HomeMy WebLinkAbout11-21-07
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lS0S6041147
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
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 01
File Number
107
Decedent's Last Name
Suffix
Date of Birth
09201947
Decedent's First Name MI
JOHN R
Spouse's First Name MI
MARY J
233747980
02132007
KITZMILLER
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
KITZMILLER
Spouse's Social Security Number
Z.os-~ 3i- SCs.2.5"
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
[!J 1. Original Return
4. Limited Estate
o
o
o
o
4a. Future Interest Compromise
(date of death after 12-12-82)
2. Supplemental Retum
o
o
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
o
o
o
6. Decedent Died Testate
(AIlach Copy of Will)
7 Decedent Maintained e living Trust
. (AIlach Copy of Trust)
8. Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received
10 Spousal Poverty Credit (date of death
. between 12-31-91 and f-1-95)
o
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
JERRY A. WEIGLE ESQUIRE 7175327388
Firm Name (If Applicable)
WEIGLE & ASSOCIATES, P.C.
,...."
c::::>
City or Post Office
SHIPPENSBURG
State
PA
ZIP Code
17257
REGISTE~ILLS ~ ON~
.~u('") 0 G)
:,Ir- -< CoI?
:"'">2- m N rri
"':0 :rJ
.:: CJ3 A
:500 ""'0 ~~
, ">'011 ::I: <
de ;~
.::0 .z::-.
;0-1
~TE FILED .v'
r--
C,,?
First line of address
126 EAST KING STREET
Second line of address
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 knowled~ and belief.
it is true, correct and comple aration of preparer other than the personal representative is based on all information of which preparer has any knoWledge.
IGNA TURE OF PERS N SP ILING RETURN DATE
Tereasa J. Houtz, Daughter 1/ ....
Jerry A. Weigle Esquire
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Side 1
lS(]5b(]41147
150Sb041147
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1SfJSbfJ42146
REV-1500 EX
Decedent's Name: John R. Kitzmiller
RECAPITULATION
Decedent's Social Security Number
233747980
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.
2.600.00
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested............. 7.
37.624 03
40.224 03
8 . 386 34
14.179 71
22.566 05
17.657 98
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, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
17.657.98
17.657 98
15.
o 00
o 00
16.
o 00
o 00
o 00
17.
o 00
18.
o 00
o 00
19. Tax Due. ...... ............... .............. ................ ........ ........... ..... ..... ..... ......... ... ................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
D
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Side 2
1SfJSbfJ42146
1SfJSbfJ42146
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21--
DECEDENTS NAME
John R. Kitzmiller
STREET ADDRESS
247 F Street
CITY I STATE /ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
0.00
3. InterestlPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
0.00
TotallnterestlPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Une 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 0.00
(5A)
(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?.... .......... ............. ................... ....... ................................... ............... ................
No
[!]
[!]
[!]
[!]
[!]
[!]
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. ~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-o ne 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 P.S. ~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) (1.3)]. 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)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAl. TH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kitzmiller, John R.
FILE NUMBER
21-
Include the proceeds of litigation and the dale the proceeds were received by the estete.
All property JoIntIy-ownecl wlth the right of SlRVIvorshlp must be disclosed on schedule F_
ITEM
NUMBER DESCRIPTION
1 1995 Buick Regal
VALUE AT DATE
OF DEATH
2.600.00
TOTAL (Also enter on Line 5, Recapitulation)
2.600.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule E (Rev. 6-98)
ReY.1510 EX+ (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
COMMClNWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Kitzmiller, John R.
FILE NUMBER
21-
This schedule must be completed and filed W the answer to any of questions 1lhrough 4 on the reverse side of the REV.1500 COVER SHEET is yes.
ITEM ~ . .- y DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE.
1 Employee Stock Ownership and Trust Plan _ 37.624.03 100.000 37.624.03
Mary Jane Kitzmiller, spouse, beneficiary
TOTAL (Also enter on line 7, Recapitulation) 37.624.03
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
1 REV-1151.EX+ (12.99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kitzmiller, John R.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 7,422.34
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year{s) Commission paid
2. Attomey's Fees Weigle & Associates, P.C. 910.00
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. Other Administrative Costs 54.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 8,386.34
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502.EX+ (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMClNWEALTHOF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kitzmiller, John R.
FILE NUMBER
21-
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Potomac Memorial
37.10
2
Smith's Funeral Home
7,385.24
Subtotal
7.422.34
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
. Rev.150Z JiX+ (6-98)
.
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
cot.NONWEAl.TH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kitzmiller, John R.
FILE NUMBER
21--
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Commonwealth of Pennsylvania - vehicle registration
22.00
2
Register of Wills, Cumberland County - filing PA Inheritance Tax Return
15.00
3
Sollenberger's - vehicle change of registration
17.00
Subtotal
54.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
~ .
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COM\AONWEAL TH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kitzmiller, John R.
FILE NUMBER
21-
Include unrelmbursed medical expen....
ITEM
NUMBER DESCRIPTION
1 Allegheny Power
2 APEX
3 Belvedere Medical
4 Blue Mountain
5 Carlisle Cardiology
6 Carlisle Hospital
7 Collection Center
8 Collection Service Center
9 Columbia Gas
10 Cresscare
11 Deb Arnold - house loan
12 Dr. Bronstein
13 Dr. Bryant
14 Dr. Raj, Lancaster HMA
15 Dr.Zal
16 Howard's Accounting
17 HSBC
VALUE AT DATE
OF DEATH
71.59
443.00
172.18
122.20
29.34
1.039.48
64.90
311.93
559.12
367.15
3.000.00
53.00
264.40
345.00
238.20
205.00
1.152.10
Total of Continuation Schedule
See attached page
TOTAL (Also enter on Line 10, Recapitulation)
14,179.71
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule I (Rev. 6-98)
-'i-<'C'~:2'''.'~ ,..
""'~''':,.'''';''''''''~.,'(,,,,,,,,~,
~ Rev-1512 ~+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
continued
COMMONWEAI.TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Kitzmiller, John R.
FILE NUMBER
21-
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
18 Internal Revenue Service 845.01
19 Kinetic 13.49
20 Lester Carl - personal loan 3,500.00
21 Midstate Medical 274.47
22 Minnich's 337.03
23 National Hospital 75.00
24 Pinker Associates 42.00
25 United Collections - gas utility 559.12
26 WMHS Hospital 95.00
TOTAL (Also enter on Line 10, Recapitulation)
14,179.71
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV.1513 EX+ (9.c10)
.
SCHEDULE ..
BENEFICIARIES
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Kitzmiller, John R.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
ttistributions,.( and transfers
under Sec. ~116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not LIst Trusteels'
FILE NUMBER
21-
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
1
Mary Jane Kitzmiller
247 F Street
Carlisle, PA 17013
Spouse
100%
17,657.98
Total 17,657.98
Enter dollar amounts for distributions shown above on lines 5 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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
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LAST WILL AND TESTAMENT OF John Robert Kitzmiller
I.
I, John Robert Kitzmiller , residing at 24218 Pine Hill Road
Rawlings Maryland, being of sound mind and in the contemplation of the
certainty of death, do hereby declare this instrument to be my last will
and testament.
II.
I hereby revoke all previous wills and codicils.
III.
I direct that the disposition of my remains be as follows:
As agreed to with my wife Mary Jane Kitzmiller
IV.
I give all the rest and residue of my estate to my spouse, Mary
Jane Kitzmiller, should She survive me for 60 days. If my spouse, Mary
Jane Kitzmiller, does not survive me, I give all the rest and residue of
my estate to Tereasa Jane Houtz. If neither Mary Jane Kitzmiller nor
Tereasa Jane Houtz, survives me, I give all the rest and residue of my
estate to my heirs as determined by the laws of the State of Keyser
W.Va, relating to descent and distribution.
V.
I appoint Lester W Carl, to act as the executor of this will, to
serve without bond. Should Lester W Carl be unable or unwilling to
serve, then I appoint Keven Carl to act as the executor of this will.
I herewith affix my signature to this will on this
,j
day of ,ot!4en1~e".
, 19 r J' .
the
at Cl.,{ess.; ~ (7J.- J-d.15
following witnesses, who witnessed
request, and in my presence.
..L/h-.;"'L}~'" in the presence of the
and subscribed this will at my
JL~~
John Robert Kitzmiller
ATTESTATION CLAUSE
On the date above written, John Robert Kitzmiller , well known to
us declared to us, and in our presence, that this instrument,
consisting of ~ pages, is their last will and testament, and John
Robert Kitzmiller , then signed this instrument in our presence, and at
John Robert Kitzmiller's request we now sign this will as witnesses in
each other's presence. Further that John Robert Kitzmiller, appeared to
us to be of sound mind and lawful age, and under no undue influence.
Witness:
... .
Address:
Witness:
Address:
Witness:
Address:
STATE OF Keyser W.Va
COUNTY OF Mineral
Before me, the undersigned authority authorized to take
acknowledgments and administer oaths, personally appeared:
John Robert Kitzmiller
dl~ve~
who after being having duly sworn or affirmed to tell the truth,
stated:
1. That John Robert Kitzmiller declared this instrument to be their
last will and testament to the witnesses.
2. That John Robert Kitzmiller signed this instrument in their
presence.
3. That the witnesses signed as witnesses in the presence of John
<..
Robert Kitzmiller and each other.
4.
the
is well known to the witnesses, and
believe John Robert Kitzmiller to be of lawful age, of
under no undue influence or constraint.
Title of Officer: ~~~'7'
My Commission Expires: ~C2t; ~.
t
)-ol)"t)
1--. --- .,- --- orriOiarsu'- - ---
I Notary Public
, Stat.€ of West Vir~inia
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NOTICE OF DISTRIBUTION ELECTIONS
Explanation of Benefits
(Spousal Beneficiary - Vested Account balance exceeds $1,000)
To: Spousal Bene6.ci~ MatyJane Kitzmiller
Re: Deceased Participant: John KimniJIe-r
Participant's Social Security Number: 233-74-7980
Date: October 11, 2007
Account Number. 91COO5013
Plan: Automated p~ Svsrems.Ine. Employees' Stock Ownership Trust and Plan ("Plan") fIb/o Tohn Kitzmiller
According to the Plan's records. you are the spousal beneficiary of John Kitzmiller (the "Participant"). As such, you are
entitled to a distribution Wlder the above Plan. The purpose of this Notice is to advise you concerning the various distribution
options provided under the Plan. After carefully studying this form and all other enclosed documents, please make your
seleaions from the options listed on the Distribution Elemon FoIlD, complete and sign the forms and all related documems
where indicated and return them to the .Administrator for processing.
a) Your proposed distribution date will be October 31, 2007. The proposed distribution date is the date the Plan
requires you to commence distribution of the Vested Interest in the Account.
b) Account Value:
(1) Vested portion:
(2) Non-vested portion:
$37,624.03
$0.00
Total Account Balance [(1) + (2)]:
$37.624.03
The values are from the latest valuation of the Account. There may be a later valuation before your acrual distribution.
c) MINIMUM NOTICE PERIOD. For at least 30 days after you receive this notice, you have the right to
consider your decision ,,>bether to consent to a distribution of the Vested Interest in the Account, whether to choose
a lump sum Pa}'llleIJt, installment pa}-ments or the Full Cash Refund Life ..'\nnuity, and whether to elect a direct
rollover of any poniOD of yom- distribution eligible for rollover. If you sign and return the attached Distribution
Election Form to the Administrator less than 30 days after you receive this notice, the Administrator's receipt of your
signed form is your affirmative waiver of any unexpired portion of the minimum 3D-cIa)- period and your a:ffirmative
election of a distribution or a direct rollover.
1. Other forms included with this notice. We have provided you the following forms:
Distributim Election Fann. Use this form to elect pa;yment of your benefits. See the explanation of your benefit options
in p~oraph 2.
Nolia of Autanatic Bendiciary. In. the event that you receive a distribution in the form of instalhnent payments or a Full
Cash Refund Life Annuity, a beneficiary may become entided to a portion of your distribution. This form notifies
you of the person or persons who will. be your automatic beneficiary or beneficiaries under tb.e Plan. 'This form also
norifies you of y.our right to design'ate an alternative beneficiaIy or beneficiaries.
StJeJial Tax Notia Rexarrlinr! Plan. PtZ}rTIeJ1t. This notice explains your right to elect a direct rollover of the Vested Interest
in the Account to another plan. or IRA. This notice also explains the income tax withholding rules applicable when
you receive payment from the Plan.
The "Benefit Commencement Date" is the acrual distribution date .if you elect to receive a lump sum distribution. H
you elect to receive installmem payments or the Full Cash Refund Life Annuity-, the Benefit Commencemem Date
will be the date you are to receive the first annuity or installment payment.
2. Normal fonn of benefit payment. The normal form of benefit payment under these circumstances is the Full Cash
Refund Life Annuity purchased from an insurance company, under which monthly amounts are paid to you during your
life and if such payments do not equal or exceed the original cost of the annuit}., the balance of such original cost will be
paid to your beneficiary after your death..
(OO075584J:K:X:;4}