HomeMy WebLinkAbout03-07-07
RE~1500 EX + (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICiAl USE ONLY
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FILE NUMBER
21 -0 6 0 3 8 7
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
James Kenneth Johnson
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
2 04- 3 0 - 6 9 1 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
02/16/2006 08/20/1925
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
n/a
SOCIAL SECURITY NUMBER
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[Xl 1. Original Retum
D 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum
D 4a. Future Interest Compromise (date 01 death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
D 3. Remainder Retum (date 01 death priortc 12-13-82)
D 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
John H. Brou'os Es uire 4 North Hanover Street
FIRM NAME (If Applicable)
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Carlisle, PA 17013
TELEPHONE NUMBER
717-243-4574
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
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OFFICIAL USE ONLY
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5,513.77 ,~:.:
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(8)
5,513.77
2,101.00
24,253.63
(11)
(12)
(13)
26,354.63
-20,840.86
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
-20,840.86
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
0.00 X _(15) 0.00
3,412.77 X .045 (16) 153.57
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 153.57
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TOANSWERALL QUESTIONS ON REVERSE SIDE AND RECHECKMA TH < <
Decedents ompl ete ress:
STREET ADDRESS
CITY I STATE I ZIP
· C
Add
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
153.57
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
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 (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. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
153.57
153.57
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.... ......................... ............. .............. ...................................... 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..................................................................... ........... .... ...................0 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
DATE
3/7/2007
SIGNATURE OF PREPA E
DATE
3/7/2007
ADDRESS
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. 99116 (a) (1.1) (ii)].
The statute does not exemot 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. 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 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 12% [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-1508 EX + (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
James Kenneth Johnson
FILE NUMBER
21 06
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.
0387
ITEM
NUMBER
1.
DESCRIPTION
Sovereign Bank - Account Number 1691024392
921 Cavalry Road
Carlisle, PA 17013
VALUE AT DATE
OF DEATH
5,513.77
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
5513.77
RE;v-1511 EX + (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
James Kenneth Johnson
21
06
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
Grave Marker - Carlisle Memorial Service, 41 S. Bedford St., Carlisle, PA 17013
1.
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (5) Kenneth R. Johnson
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 106 Pennsylvania Avenue
City Carlisle State PA Zip 17013
Year(s) Commission Paid: 2007
AttorneyFees John H. Broujos, 4 N. Hanover St., Carlisle, 17013
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Add ress
1.
2.
3.
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees Petition of Letters Testamentary - $45.00; Will - $15.00;
Short Certificate - $20.00; JCP Fee - $10.00; Automation Fee - $5.00
5.
Accountanfs Fees
6.
Tax Return Prepare(s Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0387
AMOUNT
206.00
900.00
900.00
95.00
2101.00
REV-1512 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
James Kenneth Johnson
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21 06
Include unreimbursed medical expenses.
0387
ITEM
NUMBER
1.
DPW Long Term Care
Class 3
Total
DESCRIPTION
$24,252.63
$73,533.48
VALUE AT DATE
OF DEATH
24,253.63
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
24 253.63
''''-0'' ex "_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
James K nneth .Inhnc::nn 21 OR O~R7
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS Vnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Kenneth Randall Johnson Son 33.3%
106 Pennsylvania Avenue
Carlisle, PA 17013
2. Shirley Frisch Daughter 33.3%
206 Evergreen Road
New Cumberland, PA 17070
3. Deborah Leininger Daughter 33.3%
1365 W Route 897
Denver, PA 17517
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 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)
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tEl'. Sovereign Bank-
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41 SOUTH BEDFORD ST, CARLISLE, PA 17013
Phone: 717-243-5480 FAX 717 243-5687
Cemetery Lettering Order Form I
~:e of Cemetery: L. c::. I V (2... r State: ~~.....
Lot Number: ~ Section Number: -0 i; . y
Name ofDeceased: :T A 111 .p :) K -16[-10;15 t/ 't -p, U f5 'I T :Jfi.,JI-i t/ S D ,1./
Date of Death (Full Date): - "2000 . - _- . _ -.:<. c CJ,s-
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Date Completed:
Cost:
Traditional Burial
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Cremation
D
In order to locate the correct memorial please list other names on the monument:
Color of Monument: ~ Red Rose Black
Type of Monument: ~ Slant Flat Marker Bronze
Location of Lot in Cemetery (please draw a map to indicate where stone is located in
cemetery)
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Dillin Information
Name: . Kc v' -ct-D h. ~So,v
Address: ~o ~ P l~ K) Ve.- \
City: {} A ~ l.A 5 L ~ State: V A-
Home Phone: ;> IC-;j-.;.;;2. fTr WOIkPhone:
Signature:., . Date:
Zip:
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*lnscriptions are usually completed in 60-90 days during warm weather months.
Order taken by
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Date
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Cost
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Payment
'*
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
TPL SECTION - CASUAL TV UNIT
PO BOX 8486
HARRISBURG PA 17105-8486
July 7, 2006
STATEMENT OF CLAIM SUMMARY
Estate of JOHNSON, JAMES
800169676
INPATIENT
OUTPATIENT
LONG TERM CARE
DRUG
.00
.00
22,440.74
1,811.89
876.00
23.69
41,385.76
6,995.40
876.00
23.69
63,826.50
8,807.29
24,252.63
49,280.85
73,533.48
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W ILL
I, JAMES KENNETH JOHNSON, of 357 York Road, Carlisle, Cumberland County, Pennsylvania,
declare this to be my last will and revoke any will previously made by me.
ITEM ONE. I direct that all my debts and funeral expenses, including my gravemarker,
shall be paid from my residuary estate as soon as practicable after my decease, as a
part of the expense of the administration of my estate.
ITEM TWO. I give, devise and bequeath my entire estate to my wife, RUBY IRENE JOHNSON,
if she survives me by 60 days.
ITEM THREE. In the event that my wife, RUBY IRENE JOHNSON, predeceases me or is not
then living on the 61st day after my decease, then I give, devise and bequeath my
entire estate to my children, equally, share and share alike, per stirpes.
ITEM FOUR. I appoint my wife, RUBY IRENE JOHNSON, Executrix of this my last will.
Should she fail to qualify or cease to act as Executrix I appoint my son, KENNETH
RANDALL JOHNSON, Executor of this my last wil1. Should he fail to qualify or cease
to act as Executor I appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY of Carlisle,
Cumberland County, Pennsylvania.
ITEM FIVE. I appoint my daughter, SHIRLEY JOHNSON, guardian of any property which
passes to a minor. In each instance the guardian shall only apply during the minority
of the respective beneficiary as to any property which passes to him or her either
under this will or otherwise and with respect to which I am authorized to appoint a
guardian and have not otherwise specifically done so. Such guardian shall have the
power to use principal as well as income from time to time for the minorls support
and education (including college education, both graduate and undergraduate~ with-
out regard to his or her parent's ability to provide for such support and education,
or to make payment for these purposes, without further responsibility, to the minor
or to the minor's parent or to any person taking care of the minor. Should she fail
to qualify or cease to act I appoint KENNETH RANDALL JOHNSON. Should he fail to
qualify or cease to act I appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY of Carlisle,
Cumberland County, Pennsylvania.
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ITEM SIX. In addition to the rights and powers given to fiduciaries by law and else-
where in this will, I give to my Executor during the full time necessary for the admin-
istration of my estate the following rights and powers to be exercised in his sole
discretion.
A. To retain any real or personal property which may at any time form a part of my
estate so long as he or she deems it advisable.
~. To invest in any real or personal property without restriction to legal investments.
C. To repair, alter, improve or lease for any period of time any real or personal pro-
perty and to give options for leases.
D. To sell at public or private sale, for cash or credit, with or without security, to
exchange or to partition real or personal property and to give options for leases.
E. To make distribution i~ kind.
F. To compromise claims.
ITEM SEVEN. I direct that all taxes that may be assessed in consequence of my death
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of whatever nature and by whatever jurisdiction imposed shall be paid from my residuary
estate as a part of the expense of the administration of my estate.
ITEM EIGHT. I direct that my Executor or guardian or their successors shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this /~ day of October, 1977.
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SIGNED .\0.1'1'//'..;1/
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The preceding instrument, consisting of this and one other typewritten ~age, each
identified by the signature of the Testator, JAMES KENNETH JOHNSON, was on the day
and date thereof signed, published and declared by JAMES KENNETH JOHNSON, the Testa-
tor therein named as and for his last will, in the presence of us, who at his request,
in his presence, and in the presence of each other have subscribed our names as
witnesses hereto.
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