HomeMy WebLinkAbout10-20-06
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
DEPT,280601
HARRISBURG, PA 17128-0601
FILE NUMI3ER
21
COU~'TY CODE
06
YEAR
D~3\
NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
KARPER, FRANCES E.
SOCI~,L SECURITY NUMBER
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170-50-1593
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
06/03/2006
06/26/1897
REGISTER OF WILLS
SOCI~,L SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
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~ 1. Original Return
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4. Limited Estate
o 2. Supplernental Return
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4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy ofT rust)
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. Fe,deral Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
6. Decedent Died Testate (Attach copy
of Will)
9. Litigation Proceeds Received
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
AME COMPLETE MAILING ADDRESS
ch s: {VO V. Otto III, Esquire
~ ~ fRM NAME (If applicable)
~ ~ Martson Deardorff Williams & Otto
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ELEPHONE NUMBER
717 /243-3341
3. Closely Held Corporation, Partnership or Sole-Proprietorship
Ten East High Street
Carlisle, PA 17013
(1 ) None
(2) None
(3) None
(4) None
(5) 3,539.20
(6) None
(7) None en
(8) 3,539.20
(9) 1,099.38
(10) 350,253.47
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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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)
(11 )
351,352.85
12. Net Value of Estate (Line 8 minus Line 11)
(12)
insolvent
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
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 x .045 (16)
0 16. Amount of Line 14 taxable at lineal rate
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:::> (17)
ll. 17. Amount of Line 14 taxable at sibling rate x .12
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0
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~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
:opyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
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Decedent's Complete Address:
STREET ADDRESS
CITY
Shippensburg
STATE PA
.. liip~_u I
121 Walnut Bottom Road
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 0.00
(5A)
(5B) 0.00
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.
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: Yes No
a. retain the use or income of the property transferred;................................................................................. 0 ~
~.' ~::::~ ~h~e~;~;i:~:~s:~~~~s;~~. .S.~.~.B. ~~~. t~~. ~.~o.p.~~~ .t~~~~~~~~.e.d. .o.~ .it.S. .i.~.~~~~.;.... ~ ~ ~ ~ ~~~.......... ......................... ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
d. receive the promise for life of either payments, benefits or care?.............................................................. tJ ~
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
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.
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170 Fish HatcheIY Road
Newville, PA 17241
DATE
! () / cJ.() Joe,
ADDRESS
DATE
ADDRESS
DATE
Ten East High Street
Carlisle,PA 17013
fO/c-l-O JOb
.or 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
urviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)].
or 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%
'2 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
f assets and filing a tax return are stiB applicable even if the surviving spouse is the only beneficiary.
or dates of death on or after July 1, 2000:
he 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
arent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)).
he 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. 99116
.2) [72 P.S. 99116 (a) (1)].
he tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99'116 (a) (1.3)]. A sibling is defined,
nrlF>r SF>c:tion 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KARPER, FRANCES E.
I FILE NUMBER
21 - 06 -
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 Orrstown Bank, #103001232
DESCRIPTION
VALUE AT DATE OF
DEATH
3,539.20
TOTAL (Also enter on Line 5, Reciapitulation)
3,539.20
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSlS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KARPER, FRANCES E.
I FILE NUMBER
21 - 06 -
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
1 Fogelsanger-Bricker Funeral Home, funeral expenses exceeding balance in irrevocable burial 234.38
account at Orrstown Bank
2 Funeral reception food and church 300.00
3 Gravemarker for infant son of deceased 150.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Martson DeardorffWilIiams & Otto (estimated) 400.00
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
I
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
I
1 Register of WilIs, filing fee 15.00
TOTAL (Also enter on line 9, Recapitulation)
1,099.38
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KARPER, FRANCES E.
I FILE NUMBER
21 - 06 -
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
Shippensburg Health Care Center, account payabe
425.21
2
Department of Public Welfare, Estate Recovery Program, claim
349,828.26
TOTAL (Also enter on Line 10, Recapitulation)
350,253.47
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
September 25, 2006
MARTSON DEARDORFF WILLIAMS & OTTO
IVO V OTTO III ESQUIRE
10 EAST HIGH ST
CARLISLE PA 17013
Re: FRANCES KARPER
CIS #: 190117538
SSN: 170-50-1593
Date of Death: 06/03/2006
Dear Mr. Otto III:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $349,828.26 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective AuS[ust 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is: the Department's
itemized statement of claim.
A portion of this medical expense, namely $28,620.41, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $321,207.85,
is to be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise 1iIThether the
Commonwealth's claim is admitted and when payment may be e~~ected. If the
estate accounting is complete, please provide a copy. If t~he estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
L~~~~
TPL Program Investigator
717-772-6606
717-772-6553 FAX
Enclosure
rr. Tria L. Showaker
Ol\lotNAt RETAIN1!\) BY:
LAW OffICES
.::Ma'l:bon, CJ:::;wulO'l:ff. ~lmam! c C....tt,)
A P'ROFESSIONAi. CORPORATION
TEN EAST HIGH STREET
CARi.1Si.E. PA 11013
011)143-3341
LAST WILL AND TESTAME~I
L fRl\0iCES E. KARPER. of Southampton Township. Cumberland County, Pennsylvania.
being of sound and disposing mind and memory, do hereby make. publish and declare this to be my
Last Will and Testament. hereby revoking any and all former Wills or Codilcils by me made.
1.
r direct that all my just debts. funeral expenses, testamentary expenses and all inheritance
taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be
paid from my residuary estate as soon as practicable after my decease and as part of the
administration of my estate. Yfy Executor shall have no duty or obligation to obtain reimbursement
for any such tax so paid. even though on proceeds of insurance or other property not passing under
this Will.
/
r give. devise and bequeath all of my estate. both real and personal property. in equal shares.
unto my three children. Ida L. Showaker. Ezra E. Karper. Jf. and Elanore J. Boyles. absolutely.
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r nominate. constitute and appoint Ida L. ShO\vaker and Ezra E. Karper. Jr. and Elanore 1.
Boyles as Executors of my estate.
-+.
r direct that my E~ecutor shall not be required to file a bond to secure the faithful
performance of his duties in any jurisdiction.
5.
I authorize and empower my personal representative. in his sole and absolute discretion. to
purchase or otherwise acquire and retain any investments of which I die seized or any real or
personal property of any nature: to sell. lease. pledge. mortgage. transfer. exchange. dispose of or
grant options in regard to any or all property of any kind forming a part of my estate for such terms
and such prices as he may deem advisable: to borrow money for any purposes connected with the
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Page 1 of 3 Pages
protection and preservation of my estate; to mortgage or pledge any real or personal property
forming a part of my estate or to join in or secure the partition of same; to compromise any claims
or demands of my estate against others or of others against my estate; to make distribution in kind
and to cause any share to be composed of cash. property or undivided fractional shares in property
different in kind from any other share; to employ agents. attorneys and proxies and to delegate to
them such power as my personal representative considers desirable and to pay reasonable
compensatIOn tor such services as may be rendered by such agents. attorneys and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers.
I.\i \VITNESS WHEREOF I have hereunto set my hand and seal this ~q~ day of
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j
. 1995.
;(,~ t/!(~)u::r
Frances E. Karper
(SEAL:
SIG>..ED. SEALED. PUBLISHED AND DECLARED by the above..named Testator. as and
lor his Last \Vjjj and Testan1ent. in the presence of us. who at his request have hereunto subscribed
our names as \\itnesses thereto. in the presence of the said Testator and of each other.
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Page 2 of 3 Pages
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COMMONWEALTH OF PEl'i'NSYL VANIA
SS.
COUNTY OF CU~v1BERl.-\0JD
L Frances E. Karper. Testator. whose name is signed to the attached or foregoing instrument
having been duly qualified according to law. do hereby acknowledge that I signed and executed the
instrument as mv Last Will: that I signed it willingly; and that I signed it as my free and voluntary
act for the purposes therein expressed.
~~gA:~
Frances E. Karper
., Sworn or affirmed to and acknowledged before me by Frances E. Karper. the Testator. this
:;,\t't,ltdayof 4tr Cld5T . 1995.
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Notary Public
Nolana: Seal
Corrine L. Myers. Notary Public
Carlisle Boro. Curr;::;enana Ccuntv
My CommiSSion Exp:res May 27. 1999
COMMONWEAL TH OF PE:\TNSYL VANIA
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COCNTY OF CU\lfBERLAND
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\Ve. .L1L 'v \.. iiC.L.L..- :':c,(O '~i....~r:L-., 17. (::--r(ocr,
the witnesses whose names are signed to the attached or foregoing instrument, beh1g duly qualified
according to law. do depose and say that we were present and saw Frances E. Karper. the Testator.
sign and execute the instrument as her Last Will: that the Testator signed willingiy and that the
Testator executed it as her tree and voluntary act for the purposes therein expressed: that each of us.
in the hearing and sight of the Testator. signed the Will as witnesses: and that to the best of our
knowledlle the Testator was at that time 18 or more years of age, of sound mind and under no
constrain~ or undue intluencc. ~ '
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S\\orn or affirmed to and subscribed before me this (:;) crY1day of Ir--hV~l!G:- ,1995.
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Notary Public
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:Jage 3 of 3 Pages
'./ Notanal Seal
Corrine L Myers. Notary Public
Carlisle Bora. Cumberland County
My CommiSSion E \:,,:es May 27, 1999