HomeMy WebLinkAbout11-20-07
-I
15056051047
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
EN'fER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
Date of Birth
Decedent's Last Name
Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
SpolJse's Last Name Suffix
MI
SpolJse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL. IN APPROPRIATE OVALS BELOW
.. 1. Original Return,
~
c::>
4. Limited Estate
c::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c::>
2. Supplemental Return
c::>
c::>
c::> 4a. Future Interest Compromise (date of
death after 12-12-82)
c::> 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c::> 10. Spousal Poverty Credit (date of death c::> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CO~RESPONDENT -. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Nanie Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
~
8. Total Number of Safe Deposit Boxes
..
.,..........; "--
. :::u
--i
r'--)
o
-0
:x
r:-!
First line of address
DATE FILEDO
Correspondent's e-mail. address:
turn, including accompanying schedules and statements, and to the best of my knowledge and belief,
an the personal representative is based on all information of which preparer has any knowledge.
<.;A
1707
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
....J
--I
15056052048
REV-1500 EX
Decedent's Name:
Fo~Esr
· €~~T
Decedent's Social Security Number
1. Real estate (Schedule A):' . . . . . : . . . ; .... . :. . . . . . . . ., . . . .. . . . . . . . . . . . . . . -' 1.
RECAPITULATION
: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.
~). 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.
a. 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 Governmental 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 ~
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 OYJ~L IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
). ""_ f'." f ,~
~
. ~
o1loQ
ft
~40 ~~:>p\~
~ 15056052048
Side 2
15056052048
--I
REV-1500 EX PagEl 3
File Number
200,-00/:'13
21-01-(473
Decedent's Complete Address:
DECEDENT'S NAME Fbf{(EsT s. E:t2N~T
n_ _____"_.__.._ __ ___.._ .._____.._______ __.~_____._...__._._._ _______ ......______.___
STREET ADDRESS
__Z_QQ'Z.__~Q~JA .. A'~.F.;" ~~_e..,____
,
CITY
CAMP "\LL
STATE-PA--
ZIP I 70 I \
Tax Payments and Credits:
1. Tax Due (Pa!le 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
5,802.. '19
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
o
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 oval on Page 2, line 20 to request a refund. (4)
o
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
S,802.Q'1
o
5,802. <i <t
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. (5A)
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 [3'"
~: ;:::~~ :h~e~;~:i~~:~sii~~~::t:~. .~.~.~.I~. ~~~. ~~~. ~~~~.~.~~..t~~.~.~~~.~~~~. ~~. :~~. :~.~.~.~.e.;.:::::::::::::::::::::::::::::::::::::::::::: B ~
d. receive the promise for life of either payments, benefits or care? ..................................................................... 0 [Y/
2. :i~::~~ r~~~~~~~~ ::~~~:e~~:i~:~~t::n8~:.~~~.~~~~~~~~.t~~~~~~r.~~~.p.~.~~..~i~~i.n..~~~.:.~~~.~~.~~~~~.................... 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~
4. ~~~t~~nc:~e~~~~~i:~ I:~~~::;:;~ti~~~~~t .~~~o.~.~.~'. .~~~~i.~:. ~r. .~.~~.~.r .~~~.~~r~~~~~. :.~~.~.~.~:. .~~~~~...................... 0 ~
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)l.
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 exemot 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 parenl, or a stepparent of the child is zero (0) percent [72 PS. s9116(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. S9116('l.2) [72 PS. s9116(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 PS. s9116(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-15.02 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF r-: FILE NUMBER
rOR.f2f:ST S f:,~T ZOD7~~73 ZI-1Jl"~73
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pnce at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
'I.
DESCRIPTION
VALUE AT DATE
OF DEATH
2002 CCL.OM~J~ AVc"cAMP HJU. PA 170 I)
IfoO,ooo
TOTAL (Also enter on line 1, Recapitulation) $ 't:,O. 000
(If more space is needed, insert additional sheets of the same size)
REV-I503 Ex + (1-97)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHI,RITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Fo(l.RESr 8. ERt\1.ST
FILE NUMBER
2007. 00(,73
1.1 "07 · fX:,73
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
1..
I f'iW be:1-Jl7 f}L
P"\J~II\-L
DESCRIPTION
UZA .,
I~A #2-
VALUE AT DATE
OF DEATH
~ l.CU · 4"
17.,"3'-1.Cfl
TOTAL (Also enteron line 2, Recapitulation} $ IS: 9Zb. 37
IIf morA lmace is needed. insert additional sheets of the same size)
REV-l5OBEX + {1-97)
COMMONWEALTH OF PENNSYLVANIA
INHEHITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~ V(:fZe;.s-r
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
s. ER-Nsr
FILE NUMBER
2007.. DrXa-g
2)-D7.~7s
Include the proceeds of litigation and the dale the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
Z.
3.
Lf.
5.
DESCRIPTION
k\8T BANI' CHeclL)p.J~ Acr:.D\JNT
M Isc. CAst-l
t)\~ ~/T CAs~ geNus
VI ILr,.y ~EF\JtJ.&~
Pf<E PA ll) ~x {2EfON!).s <:Oo~1'i' - 21cf.llf-
8c.~oL - 1,~"3. 8~
CS>Ew€ft - 57. 2 ~
~to~
ftJ.
'NTl~T
VALUE AT DATE
OF DEATH
~tJ2 .oLj
I q g.SO
Z S. OD
J9.OO
I"q S. 2.7
Z , fa III . B \
10. 7 b
TOTAL (Also enter on line 5, Recapitulation) $ 2.,bBS. 57
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
~.jJ i~ <io. ,~_
~
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
IINHERITANCE TAX RETURN
RESIDENT DECEDENT
",,1. '
t '
) '.
.,. ..~ .-
-., ~,
..
'- '\ :'!;t
.",
ESTATE OF
~ r,
,\ '. ~. t\ .
"f" ".
w"
FILE NUMBER
ITEM
NUMBER
A.
B.
1.
2.
. r.
,. ,. ........', '1\. :i
. . 1"
" _..,. oj_, .~
Debts of decedent must be reported on Schedule 1. i
;'.j
DESCRIPTION
~, ~
". ,
\
1.
~E~.'.t,.1 EXPENSES: I , _ "
~t.MOfl!: fl)~l.. HoM~ \..i)CtlP A1IAC>>!b J
eou..1~ <';<<EEN c.e~&:TEt.V
'Ac.kc!.NI:X>i.F MEh\o RIAL
, .., \
..'
....
~ ./
:$
ADMINIST~ATIVE COSTS:
I
,
. .I
pers~n~1 ~ep:esentative's Commissions ~
Name 01 Personal Representative(s)
.8ocialSecurity Numb,er(sl/EIN Numbe"oJ Personal Re esentative(s)
Street Address
City
State _ Zip
,. {Year(s) Commission Paid:
"
3. Family F~emption: (II decedent's address is not the same as claimant's, attach explanation)
;"
Attorney Fees
~/A.
4.
5.
8.
'\.
10.
'\.
\1..
State _ Zip
Relationship 01 Claimant to Decedent
Probate Fees
Accountant's Fees
N/A
N/~
6.
Tax Return Preparer's Fees
....
.' ....,. ,.~
. . w
~', If' 1 '~,
AMOUNT
'it Cr~', lJ
)". .}, .\0,
'.3tO.00
.
''lS..tt)
:te"'~-
"\\
..t
~ ;
I ., .
- ':'
,,:. '1
.1.
, ~,
f'
. ,
85.00
7.
eo~ teE
SETrLtME:tlI'" CC6~ (SE"&" 8Ac.\G")
\-\oO$c: CUANttJG .. ~oVA<- (SEE &sc:.")
"COSt lt3T!.Q..\atl PAl t-3T'NC:.
If'GAc... NcS7lc..!$. CIt_@f{l(.Af'Ot) GO ~'" Jooa~1..-7S.oo
,~X1ON f~ -a8~o
1V\\6C. s.xPf~s SE 8Ac.~
J85..00
11,1S~ ..8\
\,O~.Z2.
2,O~() .()O
113.00
(,1-3)
TOTAL (Also enter on line 9, Recapitulation) $ 28; $0 \ . (,..,~
(II more space is needed, insert additional sheets 01 the same size)
~~H
8 (CD"\:\
a. CD W\""'$~I'''' f~ e><) ~ ~\
~.\~sO-~\\t~ {+
J:,.~ ~-t\'''''
d.. (4.a.c..cn~ '" ~ .().u.. <<!.
Jl., . 'T "'o.N\~ Q...L ~"'"
~:'~v.1~ 1-~
~.~~
,..... '...., .;.
,f
,
$<\, (,p':> .00
\\,5.00
\1.5.00
1-7.00
.. , .' ,,; 1 !itoo
~.. !$' .ce>.
,;' ,~11.;S1."\
~..,..'..-.
l '\~ ,2SS .8\
. . ~' ",
<':
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~. , . . .,....
~ (CCl~:)
1. ~ \-\~ (~"^~~ ~,,-b J'd.w<:)~)
.J,f'. S\Q.~ &-...u..w--v-
~.~,.,., ~~ ~~'!>
\o\-~~~
~15.00
2'2..1.'\0
~
\~O".. 1.,2.
# l2 (~:)
o. '1, ~ ~~ c:.Q\c\ ~
~ .. ~O$~~
C\ .00
SS:SO
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REV-1512 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF FCf(((E'&T S . E((N~T 2ro7--DO('73 2..J-07-D673
Re ort debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
p VALUE AT DATE
OF DEATH
201288.8\
?:I:J7.7fo
?i70 .50
'3) .33
73.loc.l
121.80
103
l/8 .00
ITEM
NUMBER DESCRIPTION
1 N\~T ~NK - ,",OM€: e~Q1T'l /I 1<129030
'l... \J<; \ (~lAb.Q,~) \
3. ~t ~3~o<1~ Cltt~~'o.."',~V\
q. ppt L ( e~\J\'(' \) ~~ ~
S. ~Y\"'~~\<tCV'\- Wet ~COn'\fn"'~
". MtT 1?A~""PAo~~~~~
1~ \UJ\t1t~ (~fio~")
&. e~\ ~~\\~ ~UJ""Cct~(Rsz.Y\~ Ntl~oY\~ l~W\lAIY
s~ ~tcQ
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
21 ~5c.f.. 87
J
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
I
II
FOtla.t:-ST S. E~T
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
&>~rrA E. "'lLtlZ..
q F'MM~~~,c..f"',~,a '~I.
Z. NANcV E. l='~"Eg
1700 \\"L-~"CI~~'ut,VC1~,rA
1.
'7'10 '2..
3.
g~bLE''' E. ERr-J6T
41q R.t.s~ t4~~~,Q,~~,PA
,q 33 0
FILE NUMBER
2007.. 00"73 2.I-07...CXo 73
RELATIONSHIP TO DECEDENT
Do Not List Trustee( s)
~L~
~t~.tT\
So~
AMOUNT OR SHARE
OF ESTATE
25%
t 32 J 2..'2.S. as
~~CI\J- ~.c."
25%
$~2.,2.'38.8S
~~~
zs%
JI 02.. 1.~g,8S
~cM. ~,
(SAa.tZ\J L.61lN6r
ZI/l#' T /.I.'IJdo f.fllo~. 02Qo.. \1'1~A 3170' So V\ ~2 ,-z.se,. 85"
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 ei'!.En~'iEE~Jl. ~
NON-TAXABLE DISTRIBUTIONS: T
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
(If more space is needed, insert additional sheets of the same size)
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
1.1
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
I'(i~ Ih\d~,-' -';tl'(~1
~ \ \ I, / .;::/
,,~~~
--::.~ (~ ,-.~ '\ :::--
----;~?/;J?~
Pl\RTlIElVIORE Funeral (-{orne & Cret~tw~\rvices, Inc.
, rs. Bonny S. Kyler .<'_ \\",,,::> Oa ~ ~ ,'fl 7,!I2/2007
9 Farmhouse Lane ~ . ~ ~
C""p HIlI, ~11 o..cl'~~->"~
services ofForrest S. Ernst ':l ~\)('''~<:>~~;.r
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way
we can. Please feel free to contact us if you have any questions in regard to this statement. The following
is an itemized statement of the services, facilities, automotive equipment and merchandise that you selected
when making the funeral arrangements.
A F ami ly Tradition ()f Caring!<
1'1), H()\ n I
'<\\ (1II1)1)l!Lll1d, !' \ I'i)/!)
I -~ \~, ~4.-+_--.2 \
Ii:! \) "cf' :':;,+h
\\ ',I \\, pal the: q", lI'( ,Ct 1m
Terms
Net 30
Due Date
8/11/2007
Account #
2007058.0
Description
Amount
I SERVICES & MERCHANDISE
Memorialization Funeral Service Grouping I\.
, 18 Gauge Steel Brushed Copper Bronze Casket " ~
'12G,uge 5'",] V,u]' ~'\ ~
Total 5en,;'~ ,"d M,~h,"d;", ~\ ~
5,550,00
2,650.00
1,111.00
(!\:h~'I\ \\ [':y:lkl1hl!":,
f.{I!I!lt!cr
9,311.00
(,,!bat J f'lllillc'llItll',:,
~ll'phcl1 K 1'111 h,'J111 '1\',
( i',P
Hlli'X f~ 1',lIth,1]1('ll',
f',,' '", " ( 'll'ldlll,I'(1I, ( Pi
i Total Cash Advances
1'lt>l,'~';llill,11 \11'lld'Ll,lllps
,,11),\.1'11)\
I I( t 1 ) \ ' ( l' !) \
G(8lrf?rE N
l~[
$9,976,11
,~j\(.<~
1Eagt IDill ttnlt ~~5tatn~nt
I, FORREST S. ERNST, of the Borough of Camp Hill,
County of Cumberland and State of Pennsylvania, make, publish and
declare this to be my Last Will and Testament, hereby revoking
and making void any and all former Wills by me at any time here-
tofore made.
1. I direct the payment of my just debts and
funeral expenses as soon after my death as may be co,venient to
my Executrix hereinafter named.
2. I give, devise and bequeath all of my property,
real, personal or mixed and wheresoever situate at the ti~e of
my death, to my wife, JEAN C. ERNST, provided she survives me by
at least thirty (30) days.
3. Should my wife fail to survive me by at least
thirty (30) days, I give, devise and bequeath all the rest,
residue and remainder of my estate to my then living issue, per
stirpes.
4. Should my wife, Jean C. Ernst, predecease me,
I appoint BARRY L. ER"ST to be guardian of the person of my minor
children.
5. Should any of my children take under the terms
of this Will while minors, I appoint BARRY L. ERNST to be
guardian of the estate of such minor with discretionary powers
to make such payments out of principal as well as interest as he
deems fit and proper, to provide for the care, support, medical
and other expenses and to provide the funds for a college
education for such minor child.
6. I name, constitute and appoint my wife, JEAN C.
ER~'ST, to be the Executrix of this my Last Will and Testament.
If my said wi:ra.shall fai-l to survive me or is unable or unwilling
---' -'-',-,'
I Z :/; !". ,
Li
Page 1 of 2 pages
to act in this capacity, I nominate and appoint BARRY L. ERNST
to be Executor of this my last Will and Testament.
this
IN WIT'WSS liliEREOF, I hereunto set my hand and seal
day of January, 1965.
c;' \ ,/ (I ~.:;.--
~- (~'- ~ ,,~ i:)~ ...-f~-<1 (~!" \1-\
(SEAL)
Signed, sealed, published and declared by the above
na~ed Testator as and for his Last Will and Testament, in the
presence of us, who at his request, in his presence, and the
presence of each other have hereunto set our hands as subscribing
wi tness es.
/~I /!
:: v\. ~-2.l. V"---J?
I