HomeMy WebLinkAbout02-21-08
-I
15D5bD41147
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 0 7
File Number
0880
Date of Birth
172014871
09142007
12101917
Decedent's Last Name
Suffix
Decedent's First Name
PAS:ICK
HARR:IBT
MI
o
(If Applicable) Enter Surviving Spouse's Infonnatlon 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
!HI 1. Original Return 0 2. Supplemental Return
o
3. Remainder Return (date of death
prior to 12-13-82)
0 4. limited Estate 0 4a. Future Interest Compromise
(date of death after 12-12-82)
!HI 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust
(Attach Copy of Win) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10 Spousal Pov~ Credit ~date of death
. between 12-31-91 and -1-95)
o 5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
o
11 . Election to tax under Sec. 9113(A)
(Attach Sch. 0)
~RRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
e Daytime Telephone Number
SBAB M. SHULTZ, BSQU:IRB 7172495373
Finn Name (If Applicable)
KB:IGHT . ASSOC:IATBS, P.C.
First line of address
11 ROADWAY DR:IVB, SU:ITB B
REGISTER OF WILLS USE QNL Y
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Second line of address
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City or Post OffIce
CARL:ISLB
State
PA
ZIP Code
17015
DATE ~ED
Corrwpondenrs HIIall add,..:
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 PE ON RESPONSIBLE FOR FILING RETURN DATE
Kathryn F. Wert
4468 Valley Road, Sherman. Dale, PA 17010
SIGNATURE OF PREPARER 0 HER THAN REPRESENTATIVE
Sean M. Shultz, Esquire
DATE
"2.. -z.. 0 I (JK'
11 Roadway Drive, Suite B, Carlisle, PA 17015
Side 1
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15[]5b[]42148
REV-1500 EX
Decedent's Name:
FASICK, HARRIET O.
172014871
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) 0 Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 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, 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
15.
152,822.47
16.
17.
18.
19. Tax Due... ........... .... ................... ...................... .................. ...................... ............ ...... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15[]5bD42148
Decedent's Social Security Number
157,148.16
157,148.16
4,325.69
4,325.69
152,822.47
152,822.47
6,877.01
6,877.01
~
15056042148
.-.J
RBV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 07 - 0880
I II-I :I-Ill-N ";:) NAME
Fasick, Harriet O.
STREET ADDRESS
4466 Valley Road
CITY \ STATE 1ZIP
Shermans Dale PA 17090
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
6,877.01
7,141.31
343.85
Total Credits (A + B + C)
(2)
7,485.16
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
0.00
608.15
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?................................................. ..................................................................... 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....... ..................... .... ....................... ................ ..... ..................... ............... ...... 0 iii
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Yes
No
o [i]
B ~
iii
iii
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. 99116 (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
(O) percent [72 P.S. 99116 (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-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 (O) percent [72 P.S. 99116 (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. 99116 1.2} [72 P.S. 99116 (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. 99116 (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.
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAL. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Fasick, Harriet O.
RLE NUMBER
21 - 07 - 0880
Include the proceeds of Iitig~tion and 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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Postmark Credit Union Savings Account No. 4242-00 1,994.60
2 Postmark Credit Union Investor's Savings Account No. 4242-13 58,628.49
3 Postmark Credit Union Certificate of Deposit 64.255.24
4 1 st National Bank of Marysville Checking Account No. 409294 28.907.00
5 Refund from Manor Care Nursing Home 3,362.83
TOTAL (Also enter on Line 5, Recapitulation) 157,148.16
.
SCH31I.E H
R.N:RALEXPENSES&
Al:ltMSTRA11VE COSTS
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Fasick, Harriet O.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 - 07 - 0880
ITEM DESCRIPTION AMOUNT
NUMBER FUNERAL EXPENSES:
A. 1 Funeral Lunch 204.08
2 Thank you flowers 58.28
3 Kimmell Funeral Home 2,580.79
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. Attorney's Fees to Knight & Associates, P.C. 900.00
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 to Register of Wills 317.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 The Sentinel - advertise letters 190.54
TOTAL (Also enter on IIn8 9, Recapitulation)
4,325.69
.
SchecUe H
FtnnI ElqBlsa B &
Ml. McAeCcstscanhJed
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Fasick, Harriet O.
FILE NUMBER
21 - 07 - 0880
2
Cumberland Law Journal - advertise letters
75.00
Page 2 of Schedule H
.REV1161~ EX+ (~)
'*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Fasick, Harriet O.
I RLE NUMBER
21 - 07 - 0880
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not Ust TruatM(a)
I. TAXABLE DISTRIBUTIONS [include outright scousal
C1istributions; and ransfers
under Sec. 9116 (a) (1.2)]
1 Eric Wert grandson 1/6 of estate
1316 Calle Cantar
Henderson, Nevada 89012
2 Jeffrey Wert grandson 1/6 of estate
138 Timber Lane
Shippensburg, PA 17257
3 Kathryn F. Wert daughter 2/3 of estate
4466 Valley Road
Shermans Dale, P A 17090
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet I
D. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS
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
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LAST WILL AND TESTAMENT
OF
HARRIET o. FASICK
I, Harriet o. Fasick, of 398 Kings Highway, Lot 39,
Marysville, Perry County, 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
wills and Codicils heretofore made by me.
ITEM I. I direct that all my debts and funeral expenses,
including my cemetery lot and gravemarker and all expenses of my
last illness, shall be paid from my residuary estate as soon as
practicable after my death as part of the expense of the
administration of my estate.
ITEM II. I make the following specific devise and bequest:
A. My two (2) cemetery lots at Rolling Green Cemetery to my
daughter, Kathryn F. Wert.
ITEM. III.. I devise and bequeath all of the rest, residue
and remainder of my estate of every nature and wherever situate as
follows:
A. One-third (1/3) of my net estate equally to my two (2)
grandsons, Eric Wert and Jeffrey Wert, or the survivor
of them.
B. The remaining two-thirds (2/3) of my net estate to my
daughter, Kathryn F. Wert. In the event she predeceases
me or dies on or before the thirtieth (30th) day
following my death, then one-third (1/3) to craig Wert
1
and the other one-third (1/3) to be divided equally
between my grandsons, Eric Wert and Jeffrey Wert, or the
survivor of them.
ITEM IV. I direct that any and all Inheritance, Estate and
Transfer taxes imposed upon my estate passing under my will or
otherwise, shall be paid out of the principal of my residual
estate.
ITEM V. I appoint Kathryn F. Wert, Executrix of this my
Last will and Testament. In the event of her renunciation, death,
resignation or inability to act for any reason whatsoever, I
appoint Eric Wert, Executor of this my Last will and Testament. I
relieve my Executrix or Executor from the necessity of posting
security in connection with her or her duties as such in any
jurisdiction in which she or he may be called upon to act.
IN WITNESS WHEREOF, I have hereunto set my hand to this my
Last Will and Testament, which consists Of'dl;L pages, to each of
which I have affixed my signature this ,17 day of ..Jr0-~JA- .
one thousand nine hundred and ninety-nine (1999). ~
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Harriet o. Fasick
2
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
PerVj
ss
. .
. .
We, a.vne{ O. (\Sit-I<' ,and f'r7M.j p,. Etter bISs./~Jer
and IJJill/on1 [I ISS/J1jfr- , 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 for the
purposes therein 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 of their knowledge the testatrix was at that
time eighteen years of.age or older, of sound mind and under no
constraint or undue influence.
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Testatrl.x
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and acknowledgoed
Fasick, Testatrix and
and acknowledged
. Dre )1C 0', and
, witnes es this
, 1999.
NOTARIAL SEAl.
JODI A. McN~ELY, Notary Public
Morysville Boro, Perry County
My COrM\~ion Expires April 7, 2003
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