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Home My WebLink About04-10-06 (2) 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) (Schedule G or L) B. 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 B minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) z o ;:: <( ..J ::) t- a:: <( o W Q: 02/04/2005 04/07/1985 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 2B0601 HARRISBURG, PA 1712B-0601 -- REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAl USE ONLY FILE NUMBER 21 -050148 COiiNTYCODE -vEAA- - - NU'UBER-- t- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Alfred C. Deimler DATE OF DEATH (MM-DD-Year) SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) 1 65- 7 0 - 2 4 5 7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS w ..... ~ :$ CI) o a::: ~ w&O :I: a::: 9 08:1:0 <C [gJ 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER 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 ofTrust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required - B. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ..... z w c z o Q. CI) W a::: a::: o o NAME Marielle F. Hazen FIRM NAME (If Applicable) Law Office of Marielle F. Hazen TELEPHONE NUMBER 717-540-4332 COMPLETE MAILING ADDRESS 2000 Linglestown Road, Suite 202 Harrisbur PA 17110 r------OFFICrAt.-USE ONLy--u---1 ; ; ..: . . I., C)-, . .1-. I I I I 14.171.99/ -c:' . I I l_ C 7i I 0) 23,777.23 ----------_J l,_' (B) 37,949.22 12,125.47 25,393.72 (11 ) (12) (13) 37,519.19 430.03 14. Net Value Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ;:: ~ ~ a.. :E o o >< ~ 15. Amount of Line 14 taxable at the Spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 1 B. Amount of Line 14 taxable at collateral rate (14) 430.03 23,777.23 X ~ (15) 0.00 0.00 X _ (16) 0.00 0.00 X .12 (17) 0.00 0.00 X .15 (1B) 0.00 (19) ~ o d t' C Add -- ece en s amp ete ress: STREET ADDRESS 1790 Good Hope Road CITY I STATE I ZIP Enola PA 17025 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 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 0.00 Tota/lnterest/Penalty ( 0 + 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 interesl on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 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. 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 iife 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 payabie upon death bank account or security at his or her death? ................. 00 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 00 For dates of death on or after January 1, 1995, the tax rate imposed on the net value of trc The statute does not exempJ a transfer to a surviving spouse from tax, and the statutory /'l 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 yea 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 line The tax rate imposed on the net value of transfers to or for the use of the decedent's sib' individual who has at least one parent in common with the decedent, whether by blood ( PA 17025 DATE ------~ ~\<- l\-\~,~\ viving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. ~ts and filing a tax return are still applicable even if r for the use of a natural parent, an adoptive parent, s noted in 72 P.S. ~9116(1.2) (72 P.S. ~9116(a)(1)]. 3)1. A sibling is defined, under Section 9102, as an REV-1508 EX + (6-98) * -- COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Alfred C. Deirnl r SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Sovereign Bank 12,501.82 Chking Acct#2561 057348 2. Verizon 459.63 Refund 3. State Farm 388.54 Refund 4. Cash 72.00 5. Personalty 750.00 Flintlock rifle, tools & hockey equipment 6. 1993 Dodge Caravan 0.00 No value - salvage title L FILE NUMBER 1 Include the proceeds of litigafion and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert addifional sheets of the same size) 14,171.99 REV-1510 EX + (6-98) - COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~STATE OF Alfred C. Deimler SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY l FILE NUMBER 21 05 148 DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DA TE OF DEATH % OF DECO'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. ING Qualified Annuity No. A823713 23,777.23 100. 23,777.23 Jeffrey & Loretta Deimler Benef (parents) Decedent 19 & living at home at death _ no tax TOTAL (Also enter on line 7 Recapitulation) $ 23,777.23 This schedule must be completed and filed ff the answer to any of Questions 1 through 4 on the reverse side of the REV -1500 COVER SHEET is yes. (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) '* COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ITEM NUMBER A. 1. 2. B. 1. 2. 3. 4. 5. 6. 7. 8. Debts of decedent must be reported on Schedule I. FUNERAL EXPENSES: Fackler-Wiedeman Funeral Home EBY Granite Works DESCRIPTION ADMINISTRA TIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Jeffrey Deimler Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 1790 Good Hope Road 566-64-9820 City Enola Year(s) Commission Paid: 2006 Attomey Fees Marielle F. Hazen State P A Family Exemption: ('f decedenfs address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Probate Fees Register of Wills - Open Probate Accountanfs Fees Tax Return Preparer's Fees Keith laudenslage Patriot News - PUblication Dauphin County Reporter - PUblication Zip FILE NUMBER Zip 17025 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) -- AMOUNT 5,453.00 1,686.00 2,173.85 2,500.00 88.00 55.00 94.62 75.00 12,125.47 REV-1512 EX + (6-98) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Alfr d C. Deimler ITEM NUMBER DESCRIPTION 1. PennState Milton Hershey Hospital Medical Bill - to be paid pro rata Include un reimbursed medical expenses. FILE NUMBER 21 05 148 2. PennState Physicians Medical Bill - to be paid pro rata VALUE AT DATE OF DEATH 18,729.81 3. West Shore EMS Medical Bill - to be paid pro rata 5,223.00 4. IRS 2004 Income Tax 556.96 5. PA Dept Revenue 2004 Income Tax 304.00 6. WSTB Local Tax 87.00 7. Ewing Enterprises unpaid mail purchase at death 228.00 264.95 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 25 393.72 REV-1513 E~ + (* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ;STATE OF SCHEDULE J BENEFICIARIES Alfred C. Deimler 21 05 0148 RELA TIONSHIP 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 translets under Sec. 9116 (a) (1.2)] 1. Jeffrey & Loretta Deimler - parents Lineal 1790 Good Hope Road 100% 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 DISTRIBUTIONS 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 $ 1- FILE NUMBER (If more space is needed, insert additional sheets of the same size)