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Home My WebLink About10-25-07 (2) --.J 15056051058 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 File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 21 07 0674 Date of Birth 182-40-8019 06/05/2007 06/09/1920 Decedent's Last Name Suffix Decedent's First Name MI Fuller Grace (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix First Name MI Spouse's Social SecuritxNumber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Fill IN APPROPRIATE OVALS BELOW {.::' 1. Original Return 2. Supplemental Retum C::J 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c.> 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 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 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8. Total Number of Safe Deposit Boxes 4. Limited Estate Michael A. Scherer, Esq Firm Name (If Applicable) O'Brien Baric & Scherer (717) 249-6873 19 West South Street ., REGISTER OF WILLS USE ONLY First line of address ..-....J Second line of address r" ... ..:,,; City or Post Office State ZIP Code DATE Fl'CiD Carlisle PA 17013 (..~,) C) I...C) Correspondent's e-mail address: 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 complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. s15 ~~p ISLE FOR FILING RETURN DATE . lit 'I>'~/ DATE /l) -tq -D1 ESS 74 Derbyshire Drive, Carlisle, PA 7015 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ---1 --.J 15056052059 REV-1500 EX Decedent's Name: Grace Fuller 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) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 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 Govemmental Bequests/See 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. 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 .0_ 16. Amount of Line 14 taxable at lineal rate X.O 45 4,543.78 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L Decedent's Social Security Number 182-40-8019 19,625.05 19,625.05 2,376.52 12,704.75 15,081.27 4,543.78 4,543.78 204.47 204.47 15056052059 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Grace Fuller STREET ADDRESS 1720 Pisgah State Road DECEDENT'S SOCIAL SECURITY NUMBER 182-40-8019 CITY Shermans Dale STATE PA ZIP 17090 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 204.47 0.00 0.00 Total Credits ( A + 8 + C ) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval 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) 204.47 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) A. Enter the interest on the tax due. 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: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 [iJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [iJ 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) (0]. 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 [72 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 beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 PS. ~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)(1.3ll. 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-15G8 EX+ (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Grace I. Fuller FILE NUMBER 21-07-0674 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. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 The Bank of Landisburg, checking acct. # 612863 19,625.05 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 19,625.05 . REV-1511 EX+ (12-99* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Grace I. Fuller FILE NUMBER 21-07-0674 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Sue E. Amsley Social Security Number(s)/EIN Number of Personal Representative(s) 20 Street Address 74 Derbyshire Drive 7479894 City Carlisle Year(s) Commission Paid: 2007 . State PA Zip 17015 2. Attomey Fees 2,000.00 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. The Sentinel 8. Cumberland Law Journal 103.00 198.52 75.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,376.52 REV-1512 EX+ (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Grace I. Fuller FILE NUMBER 21-07-0674 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Chapel Pointe At Carlisle Nursing Home, 770 South Hanover St., Carlisle, PA 17013 12,704.75 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 12,704.75 07/24/2007 08:47 71 7-78g-4 702 BANK OF LANDISBURG PAGE 01 lhe 8anROf Landisbur~ ESTABLISHED 1900 P,O. BOX 179 . LANDISBURG. PA 17040 Bank records indicate the following account balances on JUNE 5 , 2007 for GRACE I FULLER 74 DERBYSHIRE DRIVE CARLISLE PA 17013 ss # 182-40~8019 ,~!, Acct Sole Jt.Acct Opened Ownership With Acc t :iF Type Balance pr.1or'!o Interest Int Accrued Bearing Interest 1/16/07 x POA-SUE E AMSLEY ~061-286-3 DDA $ 19,625.05 NA NA \ ../ qq~ ," .~:(~'~;, v }' "-"r ~.' .~', <\~' ,~..- ,. ~ , " .~ .- .. -.f . ..... _~ ._._.. ~ .tt-~ GRACE .. FULLER "~2 1458 '710 PISGNf STA.TE RO. .~ . SHEJIIMNS DAL2. PA 1,..0 01\1'1 t~ b. ).CtJ7 J .. (J' :_~ -,$~'~=- . "_ ~l.LA1lS III - ; t . . ~ 'THE BAa~K or LANDlSBUltG ~" " . IL /~~ a<:.PA. " " 'l::'. L. I A .....II(l.l.f>U~ 1,{ . {;.6 "7J.1IVJ.#}J, ~()./; .. ~O~~!~ \~~~ o~.~a~.J~ \~5g looo~a8qOO' . 1458 $889.00 06/08/2007 .-----=-.--.~.---..-.~_..--..,----....--...... _......--.........,.. .-",- .... '.\' .... '-:<'. ., ,,;),.... '.' ..(~~g:.::;- '!'ili:;" .~ .~ '~~~~'..~. ',:. .:_~:' .-' '\: "~- ,". ./!{": . . i....,~ ..:.~)~~};.~'.. .. " '. ' .:.-, ::.:~. , . , ....~-~.::.... '-' ..''\ ,'J'. . .....'<:t. , "":,i,' ...~, tj. 'lf~~~J ." - ~"!'~~~...~ ", ..~~~i~~~l(,S . .. -" '. ~ j " - .. '.' ~.i: ," _.. ,~~ )~r '. . ..._...~~:...'.~l;.. '. .;.}r.~"; t . ,,;'" .f" ":~. -~: '., -. ,\-.'" ~./' . ;J ~.. i .- : 71 7 ~)60 -I ':J ,=. -~. ,..- I rE " _ 0 - ; I ~ : ~ _ - r 1 :_~) - .:.:... ..:...::'--::::::-- _". I:... ..........iIlR...~. ....; .:.~~..........~-... -,'-.....- - I " \..... ....,..~...\..o.:~_"::':_..w...:!...4~......... A... '.........:::"'1t t:!:.E,!!2 14 5 G ~ ". .' ; ~ t.\, 1 c:i ; ~;" '.\;,:i,) ll':.:i.-:l:.-J"_()~ ! ., /' .....\,.:.I-'.l, ,;'Q~" D,'I'E;i__~__~.._ .~, ;' :,::~~~:.II'(~llo.~+1i.^iG _ _,..~ $/~9/.o:75' \',.;' -n- e. . Ii . / r,l";"/; 7.!J7 I h-!:/c.(.~.:!-?./~O~.!.~~~(J-rlZ(..-;4'~~'dri;k~a:_;\t~i>OL1.AIt5 III ~:= I c,. (/ 'Ii I ~; THE ll.\;\:l\ O~. LANDlS1ll"RG I I :\. L.'i\llll\a\:I~C. p,\. ~t ~.--e. tt.. ' I "'" 1.31'?''\ B-03-G .x-<..!4? .er.dli'~ I?ti.I'/-.. fi .:03L~l.tt.l~t: Or;&cBG:n'3n' ~t.5~?' t"OO llLS?'S.,.- J.......~...~~....~~"l":==:..---=..~..'~L4~...__~,~..-===-~::..:'......,....~....~__~;-:r.e..,.~"';~::"':.. ' l:03J,3J.1.:.n !: ,"0001. Ja8 l S '? ~L-. -- -- '\ \ i . . LAST WILL AND TESTAMENT g: GRACE I. FULLER ~~.<""::: "'~-'" :r;'~ .00000,;f~~-!\~.T.P.~,~~, R. D. .,.',;",,~~~~l,tR~~~' ... p~~..CO~~~'~f'l1c"""\ . .'.' .. . ". '.''':1' .,:':: ;4i:!;tt.. _!"'h:,;~,~,', "," ",,' ,;it(ft$, - .-,,~-.,..;~:: ,:,~..,-;"".~ ~-,;}:;,f<,,~~~!,ji~,'JJJ;:!r' ,.:~:,.,l',j"f '-"'- "~"'.::\>-;" ;:'. '.- .~! "~A' ~~"~~".!;'r~r", ,._~~;.;,,':'~~~~'-;'; " _"" " ",,' ,,_,.... ,,_""~' .'~~'-'"~_,"~";;"""':,,,,;I;:',,'~",~ ~ \I,"" "%:;,~"';' ;it.<.,,'" -',," "'''-'':~'.~,.i-~';;!;>'':''',~'1:t;,>:,:':,,';' ,.." .,";,,'~-":,,'. ""'"'''~''.:';:' -~':'!"'~i;."",,,'i:;;,~:, " .~, . . . vania, being Cf sound and .disposing mind, memory, and under- standing, do hereby make, publish, and declare this my Last will and Testament, hereby expressly revoking all other writings in nature testamentary by me at any time heretofore made. FIRST: I direct that all my debts and funeral expenses be paid as soon after my decease as may be practicable. SECOND: I hereby give, bequeath, and devise all the rest and residue of my estate and property, real, personal and mixed, of what- soever nature and wheresoever situated, of which I may die seized or possessed or to which I may be entitled or of which I may have the right to dispose at the time of my death, absolutely and in fee simple to my husband, Clyde W. Fuller, if he is living at the time of my death. THIRD: In the event that my husband is not living at the time of my death, or in the event that he and I shall die simultaneously, then I give, bequeath and devise all of my property to my daughter, Sue E. Fleisher. FOURTH: I hereby appoint my husband, clyde W. Fuller, as Executor, of this, my Last Will and Testament, but in the event that he is unable JJ~~. 0,.~~ GRACE I. FULLER (SEAL) or unwilling to serve, I then appoint my daughter, Sue E. Fleisher, as Executrix, of this, my Last will and Testament, and t direct that they shall not be required to give bond or other security in any jurisdiction wherein proceedings may be held in connection with my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 30th day of November, 1972. WITNESS: ~;e'~ iI~~,!/~ GRACE I. FULLER (SEAL)