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HomeMy WebLinkAbout08-16-0715056041125 REV-1500 EX (os_D5> PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PoBOx28oso1 INHERITANCE TAX RETURN 2 1 0 7 0 4 7 1 Harrisbu , PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 7 5 3 2 2 5 6 4 0 4 1 0 2 0 0 7 1 0 0 8 1 9 3 7 Decedent's Last Name Suffix Decedent's First Name MI K E L L E R R O G E R M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI K E L L E R CAR O L J Spouse's Social Security Number 3 0 0 6 6 8 3 5 4 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum 4. Limited Estate QX 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 2. Supplemental Return 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 between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) t.vrtrctSPVNDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number W I L L I A M A D U N CAN 7 1 7 2 4 9 7 7 8 0 Firm Name (If Applicable) REGISTE~rt-QF WILLS U NLY D U N C A N & H A R T M A N P C `_-; n ~' _ __ '.4~ - ~ First line of address ~ -~~ _ _ ~ `-~ ~i 1 I R V I N E R O W _~~ -. Second line of address I ~` C7 - -; City or Post Office C A R L I S L E Correspondent's e-mail address: billduncan@planetcable.net State ZIP Code P A 1 7 0 1 3 ~_~ __ _ _ .:rci ~~ _,:r' _ i a ~ ''-DA7~ FILED ~ - ' 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 complex. Declaration of preparer other than the personal representative is based on aN information of whidh preparer has any knowledge. SIG ~E OF I~RSO~ESP ~CIN/SJBLE~F~R FILING RETURN _ pp~ 6~l~il I,~LESf;X'`.~~I~~ CARLISLE PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 15056041125 J 15056042126 REV-1500 EX Decedent's Social Security Number ~ecedent'sName: ROGER M. KELLER 2 7 5 3 2 2 5 6 4 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. 2 1 5 0 0 , 0 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ... .... 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ... .... 7. 3 3 9 2 0 5, 5 3 8. Total Gross Assets (total Lines 1-7) ....................... .... 8. 3 6 0 7 0 5, 5 3 9. Funeral Expenses & Administrative Costs (Schedule H) ............ .... 9. 1 1 9 2 2 , 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........ .... 10. 11. Total Deductions (total Lines 9 & 10) ....................... .... 11. 1 1 9 2 2 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ..................... .... 12. 3 4 8 7 8 3 , 5 3 13. Charitable and Governmental Bequests/Sec 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. 3 4 8 7 8 3 , 5 3 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 .o _ 3 4 8 7 8 3, 5 3 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0. 0 0 16 0. 0 0 17. Amount of Line 14 taxable 0 0 0 . at sibling rate X .12 17. 0. 0 0 18. Amount of Line 14 taxable 0 0 0 . at collateral rate X .15 18 0. 0 0 19. Tax Due ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042126 15056042126 0. 0 0 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 07 0471 DECEDENTS NAME ROGER M. KELLER STREET ADDRESS 687 S. MIDDLESEX ROAD CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: ~ • Tax Due (Page 2 line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Llne 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. 0.00 (5) 0 00 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0 00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. lid decedent make a transfer and: Yes No 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; ............................ . ^ ^ 0 . c. retain a reversionary interest; or ............................................................................................... : d. receive the promise for life of either payments, benefits or care? ....................................................... ^ ^ 0 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................... 3. Did decedent own an "intrust for' or payable upon death bank acxount or security at his or her death? ......... ^ ^ Q 4. Did decedent own an Individual Retirement Acx:ount, annuity, or other non-probate property which contains a beneficlary designation? .................................................................................................. Q ^ 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 fa the use of the surviving spouse is three (3) percent p2 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 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 p2 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 beneficlaries 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (1) 0 00 Total Credits (A + B + C) (2) Total InteresUPenalty (D + E ) (3) 0 00 0.00 (4) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, Ot, MISC. IN RES DENT DECEDENT N PERSONAL PROPERTY ESTATE OF FILE NUMBER ROGER M. KELLER 21 07 0471 Indude the proceeds of litigation and the date the proceeds were received by the estate. Atl ProPeKY joiMlY-orvnad witlr right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2002 GMC ENVOY 9,000.00 [SEE ATTACHED VALUATION] 2. 1987 CLASSIC CORVETTE 12,500.00 ]SEE ATTACHED VALUATION] TOTAL (Also enteral line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMFAONVNEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY NUMBER ROGER M. KELLER 21 07 0471 This schedule must be completed and filed 'rf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY ir~auoer~wu,~oFrr~rwwsrfrtt~,n~eaaannoru~xvrooeeeo~r~wo r"E°"n:°Fn:""SCR"1r"o""co~roFn~°~°F°r:r~uEST"TE_ DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION nvnrPUC"e~~ TAXABLE VALUE 1. STATE FARM BANK IRA 173,792.13 100. 173 792.13 [SEE ATTACHED VALUATION] , 2. COMMUNITY BANK IRA 165,413.40 100. 165,413.40 [SEE ATTACHED VALUATION] TOTAL (Also enter on line 7 Recapitulation) ~ s 339 205 53 !If mnrn enaro ie neerlnri inmrf aririifinnal eheglc of fhe eanw ci~ul REV-1511 EX + (12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ROGER M. KELLER 21 07 0471 Debts of decederK must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1. EWING BROTHERS -FUNERAL SERVICES B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Represertlative (s) Soaal Searity Number(s)/EIN Number of Personal Representative(s) 6,000.00 Street Address Cdy State Zip Year(s) Commission Paid: 2, AttomeyFees DUNCAN 8~ HARTMAN, PC 2,000.00 3. Famiy Exemption: (If decedents address is rrot the same as daimanYs, attach explanation) 3, 500.00 Claimant CAROL J. KELLER SlreetAddress 687 S. MIDDLESEX ROAD City CARLISLE S~ PA Zip 17013 Relationship of Claimant to Decedent SPOUSE 4• Probate Fees REGISTER OF WILLS FILING FEE 422.00 5 Accountants Fees 6. ~ Tax Retum Preparer's Fees 7 TOTAL (Also enter on line 9, Recapitulation) ~ s (If more space is needed, insert additional sheets of the same size) AMOUNT 1 REV-1513 EX + (9.00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERffANCE TAX RETURN RESIDENT DECEDENT OF FILE NI ROGER M. KELLER 21 07 0471 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (ndude outright spa~sal dstritHrtions, and transfers under Sec. 9116 (a) (1. )2 1. CAROL J. KELLER Spousal 687 S. MIDDLESEX ROAD 100% SHARE CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 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 ; fir mae space Is neeaea, Insert atltlltlonal sheets of the same size) LAST WILL TESTAMENT OF I, ROGER M. KELLER of 687 South Middlesex Road, South Middleton Township, Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred within my family's burial plot in accord with my expressed wishes. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative-shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath all of my estate of every nature and wherever situate unto my wife, CAROL J. KELLER, provided she survives me by thirty (30) days. In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all of my estate unto my children, ROBERT ALLEN KELLER, KEVIN WAYNE KELLER, DAVID MARTIN KELLER, LAURA LYNN KELLER and my grandson, ERIC PAUL KELLER, in equal shares, per stirpes. FIFTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate Passing under my will or otherwise, shall be paid out of the principal of my residuary estate. SIXTH I hereby nominate, constitute and appoint my wife, CAROL J. KELLER as Executrix of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of CAROL J. KELLER , I nominate, constitute and appoint LAURA LYNN KELLER as Executrix of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties, as such, in any jurisdiction in which she maybe called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executrix, in her absolute __ discretion, to retainiri the form received; and to se1T either at public or private sale ary real o~ -- - - - - personal property owned by me at the time of my death. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of one typewritten page this ~ day of .~'.~ ~ 2006. ~~w~ ~ ; ROG ~~M. KELLER ~; ,: Signed, sealed published and declared by the above named Testator ROGER M. KELLER as and ------ ---- - for his Last Will and Testamen~in the pre-sense of us-who, at his. request, in his sight_and`_ __ .___ _ presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. i' ~_ ,, COMMONWEALTH OF PENNSYLVANIA . SS. COUNTY OF CUMBERLAND I, ROGER M. KELLER ,Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ,-~~~ 1, R~bUF~R'`,~1. KELLER ',..; Sworn or affirmed to and acknowledged before me, by ROGER M. KELLER this .,~ j day of ~~~~''~ ~ ,. , 2006. a Notary Public `. -._ _ _ _._ .. __ _ r;~ COMMONWEALTH OF PENNSYL VANIA - ---- - ----------- :SS. --____ . COUNTY OF CUMBERLAND We, 1~~ `%1.;V`{'~ ~~ 1~,i~~~,.~t~'\ and ~ ~ :~~,::~1 t -~- r`i~~~-;1~~'i.,r?. s the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw ROGER M. KELLER sign and execute the instrument as his Last Will; that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. 't ` ~~~ ~ ~ (, ~ ~' ~ ~_~_ Sworn or affirmed to and subscribed before me by `Uti.1; ' ; i ~: s..~Y~ ~ ~...`t; t ~(~ l~ and `,_,~_~,~~, ~.? j~ca~h.Y'~> ,witnesses, this , 7,`~ day of ~ ;~ ~ , 2006. .~ ~. ~,~ Notary1~ublic lV~T~,f~9AL SEAS. ~at~y !". ~Jlu~mart, Notary Rtpblic .::-t~::t~lt of Carlislo, ~urr~barland Co., PA try ~~z~~r~i ,got, ~€air~s Atae~.11 20Q7 Antique Appraisals and Online Valuations Ranging From Furniture to Car Appraisals Page 1 of 2 ryo iirtd~r~k=.:~ f.~rovidecl Appraisal ID: Appraised On: Title: Date/Era/Period: Description: Condition: Origin: Provenance: 141340 24-05-2007 1987 Classic Corvette 1987 Metallic Blue, Options: Delca-Bose Music system, Electric Tuned AM/FM Sterio Radio w/seek & scan, cass tape & digital clock Black convertible top,power door lock,six way driver power seat Engine size and type: 5.7 Liter T. P.I. V8 transmission; Four -SPD Man TRANS W/Overdrive Rear end: Front suspension: alloy independent fr & 5-link rr susp. Rear suspension; Vehicle history: garage kept Extent of restoration: none Custom modifications: none Amount invested: none Owners opinion of value: $22,000 Based on: allstate verbal appraisal Vehicle history: garage kept there is a 1/2 inch scratch on drivers side rear view and some small 1/2 inch wide, paint cracking on hood of car. it only had 1 owner before my dad none Appraised By: AI Hagen This appears to be a very good example. The mileage is most impresive. I see where Appraiser Comments: you have a value opinion of $22,000. This would be a nearly impossible sale amount. The problem with this era Corvette is that there are too many on the market. The production far 1987 was a total of 30,631. * Current Fair Market Value: $12,500.00 ** Replacement Cost: $17,000.00 All values are in US currency This online appraisal is an expert's opinion of the item(s) depicted above based solely on images and information supplied by our customer. Additional information, not shown on this certificate, may have been taken into account for this online Appraisal. Please Note: Our service strives to include the best international authorities in their respective fields. While the appraiser may be an expert in rendering the valuation, please understand that they may not be completely fluent in English. "Current Fair Market Value is the amount someone might receive when selling their item to a dealer or at auction. It is also the amount most government tax agencies (IRS, Revenue Canada, Inland Revenue, etc.) recognize as the tax deductible amount were the item donated to a charitable organization. "` Replacement Cost is the retail amount one might reasonably pay to purchase the item from a dealer, gallery, store, etc. It is also the amount for which one may want to insure an item. For currency conversion go to http://w4vw.xe.net/ucclfull.shtml Whats itworthtoyo u. com Antique Appraisals and Online Valuations Ranging From Furniture to Car Appraisals Page 1 of 2 nr i~~ag€;s ~rr~~rricie~ „~ Appraisal ID: Appraised On: Title: Date/Era/Period: Description: Condition: Origin: Provenance: 143743 20-06-2007 2002 GMC ENVOY 2002 2002 GMC ENVOY 4X4 GOOD need appraisal for estate none Appraised By: AI Hagen You have requested an appraisal,for estate purposes, of a 2002 GMC Envoy (serial Appraiser Comments: number 1GKDT13S922113971). As I understand the current mileage is 46,650. I have assumed that the vehicle is in good mechanical and cosemetic condition. "Current Fair Market Value: $9,000.00 '* Replacement Cost: $13,000.00 All values are in US currency This online appraisal is an expert's opinion of the item(s) depicted above based solely on images and information supplied by our customer. Additional information, not shown on this certificate, may have been taken into account for this online Appraisal. Please Note: Our service strives to include the best international authorities in their respective fields. While the appraiser may be an expert in rendering the valuation, please understand that they may not be completely fluent in English. `Current Fair Market Value is the amount someone might receive when selling their item to a dealer or at auction. It is also the amount most government tax agencies (IRS, Revenue Canada, Inland Revenue, etc.) recognize as the tax deductible amount were the item donated to a charitable organization. "" Replacement Cost is the retail amount one might reasonably pay to purchase the item from a dealer, gallery, store, etc. It is also the amount for which one may want to insure an item. For currency conversion go to http;/lwww.xe.net/ucc/full.shtmf Whats itworthtoyou. corn 40 Sunset Blvd. Perth, ON K7H 2Y4 CANADA 613-264-9032 SPATE FARR9 .~ ~~ lA ~ I: .., 19+15URANC® ~~:: May 25, 2007 Carol J. Keller 687 S. Middlesex Rd. Carlisle, PA 17015-9224 Re: Transfer from State Farm Bank® Traditional IRA Account No: 1002351552 Transfer to State Farm Bank Traditional IRA Account No: 1015466706 Dear Ms. Keller: Thank you for choosing State Farm Bank. There are a few details to be finalized before your account file is complete. Per your request, we have transferred the funds from your deceased spouse's IRA to a 2-year fixed rate IRA Certificate of Deposit in your name. The Certificate of Deposit was issued with an annual percentage yield of 5.20°f°, based upon a rate of 5.07%. The maturity date is 5/25/09. Our records indicate your husband's date of death as 4/10/07. His plan balance was $173,792.13 on 4/10/07, the day of his death. You may need this information for tax purposes. State Farm® appreciates your business and looks forward to assisting you with your future financial needs. If you have any questions, please call State Farm Bank toll-free at 1-877-SF4-BANK (1-877-734-2265) and ask to speak to a Bank Service Specialist, or ask to be transferred directly to me at (309) 763-7894. Sincerely, Amanda McKay `~_ _ IRA Specialist ~~ State Farm Bank Operations Center/IRA Unit MEMBER P.O. Box 2316 s_~® CommunityBanks 04/27/2007 Carol J Keller Beneficiary of Roger M. Keller 687 S. Middlesex Rd Carlisle, PA 17013 Dear Carol: On behalf of the IR.A Department of Community Banks, please accept our sympathies in h~ tlezth ~.f Rouea M. Keller. Vile Fxnderstand this i~~ a difficult time _fnr both. famii_y and friends, and would like to assist you with the IRA plan of Roger M Keller held here at Community Banks. IRS rules for IRAs require to make your decision as soon as possible, normally within 30 days. Please call 866-255-2580 to reach your local Community Banks branch to make arrangements for your distribution. Please send an original death certificate in the enclosed envelope so that we may process all necessary paperwork. Beneficiary(ies): Carol J. Keller Percentage of Share: 100 Below is the required Fair Market Value for Roger M. Keller as of 04/10/2007 (date of death). Balance of IRA Plan $165,215.68 Accrued interest $ i 9 i . 72 Total Plan Value $165,413.40 Sincerely, Jacque ine E. Ford IRA Specialist ~ . P.O. Box 350 Millersburg, PA 17061 Phone 1-866-255-2580