HomeMy WebLinkAbout05-08-08 (2)
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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..Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONL.Y
County Code Year
File Number
2 1 0 8
o 0 8 0
Date of Birth
1]8 1 '6 q, 1 8,~""
Decedent's Last Name
Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
<U
1. Original Return
c=>
2. Supplemental Return
C)
4. Limited Estate
CJ
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
C>
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::::;J 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')
City or Post Office
State
ZIP Code
,...________.,_......_...._.._.___~._~_.u_....__..,_._._,,>
! REGISTER OF 'WILLS USE ONLY ,
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First line of address
4 4
Second line of address
PA
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pe~ , I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
nd mplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
RSON R SP IB F R FILING RETURN
, Executor
DATE ~?
- 5' - 00
rin s PA 17065
5 ATE, {;
Main Street. Mechanicsburi, PA 170~~
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
-I
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.-J
REV-1500 EX
Decedent's Name:
RECAPITULATION.
15056052048
George W. Ely, Sr.
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) c:::> Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested. . . . . . .. 7.
8. Total Gross Assets
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . " 9.
Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 8.
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 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-4S
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X. 15
De~dent's Social Security Number
178160189
1 0, 5...4- 7-.58
1 1, 4 9 6 .3 3
15.
16.
17.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . 19.
18.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056052048
Side 2
c=)
15056052048
---'
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21-08-0080
DECEDENT'S NAME
GeOrge W. Ely, Sr.
STREET ADDRESS
5225 Wilson Lane
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
40,026.14
37,900.00
1,895.00
Total Credits ( A + B + C ) (2)
39, 795.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 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)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(5)
(5A)
(58)
231.14
5. If Line 1 + Une 3 is greater than Line 2. enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
231.14
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN JlX" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... 0 KX
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 D
C. retain a reversionary interest; or.......................................................................................................................... 0 D
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 U
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 KX
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ U 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. S9116 (a) (1.1) (i)].
For dates of death on or after January 1 t 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 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. ~9116(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. ~9116(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-150' EX+ (6-9..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
George w. Ely, Sr.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUM BER
21-08-0080
ESTATE OF
ITEM
NUMBER
1.
DESCRIPTION
Merrill Lynch Investment Accounts:
VALUE AT DATE
OF DEATH
a. No. 87257477 $ 24,420.42
b. No. 87257792 536,079.79
c. No. 87257793 246,307.62
d. No. 87286953 6,500.49
Total:
813,308.32
TOTAL (Also enter on line 2, Recapitulation) $ 813,308.32
(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
George W. Ely, Sr.
FILE NUMBER
21-08-0080
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by t~e.,estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
2.
1995 Chevrolet 510 pickup truck
VALUE AT DATE
OF DEATH
$ 500.00
1,655.00
ITEM
NUMBER
1.
DESCRIPTION
Miscellaneous furniture, furnishings and personal property
3.
Mobile X-ray Imaging, Inc., refund account credit
6.96
4.
Chase Bank and Chase Credit Card Services, refund of account
credits
9.29
5.
Cumberland County - payment of Veteran's benefit
100.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,271.25
REV-1510 EX. (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
George W. Ely, Sr.
FILE NUMBER
21-08-0080
ESTATE OF
This schedule must be completed and filed if the an~~~r to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A copy OF THE DEED FOR REAl ESTATE.
DATE OF DEATH % OF DECD'S EXCLUSION
VALUE OF ASSET INTEREST (IF APPLICABLE)
$11,779.18 100% N/A
TAXABLE
VALUE
$11,779.18
Prudential Financial, annuity account
No. 3002075798, Beneficiary: Julie V. Ely
and George W. Ely, Jr., children of Decedent.
Date of Transfer: January 16, 2008
(date of death)
2. Merrill Lynch, IRA account No. 872-86953, 2,753.21 100% N/A 2,753.21
Beneficiary: George W. Ely, Jr., son of
Decedent. Date of Transfer: January 16,
2008 (date of death)
3. Federal Employees' Group Life Insurance, 4,263.45 100% ~,263.451 - 0
Claim No. 20080204554, Beneficiary:
George W. Ely, Jr., son of Decedent. Date of
Transfer: June 16, 2008 (date of death)
4. Department of Treasury, Government Life ~,468.00 100% ~,468.00 - 0
Insurance Policy V17102346. Beneficiary:
George W. Ely, Jr., son of Decedent.
Date of Transfer: January 16, 2008 (date of
death)
TOTAL (Also enter on line 7 Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
14,532.39
REV-1511 EX+ ('0-061.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
George W. Ely, Sr.
FILE NUMBER
21-08-0080
ESTATE OF
Debts of decedent must be reported on Schedule 1
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Hollinger Funeral Home & Crematory, Inc.
$5,160.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Waived
Street Address
City
State _ Zip
Year(s} Commission Paid:
2.
Attorney Fees to Snel baker & Brenneman, P. C.
3,500.00
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 - $108.00, plus additional
probate fee of $530.00
Accountant's Fees, miscellaneous filing fees, reserve
638.00
1,000.00
5.
6.
7.
Ta~.1JI irgoeooxfft
Advertise grant of Letters:
a. Cumberland Law Journal
b. The Sentinel
$ 75.00
174.58
249.58
TOTAL (Also enter on line 9, Recapitulation) $ 10,547.58
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
ITEM
NUMBER
1.
George W. Ely, Sr.
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmburaed medical expenses.
VALUE AT DATE
OF DEATH
$823.02
FILE NUMBER
21-08-0080
DESCRIPTION
West Shore EMS-ALS - payment on account
2.
Bethany Village - payment on account
82.93
3.
Lower Allen Township - per capita tax due
9.80
4.
East Pennsboro Ambulance Service - payment on account
33.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
948.75
OEV-1513 EX+(9<)O) ..
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Geor2e W. Elv. Jr.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
George W. Ely, Jr., 11 Brenely Lane
Mount Holly Springs, PA 17065
2". Julie V. Ely, 1612 Red Hill Road, Dauphin,
PA 17018
FILE NUMBER
21-08-0080
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
3. Carol Weidler, 107 Meadow View Lane,
Landsdale, PA 19446
Son Personalty and
46% of residue
Daughter Personalty and
46% of residue
none 2% of residue
none 2% of residue
none .5% of residue
none .5% of residue
4. Barbara Speece, 1740 Hallman Drive, Blue
Bell, PA 19422
5. Virginia Brown, 755 Lee Lane, Enola, PA
17025
6. Frances Howard, 4346 Campus Avenue, Unit
202, San Diego, CA 92103
I
I
I
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
St. Timothy Evangelic Lutheran Church, 4200 Carlisle Pike,
Camp Hill, PA 17011
1% of residue
University of Pennsylvania, Office of Alumni Relations,
3533 Locust Walk, Phildelphia, PA 19104
1% of residue
The Rails-To-Trails Conservancy
Northeast Regional Office
2131 Market Street, Suite 222, Camp Hill, PA 17011
1% of residue
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 24,558. 49
(If more space is needed. insert additional sheets of the same size)
LAST WILL AND TEST AMENT
OF
GEORGE W. EL Y
7-1-(J"-I
I, GEORGE W. EL Y, now domiciled in Cumberland County, Pennsylvania, declare this to
be my Last Will and Testament. I revoke all other wills and codicils that I may have previously
made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after my
death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
Article III
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my will or with my valuable papers and found within 30 days of
the probate of my will. Gifts may only be to persons who survive me or to organizations which exist
at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
I hereby give and bequeath all of my tangible personal property (excepting any vehicle I may
own) unto my son, GEORGE W. ELY~ JR., of Mt. Holly Springs, Pennsylvania, and to my
daughter, JULIE V. EL Y, of Dauphin County, Pennsylvania, to be divided among them as they may
agree.
Article V
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath as follows:
A. Forty-six (46%) per cent unto GEORGE W. EL Y, JR., per stirpes. It is my hope
and desire that my son utilize this inheritance to benefit the education of my
grandchildren, great grandchildren, and great great grandchildren.
B. Forty-six (460/0) per cent unto JULIE V. ELY, or if she does not survive me, then
unto her issue, if any, in equal shares, per stirpes, and if she is not survived by issue,
then unto GEORGE W. EL Y, JR, per stirpes.
- 2 -
C. Two (2%) per cent unto CAROL WEIDLER, of Lansdale, Pennsylvania, per
stirpes.
D. Two (2%) per cent unto BARBARA SPEECE, of Blue Bell, Pennsylvania, per
stirpes.
E. One (1%) per cent unto RAILS-TO-TRAILS CONSERVANCY,
PENNSYLVANIA CHAPTER, or its successors, Suite 300, 1400 Sixteenth Street,
N\i\T, Washington, D.C.
F. One (10;0) per cent unto the UNIVERSITY OF PENNSYLVANIA, ALUMNI
CENTER, or its successors, 3533 Locust Walk, Philadelphia, Pennsylvania, to be
used at their discretion.
G. One (1 %) per cent unto the CHURCH of which I am a member at the time afmy
death to be used at their discretion.
H. One-half (.5%) per cent unto VIRGINIA BRO\VN, of Cumberland County,
Pennsylvania, per stirpes.
1. One-half (.50/0) per cent unto FRANCES HOWARD, of San Diego, California, per
stirpes.
Article VI
I nominate, constitute, and appoint GEORGE W. EL Y, JR, as Executor of my Last Will
and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever
- 3 -
of my Executor, I nominate, constitute and appoint my nephew, STEVEN SPEECE, as successor
Executor of my Last Will and Testament. I direct that my Executor or successor Ex:.ecutor be
permitted to serve without bond and in addition to those powers granted by law, I grant them power
to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could
have filed ifliving. My Executor and successor Executor shall receive reasonable compensation for
services rendered to my estate.
Article VI
In addition to the powers conferred by law, I authorize my Executor and successor Executor,
in his absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate or
personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
- 4 -
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such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
G) to receive reasonable compensation in accordance with their standard schedule of fees in
effect while their services are performed.
IN WITNESS WHEREOF, I, GEORGE W. EL Y, hereby set my hand to this my Last Will
and Testament, on 7 - / -t/ -7"
, 2004.
~
~GEORGE .. Y
In our presence, the above-named GEORGE W. EL Y signed this and declared this to be his
Last Will and Testament and now at his request, in his presence, and in the presence of each other,
we sign as witnesses.
Name
----\ ~-
~~ [~%
~11?d(l- *~cuf;
{ "
Address
845 Sir Thomas Court. Suite 12, Harrisburg, PA 17109
845 Sir Thomas Court, Suite 12, Harrisburg, FA 17109
- 5 -
"'Y.I"~'-'.)'-"""""'''''''''''.~'''''')',':-::''_~''i'~~-::c";;,,,-:,,;:.~...~'t!"',.~,>":',"'" t .' C'-:"'1'>,~:~~\'<l::,:",;~:'n-~0'~':""''':'"!''''' 7
I, GEORGE W. EL Y, Testator, who signed the foregoing instrument, having been duly
qualified according to law, acknowledge that I signed and executed this instrument as my Will, and
that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
GEORGE W. ELY, the Testator,
on 7-1 ,2004.
~:r4!IL'I~ (l t; pt
ot 'Public
G~~
COMMmMEAllH Of mJmtVAfftA
NOTARlAl SEAL
JACGUEUNE A. mLY, MOTARY PUBUC
UlWER PAXTON lWP.. OAUPHlH courm
fI{ toMMISStGN EXPlRES 11ft. 17. 2M1
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testator sign and execute this
instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the
purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
by Jva,% r;herSCJr~
and~/~Q I1da. f)ido/t
\vitnesses, on I I 7 -I ' 2004.
g,~/:-I'- Cbus~
ftness )
~J/7drJ~ YI0:J(lAC
Witness
J:a~)Jj~1~ (. Xdft
f otaf)1 Public
COMMONWEALTH Of' PENNSYLVANIA - 6 -
NOTARIAL SEAt
JACQUBJNE A. KELi" NOTARY PUBLIC
toWER PAXTON TWP., DAUPHIN COUNTY
MY COMMISSION EXPlRES DEC.l7, 2001
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