HomeMy WebLinkAbout08-22-07 (2)
REV-1500 EX + (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
I-
Z
W
C
W
U
W
C
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Ste henson. Shirle E.
DATE OF DEATH (MM-DD-Year)
OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
2 1 -0 7 0 6 5 5
""'Cc'iUNTYCOOE -vEAR- - - NuMBER- -
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 68- 2 6 - 4 078
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
04/23/2007 09/28/1932
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
W
f-
li::~(/)
uO::li::
wl1.u
:r 00
U 0:: oJ
l1.lD
l1.
c(
l2il1. Original Return
D 4. Limited Estate
l2il 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
SOCIAL SECURITY NUMBER
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113{A) (Attach Sch 0)
f-
Z'
W
C
Z
o
l1.
(/)
W
0::
0::
o
U
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Gerald J. Shekletski Es . 414 Bridge St.
FIRM NAME (If Applicable)
Stone LaFaver & Shekletski P.O. Box E
TELEPHONE NUMBER
717 774-7435 New Cumberland PA 17070
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
z
o
i=
<(
..J
~
!::
l1.
<(
U
w
0::
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(1)
(2)
(3)
(4)
(5)
,-
I
I
I
I
I
~
.=
=
--.J
:0-
(=
....J
"-)
N
OFFICIAL USE ONLY -l
I
354.61
-~~
. .
-~~(J
. ,-
i 7f"
. ::0
/'
J~,;\~
-a
(6)
(~~)
- . -=~cJ
C)
~.,. C 'r
r ,-
(7)
--U
") ~--)
.~
~-
W
-J
, l
354.61
(8)
(9)
(10)
9,838.30
47,727.75
(11)
(12)
(13)
57 ,566.05
-57,211.44
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
-57,211.44
z
o
i=
<(
I-
~
l1.
:E
o
u
~
I-
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a){l.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
0.00 X _(15) 0.00
0.00 X _(16) 0.00
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 0.00
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
o
d
· C
I t Add
ece ents omPle e ress:
STREET ADDRESS
411 Market St.
CITY I STATE T ZIP
New Cumberland PA 17070
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
Total Credits ( A + B + C )
(2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
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 !XI
b. retain the right to designate who shall use the property transferred or its income; ........................................ D !XI
c. retain a reversionary interest; or ...................................................................................................... D !XI
d. receive the promise for life of either payments, benefits or care? ............................................................. D !XI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. D !XI
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D !XI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which
contains a beneficiary designation? ....................................................................................................... D !XI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS Laurie E. Bordlemay
535 7th St. New Cumberland
SIGNATURE OF PREPARER 0 NT
Co-Executrices
New Cumberland PA 17070
DATE; //~
ADDRESS
Gerald J. She , Esq.
414 BridQe St., P.O. Box E, New Cumberland
PA 17070
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 3%
[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 0% [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 0% [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 4.5%, 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 12% [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-1508 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Steohenson. Shirlev E.
FILE NUMBER
21 07
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.
0655
ITEM
NUMBER
1.
DESCRIPTION
Belco Community Credit Union checking account number 33630
VALUE AT DATE
OF DEATH
354.61
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
354.61
REV-1511 I::X + (1~-l:Il:I)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Steohenson. Shirley E.
FILE NUMBER
21
07
0655
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
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
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Letters Testamentary 58.00
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Belco Community Credit Union account number 33630 Line of Credit 4,594.92
8. Belco Community Credit Union account number 33630 VISA Classic 4,550.92
9. West Shore EMS 628.64
10. Spirit Physician Services 5.82
TOTAL (Also enter on line 9, Recapitulation) $ 9838.30
(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
Stephenson. Shirlev E.
FILE NUMBER
21
07
0655
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. JC Penny credit card account number 018-488-207-4
VALUE AT DATE
OF DEATH
643.72
2. The Home Depot credit card account number 6035320-042407674
176.47
3. Citi Cards Platinum Select credit card account number 5424181029811879
9,164.10
4. Citi Cards credit card account number 4621200086152557
14,477.13
5. Discover credit card account number 6011002560402331
11,439.92
6. Kohl's credit card account number 0313254708
963.62
7. Boscov's credit card account number 09145311
134.41
8. Spiegel credit card account number 5770911800790964
546.65
9. Sears credit card account number 5121071850741632
10,181.73
TOTAL (Also enter on line 10, Recapitulation) $
47727.75
(If more space is needed, insert additional sheets of the same size)
R<Y.""'" I'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
SteDhen~ on. !=:hirlAv F. ?1 07 ORl';l';
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 [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Laurie E. Bordlemay Lineal 0.00
535 7th St.
New Cumberland, PA 17070
2. Lyndsay M. Moyer Lineal 0.00
114 4th Avenue
New Cumberland, PA 17070
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)
ep\w:l:s\ST~?~0NSON,SH]P~EY
., !
~ '<" :
2D07 JUL 12 PM 3: 33
LAST WILL AND TESTAMENT
OF
SHIRLEY E. STEPHENSON
('LeCK (~ir:
v '_l II -..II
nvPDll~1i,I":~ In iRT
I II", ..J -,..' ~..J\J I
C~.F"/ -'",;- -~ '" .-, ~-- 0./\
I, SHIRLEY E. STEPHENSON, of the Borough of New Cumberland,
Cumberland County, Pennsylvania, declare this to be my last will and
revoke any will previously made by me.
ITEM I:
I devise and bequeath all of my estate of every nature
and wherever situate, in equal shares, to my children, LAURIE E.
BORDLEMAY, LYNDSAY M. MOYER, and PAUL L. HIMES, JR., who survive me.
ITEM II: I appoint my daughters, LAURIE E. BORDLEMAY and LYNDSAY
M. MOYER, Co-Executrices of this my last will.
ITEM V:
No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of her duties in
any jurisdiction.
IN WI'l'NESS WHEREOF, I,
SHIRLEY E. STEPHENSON,
da y 0 f }}(l f", LaJ,"::) -
. l
have hereunto set
my hand and seal this I~
, 2007.
..){( '1 it fs f' ,dt; .;.f.'k:)/l<.---
SHIRLEY E {" STEP'HENSON
~':,:; 'YC --- -- -<
-i... ----<. ~ ""_ ....
SIGNED, SEALED, PUBLISHED and DECLARED by SHIRLEY E. STEPHENSON,
the Testatrix above named, as and for her Last Will and Testament, and
in the presence of us, who at her request, in her presence and in the
pr.e__se~nce of ~ eaCh~ ~h::~ubscribed our names
~ 0 414 Bridge St.,
WltnessL-/ Address
as witnesses.
New Cumberland, PA
414 Bridge St., New Cumberland, PA
Address
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
I, SHIRLEY E. STEPHENSON, the Testatrix 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 this
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 con-
tained.
11
(. &c i",- .;2,,-'; J'-~
E. STEPHENSON
S:E?H~~SCN, tte Testatr~x, this
Swcr~ to or affirmed to and acknowledged before me by SHIRLEY E.
/ :z ja 'i ~ c ,L '1.<< a. {j _
'~\',:(..~~
~"~,::~a~y ~!.....C~~L-
'; ,n.~-:
, '- '-" I.... . .
COMMONWEAlIH OF PENNS'l'lVANIA
NOTARIAL SEk
CAROL L. TROXELL. Notary Public
New Cumberland Bora. Cumberland Co.
My Commission Expires Dec. 27. 20'J9
~-.i .-r.=- ._
'I
, Ii
CC~lMON\^JEALTH OF PENNSYLVANIA
ss:
COUNTY OF CUMBERLAND
We, C~roJ. ~,_~. S~~.\cltkk~
and
~01h l ~v vi If.e~ i~
ij the witnesses whose names are signed to the attached or foregoing
II .
i!
~ instrument, being duly qualified according to law, depose and say that
~ we were present and saw Testatrix sign and execute the instrument as
:1
!'
~ her last will; that Testatrix signed willingly and that she executed
III
it as her free and voluntary act for the purposes therein expressed;
I' that each of us in the hearing and sight of the Testatrix signed the
I will as witnesses; that to the best of our knowledge, the Testatrix
I
~ was at that time eighteen or more years of age, of sound mind and
~ under no constraint or undue influence.
II
I,
,I
II
II
II
il
II
II
Sworn to or affirmed to and acknowledged before me by
r ~~o...QcL ~. \\-'i.Lt_d,\ k ~ ancl ~~C(J-{j\N VI Lt,0--
."':C."3se3, :c,~~\.~ day Of.:s::-~.""k\ .' 20G7.
\: ':",.~,\c-l ) . ~ ~
rOMN'.ONWEAlT'rl vi Pt~;.
~ NOTARIAL SEAL , .... .
CAROL L. TROXELL, Nota;! ",\"
d a, CU"',her1a,", '."
New CUI1,berlan "O,? '.;"7 2" .
My Col11n1\<;s:'jn Expres Ce~. ~ . ..--
t,; C t3. r:/
E>~b 1 i ':
..... --...::
BELCO .i
Community Credit 'Union ..
www.belco.org
July 17,2007
Stone LaFaver & Shekletski
Attorneys at Law
414 Bridge Street
P.O. Box E
New Cumberland, P A 17070
RE: Estate of Shirley E. Stephenson a/k/a Shirley E. Hacker Himes Stephenson
S.S.#: 168-26-4078
Dear Gerald,
Here is the information for the above referenced account. If you need any further
information, please call me at 717-720-6407.
Sincerely,
Aqc~~
Finance Processing Representative
Salco Community Credit Union
449 Eisenhower Blvd., P.O. Box 82
Harrisburg, PA 17108
717-232-3526 in Harrisburg area
800-642-4482 ouIsIde of coIng area
BELCO COMMUNITY CREDIT UNION
1. Name(s) in which the account was held:
DECEDENT ESTATE INFORMATION
SHIRLEY E STEPHENSON(PRIMARY)
2. Account number: 33630
3. Balance as of date of death: 4/23/2007
Balance Accrued Dividends YTD Dividends
For 4/23/2007
Regular Savings: $ $0.00 $ $0.00 $ $0.00
Christmas Club: $ $0.00 $ $0.00 $ $0.00
Whatever Club: $ $ $
Checking: $ $354.61 $ $0.00 $ $0.00
Money Market: $ $ $
IRA: $ $ $
Certificates: Balance Accrued Dividends YTD Dividends Certificate Number
For
$ $
$ $ $
$ $ $
4. Date the account was initiated: 3/25/1975
5. Name(s) in which Safe Deposit Box was held: N/A
6. Date the box was initially rented: N/A
7. Branch address at which the box is located:
8. Loan Information: Balance Accrued Interest Per Diem Int
Line of Credit(L6) Unsecured Loans: $4,594.92 $187.78 $323.56
VISA Classic $4,550.92 $0.00 $0.00
B. Secured Loans
$ $
C. Mortgage Loans: $ $ $
$ $ $
Miscellaneous: