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Home My WebLink About03-23-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT WARNER BARBARA L 309 FIRST STREET PO BOX 194 BOILING SPRINGS, PA 17007 _nnn_ fold ESTATE INFORMATION: SSN: 189-09-5066 FILE NUMBER: 2105-0635 DECEDENT NAME: RINEHART IRENE E DATE OF PAYMENT: 03/23/2006 POSTMARK DATE: 03/23/2006 COUNTY: CUMBERLAND DATE OF DEATH: 07/01/2005 NO. CD 006466 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $572.36 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: B L WARNER CHECK# 505 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $572.36 GLENDA FARNER STRASBAUGH REGISTER OF WILLS REV.l500 EX [6'vo1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY .... Z W C W U W C w ... :.:::$ en uO:::':: wD-U :I:OO uO::..J D-al D- c( z o ~ ...I ~ t:: c.. <( u w 0::: INHERITANCE TAX RETURN RESIDENT DECEDENT FilE NUMBER 2 1 - 0 635 5 o COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Rinehart, Irene E. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) July 1, 2005 June 29, 1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A SOCIAL SECURITY NUMBER 189 - 09 5066 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER []] 1. Original Return o 4. Limited Estate []] 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (dale of death after 12.12.82) 07. Decedent Maintained a Living Trust IAttachcopyofTrust) o 10, Spousal Poverty Credit Idate of death between 12-31-91 and 1-1-95) o 3. Remainder Retum Idateofdeatl1 prior 10 12.13-82) o 5, Federal Estate Tax Retum Required -.2. 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ... Z W C Z o D- en w 0:: 0:: o U lRECJ~D~TO:' William L. Sunday FIRM NAME Ilf Applicable) 39 West Main Street Mechanicsburg, PA 17055-6230 TELEPHONE NUMBER (717) 766-9622 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) OFFICIAL USE ONLY 349458.73 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 81234.35 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) (6) (7) 59456.90 (8) 490149.98 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) (9) (10) 13502.27 1917.46 13. Charitable and Governmental Bequests/See 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) (11) 15419.73 (12) 474730.25 (13) 12011.07 (14) 462719.18 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;;: .... ~ c.. ~ o u X ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) 462719.18 x.O~ (16) x .12 (17) x .15 (18) (19) 20822.36 16. Amount of Line 14 taxable at lineal rate 20822.36 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 5225 Wilson Lane, Apt. 230, Bethany Village Lower Allen Township CITY I STAT~ PA I ZIP 1 7 0 5 5 Mecnan1csburg Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 20822.36 o 19237.50 1012.50 Total Credits ( A + B + C ) (2) 20250.00 3. Interest/Penalty if applicable D. Interest E. Penalty (3) (4) (5) (SA) (5B) o o 4. Total Interest/Penalty ( 0 + E ) 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 o 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 572.36 o B. Enter the total of Line 5 + SA. This is the BALANCE DUE. 572.36 Make Check Payable to: REGISTER OF WILLS, AGENT ~~rZ~~~~::,v~~J2l>~~~'<::$'~'Z'.,'!.~~,~i"t!';;~:s;1,.~?l.~~;:~:f;~"~-4~~~.i<.~,m~:t'!.E;Jf~~ 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;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which . b fi' d' t'? 1)(1 contains a ene IClary eSlgna Ion. ........................................................................................................................ ~ No ~ ~ Ga ~ Ga ~ 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. Barbara L. Warner Under penalties of pe~ury, I declare that I have examined this return, including accompanYing schedules and statements. and to the best of my knowledge and belief. It is tnue, correct and complete. Declaration of preparer other than the personal r presentative is based on all mformation of which pre parer has any knowledge. Executrix 309 First street P.O. Box 194 Boiling Springs, PA William L. Sunday 17007 SIGN~T~ PREPARER OTHE 'THAN REPRESENTATIVE 7./ :/ ~ ~l ' ADDRESS DATE March e>1(:7, 2006 DATE March 1, 2006 39 West Main Street, Mechanics~urg, PA 17055-6230 ~~~~;i;~:;;;~~~~"t-'-.-W~;I 1Ii!~~-~~~~~~~~c;: 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 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. ~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. ~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. ~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. ~,~".,'" *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Irene E. Rinehart FILE NUMBER 21-05-0635 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 18982.006 shs of the Income Fund of America - Class A, Fund No. 06 @ 18.41 (including all accrued earnings) $349458.73 TOTAL (Also er.ter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 349458.73 REV.l508 EX. (1.97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Irene E. Rinehart FILE NUMBER 21-05-0635 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 DESCRIPTION VALUE AT DATE OF DEATH 1. M & T Bank Classic Checking Account #71945660 Balance on Date of Death Accrued Interest to Date of Death $38574.07 o 2. PNC Bank Money Market Account 5080035002 (Savings Account) Balance on Date of Death Accrued Interest to Date of Death 33350.93 3.01 3. The Dixie Group - Pension Check Dated June 1,2005 46.37 4. The Stewardship Foundation - Charitable Annuity, check dated June 10,2005 123.33 5. GE Capital Assurance ~ Long Term Care Insurance, check dated June 16,2005 5766.00 6. GE Capital Assurance - Long Term Care Insurance, check dated 7/20/05 for period 06/17/06 through 07/01/05 558.00 7. The Dixie Group ~ Pension check dated 06/29/05 46.37 8. John Hancock - Pension check dated 07/01/05 92.58 9. Highmark ~ Premium refund 192.85 10. Highmark - Fairview Family Health Center claim 30.84 Household Goods, Furniture and Jewelry at Appraisal 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. Bedroom set - 10 years old 2 Open arm side chairs 1 Table and 4 chairs 1 Stand with drawers 1 Small stand 1 Vanity stool 1 Desk Set of TV trays 1 Small armchair armless 1 Small end table Cedar chest 1 TV - 20 years 1 Box of costume jewelry 500.00 200.00 200.00 100.00 50.00 50.00 100.00 15.00 35.00 25.00 150.00 50.00 350.00 Carried Forward (If more space is needed, insert additional sheets of the same size) $ 80609.35 ~'~"."m '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Irene E. Rinehart 21-05-0635 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 DESCRIPTION VALUE AT DATE OF DEATH Brought Forward 80609.35 24. 25. 26. 1 Antique watch on chain 1 Set of pearls 1 Diamond ring White Gold Diamond 150.00 175.00 300.00 TOTAL (Also enter on line 5, Recapitulation) $ 81234.35 (If more space is needed, insert additional sheets of the same size) RE\j.151O EX. (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Irene E. Rinehart FILE NUMBER 21-05-0635 SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY This schedule must be ccmpleted 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 %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DAnE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTAnE. VALUE OF ASSET INTEREST [IF APPLICABLE' NUMBER 1. Nationwide Life Insurance Company/ The Best of America Annuity Account # - 015431769 Date of Death Value $ 42580.49 $ 42580.49 100% 0 Cost Basis 30000.00 Actual Death Benefit $ 47445.83 Payment 47445.83 Beneficiaries: Barbara L. Wamer and Sandra K. Bricker 2. The United Methodist Stewardship Foundation of Central Pennsylvania Charitable Gift Annuity Established: March 25, 1992 Names of: Harold G. Rinehart and Irene E. Rinehart Amount of Annuity $ 20000.00 Date of Death Value $ 12011.07 12011.07 100% 0 12011.07 Beneficiary: Bethany Village Care Assurance Foundation 3. The Dixie Group, Inc. Lifetime "Supplemental Pension" Date of Death Value 0 100% 0 0 4. John Hancock Financial Services C. H. Masland and Sons Profit- Sharing and Security Plan GAC 2492 Assoc 10001 CERP 3237 Payee ID 201 Deceased 7/01/05 Group Annuity Contract 0 100% 0 0 Carried Forward $ 59456.90 (If more space is needed, insert additional sheets of the same size) R['I- ~S ~O .:...'< . \ 1-371 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Irene E. Rinehart SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-05-0635 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 %OF ITEM INCl"DE THE NAME DF THE TRANSFEREE, 1l<EIR RELATIONSHIP TO DECEDENT AND 1l<E DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAl ESTATE . NUMBER VALUE OF ASSET INTEREST IIF APPliCABLE) Brought Forward 59456.90 5. Massachusetts Mutual Life Insurance Company Annuity Certificate Issued to: Harold Rinehart Date of Birth: February 10, 1916 Group Annuity Contract No. iF3958 Contract Holder: Girard Bank as Trustee for C. H. Masland & Sons Retirement Plan for Salaried Associates Joint Annuitant: Irene E. Rinehart Date of Birth: June 29, 1920 Amount of Annuity Joint Annuitant will receive $224.30 Payable: Monthly for Life 0 100% 0 0 TOTAL (Also enter on line 7, Recapitulation) $ 59456.90 (If more space is needed, insert additional sheets of the same size) ~.""..,'., . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Irene E. Rinehart FILE NUMBER 21-05-0635 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. Myers Funeral Home, Inc. - Funeral Expenses $ 827.50 1. ADMINISTRATIVE COSTS Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representalive(s) Street Address B. City State Zip Year(s) Commission Paid: 2. 3 Attorney Fees Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant 11600.00 Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 440.00 5. Acccuntant's Fees 6. Tax Return Preparer's Fees 7. Register of Wills - Short Certificates 7/18/05 William L. Sunday, Esquire ~ Reimburse for CLJ Executrix's Notice in Cumberland Law Journal The Sentinel- Executrix's Notice 20.00 8. 9. 10. 11. 12. Dawn S. Sunday - Notary Fees Register of Wills - Filing PA Inheritance Tax and Inventory Reserved for Filing Account Notices, Recording Releases, etc. 75.00 129.77 30.00 30.00 350.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 13502.27 REV1SllEX-(I.S7) WH ~ , '.-~' ~j , . .-"".. ,- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Irene E. Rinehart 21-05-0635 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Outstanding checks drawn on M & T Bank Account #71945660 prior to date of death Check No. . Date Payee 8169 8170 6/29/05 6/30/05 Home Instead Senior Care Alert Pharmacy $ 357.50 715.83 2. Bethany Village - Account Payable 715.79 3. Home Instead Senior Care - Account Payable (6/16-6/30/05) 97.50 4. Spirit Physician Services (formerly Fairview Family Health Center) - Medical Expense Payable 30.84 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1917.46 REV.1513 EX + (1-97) ESTATE OF NUMBER I. 1. 2. II. SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER Irene E. Rinehart NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Barbara L. Wamer 309 First Street P.O. Box 194 Boiling Springs, P A 17007 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Sandra K. Bricker 502 East Elmwood Avenue Mechanicsburg, P A 17055 Daughter 21-05-0635 AMOUNT OR SHARE OF ESTATE Yz of Annuity $ 23722.92 Yz of Residue of Estate Yz of Annuity $ 23722.91 Yz of Residue of Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS The United Methodist Stewardship Foundation of Central Pennsylvania Charitable Gift Annuity Date Established - March 25, 1992 Established in names of - Harold G. and Irene E. Rinehart Amount of Charitable Gift Annuity -- $ 20,000.00 Value on Date of Death -- $12011.07 Beneficiary - Bethany Village Care Assurance Foundation 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) None $ 12011.07 12011.07