HomeMy WebLinkAbout02-21-08 (2)
,
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15056041125
REV -1500 EX (06-05)
PA Depar1ment of Revenue '*
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128..()6()1 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
Date of Birth
14901 413 6
05252 007
OFFiCtt;,L USE OHL\'
County Code Year
2 1 0 7
File Number
o 5 5 7
07301917
Decedenfs Last Name
S U THE R L I N
Suffix
Decedenfs First Name
MI
G
DOROTHY
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
S U THE R L I N
HARRY
Spouse's Social Security Number
MI
T
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of
death after 12-12-82)
o 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
o 10. Spousal Poverty Credit (date of death 0 11. ElectJon 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
FILL IN APPROPRIATE OVALS BELOW
00 1. Original Return
o 4. Limited Estate
00
o
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
D A V I D
H
RADCLIFF,
E S Q
Firm Name (If Applicable)
R A D C L IFF
LAW
OFF ICE ,
P C
First line of address
1 0 1 1
MUMMA
R 0 A D
Second line of address
SUI T E
2 0 1
City or Post Office
State
ZIP Code
LEMOYNE
P A
17043
o
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
7 1 7 2 3 6 9 3 1,8
r~ REGISTER OF W"""J'" "N'" ~::
I
l ..J
~_---EATE FltE~ ___--;=::.:.-J
Correspondent's e-mail address:DHRAD@IX.NETCOM.COM
Under penalties of pe~ury, I declare that I have examined this retum, indueling aCXXlll1panying schedules and statements, and to the best of my knowledge and belief,
it is true, corred and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN U PE 0 ESPONSIBlE FOR FILING RETURN DATE /
;2 (/f,!..E'6
NORFOLK VA 23503
DA E
;Z 2??, .200f?
ADDR
1011
LEMOYNE
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
:L505604:L:L25
PA 17043
:L505604:L125
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15056042126
REV-1500 EX
DecedenfsName: DOROTHY G. SUTHERLIN
RECAPITULATION
1. Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B)
.................................. 2.
3. Closely Held Corporation, Partnership or SoIe-Proprietorip (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 BiIing 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)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
............10.
11. Total Deductions (total Lines 9 & 10)
. . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net Value of Estate (Une 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Govemmental BequestslSec 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.O _
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
o . 0 0
15.
408858.81
16.
O. 0 0
17.
O. 0 0
18.
19. Tax Que
.. .. ........ ... . ...... .. . . ........ ..... ....... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056042126
Decedent's Social Security Number
149014136
402345.29
27247.97
9.
429593.26
1 9 5 8 6.9 8
1147.47
20734.45
408858.81
408858.81
O. 0 0
18398.65
O. 0 0
O. 0 0
18398.65
00
15056042126
-l
REV-1500 EX' Page 3
Decedenfs Complete Address:
DECEDENrS NAME
DOROTHY G. SUTHERLIN
___.._..__..~ _-0 __._~___.________.__
STREET ADDRESS
109 EGE DRIVE
File Number
21 07 0557
.--
---------TSTATE--.--.- . '--IZF~-------
I PA 117013
CITY
CARLISLE
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. DiscotJ1t
(1)
18,398.65
18,000.00
919.93
Total Credits (A + 8 + C) (2)
18,919.93
3. Interest/Penalty if applicable
D. Interest
E. Penalty
T otallnteresUPenalty ( D + E ) (3)
4. If Une 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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
521.28
0.00
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(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 em: Yes No
a. retin the use or income c:J the property transferred; ...................................................................... 0 00
b. retin the light to designate who shall use the property transferred or its income; ............................... 0 00
c. retain a reversionary interest; or ................................................................................................ 0 00
d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00
2. If death occurred after December 12, 1982, did decedent transfer property wilhin one yeat c:J death
without receiving adequate consideralion? ....................................................................................... 0 00
3. Did decedent own ell "in trust fa" or payable upon death bank account or security at his or her death? ......... 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 0 00
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 d death on or after July 1. 1994 em before JCI1UC1'y 1, 1995. the tax rate ~ on the net valuedtransfers to or for the usec:Jthe surviving spouse
is three (3) perrent (72 P.S. ~116 (a) (1.1) (i)).
For dates ct death on or after January 1, 1995. the tax rate ~ on the net value c:J transfers to or for the use of the surviving spouse is zero (0) percent
172 P.S. ~116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax. em the statutory requirements for disclosure of assets and
filing a tax return are sliD applicable even if the surviving spouse is the only beneficiary.
For dales c:J death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty~ yeas c:J age or younger at death to or for the use of a natural paent, an
adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. ~116(aX1.2)].
The tax rate imposed on the net vaue of transfers to or for the use of the decedenfs lineal beneliciaries is four em one-half (4.5) percent, except as noted in
72 P.S. ~116(1.2) (72 P.S. ~116(a)(1)].
The tax rate imposed on the net value of transters to or for the use of the decedent's siblings is twelve (12) percent (72 P.S. 59116(a)(1.3)]. A sibling is defined. under
Section 9102, as ell individual who has a11east one parent in common with the decedent. whether by blood or adoption.
RIN-1503 ~+ (6-98)
.
SCHEDULE B
STOCKS & BONDS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DOROTHY G. SUTHERLIN
FILE NUEER
21 07 0557
AI property joInIIy-ownd wIIt1 right of survIworshlp must be disclosed on Sc:heduIlI F.
ITEM
NUMBER
1.
2.
3.
4.
5.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16,
17.
DESCRIPTION
FIDELITY CASH RESERVES (ACCT NO. 2BE-316938)
PLUS ACCRUED DIVIDENDS - $13.93
VAlUE AT DATE
OF DEATH
4,108.57
EDWARD JONES MONEY MARKET TAX-FREE FUND
CUSIP 480199108
16,838.88
616 SHARES AQUA AMERICA, INC @ $22.245
CUSIP 03836W103
13,702.92
166 SHARES BANK OF AMERICA CORP @$51.02
CUSIP 060505104 WITH ACC'D DMDEND OF $92.96
8,562.28
66 SHARES MILASTAR @$2.68
176.88
56 SHARES AT&T @$40.70
CUSIP oo206R102
2,279.20
100 SHARES CITIGROUP @$54.82
CUSIP 172967101
5,482.00
128 SHARES CHEVRON CORPORATION @$80.705
CUSIP 155764100CVX WITH ACC'D DIVIDEND OF $74.24
10,404.48
120 SHARES CONOCOPHILlIPS @$75.98
CUSIP 20825C104 WITH ACC'D DMDEND OF $49.20
9,166.80
50 SHARES COCA COLA CO @$51.835
CUSIP 1912161ooKO
2,591.75
80 SHARES EXXON MOBil CORP @$83.17
CUSIP 30231 G1 02XOM WITH ACC'D DIVIDEND OF $28.00
6,681.60
100 SHARES GENERAl DYNAMICS CORP @$79.325
CUSIP369550108 GO
7,932.50
155 SHARES GENERAL ELECTRIC CO @$37.475
CUSIP 369604103 GE
5,808.63
55 SHARES INTEL CORP @$22.17
CUSIP 458140100 INTC
1,219.35
40 SHARES JOHNSON & JOHNSON @$63.335
CUSIP 478160104 JNJ WITH ACC'D DIVIDEND OF $16.60
2,550.00
210 SHARES LOWES COMPANIES INC @$32.085
CUSIP 548661107 LOW
6,737.85
TOTAL (Also enter on line 2, RecapituIalion) $
(If more space is needed, insert addiIionaI sheets of the same size)
402 345.29
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
DOROTHY G. SUTHERLIN
Decedent's Name
Page 1
21 07 0557
File Number
Schedule B - Stocks & Bonds
ITEM VAlUE AT DATE
NUMBER DESCRIPTION OF DEATH
18. 210 SHARES MICROSOFT CORP @$30.42 6,388.20
CUSIP 594918104 MSFT
19. 80 SHARES PROCTOR & GAMBLE CO @$63.12 5,049.60
CUSIP 742718109 PG
20. 70 SHARES STRYKER CORP @$66.845 4,679.15
CUSIP 863667101 SYK
21. 120 SHARES TARGET CORP @$60.545 7,279.80
CUSIP 87612E106 WITH ACC'D DIVIDEND OF $14.40
22. 205 SHARES US BANCORP DEL COM NEW @$34.35 7,041.75
CUSIP 902973304 USB
23. 140 SHARES UNITED TECHNOLOGIES CORP @$68.475 9,623.60
CUSIP 913017109 WITH ACC'D DIVIDEND OF $37.10
24. 239.39 SHARES CAPITAL INC BLOR FD CL C @$64.96 15,550.77
CUSIP 140193301 CIBCX
25. 1140.848 SHARES CAPITAL WORLD GRWTH & INC FD CL A @$45.79 52,239.43
CUSIP 140543109 CWGIX
26. 4.088.303 SHARES LORD ABBETT INVT TR US GOVT FD CL A @$2.53 10,380.07
CUSIP 543916308 LAGVX WITH ACCtD DIVIDEND OF $36.66
27. 685.154 SHARES VAN KAMPEN COMSTOCK CL A @$20.52 14,059.36
CUSIP 921120103 ACSTX
28. 1397.016 SHARES VAN KAMPEN REAL ESTATE SEC CL A@$30.64 42,804.57
CUSIP 92113P105 ACREX
29. 5000 LEHIGH CO PA IDA POLLUTION CONTROL BD @101.346 5,131.72
CUSIP 524808 BM3 PLUS ACC'D INTEREST OF $64.42
30. 5000 MONTGOMERCY CO PA HIGHER ED HL TH BD @$97.623 4,915.05
CUSIP 6136030N2 PLUS ACC'D INTEREST OF $33.90
31. 1??oo PA ECON DEV FING AUTH BD @$101.620 10,311.92
CUSfP 70869RAA1 PLUS ACC'O INTEREST OF $149.92
32. 15000 PA ST HIGHER EDL FACS BD @$98.489 14,819.58
CUSIP 70917N3B8 PLUS ACC'O INTEREST OF $46.23
SUBTOTAl SCHEDULE B
210,274.57
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
DOROTHY G. SUTHERLIN
Decedent's Name
Page 2
21 07 0557
File Number
Schedule B - Stocks & Bonds
ITEM VAlUE AT DATE
NUMBER DESCRIPTION OF DEATH
33. 1??oo PA ST HIGHER EOL FACS BO @$98.661 10,097.55
CUSIP 70917N4Q4 PLUS ACCtO INTEREST OF $231.45
34. 1??oo FEOL HOME LONA MTG SERIES 2581 @$91 9,114.58
CUSIP 31393L YD9 PLUS ACCtO INTEREST OF $14.58
35. 5000 CHL MORTAGE PASS THRU SER 2005-15 @$88.49 4,424.50
CUSIP 12669GQ87
36. 5000 CITIGROUP INC DUE 8/27/12 @$100.88n 5,111.43
CUSIP 172967BP5 PLUS ACC'O INTEREST OF $67.04
37. 6000 VERIZON MARYLAND INC DEB SER B @$82.6156 5,092.58
CUSIP 92344WAB7 PLUS ACC'O INTEREST OF $135.64
38. 1000 CIT GROUP INC NOTES @$98.6969 988.83
CUSIP 125581AE8 PLUS ACC'O INTEREST OF $1.86
39. 4000 FEOL NATIONAL MTG ASSN @$100.4062 4,045.29
CUSIP 31359MGHO PLUS ACC'O INTEREST OF $29.04
40. 4000 ALCOA INC NOTES @$102.8617 4,239.84
CUSIP 013817A03 PLUS ACC'O INTEREST OF $125.37
41. 5000 BANK ONE CORP SR NOTES @$100.4750 5,117.45
CUSIP 06423MN3 PLUS ACC'O INTEREST OF $93.70
42. 5000 VERIZON NEW ENG INC SR NOTES @$103.2980 5,228.12
CUSIP 92344RAAO PLUS ACC'O INTEREST OF $63.22
43. 5000 TARGET CORP NOTES @$100.2191 5,111.09
CUSIP 87612EAJ5 PLUS ACC'O INTEREST OF $100.14
44. 5000 SBC COMMU7NCATION INC @$101.3975 5,212.13
CUSIP 78387GAM5 PLUS ACC'O INTEREST OF $142.25
45. 8000 US TREASURY NOTES DUE 5/15/08 8,056.00
CUSIP 9128274F6 PLUS ACC'O INTEREST OF $12.33
46. 4000 US TREAS NOTES DUE 2/15112@$100.4141 4,069.98
CUSIP 91282nLO PLUS ACC'O INTEREST OF $53.42
47. 6000 US TREASURY NOTES DUE 2/15/12 6,113.81
CUSIP 9128273EO PLUS ACC'O INTEREST OF $100.68
SUBTOTAl SCHEDULE B
82,023.18
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
DOROTHY G. SUTHERLIN
Decedent's Name
Page 3
21 07 0557
File Number
Schedule B - Stocks & Bonds
ITEM VAlUE AT DATE
NUMBER DESCRIPTION OF DEATH
48. 14 SHARES VERIZON COMMUNICATIONS @$42.44 594.16
CUSIP 92343V104
49. 12 SHARES LUCENT TEHCNOLOGIES @$.18 2.16
CUSIP 549463107
SO. 6 SHARES QWEST COMMUNICATIONS NATL @$9.95 59.70
CUSIP 749121109
51. 5000 GENERAL ELECTRIC CAPITAL CORP MEO TERM NOTE SER A @$99.984 5,047.83
PLUS ACetO INTEREST OF $48.63
52. VOOAFONE, PLC 100.00
SUBTOTAL SCHEDULE B 5,803.85
GRAND TOTAl SCHEDULE B $ 402,345.29
REV-1508 EX + (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DOROTHY G. SUTHERLIN
FILE NUMBER
21 07 0557
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
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
DESCRIPTION
VALUE AT DATE
OF DEATH
32.55
HIGHMARK - PREMIUM REFUNDS
TWELVE U,S, SAVINGS BONDS (SEE ATTACHMENT)
1,763.72
WORLD SAVINGS BANK
8,088.19
AARP REFUND
27.00
COUNTY EDUCATORS FEDL CREDIT UNION ACCT NO. 7170000665193
CHECKING ACCT
14,030.09
STERLING SILVERWARE AND SERVING PIECES
(SEE LISTING ATTACHED)
REFUND - LADIES HOME JOURNAL
1,019.00
9.98
PERSONAL PROPERTY (SEE LISTING ATTACHED)
88.50
AMETHYST PIN
45.00
AMETHYST PENDANT
60.00
SEA URCHIN PINE
35.00
RUBY BRACELET
60.00
COUNTY EDUCATORS FEDL CREDIT UNION SAVINGS ACCT
559.96
STATE OF NEW JERSEY - PENSION PAYMENT
1,428.98
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, iIS8If addilionaI sheeIs of the same size)
27.247.97
ESTATE OF DOROTHY G. SUTHERLIN
S.S.# 149-01-4136
FILE NO. 21-07-0557
A IT ACHMENT TO P A 1500 SCHEDULE E, ITEM #2
U.S. SAVINGS BONDS
SERIAL # FACE AMOUNT ISSUE DATE VALUE 5/2512007
L2102605120E $ 50.00 JAN 1978 $ 246.92
L2178302316E $ 50.00 NOV 1979 $ 200.40
K3667218EE $ 75.00 JUN 1980 $ 218.61
KI0200351EE $ 75.00 JAN 1981 $ 196.44
K46118949EE $ 75.00 SEP 1984 $ 128.52
K48996246EE $ 75.00 APR 1985 $ 126.00
K52781138EE $ 75.00 NOV 1985 $ 123.54
K060686784EE $ 75.00 JUN 1986 $ 118.74
KO 1597908EE $ 75.00 FEB 1987 $ 104.67
K75052217EE $ 75.00 SEPT 1987 $ 102.60
K81923813EE $ 75.00 MAY 1988 $ 100.59
K84665703EE $ 75.00 DEC 1988 $ 96.69
$1,763.72
,
/
I
/
APPRAISAL
This is to certify that I, Meyer Chovitz, P.O. Box 1073, Virginia Beach, Virginia
23451, telephone (757) 428-4008, am a qualified appraiser of the articles listed below,
having been an established antique dealer in the Tidewater area of Virginia for over 35
years. To the best of my knowledge, the item(s) listed below, which I have examined, are
authentic as they are listed. The appraiser is not interested in the buying or selling of
these item(s). This appraisal is made at the request of:
Name:
Estate of Dorothy Sutherlin
Address:
505 E. Government Avenue
Norfolk, Virginia 23503
The purpose of this appraisal is:
Fair MarketValue
In my judgment their values are as
follows:
Number Description
Appraisal Value
2
18 STERLING SILVER TEASPOONS. Gorham, "Chesterfield"
pattern, patented 1908.
Total weight: approximately 13 troy ounces
FOUR CONTINENTAL STERLING SILVER SERVING
SPOONS AND TWO DESSERT SPOONS.
Total weight: approximately 8 Y2 troy ounces
APPROXIMATELY 27 PIECES ASSORTED STERLING
SIL VER SPOONS, SUGAR, SHELL, BUTTER KNIFE, PICKLE
FORK, SCRAPER, N APKlN RINGS, ETC.
TWO AMERICAN COIN SILVER DESSERT SPOONS. With
fiddleback handles. Nineteenth century.
Total weight: approximately 1 Y2 troy ounces
3
4
Replacement Value is the amount it would cost to replace an
item with one of similar and like quality purchased in the most
appropriate marketplace within a limited amount of time.
Comparative Market Data Approach is based on past prices for
similar works by the same artist or artisan, or similar works by
another artist or artisan of equal standing and related reputation.
SECONDARY MARKET
---~~~-------
effective date July 6, 2007
$ 504.00
150.00
285.00
80.00
ESTATE OF DOROTHY G. SUTHERLIN
S.S.# 149-01-4136
FILE NO. 21-07-0557
A IT ACHMENT TO P A 1500 SCHEDULE E, ITEM #8
PERSONAL PROPERTY
TILT TOP TABLE $ 10.00
SMALL CHAIR 5.00
WOODEN WASTEBASKET 2.50
MARTHA WASHINGTON CABINET 5.00
MIRROR 2.50
GEORGE WASHINGTON PICTURE 1.00
WHA T-NOT-SHELF 10.00
MAHOGANY ROCKER 10.00
LARGE ROCKER 5.00
SMALL ROCKER 5.00
UPHOLSTERED OAK ROCKER 5.00
BOWL & PITCHER 2.50
COSTUME JEWELRY 25.00
TOTAL $ 88.50
REV-1509 E)t + (6-98)
.
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY -OWNED PROPERTY
ESTATE OF
DOROTHY G. SUTHERLIN
FILE NUMBER
21 07 0557
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
ADDRESS
RELATIONSHIP TO DECEDENT
A. HARRY T. SUTHERLIN
109 EGE DRIVE
CARLISLE, PA 17013
SURVIVING SPOUSE
B
c
JOINTL Y..owNED PROPERTY:
lETTER o..TE DESCRIPTION OF PROPERTY "OF DATE OF DEATH
ITEM FOR JOINT MADE INClUDE NAIoE OF FlNAHClAt.INSTITUT1OH AND BANK ACCOUNT NUMBER OR S1YlAR DATE OF DEATH OECO'S VAlUE OF
NUMIlER TENANT JOINT IDENTIFYING NIMlER ATTAOi DEED FORJOINTL Y-HElD REAl ESTATE. VAlUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. ALL OTHER PROPERTY NOT LISTED ON THIS
RETURN IS JOINTL Y HELD WITH SURVIVING
SPOUSE
TOTAL (Also enter on line 6, RecapiIlrlation) $
(If more space is needed. iIsert addilionaI sheets of the same size)
~-1511 EX+(12-99)
.
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DOROTHY G. SUTHERLIN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 07 0557
Deba of decedent IIIUSt be repoI1Ild on Sc:hed4de L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hoffman-Roth Funeral Home 2,581.84
2. Hazelwood Cemetery - Grave Opening 500.00
3. Funeral Luncheon 549.85
4. Minister Honorarium 100.00
5. Drew Memorial Company - Footstone 1,157.00
6. Flowers - Funeral 100.00
B. ADMINISTRATIVE COSTS:
1. Personal RepreseI.taive's Commissions
Name of Personal Rep.ese.ftative (s)
Social Security Number(s)/EIN Number of Personal Repleselllative(s)
S1reet Address
City Slate Zip
Year(s) CoIIRI.iss;o.. Paid:
2. AtDneyFees RADCLIFF LAW OFFICE, P.C. 12,887.80
3. Family Exemption: (If decedent's address is not lie same as cIaimanl's, attach explanation)
Claimant
S1reet Address
City Slate Zip
ReIaIioIlShip d CIainant tl Decedent
4. ProbMeFees original paid - 142.00 462.00
Additional probate - 320.00
5. Aaxluntanfs Fees
6. Tax ReUn Preparer's Fees
7. Filing fee - return and inventory 30.00
8. Legal advertising - Cumber1and law Journal 75.00
9. Legal advertising - The Sentinel 118.72
10. Additional death certificates 89.00
11. Additional short certificates - 44.00
12. Certified Mail charges (RLO) 7.61
13. Executor's travel expenses 500.83
14. Clean up and removal items from personal residence 200.00
15. Packing Supplies 183.33
TOTAL (Also enter on line 9, RecapituIaIion) $ 19586.98
(If more space is needed. insert addiIionaI sheets d the same size)
REv-1512 EX + (12-03)
*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DOROTHY G. SUTHERLIN
FILE NUMBER
21 07 0557
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
1. Cumbertand Crossings 839.22
2. West Shore EMS 93.61
3. Masland Associates 104.64
4. American Stock Transfer (Surety Bond) 40.00
5. Computershare (Surety Bond) 70.00
TOTAl. (Also enter on line 10, Recapitulation) $
(If more spac;e is needed. insert addiIionaI sheets of the same size)
1 147.47
""'''''''''*
COMMONWEAl TIi OF PENNSYlVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
ESTATE OF
DOROTHY G. SUTHERLIN
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 07 0557
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List TrusIIIe(a) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include ou1right~ distributions. and Iransfers under
See. 9116 (a)(1 )]
1. RANDOLPH GROSS Lineal 122,952.93
1849 UNDENHALL DRIVE
LOVELAND, OH 45140 (pers Prop 435.83)
2. NANCY WALSH Lineal 162,952.93
10 NASH ROAD
ACTON, MA 01720 (pers Prop 435.83)
3. KARL W. GROSS Lineal 40,839.04
6710 ROBISON LANE
SALINE, MI 48176
4. MARTHA E. GROSS Lineal 40,839.04
505 EAST GOVERNMENT AVENUE
NORFOLK, VA 23503
5. JUUA K. GROSS Lineal 40,839.03
505 EAST GOVERNMENT AVENUE
NORFOLK, VA 23503
6. RICHARD GROSS Lineal 435.84
505 EAST GOVERNMENT AVENUE
NORFOLK, VA 23503
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 TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
,.
TOTAL OF PART U - 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)
LAST WILL AND TESTAMENT COpy
KNOW ALL MEN BY THESE PRESENTS, that I~ DOROTHY G. SUTHERLIN
currently residing at 109 Ege Drive, Carlisle, Cumberland County, Commonwealth of
Pennsylvania, being in good health and of sound and disposing memory do hereby make, declare
and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils
heretofore made by me.
FIRST: I direct that all of my debts not barred by the statute of limitations,
expenses of my last illness, funeral expenses, costs of administration and claims allotted in the
administration of my estate shall be paid by my Executor hereinafter named, from my estate as
soon after my decease as shall be found convenient.
SECOND: I give and bequeath the sum of FORTY THOUSAND ($40,000.00)
DOLLARS to my daughter NANCY WALSH.
TIDRD: If at the time of my death, I have any equity remaining in Cumberland
Crossings or any traceable proceeds, I give and bequeath that into two equal shares as follows:
A) One share shall be divided equally between RICHARD GROSS,
RANDOLPH GROSS and NANCY WALSH; and
B) One share shall be divided equally between my spouse's children GERARD
K. SUTHERLIN and MARIETTA SUTHERLIN and my spouse's step children WILLIAM R.
FERRY and RICHARD L. FERRY.
FOURTH: I bequeath my automobiles, household and personal effects and other
tangible personalty like nature (not including cash or securities), together with any existing
insurance thereon, to my children RICHARD GROSS, RANDOLPH GROSS and NANCY
WALSH, to be divided among them as they agree or, if they are unable to agree, then by making
,~~ ~,~~~~
alternate selections of items in turn, with the oldest going first, until each has selected an equal
dollar amount. Any of the above items not so disposed of shall be sold by my personal
representative and the proceeds added to my residuary estate.
FIFTH: I give, devise and bequeath the rest, residue and remainder of my estate,
whether real, personal or mixed, and of any nature whatsoever and wherever situate, to my
children RICHARD GROSS, RANDOLPH GROSS and NANCY WALSH.
If any of them should fail to survive me, then to their respective issue, per stirpes.
SIXTH: I hereby nominate, constitute, and appoint RICHARD GROSS,
RANDOLPH GROSS and NANCY WALSH, or the survivor of them, as Executors of this, my
Last Will and Testament, without necessity for posting security regardless of state of residence.
All references to the Executor herein shall be applicable to said substitute Executor.
SEVENTH: If any income or principal shall be payable under my Last Will and
Testament or by operation oflaw to a beneficiary who has not yet attained the age of twenty-one
(21), my Executors shall appoint a custodian and a substitute custodian for said beneficiary in
accordance with the Pennsylvania Uniform Transfers to Minor Act. Nothing herein shall prevent
my Executors from serving as custodian.
EIGHTH: To the greatest extent permitted by law, no interest in income or principal
shall be assignable by, or available to anyone having a claim against, a beneficiary before actual
payment to the beneficiary. However, a beneficiary may assign any part or all of his or her
interest to his or her descendants.
NINTH: My Executor shall have, in addition to the powers and authority conferred
upon him by law, the following additional powers and authority:
1. To sell at public or private sale, exchange, transfer, partition, give options upon,
lease, mortgage, pledge or otherwise dispose of any property, real or personal, at any time
~~ ~. ~.~~ 2
constituting a portion of my estate, and upon such terms and conditions as the Executor shall
deem wise.
2. To invest any money at any time in such bonds, stocks, notes, real estate,
mortgages, life insurance, annuities or other securities, or such property, real or personal, as the
Executor shall deem wise, without being limited by any statutes or rule of law regarding
investments by the Executor.
3. To retain, without incurring any liability, as investments, any property owned by
me at the time of my death, as long as my Executor may deem it wise, and even though such
property is not the kind of property an Executor would purchase as an investment; and even
though to retain such property might violate sound diversification principles.
4. To cause any security or other property which may constitute a portion of my
estate to be issued, held or registered in the Executor's own name, or in the name of a nominee,
or in such form that title will pass by delivery.
5. To consent to the reorganization, consolidation, readjustment of the financial
structure, or sale of the assets of any corporation or other organization, the securities of which
constitute a portion of my estate, and to take any action with reference to such securities which,
in the opinion of the Executor is necessary to obtain the benefit of any such reorganization,
consolidation, readjustment or sale; to exercise any conversion privilege or subscription right
given to my Executor as owner of any securities constituting a portion of my estate resulting
from any reorganization, consolidation, readjustment, sale, conversion or subscription.
6. To pay all costs, taxes, charges and expenses in connection with the
administration of my estate, including such compensations to Executor which shall be in
accordance with established fees throughout the period of administration of my estate.
7. To determine what is "income" and what is "principal" hereunder, and my
Executor's decision thereon shall be final; and to purchase securities at a premium or discount,
d)~;;:: b,~
,
3
and to apply or charge said premium or discount against income or principal as the Executor may
determine.
8. The Executo! may make payments to or on behalf of any person who is the
beneficiary hereunder but in no event, however, shall payments be made to any creditor or other
such person because of anticipation of payment by the beneficiary, and any such claim made by
way of anticipation by the beneficiary shall be of no validity or legal effect.
9. To borrow money from any person, firm or corporation, including any
corporation acting as an Executor hereunder, for the purpose of protecting and preserving or
improving my estate hereunder; to execute promissory notes or other obligations for amounts so
borrowed.
10. To employ legal counsel, accountants, brokers, investment advisors, custodians,
managers and other agents and employees and to pay reasonable compensation out of my estate
or any funds held hereunder to which said compensation is attributable.
11. To carry on any business owned or controlled by me at my death for whatever
period oftime my Executor shall think proper, and my Executor shall have the power to do any
and all things my Executor deems necessary or appropriate, including the power to close out,
liquidate or sell the business at such time and upon such terms as my Executor shall deem best.
12. To do all other acts in my Executor's judgment necessary or desirable for the
proper and advantageous management, investment and distribution of my estate.
TENTH: I direct that all transfer and inheritance taxes, state or federal, assessed
because of my death, whether the funds, property or insurance proceeds to which such taxes are
attributable pass under this Will or not, shall be paid out of my residuary estate; that my Executor
pay, or provide for payment of all such taxes at such time, or times, and in such manner as my
Executor deems best.
~7 ~.<s~~
o
4
IN WITNESS WHEREOF, I, DOROTHY G. SUTHERLIN, the Testator to this, my Last
Will and Testament, typewritten on five sheets of paper which I have identified. at the bottom of
each page by my signature, hereunto set my hand and seal the \ (--e:, day of
~i I 2003. -
COpy
~ ~S~::.
DOROL G. SUTHERLIN
The preceding instrument consisting of this and four other typewritten pages, each identified by
the signature of the Testator, DOROTHY G. SUTHERLIN, this day and date thereof signed,
published and declared by DOROTHY G. SUTHERLIN, the Testator therein named, as and for
her Last Will, in the presence of us who, at her request, in her presence, and in the presence of
each other have subscribed our names as witnesses.
.t~hO
5
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CI.( mjjE~iJJ N 'b
SS
I, DOROTHY G. SUTHERLIN, Testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
:;;~ ~ <;;~
DOROTHY . SUTHERLIN
Sworn or affirmed to and acknowledged before me by DOROTHY G. SUTHERLIN, the
Testator, the l'lUulaYOn ' 2003.
(SEAL)
~~~f :/ tCutlctfJ
NOTARIAL SEAL
Roberta L. Radcliff, Notary Public
Wormleysburg Borough, County of Cumberland
My Commission Expires Jan. 20, 2005
Sworn or affirmed to and subscri
fJ1,eJl-A-EL j() ve-
,
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF ~UfrI13:aLIf N ';)
We 'o.,1J ft.) 1/;fI W~ Iff and fi/}'C/1IU / La./e , the
witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw Testator sign and execute the instrument as her
Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and
that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound
mind and onder no constraint or undoe influence. 1/. ' ~)
4tv~~~
to before me by --o1t/tD /J, RA'o U IFF and
witnesses, this I ~f1--/ day of
: SS
6
(SEAL)
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