HomeMy WebLinkAbout06-27-07
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:1505b04:1:147
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
*'
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 7
File Number
0174
Decedent's Last Name
Suffix
Date of Birth
10091926
Decedent's First Name MI
ROBERT H
Spouse's First Name MI
PEARL E
157203475
02082007
PETERSEN
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
PETERSEN
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~J 1. Original Return
D 4. Limited Estate
rX I 6. Decedent Died Testate
l':'.~ (Attach Copy of Will)
[] 9. Litigation Proceeds Received
D
D
D
D
4a. Future Interest Compromise
(date of death aller 12-12-82)
D
D
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
2. Supplemental Return
7 Decedent Maintained a Living Trust
. (Allach Copy of Trust)
8. Total Number of Safe Deposit Boxes
10 Spousal Poverty Credrt (date of death
. between 12-31-91 and 1-1-95)
D
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
~ORRESPONDENT _ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
JAMES D. HUGHES ESQ. 7172496333
354 ALEXANDER SPRING ROAD,
""
REGIS~& WILLS~E O~"€ f~'
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~500
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jiATE FILED c.,.)
:J:IIO
:x
Firm Name (If Applicable)
SALZMANN HUGHES PC
First line of address
Second line of address
CARLISLE
PA
ZIP Code
17015
City or Post Office State
Correspondent's e-mail address:
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.
SIGNA URE OF PERS N PONSIBLE FOR FILING RETURN. DATE
Tracy L. Olson
()r, '20 . ()
Jart;les D. Hughes Esq.
exander Spring Road, Suite 1, Carlisle, PA 17015
Side 1
:1S0S604:1:147
J,SOSb04:1:147
--.Jv1
-.J
15056042148
REV-1500 EX
Decedenl'sName: Robert H. Petersen
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) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property .
(Schedule G) D 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.N.~~~alu~~ubj~ct t~_Tax SLine 12 minus Line 13)........................:........................ 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
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
39.748 03
15.
o 00
16.
o 00
17.
o 00
18.
19. Tax Due................. ............. .................................................................................... ... 19.
20: FILL: Ill! THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
~
~'R~
~~
Side 2
L
15056042148
Decedent's Social Security Number
157203475
49.088.72
49 088,72
--~-
9 340.69
9 340 69
39 748 03
39,748.03
o 00
o 00
o 00
o 00
o 00
D
15056042148
-.J
REV-1500 EX Page 3
Decedent's Complete Address: .
DECEDENT'S NAME
Robert H. Petersen
--~-----------_._-_._~---
STREET ADDRESS
325 Wesley Drive
File Number 21-07 -0174
ISTATE-TZIP
PA I 17055
CITY
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 0.00
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
TotallnteresUPenalty (0 + E)
;
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
[]
o
[J
[J
[]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ [J
4. ~~t~~:~e~~~~~i:~1 ~~~~~~:o~~~~.~.~.~.~.~ .~~~~~~~.:. ~~~~~~~'. .~~. ~~~~~. .~.~.~.~:.~~~~~~. :..~~:.~~ .~.~~~~........... ...... [] [~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..................................................................................
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or..................................................................................................................
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?..................................................................................................................... .
No
I
~
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 tcfx 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 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 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.1503 EX+ (8.98)
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Petersen, Robert H.
FILE NUMBER
21-07-0174
ESTATE OF
All property jolntly-owned with right of survlvol'llhlp must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 Edward Jones - acct. #377-09071-1-5 with Bonds, 49,088.72
Stocks & Mutual Funds
TOTAL (Also enter on Line 2, Recapitulation) 49,088.72
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
REV.1151 EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINiStRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
ESTATE OF
Petersen, Robert H.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-07-0174
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
Ewing Brothers
4,930.69
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) I EIN Numberof Personal Representative(s):
Street Address
City
Year(s) Commission paid
State Zip
2.
Attorney's Fees
SALZMANN HUGHES PC
750.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Pearl E. Petersen
Street Address 325 Wesley Drive
City Mechanicsburg
3,500.00
Relationship of Claimant to Decedent
State
Spouse
PA
Zip
17055
4.
Probate Fees
160.00
5. Accountant's Fees
."
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation)
9,340.69
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
REV.1813 EX+ (9-001
*'
SCHEDULE ~
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Petersen, Robert H.
NAME AND ADDRESS OF
PERSON(S) RECEIVING .pROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions.l. and transfers
under Sec. ~116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trustee/sl
FILE NUMBER
21-07-0174
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
I.
Pearl E. Petersen
325 Wesley Drive
Mechanicsburg, PA 17055
Spouse
lCO%,
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropnate, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
Oriqinal .picked up bV Tracv L. Olson on () 2.. 23 0'7'
Siqned~ "- (10.--
LAST WILL AND TESTAMENT
I, ROBERT H. PETERSEN, of Lower Allen Township, Cumberland County,
Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make,
publish and declare this to be my Last Will and Testament, hereby revoking all Wills and
Codicils heretofore made by me.
ONE.
I direct my Executor or Exeeutmf,1lS--the case lllay-be, to pay all-of my
debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore,
I direct that all state, inheritance, succession and other death taxes imposed or payable by reason
of my death and interest and penalties thereon with respect to all property composing of my gross
estate for death tax purposes, whether or not such property passes under this Will, shall be paid
~
~
by the Executor or Executrix of my estate. Further, to the extent that sufficient assets exist in my
estate, any and all inheritance or other estate taxes, whether to non-charitable or charitable
beneficiaries, shall be paid by my Executor or Execurx'ffom the residuary of my estate.
. \~::/ ,;'
TWO. My Executor or Executrix may, \'at his~'6r her discretion, compromise
. <." .,,; i::; .
claims, borrow money, retain property for such length of time as(,he!'O'r she may deem proper;
. .
lease and sell property for such prices, on such terms, at public or private sales, as he or she may
\
deem proper; and invest estate property and income without restriction to legal investments
unless otherwise provided hereunder. I authorize and empower my Executor or Executrlx to sell
any realty and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale
therefor, in fee simple, as I could do if living. My Executor or Executrix is authorized and
empowered to engage in any b~siness in which I may be engaged at my death, for such period of
. time after my death as seems expedient to said Executor or Executrix.
THREE. I give, devise and bequeath all of my estate of whatever nature and
wherever situate to my spouse, PEARL E. PETERSEN.
FOUR. If my spouse, PEARL E. PETERSEN, does not survive me by a period of
at least sixty (60) days, I then give, devise and bequeath the rest, residue and remainder of my
estate as follows:
A. Fifty percent (50%) to TRACY L. OLSON, Enola, Pennsylvania; ;f RfJ
B. Fifty percent (50%) to be divided in equal shares between the following
charitable organizations for their general charitable purposes: HELEN KRAUSE
ANIMAL FOUNDAtION,. Dillsburg, Pennsylvania, THE SALVATION ARMY,
Carlisle, Pennsylvania and the DISABLED AMERICAN VETERANS, 3725 Alexandria
Pike, Cold Springs, KentUcky to' be used for disabled veterans from the Central
Pennsylvania Region.
C. In the event that any of these institutions named above cease to exist prior
to the time of my decease and there is no successor entity with the same purpose, then in
that event, its respective. share shall be divided equally between the other residual
beneficiaries of this Paragraph Four.
FIVE. I hereby nominate and appoint TRACY L. OLSON, to be the Executrix of A1# P
this my Last Will and Testament. In the event for whatever reason she is unable to serve as the
Executrix of my estate, I hereby appoint JAMES D. HUGHES to be the substitute Executor of
this my Last Will and Testament, whereby the said substitute personal representative shall have
the same powers as are given to the original Executrix hereunder.
2
SIX. No person(s) shall benefit hereunder unless such beneficiary shall survive
me by sixty (60) days.
SEVEN.
No Exe~utrix or' Exec~tor acting hereunder shall be required to post bond
or enter security in this or any other jurisdiction.
EIGHT.
No beneficiary may assign, anticipate or pledge its interest in any income
or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or
otherwise reach any such interest.
NINE.
If any person or institution entitled to share in any distribution under the
terms of this my Last Will and Testament becomes an adverse party in any proceeding to contest
the probate of this Last Will and Testament, such person or institution shall forfeit his, her or its
entire interest inherited hereunder and all provisions in favor of such person or institution shall
be declared void and of no effect. The share of such person or institution so forfeited shall be
distributed as part of the residue pursuant to Paragraph Four hereof except that if such person or.
institution is entitled to share in the said residue, that. interest shall be distributed proportionately
to the other residuary distributees.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~.J day of
February, 2006.
IP crW-# ~(SEAL)
ROBERT H. PETERSEN
3
Signed, sealed, published and declared by the above-named person as and for a Last Will
and Testament, in our presence, who atsaid person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
4
(Ylm
ACKNOWLEDGMENT AND AFFIDAVIT
WE, ROBERT H. PETERSEN, JAMES D. HUGHES, and KAMELA S.
CORNMAN, the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the unders~gned authority that the
testator signed and executed the instrument as his Last Will, and that he had signed willingly,
and that he executed it as his free and voluntary act for the purpose herein expressed, and that
each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and
that to the best of their, knowledge the. testator. was, at that time, eighteen years of age or older, of
sound mind and under no constraint or undue influence.
COMMONWEALTH OF PENNSYL VANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged ~fore me by ROBERT H. PETERSEN, the
testator herein, and subscribed and swoI1h~l ore me by JAMES D. HUGHES and
KAMELA S. CORNMAN, witnesses, this.drl!.. ay f Feb ry,20
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
J~ineL~'~
eanisle~. ~ 14 2007
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