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Home My WebLink About03-28-07 /' -.J 15[]5b[]41125 REV-1500 EX (06-05) PA Department of Revenue * ~~~~:~~~:o~uaITaxes INHERITANCE TAX RETURN Harrisburg, PA 17128-0001 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 7 File Number 007 9 Date of Birth 21309 7 7 0 3 1 2 2 7 2 0 0 6 o 2 1 9 1 9 1 3 Decedent's Last Name Suffix Decedent's First Name Berwager Mar y MI E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix B e r wag e r Spouse's Social Security Number Spouse's First Name Stuart MI V THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW [ZJ 1. Original Retum o 4. Limited Estate [ZJ o o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach Copy of Trust) o 10. Spousal Poverty Credit (date of death 0 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 o o 3. Remainder Return (date of death prior to 12-13-82) 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 Dan i e 1 Firm Name (If Applicable) M. F r e y , Esquire 717 637 623 9 r-..:> = City or Post Office H a n 0 v e r State ZIP Code REGISTE@~ILLS USI!-9NL Y '~l ;rS ~ ::q;~ :::0 (~~~ ~ 3~~ ~ ~::::.j 6ATE FILED (J1 Bar 1 e y First line of address Snyder L L C 1 4 Center Square Second line of address P A 17331 Correspondent's e-mail address:dfrey@barley.com Under penalties of pe~ury, I declare that I have examined this retum, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and . Declaratio of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge. SIGNATURE OF P 0 E F FIL URN DATE 17011 b S Center Square, Hanover, PA 17331 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15[]5b[]41125 15[]5b[]41125 ~ --I 15056042126 REV-1500 EX Decedent's Name: Mary E. Berwager 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) D Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous N,Q!!;"Probate Property (Schedule G) U Separate Billing Requested. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 9. 2 4 8 5. 3 5 5 9 9 8. 0 0 1 7 8 0 3. 9 7 2 3 8 0 1. 9 7 O. 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) 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 Subject to Tax (Line 12 minus Line 13) ..................14. o. 0 0 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.O _ 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 o . 0 0 15. o . 0 0 16. o . 0 0 17. o . 0 0 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 Decedent's Social Security Number 213097703 2485.35 o. 0 0 O. 0 0 O. 0 0 O. 0 0 O. 0 0 D 15056042126 --.J . REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 07 0079 DECEDENTS NAME Marv E. Berwager STREET ADDRESS 1828 Willow Road CITY I STATE I ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 Total Interest/Penalty ( 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) 0.00 0.00 0.00 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; ...................................................................... 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. 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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. . """.'503 EX . I'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Mary E. BerwaQer FILE NUMBER 21 07 0079 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 126 Shares, ACNB Corporation, common, @ $19.725 Cusip 0000868109 VALUE AT DATE OF DEATH 2,485.35 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2.485.35 REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. Berwager SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 07 0079 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Panebaker Funeral Home, balance due for funeral expense 209.00 2. Sneeringer Memorials, grave marker 1,195.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Barley Snyder, LLC 1,000.00 3. Family Exemption: (If deoedenfs address is not the same as claimanfs, attach explanation) 3,500.00 Claimant Stuart V. Berwager Street Address 1828 Willow Road City Camp Hill State P A Zip 17011 Relationship of Claimant to Decedent spouse 4. Probate Fees (see below) 5. Accountanfs Fees 6. Tax Return Prepare~s Fees 7. Register of Wills, Letters Testamentary and Short Certificate 64.00 Register of Wills, filing PA inheritance tax return 15.00 8. Barley Snyder, LLC, reimbursement for postage (including certified mail fees) 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 5 998.00 (If more space is needed, insert additional sheets of the same size) R~V-1512 EX + (12-03) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary E. Berwager FILE NUMBER 21 07 0079 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Pennsylvania Department of Public Welfare Class 3 claim VALUE AT DATE OF DEATH 942.64 2. Pennsylvania Department of Public Welfare Class 6 claim 16,861.33 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 17 803.97 . ....,.,,,"". '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Marv E. Berwaaer 21 07 0079 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trostee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include O~ht s~usal distributions. and IIansfers under Sec. 9116 (a (1. )] 1. Tammy Wilson Tyler Lineal 3611 Northwoods Drive, Kissimmee, FL 34746 2. Eileen Davis Lineal P. O. Box 4347, Eagle, CO 81631 3. Kathleen Ann Berwager Lineal 409 Hummel Avenue, Lemoyne, PA 17043 4. Barbara Rider Lineal 108 North Street, McSherrystown, PA 17344 5. Anita L. Shrader Lineal 731 North Street, McSherrystown, PA 17344 6. Kay Hyde Lineal 11832 Magnolia Street, Garden Grove, CA 92841 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. Annunciation of the Blessed Virgin Mary Church 26 North Third Street, McSherrystown, PA 17344 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) .I' LAST WILL AND .TESTAMENT I, MARYELIZABETH BERWAGER, of 1828 Willow Road, Camp Hill, County of Cumberland, Pennsylvania, do hereby make, publish, and declare this to be my LAST WILL AND TESTAMENT, revoking any and all prior wills and codicils, in manner following, that is to say, FIRST, that I direct that my Personal Representative shall pay all of my just debts and funeral expenses as soon as this shall be practicable. SECOND, that upon my death, I give, devise and bequeath all of property, real, personal and mixed to be divided as follows: a. I give and bequeath One Percent (I %) of my net distributable estate to each of the following beneficiaries: my granddaughters, TAMI WILSON TYLER and EILEEN DAVIS', and my step-daughter, KATHLEEN ANN BERWAGER. b. I give and bequeath One Percent (I %) of my net distributable estate to ST. MARY'S CHURCH, McSherrystown, Pennsylvania. c. I give, devise and bequeath the remaining Ninety-Six Percent (96%) of my net distributable estate to be divided equally among my surviving children, BARBARA RIDER, ANITA L. SHRADER and KAYE HYDE. THIRD, that! hereby appoint my husband, STUART V. BERWAGER, as the Executor of my Estate. If he is unable or unwilling to perform in this capacity, then 1 hereby appoint BARBARA RIDER as the Executrix. I direct ", that my personal representative shall not be required to post bond in this or in .;11 any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 19th day of May, 2003. hJ~S-~",L~~--~~ MARYE ZABET ERWAG R cr /' /. ~ L:~~ L:~~ WITNESS 'dJuViz 117. 7JiAa WITNESS ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, MARYELIZABETH BERWAGER, testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I have signed and executed the instrument as my Last Will and Testament; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. Swom or affirmed to and acknowledged before me by MARYELIZABETH BERWAGER, the testatrix, this 19th day of May, 2003. ~. ZZ;a1I': ~€.~~~ M RYE ~AB B R GER V' ~ II'~~ TARY BLIC _t5Ir~J My Commliislon Expires Jan. 'Z1. Member. PennsylVania As$OCiation of NotarieS _''-'':t1"d~ I . --~ " ,,;" -__. --., , . ~ - - . ;k.... -.~ . ~ ".-,. " AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN WE, CHARLES E. PETRIE and RUTH M. PETRIE, 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 AND TESTAMENT; that MARYELIZABETH BERWAGER 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. Swom or affirmed to. and subscribed before me by CHARLES E. PETRIE [C,J ~ and RUTH M. PETRIE, witnesses, this ~ day of May, 2003. A /.'.1 O~~E4~~ WITNESS ~-m(m.u WITNESS ~iJ~ jl /!~ TARY BLIC NotarIal Seal ~~JAM~.' . My COmmRHIIOn '-A'" a,~.RIoo5 Memtler. 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