HomeMy WebLinkAbout05-14-08
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes 'illll
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(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
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. Spousal Poverty Credit (date of death <:::) 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
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
~
8. Total Number of Safe Deposit Boxes
<:::)
First line of address
REGISTE~O~ILLS USE:
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DATE FILED (J1
Second line of address
or Post Office
State
Correspondent's e-mail address: (\ () \" m 2\.. n\ I ) II (' 1.d 6) Com r.3 S-t I net-
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, r ct and complete. Declaration of preparer other th the personal representative is based on all information of which preparer has any knowledge.
~/
A DR SC!
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SIGNATURE OF PREPARE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
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REV-1500 EX
Decedent's Name:
RECAPITULATION
15056052048
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). . . . . . . . . . . . . . . . . . . . . . . . . . -
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, or
transfers under Sec. 9116
(a)(1.2) X .0_
16. Amount of line 14 .t?~le
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
19. TAX DUE. . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
8.
15.
16.
17.
18.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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1--1
15056052048
Side 2
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15056052048
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REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME . 10
61-or\ a oS, _.. 'U~s.set--
ST~~5 uJf:'5~5 n6'fe)
i c sbu
8-1 ____Ol--_Ql 3 ~
4d.1\
CITY
S~TH
ZIP/-=t-O 5':5
Tax Payments and Credits.
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
$0
(1)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
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)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
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 II
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 I)
c. retain a reversionary interest; or......................................................................................................................... 0 .
d. receive the promise for life of either payments, benefits or care? ..................................................................... 0 ..
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 fIl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 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 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 PS. 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 PS. ~9116(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 + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
~SS7~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF \
G 0('\0
s.
FILE NUMBER
d-\ - 0+ - O~3~
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
~~\",\ dCC'\-__ fYl'l- T 6dl\ K ~"\'b~3135't'b5)
t~eQk5 cJCc.-\- lY\'t- 'I i:JClItk c<i:q~c\ HO't:tdO )
~,C, 6o~ ~+-
lbl)~,\o Q)~ \4d-~-O+lo1-
CS1akne~+~ a{6cle~
d.
VALUE AT DATE
OF DEATH
4- J ) 0 C1..+ I
;;25,03
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$ If, 134-.14
I
REV-1511 EX+ (10-06)*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF \ '
G 0, \ a
s.
Bc:"5~<;-er
FILE NUMBER
d\ - O,:\- 4.. 0'1--3?J
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:'
1'Pa\~emo\€- t=\Jller-o\\-\oMe) \Dew ~mbe.,landJP
J, rY\edt~n\CS~\){'j Ceme~~_~\cl-\ mJu~)rA
3, ~I t'\~\ c\, meffio\'ldk~l1\'€c~al)iCS ~) ~R
+, EN:- <<\00(\10, (\) ('\)<:-\o3')~ CfUne~\ ~h~ ~
DESCRIPTION
AMOUNT
t \O)1q~.o~
~ ~ f)JjO
\ ) i-ro ,DO
( '~/Jl-
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City
State _Zip
Year(s) Commission Paid:
2. Attorney Fees
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
6.
5. Accountant's Fees
7.
<::6.
q,
10.
II,
\6--.
Tax Return Pre parer's Fees
~+ ruews.~apeJ ~S-\a~ f\~~~
Cu",'oe'-\Q.\ld l~w --rO\l~ l'\i).-! C es-t.-k f\Jie~
~u'" be.- \ o,l\.d ~\.ll'\~ ~~ '. ~ o-t- WI \ \ s .
\ \ (Le~fs\'\Dr'1 -~~ll{.\cdieslf~~U{\C~() )
~ ~\O-\ S~ (' '\ J s: b a+\- \ ed wa~r (60-\ C\')Ge- due-)
ftT'+T Cf h 0 y\e.- )
bd\ort\OwerS C('O'\~ {)\c.b . ~A (po\Ot) C-c= dU~
lloO ,0 d.
--:r 5' . Do
I.oJ,DD
..0+
4~ , d-()
3 () , OC)
TOTAL (Also enter on line 9, Recapitulation) $ \ '3 lo i-O \ ~~
(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
G\o\,-\ "
s,
~ess -er
'" FILE NUMBER
c?'-\ -01 - 0 'q-3 ?:>
ITEM
NUMBER
1.
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
$ /lP,LP cJ
q,Th
DESCRIPTiON
re_der-o-\ \ a-X ot.O€..d '~r ~()~
LUes-\- s,\0.o ~ T ct-)(
~er c-Qp ~ -\a
d,
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
d-lo I Y-Y-
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
G \ 00\a
s,
~eSSLAl
NUMBER
I
L{L
FILE NUMBER
d-.\- O==\- - Ol-33
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
SO(\
fu:j~
])a ~~ h*-,
dcfJ /0
d~!b
cf-:) ~
d--:) %
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
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
1 b&'oar-c S'S~~~I~a lku ~k
I'/, t.\ c:, le\ SLi"e. l0o:\d j \Y)e<;c) It 2 5
d. :r~~ ~c:-r ~ ~.).olo
~\q ~ ~ab\o~()J
\?)o r r~ 0 ~r=\ ~ s}~-,A-- q d-O 0 +
3, 3\\ \ SN\\+~
~i-.:)o Tara lOr\~
Yo \~ I -ffi \ -:tL\-{) L\-
(\jor-m5 fY\une.1e-1
\0+5 QOLlI\~ clu b i<JocJ
CorY\ P t-L \ l ;-f Cl l--=t-o \ \
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 TESTAMENT OF GLORIA S. BESSER
I, Gloria S. Besser, of the Borough of Mechanicsburg,
County of Cumberland and State of Pennsylvania, being
of sound and disposing mind, memory' 3nd understanding
do make, publish and declare this my Last Will and
Testament.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can
conveniently be done.
I give and bequeath all the rest, residue and remainder
of my estate, of whatsoever nature and wheresoever
situate, to my four children, share and share alike.
In this respect, I nominate, constitute and appoint
my daughter, Norma A. Munchel, Executrix of this my
last will and testament.
In witness whereof, I have hereunto set my hand and
seal this lJ....s,L day of May, A.D. 2007.
Signed, sealed, published and declared by the above
named Gloria S. Besser, as and for her last will and
Statement, in the presence of us who have subscribed
our names hereto as witnesses, at the request of said
testatrix, in her presence and in the presence of each
other.
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Notaris! Seal l'
Judith f,.~. V1lenberg. l\!otary PuL/ic
YleChanicstu,g GOI\.), Co;iT:beriand C(l;mtv,
My Commission Expires Sept. 27, 2009 - i
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JUN.30-JUL.30,2007
1 OF 3
00
o 06117tt NM 117
131
GLORIA S BESSER
NORMA A MUNCHEL
335 WESLEY DR APT 211
MECHANICSBURG PA 17055-3565
SELECTED ...ACCOUNT . SUMMARy
ACCOUNT
TYPE
ACCOUNT
NUMBER
INTEREST EARNED
YEAR-TO-DATE
I1ATURITY
DATE
ENDING
BALANCE
M&T CLASSIC CHECKING W/INTEREST
000009843135485
0.14
4,109.71
TOTAL DEPOSITS
4,109.71
M&T CLASSIC CHECKING W/INTEREST
-I
. ACCOUNT I GLORIA S BESSER
.. tITl.E. . NORI1A A MUNCHEL
ACCOUNT NO. 9843135485
INTEREST EARNED FOR STATEI1ENT PERIOD
I1ECHANICSBURG
0.09
DEPOSITS &
OTHER ADDITIONS
NO. AMOUNT
4 4,815.17
CURRENT
INTERESTPD
224.05
0.10
ACTIVITY
DEPOSITS~INTERESTCHECKS&OTHER
&OTMER . ADDITIOMS .SUBTRACTIONS
06-30-07 BEGINNING BALANCE
07-02-07 BANK OF NEW YORK PENS PHTS
07-02-07 CHECK NUI1BER 0139
07-02-07 AMER.GEN.LIFE-OK INS PREM
07-03-07 US TREASURY 303 SOC SEC
07-09-07 CHECK NUHBER 0148
07-10-07 CHECK NUI1BER 0151
07-13-07 CHECK NUMBER 0145
07-18-07 DEPOSIT
07-20-07 CHECK NUI1BER 0153
07-23-07 DEPOSIT
07-25-07 CHECK NUI1BER 0154
07-30-07 INTEREST PAYMENT
$224.05
136.50
15.96
4.90
1.80
339.69
1,032.69
1,011.69
828.69
810.74
4,771.38
4,769.58
4,794.61
4,109.61
4,109.71
693.00
21. 00
183.00
17.95
3,960.64
25.03
685.00
0.10
ENDING BALANCE
$4,109.71
L008A (1/03)
M&['Bank
JUL.07-AUG.06,2007
1 OF 1
ACCOUHT.NO.
9841407720 "&T CLASSIC CHECKING W/INTEREST
00 0 06117" N" 017
16170
GLORIA S BESSER
NORMA A MUNCHEL
335 WESLEY DR APT 211
MECHANICSBURG PA 17055-3565
INTEREST PAID YEAR TO DATE
0.20
"ECHANICSBURG
BEGINNING ......... .......... .......DEPOSITSS.... -.... OTHER CURRENT -cc. ENDING
&ALA/iK:E . OTHER ADDITIONS · cHECkS · PAID .. ..... SUBTRACTIONS INtERESt".PD ..&AlANCE
NO I A~T NO I A"OUNT NO I A~T
25 03 01 0 00 01 0 00 1 1 25 03 0 00 0 00
ACCOUNT SUMMARY
ACTIVITY
DEPO$1TS~ INTEREST CHECKS & OtHER .
&OTHERADDITIONS SUBTRAcf:IONS
07-07-07 BEGINNING BALANCE
07-23-07 CLOSEOUT
.
25.03
$25.03
0.00
ENDING BALANCE $0.00
ANNUAL PERCENTAGE YIELD EARNED = 0.00 %
FOR QUESTIONS ABOUT YOUR ACCOUNT CALL 1-800-724-2440.
STILL RENTING? "&T ~KES H~EBUYING EASY EVEN IF YOU HAVE:
- LITTLE ~EY FOR A DOWN PAY"ENT
_ LESS-tHAN-PERFECT CREDIT OR NO CREDIT HISTORY
- A RECENT JOB CHANGE
TO FIND OUT ~RE CALL 1-800-557-0535 OR VISIT "&T AT WWW."TB.CO".
"&1 IS AN EQUAL HOUSING LENDER.
I !lOA A rfln::l\
A Family Tradition Of Caring@
PARTHEMORE Funeral Home & Cremation Services, Inc.
Mrs. Norma A. Munchel
1075 Country Club Road
Camp Hill, PA 17011
7/30/2007
For the services of Gloria S. Besser
1303 Bridge Street
P.O. Box 431
New Cumberland, PA 17070
(717) 774-7721
(Fax) 774-5546
www.parthemore.com
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way
we can. Please feel free to contact us if you have any questions in regard to this statement. The following
is an itemized statement of the services, facilities, automotive equipment and merchandise that you selected
when making the funeral arrangements.
I-~Term;--r--D~~ Dat;---i- Account # . .J
[-~-N~t ion .~ ! uun 8/29/2007 .. I n-W07064.0 ---
Description
Amount
SERVICES & MERCHANDISE
Traditional Funeral Service
"Treasured Rose" Stationery Set
18 Gauge White Shaded Rose Casket
12 Gauge Steel Vault
5,390.00
165.00
1,760.00
1,111.00
Gilbert W. Parthemore,
Founder
Total Services and Merchandise
8,426.00
Gilbert 1. Parthemore,
Supervisor
.
CASH ADVANCE ITEMS
Death Notice, Harrisburg Patriot
Death Notice, York
10 Certified Copies of Death Certificates
Hairdresser
Tent & Cemetery Equipment
Transportation, National Mortuary Shipping
(2) Clergy Honoraria
Organist Honorarium
Flowers, Casket Spray
Flowers, Matching Garland
Grave Opening
190.00
137.00
107.00
40.00
150.00
460.00
200.00
125.00
296.80
84.80
750.00
Stephen K. Parthemore,
CFSP
Bruce R. Parthemore,
Pre-Need Coordinator, CPC
T ota! Cash Advances
2,540.60
Professional Memberships:
NFDA . PFDA
DCFDA. CCFDA
Immediate Pay Discount - Thank you!
-168.52
~
The Rule You Kno.".:
The People You Trust
Total
-~--~----~~~---
Payments/Credits
$10,798.08
$0.00
Balance Due
$10,798.08
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