HomeMy WebLinkAbout10-15-07 (2)
~
REV-1500 EX (06-05)
PA OepartmentofRewnue
Bureau cllndNidual TlIlC8S
PO BOX 280601
Harrisburg, PA 17128-0601
15056041158
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Yssr
21 07
File Number
0080
ENTER DECEDENT INFORMAllON BELOW
Social Security Number Date of Death
191-28-2232 01192007
Date of Birth
11141934
Decedent's Last Name
FALLON
Suffix.
Decedent's First Name
SARAH
MI
E
(If Applicable) Enter Swvivlng 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 ntE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
00 1. Original Retum
o 4. Limited Estate
00 6. Decedent Died Testate
(Attach Copy of Will)
o 9. Litigation Proceeds Received
Future Interest Compromise (date of
death after 12-12-82)
Decedent Maintained a Living Trust
(Attach Copy of Trust)
Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THI$ SEC'nON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDEHTIAL TAX IHFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
717-730-7454
02.
04a.
Suppiemehtal Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
07.
010.
L 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A)
DEBRA KARNS KLINGER
Firm Name (If Applicable)
C)
REGISTER OF
First line of address
201 EWE ROAD
c.;~
Second line of address
s
5;"'
City or Post OffICe
MECHANICSBURG
State
PA
ZIP Code
17055
DATE FILED
o
Correspondent's e-mail address:
Under penalties of perjury, I dedlll8 that I have examined thls retum, InclUding accompanying schedules and lIlalements, and to the best of my knowledge and belief.
it Is tnJe, COITect and complelll. 0 of PI'8J*W othll' th8'Ithe pel'llOn81 represootallw Is based on a11lnfonnation of which prePlll8f has any knowledge.
$1 RE F PER NSIBLE FOR FILING RETURN DAJEU j ~ t/""f
DATE
ADDRESS
PLEASE USE ORICINAL F~ ONLY
Side 1
L
15056041158
6M4647 2.000
15056041158
~
---1
15056042159
REV-1500 EX
Decedent's Social Security Number
191-28-2232
Decedent's NameFALLON
RECAPITULATION
SARAH
E
1. Real estate (Schedule A) . . . . . . . . . . , . , . . . . . . . . , , . . . . . . 1.
55407.55
0.00
0.00
2. Stocks and Bonds (Schedule B). . . . , , , . , . . , , . . . . . . . . , , . . . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C). . . . . . a.
4. Mortgages & Notes Receivable (Schedule D). . , . . . . . . . . . . . . . , . . . 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E). . . . . . . . 5.
0.00
2096.24
0,00
6. Jointly Owned Property (Schedule F) D Separate Billing Requested . . . . . 6.
7. Inter-Vivos Transfers & MlsceItaneous Non-Probete Property
(Schedule G) D Separate Billing Requested . . . . . 7.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . , . . . . . . . . 9.
0,00
57503.79
5113.32
14987.92
20101.24
37402.55
0.00
37402.55
8. Total Grou AI... (total Lines 1-7). . . . . . . . . . . . , . . . . , . . , . . . 8.
10. Debts of Decedent, Mortgage liabilities. & Liens (Schedutel). . , , , . . . . . . 10.
11. Total Deductions (total lines 9 & 10). . . , . . . . . . . , . . . . . . . . . . 11.
12. NetVafue ofEstafe (line 8 minus line 11) . , . . . , . , . . , , , . . . , . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an e1$Clion to tax has not been made (Schedule J). . . , , . . . . . . . . , . . 13.
14. Net Value Subject to To (line 12 minus line 13) ............... 14.
TAX COMPUTATION - see INSTRucnONS FOR APPLICABLE RATES
15. Amount of line 14 talCllble
at the spousal tax rate. or
transfers u~ Sec. 9116
(a)(1.2) X .0_ 0 . 00
16. Amount of line 14 taxable
at Iineel rete X .04 5 3 74 02 . 5 5
17. Amount of line 14 talCllble
at sibling rate X .12 0 , 00
18. Amount of line 14 taJcable
at collateral rate X .15 0 . 0 0
15. 0.00
16. 1683.11
17. 0.00
18. 0.00
19. 1683.11
D
19. TAX DUE , . , . . . . . . . , . . . . , . . , . . . . . . . . . . . . . . , ,
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056042159
6M4648 2.000
15056042159
---1
REV-1500 EX Page 3
Decedent's Com lete Address:
DECEDENT'S NAME
FALLON SARAH
STREET ADDRESS
1820 HEISMAN DENS DRIVE
File Number
0080
E
CITY
CARLISLE
STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal PoYerly Credit
B. Prior Payments
C. Discount
(1)
ZIP
17013
1683.11
0.00
1500.00
78.95
Total Credits (A + 8 + C) (2)
1578.95
3. Interest/Penalty If applicable
D. Interest
E. Penalty
0.00
0.00
0.00
TolallnlerestlPenally (0 + E) (3)
4. If line 21s greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill In box on Peg. 2, Une 20 to r8quest. refund. (4)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
104.16
A. Enter the interest on the tax due. (SA)
0.00
B. Enter the total of Line 5 + SA This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
104.16
PLEASE ANSWER THE FOLLOWING QUESnONS BY PLACING AN -)(" IN THE APPROPRIATE BLOCKS
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. retaln a reversionalylnterest; 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Old decedent own an "in trust for" or payable upon death bank account or security at his or her death? .
4. Did decedent own an Individual Retirement Accqunt, annuity, or other ~e property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
o
o
o
o
o
o
o
No
[K]
[X]
[X]
[X]
[Xl
[X]
[X]
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. ~116 (a) (1.1) (il)]. 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 stili applicable even if the suMving 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 use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. ~116(a)(1.2)]. .
The tax rate Imposed on the net velue of transfers to or for the use of the decedent's lineal beneficiaries Is four and one-half (4.5) percent, except as noled in
72 P.S. ~9116(1.2) [72 P.S. ~116(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)J. 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.
6M4671 1.000
REV-1502 EX + (6-88)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Sarah B. 'allon 2107 0080
All ....1 pr'OplII1y _nect -*tly 01' .. a WllIInt In common must be ntpCIIt1Id at fair martcet value. Fair market value Is defined 8S the price at v.flich property would be
exchanged ~ a wiling buyer and a wilUng saller, neither being compelled 10 buy" 881, both having --.abIe knowledge or the I818vant fads.
Re.l propeIty which Is joInlIy__ with right fII survivonhlp must be dlsclaeecl on Sc:hedu.. F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Net proceeds from sale of real estate located at 1820
Reisman Gardens Drive, Carlisle, PA, copy of settlement
sheet attached
55,407.55
3W4895 1.000
,orAL (Also enter on line 1, Recapitulation)
(If more space Is needed. insert additional sheeIs at the same sI2s)
$
55,407.55
REV-I508 EX + (6-911)
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
esTATE OF
Sarah B. Pallon
FILE NUMBER
21 07 0080
Include the proceeds of lltigllllan and Ihe dale the proceeds ~ ~ by the eslale.
All PI8I*tJ jIIInIIy-owned wllh Ihe rtght oIsurvlwor8hlp must be cIIsc:IMed on 8cheduIe F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Checking Account with Americhoice
318.10
2
Savings Account with Americhoice
5.00
3
Refund from Bmbarq Telephone
6.14
4
Refund of 2006 Federal Individual Income Tax
85.00
5
SBP Contribution - Grubers April 2007
415.00
6
Furniture
742.00
7
1989 Chrysler New Yorker
525.00
3W46AD 1.000
TOTAL (Also enter on line 5 ..,uu~ Iationl $
(If more ~ is ~ In8Mt addllionaI sheets dthe _ size)
2,096.24
Bstate of: Sarah B. Fallon
191-28-2232
Schedule H Part 7 (Page 2)
3
4
5
6
Liberty Mutual - Homeowners & Car Insurance
PP&L - electric service
North Middleton Township - water & sewer service
Bmbarq - telephone service
95.00
196.80
114.10
100.13
Total (Carry forward to main schedule)
506.03
REV-1512 EX~ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Sarah B. Fallon
SCHEDULE I
DEBTS OF DECEDENT.
MORTGAGE LIABILITIES. & LIENS
FILE NUMBER
21 07 0080
Report debts incurred by the decedent prior to death which remained unpaid as of the date d death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Americhoice FCU - Visa
VALUE AT DATE
OF DEATH
9,234.88
2 Americhoice - Personal Loan
2,332.72
3 Bmbarq - statement
44.00
4 Bon Ton - credit card statement
49.96
5 Blair Clothing - credit card statement
91. 53
6 Lowes - credit card statement
271. 85
7 North Middleton Township - statement
79.90
8 PP&L - statement
198.93
9 Home Depot - credit card statement
1,021. 51
10 MCI - statement
102.26
11 Liberty Mutual - statement
90.70
12 US Go1dshield Blite - statement
94.85
13 Hasland Associates Inc - professional services
202.05
14 Carlisle General Hospital - professional services
992.00
15 Real Estate Tax.
66.45
16 Lancaster HIlA - statement
66.45
17 IBK - medical insurance
13.80
18 Philip Carey MD
professional services
30.34
19 Kinetic Imagery - statement
3.74
3W46AH 2.000
TOTAL (Also enter on line 10. Recapitulation) $
(If more space is needed. insert additional sheets fA the same size)
14,987.92
REV-1513 EX+ (~)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
ESTATE OF
Sarah B. Fallon
FILE NUMBER
21 07 0080
NUMBER
I
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Debra K. Klinger
201 Ewe Road
Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
Do Not List Trust8e(s)
AMOUNT OR SHARE
OF ESTATE
All of Residue: 37,402.55
Daughter
37,402.55
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46AI 1.000
TOTAL OF PART.. 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)
$
0.00
...
.
LAST WILL AND TESTAMENT
OF
SARAH E. FALLON
I, SAPJWE. FALLON, of the County of Cumberland and
Commonwealth of Pennsylvania, being of sound mind, memory and
understanding, do make and publish this, my Last Will and
Testament, hereby revoking and making void all former Wills by me
at any time heretofore made.
, FIRST:
I direct 'my hereinafter named Executrix to pay all
my legally enforceable debts, funeral expenses, administration
expenses, and inheritance, estate, succession or excise taxes,
which I owe or may become due on account of my death, as soon as
may be convenient after my decease.
SECOND:
I give, devise and bequeath all of my property, be
it real, personal and mixed, whatsoever and wheresoever the same
may be situate at the time of my death, to my daughter, DEBRA'KARNS
KLINGER; if she survives me.
THIRD :
In the event my daughter, DEBRA KARNS KLINGER,
predeceases me or fails to survive me, I give, devise and bequeath
all of my property, be ft real, personal or mixed, whatsoever and
wheresoever the same may be situate at the time of my death in
equal shares as follows:
A) One third (1/3) of my estate is to pass to my grandson,
JASON NEDROW, if he
survives me.
~(/7 ~;-A-~ (SEAL)
'SaraJi . Falla
Page 1 of 3 Pages
I
B) One third (1/3) of my estate is to pass to my
granddaughter, DANYELLE NEDROW, providing she has
attained the age of twenty-one (21) years at the time of
my death. In the event DANYELLE NEDROW is under the age
of twenty-one (21) years at the time of my death, I
direct that her share of my estate shall pass In Trust as
set forth below.
C) One third (1/3) of my estate is to pass to my grandson,
PATRICK KLINGER, providing he has attained the age of
twenty-one (21) years at the time of my death.
In the
event PATRICK KLINGER is under the age of twenty-one (21)
years at the time of my death, I direct that his share of
my estate shall pass In Trust as set forth below.
In the event either or both my granddaughter, DANYELLE NEDROW,
or my grandson; PATRICK KLINGER, are under the age of twenty-one
(21) years at the time of my death, I direct that said
granddaughter's and/or grandson's share of my estate shall pass In
Trust, and I nominate, constitute and appoint GLENN P.KLINGER, as
Trustee of each of the aforesaid Trusts.
I direct that as Trustee, GLENN P. KLINGER is authorized and
empowered to expend so much from the principal and/or income of the
Trust for my aforesaid granddaughter and/or grandson, as may be
necessary in the sole discretion of the Trustee for the support,
education and welfare of said granddaughter and/or grandson without
the necessity of posting bond or securing Court approval for said
expenditures.
Page 2 of 3 Pages
~h t?$eP~ (SEAL)
Sarah E. Fall n
.
I further direct that as my granddaughter, DANYELLE NEDROW, or
my grandson, PATRICK KLINGER, attains the age of twenty-one (21)
years, the Trust established herein for said granddaughter or
grandson, as the case may be, shall terminate and all principal and
any accumulated income of that Trust shall be paid to said
granddaughter or grandson outright.
FOURTH :
I nominate, constitute and appoint my daughter,
DEBRA KARNS KLINGER, as Executrix of this, my Last Will. and
Testament, authorizing and empowering her to sell and convey any
and all real estate of which I may die seized and possessed. In
the event my daughter, DEBRA KARNS KLINGER, is unwilling or unable
to act as Executrix, I nominate, constitute and appoint MELLON
BANK, N.A., as Executor of this my Last Will and Testament.
I .further direct' that my Executrix or personal representative
shall not be required to post bond to act in said capacity.
IN WITNESS WHEREOF, I, SARAH E. FALLON, have hereunto set my
hand and seal, to this my Last Will and Testament, this ~ day
of ....... .//t;Yt. , 1995.
SIGNED, SEALED, PUBLISHED
and DECLARED by the above-
named Testatrix, SARAH E.
FALLON, as and for her
Last Will and Testament, in
the presence of us, who at
her request and in the
presence of each other, have
hereunto set our names as
J..i tne~ses :
(b_~ ~\...A.... ~ \:..0
Residing at: 0 :
.::~ S~CI"\RE Wp-'-( D,LL.'St',.)(,<0- rAt7<l\'f.
~~(.~C> -~?~'(-SEAL)
SARAH i. FALLON
c,\pak\will \fallon.sef
. ,r
A. . B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1-DFHA 2.DFmHA 3. DCONV. UNINS. 4.DVA 5. ~CONV. INS.
6. FILE NUMtlER: 17. LUAN :
SETTLEMENT STATEMENT SANFORD 1722528
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked 'TPOCr were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (SANFORD.PFDISANFORDI24)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
WILLIAM SANFORD DEBRA KARNS KLINGER. Executrix TAYLOR. BEAN & WHITAKER
MORTGAGE CORP.
MAIL STOP-S 1417 N. MAGNOLIA AVE.
OCALA, FL 34475-9078
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 20-1624913 I. SETTLEMENT DATE:
1820 HEISHMAN GARDENS DRIVE GUARANTEED ABSTRACT SERVICES, INC.
CARLISLE, PA 17013 May 17,2007
NO. MIDDLETON TWP, CUMBERLAND CO. PLACE OF SETTLEMENT
PRUDENTIAL THOMPSON WOOD REAL ESTATE
3815 Market St, Camp Hili, PA 17011
J. -. ;IIUN 1\. __n.m ut' IIVI~
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. l,;Ontract :sales t"nce 66,900.00 401. l,;Ontract Sales Pnce 66.900.00
102. Personal Property 402. t"ersonal t"roperty
1 03. :semement Charges to Borrower (Line 1400) 4,500.53 403.
104. 404.
105. 405.
Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance
106. COuntyfTwp Taxes 05/17/07 to 01/01/08 11::1.04 406. t,;ountyrrwp I axes 05/17/07 to 01/01/08 115.84
107. t,;ity Tax to 407. t,;lty fax to
108. :scnool I ax 05/17/07 to 07/01/07 85.38 408. :scnOOI I ax 05/17/07 to 07/01,u7 85.38
109. 409.
110. 41U.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 71,601.75 420. GROSS AMOUNT DUE TO SELLER 67,101.22
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. ueposlt or earnest money 500.00 501. Excess Deposit (See Instructions)
202. Principal~ount of New Loan(s) 66,900.00 502. SelUement Charges to Seller (Line 1400) 7,679.67
203. EXisting loan(s) taken subject to 503. EXIsting loan(s) taken subject to
204. 504. paYOff of fjrst Mortgage
205. ouo. r-ayoff or secono Mongage
06. 506.
207. 507. (Deposit disb. as proceeds)
208. 508.
209. t,;REDIT 4,014.00 509. , '-'VV I '-'''CUll 4,014.00
IIdJustments I-or ,terns unpaia t:Jy ::;eller AaJustments I-or Items unpaia t:Jy Seller
210. t,;ountytrwp Taxes to 510. CountylTwp Taxes to
211. L;ity I ax to 511. L;ity rax to
212. scnool Tax to 512. School Tax to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
21ts. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 71,414.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 11,693.67
1300. (;A5H A.I ;:)c I ". : DUU. \.A.;:)M..... "'" I :
301. Gross Amount Uue From Borrower (Une 120) 71.601.75 601. I.::iross Amount uue 10 Seller (Line 420) 67,101.22
302. Less Amount Paid tlY't'or tlorrower (Line 220) 1\ 71,414.00 602. Less Reductions Due Seller (Line 520) 11,693.67
303. CASH ( X FROM) ( TO) BORROWER 187.75 603. CASH ( X TO) ( FROM) SELLER 55,407.55
OMB NO 2502 0265 ...-....
The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of tilis statement & any attachments referred to herein.
B<<row~ Id~ ~
Seller
~f-~c::.
J 1:)J~ \35.CD
'Fti qQ,Oo
p... 1> D 45.(J,.:)
"fi::-