HomeMy WebLinkAbout06-07-07
NAME
Susan H. Confair Es uire
FIRM NAME (If Applicable)
Rea er & Adler PC
TELEPHONE NUMBER
717 763-1383 Carn Hill
REFER TO METHOD OF COMPUTATION IN THE NONRESIDENT DECEDENT INSTRUCTION BOOKLET (REV-1736)
Check One: [Xl Flat Rate 0 Proportionate (Complete Worksheet on Reverse Side)
FILE THIS RETURN WITH:
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1737.A
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
I-
Z
W
Q
W
o
W
Q
DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL)
Keller Robert Luther
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
03/06/2005 02/14/1926
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
UJ
~
~-rn
CJ It: ~
UJ Q. CJ
%00
.. 1t:...J
....Q.m
Q.
0(
[X] 1. Original Return
D 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dalBofdeath after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (dalBofdeath between 12.31-91 and 1-1-95)
COMPLETE MAILING ADDRESS
2331 Market Street
METHOD
z
o
i=
<(
...I
::l
l-
ii:
<(
o
w
0::
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
(Schedule C)
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 Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(8)
(11)
(12)
(13)
(14)
FILE NUMBER
..L 1 - 0 -L JL .L ...4... ..4.. _
COUNTY"Cc55E ----YEAR NUMBER
SOCIAL SECURITY NUMBER
2 0 5 - 1 6 - 7 3 6 2
SOCIAL SECURITY NUMBER
o 3. Remainder Return (dalBofdeathpriorto 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
PA
17011
172,000.00
_......i
(--
r""-
I
-l
--r_"
t3
0.00
c:.
172,000.00
0.00
2,637.44
2,637.44
169,362.56
0.00
W
O::z
WO
~-
~t-
ui!
W::J
~Q.
U:E
xO
UU
~~
c(t-
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
WHEN PROPORTIONATE METHOD IS ELECTED, REFER TO WORKSHEET ON REVERSE SIDE FOR AMOUNTS TO BE ENTERED ON LINES 15 THRU 18.
169,362.56
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
0.00 X .0_ (15)
169,362.56 X .O~ (16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due. Make check payable to Commonwealth of PA
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0.00
7,621.32
0.00
0.00
0.00
.f
~
Ui
en
e
"0
~
S
CD
a.
E
o
o
en
...
c
CD
~
CD
CJ
CD
C
-
Q)
Q)
~
en
en~
eno
~N
o.
~Z
.....ex>
wo
~m
1-0
en~
~oooo
uJ~
~O
f~c
gUJ~
a. a: 13'
~~~
u.I~cn
i=~!
~~...
~z~
1\ ffi;:
ta.~
ou.~
~~~
5c~ .
a.~z~
ro~ffiu.l
cn..J a. fa
zuJzo
o~ouJ
~8uJ~
u.I !;(x
:;:)~o""
Ou.lou.
o~..JO
zuJ>-X .,
i!;(~S ~
g~~c ~
5t=;~uJ ~
u.~a.~ ~
uJ a. <l u.. to
~gzO JJ
~a.O~ ~
~uJ~uJ C
U) X uJ >- 10)
z....a.uJ
ct\!:""'Z
uJ en ..J 0 -0
en~!SZ :2
.cs:oox 0
~9tt: ~
a. CD"';:
~oooo
i
,...
0)
c
~ €
i i
~ 5
5 8. c:
~ ~. ~ ~
~ ~ 0) .u
~ 5 'tn ~
g 0 ~ ~
ij t t i ~
~~ ~-~~.
~O) s-ogs.
i-6 ~:2e::J
.p$ e-o_O):m
~::J ~~~to
O)~ o...nc~
~-m ~-8o.
o.~o~~i~
~~./J'O ~g.g
'Oi~~; 1;)
~.~~5 ~"i~
t/I - 0 g'.s
8 0) ~ 0) ....:~-c
.~ "9 ~ .~ ~ ~ to
~ :E: .~ eO. e i
~.~~ (l) i:; 0
~(l)~-6 ~:i~
~-6tO(l) ~l
C C C .~
ii~-J:i~
'i~c:::e ~~:2
as .t:i 0 ~ :::: '0 0
N
~
CD
0..('1)
N('I)
L----
UJ
~...J
~u..
~
N
('I)
~
N
CD
t-
-
..-
-
~
8
.S:
:@
l!
:a
!
o
"0- --
c~ ~
as ~ 0
sc~~-i~
Q)Q)::O-Q)
CD ~ E ~ E
e a.. ~- ~c
>- Q;" a.. ~ a..::J 8
CO::J-~5
0. 0 ~ cs.,c .~
><~~~D.:~
cot-o<ccoo
t-~N
~
~~
u\-
...
1
is.
II
e:
Ii
~l
~~
~i
~~
11
~ . 1'-
fni 'Ii
::) ::) i g
~ tii Ii
0<< ll\.o
~~ .t.;
;i: U.I I- ~ 'E
g >- ~ t~
i6 In ue
"'t;! U;~ Q-
... Z < a>t:
::J 0 Q. .g 1 (!)
~ _ ::0 :z
~ ~ ~ j ;!
c: ~ t: I~ ~
~g OU.l ~o
~ ~ ~ ~ ~t w
~ cOliS ...J
~.~ ~ 'i lIS ~
~.8 U.I ~lll
:2 ~ i= !l
.~ .u '5
~;g u.. =c
0) 0 1Iii
aC>- -5
c.8 ~ ~~
~ to 0 l~
~. c: ~ I- -.1
i 0) ~ ffi .1 i
~ 1 ~ ~ "51
-,~~1 i U
.-. ... ~ ~ ~
- ::J ,!l!
o
o
.l!2
s=
<<i
~
\0
'"'"
\0
...-l
CI:)
g
o
+
co
+
<C
~ \0
i Lf)
o
"'ffi
-0
t-
\0
...-l ,
CI:)
Q)
~
'5.
0-
m
~
c:
&1~
~....m
Q)~~
(j).Ea..
:Eciu.i
~
o
o
o
o
t
0.
S
.!
e
~
5
c
~
5
o
o
c::i
ff
~
uJ
+
o
-
~
"'ffi
~
a..
~
~ ~
JB c:
.E ~
~~
t-'6
Q)
-s
....
~
~ S
("") ~
~ !
:::J ::J
+ -
..- . CD
~~g>>
:::JuJa.
~~ g
-5<c()C
~&:.8
m~~
~Q)..e:
;;:i-50
Q).~
:5~
~t-
-<i LC'i
Q
~
<:)
~
:::>>
51
::c
~
U.I
tii
...I
Q.
:E
o
<.J
\0
'"'"
\0
...-l
CI:)
e
~
c s
-i c:
... Q)
as ~
'I '6
~ ~
~ $
~
N
Q)
c
:.:J
ffi
-5
....
~
Q)
c,w
en:;:)
.- C
~~
:::Jt-
~~
Q) .~
:5~
~ t-
co'
CI:)
r-
("I"')
""
..
CI:)
~
!eo
Q)
::J
-0
~
Q)
-5
c
o
~
~
.S:
Q)
~
$
c
uJ
-<i
"'ffi
g
Q)
-5
....
JB
c
uJ
cri
UJ
~
o
~
~
.....
'Z
W
en
~
0..
~
~
::I:
I-
a::
U.I
::J:
5
a::
~
0..
W
a::
0..
u..
o
~
=>
~
:z
(!)
en
tu
w
:s:
U)
~
a:-
o ~
~~
c~
O:iS
X 'j
t:i~
:i ~.~
8.a
W e~
~ 0. ~
<(1QC
Z E cf
o .~.S
~'i
~ ~~
o ~~
0.~8.
9 ~ e
....1-0.
o.~
en
en
UJ
a::
o
~
5 -g (l).s ::~
.s to_6 0 ~ ~ ~
.i (l) S .l!2 .s ~ ~t
v, :5E~ ~ 8 tOS=
~ 'O,go (l) x (p'~
.b $~g- ~ (l) ::~
~ ::J::J 8. ~ ~-. $~
~ ~U):~ 8, ~ 0~
> 5 5Z' ~ 5.......l!2 0.. -0
! ~:~: g.~.~ g.~
~ .s~~ ~~;B ~€
5 ~ : 'c ~~ ~ ..... ~
in 0 ~ '0 C;;.8 .: ~
'i c '";: 0) ~ <0') _ Q) E
sq ~ J!! ~ to cri $ .S E
0. '0 ~ ~ ~o: ~ ;e 8
.6 0) ~ ,g 0) C'! U) ~ .S
i ~; I i l~ 1 llc
~ (l)~~ I~"'CI ~
= :5-tO -0=0) 0)0
~ gge ~-6 6 :51;)
$::=: l!nl i (.) 0) '0 '0 .m
..... :.=- (5 "'" -g ~ (l) (l) <<i
-_"'CIs ~~ ~ rJ)
~"-:.$ o)c Q) ~~
co::.:.6 a to g ~:5 :5~
~ ~ .$ -m .~ ~ ~ .E .E ~
~tO e O)ii: ~ ~
~~ st:-g e* 5 .510
.g c.cn Q)::::::: to ,g to .s ~ .9-6
.8cri :5ei ~ 5_ ~s ~~
-00: ~~us ~~ ~~ ~.~
i6 C'! $ ~~ .. g ~ ~ c" ~ to
...,.t::......<<io 8_0._c.cn-U)
$~"':_~ oOQ)OcriotO
_C") ?:to =' C'!_~~ ~o: ~~
...:.l!2 co:: ~ ...... 10 go 10 C'! 10.....
~$ ~$~ >-> >..... >0>
::J to v, -...,::J -O)"i -0) ~ ~ c
::.::J 8.. ::. en'. '6.... - - "" 0
_ _ ....ccc<'!c'R
~ U) ~ 0.. .g a>. (l) to Q)..... Q) Q)
~.~ ~~~ ~:5~ ~~ ~ce
o.~ 0~0) 55~ oto o~
5~ gbE g-go.~::~c
:5 ~ :5.l!2.~ :5 U) ~ ~ $ ~ ::J. C
m ~ m $ a'i- m 8..,g ~0 ~ 'i,g
-0 _ -0 ::J8. ~ to '0.6 c .- 0.. .-.E g-
'00'0 ?:;B 'O.Sl to .$C'! .$ 0)-0
~$ ~~.9Q) ~e'O er- e~~
....=' ..-ca.! -><$ s~ x.-o
~ ~ ~:~ -m 2:' ~ ~::J ~.$o ~ &~
&.s & ~~ 5 &~~ j::: c ~~~
o
o
ci
o
o
c::i
o
o
c::i
o
o
c::i
o
o
c::i
-i
t
~
c.
~
€
c
o
€ ~
~
o
<.J
=
t-
Q)
~
'0
GO
....
t::..
SE
-
~
0)
:is
~
-6
.s
i:
'i :
-oC;:;-
~~
::J C
~~
to.....
~.~
U)~
g 0)
'6~
.g~
~!.
~ ~
~,g
~ .~
_ C
.19 to
~g
r--:
~
i
~
cD
....
~
t ~ ~
-o'iC;:;-
'0 ~ 0) x
~':::5~
1U~~
-oEo'i
g, <( i .5
~tq"e
Q) _ 0..
~~)(
~to~
1 ~ \
c%~m
co
0)
c:
:.::i
-
(l)
~
e:..
c:
0)
:2
~
to
.~
2 :
;:...,.
~N
i ~
0..::J
to e
~,g
to..,.
S 0)
-m .S
UJn
!g
~.g
I-~
x
s
e
~
.$
,m
8 \
<<i~
..92 (l)
,g C
~d
I- C
gt
~ e
4:0..
oi
j N
ttl 0)
~ :5
~ e
t ~
.f!1~ (l)
:2
.~
to 0
~ ~
~ 8..
~ e
I- 0..
x
~
~
~:
m~
..92 0)
,g C
~d
1-5
-~
58..
~ e
4:0..
me;;-
~ 0)
,DC
C'Cl:.::i
~-
I-C
-~
58.
~ e
4:0..
cO
cD
~ ~ ..t
..n
R~-1737-1 EX +{9-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG PA 17128-0601
NONRESIDENT DECEDENT
AFFIDAVIT OF DOMICILE
This affidavit must be completed and sworn to by a person having personal knowledge of these
facts, preferably by a surviving spouse or member of the decedent's family.
Date of Death
03/06/2005
Name of Decedent
Keller, Robert Luther
Legal Address at Time of Death:
Street Address
FL
Zip Code
33612
10908 N. 20th Street
City/Borough
Tampa
State
The following information is submitted in support of the statement that the above individual was
not domiciled in the Commonwealth of Pennsylvania at the date of death.
1. Names and addresses of the decedent's surviving spouse and members of his/her immediate family:
Name and relationship to decedent
Cherie A. Keller, Daughter
Street Address
10908 N. 20th Street
Name and relationship to decedent
City/Borough
Tampa
State
FL
Zip Code
33612-6135
Street Address
City/Borough
State
Zip Code
Name and relationship to decedent
Street Address
City/Borough
State
Zip Code
2. Did the decedent ever live in Pennsylvania?
If yes, during what periods?
1926 - 2003
\Xl Yes
o No
3. Did the decedent spend time in Pennsylvania during the five years preceding death?
If yes, during what periods and at what address?
1962 through 2000 -513 W. Lisburn Road, Mechanicsburg, Pennsylvania
\Xl Yes
o No
Continued on a Separate Paae
4. What was the nature of decedenfs places of residence during the five years immediately preceding death?
Indicate whether decedent resided in a house or apartment and whether it was rented or owned by the decedent, and/or whether decedent resided in a hotel
or the home of relatives or friends.
Decedent owned and resided in Florida in a single family home and various assisted and skilled nursing facilities located in
Continued on a Separate Page
5. Was the decedent employed during the five years preceding death? 0 Yes
If yes, list the name and address of employer(s}.
IX] No
6. Did the decedent leave a will? IX] Yes 0 No
If yes, state the court which admitted the will to probate, the date admitted, and attach a copy, including all codicils, and a certificate of issuance of
letters testamentary.
Circuit Court for Hillsborough County. Florida
7. If the decedent did not leave a will, has an administrator of his estate been appointed? 0 Yes 0 No
If yes, state the court which appointed the administrator, the date of appointment, and attach a certificate of the issuance of letters of administration.
8. At any time during the last five years did the decedent execute a will, a codicil, trust indentu~ deed, mortgage, lease or any other document in which
the decedent was described as a resident of Pennsylvania? u Yes \Xl No
If yes, describe such document.
NONRESIDENT DECEDENT AFFIDAVIT OF DOMICILE (continued) Page 2
9. Had the decedent paid a tax on Income or on intangible property to any state, county, or municipality during the last five years?
If yes, where and when was it paid? !XI Yes 0 No
Upon decedent's move to Florida, he ceased paying income taxes in Pennsylvania. Florida does not assess income taxes
Continued on a Separate Page
10. To what regional office of the Internal Revenue Service did the decedent forward his Federal Income Tax returns during the last five years
preceding death?
Atlanta. GA.
11. At the time of death, did the decedent own, individually or jointly, any interest In real property, including lease-holds or tangible personal property
located in Pennsylvania? /Xl Yes 0 No
If yes, describe the property in detail.
House at 513 W. Lisburn Road. MechanicsburQ. Pennsylvania.
12. In what business activities was the decedent engaged during the last fIVe years preceding death?
Indicate whether decedent was employed or otherwise engaged in business, and state the names and the addresses of the persons, firms or corporations with
which the decedent had such business affiliations. (Except for employer listed in #5)
Retired
13. What is the estimated gross value of the decedenfs estate, wheresoever situated, exclusive of real property and tangible property located outside
of Pennsylvania?
Approximately $307,000.00
14. At the time of death, did the decedent own or operate an automobile? 0 Yes
If yes, in which state was it registered?
\XI No
15. At the time of death, was the decedent a member of a church or any other organization? 0 Yes
If yes, provide the name and address of the church or any other organization.
\XI No
16. State the purpose or reason the decedent owned real property In Pennsylvania.
Had not yet sold the family home.
17. Include any other information you wish to submit In support of the contention that the individual was not domiciled in Pennsylvania at the time
of death. If more space is needed, insert additional sheets of same size.
Name of person completing affidavit
Relationship to decedent
Cherie A. Keller
Street Address
dau hter
10908 N. 20th Street
City
Tampa
State
Zip Code
FL
33612.6135
Under penalties of perjury, I declare that based on my personal knowledge of the decedent, the
information provided on this form is true, correct and complete.
Signature of person completing affidavit Date
Continuation of REV-1737-A Inheritance Tax Return Nonresident Decedent
Keller, Robert Luther
21
07
0342
Page 1
3. Periods Decedent Lived in Pennsylvania During the Five Years Preceding Death
2000-2003 - Outlooke Pointe, 153 Logan - Dillsburg, Pennsylvania
Continuation of REV-1737-A Inheritance Tax Return Nonresident Decedent
Keller, Robert Luther
21
07
0342
Page 2
4. Decedent's Places of Residence During the Five Years Immediately Preceding Death
Florida for the five years immediately preceding death.
REV-1~37-2 EX + (9-0.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE A, PART 1
REAL ESTATE
IN PENNSYLVANIA
FilE NUMBER
Keller, Robert Luther 21-070342
Part 1 must include all real property owned by the decedent individually or as a tenant in common with another party{ies), having its
situs in Pennsylvania. Property which is jointly-owned with right of survivorship should be disclosed on Schedule F. All real estate
must be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and
a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
ITEM
NUMBER DESCRIPTION VALUE AT DATE OF DEATH
1. 513 W. Lisburn Road, Mechanicsburg, Pennsylvania 17055, Upper Allen Township 172,000.00
PART 1 TOTAL
S 172.000.00
PART 2 TOTAL
Proportionate Method Only from reverse side $
TOTAL (Also enter on line 1, Recapitulation) $ 172.000.00
(If more space is needed, insert additional sheets of the same size)
REV-1~37 -4 EX + ,(9-0,*-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE E, PART 1
MISCELLANEOUS
PERSONAL PROPERTY
FILE NUMBER
Keller, Robert Luther 21-070342
Part 1 must include all tangible personal properly having its situs in Pennsylvania. Examples of tangible personal property are
jewelry, furniture, paintings, etc. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
Complete Part 2 on reverse side ONLY when the proportionate method of tax computation is elected.
ITEM
NUMBER DESCRIPTION VALUE AT DATE OF DEATH
1. N/A
PART 1 TOTAL
$
PART 2 TOTAL
Proportionate Method Only from reverse side $
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1~37-5 EX + ,(9-0.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE F, PART 1
JOINTLY-OWNED PROPERTY
FilE NUMBER
Keller, Robert Luther 21-070342
Part 1 must include jointly-owned real estate and tangible personal property located in Pennsylvania. Complete Part 2, on reverse side to
include all other jointly held property whenever located ONLY WHEN THE PROPORTIONATE METHOD OF TAX COMPUTATION IS
ELECTED. 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. N/A
B.
c.
PART 1 . JOINTLY OWNED PROPERTY LOCATED IN PENNSYLVANIA
LETTER DATE DESCRIPTION OF PROPERTY DATE OF DEATH %OF DATE OF DEATH
ITEM FOR JOINT MADE DECD'S VALUE OF
NUMBER TENANT JOINT Attach deed for join~y-held real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A.
PART 1 TOTAL
$
PART 2 TOTAL
Proportionate Method Only from reverse side $
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1~37-6 EX -,(9-01'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS a
MISC. NON-PROBATE PROPERTY
Use Schedule G. Part 2, ONLY for
proportionate method of tax computation.
FILE NUMBER
Keller. Robert Luther 21-070342
Part 1 must include all transfers of real estate and intangible personal property located in Pennsylvania.
Complete Part 2 ONLY WHEN THE PROPORTIONATE METHOD OF TAX COMPUTATION IS ELECTED.
Include in the description of property the date the transfer was made and the name and relationship of the transferee. This schedule
must be completed and filed if the answer to questions 1 through 4 on the reverse side of the REV-1737 cover sheet is yes.
PART 1 - PROPERTY OR TANGIBLE PERSONAL PROPERTY LOCATED IN PENNSYLVANIA THAT WAS TRANSFERRED
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
Include the name of the transferee. their relationship to Decedent and the date of
transfer. Attach a copy of the deed for real estate.
DATE OF DEATH
VALUE OF ASSET
%OF
DECO'S
INTEREST
EXCLUSION
(IF APPLICABLE) TAXABLE VALUE
0.00
PART 2 - ALL OTHER TRANSFERS
PART 1 TOTAL $
0.00
$
$
0.00
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
Include the name of the transferee, their relationship to Decedent and the date of
transfer. Attach a copy of the deed for real estate.
DATE OF DEATH
VALUE OF ASSET
%OF
DECO'S EXCLUSION
INTEREST (IF APPLICABLE) TAXABLE VALUE
PART 2 TOTAL $ $ $
TOTAL (Also enter on line 7, Recapitulation) $ 0.00
(If more space is needed. insert additional sheets of the same size)
REV-1~37-7 EX + .19-01',*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
Use Schedule I, Part 2, ONLY for
proportionate method of tax computation.
FILE NUMBER
Keller, Robert Luther 21-070342
Part 1 must include mortgage liabilities, liens and taxes against the Pennsylvania realty that were due and
owing as of the date of decedent's death.
Complete Part 2 ONLY when the proportionate method of tax computation is elected.
PART 1 . OBLIGATIONS AGAINST PENNSYLVANIA REALTY
ITEM
NUMBER DESCRIPTION
1. Upper Allen Township -1st Quarter Sewer
AMOUNT
100.00
2.
2005 CountylTownship Real Estate Taxes for parcel 42-30-2110-023 and 42-30-2110-023A
455.03
3.
2005/2006 School Real Estate Taxes for parcel 42-30-2110-023 and 42-30-2110-023A
2,082.41
PART 2 . ALL OTHER DEBTS OF THE DECEDENT
TOTAL PART 1 $
2,637.44
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
TOTAL PART 2 $
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2637.44
REV-1737-7 EX + 19-0(\~_
REVERSE, . ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Keller, Robert Luther
21-070342
When flat rate method is elected, list the beneficiaries of the Pennsylvania property.
When proportionate method is elected, list all beneficiaries.
RELATIONSHIP TO
DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSONlS) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)]
1. Cherie A. Keller Daughterl Lineal 169,362.56
10908 North 20th Street
Tampa, FL 33612
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE
SIDE OF REV-1737 COVER SHEET AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. 0.00
TOTAL OF PART II
ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1737 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
, ,
. " :'
\ .
. .
. . .
. -. .
"PART FOUR.:'DEFlNITIONS
4.01 Survive. . .
4.02' Issue,. Descendants,' and Children.
. .4.03 Persdnaland Household Effects..'
4.04 Residue. . '
4.05 Per Stirpes.' .
4.06 Code;
. .
.'. .
PART FIVE: MISCELLANEOUS
5.01 UseofWords. '
5.02 Invalid Provisions. '.
5.03 Headings; Table ofContents~
Attestation .
. .
Signatures of Witnesses '.
Self-Proving Clause
WILL.OFROBERT L. KELLER
I, Robert L. Keller of Cumberland County, Pennsylvania, declare this to be my
Will. I revoke any previous Wills and Codicils~
USE OF DEFINED TERMS
. . . .
I have used several terms in this Will that are defined in Part Four. I have
reviewed in detail the definitions setforth in Part Four, and I direct that those defInitions
shall apply throughout this Will,unless the context in which a defined term is used clearly
implies' another meaning. '. .
PART ONE .
APPOINTMENTS AND IDENTIFICATIONS-
. .
. .
'l.01'Children. At the time .of signing this Will Ihave the following child: Cherie
'A. Keller. Further definition of my children, issue, and descendants appears inPart Four
of this Will.' . ,
L02Executor. I appoint CherieA.Keller of Hills borough County, Florida as my
Executor. .'
fiERiAEQ]
2'
: .
"
, . . .
. . .
. .. .
. . .' . " ..
1.03 Srtccessor Executor. If my original Executor ceases or fails to serve, I
appoint Gloria Keller of CumbeTland ~ounty;Pennsylvam~ as'myExecutor. Any
Exequtor original or successor, named herein may he referred to herein as my Executor.
. PART TWO'
. .
DISPOSITIONS
. . .
. .
. , . .
. .~
. . . '.' ....
2.01 General. I int~nd to dispose of all of my property.
. . .
2.02 Personal and Household Effects. .
. .
. .
. (1) Gift' to Children.
. . .
. .
. . .
. (a) My Executor shall distribute niy Personal and Household Effects among my
children who survive me, in shares of substantially equal value as determined by my
children; but .. .
'(b)Ifmy children fail to make this deteiniinationwithin six (6) months after my
death or if they are incapable of making a division 'among themselves because of age or
for other reasons, then my Executor shall determine the share of each child.
Notwithstanding the foregoing sentence, my Executor in its sole and absolute discretion
may include my Personal and Household Effects directly in my Residue or sell any such
property and include the proceeds'in my Residue'. .
Any division and distribution made Oy my Executor shall be binding upon all
persons, including my children. .
. .
. . '. .... .
(2}.No Survivor. Ifnone of my childfen survives me, my Personal and Household
Effects shall be added to my Residue.' .
2.03 Residue. .
. (2) Major Disaster. If all of my descendants fail to survive me, my Executor shall
distribute my Residue to those persons who would inherit from me in accordance with the
laws of intestate succession then in effect in the Commonwealth ofPennsylvani~..
3
. "
. .
,'PARTTaREE
. ' .
. . . .
ADMINISTRATION OF ESTATE
. - . .
. .' . . -'
. '., .. .' . ,".
'. 3.01 Payment of Debts. and Taxes:Exceptas9therwise provfdedin.this Will,I
direct that all my legally enforceable debts, fune~al expenses, expenses of the
. administration ofmy estate, and federal.estate and. state inberitance taXes,inchiding
.' interest andpep.alties thereon, becoming payable because of my death{exc~pt an~
generati~n-sJq.pping' traJ:lsfer tax imposed by'Section2601'ofthe Code or any recapture '.
taX impos~d bySectioi12032A bfthe Code) be paid.out afmy Residue. Any debts from
borrowing the cash surrerider value ora:n.y1ife insurance policy shall be paid from the ·
proceeds of the respective policy, 'and my Res.i4ue shall not be burdened with such
indebtedness. . . .
3.02 Powers of Executor.
. .' .
. " .
. ." " .
. . ..
. .. .: .'
. . . " . .
. '.
. '
. .
. .
(1) Genera1.In addition to the powers given to my Executor bylaw,I grant to my
. Executor the folloWing powers with respeCt to my estate: - '
(a) To retain any property of my estate; :
. . . .
(b) To convey, -sel~, fransfer, exchange, partition, mortgage, pledge, leaSe, assign,
or ot~erwisedispose of; hypothecate, or ~eal with any and all properties in my estate;
(c) To borrow or lend money for such purposes and on such tems and conditions
as my Executor deems appropriate;
(d) To invest and reinvest any assets, funds, properties, or income of my estate in
such properties or investments as my Executor deems appropriate; . .
. .' .
. ' .
.' -.
. . . " . .
, (e) To extend or'renew any indebtedness upon such terms and for such time or
times as my Executor deems appropriate; .'. . .
(f) To settle claims in favor of or against my estate; and
. .
. '
(g) To continue the operation of any proprietorship, partnership,'corporation,or
other business owned by my estate, inc1udmgthe power to carry out and enforce the
provisions of any agreement for the dispositionofiny interest in any such business
enterprise, even though my Executor may be financia11yinterested in such business or
agreement.
. .. . . . .
My Executor may exercise these powers for any purpose and upon such tenns,
conditions, and limitations (whether or not'to exist longer than the adrillnistratiqn of my
estate ) which i.n thejudgmentof my Executor shall be in the best interest of my estate
and the beneficiaries thereof. .
4
I'. . .,
t, .'
" ,
(2) Tllrie: and Method of Distribtition~ 'Fin~l distribution of my estate 'shall be '
,made wherimy Executor determines the tirneto be appropriate.'Priorthereto, partial ,
distributions 'may be made whenever my Executor shalfdeem it 'advisable.:Disti1butions'
may be made in cash or in kind, or Pazt1yin each, and for this purpose" t~e detenn~ation
of my Executor as to the valtieofanyproperty distributed in kind s~al1.be conclusive~
, '
, ,
(~) SeleCtion of, Assets for Disttibution. ,. MyExectitor shall}nits sole and
absolute discretion select: assets or property to be distributed 'insatisfactionof any devise
or bequest in my Wil~ without respect to the income tax b~is of such 'assets or property.
My Executor specifically is excused from any duty ofiIl1parti~litywithrespect to the '
, income tax basis of such property.' "
. .'. ..' . . .
. .. . . -. .
, (4) Conflicts of Interest. Irealize that in th~ course of the administration of my
estate conflicts of inter est may develop betWeen'beneficiaries ofinyestate. For example,
conflicts may developpecause ,of a ch()ice of alternatives involved in valuing assets for
- .. .
vario.us p,urposes.,Iri theres,olutionofany, co, nflict of interest; I request (bufdo not so' ,
direct) that my Executor first make a reasonable effort to determinethe overall effect of
the conflict in the ,administration' of my estate' and in the distriputionsto, be made and then
make reasonable efforts to resolve the confliCfby the mutual agreement of the respective,
beneficiaries or recipients. 'In'the event that a mutual agreement 'cannot be reached after
reasonable efforts, myExecutor shall resolve the conflict in its sole and absolute
discretion~' "
(5) Elections 'and Options. I confer upon my ExecutQr.thesole and,absolute ,
discretion to exercise anyelection or option given to my Executor under the revenue laws
of the United States or any state in which this Will may be probated or in ~hich property
of which l own an interest at the time of my death may be loc~ted. My Executor may
exercise such discretion without regard to the relative,interests of the beneficiaries of my
estate, without compensating adjustments among the beneficiaries of my estate, and
notwithstanding thep~ssibjlitythat such decisions may increase the amount of my ,
taxable estate. Without limiting the generality of the foregoing sentence, my Executor is
authorized, in its sole discretion, to claim any expense of administration of my estate as '
, an estate tax deduction or as an income tax deduction; to elect, to extend the payment 'of
any tax over such peri{)d as may seem 'appropriate to my Executor and available, under
law; to elect to value any aSset of my ~s~ate under any'alternative Evaluation formula
which may be pernntted under the Code; to select the alternative valuation dates for the
, valuation of my estate; to disdaiin or renounce, in whole or in part, any gift, inheritance,,'
life insurance, or employee, benefitpayable to my estate; and to file any tax returns for
any year or years for which I have not filed such return or returns prior to my death and
,to pay any taxes (together with any interest and penalties thereoIl) as my Executor shall
~~~p~' ,
. . ~ . .
, '
, '
(6) Encumbered Distribution. My Executor is authorized to' ~istribute to any
beneficiary of my estate anY,asset ofmy estate subject to'any ahd all iIldebtedness
incurred by me or by my Executorwhich indebtedness, in the sole and absolute discretion
'f7':V'E '-'--..,
~, '"BL,F~.r,:,: ",:1'
. 0,: t.".~ t<:..l .
5,
r'
"
, . .' . . .... ." .
. .. .'
" .' ~.
. . , .
or opUrlon of triyE~ecutor,need' ~otbe paid first, or to distribtite, any such property or '
asset subject to any,or aU mortgages, deeds o,ftrust" or the liens" encumbrances, or.
obligations created 9Y mear by my Executor. . ' ,
. ,
. .'. .'
',' '.' ",'. . , '. .. '. . . ,'.. .". .' . ."',
, " (7) Methods of Payment to ,Certain Beneficiaries. . if anybeneficiary to, whom ,my
'Executor is'authoriied,\Jy this instrument'to'mak~ distributions is under'a le'gal.'disab~lity,
or is; in the opimonofmy Executor, incapable of properly managing his. or.her affair~,
, my ~xecutormay make such distributions many' one, or more of the following ways:
, ,
, (a) Tos\fc~ beneficiarydirectly; '.
, ,
. , '.' '. .'
, (b) To the guardian, cOmIni~ee, conservator, or ~thersimilar official of such
beneficiary;' ,
.' . . .
(c) To'a rdativeofsuch:beneficiaryto be exptmdedby'such relative for the
benefit of such beneficiary, including payinentto suchrehltive;'
(d) To a custodian selec~ed hy my Executor un~er an 'applicable Uniform
Transfers to Minors Act; or
( e) By my Executor expending'the Sa.i11e directly for the benefit. of such
beneficiary. ' , -
Any person (other than the benefi9iary) who receives a distribution for the benefit of the
beneficiary pursuant to the preceding sentence is authorized to give a valid receipt and
discharge for.the distribution. The ' distribution to such beneficiary or 'other person to'
whom payment is made or entrusted shallbe.aconiplete discharge to my Ex~cutor,ari.d
my Executor shall be without obligation to see to the further application of such
distribution. '
. , ,
. . ".
, . ,
. '. .
. ..' ..
, . ,
, (8) Executor's Discretion Controlling. Any decision made undertbis Section or
any other provision of this Will by my Executor with respect to any matte~ shall bind
, each beneficiary afmy estate, and any other person howsoever interested in 'my estate;
and my Executor shall not be,req'firedto make ariycompensatirig adjustme11ts between,'
income orprincipal oramorig any benefiCiaries, tJ:ustees, or any other person as a result
of my Executor's action or inaction.
. . . . .'
. ..... .
. . "
, , ,
3.03 Transaction.s With Related Parties'- The powers' of my Executor to enter into '
any transaction shall in noway be limited by the fact that th~ same or another party to
such transaction is an Executor of my estate or of any other'estate; a beneficiary afmy
estateor of any other estate; the estate of such berieficiary(whether living ordeceased); a
trust (created herein or elsewhere); or ail ~xecutor or trust~e of any such estate or trust.
, : 3.,04 Administration of Out-of.~State ~roperties. If the appointment of an 'ancillary
personal representative afmy estate is riecessaryor desirable in any jurisdiction in which
no Executor of mine is able arid willing to act, my Executor may appoint;' by.written
6
r
"
. .
, . . ..
. . .
'. instrument, any individual or corporation. as myandUa.iy personal representative iri that.' .
jurisdicti~n. My ancillary personal representative mayb~ an officer .oremployeeofmy .
Executor, shali serve free of cOUrt~upervision insofar as legally possible, and shall have::
'.. all the powers and' discretioliwith respect to. my estate in. that jurisdiction that my', .
Executor is.given in thfsWilL My Execlitor~rtlay reaSonably compensate myailcillary .
. personal represeritative for itsservipes, may reiriiburse it fot its' expeilses~ and may.. .
. absolve itl from any requirement that it furnish bond or other security. .' '. . ..'
. . .
. .-' .
. . . .
.. . . 3..05 Accountingto Successor Executor.. Any successor Executor. is
authorized (but not directed) to accept the assets delivered by or for a 'predecess~r
Executor on the' basis of the' accountiIig therefor.without requiring an . auditor other
. ind~endentaccounting of the acts of such predecessor Executor.. Any.successor. . .
Executor shall not be liable for,'or liable for failure to rectify,. any act or omission of any
predecessor Executor.' '. . . .'
. . ... . .
. . .
. 3.06 Compensation and Botid.'No Executor shall funllsh bond. 'Any Executor'
. herein named or othenvise appointed shall be entitled to'reasonable fees commensurate
with its duties' arid responsibi1ities~taking.iritoaccount the.value and nature of my estate
. and the time and 'work involved, without regard to any statutory provision as to fees, and.
if itis a corporation, then not less than its then current minimum fee for such serVices.' if
any licensed attorney or certified public accountant shall serVe as Executor, such person. .
shall be compensated for s.ervice~ rendered on the basis of such person's customary
charges for legal or accounting services. .'
. . .
3.07 Liability of Executor. The Executor shall be liable only for its own
negligence or willful misconduct. .
. PART FOUR'
DEFINITIONS
. .'
. 4.01 Survive. Forpurposes of this. Will, one person shall be regarded as having
survived another only if the former su~ved the latter by sixty (60) days or more.
.7
\ .
"
\..
. .
.... 4.03Personal andHousehold~ffects~. All references in this Will to my "Personal
and Household Effects" shal..l mean my jewelry, clothing~ books, china, crysta.land .
. .
silverware, furniture and furnishings, objects ~f art, boats, automobiles,. club.. .... .
memberships,. and all other personal property. of a nature, use, and,'classification.similar to
. the foregoing, and includes all rights ,that Imay have tinder anYlnsurance policies . ,
relating thereto.. Expressly excluded:from this d~finition is atiytangiblepersona1.
property regularly used in connection Willi any bus~ess inwhich lo-wnany interest.
,. . .' .- . . .' '. .
. .' .. . . .
4.04 Residue~A11 referellcesin this Will to my "Residue" shall mean allthe
remainder of my property,. of whatsoever kiild (wh~ther real, persOnal, or mix ed, and '.
whether tangible or intangible) and wheresoever situated (and including all lapsed'
bequests and deviseswhi6hfail for any reason), not specifically disposed of herein.
Should I possess one or more powers of appointment,. however, I call attention to the fact
thatl do not desire to exercise'anysuch power; neither such powernoranyproperty .
subject to any such power shaUbe regarded as part of my Residue. .
. . ~ . . .' .
. .
. .'
. .
. . , . " . .
. . " . .
4.05 Per Stirpes. All references in this Will to "per stirpes " shall!lle~ a
distribution in accordance with this.Section.' Whenever a distribution is to be made to the
descendants 0 t any person, the .property to' be distributed shall be divided. into. a.s marly.
shares as there.are (I)-living children of the pers()n, arid (2) deceased children.ofthe
person who' left descendants who are theI1living. Each living child (if any) shall take one.
share and the share .of each deceased child sJ:1all be divided among his then living.
descendants in the same manner. .
4.06 Code. All references in, this Will to the "Code" shallmean the Internal
Revenue' Code of 1986, as amended, arid'shall be deemed to refer to correspondirtg
provisions of any subsequent . federal tax law.
PART. FIVE
MISCELLANEOUS
5.01Use of Words; As usedin this Will, wheneverthe context so indicates, the
genderof all words shall include the mascu.line, feffil.'nine, and neuter, and. the numbe. r of
.' .
all w~rds. shall include the singular and plural. .
. .
. .'
, . 5.02 InvalidProvisions. If any part of this Will shall be invalid~ illegal, or
inoperative for. any. reaSon, it is my: intention that the remaining parts; so far as possible
and reasonable~ shallbe effective and fully operative. My Ex.ecutor may seek and o~tai~
court instructions for the purpose of carrying' out as nearly as may he possible the .
intention of this Will as shown by the terms hereof, including any terms held invalid,
illegal, or inoperative. . .,
8
"
" '. .
. .
. - . . .
5.03 Headings; Table qfContents. Th~ Table o~C9ntents and the headings used
throughout this Will have been inserted fQr adininistratjve yonvenience only, and do not
constitute matter to, be construed in interpreting this WilL, ' ' ' ,
. . .' .' .
, '
. . . .' .' .~.
.' . . . - . ..
" , In 'Vlit:ness' ~ereof,I hav~ S,ef~Y han~a111 'seal to this my last Will and ,
Testament, this ,.;t),tlf1, " dayof Hrn, , ',:2003.' , ,
;~ ~~~ (SEAL)....
Robert L.Keller
, ' '
, ' '
, ,
, '
. , . .'
, Signed, seale~, published and declared by RobertL.Keller, the above-named ,
testator, as arid for his last Will and Testament, in the presence of us, who, at his request,
in his presence at the s~e time,. have hereunto subscribed our names as witnesses.,
). ~iZ-~~)t tk .Carrp Jl-;u ~ fA-11o Ii
ature 0 witness) , Address' '
',..x1. .~.. trf (irk.. Dr;{(. . m;U/dwn, Of- /l0(1
(signature of witness ) Address
COMMONWEALTH OF PENN8YL VANIA :
'COUNTY 'OF 'CUMBERLAND:
:88.
" We,~o~} L . "eUcK , ,J;tn (t1~'1'W, L.ot"lte p,,,ty;JLarid' "
~ ~ Jle~iOt'\" , , the Testator and the witnesses, respectively, whose names are'signed
to the fOl;'egoin'g instrument, being first duly sworn, do hereby declare to the undersigned
authority that the Testator signed and executed the instnimentashis last Will and that he '
had' signed willingly, and that he executedit as his free and voluntary act for the
purposes therein expressed, and that each of thewitness,es, in the presence and hearing of'
the Testator, signed the WiUaswitness and that to the best of each 'such witness's
knowledge the testator was at thattime eighteen years of age or older, ofsoundmil1:d arid
under no constnrint or undue influence . ' ,
, [VERfF!EJ2J
9 '
'.
, .
.
, "
" .
, '
. . ..~Dokl~ ...
Testatort1tJo-v ~ '., .. . ...., .
Witness .r~.
. .
WitnesuZatJ:r .
Witness.~ .<J..~.
Subscribed, ~wom to and acknowleaged befo.reme by Robert L. Keller, the . /,
T, eSft~"tor, an" d subscnb~d and sw~m bero, name bY" ~ ' ' . lA..~t r.tt.~ ,
Ilt\., ~.u" ,wltnesses, this Q2!1- . day of .,'. ' 2003., . ,
cl ~
\ ' , ' '.'
~ . ~
- '~.. ,.-
NO~liC - \ -
My Commission Expires:
Notarial seal
,.. L, s~. Notal1 Pu., ,blie.
. c.. lml Boro. Cumberland County
Ny Commission Exp~ Apr. 1 If 1Q06 j
, ---
[VERIFIEDJ
10