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HomeMy WebLinkAbout06-14-07 .:.J 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue '* County Code Year Bureau of Individual Taxes. INHERITANCE TAX RETURN PO BOX 280601 Harrisbur , PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~~ Suffix []]] File Number Decedent's First Name MI trI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix []]] Spouse's First Name MI o Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return <::) 2. Supplemental Retum <::) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required <::) <::) 4a. Future Interest Compromise (date of death after 12-12-82) <::) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) <::) 10. Spousal Poverty Credit (date of death <::) 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 Da ime Tele hone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received ~ 8. Total Number of Safe Deposit Boxes 4. Limited Estate <::) - <::) REGISTER OF WILLS US~9NLY G:.::t o co::> r-=; Q -, :::::)0 'I_ ~x~ fj-; ~ ~ ~~~0 ~~!:~.i -- ;,..:,) c Correspondent's e-mail address: ~/~ @ A-oL- .c..~ 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 personal representative is based on all information of which preparer has any knowledge. SIGNAT RE OF PERSON RESPONSI E FOR FILING RETURN D :rE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --.J --.J REV-1500 EX 15056052048 Decedent's Name: 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::::) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::::) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 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 GQvernmental 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. 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 .0_ 16. Amount of Line 14 taxable at lineal rate X.O.!iS 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. Decedent's Social Security Number 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052048 Side 2 c::::) 15056052048 --I REV-15fJO EX Page 3 . Decedent's Complete Address: DECEDENT'S NAME ---~ STREET A ESS File Number 2-00(,. - t>M- CITY ,. Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) f 33. '-I t) 3. Interest/Penalty if applicable D. Interest E. Penalty --tj- Total Credits (A + 8 + C ) (2) 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) c- (33L~7:> 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) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) ~ 33. 't t) 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 IB'" b. retain the right to designate who shall use the property transferred or its income; ............................................ D L8 c. retain a reversionary interest; or.......................................................................................................................... D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D ~ 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. 99116 (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. 99116 (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. 99116(1.2) [72 P.S. 99116(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-1508EX+(1-97) W' '. . , \ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF (-'rU~ tJA-t;..LE FILE NUMBER 2-(90(.;- oof-7R' Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION ~~,J G- Prcc-oo NT - Aec-,- #- 5' -lflJOLf-- 5'G 83 P N c.. Bf11J "- ILf"o cltl1AP t+lL-L 'SHoPPtNt;- I'(AU- Cltwl'/> 1ft L1- (pA ~ 17 <!> IJ VALUE AT DATE OF DEATH 2 , S-q 3 I ( ~ ').. L LDlltuJ G-, JEfJELfl- '(I B oo~ S I' MPUIrtJceS,. (~~uJA11E1 erc, f I {)O tJ . (ft) TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) . " '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ~~ ~ NA-c-tE Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH FILE NUMBER U Ob ---t90~7P ITEM NUMBER 1. DESCRIPTION ~ILL pon-: P/r1M-MEfJ'c.. I tJTCfUCPT ~ eLEC~OES &LUC-()~ t3U>OD G 17..S2.. "'1-7a r;,. 't 2- lfJEST ,tJOflE ~ -AL-.-S 2Ds GfJA1JOVrew Me. 5'TE.. 21' C t1'MP Hi LL, Pit. '71)' J CJr;tJ- ~ 307 ( 35M- 1/)1t1E .... r~L2~b TOTAL (Also enter on line 10, Recapitulation) $ (11 more space is needed, insert additional sheets of the same size) t,)f<~1.f REV-1513 EX+ (9-00) .,". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under j Sec. 9116 (a) (1.2)] 1. Ctte(L.'l L STeJEN5 D~7EP- I g-o 4- G-(U:::aJ Sf {~LS6tJM.(PA. li/01- L /CBII/J 1JIr6.L-E ~ ",J J lq~7 PtltJCET()fJ!r1J2. GIn41P If--tLL, (J/J. - 17~ I , ~. CtfP-1 SToPHer-- tJ /rCLE 2b S. 2-7~ S7: C/r11A.p (f-fl-L, P'+ , 17~1 J 5t),J j 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 n - 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) j .:Jkc,. ,it" ,I< '~l~u.,.oJ";'" ."""'~~~'"_.,...,.....:=- '~..... ~~,~'"~ .."H""" ". . ~~.,,~.'''''''''''.,. ,-...' ~._" ,"",",j,',.''''~'",.!".w"""", " Ui..,d~~-L.'; .;;;.j,'...~;,;.l~;4\i~;';;'il:iLMi~" " ,~l:~ii('~~':L,ill,~ ",""" 4c'~~~~Ji;~~'fl:'i-;;~,'/i,;j~~~~~ WEST SHORE EMS - ALS 205 GRANOVIEW AVE SUITE 211 CAMP HILL, PA 17011 Phone #: (800) 367-0512 Federal Tax 10: 23.2463002 INSURANCE: PALMETTO GBA W A2061 08609 PATIENT NUMBER: CALL NUMBER: DATE OF CALL: TIME OF CALL: CALLER: FROM: TO: 54388 REJ 3071352A NONE 09/22/2006 PATIENT NAME: LAURA NAGLE 3071352A 226 N 23RD ST HOLY SPIRIT HOSPITAL LAURA NAGLE 226 N 23RD ST CAMP HILL, PA 17011 REASON(S) FOR TRANSPORT ALTERED LEVEl.. OF CONSCIOU INVOICE DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT PARAMEDIC INTERCEPT EKG ELECTRODES GLUCOSE BLOOD A0999 A0396 A0394 1.0 1.0 1.0 617.52 4.70 6.42 617.52 4.70 6.42 ~ tj~~ ~ ~ ~(p 1 "'1.- )\ lP 0 v<>{ 628 64 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT . . "'_~_I - .. .... PLEASE PAY THIS AMOUNT - INVOICE DUE UPON RECEIPT --- RETURNED CHECK FEE - $32.00 $628.64 t ~, '" LAST WILL & TESTAMENT OF LAlJRA JANE NAGLE '\., .AND NOW BE I';rRE~MBERED, thi~12th day ofOctober,2005,that I, LAURA JANE NAGLE, of the Borough of Camp Hill, County of Cumberland, and Commonwealth of Pennsylvania, declare the following to be my LAST wiLL AND . .TESTAMENT, hereby.revokiBg all Wills and Codicil$ heretofore made by me. FIRST: I direct that all my just debts, expenses of any last illness, and funeral expenses shall be paid f:rommy estate as. soon as practicable after my..decease as a part of the achn.inistration of my estate. SECOND: I give and bequeath all of the personalty that may be found in my residence at the time of my death to my children .hereinafternamed.according to their desire. Should any item therein remain unclaimed or should any item be desired by more than one of my children, said item, or items, shall be sold and the proceeds thereof be distributed in accordance with my Last Will & Testament as set forth in' THIlMlofthis document THIRJ;>:. With the res!, residue,' and remainder of my estate, whether real, personal, or mixed, I hereby give, devise, and bequeath; and in equai shares, share and share alike, to my loving chiidFen, KEVIN ALLAN NAGLE, Camp Hill, CHRISTOPHER EUGENE NAGLE, Camp Hill, and CHERYL SUZANNE STEVENS, Hanisburg, per stirpes. FOURTH: Until.distributed,no giftorber1eficial interest shall be subject to anticipation or to voluntary or.involuntaryalienation. FIFTH: In the event all of the above-named beneficiaries predecease me or fail to survive my death by the stipulated time period, failing to leave surviving issue, then I direct that my entire estate be distributed to my next ofkin as then ascertained under the in testate laws of Pennsylvania, then in existence, so long as my next of kin shall not 10f4 '-, Last Will & Testament of Laura Jane Nagle include the Commonwealth ofPennsylvaqia, and shall be construed to include, if necessary, my next of kin in addition to those designated under the in testate laws of Penn$Ylvania. , SIXTH: I hereby grant to my Executor hereinafter named, the following "- full powers and authority, in addition to. those powers and authority given by law or by this .iiiStri:lIiieni otherwise: A. To sell. any and all real estate of which I die seized, at public or private sale, for such prices and llponsuchteJ:msand conditions as my Executrix shall deem advisable, and to make, execute and deliver good and sufficient deed. or deeds . thereof, conveying title thereto . in fee simple absolute or for any less estate to any purchaser or purchasers; B. To make. distribution of my estate in kind, in cash, or partly in kind and partly in cash, as my Executrix shall believe advisable; C. 1oC<>1nproInise any claim or controversy; .and/or D. To.repair, alter, .or improve any real or personal property for the benefit of my estate. J SEVENTH: I direct that my Executor pay .out of my residuary estate in the same manner asanexpenseofadIninistration, all death, succession, transfer, estate and inheritance taxes assessed upon or with respect to any property that is included in my estate for computing any..ofsuch'taxes. . EIGHTH: I hereby name and appoint my loving son, KEVIN . "- ALLAN NAGLE as Executor of this my Last Will and Testament. Should KEVIN ALLAN NAGLE predecease me or be unwilliIlg or unable to serve in such capacity, then I name and appoint my loving son, CHRISTOPHER EUGENE NAGLE as Executor of this my Last Will & Testament. NINTH: I hereby direct that my personal representative, trustee, custodian andguardian of any and all minor's estates shall not be required to give bond for the faithful perf.ormance .of their duties in any jurisdicti.on. .TENTH: I request that in the event his services are available, that ALLEN D. MOYER, Att.orney at Law, .of the LAW OFFICES OF LESLIE DAVID 2of4 " , Last Will & Testament of Laura Jane Nagle JACOBSON of Harrisburg, Pennsylvania, be retained as the attorney in the administration of my estate because ofms familiarity with my affairs. IN WITNESS WHEREOF, I have hereunto set my hand and seal on thi~strument only, this the 12th day of October, 2005. This Document, in its entirety, consists of four pag~s,tl.rls. b~iI1~~llg~ '.rln-~e. . . . .....~" ~h/1~A LAURA JANE NAGLE . . (SEAL) SIGNED, SEALED, PuBLISHED AND DECLARED by the above.named Testatrix., LAURA JANE NAGLE, as her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. of Harrisburg, Pennsylvania. of Harrisburg, Pennsylvania 3of4 '" '. ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYL V ANlA ) ) SS: ) COUNTY OF DAUPHIN '!. WE, LAURAJANE NAGLE, LESLIE D. JACOBSON, ,and CHAD JULIUS, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix sign~ and executed the instrument as her Last Will & Testament and that she signedw:H~i'ngly,anc:l that she executed it as her free and voluntary act for the purposes heremexpress~d,~'atJ.d that each of the witnesses, in the presence and hearing' of the Testatrix, sign~d tl1eWill as witness and that to the best of their kno~ledge, the Testatrix was atthatum.e,eight~nyears of age' or older, of sound mind, and under no constraint or undue influence. ~L~ LAURA JANE NAGLE, 1:. . trix , (SEAL) (SEAL) (SEAL) EDGED before me by LAURA JANE the Testatrix, and subscribed and sworn to before me by LESLIE D. JACOBSON and CHAD NOTAAlALSEAL TNAMY,I.. KmERERrNOTNWPUBtJC SWATMA 1Wf':. 00UN1'Y of'~: , flfCOMMSSK* EXPIRES ~ .211)6" (SEAL) 40f4 Regular Cl.tecking Account Statement PNC Bank' 0PNCBANK For the period 09/12/2008 to 10/11/2008 Primary account number: 51-4004-5983 Page 1 of 3 Number of enclosures: 0 K HENRY NAGLE MRS H NAGLE 226 N 23RD- ST CAMP HILL PA 17011-3822 Q For 24-hour banking, and transaction or interest rate information, sign on to . 1r PNC Bank Online Banking at pnc.com. For customer service cail1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espattol, 1-866-HOj..A-PNC Movlngl Please contact us at 1-888-PNC-BANK ~ Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 liiVisit us at pnc.com I TDDterminal: 1-800-531-1648 For hearing impaired clients only IHPORTANT ACCOUNT INFORHATION Supplement to the Conswner Schedule of Service Charges and Fees The infonnation below supplements certaul intonnation in our Consumer Schedule of Service Charges and Fees. Please retain tIlis infonnation with your records. Effective 9/23/06 Now Available - Stop Payments on Visa@ Recurring PreautIlorized Payments You may now stop payment on a Visa recurring preauthorized payment originated by use of your PNC Check Card. lllese Visa stop payment orders must be made at least three (3) business days priOl" to the schedtded posting date of the tmnsactionand shall be etlective for two (2) years from the date the order is received. At least one (l)tmnsaction must have previously posted. Visa stop payment orders are sU~lect to a $31 fee. Please call 1-800-PNC-BANK (1-800-762-2265) or contactyourlocalPNC Bank Branch to initiate a stop payment. R.gul.... Ch.cking Account SUDlmary Account number: 51-4004-5983 Henry Nagle Mrs H Nagle Balance Summary Average monthly balance 2,624.87 End i ng balance 2,548.~6 Charges' and fees 18.99 Please see the Activity Detail section for 'additional information. ' Beginning balance 2;754.00 Deposits and other additions .00 Checks and other deductions 205.44 Tran_ction Summary Checks paid/ withdrawals Check Card POS signed transactions Check Card/Bankcard POS PIN transactions 3 o o Total ATM transactions PNC Bank ATM transactions Other Bank ATM transactions o o o FORM953R.l005 Regular Checking Acconnt Statement a For 24-hour information, sign on to PNC Bank Online Banking. on pnc.com. Accountnulnber:51400~5983.continued For tile period 09/12/2006 to 10/11/2006 HENRY NAGLE Primary account number: 51-4004-5983 Page 2 of 3 Activity Detail Checks and Substitute Checks Check Date number Amount 'pald 9743 45.58 '09/19 9745 * 64.97 09425 Reference nu mber 025687245 028198965 Check number 9748 >I< Amount 42.63 Date paid 09/28 Reference number E094081151 * Gap in check sequence There were 3 checks listed totaling $153.18. There was 1 Online or Electronic Banking Deduction totaling $33.27. Online and Electronic Banking Deductions Date Amount Description 09/19 33.27 Payment,E-Check Check Pymt Verizon ARC 9744 Date 09/21 10/11 Amount Description 16.99 Check Printing Fee 2.00 Check Images In Statement Fee There were 2 Other Deductions totaling $18.99. Other Deductions Daily Balance Detail Date Balance 09/12 2,754.00 09/19 2,675.15 Date ~2J 09/25 Balance 2 658'~9 2,593.19 Date 09/28 10/11 Balance 2,550.56 2,548.56 Looking for the perfect gift? The American Express@ Gift Cheque is accepted at over a million places and now comes with Special Offers from retailers, restaurants and other merchants nationwide. Visit www.americanexpress.com/specialoffers for more details. * * Tenns, conditions, restrictions, and fees apply.