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Home My WebLink About07-12-07 . .-.J 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 Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 21 06 0393 Date of Birth 201-18-4571 03/08/2006 07/01/1923 Decedent's Last Name Suffix Decedent's First Name MI Bixler Vivian B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's 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 ca:> 1. Original Return C:=::) 2. Supplemental Return C:1 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::::::> 4. Limited Estate ~ (,;;::::) 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::J 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 Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes c=> Robert A Hopstetter Esq Firm Name (If Applicable) FeemanMesics&Hopstetter (717) 272-3477 City or Post Office State ZIP Code f',,) c=:t REGISTER ~ILLS USE o~ C;:o C- ::~""' :0 c: 711-00 I . ..1.- I "~ 2:;:: rn ~~: ~ ~ ("')0 JQ-n ;-....'\I~ --' -'0 OA-Ho=do :J> ....... "i"'-----' ~;S ("") ::Y.J ,'J tf1 CJ First line of address 247 S 8th St N Second line of address c::) -1'''1 '-11 (.:-) ~ Lebanon PA 17042 -0 :x N .. <..rt o Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, 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. ::<Jt PERSON RE PO BLE F!L1N ETURN ~ ~ Ol 0-0 7 Burnadetta Bixler Executrix 2 Creek Bank Dr Mechanicsburg PA 17050 :~~~~TATlVE 7/f;b7 Robert A Ho~:-e:%;eeman Mesics & Hopsetter PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 .-J -I 15056052059 REV-1500 EX Decedent's Name: Vivian B Bixler 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) (=:i Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C1 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 Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value SubjecttoTax (Line 12 minus Line 13) ........................14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPUCABLE 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_ 17. Amount of Line 14 taxable at sibling rate X .12 323,623.20 18. Amount of Line 14 taxable at collateral rate X. 15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 201-18-4571 Decedent's Social Security Number 59,575.19 147,308.06 139,737.27 346,620.52 22,038.10 959.22 22,997.32 323,623.20 38,834.78 38,834.78 15056052059 ---I REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME Vivian B Bixler STREET ADDRESS 2 Creek Bank Drive FJ!!.~"'m~'r 0393 DECEDENT'S SOCIAL SECURITY NUMBER 201-18-4571 CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 38,834.78 30,000.00 1,578.95 Total Credits ( A + 8 + C ) (2) 31,578.95 3. Interest/Penalty if applicable D. Interest E. Penalty 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. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5) (5A) (58) 7,255.83 334.17 7,590.00 A. Enter the interest on the tax 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 [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 Ii] c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 Ii] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 Ii] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............. 0 [i] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [i] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax 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 zem (0) percent [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV.1503 EX + (6-98) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Bixler Vivian Bethea FILE NUMBER 21 06 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0393 ITEM NUMBER DESCRIPTION 1. 1890 SHS. SPRINT @ 22.53 2. 250 SHS. SPRINT @ 22.53 3. 209 SHS. ALL TEL @ 65.815 4. 37.77 SHS ALL TEL @ 65.815 5. 12 SHS EMBARQ @ 0 6. 94 SHS EMBARQ @ 0 7. 232 SHS WINDSTREAM @ 12.35 8. 23 SHS WINDSTREAM @ 12.35 VALUE AT DATE OF DEATH 42,581.70 5,632.50 5,725.91 2,485.83 0.00 0.00 2,865.20 284.05 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 59.575.19 REV-1508 EX + (6-98) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bixler Vivian Bethea 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. 0393 ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. DESCRIPTION Integreity Bank: Certificate of Deposit #10186 - $10,000.00 / accrued int $21.86 Certificate of Deposit #10187 - $10,000.00/ accrued int $21.86 Members First Federal Credit Union: Savings Acct #254365-00 $25.00 Certificate of Deposit #254365-40 - $10,000.00 / accrued int $8.46 Members First Federal Credit Union: Certificate of Deposit #254365- 41 - $10,000.00 / accrued int $8.46 Certificate of Deposit #254365- 42 - $10,000.00 I accrued int $8.46 Members First Federal Credit Union: Certificate of Deposit #254365- 43 - $10,000.00 I accrued int $8.46 Certificate of Deposit #254365- 44 - $10,000.00 I accrued int $8.46 Fulton Bank: Certificate of Deposit #025-0170393 - $10,000.00 / accrued int $13.20 The Bank of Landisburg: Certificate of Deposit #700013672 - $10,000.00 / accrued int $17.00 Certificate of Deposit #700013673 - $10,000.00/ accrued int $17.00 The Bank of Landisburg: Certificate of Deposit #700013674 - $10,000.00 I accrued int $17.00 Certificate of Deposit #700013791 - $10,000.00 I accrued int $16.77 The First National Bank of Newport: Checing acct #2207676801 Quantum Imaging & Therapeutic Associates - refund 10. US Treasury - income tax refund VALUE AT DATE OF DEATH 20,043.72 10,033.46 20,016.92 20,016.92 10,013.20 20,034.00 20,033.77 25,950.11 45.96 1,120.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 147 308.06 REV-1509 EX + (6-98) * SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bixler Vivian Bethea FILE NUMBER 21 06 0393 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. Burnadetta Bixler 2 Creek Bank Drive Mechanicsburg, PA 17020 Sister B c JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 2/2000 2 Creek Bank Drive, Mechanicsburg, PA 17022 244,700.00 50. 122,350.00 (Silver Spring Twp/Cumberland Co) 2. A 6/1999 890 SHS. SPRINT @ 22.53 20,051.70 50. 10,025.85 3. A 6/1999 209 SHS. ALL TEL @ 65.815 13,623.67 50. 6,811.84 4. A 6/1999 44 SHS EMBARQ @ 50. 0.00 5. A 6/1999 89 SHS WINDSTREAM @ 12.35 1,099.15 50. 549.58 TOTAL (Also enter on line 6, Recapitulation) $ 139 737.27 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) .. SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bixler Vivian Bethea FILE NUMBER 21 06 0393 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Central PA Pulminary Assoc 2. Pinnacle Health Medical Services 3. Quantum Imaging & Therapuetic 4. Metro Medical Services 5. Holy Spirit Hospital 6. Central PA Imaging VALUE AT DATE OF DEATH 161.26 24.06 21.86 46.20 695.71 10.13 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 959.22 REV-1511 EX + (12-99) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF Bixler Vivian Bethea Debts of decedent must be reported on Schedule I. 21 06 0393 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ronald C. L. Smith Funeral Home 325 N. High St., Duncannon, PA 17020 6,189.00 2. Ronald C. l. Smith Funeral Home - death certificates 114.00 3. Ranch House - funeral luncheon 300.00 4. Duncannon Record - Thank You ad 5.10 5. Rice Memorial Works - tombstone 5,350.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Feeman Mesics & Hopstetter 9,750.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 330.00 5. Accountanfs Fees 6. Tax Return Prepare~s Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 22.038.10 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (~-~_ . '~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Bixler Vivian ro. 'L 21 06 0393 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 ~nclude outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] 1. Burnadetta Bixler Sister 100% 2 Creek Bank Drive Mechanicsburg 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 $ (If more space is needed, insert additional sheets of the same size) p LAST WILL AND TESTAMENT County of r--.,) c:~ f:;:-_.J n C-.... ~::;) :r~ - '-"f "7'~t... I, VIVIAN BETHEA BIXLER, of the Borough of Dupsfrlnonf ;':';: Lq 1- Perry, and Commonwealth of Pennsylvania, bein~<~~ sound ) ,-=) -'-1:\ ~ and disposing mind, memory and understanding, do hereby}:~ke, ~ . ~.. I~ ~_~ '1 .HI - -> . . <"''1 publish and declare the following as and for my Last Will andU1 Testament, hereby r~voking and making null and void any and all former wills by me at any. time heretofore made, viz: ITEM I. I direct that all my just debts and funeral expenses including my. grave marker shall be paid from my residuary estate as soon. as practicable after my decease as a part of the expense of the administration of my estate. ITEM II. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expense of the administration of my estate. ITEM III. I give, devise, and bequeath my entire estate, real, personal, and mixed, of whatever nature and wherever situate unto my sister, BURNADETTA BIXLER. ITEM IV. In the event my sister, Burnadetta Bixler, shall predecease me, or die simultaneously with me, or so nearly so that it cannot be determined which of us survived the Page 1 of 4 ::'Ti (Tj (:;~.,.? <'..,) C;j fl'l ,C:J C') ! -:-1 ---:-1 ?:; ITl other, then, in any of such events, I give, devise, and bequeath my entire estate, real, personal, and mixed, of whatever nature and wherever situate unto my sister, RUTH E. BIXLER. ITEM V. In the event both of my sister, Burnadetta Bixler and Ruth E. Bixler, shall predecease me, or die simultaneously with me, or so nearly so that it cannot be determined which of us survived the other, then, in any of such events, I order and direct my hereinafter named Executrix to convert my entire estate into cash as soon as it may be convenient after my decease, and to that end I hereby authorize, direct, and empower my said Executrix to sell all of the real estate of which I may die seized at eithe~ public or private sale or sales, for the:.best price or prices obtainable therefor, and to give good and sufficient deed or deeds "therefor, in fee simple, to the purchaser or purchasers thereof. The money so obtained from the conversion of my estate, I give and bequeath unto the following individuals, in equal shares: 1. ONE (1) equal share to my sister, E. LEONA HENNESSY; and 2. ONE (1) equal share to my sister, ANNA R. PENNINGTON. Page 2 of 4 ITEM VI. I appoint my sister, BURNADETTA BIXLER, as Executrix of this, my Last Will and Testament. In the event I am not survived by my said sister, Burnadetta Bixler, or she fails to qualify or ceases to act as Executrix of my estate, I appoint my sister, RUTH E. BIXLER, as Executrix of this, my Last Will and Testament. In the further event I am not survived by my said sister, Ruth E. Bixler, or she fails to qualify or ceases to act as Executrix of my e.state, I appoint my sister, E. LEONA HENNESSY, as Executrix of this, my Last Will and Testament. ITEM VII. I hereby direct that no Executrix shall be required to give any bond in any jurisdiction and that if, notwithstanding this direction, any bond is required by any Law, Statute, or Rule of .Court, no sureties shall be required thereon. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of this and three (3) other pages, this ~ day of ~~V4dl ,A.D., 1997. d...~ iJztt",,-,~ (SEAL) Vivian Bethea Bixler SIGNED, SEALED, PUBLISHED and DECLARED by VIVIAN BETHEA BIXLER, Testatrix above named, as and for her Last Will and Testament, and we at her request, in her presence, and in the presence of Page 3 of 4 each other, have subscribed our names as attesting witnesses thereof. ~~ ..' ~A// ~ c:/ /~....~L ~~ 2:.~ /7lLlhj -.i;() ~LLLOJ I J .I ( i/ I t2cf7 S. Yr( Sr: Address Lehtfl.,...,,,,,.:J. r'!A- t7~..2. , t IJI (2,1 a /x.h~iL!J ~(;t..V .k?o [cd Address .JY'(UlLI.../:/:,.>tt../LP.. -Pi} /71'//-.331.1 / . Address Page 4 of 4