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Home My WebLink About04-28-08 (2) ....J 15056051047 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 Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 2.1 O,S OQ,Q.....66 174 Decedent's Last Name Date of Birth Suffix Decedent's First Name MI R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW d> 1. Original Return C) 2. Supplemental Return c=> 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::; 4. Limited Estate C) cp c::> 4a. Future Interest Compromise (date of death after 12-12-82) C) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::> 10. Spousal Poverty Credit (date of death C) 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 Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8. Total Number of Safe Deposit Boxes C) 8 Firm Name (If Applicable) S N.E L..B AK.E.R.& First line of address REGISTER OF WILLS USE ONLY City or Post Office State ZIP Code I I 1....._................. o .~~S .~~j ~ ~ "'-:: "'r::; :.-:' i~~ ~, DAt"tt fi~ ...............t:::).e............ .:0 12.-1 -0 ............~. ~ N en r--.:JI c::;, c.:.:> ~I :n I' .:::n t T1 :l.Jb .,'1 0 -0 I (~'-) C) ::=0 I (-~ =u N I "tS~ CO I -.-:] CJl i c) 1-.".',0 ..........I,~f~a ,.~- r. I (..)") C-) -f"l Second line of address M E C H A N I C S BUR G P A Correspondent's e-mail address: .---., . ing accompanying schedules and statements, and to the best of my knowledge and belief, onal representative is based on all information of which preparer has any knowledge. , Executor Dh ~ ~ ':2:J.. ~ / / tf ("'<li ()~ DATE 193'J3 ADDRESS 44 West Main Streer, MprhQn;r~hllr~, PA 17()t)l) PLEASE US ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 -I ~ -J-.ft / /J V'~tY ~ ~ J!.~ ~ ~ ~ REV-1500 EX Decedent's Name: RECAPIT.U~ATION 15056052048 Violet R. Lilley 1. Real estate (Schedule A). .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . 6. Jointly Owned Property (Schedule F) c=> Separate Billing Requested . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c=> Separate Billing Requested.. . . . . . . 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental 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 .0 _ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Decedent's Social Security Number 1,1.4 4:.,0, ],.0...8..3 2. 3. 4. . 5. 6. 7. 8. 9. o ..0 a 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052048 Side 2 c::::) 15056052048 -.J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-00066 DECEDENT'S NAME Violet R. Lilley STREET ADDRESS 422 Walnut Bottom Road CITY Carlisle 1 STATE PA \ ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) -0- Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 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) B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5A) (58) A. Enter the interest on the tax due. -0- Make Check Payable to: REGISTER OF WILLS, A GENT 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 !Xl b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 !Xl c. retain a reversionary interest; or.......................................................................................................................... 0 IX] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 IX] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 IX] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 IX] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 00 0 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 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 appHcable 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)]. 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-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Violet R. Lilley 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. FILE NUMBER 21-08-00066 ITEM NUMBER 1. DESCRIPTION M&T Bank, Checking Account No. 424900 VALUE AT DATE OF DEATH 2,037.47 5,231.65 2. M&T Bank, Savings Account No. 015004202120660 3. Highmark Insurance - premium refund 325.62 4. Thornwald Home, resident savings account 42.69 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7,637.43 REV-'5'O EX+ 16-9.* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Violet R. Lilley FI LE NUMBER 21-08-00066 This schedule m~st 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 DATE OF DEATH ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLIC}\BLEj VALUE 1. Prudential Financial Life Insurance Policies $7,973.49 100% 100% -0- 068698049 and 080725774, payable upon death to Estate of Decedent. Date of transfer: December 21, 2007 TOTAL (Also enter on line 7 Recapitulation) $ -0- (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ 1'0-05). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Violet R. Lilley FILE NUMBER 21-08-00066 ESTATE OF Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: 1. DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) John C. Lilley, Jr. 149 Bethel Road 750.00 Street Address City Oxford State~Zip 19363 Year(s) Commission Paid: 2008 2. Attorney Fees to Snelbaker & Brenneman, P. C. 2,000.00 3. Family Exemption: (Ii 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 84.00 5. Accountant's Fees, mics. administrative expenses, reserve 750.00 6. Tax Return Preparer's Fees 7. Advertise grant of Letters Testamentary: a. Cumberland Law Journal: b. The Sentinel: $ 75.00 166.60 241.60 TOTAL (Also enter on line 9, Recapitulation) $ 3,825.60 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & UENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Violet R. Lilley 21-08-00066 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH 1,039.52 ITEM NUMBER 1. DESCRIPTION Thornwald Home, payment due on account 2. Social Security Administration - return of benefits 998.00 3. Commonwealth of pennsylvania, Department of Public Welfare, Estate Recovery Program claim 81,325.77 TOTAL (Also enter on line 10, Recapitulation) $ 83,363.29 (If more space is needed, insert additional sheets of the same size) REV.1513 EX+ (9-00) '*' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Violet R. Lilley FILE NUMBER 21-08-00066 NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) John C. Lilley, Jr. 149 Bethel Road Oxford, PA 19363 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE Son 80% of residue 2. Clark Lilley 24 N. Bridge Street Christiana, PA 17509 Grandson 5% of residue 3. Taryn Lilley 710 Stone Mill Drive SE Cartersville, GA 30121 Granddaughter 5% of residue 4. Cindy Mikeworth 140 Suncrest Drive Greenwood, IN 46143 Granddaughter 5% of residue 5. David Diehl 3642 DeCamp Drive Indianapolis, IN 46225 Grandson 5% of residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 B I 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) .W OFFICES IELBAKER. :ENNEMAN " SPARE LAST WILL AND TESTAMENT OF VIOLET R. LILLEY I, VIOLET R LILLEY, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare tlus as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be paid as soon as practical after my death by my Executor, hereinafter named. I direct that all taxes that may be assessed as a consequence of my death shall be paid from my residuary estate as part of the expenses of the administration of my estate. 2. All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath as follows: A. I give Eighty percentum (80%) to my son, JOHN C. LILLEY, JR. B. I give Five percentum (5%) to my granddaughter, CINDY DIEHL. C. I give Five percentum (5%) to my grandson, DAVID DJEHL. D. I give Five percentum (5%) to my grandson, CLARK LILLEY. E. I give Five percentum (5%) to my granddaughter, T ARYN LILLEY. In the event my son, JOHN C. LILLEY, JR., should predecease me, I direct that the share he would have received hereunder shall pass in equal shares to his issue surviving me per stirpes. 3. I hereby nominate, constitute and appoint my son, JOHN C. LILLEY, JR., as Executor of this my Last Will and Testament, but should he predecease me or fail to qualifY, then in such event, I nominate, constitute and appoint KEYSTONE FINANCIAL or its successor by merger or other corporate reorganization as Executor of this my Last Will and Testament. I further direct that no person or entity serving as Executor hereunder shall be required to post any bond to ""-- LAW OFFICES .NELBAKER. JRENNEMAN & SPARE secure the faithful performance of his or its duties in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on Two (2) pages this 291h day of June, 2000. ( ( .-j"ff+--,o t ':> vt.jj-~ /r. v JJ~ Violet R. Lilley (j (SEAL) Signed, sealed, published and declared by VIOLET R. LILLEY, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~(~~ (SEAL) -JM~ iIf. 3y)lSEAL) .r II -2- .AW OFFICES NEI.BAKER, RENNEMAN 8: SPARE COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND We, VIOLET R. LILLEY, KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, 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 Testament 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 ofthe Testatrix, signed the Will as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. t?~~ Ie. f.ze ~ ; Testatrix ;j" ld~~ Witness k/J~./( ~4 ,/ Witness / ! Subscribed, sworn to and acknowledged before me by VIOLET R LILLEY, Testatrix, and subscribed and sworn to before me by KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCIJ, witnesses, this 29th day of June, 2000. ~~~.~ (A Notary PubJj 7) , ,