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Home My WebLink About05-14-07 ~ 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 Number Date of Death OFFICIAL USE ONLY ~?~~tygode Year INHERITANCE TAX RETURN 21 RESIDENT DECEDENT File Number Date of Birth 188-12-5620 02/21/2007 02/23/1924 Decedent's First Name William MI W (If Applicable) Enter Surviving Spouse's Information Below Last Name Suffix First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (8) 1. Original Return c:::> 2. Supplemental Return c:::> 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::> c:::> 4a. Future Interest Compromise (date of death after 12-12-82) c:::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::> 10. Spousal Poverty Credit (date of death c:> 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 g~ytirTl~!ElIElphone~urTl~er 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes 4. Limited Estate c:> ~ c:> C. Sheely, Esquire :717-697-7050 1~:",) C. Sheely, Attorney at Law -, .-......,.'., ................................................'.:...::1-........."",................................:,,'.:,...:.-.-................, REGISTeR~~ILLS UQNLY - i i I Firm Name .'-r: :-1 First line of address 127 South Market Street Second line of address .~ity.or..~ost..()fficEl , Mechanicsburg State ZIP Code l_ C:~; Box 95 .. DATE FILED G~ . ~-_._---~~-_.__.._---- ipA , 7055 Correspondent's e-mail addresS:.andrewc.sheely@verizon.net Under penalties of perjury, I declare that I have examined this retum, 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 persona epresentative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN c/ George T. Blessing, Executor 6J AnnRF!':!': 10717 Calston Way, San Diego~. CA 92126 .SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE /J j. _ J /I Q Andrew C. Sheely, Esquire ff;n~C .(), p.nnRFC;:C;: 127 S. Market St.,P.C. Box 95,Mechanicsbur PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 -.J ...J 15056052059 REV-1500 EX Decedent's Social Number Decedent's Name: Blessing, William W. 188-12-5620 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. 23,040.35 6. Jointly Owned Property (Schedule F) c:::; Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property "..- (Schedule G) c:::; Separate Billing Requested.. . . . . . . 7. 105,135.04 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 128,175.39 . 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . . 9. 2,674.86 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 511.41 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3,186.27 .' 12. Net Value of Estate (Line 8 minus Line 11) . .. .... ...."... ..;........ .... . ..12. 124,989.12 13. Charitable and Governmental BeQuestSlSec9113 Trusts for which an eJection to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ 0........ 14. 124,989.12 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unc4"r ~ec. 9116 (a)(1.2) X .0. 16. Amount of Line 14 t",v~ble at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X. 15 15. 124,989.12 16. 5,624.51 '.' c.. 17. " 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 5,624.51 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c::::Jl L 15056052059 Side 2 15056052059 .-J REoV-1500 EX, Page 3 Decedent's Complete Address: DECEDENT'S NAME William W. Blessing DECEDENT'S SOCIAL SECURITY NUMBER 188-12-5620 STREET ADDRESS 824 Lisburn Road CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,624.51 5,328.50 296.01- 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) 5,624.51 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) A. Enter the interest on the tax due. (SA) (5B) B. Enter the total of Line 5 + 5A. This ;s the BALANCE DUE. 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 [iJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 lil d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 (iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [iJ 0 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. S9116 (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. 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 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. 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 four and one-half (4.5) percent, except as noted in 72 P.S. S9116(1.2) [72 P.S. s9116(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. 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-150B EX+ (B-9B) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER WILLIAM w. BL~SSrNG 21-07-0183 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. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. PSECU Saving Account Account # 0188125620 $10,863.27 2. PSECU Checking Account Account # 0188125620 $ 3,124.55 3. PSECU Certificate of Deposit Account # 0188125620 6. Verizon refund $ 5,662.35 $ 70.00 $ 3,315.53 $ 4.75 4. Erie Insurance Company Refund 5. The Woods - refund of security deposit and rent TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 23,040.45 PSECU NO. 4203 P. Maroh 12,2007 '10: From: Re:,;" . AoCdUi1f#: 'i, V .~..~.,,; ,'F j Attomey Andrew Sheely PSEClJ-PA State Employees Credit Union William Blessing 0188125620 Attorney Sheely, This memo is being sent to contlnn the balances in the above referenced account on 2121/07, the date of death for William Blessing. Savings (51) .Checking (54) Certiflcat~ (CD) ~ VISA (L9) ~ $10,863.27 $, .3,124.55 $ 5,662.35 . $ 67.36 If you have further questions, please do not hesitate to call. Thank you. . Sincerely,. . Trec;:y Bosak Member Services j i pennwlvania State I!mDlovees Credit Union ' . Main hidrus; 1 Cmiil Union Place, Hem.burg, p.o. ltl10-2990 . 717.2i4.8484 . 800.237.7328) ~ . _ Mailing Address: P.O. Bo.x 67013, Ho~l PA 17106.7013.711..777.2100 (lRDI . 800.472.1967 (TDOl.~ "'it o:tadtr uniol'l ial1ldcrOlly InlUl'lld bvili. NaUonal C.eclil Union Adminittttllion. Equal Opp;wtunlly I.e. WWW.pncu.COM I REV-15~O EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF William W. Blessing FILE NUMBER 21-07-0183 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY INCLUOE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO OECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OFTRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST OF APPLICABLE) VALUE 1. Thrivent Financial Annuity - Contract #9146655 $59,907.04 $59,907, 2. John Hancock Annuity Account #SG0950086 $45,228,01 $45,228.0 TOTAL (Also enter on line 7 Recapitulation) $ 105,135.0 04 5 (If more space is needed, insert additional sheets of the same size) e2/27/2ee7 le:ee 71773e9615 THRIVENT FINANCIAL PAGE el ~ Thrlllent Flnandal . for Lutherans. D.ath B8neflt Inforrnatlon Settlement Agreement Con DIoMHd: WHllam W Blessing Dete of Date P Claim N th: 0212112007' : 0212612007 . ber;382435 ~th '''~efIt . ,".' Coat B..is Taxable Gain $ $ 58,330.40 1,576.64 - TotI.,.,.... 'eneflt $ 51,807.04 ~-oe.llnataon . Be.. Coverage: pilIDdEEOSWILL BE'PAID,TO GEORGE T BLESSING. 10717 CALSTON WAY. 92126, CHILD, IF SURVIVING; OTHERWISE TO CAROL A BLESSING, 10717 C DI!GCfCA, 02126,DAUGH1'ER-IN-LAW, IF SURVIVING; OTHERWISE TO ALL OF THE INSURED/ANNUITANT, eaUALL Y TO THE SURVIVOR(S); OTHERWISE Of. IH_~..QWNER. _', ..,.... _. _ ',' DIEGO, CA, TON WAY, SAN DCHILDREN o THE ESTA TE a.... ~ 1. IMPORTANT TAX REQUIREMENTS: Each beneficillry wi. be subject to 'withholding for their sha... of the taxable gain. Each beneficiary nMds to co W-4P MCtion on the C18lmant'. Statement. If NO withhotding i. desired. the firs ; 'tubatltute W-4PshbUkfbe check-*,. If the benefICiary DOES want withholding. . Mctionsbould be'cOmptet8d. 2. To..afst ttteberiefttiaiy In selecting a distribution method, you should refer to I No.1: This chart can be printed from InfoSouroe, Customer Service. Claims, De Charta. Income tax e the lUb8tltute eollon In the appropriate Page 2 of 3 oec.ased's Cust riD: 502897785 REV-1511 EX+ (12-99)_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF WILLIAM W. BLESSING FILE NlfIi~o 7 - 0 18 3 Debts of decedent must be reported on Schedule L ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. PARTBEMORE FURERAL BOME - BALARCE $ 139.65 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) GEORGE T. BLESSIRG, EXECUTOR Social Security Number(s)/EIN Number of Personal Representalive(s) 10717 CALSTOR WAY $ 0.00 Streel Address City !!laM DTJ.:an Stale~Zip Q.,1.,,; Year(s) Commission Paid: 2. Attorney Fees ARDREW C. SBEELI, ESQUIRE, PER AGREEMERT $ 1,050.00 3. Family Exemption: (If decedenfs address is notlhe same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent 4. Probata Fees CUMBERLARD COURTI REGISTER OF WILLS $ 114..00 5. Accountanfs Fees 6. Tax Return Pre parer's Fees TRAVEL EXPERSES ASSOCIATED WITB EXECUTOR'S RETURR TO PA TO ADMINISTER ESTATE,IRCLUDIRG AIRFARE, CAR RERTAL, LODGIRG, MEALS ARD PARKIRG F ES DEATB CERTIFICATES $ 795.61 $ 61.00 7. FILIRG FEES FOR IRBERITARCE TAX RETURRS $ 15.00 Reserves to cODclude admiDistratioD of Estate, iDcludiDg $ 500.00 preparatioD of decedeDt's fiDal iDcome tax returD, COSts, pos age TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert add~ional sheets of the same size) 2,676.86 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17G13 Receipt Date: Receipt Time: Receipt No.: 2/26/2007 13:30:01 1047460 BLESSING WILLIAM W Estate File No. : Paid By Remarks: 2007-00183 AJW ------------------------ Receipt Distribution ------------------------ Fee/Tax Description PaYment Amount Payee Name PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Cash Total Received......... 60.00 15.00 24.00 10.00 5.00 ---------------- $114.00 $114.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND COUNTY GENERAL FUN REV-1512 EX+ (6-98) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESI DENT DECEDENT ESTATE OF WILLIAM W. BLESSING 21-07-0183 Include unrelmbursed medical expenses. FILE NUMBER ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH VISA - final bill 67.36 2. SERS Reimbursement 361.50 3. Alert Pharmacy Services - final bill 28.37 4. Comcast - final bill 11.07 5. AT&T - final bill 6.33 6. Podiatrist 36.78 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 511.41 Rfli.1513 EX + (1-87) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WILLIAM W. BLESSING FILE NUMBER 21-07-0183 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 (include outright spousal distributions) 1. George T + Blessing Son 100 % Rest, Residue 10717 Calston Way and Remainder of San Diego, CA 92126 of Estate per Will . ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additionabsheets of the same size) LAST WILL AND TESTAMENT OF WILLIAM W. BLESSING I, WILLIAM W. BLESSING, of 824 lisburn Road, Camp Hill, (Lower Allen Township), Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. fIRST: I direct that all inheritance, estate, transfer, succession and death taxes, as well as my just debts and funeral expenses, of any kind whatsoever, which may be payable by reason of my death, shall be paid out of the principal of my estate as the same can conveniently be done. SECONQ: I give, devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any propert.y over which I hold power of appointment and together with any insurance policies thereon, unto my son, GEORGE T. BLESSING, of San Diego, California, provided he survives me by thirty (30) days. TIilRD: Should my son, GEORGE T. BLESSING predecease me, then I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, to Iny daughter-in-law, CAROL A. BLESSING, of San Diego, California. Should both GEORGE T. BLESSING and CAROL A ~ BLESSING predecease me, then I devise and bequeath all the rest, residue ~ and remainder of my estate of whatever nature and wherever situate, inc1ud- ing any property over which I hold power of appointment and together with any insurance policies thereon to my grandson, DANIEL NAM MOON BLESSING. FOURTH: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instrwnents for transfer of the property and to receive the proceeds of any disposition. (B) To partition, subdivide, or improve real estate and to enter into agreenlents concerning the partition, subdivision, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. ~ ~ ~ (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stockS, com- mon trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduciaries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insur- 2 ance policies or in other investments. (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named beneficiaries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or im- prove any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent provided for by the plan or the law. .ElEI.H: I nominate and appoint GEORGE T. BLESSING, Executor, of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of GEORGE T. BLESSING, 1 nominate and appoint CAROLA. BLESSING Executrix of this, my Last Will and Testament. 1 direct that my Executor or Executrix, as the case may be, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this / 7day of August, 2005. ... ( SEAL) WILLIAM W. BLESSING 3 . . Signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament in our presence, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. 73/ ~"'Q.(!f.,;I'I..~"";'S"V. ~ ~ (2.~ Address 17"sYr Name CPl,t:t~l.ztil, flMon,(Jo11 ~tJ(Yj, ()yu~ 4 Address PA I{OS:) Name 0= 4