HomeMy WebLinkAbout10-18-07
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REV-1500 EX(06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
15056041158
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
21 07
File Number
0168
ENTER DECEDENT INFORMATION BELOW
Social Security Number
195-28-4541
Date of Death
02012007
Date of Birth
09241936
Decedent's Last Name
DEVEREAUX
Suffix
Decedent's First Name
DIANNE
MI
M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
DEVEREAUX
Spouse's First Name
RAYMOND
MI
C
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
[]] 1. Original Return
o 4. Limited Estate
[K] 6. Decedent Died Testate
(Attach Copy of Will)
o 9. Litigation Proceeds Received
.D--..- 8. Total Number of Safe Deposit Boxes
Spousal Poverty Credit (date of death 0 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
RICHARD C. SNELBAKER 717-697-8528
07.
010.
Future Interest Compromise (date of
death after 12-12-82)
Decedent Maintained a Living Trust
(Attach Copy of Trust)
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
o 2.
04a.
Supplemental Return
Firm Name (If Applicable)
SNELBAKER & BRENNEMAN, P.C.
c)
-,
REGISTER OF WILLS USE oNLY
, . l'"
First line of address
C)
44 WEST MAIN STREET
Second line of address
P.O. BOX 318
( "
.-' .
City or Post Office
MECHANICSBURG
State ZIP Code
PA 17055
DATE FILED
r-
..;..
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.
S
2702 LOGAN ST., CAMP HILL,PA 17011
D IE
C. SNELBAKER, ESQUIRE 44 WEST MAIN ST., MECHANICSBURG, PA
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041158
6M4647 2.000
15056041158
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15056042159
REV-1500 EX
Decedent's NameD EVE REA U X D I ANN E
RECAPITULATION
Decedent's Social Security Number
195-28-4541
M
1. Real estate (Schedule A) . 1.
0.00
0.00
0.00
2. Stocks and Bonds (Schedule B) . . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C). . :l.
4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . 4.
0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . 5.
1415.85
0.00
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.
9. Funeral Expenses & Administrative Costs (Schedule H). . 9.
0.00
1415.85
3916.00
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . 8.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). 10.
0.00
3916.00
11. Total Deductions (total Lines 9 & 10). . . . 11.
12. Net Value of Estate (line 8 minus Line 11) . 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) . 13.
-2500.15
0.00
14. Net Value Subject to Tax (line 12 minus Line 13) 14.
-2500.15
TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of li ne 14 taxable
at the spousal tax rate, or
transfers uJger Sec. 9116
(a)(1.2) X .0_
16. Amount of line 14.1axable
at lineal rate X .O~
17. Amount of line 14 taxable
at sibling rate X .12
18. Amount of line 14 taxable
at collateral rate X .15
0.00
15. 0.00
16. 0.00
17. 0.00
18. 0.00
19. 0.00
D
0.00
0.00
0.00
19. TAX DUE . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
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15056042159
6M4648 2.000
15056042159
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number
0168
DECEDENT'S NAME
DEVEREAUX DIANNE M
STREET ADDRESS
2702 LOGAN STREET, CAMP HILL
CUMBERLAND COUNTY
CITY II STATE I. ZIP
CAMP HILL PA 17011-
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
0.00
0.00
0.00
0.00
Total Credits (A + B + C) (2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
0.00
0.00
0.00
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 box on Page 2, Line 20 to request a refund. (4)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
A. Enter the interest on the tax due.
(SA)
0.00
B. Enter the total of Line S + SA. This is the BALANCE DUE.
(58)
0.00
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:
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did 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 Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
D
D
D
D
D
D
D
No
00
[K]
[K]
IX]
[X]
IX]
[K]
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. 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 zero (0) percent
[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.
F or 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. 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. 89116(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.
6M4671 1.000
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Dianne M. Devereaux
FILE NUMBER
21 07 0168
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Belco Community Credit Union
checking account, #1846906
1,415.85
3W46AD 1000
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,415.85
REV-1S11 EX + (12-99)
COMMONWEALTH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dianne M. Devereaux
ITEM
NUMBER
A.
B.
1.
FUNERAL EXPENSES:
Myers Funeral Home, Inc
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
DESCRIPTION
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Claimant
Street Address
City
Relationship of Claimant to Decedent
4.
Probate Fees
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
State
Zip
Street Address
City
Year(s) Commission Paid:
2.
Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
3W46AG 1.000
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
State
Zip
Register of Wills
filing fee for Inheritance Tax Return
FILE NUMBER
21 07 0168
TOTAL (Also enter on line 9. Recapitulation)
(If more space is needed, inser! additional sheets of the same si ze)
$
AMOUNT
3,497.00
350.00
54.00
15.00
3,916.00
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYL VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dianne M. Devereaux
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 07 0168
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Raymond C. Devereaux
2702 Logan Street
Camp Hill, PA 17011
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
NUMBER
I
Surviving Spouse
0.00
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 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)
$
0.00
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AW OFFICES
NELBAKER
8:
~ENNEMAN
LAST WILL AND TESTAMENT
I, DIANNE M. DEVEREAUX, of the Borough of Camp Hill,
County of Cumberland, and Commonwealth of Pennsylvania, being of
sound and disposing mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament,
hereby revoking and making void all former wills and codicils by
me at any time heretofore made.
FIRST. I order and direct that all my just debts and
funeral expenses be paid by my Executor or Executors, as the
case may be, hereinafter named, as soon as conveniently may be
done after my decease.
SECOND. I give, devise and bequeath all the rest, residue
and remainder of my Estate, real, personal and ,mixed, whatsoever
and wheresoever situated, unto my husband, RAYMOND C. DEVEREAUX,
absolutely and in fee simple, if he survives me by as many as
sixty (60) days.
THIRD. If my husband, RAYMOND C. DEVEREAUX, does not
survive me by as many as sixty (60) days, then and in that
event, I give, devise and bequeath all the rest, residue and
remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situated, in equal shares unto my four children,
namely, TIMOTHY J. LEIPHART, TODD R. DEVEREAUX, BETH L.
DEVEREAUX and STEVEN C. DEVEREAUX, share and share alike,
absolutely and in fee simple.
If any of my said children should predecease me, I
order and direct that the foregoing share of my estate
attributable to such deceased child shall be distributed among
his or her lawful issue per stirpes by representation and not
per capita, subject, however, to the protective trust provisions
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H::LBAKER
8<
~ENNEMAN
as contained in Item Fourtp hereinbelow with respect to any
beneficiary who has not attained the age of twenty-five (25)
years at the time for distribution.
FOURTH. If any beneficiary hereinabove has not attained
the age of twenty-five (25) years at the time of distribution, I
order and direct that the distributive share of such person
shall be paid over and delivered unto DAUPHIN DEPOSIT BANK AND
TRUST COMPANY, of Harrisburg, Pennsylvania, (or its successor by
merger, consolidation or other corporate reorganization) as my
testamentary Trustee, IN TRUST, NEVERTHELESS, to hold, manage,
invest, accumulate income and reinvest until said beneficiary
attains the age of twenty-five (25) years, at which time said
trust shall be terminated and the net proceeds thereof be paid
over to the beneficiary absolutely.
I authorize and empower my said Trustee to invest the
assets of said trust in any reasonable manner and not be limited
or restricted to so-called "legal" or statutory investments for
fiduciaries.
I designate any trust hereunder to be a spend-thrift
trust. The beneficiary shall have no right to invade, pledge,
assign or otherwise dispose of the assets of said trust
(including income) nor shall any creditor of a beneficiary have
any right to seize, levy or execute upon said assets by reason
of any pledge, assignment or other transfer, voluntarily or
involuntarily, made by said beneficiary.
I further authorize and empower my said Trustee to
use, consume, expend and apply from time to time such amounts of
principal and income of and from said trust which in the
exercise of its sole discretion shall be determined to be
reasonable and necessary for the beneficiary's education. The
term "education" shall be construed and interpreted to mean
-2-
college or other post-highschobl training which is intended to
improve the beneficiary's productivity as an adult or enhance the
quality of his or her life. In considering what is reasonable
and necessary, my said Trustee shall take into consideration the
primary responsibility of the beneficiary's surviving parent to
provide such education. It is my will and intention that the
foregoing discretionary provision for education shall be
supplementary to the parent's primary responsibility.
LASTLY. I nominate, constitute and appoint my husband,
namely, RAYMOND C. DEVEREAUX, to be the Executor of this, my Last
Will and Testament, but if for any reason he should fail to
qualify as such Executor or cease so to serve, then and in that
event, I nominate, constitute and appoint my sons, namely,
TIMOTHY J. LEIPHART and STEVEN C. DEVEREAUX, (or either of them
in the event that one should fail to qualify or case so to serve)
to be the Executors hereof, each and all to serve without bond or
other security as a condition of qualification hereunder.
IN WITNESS WHEREOF, I, DIANNE M. DEVEREAUX, have hereunto
set my hand and seal to this, my Last Will and Testament which
consists of three (3) typewritten pages to each of which I have
affixed my signature this 6th day of April A.D., One Thousand
Nine Hundred Ninety-three (1993).
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LAW OFFICES
SNELBAKER
8:
3RENNEMAN
The preceding instrument, consisting of this and two (2)
other typewritten pages, each identified by the signature of the
Testatrix, was on the date thereof signed, sealed, published and
declared by DIANNE M. DEVEREAUX, the Testatrix therein named, as
and for her Last Will and Testament, in the presence of us, who,
at her request, in her presence, a"n~d' '" he presence of each
other, have subscribed our names as/witn s re~o.
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COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY
OF
CUMBERLAND )
We, DIANNE M. DEVEREAUX, RICHARD C. SNELBAKER and JANET R.
STEGNER, the Testatrix and the witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testatrix signed and executed the instrument as her
Last will and Testament and that she had signed willingly, and
that she executed it as her free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the Testatrix, signed the Will as a
witness and that to the best of his or her knowledge the
Testatrix was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
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Witness
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Witness
Subscribed, sworn to and acknowledged before me by DIANNE M.
DEVEREAUX, the Testatrix, and subscribed and sworn to before me
by RICHARD C. SNELBAKER and JANET R. STEGNER, witnesses, this
6th day of April, 1993.
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Notary Public
W OFFICES
IELBAKER
II:
ENNEMAN
Notarial sOOI PubliC
Catharine E. f3OOSUl1l. ~ Cotffl
MeQhar1icsbUi9 ~lough! CuFeb 27 1994
My CornmiSSlOll Exjjre5 . ,
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