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Home My WebLink About07-23-08~` 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN q PO BOX 280601 ~, ` ~ ~ 2 I l Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth D~ i ~~oo~ 09' l z i!~93 ~ Decedent's Last Name Suffix Decedent's First Name MI ~'J ~' 5 S .N F R l~l 2 5 L c~ r S (''1 (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 O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82} O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA;K INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~c~rT" ~F5SN~~ i'~ 7 ~3~ ~7y~ Firm Name (If Applicable) First line of address " ~ 9 ~ C (~ C-~'/V Second line of address City or Post Office C ,4 rr F hl i ~ ~ L ~ ~,~ F ~~ i v L-" Correspondent's a-mail address State >~~ REGISTER OF WILLS USE ONLY c~ C-7 `~ U -,-I ==~; c...... ~ - - =~ - ~ -- ~-I-, t~.a - :~ , ~ ~ (;-> • Di4`~ FILED n tV ' ZIP Code ~ I 7 ~ ~ ~~ '' -~ ~ 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. D preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE ,~ SON RESPO SIBLE FOR FILING RETURN DATE ADDRESS SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 7 15056051047 15056051047 J 15i756~52~48 REV-1500 EX RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. 2. Stocks and 8onds(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. ~ ~ 7 7 ~ • Z~ 7 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Q Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) ..... .................. ......... .. 8. ~ ~ 7 7 ~ . ~' 9. Funeral Expenses & Administrative Costs {Schedule H) ................... .. 9. ,j ~ `c (~ . ~• 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 3 ~ ~ ~ . ~ Z 11. Total Deductions {total Lines 9 & 10) ................................. .. 11. ~ ~S L -[~j , .~ `~ 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ~ ~ ~ 7 3 . ~ L' 13. Charitable and Governmental BequestslSec 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. ~ a~' J / V J~ ~-' TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0~`<~~ y L' 1 7 ~ 3 ~-~ 16. • 17. Amount of Line 14 taxable at sibling rate X .12 . 17. 18. Amount of Line 14 taxable at collateral rate X .15 • 18. • 19. TAX DUE ....................................................... ..19. 2 / ~ ~ , ~ G~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT CJ ~o~~. ~ ~ ¢'~ 15056052048 Side 2 1505652048 J l + i' REV-150Q EX Page 3 Decedent's Complete Address: STREET ADDRESS a ~~ ~.; a ~1,~ ~ l~ ~ ~ ~' ~-~l~ CITY ~-- n ~~,' Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) ~l (v /; ~G) Total Credits (A + B + C) (2} 3. InteresUPenalty if applicable D. Interest. E. Penalty Total InterestlPenalty (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) ,2 j ~, ~`f j ~ (~ A. Enter the interest on the ta:K due. (5A) B, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ j ~, %l , `~ U Make Check Payable fo: 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 :................................................................................... ....... ^ b. retain the right to designate who shall use the property transferred or its income : .................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ ,~ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... ....... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... ....... ^ 4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................ ....... ^ 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. §9116 (a) (1.1) (i)J. 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. §9116 (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 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 (O) 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. §9116(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. §9116(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. File Number ,~ ~~~~,' ,_ ~c~~ STATE ~ ZIP (~,~ i 7~ ' REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. (GPs ~~ YU QC~)( [o ~~L"3 /-~aPriS~:ruVC~ P~ 17rIJ /~d' 1 ~anK P v a Elu `I~ '7 ~on~ ~a~-~Gf ~c'~..c~~~ n f" ~ ~'y~77S~7S9/ Gl,~~) nc~ ifG'GC3u ~ ~ 9€~3c ~ )0 7a v f~PSf~rci~ G'ttcL~S ~. ~.;~ ~ ~y Rte,,. s~; ~ ~ec~wo~ : n S~, fie u: ~~~p~ s;~.~~ Gl~tt,;~~ Je;.we~r~ r/ I; ~c~s + Qat1, /Sci."`' ~ ~1~. ~w i OC>, fx' 3vtJ. pe j OD. ~~~ Sa. ~,a ~ O, ~~ ~ 9 ~ U' '~~ ~~ yam. ~9 ~I3.Z ~ , ~~,~. qo~, TOTAL (Also enter on line 5, Recapitulation) I $ ~ ~ 7 `~/, ~`~ (If more space is needed, insert additions( sheets of the same size) REV-1511 EX+ (10-06) ~.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. a2/~- } 41 Gt w~t~ f'L'', r"~-t n e ~{-c; l `"1 £Jr/t ~ `~ ~ oC ~i ~ , ~ 9 1~rlc~~e ~~i~~t - //t..: L.um~irr~c~HC~ 1_~ 17c%7~~ ~^ /,En1 ~ mC~r~ q ~ l"p 6C~Cd` S B. ADMlNlSTRATIVE COSTS: 1. Personal Re:presentative's Commissions Name of Personal Representative(s) Street Address City State Year(s) Commission Paid: 2~ Attorney Fees 3. Family Exernption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City _ State Relationship of Claimant to Decedent 4. Probate Fees C`A^'r~r^ Qv~cQ ~f~c~n~ct 5. Accountants Fees J li. Tax Retu//rn Preparer's Fees T J e514r~ev~C~v~~y - 1'1~.~~ t'~~r.`~t X81 ,R~ ~zs.95~ ~~~ UU ~ .Z, ~• c7U J, ~~u ~ ~z. ~a a2S , vc~ TOTAL (Also enter on line 9, Recapitulation) I $ ~ / ~'~ (If more space is needed, insert additional sheets of the same size) Zip Zip • REV-1512 EX+ (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT FILE NUMBER ESTATE OF ~/J ~~ 2 i Q L ~; 5 ~ l ' /~" SS r'~ ~ {_ n~Z L~f ~~~ - 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 ITEM DESCRIPTION OF DEATH NUMBER 1. ~ ~~ e •e~ 2 - ~~ ~'-'[a ~° ~ ~ ~a r~ ~~ , ~-JG•.~~ wtS FiriS 1L~a.~3~1 3 _ o+ • ~ ~ ~7 p~n~~~~r T x q . ~ ~~ l'~c~.a f ~t s 1 t-c~L'Y'~c.~ 1\en•~" l~5 ~l~ coo tJGI /U,Z;oo ~~• ~~ PA~c~ ,~g.,£~ ai.t~~ PPS ,~:i,.~ 80 ~y J~~,~•o-~ 1~. ~~1 ~ Is~~ ~ l r a~~~~3 ,9~, 37 TOTAL (Also enter on line 10, Recapitulation) $ I ~~'~ 3~ , ~.~ (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 SCI~IEDULE J BENEFICIARIES ESTATE OF FILE NIJMBER 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. "~ + 3 ~ 5c t, ~} ~; n1 ~ ss ~+ ~ ~~- ~ ~~ r-~t ~ 3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 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 TESTAMENT OF LOIS MARIE MESSNER I, LOIS MARIE MESSNER, a resident of Lower Allen Township, County of Cumberland, in the State of Pennsylvania, being of sound mind, do make and declare this to be my Last Will and Testament expressly revoking all my prior wills and codicils at any time made. I. EXECUTOR: I appoint SCOTT EUGENE MESSNER of York County, as Executor of this my Last Will and Testament and provide if this Executor is unable or unwilling to serve then I appoint ELIZABETH IRENE MESSNER of York County as alternate Executor. My Executor shall be authorized to carry out all provisions of this Will and pay my just debts, obligations and funeral expenses. I further provide my Executor shall not be required to post surety bond in this or any other jurisdiction, and direct that no expert appraisal be made of my estate unless required by law. II. BEQUESTS: I give all my property, real, personal, or mixed, to my three children in equal shares. If any of my children do not survive me, then I give all of their share of my property to their children. IN WITNESS WHEREOF, I have hereunto set my hand this ~c!'l"day of, s({~~~'<r' ~~ ~r4~~•~,~,- , 2 ` ~ t: `~ Signature ~~ - ", -i " .._: l~ IV. WITNESSED: - _ ~ The testator has signed this will at the end and on each other separate page, and. ,~ has declared or signified in our presence that it is his/her last will~arid testament, and in the presence of the testator and each other we have hereunto subscribed our-names this day ~ 1}.~i.G~°f ~ ;v C'{ - , 2 C^ <; c~ Witness Signature Address ~ + r Witness Signature Address y/~;L~ ~ Wit % /~ ~ <. 1.~ :~ (`. ~ ~ ~ "r~r ...~y ~" ~'~L'»1,{; ~r;~L'-L~ _ i"~r / ~C''i .~1 i ness Signature Address ~ Y~ -~~, ~~~~~ ~ 5,., ~> sue,-, b~~~ ~~N.:.~~,:,~" )1~c. :~~~.,;s ` t ~~ ~a -;~~.~ ~ ~ ~`JC~CCIh uC~~l• ~..~ ; / ` ~/ - ly ~)3 t is n ~ .~ 3 f.r h;n L ~ -sue n ~ / x5.131! r r -. •~ ~ Jt'. ',~CCit J 4