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Home My WebLink About03-20-07 ~ 15056051058 REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes . PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY ~ounty~ode Vear INHERITANCE TAX RETURN RESIDENT DECEDENT File Number 21 06 ~ Q';}.\Cf\ 198-30-0191 02/23/2006 Date of Birth ~i/!Ili2;i HELEN MI Decedent's Last Name KEIM W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix First Name MI KEIM JOHN W Spouse's Social Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ca> 1. Original Retum e:::.::::;) 2. Supplemental Retum e:::.::::;) 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required ct! e:::.::::;) 4a. Future Interest Compromise (date of death after 12-12-82) e:::.::::;) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) e:::.::::;) 10. Spousal Poverty Credit (date of death e:::.::::;) 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 [)aytirneTelephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes 4. Limited Estate e:::.::::;) THOMAS E. FLOWER i (717) 737-3405 ;"" ,~ Firm Name (If Applicable) SAlOIS, FLOWER, LINDSAY REGISTER OF WILLS USE ONt.'!" or Post Office State ZIP Code -;:1 First line of address 2109 MARKET STREET Second line of address r",) en CAMP HILL Correspondent's e-mail address: Under penalties of pe~ury, 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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which pre parer has any knowledge. ~F PERSON E5PON9IBLE FOR FILING R RN D~T7' , J 3/'707 ADD 5 E McGINN, 13 BENTLEY PLACE, CARLISLE, PA 17013 .~_.__. 51 T DATE 03/01/07 DRE SAlOIS, FLOWER & LINDSAY, 2109 MARKET STREET, CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 -.J '#- -.J 15056052059 REV-1500 EX Decedent's Name: HELEN W KEIM RECAPITULATION 1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 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. 6. Jointly Owned Property (Schedule F) c:::J Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::J Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. Decedent's Social 198-30-0191 85,989.00 85,989.00 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subjectto Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. 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 .0JL 85,989.00 16. Amount of Line 14 taxable at lineal rate X.O_ 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 85,989.00 85,989.00 15. 85,989.00 16. 17. 18. c:::J 15056052059 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME HELEN W KEIM .---.-. STREET ADDRESS ONE LONGSDORF WAY DECEDENTS SOCIAL SECURITY NUMBER 198-30-0191 CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C ) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + 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) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 0.00 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;.......................................................................................... D [KJ b. retain the right to designate who shall use the property transferred or its income; ............................................ D [KJ c. retain a reversionary interest; or.......................................................................................................................... D [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... D [iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ...... ............................................ .......................................... .......... ........ D [iJ 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? .............. D [KJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D [KJ 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. ~9116 (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. ~9116 (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. ~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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1 .2) [72 P.S. ~9116(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. ~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 or adoption. REV-150S EX+ (6-S8* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF HELEN W. KEIM FILE NUMBER 21-06-0629 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 ADDRESS RELATIONSHIP TO DECEDENT A. JOHN W. KEIM (DECEASED 07/16/2006) " SURVIVING SPOUSE B C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY lOOF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. INTEREST DECEDENT'S INTEREST 1. A. MEMBERS 1ST F.C.U., CHECKING ACCOUNT 214304 24,000.00 50 2 A MEMBERS 1ST F.C.U., SAVINGS ACCOUNT 214304 50.00 50 25.00 3 A CERTIFICATE OF DEPOSIT#214304-40 50 50,000.00 4 A CERTIFICATE OF DEPOSIT #214304-46 50 7,500.00 5 A CERTIFICATE OF DEPOSIT #214304-47 50 15,000.00 6 A US SAVINGS BONDS 50 964.00 TOTAL (Also enter on line 6, Recapitulation) $ (if more space is needed, insert additional sheets of the same size) 85,989.00 REV-1513 EX. (9-00) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF HELEN W. KEIM NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] JOHN W. KEIM (DECEASED 07/16/2006) RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SURVIVING SPOUSE FILE NUMBER 21-06-0658 AMOUNT OR SHARE OF ESTATE $ 85,989.00 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 TOTAL OF PART 11- 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) LAST WILL AND TESTAMENT OF HELEN W. KEIM I, HELEN W. KEIM, of 214 Todd Circle, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former WHls, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executrix or Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: I give, devise and bequeath all the rest, residue and remainder of my estate to my husband, JOHN W. KEIM, provided he survives me by a period of thirty (30) days. THIRD: In the event that my husband, JOHN W. KEIM, fails to survive me by thirty (30) days, I give, devise and bequeath all the rest, residu~ and remainder of my estate as follows: A. Forty-five (45%) percent of my estate to my daughter, MARY LOUISE McGINN; B. Thirty-five (35%) percent of my estate to my son, JOHN W. KEIM, JR.; C. Ten (10%) percent of my estate to my grandson, BRETT J. KEIM; and D. Ten (10%) percent of my estate to my grandson, WALTER J. KEIM, JR. LASTLY: I nominate, constitute and appoint my daughter, MARY LOUISE McGINN, to be the Executrix of this my Last Will and Testament. In the event that my said daughter, MARY LOUISE McGINN, shall be unable to serve as Executrix for any reason, I appoint my granddaughter, KRISTIN L. MAHOONEY, as Executrix. No Executrix shall be required to file bond in this or any other jurisdiction. ~ ~ ~~NESS ::::EOF, Aj h~:; set my hand and sealthi~ 2004. !it tJ'Y1/ tv, I( frirt/ Helen W. Keim SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: ~(tw1A \),~~ ~~/~~ 2 ., COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND I, HELEN W. KEIM, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by HELEN W. KEIM, the Testatrix, this 25th day of AUCJll!':t , 2004. ""; 1 . t /(J i~ /V1./ lv, ~ Helen W. Keirn, Testatrix NOTARIAL SEAL RENEE L MURRAY, Notary Public Cartisle Boro. Cumberland County, PA My Commission Expires Dec. 13, 2005~ 3 COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND We James D. Flower, Jr., Esq. and Dawn L. Flower , ' the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by James D. Flower, Jr. Esq. and Dawn L. Flower this 25th day of August 2004. ~~.~~* . . Wrtness 4u-7/ ~~..u4-/ Itness Ikua m , (J Notary Public NOTARiAl SEAL RENEE L MURRAY, Nmary Public Carlisle Boro, CumbsrJand County, PA My Commission Expires Dec. 13, 2005 4 JOHN E. SLIKE ROBERT C. SAlOIS JAMES D. FLOWER, JR CAROLJ. LINDSAY JOHN B. LAMPI MICHAEL L. SOLOMON GEORGE F. DOUGLAS, III DEAN E. REYNOSA THOMAS E. FLOWER MARYLOU MATAS SUZANNE C. HIXENBAUGH LAW OFFICES SAIDIS, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407 EMAIL: attorney@sfl-Iaw.com www.sfl-Iaw.com (C(Q)[?Y CARLISLE OFFICE: 26 WEST HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL March 1, 2007 Department of Revenue Bureau of Individual Taxes Department 280601 Harrisburg, PAl 7128-060 1 Re: Estate of Helen W. Keirn File No. 2106-0269 Dear Sir or Madam: Helen W. Keirn died February 23, 2006, survived by her spouse, John W. Keirn, who died July 16, 2006. At the time of Helen's death, the couple owned all property by the entireties, which property consisted of joint checking, savings and certificates of deposit, joint US Savings Bonds, and the modest furnishings of their rooms at a retirement home. Helen had made a will, leaving all of her property to John, and naming their daughter Mary Louise McGinn as executrix. After Helen's death, Ms. McGinn inquired at her parents' bank whether anything had to be done to retitle her parents' joint accounts, as a result of the death of her mother. Ms. McGinn was (mis)informed that she would need a Short Certificate from the Register of Wills. That is why she needlessly opened an estate for her mother, who had no probate property. Very truly yours, SAIDIS, FLOWER & LINDSAY ("") - I I': n f"-- - . -.,:,,~ :,T) f'-) C) Thomas E. Flower ,r'-"', TEF:se Enclosures , : --;:) ::;-= :..:~ f'-j 0\ JOHN E. SLIKE ROBERT C. SAlOIS JAMES D. FLOWER, JR CAROLJ. LINDSAY JOHN B. LAMPI MICHAEL L. SOLOMON GEORGE F. DOUGLAS, III DEAN E. REYNOSA THOMAS E. FLOWER MARYLOU MATAS SUZANNE C. HIXENBAUGH LAW OFFICES SAIDIS, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYL VANIA 17011 TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407 EMAIL: attorney@sfl-Iaw.com www.sfl-Iaw.com CARLISLE OFFICE: 26 WEST HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL March 16, 2007 Office of the Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Estate of Helen W. Keirn File No. 21-06-0629 Dear Sir or Madam: Enclosed are the original and one copy of the Inheritance Tax Return for the above- referenced decedent. Also enclosed is a check in the amount of$15.00 in payment of the filing fee. Please contact me if you have any questions regarding this matter. Very truly yours, SAID IS, FLOWER & LINDSAY '1f1/rJA}r r ffNSy~ J Thomas E. Flower J n ,.....:) = ',"") ---."..j . , -. ;co, "" , '. .' (-, ; , ) ) C--..J _J: --~; c: I , - .. --, ) (j (; 1 TEF:se Enclosures cc: Mary Lou McGinn (w/o enc.) Ill! iN :::::... - - .- - - - - - ~ = - - . - -- - - - - --- - --- "-0 "'J 1- I ~ ~ ;~ C] ::::::;, C'J 1..)-: r/ u_c (-.J i:t r 0:::, O~ l' .', '--- ~ r/) o Z l-4 ...... , ......... ~ 11~lj ~ ""!;;: ... os ~ v1 ~ .. 'T',. ...._ ~~ ~i 0'"0\0- '16 0 s !-ll". ...... '" ~ "'u r/) l-4 o < r/) - (I.) CJ) ::J CJ) 0 =r. ~-g(l.) -O~ OOro ~ ::J 2Z';9:M CJ) C \U ~ .- ::J (I.) 0 g'OCJ)1'-- n::O::J~ o (I.)"Or.<( r.ct::a.. -ro::J ~ -~O(l.) 0(1.)0_ (I.) ..c .~ UE(I.)L: ij:::Jcro 0000 . . o ~ - -I