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Home My WebLink About12-18-06 --.J 15056041125 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes ' INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year ~ \ 6~ File Number . 0'6 '6<-+ Date of Birth 03505 7 557 092 8 2 0 0 6 06031911 Decedent's Last Name Suffix Decedent's First Name WATERMAN HELEN MI L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW IX! 1. Original Return o 4. Limited Estate IX! o 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 0 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 INFORfBTlON SHouLfiBE DIRECTED TO: Name Daytime Teli:J')t~e Numb~ ,,1: JAM E S B PAN NEB A K E R 7 1 7 ' ~ (11) 4 ~l 3, 3i- .:.~:~~ ~ -.' - -.-~:~~ REGlsttR:~-~~ILLS ~E ON~yJ-~f ~:t; :g -' -, ::j~~l 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes 2. Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required Firm Name (If Applicable) PAN NEB A K E R M 0 H R P C ~I-) First line of address 400 0 V I N EST R E E T w Second line of address City or Post Office State ZIP Code DATE FilED MID 0 LET 0 W N P A 17057 Correspondent's e-mail address:JIM@PANNEBAKERLAW.COM Under penalties~, erjury, 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, corresYand complete. De tion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUR 'OF P~SQN RE P9'NSIBLE FOR FILING R,ETURN ~ DATE... /-~) 1;7 I O? ADDRESS Alice 349 Union St Millersburg ADDRESS James pannebaker, 4000 Vine St Middletown PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 --.J ---I 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: HELEN L. WATERMAN RECAPITULATION 03505 755 7 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 15157899 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. 9 6 7 9 8 ...... . 6. Jointly Owned Property (Schedule F) o Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested. . . . . . . 7. 8. Total Gross Assets (total Lines 1-7) .......................... . 8. 1 5 2 5 4 6 9 7 9. Funeral Expenses & Administrative Costs (Schedule H) 9. 1 5 8 3 4 0 9 ............... . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 1 7 4 5 0 7 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 7 5 7 9 1 6 12. Net Value of Estate (Line 8 minus Line 11) ........................ . 12. 1 3 4 9 6 7 8 1 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 2 6 9 9 3 5 6 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 1 0 7 9 7 4 2 5 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.O _ 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable 1 0 7 9 at lineal rate X .O"!!L.- 7 4 2 4 16. 4 8 5 8 8 4 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17. 0 0 0 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18. 0 0 0 19. Tax Due . ...... ........... ..............................19. 4 8 5 8 8 4 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 L 15056042126 15056042126 ---I REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME HELEN L. WATERMAN __ - ___ ___ __________ __ _..____ u_ _ STREET ADDRESS COUNTRY MEADOWS -- --- -- -----..--- File Number 4905 E. TRINDLE RD ______ ___."___ _____.. _.___u__ CITY MECHANICSBURG STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 4,858.84 242.94 Total Credits ( A + B + C) (2) 242.94 3. Interest/Penalty if applicable D, Interest E. Penalty TotallnteresUPenalty ( 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, 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) 0.00 0.00 4,615.90 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 4,615.90 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 IX] b, retain the right to designate who shall use the property transferred or its income; ............................... 0 IX] c. retain a reversionary interest; or ................................................................................................ 0 IX] d, receive the promise for life of either payments, benefits or care? ....................................................... 0 IX] 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 IX] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... 0 IX] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 IX] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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. 99116 (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 zero (0) percent [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 zero (0) percent [72 PS. s9116(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. S9116(1,2) [72 P.S. s9116(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. s9116(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. REV-1503 EX + (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF HELEN L. WATERMAN FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION HELEN L. WATERMAN TRUST- MIDPENN BANK (SEE ATTACHED DETAIL) VALUE AT DATE OF DEATH 151,578.99 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 151,578.99 DEC-05-2006 rUE 03:31 PM MID PENN BANK 0"11 C ;C' 2~ ::r III ., ." 5' f!) tOl;)l;)l;);::J (') 01000" CC1oog~C: ~~~w~~ ~ ~~8~~ ~ ~.:>.c:oeni:" o ;;!~!P.!P. E' n ~ ~8mf!r~~olll ~ Q~ g 8 ~ ~ ; .... 0 -..... Il.! II) I>> .lII -0 ~ ~_ < :$. (; 3 (1C1)::J_!A!.~~cTl o "C....(1)JfIll 3 "'0<-" 3 C::[JJCD~ (i)m Itlx- .... iil n S' ~ [ -l -l o 0 aT. i ... ... 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S ~ tl~~ III n ~ ::t::J"~ ...Ill.... ~~~ or-en ~ 11) ~ :l' ." 3 )C' ~ lD g, 5' g 3 CD ea (II b ~ P. 04 ~d III e! - REV-15G8 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF HELEN L. WATERMAN FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION PENN PAL NOW ACCOUNT 421396 (SEE ATTACHED DETAIL) VALUE AT DATE OF DEATH 967.98 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 967.98 DEe-05-2006 TUE 03:31 PM MID PENN BANK FAX NO. 7176924861 P. 05 Account #: 421396 - Penn Pal Now Account Name: Helen Waterman Date Opened: 12/2/2003 Balance DOD: $967.96 Balance Accrued Interest DOD: $.02 Total DOD Balance: $967.98 Joint Ownership Name: N/A '1 ;, (]fL . /'I. . ~ Luw ~. 1- r ~ -1.w ~ {led. REV-1511 EX + (12-99) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF HELEN L. WATERMAN FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) MIDPENN BANK Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 349 UNION STREET City MILLERSBURG State PA Zip 17061 Year(s) Commission Paid: 2007 7,627.34 B. 2. 3. AttorneyFees PANNEBAKER & MOHR, P.C. 7,627.34 Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 314.00 5. Accountant's Fees 6. Tax Retum Prepare~s Fees 7. 8. 9. THE SENTINEL- ESTATE ADVERTISEMENT CUMBERLAND LAW JOURNAL- ESTATE ADVERTISEMENT POSTAGE 187.85 75.00 2.56 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 15 834.09 REV-1512 EX + (12-03) '* SCHEDULE' DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HELEN L. WATERMAN FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION COUNTRY MEADOWS ASSOCIATES- NURSING HOME EXPENSE VALUE AT DATE OF DEATH 1,712.05 1. 2. MOBILE X-RAY IMAGING, INC. 33.02 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,745.07 ,,,.,,,, "'.'* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HELEN L. WATERMAN SCHEDULE J BENEFICIARIES FILE NUMBER RELA T10NSHIP 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 transfers under Sec. 9116 (a) (1.2)] 1. GEORGE W. WATERMAN Lineal '300; () 1000 BONITA LANE MCHENRY, IL 60050 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 PENNSYLVANIA ASSOCIATION FOR THE BLIND 200/0 90 E. SHADY LANE ENOLA, PA 17025 TOTAL OF PART II - 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) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: ____4,1358.84 Discount: _~~.9_4 Interest Table Year Days Delinquent this time period I Balance Due this year Interest this period Before 1981 1982 1983 1984 .1985 1986 1987 19f!~ tbro_ugll1 ~91_ 1992 1993 t1!roLJgI!19_~4___ 1 !}~5 thr()ugh 1998__ 1999 2000 2001 2002 2003 2004 - -------- ..-- 2005 2006 _ ____I. TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17,1996: Penalty: INVENTORY Estate of HELEN L. WATERMAN No. 2006 00884 also known as , Deceased Date of Death Social Security No. 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 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 Decedent owned no real estate outside 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 made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. PA 17057 Personal Representative: I /' / // i r I . MIDPENN BANK, 34~NION STC,Gf.A!/ft-0t.0M-., Co MILLERSBURG, PA~: ) Dated 12/7/06 r' in :z.~. :.~J _) C', o ( . qs...- Name of Attorney: JAMES B. PANNEBAKER 1.0. No.: 09667 Address: 4000 VINE STREET MIDDLETOWN flP' Telephone: 717-944-1333 Description HELEN L. WATERMAN TRUST- MIDPENN BANK =E Value 151,578.99 PENN PAL NOW ACCOUNT 421396 (MIDPENN BANK) 967.98 Total (Attach Additional Sheets if necessary) 152,546.97 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 LA W OFFICES OF P ANNE BAKE R & MOHR, P.C. FOUR THOUSAND VINE STREET MIDDLETOWN, PENNSYLVANIA 17057-3565 TELEPHONE: 717-944-1333 FAX: 717-944-4004 WEBSITE: www.pannebakerlaw.com EMAIL: jim@pannebakerlaw.comorkendra@pannebakerlaw.com JAMES B. P ANNEBAKER December 15,2006 Attn: Wanda Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 Re: Estate of Helen L. Waterman No. 2006-00884 Dear Wanda: KENDRA A. MOHR n '-Q1 =.:20 \':r~: "j :>~ 1,.-"':," ,.::;\ ..-' t'::"--:) ~ ....--:) \:" ("1 fees. Enclosed please find a check for $30 for the Inventory and Inheritance Tax Return filing Thank you for your assistance in this matter. If you have any questions, please do not hesitate to contact me. Sincerely yours, @~ Kendra A. Mohr Enclosure - co ~ -" -""':'" - ~. - f'-' LAW OFFICES OF PANNEBAKER&MOHR, P.C. FOUR THOUSAND VINE STREET MIDDLETOWN, PENNSYLVANIA 17057-3565 TELEPHONE: 717-944-1333 FAX: 717-944-4004 WEBSITE: www.pannebakerlaw.com EMAIL: jim@pannebakerlaw.comorkendra@pannebakerlaw.com JAMES B. P ANNEBAKER KENDRA A. MOHR December 14, 2006 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle,PA 17013 Re: Estate of Helen L. Waterman No. 2006-00884 Dear Sir or Madam: Enclosed please find the Inventory and Inheritance Tax Return to be filed in the above- captioned Estate. I have also enclosed a check for $4,615.90. Please time stamp the extra copy of each document and return them to me in the enclosed envelope. Thank you for your assistance in this matter. If you have any questions, please do not hesitate to contact me. Sincerely yours, ~~/l/L- Kendra A. Mohr Enclosures