HomeMy WebLinkAbout03-20-08
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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
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
21 07
1125
Decedent's Last Name
Suffix
Date of Birth
03/20/1926
Decedent's First Name MI
Mildred E
Spouse's First Name MI
Robert A
209-12-9066
07/17/2007
Adams
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Adams
Spouse's Social Security Number
/ ~ 9 (~ q ~ 6 53
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. Spousai Poverty Credit (date of death
between 12-31-91 and 1-1-95)
o
8. Total Number of Safe Deposit Boxes
.
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
l" J
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION ll:~ULD BE DIRE~ TO:
Name Daytime Telephonet..lVlIDber co
...- :r;
(717) 243-6222 j j~ 0
-~ Fi; N
REGISTER .OFV'(I~~SE orID!
James D. Flower Jr. Esq
Firm Name (If Applicable)
Saidis Flower & Lindsay
First line of address
26 West High Street
i"""')
Second line of address
(,0
o
City or Post Office
State
ZIP Code
DATE FILED
Carlisle
PA
17013
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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE 0 E PONSI R FILING RETURN
20 DAtE
~,'ZO CJY
_..____ _u_ ... .__
_ _ _h_~ d:,7 ~8
7 13
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
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15056052059
REV-1500 EX
Decedent's Name:
Mildred
E Adams
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 Subjectto 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_
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X. 15
121,603.40
15.
0.00
16.
0.00
17.
0.00
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056052059
Side 2
209-12-9066
Decedent's Social Security Number
0.00
29,302.12
0.00
0.00
1,095.47
107,385.00
0.00
136,782.59
15,179.19
0.00
15,179.19
121,603.40
0.00
121,603.40
0.00
0.00
0.00
0.00
0.00
15056052059
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Mildred E Adams
_'_____n______
STREET ADDRESS
31 Greenfield Drive
File Number
07 1125
DECEDENT'S SOCIAL SECURITY NUMBER
209-12-9066
CITY
Carlisle
STATE
PA
. ZIP
I 17015
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + 8 + C ) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + 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)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(SA)
(58)
0.00
0.00
0.00
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
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 [i]
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i]
c. retain a reversionary interest; or.......................................................................................................................... 0 [i]
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 [i]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [i]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 [i]
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. 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 (0) percent
[72 PS. 99116 (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 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)]. Asibling 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
Mildred E. Adams
FILE NUMBER
21-07 -1125
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
308 shares, Chevron, common stock, @ $91.89/share
VALUE AT DATE
OF DEATH
28,302.12
TOTAL (Also enter on line 2, Recapitulation) $
28,302.12
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Mildred E. Adams
FILE NUMBER
21-07-1125
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
DESCRIPTION
VALUE AT DATE
OF DEATH
1 . Conseco Insurance, Premium Refund
1,095.47
TOTAL (Also enter on line 5, Recapitulation). $
1,095.47
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTlY-OWNED PROPERTY
ESTATE OF
Mildred E. Adams
FILE NUMBER
21-07-1125
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Robert A. Adams
31 Greenfield Drive, Carlisle, PA 17015
Surviving Spouse
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 ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 09/15/03 Real estate with improvements situate in South Middleton Township,
Cumberland County, PA, known as 31 Greenfield Drive, Carlisle, PA
Assessed Value. See attached assessment sheet 178,370.00 50% 89,185.00
2. A Household gods and furnishings 36,400.00 50% 18,200.00
TOTAL (Also enter on line 6, Recapitulation) $ 107,385.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mildred E. Adams
FILE NUMBER
21-07-1125
Debts of decedent must be reported on Schedule L
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Ewing Brothers Funeral Home
Headstone
Funeral flower spray
Funeral Luncheon
7,336.19
2,500.00
159.00
530.00
2.
3.
4.
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
1,000.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
3,500.00
Claimant Robert A. Adams
Street Address 31 Greenfield Drive
City Carlisle
State PA ,Zip 17015
Relationship of Claimant to Decedent Surviving Spouse
4.
Probate Fees
139.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Register of Wills, File Inheritance Tax Return
15.00
TOTAL (Also enter on line 9, Recapitulation) $
15,179.19
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Mildred E_ Adams
FILE NUMBER
21-07 -1125
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 oulright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Robert A. Adams, 31 Greenfield Drive, Carlisle, PA 17015 Surviving Spouse 122,103.40
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
None 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
None 0.00
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
TaxDB Result Details
P.age I of I
Detailed Results for Parcel 40-24-0748-003. in the 2004 Tax Assessment Database
DistrictNo 40
Parcel ID 40-24-0748-003.
MapSuffix
HouseNo 31
Direction
Street GREENFIELD DRIVE
Ownerl ADAMS, ROBERT A & MILDRED W
C/O
PropType R
PropDesc
Liv Area 1798
CurLandVal 35000
CurImpVal 143370
CurTotVal 178370
CurPretval
Acreage .22
CIGrnStat
TaxEx 1
SaleAmt 165000
SaleMo 09
SaleDa 15
SaleCe 20
Sale Y r 03
Deed BkPage 00259-01455
YearBlt 1991
HF _File_Date 10/22/2004
HF _Approval_Status A
http://taxdb.ccpa.net! details.asp ?id=40- 24-07 48-003 .&dbselect= 1
2/201200R
LAST WILL AND TESTAMENT
OF
MILDRED W. ADAMS
I, MILDRED W. ADAMS, of 308 Glendale Street, Carlisle,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making void any and all former Wills, Codicils, or
writings in the nature thereof, by me at any time heretofore made.
FIRST: I hereby order and direct my Executrix or Executor,
hereinafter named, to pay all my just debts, funeral expenses, testamentary
expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as
may be conveniently done after my death, out of my residuary estate.
SECOND: I give, devise and bequeath all of the rest, residue and
remainder of my estate, be it real, personal or mixed, of whatsoever kind and
wheresoever situate, to my husband, ROBERT A. ADAMS, provided he survive me
by thirty days.
THIRD: I have made an advance of the sum of Fifty Thousand
($50,000.00) Dollars to my daughter, BARBARA L. ADAMS. In the event that my
husband, ROBERT A. ADAMS, fails to survive me by thirty (30) days, I give my
daughter, JOANN C. EBERLE, and my son, THOMAS W. ADAMS, each the sum
of Fifty Thousand ($50,000.00) Dollars to equal the advancement made to my
daughter, BARBARA L. ADAMS. If my husband survives me by thirty (30) days,
this gift shall be deferred until his death.
FOURTH: In the event that my husband fails to survive me by thirty
days, I hereby give, devise and bequeath my residuary estate to my children, in
equal shares, THOMAS W. ADAMS, of Philadelphia, Pennsylvania, JOANN C.
EBERLE, of Charlotte, North Carolina, and BARBARA L. ADAMS, of Carlisle,
Pennsylvania.
FIFTH: If my daughter, JOANN C. EBERLE, predeceases me, I
leave the share of my estate which she would have received to her husband, JAY
EBERLE. If my son, THOMAS W. ADAMS, predeceases me, I leave the share of
my estate which he would have received, one half to my daughter, JOANN C.
EBERLE and one-half to my daughter, BARBARA L. ADAMS. If my daughter,
BARBARA L. ADAMS, predeceases me, I leave the share of my estate which she
would have received, one-half to my daughter, JOANN C. EBERLE and one-half to
my son, THOMAS W. ADAMS.
LASTLY: I nominate, constitute and appoint my husband,
ROBERT A. ADAMS, to be the Executor of this my Last Will and Testament. In the
event that my said husband, ROBERT A. ADAMS, shall be unable to serve as
Executrix for any reason, I appoint my children, THOMAS W. ADAMS, JOANN C.
EBERLE and BARBARA L. ADAMS, as Co-Executors. No Executor shall be
required to file bond in this or any other jurisdiction.
2
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
01 ih day of {]/Lc'~ , 2006.
()
!LJI Jd-\\~~ FlJo-"nl.c-
I Mildred W. Adams
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
(~~ \)~M~()
" 7 L J~ \.
j .' . '
~fI;fAI7l; . /0k0L/
3
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, MILDRED W. ADAMS, Testatrix, 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.
Swom or affirmedqO and aCknowled9fefore me, by MILDRED W
ADAMS, the Testatrix, this tit day of tu... , 2006.
/~~(l--J-1. ..QIt- u). /~~ Yi'1/'-Y
Mildred W. Adams, Testatrix
~
NOTARIAL SEAL
IRlENE I. MARHEVI<A. NOTARY PUBUC
CARUSLE. CUMBERlAND COUNTY, PA
MY COMMISSION EXPIRES JUNE 8. 2010
4
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
W . and t/7~ cI ~'7i.-U.A, J
the witne es whose names are sig d to the attached or foregoing instrument,
being dul qualified according to law, ao depose and say that we were present and
saw Testatrix 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 Testatrix signed
the Will as witnesses; and that to the best of our knowledge the Testatrix was at that
time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subscribed to before me biJo.,YLI "J J;lec~, 1-
and (b~ of ~1lJ.J-tJ,. this J qtf- day
of gU-O'LJ ,2006.
A ,/
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W/71/?f,'/ ~~A /
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.. WItness
IIJTAIIAL 8EM.
MERl.EIE t r=.IIJ1NWMUC
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