town taxes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213. to 513. to 214. to 514. to 215. to 515. to 216. to 516. to 217. to 517. to 218. to 518. to 219. to 519. to 220. Total Paid By/For Borrower 10,400.00 520. Total Reduction Amount Due Seller 11,080.00 300. Cash At Settlement From/To Borrower 301. Gross Amount due from borrower line 120 302. Less amount paid b /for borrower (line 220) 600. Cash At Settlement To/From Seller 69,174.88 601. Gross amount due to seller (line 420) 10,400.00 602. Less reductions in amt. due seiter (line 520) 67,795.63 11,080.00) 303. Cash 00 From o To Borrower 58,774.88 603. Cash 00 To D From Seller 56,715.63 SUBSTITUTE FORM 1099 SELLER STATEMENT The information contained in Blocks E, G, H, and I and on line 401 (or, line 403 and 404) is important tax information and is being furnished to the Intemal Revenue Service. If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item Is required to be reported and the IRS determines that It has not been reported. If this real estate is your principal residence, file Form 2119, Sale or Exchange of Principal Residence. for any gain, with your Income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6232 and/or Schedule 0, Form 1040). You are required to provide the Settlement Agent (named above) with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer Identification number. you may be subject to civil or criminal penalties imposed by law. Under penalties of pe~ury, I certify that the number shown on this statement is my correct taxpayer identification number. (Seller's Signature) L. Settlement Charaes 700. Total Sales/8roker's Commission based on price $ 67,000.00 lIJl %= 0.00 Paid From Paid From Division of Commission (line 700) as follows: Borrower's Selle~s Funds At Funds At 701. $ to Settlement Settlement 702. $ to 703. Commission paid at Settlement 704. 800. Items Pavable In Connection With Loan 801. Loan Oricination Fee % 802. Loan Discount % 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee 806. Mortcaae Insurance Application Fee to 807. Assumption Fee 808. 809. 810. 811. 812. 813. 900. Items Required Bv Lender To Be Paid In Advance Exclude last dav In cales -line 901 901. Interest from to <1lJ$ /dav 902. MortQaae Insurance Premium for months to 903. Hazard Insurance Premium for vears to 904. vears to 905. 1000. Reserves De oslted With Lender 1001. 1002. 1003. 1004. 1005. 1006. 1007. 1008. A rate Accountin Ad.ustment month per month per month per month per month r month r month per month 1100. Title Charees 1101. Settlement or cJosino fee to 1102. Abstract or title search to 1103. Title examination to 1104. Title insurance binder to 1105. Document preoaration to 1106. Notary fees to CASH 10.00 10.00 1107. Attornevs tees to (Includes above items numbers: ) 1108. Title insurance to MURREL R. WALTERS III, ESQUIRE 660.75 (Includes above items numbers: 1101-1104,1108 PENN ATTORNEYS TITLE INS. CO. ) 1109. Lender's coveraoe $ 1110. Owner's coveraae $ 67,000.00 1111. 1112. 1113. and Transfer Char es 1201. 1202. City/county taxlstamps: Deed 1203. State taxlstamps: Deed $ 1204. 1205. 38.50 ; Mort a e $ 670.00 ; Mort a e 670.00 ; Mort a e ; Releases 38.50 670.00 670.00 1300. Additional Sell/ement Charees 1301. Survey to 1302. Pest inspection to 1303. 1304. 1305. 1306. 1307. 1308. 1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 1,379.25 660.00 _..- Borrower WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar fonn. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. u.s. GOVERNMENT PRINTING OFFICE: 1989 0.9.14.2045 REV-15G8 EX + (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FULTZ FILE NUMBER GEORGE M. 21 05 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 00775 ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. DESCRIPTION SOVEREIGN BANK CHECKING ACCT. SOVEREIGN BANK SAVINGS ACCT. SOVEREIGN BANK CERTIFICATE OF DEPOSIT PNC BANK CERTIFICATE OF DEPOSIT PNC BANK CERTIFICATE OF DEPOSIT PNC BANK CERTIFICATE OF DEPOSIT PNC BANK CHECKING ACCT. PNC BANK SAVINGS ACCT. CHUCK BRICKER AUCTIONEER SALE PROCEEDS OF HOUSEHOLD GOODS PA EMPLOYEES BENEFIT TRUST REIMBURSEMENT 1982 CHEVY IMPALA NET SALE PRICE 1992 CHEVY PICKUP TRUCK I BLUE BOOK VALUE , FIFTEEN FIREARMS PER APPRAISAL OF CHUCK BRICKER AUCTIONEER , MET LIFE I HOMEOWNERS INSURANCE REFUND ~ lBEAVER SPRINGS HUNTING CAMP I OWNERSHIP INTEREST ALLSTATE INSURANCE AUTO INSURANCE REFUND TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 1,738.73 2,687.89 10,008.83 10,023.28 10,034.42 10,009.57 11,288.85 11,568.97 3,056.00 819.94 500.00 1,375.00 3,805.00 894.00 420.07 260.30 78,490.85 REV-1511 EX + (12-99) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FULTZ ITEM NUMBER A. 1. 2. 3. B. 1. 2. 3. 4. 5. 6. 7. 8. FILE NUMBER GEORGE M. 21 05 00775 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: SULLIVAN FUNERAL HOME UNITED METHODIST CHURCH (LUNCHEON) PEALERS - FLOWERS ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) .JEAN E. MUNDIS Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 36 RIVERVIEW ROAD 161-32-5620 City ENOLA Year(s) Commission Paid: 2006 State PA Zip 17025 Attorney Fees MURREL R. WALTERS III, ESQUIRE 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 Probate Fees REGISTER OF WILLS, CUMBERLAND COUNTY Accountant's Fees Tax Return Preparers Fees ROBERT .JONES ASSOC. - HOUSE APPRAISAL CHUCK BRICKER - AUCTION COMMISSION AND COSTS SALE OF WEST FAIRVIEW REAL ESTATE AND HOUSEHOLD GOODS TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) AMOUNT 5,946.90 100.00 156.83 6,968.00 4,350.00 375.00 300.00 2,080.00 20,276.73 REV-1512 EX + (6-98) 'W SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FULTZ FILE NUMBER GEORGE M. 21 05 00775 Include unreimbursed medical expenses. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. DESCRIPTION VALUE AT DATE OF DEATH VERIZON PHONE BILL 47.35 SCHEIN ERNST EYE ASSOCS. MEDICAL 78.22 COMCAST CABLE SERVICE 135.96 PA AMERICAN WATER WATER 74.93 NICK MAYDAK LAWN CARE 466.00 STONE'S PLUMBING & HEATING PLUMBING REPAIRS 600.00 PP&L ELECTRIC 177.83 EAST PENNSBORO TWP. TRASH & SEWER 230.00 ALLSTATE INSURANCE HOME INSURANCE 95.07 WEST SHORE EMS AMBULANCE 570.34 BILLY MORGAN BATTERY FOR 1982 IMPALA 42,36 BEVERLY RICHMOND .JUNIATA COUNTY REAL ESTATE TAXES 23.90 ALICIA D. STINE, TREASURER 423 3RD STREET, WEST FAIRVIEW REAL ESTATE TAXES & PERSONAL TAXES 1,135.67 ATT TELEPHONE 52.81 PEPTF HEALTH INSURANCE 325.87 TOTAL (Also enter on line 10, Recapitulation) $ 5,549.91 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent FULTZ Decedent's Name GEORGE M. Page 2 21 05 00775 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. SHIPLEY ENERGY 315.13 HEATING OIL 17. PENN DOT 50.00 DUPLICATE TRUCK TITLE 18. EAST PENN5BORO AMBULANCE SERVICE 461.00 AMBULANCE SERVICE 19. CHUCK BRICKER 50.00 GUN APPRAISAL 20. QUANTUM IMAGING 10.47 MEDICAL 21. JEAN MUNDIS 607.00 REIMBURSE FOR COST OF DUMPSTER I I SUBTOTAL SCHEDULE I 1,493.60 GRAND TOTAL SCHEDULE I $ 5,549.91 eev~"'''HI* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER FlJl TZ GEORGE M. 21 05 00775 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] 1. JEAN E. MUNDIS DAUGHTER 1/2 RESIDUE 36 RIVERVIEW DRIVE ENOLA, PA 17025 2. LARRY E. FULTZ SON 1/2 RESIDUE 502 MAGARO ROAD ENOLA, PA 17025 3. EMORY A. MUNDIS IV GRANDSON GUNS 36 RIVERVIEW DRIVE ENOLA, PA 17025 4. AARON FULTZ GRANDSON GUNS 160 TYLER STREET GRANTVILLE, PA 17028 5. SCOTT MILLER 1 GRANDDAUGHTER'S GUNS 115 CHURCH AVENUE HUSBAND EPHRATA, PA 17025 6. BRANDON WOLF GREAT-GRANDSON GUNS 411-E BEAVER AVENUE ENOLA, PA 17025 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 DISTRIBUT~ONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - 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)