HomeMy WebLinkAbout01-10-08 (2)
~
15056051047
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 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
Spouse's Last Name Suffix
Spouse's First Name
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
__ 1. Original Return
~
2. Supplemental Return
<::)
-C:)
4. Limited Estate
~
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
~
~ 4a. Future Interest Compromise (date of
death after 12-12-82)
c:::>> 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
~
8. Total Number of Safe Deposit Boxes
..
Firm Name (If Applicable)
C)
C) --U
-Tl
N
.j:-
-..J
Correspondent's e-mail address:
be
IX. net
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.
DATE I
A-Z f'S'z
ADDRESS HH/J LES E SH / El.J)S
fo C!7/'Jq<er ,{J/)D4, mfO.t!.I1A~'1IC~M~, ~/I /7IJSS--
PLEASE USE OR I AL FORM ONLY
Side 1
L
15056051047
15056051047
.....J
..-I
15056052048
REV-1500 EX
Decedent's Name: DO~D ,I{ Y
RECAPITULATION
H. CANN/IJG.
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) c::> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c::> Separate Billing Requested.. . . . . .. 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 Subjectto Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
Decedent's Social Security Number
~: "7 t3 I () . Cf 7 3 ; 5"
.!,. ',,-- <il+x"'x'__"--'-""'_;';c/--."N." ",-'
/) 0
.
/7St/LlCf.5r
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 .O.D-
16. Amount of Line 14~a;sable
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
.()O
pp
I 1 S Jj If '1 · ~q
. 6 0
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ................ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056052048
15.
16.
17.
18.
c:)
15056052048
....J
REV~t500 EX Pllge 3
Decedent's Complete Address:
DECEDENT'S NAME
File Number
~/- 07 - 3PB
STREET ADDRESS
f)~I?(; I/o! Y H.
. ----- ------ ------
.J
77/ Lb/l/6 s
CA /flAIl Al6
-- ------,-._- ...-------- ..----------
(;-A.fJ Ie DA/J
CITY
CAI2. LISt.. E"
----- ---------l STATEp;j----piP /70/3
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
:lIJ t!JS3, 9.5
o
- ~t:I 3e/;~-';o--
___L1~__________
., I 0 ;Z f). "0
________1--_________ ---- _..__
3. InteresUPenally if applicable
D. Interest
E. Penally
~
.:/0/ '/00. ""
Total Credits (A + B + C ) (2)
o
o
TotallnteresUPenally ( D + E )
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) <!:>
(4) t:)
(5) , '53. '15'
(5A) ~ 8. set
(5B) ~~, ~.lfq
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.
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 !Rl
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 IZI
c. retain a reversionary interest; or.......................................................................................................................... 0 ~
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 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 IZI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 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 sUNiving 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 sUNiving spouse is zero (0) percent
[72 P.S. 39116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a sUNiving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the sUNiving 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 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.
R~.15l!8EX.(1.91). . ~
~ SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INH::~i~~~i DT~E~~~~RN PERSONAL PROPERTY
ESTATE OF C A IJ NJ tJ,IP I 7:Je>flO my II.
FILE NUMBER
~/-o7~.3?~
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
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
:J.
REF=U.Nf) ROM Lt.~. ~EA-SltrlV FoIL P8eSONIti.. IJtJ~ntE rAft
R.E IU Jt./I ~ Dt;{,
1&1=u1l/J F1et;111 CDMIKDJlJlVEltlrJo! #= ~ENA.JA- FbN. ~ET2.SeMV1fL
IN t!4111G" 7JJ-X ~ ItAl ~
"'uFo Nonr: 1)ECl1:bEHJ-r ""])\0 NoT WEAtl Alty JEIUEl.Ry DUIF 7P
II $tIN &J/IJ/nON A-AJD I-IIf'R. HoUSEl1lLD !=uP.NISlfltJ'S If-AJIJ 7#1:
J.lf(~ WElJ,E SoLDI D,s m,lhu.-nn> 1VJ1/t{ 7J{E SAl.E" (),c H&< HOt('sE
SoMt yEtMS A(,~.
~
7, 3 or, {)O
~
I, 0 I r:. (')0
TOTAL (Also enter on line 5, Recapitulation) $ ~ 39'. tJO
(If more space is needed, insert additional sheets of the same size)
~.~"."., '.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF CI1I1N/JII61 t/tJeDTIiY
SCHEDULE F
JOINTLY-OWNED PROPERTY
f/,
FILE NUMBER
:l /- 07- 398
If an asset was made joint within one year ofthe decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. LOU.JSE B,lf.M
/t.J.:t 53 ~ufh PJac;fa L" TLtna
San L\a.ritQ II- Z 8S-fDZ'j
"
SJS7E::--;e
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 aocount number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. W4~hDVia F;1I4r1C.;oJ Nt;t..vork A- e4s.. ~ ,
I 61f/ld Aut ~, ~()S9 - 37!{) I~O) B3i-.2S .sz>% '0/ 4/1.13
Auf U,. dP5"tj - 37'Z ~ 5"0% ,
~ 5/11 /fJtf ~"(), ~97. 93 /10,1'18,91
(see ii~lJ1iz~' series ~f I'll/lies CLktd~~1/
q /lachei A~1'db ;1;" .e4&h //If!44ltnf).
tJt!t ~Ullt tPfUIIJIlJ WIuI1d,1l'h6I'.IHa/U;t
~111 J.lu.eI~tI<. !ltoyU" ItltA/!I, "hIllh~~ni
all4cktlh(1't1i .
A. ~ It 2/1' Chell} Ch4~~ ~,t J of Ltture-}, mb.-flY!aM.J
Aa.ct: .N" 1lY/1- 3273'/9-3 ~", 1..1/ , 50~ ~ if, 910, Ll3
p,.; n '"1".1 ~ Cf, S~D, III . a.e(!.r. ,."f. 9, j 20. 8S"
(see. Ylllkaf,b" k~r IfId?/U;~d)
TOTAL (Also enter on line 6, Recapitulation) $ I 7.s; 5.:t~. S!
(If more space is needed, insert additional sheets of the same size)
5C-lIlfP h (!.bAtTP
ESr OJ:: CAIIN/1V'6, [)oI€D/#Y If.
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HUDOCK
· MOYER.
WEALTH MANAGEMENT
November 8, 2007
Mr. Charles E. Shields, III
6 Clouser Road
Mechanicsburg, PA 17055
lZE: Doroiliy C[lft11ing
Dear Mr. Shields:
Per your request, I have researched account opening and dates when assets were
transfened for Dorothy Canning.
1) Accou11l2059-3782 which was titled Dorothy H. Canning and Louise Barr
was opened 5/11/2004 and funded with assets on 8/16/2004. These assets
were transferred from account 2059-3779 which was in the single name of
Dorothy H. Canning.
2) Account 2059-3780 which was titled Dorothy H. Canning and Louise BalT
was opened 6/11/2003 and funded with assets on 6/25/2003. Thcse assets
were transfelTed from account 2059-3779 which was in the single name of
Dorothy H. Canning.
1 hope this inf()rmation is what you were looking for. Please don't hesitate to CoJl if v,,-e
can be of any further assistance.
,...... 1
lJ;:
Deanna L. Gephart, CFP@
Operations Manager
DLG/ht
n,c data contained herein was ohtainedfl'om sources we believe rehable. but we do 110/ guarant<:e its
accl/racy. Please consult your account statements as the ClJJiciai ru;ordfiJrall account values ana'
IrunsaCllons.
Penn Tower, Suite 100. 25 West Third Street. Williamsport, PA 17701
570.326.9500. 866.855.0569. fax: 570.326.9577 . www.hudockmoyer.com
Investment products and services are offered through Wachovia Securities Financial Network. LLC, (WSFN), Member NASD/SIPC, a registered
broker-dealer and a separate non-bank affiliate of Wachovia Corporation. Hudock Moyer Wealth Management is a separate entity from WSFN. (06/07)
! nil -;:"3 - 201-:1'7 12 :37
CHEI.),' I=HA'T E:r-HiI.
301 '30::.J ::::7'34
F.C12
CHEVY CHASE' B/\Nl<.
",." ~..-- _ lo.l" l\.
(<:00 Chevy Cn;\sc Drive
Laurel. Maryland 2070:'
November 29, 2007
Charles E. Shields. III
Attonwy at Law
6 Clouser Road
Mecflanic.sburg, F'A 17055
Dear Personal Representative:
As request.ed, the date of death information for the below listed account is as follows:
ACCOUNT NUMBER:
DA TE OPENED:
ACCOUNT TITLE:
001-3278'19-3
S€ptember 12, 1986
Dorothy H. Canning
Lousie BaiT
February 12, 2007
Interest Checking
$9,820,61
DATE OF DEATH:
ACCOUNT TYPE.
BALANCE.
,ACCRUED INTEREST:
TOTAL BALANCE:
!NTEREST YTD:
TOTAL YTD INTEREST:
$0.24
$9,820.85
$2.18
$2.42
ADDITIONAL COMME~~TS
Please do not hesitate to contact me if you have any questions or require additional
a~~i~~:nlce _'iCq~Cerning this nll1tter.
/~.;) - re y ~
(t '- i7'\' ':1' ~
'-_ '",--tJ- Y" ' "'- . .
y~ Me uffev ~
Custodian of Records" ntralized Research Department
Chevy Chase Bank
/~~~3-8064
'---....._ _________ r
Reference Number:
992026
';lEV-1511 E.X+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF C J'I MA/
". ,riNG,
1J~~7#Y fl.
FILE NUMBER
c:;J../~ 07- 39tB
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule 1.
1.
FUNERAL EXPENSES:
'Konart ~Yle..rtJ HDNe
or Ca.rl.\ s Ie I ~A
'I
31:1..7'/,SO
DESCRIPTION
AMOUNT
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) L ()IJ ISE 13A-1lA!.
LUll-It/ED
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 1~~33 SfJu!h fllJelt. u.. 7U.na
City $4 h u.ttr; ftl. State If Z Zip 8 S''' Z 'f
Year(s) Commission Paid:
2.
Attorney Fees Ch ..,..ft, r::. S h.'dds 1!f"
1
~ tf.35: I)/)
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
6.
7.
~.
'I.
10,
I{.
I~.
Claimant
NONE EL./~I/'~L~
Street Address
City
Relationship of Claimant to Decedent
fYow€
State _ Zip
Probate Fees IINLrl ori~it1cJ 'ISSIAt. of short c..,.t'fje~+ts
Accountant's Fees l C.inely p(l.~at1oJ J(lin,Jer 4th.socs., Ae. (e~h'Il1.)
Tax Return Preparer's Fees ~ c-lose-oJ /0'10 J pit '-/0, /0'1', jJlf 41
0;<<
7' . Db
Jl .$"VO, 00
4.
5.
, 7 S, Db
., II s: ,zS-
'f 8: Of)
'/6: P()
IV;, /8 'lS; pf)
~/e;~ 7ff~ //~f.I)l;' J /J1~;J/~~~. , 'ir.f 3. /9
(....
____________T.?2~~~Also ent~_on line 9,_~caPitula_t~_~___!;_'i?3_~~_
If d Ii er t i :. i ':J i t1 C U. M bc.r \o.t\J La.w jDl.lr'ntJ
IJ.tlvertlsillj /~ e a,.!ls/e Sent/lie I
Ad&/;6'p"aJ c5hf)rt eerh'{.ic6.res
A"tI,'t/Ph~/ fJroj,lJ1e ~e
F/!J^j Fu. If ;(~i s/cr of
l?e/M'hullSell/eH1 Ii tkr/es e:
(If more space IS needed, insert additional sheets of the same size)
Esr. Dr CA-I'IMNGr / /JolePr~y hi.
Sf!Nep. H'/~nt&l
/3. Ildrl/6'""pl dfJ1/!J cer+!c6'caTe$,_&1f4#f.~a1_~1W. .pf..(!d/s.!1!,
~l- /) ?-.??B
'J--S,I:J{)_ . . .
I
T
REV-1513 E.X+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
C ,4If1/J1IN(;., .tJ()~T#Y II.
FILE NUMBER
NUMBER
I
RELATIONSHIP TO DECEDENT
Do Not ListTrustee(s)
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
~ L /lit frI/)h1/fS - I'/Lrtl'- SECDllltJ - pre~ee~~-
eel fJeeeclent hereIn. 7k~re h~r ff,f1
I tl{l se.cl OAM/ be-Moo ptvrt pt Ik re- s, d Ile
1.
:5; ~ +-.e-r
.2.
L OU.15€ 8lrtle
J/.f).. 33 .5o~th Plae;ta. La. TLLna
50..\1 v-tLr;' ttl. J If Z S 5f.D :z't
s i Sorer
;It-07 - 398
AMOUNT OR SHARE
OF ESTATE
AI/A-
I (90 70 of
Res,'clu.e
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTEfl TOTALI\'O'~.TAXABLE [IISTHIBUTIONS ON LINE 13 OF REV-1S00 CO\fEfl SHEE'j ~
I~
(If more space IS needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
DOROTHY HALE CANNING
BE IT REMEMBERED THAT I, DOROTHY HALE CANNING, of P.O.
Box 97, Laporte, in the County of Sullivan and Commonwealth of
Pennsylvania, being of sound mind, memory and understanding,
and considering the uncertainty of life, do hereby make,
publish and declare this my Last Will and Testament, hereby
revoking and making void any and all former Wills by me at any
time heretofore made.
FIRST: I direct that all my just debts and funeral
expenses be paid by my Executrix hereinafter named as soon
after my decease as may be convenient.
SECOND: I give, devise and bequeath the sum of One
Hundred ($100.00) Dollars unto my sister, ELVA THOMAS, of
Knights of Pythian, King Kora, Duncannon, Pennsylvania, so
long as she survives me.
THIRD: I give, devise and bequeath all the rest, residue
and remainder of my estate, whether it be real, personal or
mixed, unto my sister, LOUISE E. BARR, of 771 Longs Gap Road,
Carlisle, Pennsylvania 17013.
FOURTH: In the event the said ELVA THOMAS should
predecease me, I then give, devise and bequeath her share of
my estate unto my sister, LOUISE E. BARR.
FIFTH: In the event the said LOUISE E. BJI"RR should
.
predecease me, I then give, devise and bequeath her share of
my estate unto my niece, JO ANN POWELL, of P.O. Box 103,
Modena, New York 12548.
SIXTH: In the event that both of my said sisters, ELVA
THOMAS and LOUISE E. BARR should predecease me, I then
give, devise and bequeath all the rest, residue and remainder
of my estate, be it real, personal or mixed unto JO ANN
POWELL absolutely.
A~D LASTLY, I do make, constitute and appoint my sister,
LOUISE E. BARR to serve as Executrix of this my Last Will and
Testament.
However, in the event my above-named Executrix
should predecease me, I then nominate, constitute and appoint,
my niece, JO ANN POWELL, to serve as Executrix of this my Last
Will and Testament.
IN WITNESS WHEREOF, I have hereunto subscribed my name
and affixed my seal, the
"d.5cUt
day of ~ f/)E
, in the
year two thousand three (2003)
,(SEAL)
Signed, sealed, published and declared by DOROTHY HALE
CANNING, the Testatrix above named, as and for her Last Will
and Testament, in the presence of us, who have at her request,
subscribed our names in her presence, and in the presence of
each other, as witnesses hereto.
t~ ff,~
~~ f;u~, '" ) A /2 a -If Y111< ~1' l