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Home My WebLink About01-10-07 (2) , ' REV-1500 EX (EHXl) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBE ~L COUNlY CODE ~L 0439___ YEAR NUMBER I- Z W Q W (.) w Q DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Fusselman Helen DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 5/11/2006 3/23/1912 (IF APPLICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) M SOCIAL SECURIlY NUMBER 192":"34-5352 THIS RETUM MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ [Xl 1: Original Return :.::$nD u ~ 4, Limited Estate w 00 r.;;'1 ~ <<..J L.AJ 6. Decedent Died Test8le (Attach copy of IMII) o.aI ~ D 9. litigation Proceeds Received D 2. Supplemental R~um D 3. Remainder Return (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death aller 12-12-82) D 5. Federal Estate Tax Retum Required D 7. Decedent Maintained a Living Trust (Attach copy of Tru.t) L 8. Total Number of Safe Oeposit Boxes D 1 a. Spousal Poverty Credit (d.t..r d..th between 12-31-81 .nd 1-1-85) D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 44 West Main Street THIS SECTION MUST BE COMPLETED. ALL COltftE$PONPI:NOEAI\IDOONFIQEN'l'IALtAX INFOItMATION SHOULD BE DIRSCTEDTQ: NAME COMPLETE MAILING ADDRESS ... z w o z o 0- m w 0:: 0:: o o Richard C. Snelbaker FIRM NAME (If Applicable) Snelbaker & Brenneman P.C. lELEPHOfIE NUMBER Mechanicsburg, PA 17055 717-697-8528 (1 ) 1. Real Estate (Schedule A) 0.00 0.00 0.00 0.00 23,549.29 70,397.92 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corpor8lion, Partnership or Sole-Proprietorship (3) z o t= :s ::) I- 0: <C (.) w ~ 4. Mortgages & Notes Receivable (Schedule 0) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 322,735.39 8. Total Gross Assets (total Lines 1-7) (8) 10,751. 77 9,380.77 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) 13. Charitable and Governmental Bequests/See 9113 Trusts for v.A1ich an election to tax has not been made (Schedule J) (12) (13) OFFICIAL USE ONLY ~ = c:;:) --.I C-. :t~1< :z: ("") :=;0 r':; ::n ItlUO -}~r- .. .~~S3 (J)^ .-) ?3 ~~ ~....(-- ':6 ~-.'-i o ",. 3: C) o +:> 416,682.60 20,132.54 396,550.06 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 396,550.06 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABlE RATES 15. Amount of Line 14 taxable at the spousal tax 0.00 x .0 L (15) z rate, or transfers under Sec. 9116 (a)(1.2) 0 i= 16. Amount of Line 14 taxable at lineal rate 396,550.06 X.a 45 (16) <( I- ::) 0.00 0. 17. Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 0.00 0 18. Amount of Line 14 taxable at collateral rate x .15 (18) )( <( 19. Tax Due I- (19) 0.00 17,844.75 0.00 0.00 17,844.75 20. [K] CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > >Bi: SURE to ANSWER ALL QUes'tION$ QN R.!;VeR,$E sloe AND RECHECK MATH < < 3W4645 1.000 Decectent'sCeom lete Address: S~ ADDRESS Messiah Villa e T Cumberland Count CITY Mechanicsbur STAlE PA ZIP 17055- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 17,844.75 0.00 15,000.00 750.00 Total Credits (A + B + C) (2) 15,750.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnterestlPenalty (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 o.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) 2,094.75 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line S + 5A. This is the BALANCE DUE. Make Check Pa able to: REGISTER OF WULS, AGENT (5B) 2,094.75 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? 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] 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, induding 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 representatiw is based on all information of which pl'llparer has any knowledge. :. : OF PERSON REfZP ISLE FOR FILING ~N /) . ~~ - - · ~ ('l?!-- Joyce E. caz:pp ,xec.u trix 685 Moore's Mountain Roael, Mechanicsburg, PA 17055 S1GNAlUREOFPREPARE/,. ~. 1-'~IAIIVt: DATE ~ JIIO!cr1 ADDRESS . Richard C. Snelbaker, Esquire 44 West Main Street, Mechanicsburg, PA 17055 Yes No D D D D ~ ~ ~ ug [}g ~ ;Ai,~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 d the surviving spouse is 3% [72 P.S.~ 9916 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value dtransfers to or for the use of the surviving spouse is 0% [72 P.S. ~ 9116 (a) (1.1) (i1)] 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. ~ 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 4.5%, except as noted in 72 P.S. S 9116(1.2) [72 P.S. S 9116(a)(1)). The tax rate imposect*'1tIe net value of transfers to or for the use of the decedent's sibHngs is 12% (72 P.S. S 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 dececlent, whether by blood or adoption. 3W4646 1.000 ----------- --r--- REV-1508 EX + (6-98) COMMONVVEALTH OF PENNSYLVANIA ItltlERlTANCETAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Helen M. Fusselman FILE NUMBER 21 06 0439 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with the right of survIvorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Bank of Hanover 5,003.86 certificate of deposit, account number 145019 2 Bank of Hanover 3,016.73 certificate of deposit, account number 143095 3 Bank of Hanover 10,001. 67 certificate of deposit, account number 143093 4 Bank of Hanover 3,518.47 certificate of deposit, account number 143092 5 Bank of Hanover 2,000.97 certificate of deposit, account number 136609 6 Verizon 7.59 refund on phone service 3W46AD 1.000 TOTAL (Also enter on line 5 Recapitulation) $ (If more space is needed, insert additional sheets ct the same size) 23,549.29 - .. -- -. -----------,- --- --- REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA IN-tERlTAJICE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen M. Fusselman SCHEDULE F JOINTL Y-OWNED PROPERTY FILE NUMBER 21 06 0439 If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. Sl.RVIVING JOINT TENANT(S) NAME A. Capp, Joyce E AOORESS 685 Moore's Mountain Road, Mechanicsburg, PA 17055 RELA1l0NSHIP TO DECEDENT Daughter B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRJPTlON OF PROPERlY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUOE NMlE OF FINANCI..... INSTITUTION NCJ BAllI< ACCOlNT DATE OF DEATH DECO'S VALUE OF IILMIER OR SlMILAA IDEIIITIFYING /lUMBER. ATTACH DEED FOR NUMBER TENANT JOINT JOINTLV...eLD REAL. ESTATE. VALUE OF ASSET INTEREST CECEDENrS INTEREST 1. A. 1 A 10/7/1997 Citigroup SmithBarney 35,970.92 50.0000 17,985.46 investment account, account number 724-23524-12-790 2 A 8/10/1992 Fulton Bank 67,982.98 50.0000 33,991. 49 checking account, account number 3629-34947 3 A 5/2/1995 Sovereign Bank 20,037.83 50.0000 10,018.92 certificate of deposit, account number 1685211086 4 A 5/31/1995 Sovereign Bank 16,804.10 50.0000 8,402.05 certificate of deposit, account number 1685211706 TOTAL (Also enter on line 6 RecaPitulation) $ 70 397.92 3W46AE 1.000 (If more space is needed, insert additional sheets of the same size) REV-1510EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENT DECEDENT ESTATE OF Helen M. Fusselman FILE NUMBER 21 06 0439 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 PROPERlY ITEM K:I.L.IE TH: NloME OF TIt 'TRNISFEREE. TIEIR RELA TIONSHP TO DECEDENT A/ID DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TItOA'lEOF'IlWI!!FER. ATT.'CHACOPV OF TIE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPUCABLE\ VALUE 1. AIG SunAmerica Financial 257,712.95 100.0000 0.00 257,712.95 annuity, account number A634049735D 2 Fulton Financial Advisors 65,022.44 100.0000 0.00 65,022.44 annuity, account number 0182280 TOTAL (Also enter on line 7, Recapitulation) $ 322.735.39 (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 REV-1511 eX + (12-99) COMMONWEALTH OF PENNSYLVANIA INl-ERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen M. Fusselman SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. --- -1 FILE NUMBER 21 06 0439 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cocklin Funeral Home, Inc. funeral services 8,152.08 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representatlve(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Snelbaker & Brenneman, P.G 1,250.00 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 106.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Cumberland Law Journal advertising Executrix Notice 75.00 2 Patriot News advertising Executrix Notice 129.69 Total from continuation schedules 1,039.00 TOTAL (Also enter on line 9, Recapitulation) $ 10,751. 77 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: Helen M. Fusselman 192-34-5352 Schedule H Part 7 (Page 2) 3 Register of Wills filing fee for Inheritance Tax return 15.00 4 Register of Wills short certificates 24.00 5 Reserve for filing fees, accounting fees and other miscellaneous costs associatd with the administration of Decedent's estate 1,000.00 Total (Carry forward to main schedule) 1,039.00 REV-1512 EX + (12-03) COMMONVVEAL TH OF PENNSYLVANIA INt-ERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen M. Fusselman SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 06 0439 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death. including unreimbursed medical expenses. ITEM NWBER 1. DESCRIPTION VALUE AT DATE OF DEATH Alert Pharmacy medical expenses 79.28 2 Associated Cardiologists medical expenses 1. 76 3 Capital Area Health Associates medical expenses 112.01 4 Holy Spirit Hospital medical expenses 25.00 5 Messiah Village resident care, medical expenses 9,136.72 6 Mobil X Ray Imaging, Inc. medical expenses 26.00 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9,380.77 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INI'ERlTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen M. Fusselman 1 NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Joyce E. Capp 685 Moore's Mountain Road Mechanicsburg, PA 17055 FILE NUMBER 21 06 0439 RELAl10NSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER I ~l of Residue: 396,550.06 Daughter 396,550.06 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 3W46A11.000 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) $ 0.00 , -. ~ LAST WILL AND TESTAMENT of HELEN M. FUSSELMAN I, Helen M. Fusselman, of the Township of Carroll, County of York and Commonwealth of Pennsylvania, herewith publish and declare this to be my last Will and Testament. ITEM 1. I direct that all my just debts and funeral ex- " penses be paid as soon after my decease as may be convenient to the proper administration of my estate. ITEM 2. I give, devise and bequeath my entire estate remaining after payment of debts and expenses unto my husband, Jesse M. Fusselman, if he be liui~g at the time for destribution of my estate. ITEM 3. In the event my said husband pp.edecease me., I then give, devise and bequeath my entire estate remainl~g ~fter pay- ment of debts and expenses unto my da~ghter, Joyce E. Cappo ITEM 4. I nominate, constitute and appoint my husband, Jesse M. Fusselman, Executor of this, my last Will and Testament. If my said husband predecease me, I then appoint my daughter, Joyce E. Capp, Executrix in his place and stead. IN WITNESS WHEREOF, I, Helen M. Fusselman, have hereunto subscribed my hand to this,' my last Will and Testamerl1:, this I ;~ay of August, 1974. :~:.l,> L ~~r- I .... ~;;' l<;;....:.i"j:;..l._;. -:::.. ":;'~ --... SGNED, PUBLISHED and DECLARED by the above named Helen M. Fusselman as and for'her last Will and Testament in the presence of us, who, at her request and in her presence and in the presence of each other, . '. have s~gned our names as attesting witnesses hereto. ------~~ --: /'/ ' "I_:~., r '11 , at if U{ ;"; " . ./' 1/ j/ it' ( \ . ".,...,.Ll;:....-,.:-J I j .I-'f, I y ./ residing .;.( 7< ,j r:' '\.::7~ ~~ residirg at . ~~ , ?a