HomeMy WebLinkAbout04-07-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BLOOM STEPHEN L
2100 LONGS GAP RD
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 344-28-9911
FILE NUMBER: 2106-0057
DECEDENT NAME: SCHWAB DON A
DATE OF PAYMENT: 04/07/2006
POSTMARK DATE: 04/07/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 01/12/2006
NO. CD 006536
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $21,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$21,000.00
REMARKS:
STEPHEN BLOOM ESQ
CHECK# 000654063
SEAL
INITIALS: RSK
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
Register of Wills of Cumberland County, Pennsylvania
.
INVENTORY
. Deceased
No. 21 - 06 - 00085
Date of Death 1/16/2006
Social Security No. 189-09-4149
Estate of
Kuntz, Sr., John W.
also known as
Patricia J. Hamilton
The 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 located 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 the Decedent owned no real estate outside of 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 are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
Attorney:
Dale F Shughart, Jr. Esquire
Personal Repres'Frtive . .I I ~-/..
Signature: V~ <;\ ~
Patricia J. HamiltoV :':::..~;
J.D. No.:
19373
Signature:
Signature:
Address:
10 West High Street
Carlisle, PAl 70 13
Address: 92 Beetem Hollow Road
Newville, PAl 7241
:I:~'>:)
Telephone: 717/241-4311
Telephone: 717-486-3850
\...0
Dated:
</- t - tJ C,
Personal Property
Clothing and personal effects.
0.00
Social Security check on hand.
1,123.00
Orrstown Bank, Money Market Account # 1 06800236
Principal 80,691.93
Accrued interest 46.43
80,738.36
OlTstOwn Bank, Checking Account #106002875
Principal 23,304.56
Accrued interest 2.68
23,307.24
Ewing Brothers, refund of prepaid funeral
635.93
West Shore ALS, refund
86.07
Chapel Pointe, refund
3,824.65
SKF Pension Fund, two retirement checks on hand.
947. 14
(Attach additiona\ sheets if necessary)
Total Personal Property and Real Estate
$110,662.39
RA
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Estate of Kuntz, Sr., John W.
I Deceased
No. 21 - 06 - 00085
Date of Death l! 16/2006
Social Security No. 189-09-4149
also known as
Total Personal Property
$110,662.39
2
REV. 1500 EX + (6-00)
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG. PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
00085
NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after
12-12-82)
6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach
of Will) copy of Trust)
9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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THIS..SE9II()t1I..Mq~"@~.'Q91\.4~~E~[)~..~.~~,~g~~g~;~~[)~r19~BI_~;I~~,~gDIb'.~I~!!fEI~I~;!~~!~,g"ml~lml.'1~i...~.......
NAME COMPLETE MAILING ADDRESS
Dale F Shughart, J1'. Esquire
DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL)
Kuntz, Sr., John W.
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DA TE OF DEATH (MM-DD- YEAR)
DATE OF BIRTH (MM-DD-YEAR)
01 16/2006
10/06/1919
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
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4. Limited Estate
1. Original Return
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FIRM NAME (If applicable)
TELEPHONE NUMBER
717/241-4311
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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)
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)
189-09-4149
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o
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1
3. Remainder Return (date of death prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
10 West High Street
Carlisle, PAl 70 13
(1 ) None
(2) None
(3) None
(4) None
(5) 110,662.39
(6) None
(7) None
(8)
(9) 17,263.49
(10) 30,847.43
co
110,662.39
(11 )
48,110.92
(12)
62,551.47
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)
62,551.47
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 62,551.47 .045 (16)
0 16. Amount of Line 14 taxable at lineal rate x
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Q. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
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0
(.)
x 18. Amount of Line 14 taxable at collateral rate
c:( x .15 (18)
to-
19. Tax Due (19)
2,814.82
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
2,814.82
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Q1-
Decedent's Complete Address:
STREET ADDRESS Chapel Pointe at Carlisle
770 South Hanover Street
(Try
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
STATE PA
ZIP 17013
(1 )
2,814.82
140.74
Total Credits (A + 8 + C)
(2)
140.74
Total Interest/Penalty (0 + E)
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
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.
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 2,674.08
(SA)
(58) 2,674.08
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:
a. retain the use or income of the property transferred;................................................................................
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or... .... ................ .............. ....................... ................... ......... ..... ......... ..... ....
d. receive the promise for life of either payments, benefits or care? .............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?..................................................................................................................... .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?................ ........... .............. ............................. ................................................
Yes No
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D ~
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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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Patricia J. Hamilton
For dates of death on or after January 1, 1995, the tax rate in
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a 1
of assets and filing a tax return are still applicable even if the
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a dec
parent, an adoptive parent, or a stepparent of the child is 0%
The tax rate imposed on the net value of transfers to or for th
1.2) [72 P .S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for th
under Section 9102, as an individual who has at least one pa
DATE
92 Beetem Hollow Road
Newville, P A 17241
ADDRESS
DATE
ADDRESS
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10 West High Street
Carlisle, P A 17013
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i on the net value of transfers to or for the use of the
sfers to or for the use of the surviving spouse is 0%
'om tax, and the statutory requirements for disclosure
!neficiary.
)f age or younger at death to or for the use of a natural
~"L
leneficiaries is 4.5%, except as noted in 72 P.S. 99116
; is 12% [72 P.S. 99116 (a) (1.3)]. A sibling is defined,
ent, whether by blood or adoption.
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COMMONWEAL TH OF PENNSYLVANIA
. INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Kuntz, Sr., John W.
FILE NUMBER
21 - 06 - 00085
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
1 Clothing and personal effects.
DESCRIPTION
VALUE AT DATE OF
DEATH
0.00
2
Social Security check on hand.
1,123.00
3
OlTstOwn Bank, Money Market Account # 1 06800236
Principal 80,691.93
Accrued interest 46.43
80,738.36
4
OlTstown Bank, Checking Account #106002875
Principal 23,304.56
Accrued interest 2.68
23,307.24
5
E wing Brothers, refund of prepaid funeral
635.93
6
West Shore ALS, refund
86.07
7
Chapel Pointe, refund
3,824.65
8
SKF Pension Fund, two retirement checks on hand.
947. 14
TOTAL (Also enter on Line 5, Recapitulation)
110,662.39
*'
SCHEDULE H
RJNERAL. EXPENSES &
ADIVINSTRA11VE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kuntz, Sr., John W.
FILE NUMBER
21 - 06 - 00085
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Ewing Brothers, funeral
2
Patricia Hamilton, family meal
3
Eby Granite Works, headstone
4
The Sentinel, obituary notice
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Social Security Number(s) I EIN Number of Personal Representative(s):
2.
Street Address
City State _ Zip
Year(s) Commission paid 2006
Attorney's Fees Dale F. Shughart, Jr., Esquire (estimated)
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
State
Zip
4.
City
Relationship of Claimant to Decedent
Probate Fees Register of Wills - Paid $65 owe $215
5. Accountant's Fees
6.
Tax Return Preparer's Fees H & R Block, (estimated)
7.
1
Other Administrative Costs
Register of Wills, Short Certificates
2
Cumberland Law J oumal, advertise Letters
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
7,691.00
234.00
1,567.00
70.32
6,150.00
280.00
500.00
8.00
75.00
688.17
17,263.49
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENTDECEDENI
ESTATE OF
Kuntz, Sf., John W.
3
The Sentinel, advertise
4
Postmaster, stamps/certified mail
SchedUe H
FlIleraI ExpeIISCS &
ActniristralNe Costs cootiooed
5
Register of Wills, filing Inheritance Tax Return and Inventory
6
Reserve for final account.
FILE NUMBER
21 - 06 - 00085
Page 2 of Schedule H
129.77
28.40
30.00
500.00
ESTATE OF
.~.......
~
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
CpMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Kuntz, Sr., John W.
Include unreimbursed medical expenses.
ITEM
NUMBER
I
2
3
4
5
6
7
DESCRIPTION
Checks written before death and clearing after death:
#241 446.16 - Millenium Pharmacy
#242 12285.31 - Chapel Pointe at Carlisle
Belvedere Medical Center, medical bill
P A Depm1ment of Public Welfare, medical assistance reimbursement
Millenium Pharmacy, medicine
CV Nephrology Assoc., medical bill
P A Depm1ment of Revenue, 2005 state income taxes
U.S. Treasury, 2005 Federal income taxes
.
FILE NUMBER
21 - 06 - 00085
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
12,731.47
31.39
17,127.31
433.43
57.83
3.00
463.00
30,847.43
REV-1513 EJ,(+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kuntz, Sf., John W.
FILE NUMBER
21 - 06 - 00085
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
00 NotUst Trustee(s)
AMOUNT OR SHARE
OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Patricia J. Hamilton
92 Beetem Hollow Road
Newville, P A 17241
Daughter
One- third
2 Winifred K. Stern
11 Stoner Road
Newville, P A 17241
Daughter
One- third
3 John W. Kuntz, Jr.
96 Fish Hatchery Road
Newville, P A 17241
Sons
One-third
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
RPR 04 2000 8:08AM
HP LASERJET 3200
p _ 1
ORRSTOWNBANK
A T'radit-ioJl of ExcellenLte
April 5, 2006
TO: Dale F St'lughart JR
Attorney at Law
33 East High Street Suite 203
Carlisle, PA 17013
77 East Ki ng Slrt't'l
P.O. Uox 250
Sbippenshurg, PA 17257
FROM: Timothea Moose
Cust Sen.'ice Specialist
P.O. BOX 250
SHIPPENSBURG PA 17257"0250
RE: ESTATE OF John W Kuntz Sr
DATE OF DEATH: January 16.2006
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE
FOLLOWING ACCOUNTS V"'TH ORRSTO\^JN BANK:
ACCOUNT NO. TITLE OF ACCOUNT DATE OP~NED PRINCIPAL & ACCRUED INTERE;?'J
CERTIFICATES OF DEPOSIT
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED iNTERE~I
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