HomeMy WebLinkAbout02-06-07
REV-l000 EX (HO)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT,280601
HARRISBURG, PA 17128-0601
REV.1500
OFFICIAL USE ONLY
DECEDENfS NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ Kelly, Sylvia C.
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ OS/23/2006 OS/29/1926
W (IF APPUCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDle INITIAL)
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INHERITANCE TAX RETURNnENlM~EO:r
. RESIDENT DECEDENT ~ YEAA
ol_i _'
NUMBER
SOCIAL SECURITY NUMBER
016 - 20
8874
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
. [1Q 1. Original Return
[!I 4. Umlted Estate
[XJ 6. Decedent Died Testate (AIllK:h copy of WIll)
o 9. Utigatlon Proc8eds Received
D 2. Supplemental Return
o 4a. Future Interest cOmpromise (dale of doIth Iller 12-12-82) .
.0 7. Decedent Maintained a LMngTrusl~copyolTIUII)
o .10. Spousal Poverty Creellt (clIlIoIdullbeIwien 12-31.8111ld 1-1-85)
D 3. RernalriderReturn (dat8oldellh pilor to. 12-13-82)
o 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Se<:. 9113(A) (Altach Sell 0)
NAME
Anthon L. DeLuca
FIRM NAME (" AppicIIlIt)
An h n
TELEPHONE NUMBER
717-258-684'4
COMPLETE MAILING ADDRESS
p.e. Box 358
113 Front Street
Boiling Springs, 'PA 17007
(1)
(2)
(3)
(4)
(5)
-0-
-0-
-O~
-0-
4,222.61
OFFICIAL USE ONLY
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1. Real Estate (Schedule A)
2. Stocks and Bonds (SchedUle B)
3. Closely Held Corporallon, Par1nerahlp or SoIe-PlOprjetorlhlp
4. Mortgages & Notes Recelveble (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate BIlling Requested
7. Inlilr.V\vos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. TolII Gross Aneta (total lines 1-7)
. 9. Funeral Expenses & Admlniitrative Costs (~u1e H)
10. Debts of Decedent Mortgage LlabIll1les, & Uens (Schec!uJe I)
11. Total Deductiona (total Unes 9 & 10)
12. Net Value of Estata (Une 8 minus Une 11).
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(11) $6,786.59
(12) <243.01>
. (13) -0-
.. (14) -0-
x.O_ (15) -0-
x.O_ (16) -O-
x .12 (17) -0-
-O-
x .15 (18)
(19) -0-
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(6)
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2,320.97
N
(7) .
4,369.50
(8)
$6,543.58
- (9)
(10) .
2,417.09
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14. Net Value Subject to Tax (Une 12 minus Une 13) "
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
15. Amount of Line 14 taxable at 1IIe spousal tax
rate, or transfers under See. 9116 (a)(1.2)
16. Amount -of Une 14 taxable alllneal.rate
17. Amount of Une 14 taxable at sibling rate
18. Amount of Una 14 taxable at collateral rate
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS 210 Hill Street
CITY Mt. Holl
STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. CreditslPayments
A Spousal POverty Credit
B. Prior Payments
C. Discount
(1)
-0-
. total Credits (A + B + C ). (2)
-0-
3.
InterestlPenalty If applic:able
D. Interest
E. Penalty
5. If Line 1 + Line 31s greater than Line 2, enter the difference. Thls.ls the TAX DUE.
. A. Enter the interest on the tax due.
(5)
. (SA)
:"0'-
-0-
":;0-
-0-
4.
. .... .' .'. . ..' '.' .TotallriterestlPenaltY r 0 + E )' (3)
If Line 2 is' greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT;
Ch.ck box on Page1Une 20 to request . refund (4)
B. Enter the total of Une 5 + SA. This Is the BALANCE DUE. (5B) _ b _
Make Chec~ 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 IZJ
b.retaln the right to designate who shall use the property transferred or Its Income; .:..................................:....... 0 IX]
c. retain a reversionary Interest or..............................................;............................................................................. D. IZJ ,
d.recelve the promise forUfe of either payments, benefits oi care? .....................'.......................:.......,................ 0 ~
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? ...........':.. . D'
4. Old decedent own an Individual Retirement Account, annuity; or other non-probate property which .
contains a beneficiary designation? ................................................................................................;......;.................. ~ '
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 3%
[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 0% [72 P.S. S9116 (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 i9
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 ~eceased child twenty-one years Qf 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. 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 4.5%, except as noted in n P.S. ~9116(1.2) [72 P.S. S9116(a)(1)].
The tax rate Imposed on the net value of transfers to or for.theus8 oflhe.d8cederirs Siblfogsis,12'% t72 P.S. ~9116(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 oradOplion. ..'
REV.IS08 EX + (2.87)
'*'
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
, Please' Pririt or Type'
FILE NUMBER
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
"
ESTATE OF
Sylvia C. Kelly'
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F)
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1 .
Personal Savings account, #15004200022355, at
M&T Bank;
$2,029.80
2.
Classic checking account, #687332; at M&T Bank
1,680.25
3.
Miscellaneous items of personal property
512.56
TOTAL (Also enter on line 5, Recapitulation) S
4,222.61
(Attach additional 8Y2" )( 11" sheets if more space is needed.)
REV-1410 EX+ 12-87)
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~~~
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
TRANSFERS
PLEASE PRINT OR TYPE
ESTATE OF
FILE. NUMBER
Sylvia C. Kelly
THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES.
ITEM DESCRIPTION OF PROPERTY TOTAL VALUE DECO. DOLLAR V ALU E
EXCLUSION % OF DECEDENT'S
NUMBER Include nome of the transferee, their relationship to decedent, dote of transfer. OF ASSET INT. INTEREST
AAFES Benefit $2,320.97 100 $2,320.97
TOTAL (Also enter on line 7, Recapitulation) S 2,320.97
(If more space is needed, insert additional sheets of some size.)
REV.1511 EX+ (7.88\
ESTATE OF
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or Type
· FILE NUMBER
I
Sylvia C. Kelly
I Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
3. Family Exemption
Claimant
Address of Claimant at decedent's death
Street Address
City
ITEM
NUMBER
A.
1.
B.
2.
4.
C.
1.
2.
3.
4;
5.
6.
7.
8.
DESCRIPTION
AMOUNT
Funeral Expenses:
Dugan Funeral Home, Inc.
111 South Main Street
Bendersville, PA 17306
$3,724.50
'If
-0-
Year Commissions paid
Attorney Fees Anthony L. DeLuca, Esquire
600.00
Relationship
-0-
State
Zip Code
Probate Fees
30.00
Miscellaneous Expenses:
Filing Fee - Inheritance Tax
15.00
TOTAL (Also enter on line 9, Recapitulation)
$
(If more space is needed, insert additional sheets of same size.)
EV.1512 EX+ (9-11)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT' DECEDENT
ESTATE OF
SCHEDULE "1"
DEBTS OF DECEDENT,
MORTGAGES, AND LIENS
FILE NUMBER
Sylvia C. Kelly
ITEM
NUMBER
DESCRIPTION
AMOUNT
2.
Carlisle REgional Medical Center - Medical
$222.50
566.80
1.
Belvedere Medical Corp. - Medical
3.
Cumberland Pathology Associates - Medical
178.30
40.00
4.
Hartzell Eye MDS
5.
HCR Manor Care - Nursing
1,190.00
6.
Penn Rehab Assocs. - Medical
120.70
7.
Blue Mountain Ane~thesia Assoc. - Medical
48.00
8.
Philip D. Carey, M.D. - Medical
50.79
. };,
TOTAL (Also enter on line 10, Recapitulation)
$ 2.417.0Q
,.
,_ I
i
LAST WllL AND TESTAMENT
OF
SYLVIA C. KELLY
I SYLVIA C. KELLY, a resident of Mt. Holly Springs, Cumberland County,
, .
PeIlllSylvania being of sound mind, memory and understanding, do hereby make, publish
and declare this to be'my Last Will and Testam~nt, hereby revoking all Wills and
Codicils heretofore made by me.
ITEM 1: I direct that all my just debts, the expense,s of my last illness and
funeral expenses be paid as soon after my decease as the same can conveniently be done.
ITEM 2: I direct that there shall be paid out of my residuary estate all estate,
inheritance and like taxes together with any interest or. p~ty thereon imposed by the
government of the United States, or any state or. territory thereof, or by any foreisn
government or political subdivision thereof, in respect to all property required to be
included in my gross estate for estat~, inheritance or like 'tax purposes by any of such
governments, whether the property passes tmdei-this Will or otherwise, exCluding,
however, any property over which I have a taxable power ofappointtnent, provided,
however, 'that no residuary beneficiary sh;Ul by reason of this provision be denied the
' .
, .
, .
benefit of any deduction, credit, favorabl~ rate of tax or other benefit which by law
enures to such beneficiary.
ITEM 3: It is my wish that my remains. be 'cremated and my ashes be'distributed
in Peabody, MassachUsetts.
~A~eM
S. C. KELLY '. . - ')I
1
f1(Jf6rY- \l~ t1 ,
..- /
LAST WILL AND TESTAMENT
OF
SYLVIA C. KELLY
ITEM 4:
I give, devi,se and bequeath all of the rest, residue and remainder of
my estate, real, personal and mixed, of whatsoever kind and nature, and wheresoever
situate at the time of my death, unto my sister, ELAINE D. SLUSSER, provided,
however, that she survives me and is living sixty (60) days after the date of my death.
. .
ITEM 5: . If ~d in the event that my sister, ELAINE D. SLUSSER, does not
survive me and is not living sixty(60) days after the date of my death, then and in such
event, I give, devise and bequeath all of the rest, residu.eand remainder of my estate, real,
personal and mixed, of whatsoever kind and nature, and wheresoever situate at the time
ITEM 6: I hereby nominate, constitute and appoint my sister, ELAINE D.
SLUSSER, Executrix of this my Last Will and Testament, with full power to do any and
all things necessary for the complete administration of my estate, and direct that no bond
or other surety is required of her in this or any other jurisdiction for her perfonnance of
this office.
If and in the event that my sister, ELAINB D. SLUSSER, does not survive me and
is not living sixty (6Q) days after the 'date of my death, or does not complete her duties as
. .
Executrix, t4en and in such event, I hereby nominate, constitute .~d appoint my s~ep-son,
2
,- /
LAST wn.L AND mSTAMENT
OF
SYLVIA C. KELLY
i
i
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\
\
I
I
HERBERT J. COMEAU, JR., Executor of this my Last Will and Testament, with full
power to do any and all things necessary for the complete administration of my estate,
and direct that no pond or other surety is required ofhim in this or any other jurisdiction
for his performance of this office.
ITEM 7: If any provision of this Will or of any Codicil hereto is held to be
inoperative, invalid or illegal, it is my inteI1tion that all the remaining provisions thereof
shall continue to b~ fully operative and eff~tive, so far as is possible and reasonable.
IN WITNESS WHEREOF, I, SYLVIA C. KELLY, the Testatrix, have to this my
Last Will and Testament, typewritten on three (3) consecutively numbered pages,
subscribed my name and affixed my seal this' J ~ 'y of September, 2005.
, .
*~ .(SEAL)
S' C.KBLLY .
Signed, sealed, published and declared by the above named S)'L VIA C. KELLY, as and
for her Last Will and Testament, in the presence of US, who have hereunto subscribed our
llatn:~ et her J;eq~st. as wit;n~.lWet9"iu'the p.resence of the S~(1: Tematrix,aiidof
each other. .' ..' '~ '. '. . .
~ .
. .
. .' . . . 113 .:tl';'A.J't!- .s"r/l~~'f
~. ~residing at $';'L..:,f -?~ t~. Ir~~ 7
. . ." . './13 \1'~ A1
~JJ(j ~dingat fj~7 '~'<-'~I ~- /7"7
3