HomeMy WebLinkAbout03-06-08 (3)
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue*,
Bureau of Individual Taxes '. . INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
2 1 0 7
o 8 6 3
Date of Birth
19532 1 465
o 6 0 6 2 0 0 7
o 1 2 2 194 1
Decedent's Last Name
Suffix
Decedent's First Name
MI
Lehmer
L a r
y
E
(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
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 0 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
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return
o 4. Limited Estate
~
o
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
o
8. Total Number of Safe Deposit Boxes
o a v i d
H
St 0 n e,
Esqui re
7177747435
Firm Name (If Applicable)
REGISTER OF WILLSUSEONL.Y-
St 0 n e
LaFaver
Shekl et sk
First line of address
414
B r
d 9 e
St r e e t
Second line of address
City or Post Office
State
ZIP Code
DATE FILED
New
Cumberl and
P A
17070
Correspondent's e-mail address:dstone@stonelaw.net
Under penalties of pe~ury, 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.
SIGNATU~ OF PERSON RESPONSIBLE FOR FILING RETURN DATE
j..J&U-l~ /~ ~0-?LJ C Ju r! 3 - 5-08
ADDRESS (
1710 worthR d Cam Hill PA 17011
DATE
3.- 5--DE5
New Cumberland
PLEASE USE ORIGINAL FORM ONLY
PA 17070
Side 1
L
15056041125
15C56C41125
--1
--.J
15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Larry E. Lehmer
RECAPITULATION
9 5 3 2
1 4 6 5
1. Real estate (Schedule A)
1.
2. Stocks and Bonds (Schedule B)
2.
880.0
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)
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous N\ill;Probate Property
(Schedule G) U Separate Billing Requested
5.
8257.0
6.
7.
25.83
62.85
4424.80
9
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.
4289.82
11. Total Deductions (total Lines 9 & 10)
. . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
8 7
4 . 6 2
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.
448.23
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 4 4 8 . 2 3
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 _ 0 . 0 0 15. o . 0 0
16. Amount of Line 14 taxable
at lineal rate X .O~ 4 4 8 . 2 3 16. 2 o . 1 7
17. Amount of Line 14 taxable o .
at sibling rate X .12 0 0 17. o . 0 0
18. Amount of Line 14 taxable 0 . 0
at collateral rate X .15 0 18. o . 0 0
19. Tax Due 19. 2 o . 7
.........,.................. . ................ .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
L
15056042126
15056C42126
--.J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Larry E. Lehmer
STREET ADDRESS
208 Senate Avenue
File Number
21 07 0863
CITY
Camp Hill
STATE
PA
ZIP
17011-
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
20.17
Total Credits ( A + 8 + C ) (2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E ) (3)
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. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
0.00
20.17
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
A. Enter the interest on the tax due.
20.17
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; .... ......................................................... ......... D [g]
b. retain the right to designate who shall use the property transferred or its income; .............. ........ ......... D [g]
c. retain a reversionary interest; or ................................................................................................ D [g]
d. receive the promise for life of either payments, benefits or care? ....................................................... D [g]
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... D [g]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... D [g]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............. ...... ........ ....... .... ... ........ ........................................... ...... [g] D
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 surviving spouse
is three (3) percent [72 P.S. 39116 (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 (0) percent
[72 P.S 39116 (a) (1.1) (ii)]. The statute does not exempt 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 (0) percent [72 PS. 39116(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 PS 39116(1.2) [72 PS 39116(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. 39116(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.
REV-1503 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Larry E. Lehmer
FILE NUMBER
21 07 0863
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
54.355 shares Prudentiallnvstmts-Jennison Utility Fd CI A @ $16.190 each
Fund #0009
VALUE AT DATE
OF DEATH
880.01
TOTAL (Also enter on line 2. Recapitulation) $
880.01
(If more space is needed, insert additional sheets of the same size)
REV-15G8 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Larry E. Lehmer
FilE NUMBER
21 07 0863
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.
DESCRIPTION
AmeriChoice Federal Credit Union-Checking Acct.
VALUE AT DATE
OF DEATH
2,328.11
2
AmeriChoice Federal Credit Union-Savings Acct
46.51
3
Car sold to Douglas Lehmer
3,500.00
4
Donegal Insurance-refund on car insurance
230.00
5
Donegal Insurance-refund on renters insurance
89.00
6
Indian jewelry & 2 dolls sold to Rose Marie Salter
715.00
7
Net proceeds of personal property sold at Haars Auction
570.39
8
Security deposit returned on apartment
778.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8,257.01
REV-1510 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
ESTATE OF
Larry E. Lehmer
FILE NUMBER
21 07 0863
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM ;NCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE OEEO FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. AmeriChoice Federal Credit Union-IRA 25.83 100. 25.83
beneficiary estate
TOTAL (Also enter on line 7 Recapitulation) $ 25.83
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Larry E. Lehmer
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 07 0863
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Musselmans Funeral Home-funeral expenses 2,088.81
2. Musselmans Funeral Home-funeral expenses 376.19
3. Musselmans Funeral Home-funeral expenses 70.51
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees David H. Stone, Esquire 1,250.00
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 Cumberland County Register of Wills 117.00
5. Accountant's Fees
6. Tax Return Preparers Fees
7. Beckley & Madden-Attorneys fee on consultation of estate 301.49
IBM-medical insurance premium 90.80
Register of Wills-filing Inh Tax Return and Inventory 30.00
Reserve for closing expenses 100.00
TOTAL (Also enter on line 9, Recapitulation) $ 4,424.80
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Larry E. Lehmer
FILE NUMBER
21 07 0863
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
Moffitt Heart & Vascular Group-debt of decedent 17.98
2 East Shore Psychiatric Assoc-debt of decedent 46.70
3 Internists of Central PA-debt of last illness 110.59
4 Pinnacle Health Hospital-services rendered 25.00
5 MSHMC Physicians Group-services rendered 11.34
6 Pathology Assoc of Central PA-services rendered 7.31
7 Patient Accts Billing Office-(Triumph)-debt of dec 2,976.00
8 Quantum Imaging-services rendered 2.06
9 Capital Area Surgerical Assoc-services rendered 37.76
10 VISA card - debt of decedent 280.81
11 South Central EMS-ambulance services 40.00
12 West Shore Emerg Med Servs.-ambulance services 663.64
13 Community Life Team EMS-services rendered 70.63
TOTAL (Also enter on line 10, Recapitulation) $
4,289.82
(If more space is needed, Insert additional sheets of the same size)
""'''''''''.
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
L E L h
SCHEDULE J
BENEFICIARIES
FILE NUMBER
arrv e mer 21 07 0863
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 [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 Debra Lynn Devlin Lineal 149.41
1710 Letchworth Road
Cam Hill, PA 17011
2 Douglas Scott Lehmer Lineal 149.41
1109 Revere Lane
Pueblo CO 81001-
3 Eric Todd Lehmer Lineal 149.41
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 - 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 TESTA~ENT
I, Larry E Lehmer , a resident of Harrisburg , County of Dauphin
State of Pennsylvania, being of sound and disposing mind, memory, and
understandin~, do hereby make, publish, and. declare this to be my Last
Hill and Testament, and hereby revoke all former wills made by ~e.
ARTICLE I
I direct that all my legal and enforceable debts, including funeral
expenses, expenses of last illness, and the expense of the administration
of my estate, be paid by my Executrix hereinafter named, as soon after my
decease as may be practical.
ARTICLE II
All the rest, residue, and remainder of my ~roperty, real, personal, and
mixed, at whatever time acquired by me, and wheresoever situated
(hereinafter called residuary estate), I give, devise and bequeath to
See below
ARTICLE III
In the event the person named in ARTICLE II shall predecease me, than I
direct that my residuary estate be divided into as many parts or shares as
there are children survivin~ me, and that one part or share be paid over
and distributed to each child. These children are: Douglas Scott Lehmer,
Debra Lynn Devlin, and Eric Todd Lehmer
~~"
ARTICLE IV
I appoint as Executrix, to serve without bond, the person named in ARTICLE II.
I give my Executrix the fullest power and authority in all matters and
questions, including complete authority to sell at public or private sale,
. .
for 'c~~h or credit, with or without security, invest, reinvest, mortgage,
to compromise and settle claims, lease pledge, and dispose of all property,
at such times upon such terms and conditions as may be determined, all without
court order.
ARTICLE V
If the person named in Article IV shall predecease me, than I appoint
My daughter Debra Lynn Devlin.
as Exectrix without bond, with full powers as heretofore described.
IN WITNESS WHEREOF, I hereby
sign, seal, and declare this as my Last Will
day Ofn 2,,001. .
7 L- 4L-./
. (Signature)
and Testament this II
Signed, sealed and declared by the Testator as and for this Last Will and
Testament in the presence of us, who at his! request, in his/her presence,
ner
each other, have subscribed our ~. es as witness
lIS- P./~ .~ APj--96,tJL
~,.
. 9 u
Address .
and in the
~P:;~AS ~ lJRlJl'-j
\ 7 I D l
Witness
Address
sub:1cri~ ana Sworn to betor~ m~ tilis
Li:L1avof .~;;200 r
';?i~ -/ -
_ J/;/#l/
(Off",.1 TiUc) 'f
"Ay commission f',oires
1~'~-"~~:":-'~,":~~;~'7::'-----'1
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My CGT~i:.' -...J
~ Prudential
~
January 9, 2008
STONE LEFAVER AND SHEKLETSKI
ATTORNEYS AT LAW
ATTN DAVID H STONE
414 BRODGE STREET
PO BOX E
NEW CUMBERLAND PA 17070
RE:
Prudential
9559449500/560091
0009- XXXXXXl169
LARRY E LEHMER
Reference Number:
Account:
Registration:
Dear Attorney Stone:
This letter is in regard to your recent correspondence.
As of the close of business on June 6, 2007, the above referenced account was valued at $880.01.
This value is based on a balance of 54.355 shares at the Net Asset Value (NAV) price of$16.19
per share. As changing market conditions may cause the NA V price to fluctuate on a daily basis,
the account value is subject to change.
If you have questions or need further assistance, please contact the Prudential Mutual Fund
Service Center at (800) 225-1852 Monday through Friday between 8:00 a.m. and 8:00 p.m.
Eastern time. For account information that is available 24 hours a day, 7 days a week, you may
access your account online at www.prudential.com.
Sincerely,
Jo-Anne Morse
Sr. Investor Services Specialist
Prudential Investments
Prudential Mutual Fund Services LLC
POBox 9655
Providence, RI 02940
(800) 225-1852
www.prudential.com
~ AmeriChoice
- ~FEDERAL CREDIT UNION
Building Relationships For Life
December 3, 2007
RE: Estate of Larry Lehmer
SS# 195-32-1465
To whom it may concern:
The following is the date of death balances for all accounts as requested.
Savings balance $ 46.51
Checking ba1ance$ 2328.11
Visa ba1ance$ 280.81
The visa bill was paid off and closed on 6/8/07, leaving a checking account balance of
$ 2047.30.
Feel free to contact me with any questions or concerns at (717)697-3474, ext. 4515.
Sincerely,
rn7Cv~,~ U :3 t~ ! nL
Maggie Strohm
Operations Administrator
G:t
Fi)IJJI,!-O..;)l"C
l,.ENOER
CRil;I~ UNI'ONS'