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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
~ 01
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
O~~ dJ
Date of Birth
294-36-2956
05/08/2007
03/18/1924
Decedent's Last Name
Suffix
Decedent's First Name
MI
Klain
Phyllis
M
(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
. 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate
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
B. Total Number of Safe Deposit Boxes
Louis R. Martin, Esq.
Firm Name (If Applicable)
(717) 230-9715
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REGiSTER ()P~~ USE ONIL..
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First line of address
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214 State Street
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Second line of address
City or Post Office
State
liP Code
Harrisburg
PA
17101
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. Dec ration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OZ!tPE RESP SIBLE FOR Fl. LING RETURN DATE
1- l.. ,",...0 .&
ADDRESS
120 Cragmoor Rd., York Haven,
:D::RE~eARERP' n<AN~'" I F:C loB
214 State Street, Harrisburg, A 17101 II
PLEASE USE ORIGINAL FORM ONLY
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15056051058
Side 1
15056051058
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15056052059
REV-1500 EX
Decedent's Name:
Phyllis
M Klain
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 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 45
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
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15056052059
Side 2
294-36-2956
Decedent's Social Security Number
175,000.00
38,481.46
6,076.62
219,558.08
33,185.09
1,625.93
34,811.02
184,747.06
184,747.06
184,747.06
8,313.62
.
15056052059
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REV-1502 EX... (6-98)
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SCHEDULE A
REAL ESTATE
COMMONV\;EALTH OF PENNSYLVNJlA.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Phyllis M. Klain
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 price 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 jointJy-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
ITEM
NUMBER
1.
DESCRIPTION
Single Family Ranch House-20 Grinnel Drive, Lower Allen Twp., Cumberland County
VALUE AT DATE
OF DEATH
175,00000
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
175,000.00
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REV-1 bO:j EX+- (6-98) 1.1
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COMMONVVEf\LTH OF PENNSYLVANI!'
INHERITi\NCE T/\X RETURN
RESiDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Phyllis M. Klain
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
109 Shares Bell Canada Stock
2,150.00
2.
2436.211 Shares Openheimer
24,489.69
3.
American Funds
11,841.77
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
38,481.46
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REV-15Of3 EX+ (6-98)
SCHEDULEE
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Phyllis M. Klain
FILE NUMBER
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Sovereign Bank Account #233-111-3211 4,216.74
2. Refund SECO Service 200.00
3. Refund prepayment Patriot News 29.05
4. Refund Highmark Insurance 386.08
5. Auction Personalty 1,244.75
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
6,076.62
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REV-1511 EX+ (12'99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Phyllis M. Klain
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
4
FUNERAL EXPENSES:
Parthemore Funeral Home, New Cumberland, PA 17070
Cremation
Interment
JDK catered lunch
St. Stephens Church
2.545.02
500.00
700.00
635.61
600.00
1.
2.
3.
5
B. ADMINISTRATIVE COSTS:
1- Personal Representative's Commissions 5,000.00
Name of Personal Representative(s) Daniel Klain
Social Security Number(s)/EIN Number of Personal Representative(s) 173-56-7556
Street Address 120 Cragmoor Rd.
City Yark Haven State P A Zip 17370
Year(s) Commission Paid: 2007
2. Attorney Fees 2,500.00
3. Family Exemption: (If decedent's address is not the same as claimant'&, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 605.64
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Maintenance, repairs, utilities of realty prior to sale 5.149.07
8. Closing costs sale of realty 14.449."75
9. Memorial Harrisburg Academy 500 00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
33.18509
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REV-1512 EX. (12-03)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Phyllis M. Klain
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
FILE NUMBER
1.
3
Indiana Pennsylvania Hospital 1,155.00
PP&L 2.37
Verizon 81.37
UGI 159.35
Pa. American Water 15.82
Lifeline 112.86
Comcast 99.16
2.
4.
5.
6.
7.
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,625.93
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F<EV-1513 EX+ (9~OOi
SCHEDULE J
BENEFICIARIES
COMMONWEALTH 0:: PENNSYLVANIA
INHERITANCE TAX RETURN
RES!DENT DECEDENT
ESTATE OF
Phyllis M. Klain
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
1 Daniel Klain (son), 120 Cragmoor Rd., York Haven, PA 17370 50% of Estate
2. Matthew Klain (son), 1795 Barkley Rd., Clarksburg, PA 15725 50% of Estate
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed. insert additional sheets of the same size)
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LAST WILL AND TESTAMENT
OF
PHYLLIS M. KLAIN
I, PHYLLIS M. KLAIN, of the Township of Lower Allen, County of Cumberland,
Commonwealth of Pennsylvania, being of sound and disposing mind, memory and
understanding do make, publish and declare this to be my Last Will and Testament, hereby
revoking all prior Wills and Codicils made by me.
ITEM I:
I direct that the expenses of my last illness and funeral shall be paid out of
my Estate as soon after my decease as may be convenient.
ITEM II:
All the rest, residue and remainder of my Estate, real, personal and mixed,
I give, devise and bequeath unto my beloved husband, AMBROSE. KLAIN.
.ImM-III~ . I11-the-eventthatmyhusband,AMBROSE KhAIN, should-predec~ase me
(For the purposes of this, my Last Will and Testament the word "predecease" shall be construed
to include simultaneous deaths, deaths within sixty days after the death of the "predeceased"
individual, or deaths under circumstances in which it cannot be determined whether I or the
"predeceasing" individual died first.) then and in that event I give, devise and bequeath the rest,
residue and remainder of my Estate, real, personal and mixed, unto my beloved sons,
MATTHEW NEWTON KLAIN and DANIEL FRASER KLAIN, according to the following
terms:
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(A) Share and share alike; except that, in the event that both sons are able to
agree as to which should take any particular item or items, then the subject
or subjects of such agreement shall pass specifically to the agreed upon
individual.
(B) In the event that one of my sons shall predecease me then the portion of
my Estate that would otherwise have passed to that son shall pass to his
issue per stirpes, or in the event of a failure of his issue, to the other.
(C) In the event that both of my sons should predecease me leaving issue, then
the shares otherwise going to each individual son shall go to that son's
issue per stir.pes.
ITEM IV:
I direct that all legacies and shares, while in the hands of my Executor or
Substitute Executors, shall not be subject to attachment, execution or sequestration for any debt,
contract, obligation or liability of any legatee or beneficiary, and shall not be subject to pledge,
assignment, conveyance or anticipation.
ITEM V:
I direct that all estate, inheritance and succession taxes shall be paid out of
my residuary estate to the same effect as if said taxes were expenses of administration, and that
all life insurance proceeds, property held with my said husband as tenants by the entireties,
legacies, devises and other gifts made by this, my Will, or by any Codicil hereto, shall be free
and clear thereof; in the absolute discretion of my Executor or Substitute Executors, he/they may
pay such taxes immediately, or may postpone the time of payment of taxes on future or
remainder interests until possession thereof accrues to the beneficiaries.
2
,
ITEM VI:
A.
I direct that my Executor or Substitute Executors shall have the power:
For the payment of debts or for any purpose of administration or
distribution, to sell, mortgage, lese, alter, improve, partition and exchange all or any of my real
estate, and to sell the same public or private sale, for such prices and upon such terms as to cash
and credit as he may deem best or upon the reservation of ground rents and the said ground rents
in turn to extinguish or assign, and to grant and convey good and sufficient title, without liability
on the part of the purchasers, to see to the application of the purchase or consideration monies.
This power shall not be construed to work a conversion of the real estate unless and until the
power is actually exercised.
B. To sell and transfer, either in person or by attorney, all stocks, bonds,
investments and other personal property owned by me without liability on the part of the
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purchasers to see to the application of the purchase or consideration monies.
C. To borrow such sums of money as may be required for the purpose of the
Estate, and to secure the loan by a pledge of all or any part of my Estate property, or mortgage,
and to execute an accompanying bond authorizing 01 other evidence of indebtedness. Persons or
corporations advancing money to the Executor or Substitute Executors need not inquire into the
necessity.
ITEM VII:
I hereby nominate, constitute and appoint AMBROSE KLAIN, my
husband, as Executor of this, my Last Will and Testament. In the event that AMBROSE KLAIN
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shall predecease me or die prior to the settlement of my Estate, I then nominate, constitute and
appoint my sons, MATTHEW NEWTON KLAIN and DANIEL FRASER KLAIN as Substitute
Co-Executors of this, my Last Will and Testament.
K=d-.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of
?~~/
, 2000.
~k) "1c<c1~+ ki",,;
PHYLLIS M. KLAIN
The preceding instrument, consisting of this and three (3) other pages, was on the date
thereof signed, published and declared by PHYLLIS M. KLAIN, the Testatrix therein named, 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 hereto.
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COMMONWEALTH OF PENNSYLVANIA
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COUNTY OF (!.u ,-118 €.IU-A Al~
WE, PHYLLIS M. KLAIN, and ~.;f c.~~.L/v<L.aV; and
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/xl-cyLr.~/ /; {).~~ ' the Testatrix and the witnesses, respectively, whose
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
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for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of
the Testatrix, signed the Will as witnesses and that to the best of their knowledge the Testatrix
was that time eighteen (18) years of age or older, of sound mind and under no constraint or
undue influence.
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PHYLLIS M. KLAIN
Subscribed, sworn to and acknowledged before Il}e by PHyt,LIS M. KLAIN, the Testatrix, and
subscribed and sw~rn to before I31e ~y ~_~ >f U--r-d3--L4-~ , and
. T~A,fo~ ,~tne~:;:;~l~t0
Notary Public
Notarial Seal Public
Catheri,:,s J. Wa~~~b~~:'~ County
Camp HI!' B'~~Expires Sept. 22. 201)3
My Commlssl
. Association ot Notarial
Member, Pennsylvania
5
LOUIS R. MARTIN
COUNSELOR AT LAw
January 28,2008
2 I 4 STATE STREET
HARRISBURG, PA I 7 10 1
(717) 230-9715
FAX (7 17) 230-8534
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Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PAl 7013
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Re: Inheritance Tax Return - Estate of Phyllis M. Klain
File No. 2007-00482
Dear Register of Wills:
Enclosed for filing is the inheritance tax return for the Estate of Phyllis M. Klain.
I have enclosed a check in the amount of$15.00 to cover the filing fees. I have also
enclosed a copy of the return to be stamped and mailed back to my office in the self-
addressed stamped envelope.
If you have any questions, please feel free to call my office. Thank you for your
assistance.
Very truly yours,
~0M~f\AcJc
Louis R. Martin, Esq.
LRM:skj
Cc: Daniel Klain
Enclosure
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