HomeMy WebLinkAbout09-15-06
--I
15056051047
REV-1500EX(06-05)
PA Department of Revenue .
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
1 8 1 3,2
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Decedent's last Name
PUG H
Suffix
Decedent's First Name
MI
M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's last Name Suffix
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
c::::> 1. Original Retum c::>
c::::>
c::> 4a. Future Interest Compromise (date of
death after 12-12-82)
c::> 7. Decedent Maintained a living Trust
(Attach Copy of Trust)
c::> 10. Spousal Poverty Credit (date of death c::> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Number
c::>
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
2. Supplemental Retum
c::>
c::::> 4. limited Estate
c::::>
6. Decedent Died Testate
(Attach Copy of Will)
9. litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
Firm Name (If Applicable)
::"'.:~.;::'~"}:::,.:
W ILL I A M C
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KOLLAS 'AiN:D:i
First line of address
1 1 0 4
SUI T E
City or Post Office
...
Correspondent's e-mail address:carole@kollasandkennedv.com
f perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief,
nd complet a n of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
ERSO LE F R FILING RETURN DATE
9/14/06
ADD E'tSq 1+'9-"- f1~~(-(~p(csbvtU;-- fA- /70)()
SIGNATU~QF PREPARER ATIj~ ~JN REPRESENTATIVE
J/AJ AM .A1A/I/~ 6?.L cu:;.<J.--:J--
RESS
/ I {) ~ reA-v vJ [;? () () If. V~( {/ ("7 10 C{ C-1tM f> l-t/ Lt-- P If-
., PLEASE USE ORIGINAL FORM ONLY
DATE
9/14/06
1701 (
Side 1
L
15056051047
15056051047
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~
REV-1500 EX Page 3
Decedent's Complete Address:
F.1e Number
DECEDENTS NAME
David M. Pugh
STREET ADDRESS 64 High Ridge Trail
CITY Mechanicsburg I STATE PA I ZIP 17050
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. C~~a~ems
A. Spousal Poverty C~it
B. Prior Payments
C. Discount
(1)
0.00
Total C~its ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill In oval on Page 2, Une 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)
oioo
Make Check Payable to: REGISTER OF WILLS, AGENT
'~g~"'ii~~
...'~.
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 IXI
c. retain a reversionary interest; or.......................................................................................................................... 0 IXI
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 IXI
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 I!l
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
III [I ~~. ~J_ J J!lJ1.. ITI '~J.~, ,~.,.,JJH rr:::1
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 three (3) percent [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed o~Jhe net value of transfers to or for the use of the surviving spouse is zero (0) percent
[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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [72 P.S. 99116(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.
-I
1505605204&
REV-1500 EX
Decedent's Name: David M. Pu h
RECAPITULATION
1. Real estate (Schedule A). ............................................ 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) c:::> Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
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). .. . . . . . . . . .. . . . .. . .. . . . .. . .. ... .. . 11.
12. Net Value of Estate (line 8 minus Line 11) . . . . . . . . .. . . . . . . . . .. . . . .. . . . .. 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value SubJectto Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0_ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
./
Side 2
L
1505605204&
c::>
1505605204&
--.J
......'...ex.(t-Hl..
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF OA vro M. PUGH
leNIDULI I
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
2105-1 CB4
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1. Smith Barney Bank Deposit (See Schedule)
78,076.57
/
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
78,076.57
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REV-15" ex. 112-99).
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
leN.DULI H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
DAVID M. PUGH
FILE NUMBER 21 05- 1 084
Debts of decedent must be reported on Schedule L
ITEM
NUMBER
A. FUNERAL EXPENSES;
1.
DESCRIPTION
AMOUNT
Gilbert Bailey
8,000.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)lEIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2. Attomey Fees
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7.
/'
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8,000.00
REV-I512E'- (12<3) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
DAVID M. PUGH
FILE NUMBER
2105-1084
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Fulton Bank
200 N. 3rd street
Harrisburg, PA
Business Loan
200,199.24
2.
Community Banks
150 Market Square
Millersburg, PA
Business Loan
101,239.48
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
301,438.72
~ DEPA~NT OF HOUSING AND URBAN DEVELOPMENT
A.. HUD.1 UNIFORM SETTLEMENT STATEMENT
B. TVDe of Loan
1.[ ] FHA 2.( ] FmHA 3.[ ] Conv. Unins. 16. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4.[ ] VA 5.() Conv. Ins. I '
C. NOTE: This form furnishes a statement of settlement costs. Amounts paid to and by the se~lement a~ent are shown. Items marked
-(p 0 c )- were paid outside the closing' they are shown for Informational purposes and are not Included In the totals.
. . . ,
0: Name & Address of Borrower: E. Name, Address & TIN of Seller: F. Name & Address of Lender:
Sharon L. Pugh Mortgage Master, Inc.
64 High Ridge Trail 102 Elm Street
Mechanlcsburg PA 17050 WalDOle . MA 02081
,
G. Property Location: TIN of Seller: I H. Settlement Agent:
64 High Ridge Trail Place of Settlement William C. Kollas
Mechanlcsburg, PA 17050 1104 Femwood Avenue
Camp Hill, PA 17011 l. Settlement Date: Dee 12, 2006
J. Summary of Borrower's Transaction
100 Gross Amount Due from Borrower:
K. Summary of Seller's Transaction
400. Gross Amount Due to Seller:
101. Contract sales price 401. Contract sales Price
102.PersonalProoertv 402.PersonalPropertv
103. Borrower's settlement charaes Cline 1400) 9,729.17 403.Prindpalamountofnewloan(s)
104. PaYOff to Fulton Bank 241,348.83 404.
105. PaYOff to Fulton Bank 200,199.24 405.
Adjustments for Items paid bv seller In advance Adjustments for Items paid by seller In advance
106. Cltvltown taxes to 406.Ciwltowntaxes to
107. Counw taxes to 407. County taxes to
108. Assessments to 408. Assessments to
109. to 409. to \
110. 410.
111. Pavoff to Community Banks 101,239.48 411.
112. 412.
113. 413.
120. Gross Amount Due from Borrower 552 516.72 420. Gross Amount Due to Seller
200. Amounts Paid by or In Behalf of Borrower: 500. Reductions In Amount Due to Seller:
201. DeDOsits or earnest money 501. Excess deDOsit (see instructions)
202. Principal amount of new loan(s) 400 000.00 502. Settlement charges to seller (line 1400)
203. Existing Ioan(s) taken sublect to 503. Existina loan(s) taken subiect to
204. 504. Payoff of first mortgage
205. 2nd Loan with Mortgage Masters. Inc. 99,722.84 505. Payoff of second mortgage
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller
210. Cltyltown taxes to 510.Citvltowntaxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. to 513. to
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid Syltor Borrower 499,722.84 520. Total Reduction Amount Due Seller
300. Cash at Settlement Fromlto Borrower 600. Cash at Settlement Toltrom Seller
301. Gross amount due from borrower (line 120) 552,516.72 601. Gross amount due to seller (line 420)
302. less amounts paid bylfor borrower (line 220) 499,722.84 602. Less reductions in amount due seller (line 520)
303. Cash 111 from 101 to Borrower 52,793.88 603. Cash fDl to f01 from Seller
Substitute Form 1099 Seller Statement
The Information in Blocks E. G, H, I & line 401 (or, if line 401 is asterisked, line 403 and 404) is Important tax Information and is being furnished
to the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this item is required to be reported and
the IRS determines that It has not been reported. If this real estate is your prindpal residence, file Form 2119. Sale or Exchange of Principal
Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or
Schedule 0 (Form 1040). You are required to provide the Settlement Agent (named above) with your correct taxpayer identification number. If
you do not provide the Settlement Agent with your taxpayer identification number. you may be subject to civil or criminal penalties imposed by law.
Under penalties of pefjury, I certify that the number shown on this statement is my correct taxpayer Identification number.
(Seller)
(Seller)
O'TholpeFo,mu:om
....:.. .-
100. Total Sales/Broker's Commission: (based on Drice) 0.00 ta>. % Paid from Paid From
Division of Commission (line 700\ as follows: Borrower's Seller's
Funds at Funds at
701. Settlement Settlement
702.
703. Commission Daid at Settlement
704.
800. Items Pavable in Connection with Loan 500.00
801. Loan Oriaination Fee - 0.125% to Mortaaae Master. Inc.
802. Loan Discount
803. ADDraisal Fee to Vincent Minnici bv Borrower POC $300
804. Credit ReDOrt to Factual Data 9.19
805. Lender's Insoedion Fee
806. Mortaaae Insurance Aoolication Fee 175.00
807. Administrative Fee to Netbank
808. Underwritina Fee to Mortaaae Master Inc. 65.00
809. Flood Certification Fee to FAFDS 14.00
81n Tav to . 73.00
811. Processino Fee to Mortaaae Master. Inc. 185.00
812. Fundina Fee to Netbank 75.00
813. Yield Soread Premium Mortaaae Master Inc. oaid bv Netbank POC $2 656.00
814.
900. Items Reauired bY Lender to Be Paid in Advance
901. Interest from Dec 16 2005 to Jan. 1.2006 ta>. 63.0100 oerdav 1 008.16
902. Mortaaae Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000. Reserves Deposited with Lender
1001. Hazard insurance 11 months l ~ 289.50 Der month 3.184.50
1002. Mortaaae Insurance months ( ~ Der month
1003. City orooertv taxes 10 months I ~ 150.62 oer month 1.506.20
1004. County Drooertv taxes 6 months ~ D. 519.52 Der month 3.117.12
1005. Annual assessments months ~ j) Der month
1006. months ~ il Der month
1007. Aaareaate Adiustment (2050.0m
1008.
1009. Aaareaate Accountina Adiustment
1100. Title Charaes
1101. Settlement/closina fee
11n, .L . .... ... ~nrl In~ 135.00
1103. Title examination
1104. Title insurance binder to Stewart Title 1.507.50
1105. Document DreDaration
1106. Notarvfees
1107. Attorneys fees
{includes above item numbers
1108. Title insurance to ASAP Endorsements 100. 300. 8.1 150.00
(includes above item numbers
1109. Lender's coveraae
1110. OWner's coverage
1111.
1112.
1113.
1200. Government Recordlna and Transfer Charaes
1201. Recordina fees: Oeed Mortaaae 54.50 Release 54.50
1202. City/county tax/stamos: Deed Mortaaae
1203. State tax/stamos: Deed Mortaaae
1204.
1205.
1206.
1300. Additional Settlement Charaes
1301. Survev
1302. Pest Insoection
1303.
1304.
1305. Wirina Fee to Kallas and Kennedv 20.00
1306.
1307.
1308.
1400. Total Settlement Charaes fThls Number Transfers to Lines 103 & 502 Above) 9 729.17 0.00
CERTIFICATION
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my know ge and
all receipts and disbursements made on my account or by me in this transaction. I fu er carti t
Settlemerit Statement.
Seller
it is a true and accurate statement of
ve received a copy of the HUD-1
Borrower
Seller
Borrower
Sharon L. Pugh
To the best of my knowledge the HUD-1 Settlement Statement which I have prepared is true and accurate account of the funds which were
received and have been or will be disbursed by the undersigned as part of the settlement of this transaction.
Settlement Agent Date
William C. Kallas
WARNING: k II. crime to knowingly meke f111se stetementa to the United States OIl this arany other similar torm. Penalties upon convlcUon can Include a fine and Inlptllonment FOr
.......: TIlle 18 U.S. Code SectIon 1001 and Sec:IIon 1010.
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.'CERTIFICATION OF NOTICE
.tiNDER RULE 5.6(a)'
Name of Decedent:
DAVID. M. PUGH.
Date of Death: 9/30 /2005
Will No. 2005"701804
Adm. No. 21-05-1084
To the Register:
. .
I certify that notice of estate administration required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiaries of the above-captioned
estate on
Name
Address
NOT APPLICABLE
. Date:
9/14/06
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(Signature)
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'Name: William C Knll~Q
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Address: 1104 Fp-rnwnnn n'T.-::IO
Camp Hill. PA 17011
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Telephone (/11 731-16011
Personal Representative
x Counsel for Personal
Representative
Capacity:
LAW OffiCES OF
KOLLAS AND KENNEDY
1104 FERNWOOD AVENUE
CAMP HILL, PENNSYLVANIA 17011
WilLIAM C. KOlLAS
JAMES W. KOlLAS
OF COUNSEL
MARY KOlLAS KENNEDY
TELEPHONE NO. (717) 731-1600
FAX NO. (717) 731-1460
September 14, 2006
Glenda Farner Strasbaugh
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
RE: Estate of David M. Pugh
File Number: 2005-01084
Dear Ms. Strasbaugh:
Enclosed please find an original and two (2) copies of the Inheritance Tax Return, Status
Report, Certification of Notice and Form REV-1500 to be filed in the above-referenced estate.
Kindly, time-stamp one copy of each and return them in the enclosed self-addressed, stamped
envelope. Also, enclosed is a check in the amount of $15.00 for the filing fee.
If you should have any questions, please do not hesitate to contact my office.
Very truly yours,
KaLLAS AND KENNEDY
LrJ~ C. ILv UJ'vY/ CoJL
William C. Kollas
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