HomeMy WebLinkAbout04-19-07 (2)
REV-15oo 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 8 8 0
COuNTYCOOE -YEAr- - - NuMeER- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Helm Marion E
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 8 1 - 3 6 - 1 494
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
7/18/2006 5/16/1909
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
~ 1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy 01 Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date 01 death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy o!Trust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
o 3. Remainder Retum (date 01 death prior to 12-13-82)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
rHIS.SEC110NMUSTaECOMI'LSrEP...ALLCORRSSPONOENCE...ANOCONFJOENTIALTAXINFORMATIONSHOULO...BE.OIRECrEO..TO;
NAME COMPLETE MAILING ADDRESS
Forest N M ers 137 Park Place West
FIRM NAME (II Applicable)
Law Office Forest N M ers
TELEPHONE NUMBER
717.532.9046 Shi
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)
o 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 BequestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
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(,...)
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7 ,883.64
7,883.64
884.74
6,998.90
6,998.90
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00
314.95
0.00
0.00
314.95
16. Amount of Line 14 taxable at lineal rate
0.00 X _(15)
6,998.90 X .045 (16)
0.00 X .12 (17)
0.00 X .15 (18)
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due (19)
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:>..:> iyBE}SURE...TO ANSWER ALL QUESTIONS o.N. REVERSE SIPE..AN D.RECHECi<.MATH <..<
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ece ents omple e ress:
STREET ADDRESS
442 Walnut Bottom Rd
CITY I STATE T ZIP
Carlisle PA 1 721 3-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
314.95
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + 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 to: REGISTER OF WILLS, AGENT
0.00
0.00
314.95
314.95
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.
~ R.
192 Sherwood Dr
Walnut Bottom PA ChambersburQ PA
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
ADDRESS ~~e West
ShippensburQ
DATE
~3
PA 17257
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. ~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 orfor the use of the survivinn '",,,use is 0% 172 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 a u, "--'-'4 ^uon 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 1 't\r V 3nt,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. IV
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 nc ,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. ~9116(a)(1.3))., 3n
individual who has at least one parent in common with the decedent, whether by blood or adoption.
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LAST WILL AND TESTfu~NT
OF
MARION ELIZABETH HELM
I, MARION ELIZABETH HELM, of R.D.HI, Box 338, Shippensburg, South
Newton Township, Cumberland County, Pennsylvania, being of sound and disposing
mind, memory and understanding do hereby make, publish and declare this as
and for my Last will and Testament, hereby revoking all other wills and codicils
thereto, heretofore, made by me.
FIRST
I direct the payment of my debts and the expenses of my last illness
and funeral from my estate as soon after my death as conveniently may be done.
In the event I am not the owner of a cemetery lot at the time of my death, I
direct my Executor to purchase such lot, with a contract for perpetual care,
for the interment of my body, and to improve the lot and have erected thereon
a suitable headstone and marker.
SECOND
I give, devise and bequeath all my property, whether real or personal,
tangible or intangible, together with all insurance policies thereon, unto
my husband, LAWRENCE R. HELM, provided he shall survive me by thirty (30) days.
In the event my husband fails to survive me by thirty (30) days, I then,
give, devise and bequeath all my estate, whether real or personal property,
tangible or intangible, together with all insurance policies thereon, in as
nearly equal shares as possible, unto my children, Lawrence Helm, Jr., Gail
Kunkleman and Robert Helm, provided they shall survive me by thirty (30) days,
per stripes.
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THIRD
In the event my husband predeceases me, I give, devise and bequeath
to my daughter, Gail Kunkleman, the following items:
Diamond ring
Elephant table
China head doll
Large framed picture of mother
Clock that belonged to grandfather
Japanese tea set of dishes
FOURTH
I direct that any and all inheritance, estate or transfer taxes imposed
upon my estate, whether passing under my will or otherwise, shall be paid from
my estate.
FIFTH
Any and all sum or sums, whether in cash or in kind and whether for
principal or income, payable to the beneficiaries, or any of them, shall be
made upon the sole receipt of the respective individual to whom the payment is
made and free from anticipation, alienation, assignment, attachment or pledge
and free from control by the creditors of such beneficiary. All shares of
principal and income herein given shall be free from anticipation, assign-
ment, pledge or obligation of any beneficiary and shall not be subject to any
execution or attachment.
SIXTH
I nominate, constitute and appoint my husband, Lawrence R. Helm, Executor
of this my Last will and Testament. In the event of the death, resignation,
renunciation or inability to act for any reason whatsoever of my said husband,
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I nominate, constitute and appoint my children, Lawrence Helm, Jr., Gail
Kunkleman and Robert Helm, co-Executors of this my Last will and Testament. I
hereby relieve my Executor from the necessity of posting security in connection
with his duties as such in any jurisdiction in which he may be called upon
to act, insofar as I am able by law to do so.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last
will and Testament, consisting of three (3) typewritten pages, the first two
(2) of which bear my signature in the margin for the purpose of identification,
this 'It!- day of
)n~~
, 1982.
i~{-;,~riz~~ ~ U:L,.,
Testatrix
SIGNED, SEALED PUBLISHED AND DECLARED by the above named Testatrix,
Marion Elizabeth Helm, as and for her Last will and Testament in the presence
of us who at her request and in her sight and presence and in the sight and
presence of each other have hereunto subscribed our names as witnesses:
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COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I. Marion Elizabeth Helm, the Testatrix whose name is signed to the
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last will and
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Testament; that I signed it willingl~ that I signed it as my free and
voluntary act for the purposes therein expressed.
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"I-<-<v"\ 'C~e:....J1':"'e/~
Ma~ion Elizabeth Helm
Testatrix
~~.
Sworn or affirmed to and
acknowledged before me by
Marion Elizabeth Helm,
Testatrix, the ~h.. day
of
f"4\ 0. Y-<:.h
, 1982.
,..~~~..O.J~~. ~~~~~,- /
Notary Public
My Commission Expires:
10/29/84
COMMONWEALTH OF PENNSYVLANIA
ss
COUNTY OF CUMBERLAND
We,
~rorl- N. Mye..-...r
and
Jo'(u- /1-. Cr-ou.s-e.
, the
witnesses whose names are signed to the foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw
Marion Elizabeth Helm, Testatrix, sign and execute the instrument as her Last
Will and Testament, that she signed it willingly and that she executed as her
free act and voluntary act for the purposes therein expressed, that each of
us in the hearing and sight of the Testator signed the will as witnesses; and
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REV-15G8 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Helm Marion. E
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
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.
0880
ITEM
NUMBER
1.
M&T Bank; Ckng #97286532
Checking Account
2
Prudential Financial mutual fund
3
F&M Savings #08-02461
4
Conseco Senior Health, refund
5
Conseco Senior Health, refund
6
Conseco Senior Health, refund
DESCRIPTION
VALUE AT DATE
OF DEATH
6402.27
1113.75
336.70
20.97
8.11
1.84
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
7 883.64
REV-1511 EX + (12-99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ESTATE OF
Helm. Marion E
21
06
0880
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Gail Kunkleman Lawrence Helm Jr Robert Helm
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 43 Hammond Rd 192 Sherwood Dr 50 Creek Rd
City Walnut Bottom ChambersburQ Newville State all PA Zip
Year(s) Commission Paid:
2. Attomey Fees Law Office Forest N Myers, Esq. 325.00
3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Petition for Letters $60.00; filing Will $15.00; 4 Short Certs $16.00; JCP & 121.00
Auto fee $15.00; filing Inheritance Tax Return $15.00
5. Accountanfs Fees
6. Tax Retum Preparer's Fees
7. F&M Bank, research fees, decedent's accounts 10.00
TOTAL (Also enter on line 9, Recapitulation) $ 456.00
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
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SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
Helm. Marion. E
21
06
0880
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
259.71
Pharmacare, medical
21.25
2 Andorra Radiology Assoc, medical
3 Hospital bill, medical
4 Masland Assoc, medical
5 Appalachian Ortho, medical
6 Paul Dalbey, DPM, medical
7 Smith Radiology, medical
8 Spring Road Family Practice, medical
9 Thomwood Home, medical
20.97
13.08
9.98
8.11
1.84
43.80
50.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
428.74
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
HAlm .- E 21 06 ORRO
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 Helm Jr, Lawrence
192 Sherwood Dr One-third residue
Chambersburg PA 17201-
2 Helm, Robert Collateral
50 Creek Rd One-third residue
Newville PA 17241-
3 Kunkleman, Gail A Collateral
43 Hammond Road One-third residue
Walnut Bottom PA 17266-
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 $
FILE NUMBER
(If more space is needed, insert additional sheets of the same size)