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Home My WebLink About12-11-07 ~ 15056041147 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 2 1 0 7 0914 Date of Birth 206109008 09112007 08191919 Decedent's Last Name Suffix Decedent's First Name SOURBEER VELDA MI I (If Applicable) Enter Surviving 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 THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW D 1. Original Return D 4. Limited Estate [K] o 6. Decedent Died Testate (Attach Copy of WII) D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) 0 4a. Future Interest Compromise 0 5. Federal Estate Tax Return Required (date of death after 12-12-82) 0 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 0 10 Spousal Povert)< Credit ~ date of death 0 11. Election to tax under Sec. 9113(A) . between 12-31-91 and -1-95) (Attach Sch. 0) 9. Litigation Proceecls Received ~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number EDMUND G. MYERS 7177614540 301 MARKET STREET ".} REGIST~~WlLLS liSt ONLY. ,r;J : -~E ;;2 r.:~ r'.; ; '~i - rn l~{j ;I? Firm Name (If Applicable) JOHNSON DUFFIE First line of address Second line of address City or Post Office LEMOYNE State PA ZIP Code 17043 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE m~ \L...l)L~ Marilyn K Duck I~-JO -:1.00) ADDRESS 154 South Enola Drive, Enola, PA 17025 S~P:Z OTHER THAN REPRESENTATIVE ADDRESS ~ EDMUND G. MYERS DATE r Zp. It>} 301 MARKET STREET, LEMOYNE, PA 17043 Side 1 L 15056041147 15056041147 ---I Ii --.J 15056042148 REV-1500 EX Decedent's Name: Velda I SOU RBEER 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) D Separate Billing Requested............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D 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 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. 16. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X ~ 0.00 15. Amount of Line 14 taxable at lineal rate X .045 0.00 16. Amount of Line 14 taxable at sibling rate X .12 0.00 17. Amount of Line 14 taxable at collateral rate X .15 0.00 18. 17. 18. 19. Tax Due..................................... ............ ..... ............................................................ J.9. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 Decedent's Social Security Number 206109008 283.02 2,371.81 2,654.83 980.90 1,769.18 2,750.08 -95.25 -95.25 0.00 0.00 0.00 0.00 0.00 D 15056042148 ---I Rev-15Q8 EX+ (6-98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SOURBEER, Velda I FILE NUMBER 21-07-0914 Include the proceeds of litigation end the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 River Source Long Term Care Insurance 264.00 2 Embarq Management Company 13.02 3 Erie Insurance - Refund 6.00 TOTAL (Also enter on Line 5, Recapitulation) 283.02 (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) "'-'509 Ell. I''''' . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY SOURBEER, Velda I FILE NUMBER 21-07-0914 ESTATE OF If an asset was made joint within one year of the decedenfs date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A. Bonnie L Bagwell ADDRESS RELATIONSHIP TO DECEDENT Daughter 49 Grant Street Enola, P A 17025 B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENTS INTEREST JOINTLY-HELD REAL ESTATE. 1 A 6/1/1973 PNC Bank Checking Account No. 4.743.61 50.000% 2.371.81 51-4006-0569 TOTAL (Also enter on Line 6, Recapitulation) 2.371.81 (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 F (Rev. 6-98) REV-1151 EX+ (12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SOURBEER, Velda I FilE NUMBER 21-07-0914 ESTATE OF Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 170.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attomey's Fees Johnson Duffie 500.00 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 58.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 252.90 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 980.90 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-15q,2 EX+ (6-98) . SCHEDULE H-A FUNERAL EXPENSES continued COMMONlNEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SOURBEER, Velda I FILE NUMBER 21-07-0914 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Romberger Memorials 170.00 Subtotal 170.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-150,2 EX+ (6-98) . SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONIIIIEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SOURBEER, Velda I FILE NUMBER 21-07-0914 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland County Register of Wills Office - Filing Fees for Inheritence Tax Return ($15.00) and Inventory ($15.00) 30.00 2 The Cumberland Law Journal - Notice of Estate Administration 75.00 3 The Patriot News - Notice of Estate Administration 147.90 Subtotal 252.90 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-151,2 EX+ (6-98) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SOURBEER, Velda I FILE NUMBER 21-07-0914 Include unreimburaed medical expenaea. ITEM NUMBER DESCRIPTION 1 Mobile X-ray Imaging VALUE AT DATE OF DEATH 33.23 2 PNC Bank Checking Account No. 51-4006-0569 - Bank Charges 2.00 3 Thornwald Home - Final nursing home care charges 1.733.95 TOTAL (Also enter on Line 10, Recapitulation) 1,769.18 (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) REV-1513 EX+ (9-00) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER SOURBEER, Velda I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal Clistributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER 21-07-0914 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. Bonnie L BAGWELL 49 Grant Street Enola, P A 17025 Marilyn K DUCK 154 South Enola Drive Enola, PA 17025 Daughter 1/2 of Estate Daughter 1/2 of Estate Total Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, 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 SHEE 0.00 Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule J (Rev. 6-98) EXHIBIT A EXHIBIT B :318223 ESTATE OF VELDA L SOURBEER SCHEDULE OF EXHIBITS Last Will and Testament of Velda 1 Sourbeer signed and dated December 2, 1999. PNC Bank Checking Account Date of Death Letter. - -) l~...... --:--. .._ o "( .. ::> .....:.. -, -0__, \.._ mast Bill nub IDtstamtnt OF VELDA I. SOURBEER I, VELDA I. SOURBEER, of East Pennsboro Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS I direct the payment of all my legal debts and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II TANGffiLEPERSONALPROPERTY I give and bequeath my automobile(s), household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto those of my children who survive me to be divided between them by my Executrix with due regard for their personal preferences in as nearly equal shares as practicable. ARTICLE III REST, RESIDUE AND REMAINDER I gIve, devise and bequeath all the rest, residue and remainder of my Estate, of whatsoever nature and wheresoever situate, in equal shares unto my daughters, MARILYN K. --_. .____..n ~--..-.-_..-._----~:------:.:-;---;.-.. ~.- .,,- - -.'.7 .~._- -- --_.. ~.. -.-_--... '-' -- ---J-;-'-- ---..:----.--:--0---. -- ..----:.;:-- - '. -. . ... ."""""', "'- DUCK and BONNIE L. BAGWELL. In the event that either of my daughters predeceases me, I give, devise and bequeath the share of such deceased daughter unto her then-living issue, per stirpes. ARTICLE IV UNIFORM TRUSTS FOR MINORS ACT In the event that any beneficiary of my Will shall not have reached the age of twenty-one (21) years at the time for distribution of his or her share, distribution of said share may be made in the discretion of my personal Representative after considering the age and needs of the beneficiary, either directly to the beneficiary or to a Custodian under the Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A. 9 5301 et seq., or the applicable Uniform Gifts to Minors Act or UI#form Transfers to Minors Act in the state of residence of such beneficiary as the case may be. . My Personal Representative may designate as such Custodian any institution or person, including my Personal Representative, qualified to act as a Custodian for such beneficiary under such Act in effect at the time such distribution is made. A receipt for any payment or distribution so made shall be a full discharge therefor to my Personal Representative, who shall not be responsible to see to, or be liable for, the application of such proceeds thereafter. ARTICLE V PERSONAL REPRESENTATIVE I name, constitute and appoint my daughter, MARILYN K. DUCK, Executrix of this my Last Will and Testament. Should my daughter, MARILYN K. DUCK, fail to qualify or cease to so act, I name, constitute and appoint my daughter, BONNIE L. BAGWELL, Alternate Executrix to complete the administration of my Estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. 2 IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~ day of ~ , 1999. .7!La/J;~ (SEAL) VELDA I. SOURBEER Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~Jt~ Witness ~~o G- f 3 ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND We, VELDA I. SOURBEE~ ~i(~~ j, CO})d\\ , 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 that she had signed willingly and that she executed it as her free and voluntary act for the purposes ~erein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best ofhis/her knowledge the Testatrix was at 'r t~un~ 6.. ~e(r , the Testatrix and the' witnesses, respectively, whose and that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~J;k~~ VELDA I. SOURBEER ~~ Witness .. () r w~ ~ Subscribed, sworn to and acknowledged before me by VELDA I. SOURBEER, Testatrix, and l?Ov-n.lR en. \'l\'-I!ik and _fhic~"\q e\ 1. C'9nid.1 witnesses, this Rr4 day of efl)~' , 1999. Notarial Seal Daria C. Pal'm<<!r. Notal'Y Public Lem0yn8 Boto, cumbet1and county My CommiSSion ~res. Dec. 29. 200~ Member, pennsylvanlJ AIIOOletton of Nollri.. (l~~c ~~ , ~ Public 4 ..-_,-_--y..___ __ ._____u._n ",;----' -'.' ---------. 1,.' ---.= " .------,-....-.-....--. -_._-----, . - . -. I r . - i - ,-' '""\, "....,...J,:Y',..' .".. . .. - ~ .. - :' '".,"'. -.", ...... .. . '\7:tG~'}ii~';i-1 t... o :.c r Z 111 en ~ 0 ~ ~ ~ z Z -l - pl g ~ 0 "1J ~ rn C 111 -< - 'Tl ZtnO'Tl ffi ~ ~ [ii. -< r 1&1 - r )0 ;0 en < ~ ~ > P1 ~ :E > )0 ~ <- t&j t"i tj > H en o o ~ D' t&j t&j ~ ~ o ~ ~ ~ t . ~ "' . ~ "' Nov. 15. 2007 3:57PM PNC BANK 412-705-2747 No. 5637 P. 1/1 I . ~ ~ G PNCBAN< Th~ Thinking Behind The Maney November IS, 2007 . Johnson Duffie Law Offices At1n: Dana Weiseman 301 Market StPOBox 109 . Lempyne1 PA 17043 .RE: Velda I Sourbeer (Deceased) SSN: 206-10-9088 DOD: 09-11-2007 Dear Ms. Weiseman: In response to your request for Date of Death balances for the customer noted above, our records show the following: Cbecking Ac:c:onnt Account # 4150060569 Established 06-01-1913 VELDA I SOURBEER BONNIE L BAGWELL DOD balance: $4,743.61 + 0.00 accrued interest Interest paid 01-01-2007 thrn 09-11-2007 $10.77 YTI? Please note that this office only provides date of death balances for deposit accounts (lRAs, CDs, Checking and Savings aCcounts). We do Dot process any financial transactions or provide statements. If you need assistance with BIIy of these items, please call1-888-PNC-BANK (1..888-762-2265) or stop by your local me Bank branch office. ~dJV Member FDIC Page 1 of 1 ~ cO ~~ J r- .... <' _~t -~~ ., t& ~\ 4'\ ""0 ~O ~ ~ ---;-"- =--im. ~ ~ , ~ -a ~ , !t u -Tn ~ u.. ~ ~ ~