HomeMy WebLinkAbout01-12-07
NO LETTERS
-.J
REV-1500 EX (06-05)
15056051058
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisbura PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
~-~.._-_.._--~_._.-_...._~--~ i
'22'8-16-5147 I 106/24/2006
Decedent's Last Name
~hi~_e~-=_____~__=-~_~_J
(If Applicable) Enter Surviving Spouse's Information Below
Spous~'s~~~t l\Iame___________
-,
INHERITANCE TAX RETURN County Code Year File Number
RESIDENT DECEDENT [;\[ ~-i I bt:l-=-S ---l
I ~ I c.:::..:::.... I I ' "\ i
Date of Birth
---, r-------~-~~1
J i07/20/1921 __J
Suffix Decedent's First Name
'--'--~ 1-.-----.---------------
IJr l~arry_______ _________
MI
Iw
Spouse's First Name
~_._~_.,---.._-~. -----
MI
Spouse's Social Security Number
-- ..---..- -- --..----- '--'1
_____________--..J
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
.
1. Original Return
C::J 2. Supplemental Return
C::J 3. Remainder Return (date of death
prior to 12-13-82)
C::J
4. Limited Estate
C::J 4a. Future Interest Compromise (date
of death after 12-12-82)
C::J 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
C::J 10. Spousal Poverty Credit (date of death C::J 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 Daytime Telephone Number
----I r?-17-236~9301--------
L___________._____ _______________
C::J
5. Federal Estate Tax Return Required
.
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
C::J
[David A. Wion, Esquire
Firm Nam~ (If!\Pfl~(;iIbl(l.L___
Wion, Zullli & Seibert
REGISTER OF WILLS US~ gNL Y
() ~;
First line of address
'~.......'-,
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L._..__._____.__.___~____________._.__~._..__________~~_'__~'_'___'_____
~
1
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I
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! . ... . -
'L DATE FILED :.~
-~---_.__._.--------=:::-------------"""-..........-
<'
.109 Locust Street
Second line of address
r0
Eity or Post Office .
)Harrisburg
I
State
r----~
~J
ZIP Code
_.--------='-~.
." !
f<)
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117101
Correspondent's e-mail address:
Under penalties of perjury. I declare that' 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.
S:N~_:~RrON ..IBLE FOR~~IN:_R~T~~~______ ___________
ADDR~~~=ct ~
SIG~~R()THER ~-EPRESENTATIVE---- .. -------
DATj
..--lll J }__(22__
~Lk_~~-2------. .
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
---.J
-.J
15056052059
REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
~8-16-5147 ---
i-- I
I ~ 15.
12,602.46'
1- 16.
17.
----1
I
I 1 18.
19.
RECAPITULATION
1.
Real estate (Schedule A)
2.
Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)
4.
Mortgages & Notes Receivable (Schedule D)
5.
6.
7.
Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)
Jointly Owned Property (Schedule F)
C::J Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) C::J Separate Billing Requested
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.
13.
Net Value of Estate (Line 8 minus Line 11)
Charitable and Governmental Bequests/See 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)
--------..--. _._.----~._--------_.~~-,..~---~-~_.._--_._- -----------
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 ~__
16. Amount of Line 14 taxable
at lineal rate X 0.0450
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE
1--
1.
---------------~-l
$ 0.00
2.
$ 0.00
$3,005.22 .
3.
4.
$ 0.00 i
--------.---.---..-------------j
5. I
1_ ------
6.
1____
~-
;
9. I
I
10. II
11.
12. l----
$5,061.191
1
$1,229.92
I
$6,800.00
$16,096.331
$2,981.80 !
$ 51?:Q7J
I
1
$3,493.87 !
$12,602.461
--1
13. I $ 0.00
r ---------------------- -----
__~ 4'_l__ ___
$12,602.46
$567.11
_.._----------~--
$ O:OoJ
I
I
L--_______
$ 0.00 i
I
I
$ 567.11
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
C::J
Side 2
15056052059
L
15056052059
REV-1500 EX Page 3
File Number
1\[-1]
L__~ ~
Decedent's Complete Address:
IDECEDENT'SNAME-
I H...arry W. Shively, Jr.
~.....,~----~~---
i STREET ADDRESS
· 4905 E. Trindle Road
_____J
._-~------_._--- ..,~ -- --.. ---~-- - --_._-_._---_._--~--_._------
DECEDENT'S SOCIAL SECURITY NUMBER
178-16-5147
L ..' --------
iCITY
. Mechanics~urg ,______
I STATE
____________ ! PA
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (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 avalon 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)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
ZIP
17050
$ 567.11
$ 0.00
$ 0.00
$ 0.00
$ 567.11
(5A)
(5B)
$567.11
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;
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?
o
o
o
o
o
o
o
x
x
x
x
x
x
x
o
x
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 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 four and one-half (4.5) percent, except as noted in 72
P.S. 99116(1.2) [72 P.S. 99116(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.
REV.1503EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
harry W.
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
3.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,535.75
770.85
698.62
FFSC - 61 Shares @$25.18
Met Life Stock - 000 value
Prudential Retirement Plan - 000 value
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$3,005.22
REV-150B EX -+ (6-9B)
.v
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Harry W.
Harry W. Shively, Jr.
FILE NUMBER
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
5,061.19
1.
PNC - Checking Acct. No. 5140236181 - DOD value
TOTAL (Also enter on line 5, Recapitulation) $5,061.19
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
,?
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Harry W, Shively, Jr.
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A, Timothy B, Sharretts
ADDRESS
RELATIONSHIP TO DECEDENT
435 Marsh Run Road, New Cumberland, Pa
Son-in-Law
R
C,
JOINTLY-OWNED PROPERTY:
ITEM lETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
NUMBER FOR JOINT MADE Include name of financial institution and bank account number or similar Identifying number DATE OF DEATH DECO'S VALUE OF
TENANT JOINT Attach deed for JOintly-held real estate, VALUE OF ASSET INTERE DECEDENT'S INTEREST
~T
1 A 6/17/93 PNC Bank Savings Account No 5130424429 DOD value 2A5983 50% 1,229\/
TOTAL (Also enter on line 6, Recapitulation) $1,2290
?-
(If more space IS needed, Insert additional sheets of the same size)
REV-1510 EX + (6-98)
.~
'1'
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Harry W. Shively, Jr.
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF DECD'S
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH INTEREST EXCLUSION TAXABLE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET (IF APPLICABLE) VALUE
1. 2001 Buick Regal LS Sedan to Cathilee G. Sharretts - Stepdaughter 9,800.00 100% 3000.00 6.800.(
6/20/2006 transferred
TOTAL (Also enter on line 7, Recapitulation) 6,800.(
. .
(If more space IS needed, Insert additional sheets of the same size)
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Harry W. Shively, Jr.
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Parthemore Funeral Home 2,231.80
B ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
-
Year(s) Commission Paid:
2. Attorney Fees - Wion, Zulli & Seibert 750.00
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.
TOTAL (Also enter on line 9, Recapitulation) $2,981.80
. .
(If more space IS needed, Insert additional sheets of the same size)
REV.1512 EX + (12.03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES. & LIENS
ESTATE OF
Harry W. Shively, Jr.
FILE NUMBER
Record debts incurred by the decedent prior to death which remained unpaid as of the date of death, include unreimbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
DESCRIPTION
Darren Banbaci, MD. - Medical bill
Burick, & Azizkhan - Medical bill
Jackson Gasterinterology - Medical bill
Quantum Imaging - Medical bill
Robert Kantor, MD - Medical bill
Moffitt Heart & Vascular Group - Medical bill
Health South - Medical bill
Kunkel Surgical Group - Medical bill
Mobil Xray - Medical bill
Pinnacle Health - Medical bill
AMOUNT
15.06
188.94
49.12
31.62
34.11
98.11
24.64
34.11
24.66
11.70
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, Insert additional sheets of the same size)
$ 512.07
REV.1513 EX + (9-00))
v
'1\
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Harry W.
Shively, Jr.
FilE NUMBER
RELATIONSHIP TO DECEDENT MIOUNT OR
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s) SHARE
OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
I transfers under Sec. 9116 (a) (1.2)]
1 Cathilee G. Sharretts Step-daughter 1/2 residue &
435 Marsh Run Road Pers. Prop.
New Cumberland, PA 17070
2. Karen L. Jung Step-daughter 1/2 residue
26056 Pheasant Run
Lindstrom, MN 55045
3. Timothy B. Sharretts Step-son-in-Iaw Pers. Prop.
435 Marsh Run Road
New Cumberland, PA 17070
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.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
0.00
(If more space is needed, insert additional sheets of the same size)
1l.Last Bill alto W~glaln~ltt
OF
HARRY W. SillVEL Y, JR.
1, HARRY W. SHIVELY, JR., of New Cumberland, Cumberland County,
Pennsylvania, being of sound mind, memory and understanding, do make, publish and
declare the following to be my Last Will and Testament, hereby revoking and making
void, any and all wills, codicils and testamentary dispositions by me at any time
heretofore made.
ITEM I. I direct that all my just debts and funeral expenses be paid and
satisfied by my Executor hereinafter named as soon as conveniently may be after my
decease.
ITEM ll. I give, devise and bequeath my two (2) RCA Television Sets, my
Stereo and Entertainment Center, my Thomasville Living Room Sofa, Sofa Chair and
Sleeper Sofa, my 2001 Regal Buick Automobile, my Masonic Ring and all my Tools to
my step-daughter, CA TillLEE G. SHARRETTS and her husband, TIMOTHY B.
SHARRETTS, or the survivor of them.
ITEM ID. All the rest, residue and remainder of my estate, whether real,
personal and mixed, and wherever located or situate, I give, devise and bequeath to my
step-daughters, CATHILEE G. SHARRETTS, DIANA L. HUNTER, and KAREN L.
JUNG, per stirpes.
ITEM N. I nominate, constitute and appoint, TIMOTHY B. SHARRETTS, as
Executor of this my Last Will and Testament. If the said Timothy B. Sharretts is unable
or unwilling to serve in this capacity, or having served, is unable or unwilling to continue
to serve, I then appoint my step-daughter, CATHILEE G. SHARRETTS, as Executrix of
this my Last Will and Testament.
ITEM V. Without limitation of the powers confelTed upon them by this Will,
by statute or rule oflaw, including the provisions of Pennsylvania Chapter 75 of the
Pennsylvania Estate and Fiduciary Code (20 P.S. S7501, et.seq.) which Chapter 75 I
expressly provide shall not apply to any trust created under this Will, any fiduciary under
this Will is specifically authorized and empowered to retain, purchase or otherwise
acquire without restriction any stocks, bonds, mortgages, notes or other securities, or
other variety of real or personal property, even though such property may not be of the
character allowed by law; to sell, lease, pledge, mortgage, exchange, convert or otherwise
dispose of any property at any time forming part of my estate, in such manner including
public or private sale, at such times, for such purposes and for such prices and upon such
terms and conditions as said fiduciary shall deem advisable; to bOlTOW money whenever
in the judgment of my fiduciary it may be advisable, and as security to mortgage or
pledge any property forming part of my estate on such terms and conditions as said
fiduciary may deem advisable; to compromise or otherwise adjust any claims or demands
in favor of or against my estate; to continue, manage and operate any existing business or
enterprise in which I may have an interest as proprietor, partner or principal stockholder
at the time of my death, and any interest therein, for as long a period as to my fiduciary
shall seem advisable or desirable in the best interests of my estate, and in so doing to
renew, reissue or to make originally all forms or evidences of indebtedness binding my
estate for the payment of such sums as my fiduciary may think necessary, with like power
2
to exercise this right to bind my estate by endorsement of negotiable paper or other forms
of instruments and/or to settle, discontinue, liquidate or sell any business or interest
therein, at any time, at public or private sale, upon such terms, for cash or on credit, with
or without security, and with or without interest, in such manner and at such prices as in
my fiduciary's judgment and discretion may be proper, advisable or advantageous; to
make distribution, division or apportionment 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 execute and deliver such instruments as may be necessary to
carry out any of these powers; and to do all other acts which any fiduciary under this Will
may deem necessary or desirable for the proper execution or discharge of any powers or
duties held or imposed upon him, or her, or it whether by the terms of this Will or by law,
any fiduciary under this Will to have all of the discretion and power to do or refrain from
doing any or all of the foregoing things to the same extent and as fully, in all respects, as I
could do myself if living.
ITEM VI. All estate taxes, inheritance taxes, transfer taxes and other taxes of a
similar nature payable by reason of my death to any government or subdivision thereof
upon or with respect to any property subject to any such ("Death Ta'<.es"), and any
penalties thereon, shall be paid by the Executor out of the principal of my estate, and all
interest with respect to any such taxes shall be paid by the Executor out of the income or
oprincipal or partly out of the income and partly out of the principal of such portion of my
estate in the absolute discretion of the Executor, without reimbursement from or
apportionment among the beneficiaries, recipients or owners of such property for any
3
such taxes, penalties or interest.
ITEM VIT. No fiduciary herein named shall be required to enter bond or security
in any jurisdiction for the performance of duties.
IN WITNESS WHEREOF, I, HARRY W. SHIVELY, JR., have hereunto set my
hand and seal this ~ day of
Sc:f1;EI'1'5h'" Ie..
, 2001.
~ ~
.i -< l(..J. . (SEAL)
~ W. Shively, Jr.
Signed, sealed, published and declared as and for the Last Will and Testament of
HARRY W. SHIVELY, JR., the Testator, in our presence, who in his presence, and in
the presence of each other, and at his request, have hereunto set our hands as subscribing
witnesses hereto.
tfJJ ri. t~,
Name
LALV1l0l1t~ }!7CUzP
Name'
!oe; !-cc.r;:(- fY.." ~ f 4, I?(()(
Address
)oq l~Stj rtbo PA
Address
LI
COMMONWEALTH OF PENNSYLVANIA
: SS:
COUNTY OF DAUPHIN
We, HARRY W. SHIVELY, JR., \) W"( cL -14 ~)( 0 J and
LA; <<" 1f -.(. ftvJ I ' 1he 1e,_' and 1he witnesses
respectively, whose names are signed to the attached or foregoing instrument, being first
duly sworn, do hereby declare to the undersigned officer that the Testator signed the
instrument as his Last Will and that he signed voluntarily and that each of the witnesses
in the presence of the Testator at his request, and in the presence of each other, signed the
Will as a witness and that to the best of the knowledge of each witness, the Testator was
at the time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Witness
Sworn to and subscribed before
me by HARRY W. SHIVELY, JR, the
Testator, and subscribed and sworn to
before me by Cv<J ."J.- LUi ",'oJ and
IAJ -e. l'\. "" If the witnesses,
on this . 0 day of ~ ,200!.
\~
NOtary .. blic .
My Commission Expires:
NOTARIAL SEAL
ANN J. lONG, Notary Public
City of Harrisburg, Dauphin County
My Corrunission Expires Oct 30, 2003
'5