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Home My WebLink About04-28-06 REV-1500 EX (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 COUNTY CODE -.9L __!l :LO YEAR NUMBER I- Z W C w () w C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Metzdorf Helen DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 7/28/2005 7/27/1915 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Not Applicable [X] 1. Original Retum [X] 4. Limited Estate D 6. Decedent Died Testate (Attach copy of 'Mil) D 9. Litigation Proceeds Received v SOCIAL SECURITY NUMBER 177-42-2455 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ~~CI) () O::~ w n.() J:OO () 0::....1 n.CO n. < D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-B-82) D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required D 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (d,te of death betwee, 12-31-91 "d 1-1-95) D 11. Election to tax under Sec. 9113(A)(Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z l1J C Z o lL '" l1J II:: II:: o o Howell C. Mette, Es ire FIRM NAME (If Applicable) 3401 North Front Street METTE, EVANS & WOODSIDE TELEPHONE NUMBER PO Box 5950 717-232-5000 Harrisburg, PA 17110-0950 1. Real Estate (Schedule A) (1) 0.00 0.00 0.00 0.00 4,458.28 436,608.23 OFFICIAL USE ONLY r' , ,,--; 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) (4) (5) z o i= :5 ::> l- e:: <( () W c::: 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) (6) 0.00 8. Total Gross Assets (total Lines 1-7) (8) 4,206.15 4,615.66 441,066.51 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) (13) 8,821.81 432,244.70 0.00 11. Total Deductions (total Lines 9 & 10) (11) 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) (12) 14 Net Value Subjeclto Tax (Line 12 minus Line 13) (14) 432,244.70 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax z rate, or transfers under Sec. 9116 (a)(1.2) o ~ 16. Amount of Line 14 taxable at lineal rate I- :;) ~ 17. Amount of Line 14 taxable at sibling rate o () 18. Amount of Line 14 taxable at collateral rate >< ~ 19. Tax Due 20. D 0.00 x .0 L(15) x .0 45 (16) x .12 (17) x .15 (18) (19) 0.00 19,451. 01 0.00 432,244.70 0.00 0.00 0.00 19,451. 01 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1000 M Decedent's complete Address: STREET ADDRESS 100 Mount Allen Drive Cumberland CITY I STATE I ZIP Mechanicsburq PA 17050- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 19,451.01 0.00 18,330.61 964.77 Total Credits (A + B + C) (2) 19,295.38 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty (0 + E) (3) 0.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 155.63 A. Enter the interest on the tax due. (5A) 0.00 B. (5B) AGENT 155.63 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? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D ~ 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 De::::laration of preparer other than the personal representative is based on all information of which preparer has any knO'Nledge (' Yes No D D D D og og ~ D []] og Houghton, MI ADDRESS 3401 N. Front Street, PO Box 5950 Harrisburg, PA 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. 99916 (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 P.S. 99116(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. 9 9116(1.2) [72 P.S. 991 16(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. 9 9116(a)(1.3)J. 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. 3W4646 1.000 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Helen V. Metzdorf FILE NUMBER 2105 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 Furniture, sale price 1,554.28 2 PA Department of Revenue, 2005 income tax refund 308.00 3 U.S. Treasury, 2005 income tax refund 2,596.00 3W46AD 1.000 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4,458.28 'lEV-1509 EX + (&-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen V. Metzdorf SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21 05 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINTTENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Heldt, Patricia A P.O. Box 574, 21812 Woodland Road, Houghton, MI 49931 Daughter B. c. JOINTLY-OWNED PROPERTY: lETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FlNANCIAllNSTITUTIQN AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF N...MBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 1 A Pre-6/28/0l Commerce Bank Checking Account #0536258213 19,362.20 50.0000 9,681. 10 2 A Pre-6/28/0~ Cortland General Money Market Fund 20,104.46 50.0000 10,052.23 3 A Pre-6/28/0~ Securities, listed on Schedule F-1 attached 833,749.80 50.0000 416,874.90 TOTAL (Also enter on line 6 Recaoitulationl $ 436,608.23 3W46AF 1 000 (If more space is needed, insert addrtional sheets of the same size) Date of Death: 07/28/2005 Valuation Date: 07/28/2005 Processing Date: 08/15/2005 Shares or Par Security Description 1 ) 13036.515 AIM FDS GROUP (008879306) PREMIER EQTY A Mutual Fund (as quoted by NASDAQ) 07/28/2005 2) 200 BRISTOL MYERS SQUIBB CO (110122108) COM New York Stock Exchange 07/28/2005 ~~cate valuatlon Schedule F-l Securities High/Ask 25.47000 Low/Bid 10.20000 Mkt 25.15000 H/L 3) Div: 0.28 Ex: 06/29/2005 Rec: 07/01/2005 Pay: 08/01/2005 6681.545 DELAWARE GROUP EQUITY FDS II (245907100) LRG CAP VAL A Mutual Fund (as quoted by NASDAQ) 07/28/2005 4 ) 4110.669 EATON VANCE SPL INVT TR (277905832) UTI1S FD CL A Mutual Fund (as quoted by NASDAQ) 07/28/2005 5) 100 EMERSON ELEC CO (291011104) COM New York Stock Exchange 07/28/2005 6) 6119.163 FRANKLIN FED TAX FREE INCOME (353519101) CL A Mutual Fund (as quoted by NASDAQ) 07/28/2005 7 ) 1092 HEALTH CARE PPTY INVS INC (421915109) COM New York Stock Exchange 07/28/2005 8 ) 660 KIMCO REALTY CORP (49446R109) COM New York Stock Exchange 07/28/2005 9) 50000 KISLAK NATL BK MIAMI FL (49777SAY2) Financial Times Interactive Data DTD: 10/30/2002 Mat: 10/30/2017 5.5% 07/28/2005 Int: 04/30/2005 to 07/28/2005 10) 5775 LIBERTY ALL STAR EQUITY FD (530158104) SH BEN INT New York Stock Exchange 07/28/2005 11) 4000 TRI CONTL CORP (895436103) COM New York Stock Exchange 07/28/2005 67.00000 28.23000 65.77000 9.53000 18.61000 Page 1 19.06000 Mkt 11. 07000 Mkt 66.34000 H/L 12.26000 Mkt 27.90000 H/L 64.49000 H/L 99.28030 Mkt 9.43000 H/L 18.47000 H/L Estate of: Metzdorf.He1en.estate Account: 13065-0001 Report Type: Date of Death Number of Securities: 15 File 10: Metzdorf.Helen.estate Mean and/or Div and Int Security Adjustments Accruals Value 10.200000 132,972.45 25.310000 5,062.00 56.00 19.060000 127,350.25 11. 070000 45,505.11 66.670000 6,667.00 12.260000 75,020.94 28.065000 30,646.98 65.130000 42,985.80 99.280300 49,640.15 672.22 9.480000 54,747.00 18.540000 74,160.00 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4) Date ot Death: U/IL~/LUU~ Valuation Date: 07/28/2005 Processing Date: 08/15/2005 ~state ot: Metzdort.Helen.estate Account: 13065-0001 Report Type: Date of Death Number of Securities: 15 File ID: Metzdorf.Helen.estate Shares or Par Security Description High/ASk Low/Bid Mean and/or Div and Int Security Adjustments Accruals Value 12) 3300 UGI CORP NEW (902681105) COM New York Stock Exchange 07/28/2005 29.30000 28.41000 H/L 28.855000 95,221.50 13) 1476.661 VAN KAMPEN COMSTOCK FUND (92112D301) CL C Mutual Fund (as quoted by NASDAQ) 07/28/2005 18.70000 Mkt 18.700000 27,613.56 14) 235 WASHINGTON MUT INC (939322103) COM New York Stock Exchange 07/28/2005 43.12000 42.79000 H/L Div: 0.480000 Ex: 07/27/2005 Rec: 07/29/2005 Pay: 08/15/2005 42.955000 + 0.480000 43.435000 10,207.23 15) 1760.332 WASHINGTON MUT INVS FD INC (939330304) CL C Mutual Fund (as quoted by NASDAQ) 07/28/2005 31.37000 Mkt 31.370000 55,221. 61 Total Value Total Accrual Total $833,749.80 $833,021.58 $728.22 Page 2 This report was produced with EstateVa1, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Helen V. Metzdorf FILE NUMBER 2105 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Acacia Park Cemetery, Chicago, Illinois 1,080.00 Total from continuation schedules 126.15 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3,000.00 3. 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 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. None TOTAL (Also enter on line 9, Recapitulation) $ 4.206.15 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) state o~: Helen V. Metzdorf 177-42-2455 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Myers-Harner Funeral Home, Camp Hill, PA 126.15 l'nr..l Cr...rrv forward to main schedule) 126_'''' REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen V. Metzdorf SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 05 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Messiah Village 4,615.66 3W46AH 2000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4 615.66 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen V Metzdorf NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J Patricia A. Heldt P.O. Box 574 21812 Woodland Road Houghton, MI 49931 1 100% of Residue: 432,244.70 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter FILE NUMBER 2105 AMOUNT OR SHARE OF ESTATE 432,244.70 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 11- 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) 3W46AI 1000 $ 0.00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RECEIVED FROM: METTE HOWELL C 3401 NORTH FRONT STREET PO BOX 5950 HARRISBURG, PA 17110-0950 nnun fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2105-0920 DECEDENT NAME: METZDORF HELEN DATE OF PAYMENT: 05/01/2006 POSTMARK DATE: 04/27/2006 COUNTY: CUMBERLAND DATE OF DEATH: 07/24/2005 NO. CD 006629 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $155.63 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 1170 SEAL INITIALS: MG RECEIVED BY: REGISTER OF WILLS $155.63 GLENDA FARNER STRASBAUGH REGISTER OF WILLS METTE, EVANS & WOODSIDE A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 3401 NORTH FRONT STREET P.O. BOX :59:50 HARRISBURG, PA 17110-09:50 HOWELL C. METTE IRS NO. 23-198:0;00:0; TELEPHOl'>"E (717) 232-5000 FAX (717) 236-1816 HTTP://WWW.METTE.COM April 27, 2006 CERTIFIED MAIL RETURN RECEIPT REQUESTED Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Helen V. Metzdorf Dear Ms. Strasbaugh: Enclosed for filing are the following: 1. Original and one copy ofREV-1500, Inheritance Tax Return Resident Decedent. 2. Check in the amount of$155.63 in payment of taxes due. 2. Check in the amount of $15 in payment of filing fees. Please contact the undersigned with any questions. Sincerely, ~ e f\,., ;\;: ,~ t t j I"~ i ,! , 'l f\ .J:}l .! '1 \ ::~ 7ft) Y/J I rv' v VVl \"1. \.(/"~ iI~well C. Mette HCM/lmg Enclosures cc: Patricia Heldt 448069vl Wyomissing Office 11105 Berkshire Boulevard, Suite 320 I Wyomissing, P A 19610 I Telephone (610) 374-11351 Facsimile (610) 371-951 11.__ g~~~E Hntol~~ VolOttol ~~~~~ ~~ ~~ c:::n~l:IO VolOH t-'tolnt'" Vol e~~~~ W~~ g; Glg E; Vol ~ tol - -. - -- II ~ ~ II o .. >~ == CoO '"d~ >- ~ ::o~ ::c S>~tr.j ::c z~t'=.j:' .... 0 ~ en ~~..j oo~::co~< ~~~~~~ p~~~~oo ~><oooo~ >gZ~~~ .... 0. ~ '"d <<0 ~OOOt"lo ::; =a~~0 6 tfj >-3t::l CC tfj -00 0. '--" o~ o '"":I zt::l tr.j ~ o o -'= o l.n l.n o o o o o ru IT" ru l:-' -.I ru ~ ru - - - - - !~ - - - - - ::::::- - - -