HomeMy WebLinkAbout01-27-06
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
William S. Dick 13 West Main Street
FIRM NAME (If Applicable)
Dick Stein & Schemel LLP Suite 210
TELEPHONE NUMBER
717 762-1160 Wa nesboro PA 17268
OFFICIAL USE ONLY
REV.1500 EX + (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Crider John A.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
06/27/2005 07/08/1926
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Crider Vera R.
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[KJ 1. Original Return
o 4. Limited Estate
[KJ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy olTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Scheduie G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
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)
(8)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00 X _(15)
0.00 X _(16)
0.00 X .12 (17)
0.00 X .15 (18)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
OFFICIAL USE ONLY
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FILE NUMBER
2 1 -05 0 5 7 9
CO'UNTYCODE ~- - - NUMaER- -
SOCIAL SECURITY NUMBER
2 0 1 - 1 8 - 5 9 1 3
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AttachSchO)
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11 ,673.76 I
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5,556.85l~__~~ ---____J
17,230.61
14,673.11
2,920.21
17,593.32
-362.71
-362.71
0.00
0.00
0.00
0.00
0.00
19. Tax Due (19)
20. 0
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
STREET ADDRESS
1050 GreensprinQ Road
CITY 1 STATE I ZIP
Newville PA 17241
Decedent's Complete Address:
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
332.50
17.50
Total Credits (A + B + C)
(2)
350.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 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)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
350.00
0.00
0.00
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 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.
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DATE
2c'{' t
101 Hill rest Avenue
Fayetteville PA 17222
DATE
J,Ul ;Lv, ..2L}/:) (,
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PA 17268
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. S9116 (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. S9116 (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. s9116(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. S9116(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. s9116(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-150B EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Crider. John A.
FILE NUMBER
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.
0579
ITEM
NUMBER
1.
DESCRIPTION
Commonwealth of Pennsylvania, Rev. rebate
VALUE AT DATE
OF DEATH
374.00
2.
Verizon Wireless, refund of wireless telephone service
25.86
3.
Casses Chiropractic Clinic, P.C., refund of prepaid services
56.21
4.
Orrstown Bank, checking account # 103005428
7,097.69
5.
1997 Mercury Sable LS Wagon 4 door, at Kelley Blue Book private party value
3,970.00
5.
1992 Chevrolet S-10, VIN 1GCCS14AfN2105013, at sales price
150.00
6. Decedent died when struck by a vehicle while crossing the road. The estate expects to
receive insurance proceeds from Survival action. When this is finalized, a Supplemental
Return will be filed.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
11 673.76
REV-1511 EX + (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Crider John A.
FILE NUMBER
21
05
0579
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Shull-Koontz Memorials, headstone & engraving 890.00
2. Soloist for funeral service 20.00
3. Foge/songer-Bricker Funeral Home, Inc., funeral services 9,011.41
4. Air Hill Brethren in Christ Church, church services 265.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Yea~s) Commission Paid:
2. Attomey Fees Dick, Stein & Schemel, LLP 3,000.00
3. Family Exemption: (If decedent's address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Glenda Farner Strasbaugh, Register of Wills 144.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. The News Chronicle, advertise Personal Representative's Notice 92.75
8. Cumberland Law Journal, advertise Personal Representative's Notice 75.00
9. Ford Motor Credit, duplicate title fee 22.50
10. Dick, Stein & Schemel, LLP reimbursement for postage, notary fees & travel expenses 59.35
11. Richard K. Hoskinson, Esq., attorney's fees 220.00
12. Nationwide Insurance, car insurance 873.10
TOTAL (Also enter on line 9, Recapitulation) $ 14 673.11
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
.
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Crider. John A.
FILE NUMBER
21
05
0579
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1. Summit Cancer Services, medical services
842.86
2. CHS/Cancer Treatment Center, medical services
2,027.09
3. Graham Medical Clinic, PC, medical services
50.26
4. There are significant medical expenses arising out of decedent's death. Whether or not
these are paid by insurance, they will be deducted from the proceeds shown on a
Supplemental Return.
TOTAL (Also enter on line 10, Recapitulation) $
2920.21
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Cridl'lr .fohn A. ?1 Ofi 057Q
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. Vera Rice Crider Spousal
1050 Greenspring Road
Newville, PA 17241
2. Samuel J. Hartman Lineal
7743 S. E. FredEvons
Lawson, MO 64062
3. Paul E. Hartman Lineal
130 Lancaster Avenue
Enola, PA 17028
4. Kenneth R. Hartman Lineal
8650 T omstown Road
Waynesboro, PA 17268
5. Marie Ann Fitzgerald Lineal
101 Hillcrest Avenue
Fayetteville, PA 17222
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIA TE, 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
t
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
FilE NUMBER
(If more space is needed, insert additional sheets of the same size)
Cumberland County
INVENTORY
Estate of Crider, John A.
No. 21
05
0579
also known as
, Deceased
Date of Death 6/27/2005
Social Security No. 201-18-5913
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.. "
Personal Representative:
Name of
Attorney: William S. Dick
1.0. No.: 24566
Kenneth R. Hartman
Marie Ann FitzQerald
Dated ;J;) II , J~ lccCJ
.
Address: 13 West Main Street
Waynesboro
Telephone: (717) 762-1160
PA 17268
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Description
Commonwealth of Pennsylvania, Rev. rebate
Value
374.00
Verizon Wireless, refund of wireless telephone service
25.86
Casses Chiropractic Clinic, P.C., refund of prepaid services
56.21
Orrstown Bank, checking account # 103005428
7,097.69
1997 Mercury Sable LS Wagon 4 door, at Kelley Blue Book
private party value
3,970.00
1992 Chevrolet S-10, VIN 1GCCS14AIN2105013, at sales price
150.00
Total
(Attach Additional Sheets if necessary)
11,673.76
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
Continuation of Inventory
Crider, John A.
21
05
0579
Page 1
Description of Inventory
Description
Decedent died when struck by a vehicle while crossing the road. The
estate expects to receive insurance proceeds from a Survival action. When
this is finalized, a Supplement Inheritance Tax Return will be filed.
Value
Subtotal $
Grand Total $
11,673.76
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Recetpt Date:
Rece:J.-pt Time:
Recelpt No.:
1/27/2006
13:33:12
1043197
CRIDER JOHN A
Estate File No. :
Paid By Remarks:
2005-00579
WILLIAM DICK, ESQ
RSK
------------------------ Receipt Distribution ------------------------
Fee/Tax Description
INH TAX RETURN
INVENTORY
ADD PROBATE FEE
Check# 104
Total Received.........
Payment Amount
15.00
15.00
15.00
Payee Name
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
$45.00
$45.00
DICK, STEIN & SCHEMEL, LLP
A TTOR1\iE\/ S 1-\. T LA\rV ut-n@rJa'ililt'W!IT'j; _1" f~~.1!'l:' ll'Unn''1fUlm\II.l I [P
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WILLIAM S. DICK
JAMES M. STEIN!
PAUL T. SCHEMEU
J. EDGAR WINE
JOHN W. FREY
13 WEST MAIN STREET
SUITE 210
W A YNESBORO, P A 17268
(717) 762-1160
(717) 762-6040 (FAX)
January 25, 2006
11 NORTH CARLISLE STREET
SUITE 103A
GREENCASTLE, PA 17225
(717) 597-0200
Commonwealth of Pennsylvania
Department of Revenue
Dept. 280601
Harrisburg, PA 17128-0601
Subject:
Estate of John A. Crider
File No. 21-05-0579
Dear Sir/Madam:
Weare not requesting a refund of inheritance taxes paid at this time. There is a pending
survival action in the above-referenced estate as well as significant medical expenses arising out of
decedent's death. Whether or not these are paid by insurance, they will be deducted from the
proceeds shown on a Supplemental Return. Weare anticipating the credit will be used against future
taxes.
Please contact my office with any questions you may have.
Very truly yours,
WSD/emf
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William S. Dic1--~
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Enclosure
'ALSO ADMITTED IN IOWA
'ALSO ADMITTED IN MARYLAND