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HomeMy WebLinkAbout08-20-0815056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year Fi4e Number Bureau of individual Taxes INHERITANCE TAX RETURN Po sox z6o6ot 21 07 0568 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 184-24-2729 05/21 /2007 07/03/1931 Decedent's Last Name Suffix Decedent's First Name MI Crissman Jacquelyn Y (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supp{emental Re1um 3. Remainder Retum (date of death prior to 12-13-82} 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Retum Required death after 12-12-82) • 6. Decedent Died Testate 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 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. O} CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX NiFORMATiON SHOULD BE DIRECTED T0: Name Daytime Telephone Number Keith Crissman Firm Name (If Applicable) First line of address 10565 Longfellow Trace Second line of address City or Post Office Shreveport Correspondent's a fgail address: Keith. {318) 455-6786 REGISTER Of~WILLS USE Oplt~' _ C'_i _ i _ :_ , n o -, _ _ , ~..., i ~--- - State ZIP Code DATE-ii1LED - - ~~ La 71106 tv ' com Under allies of pe u 1 dedare that I have examined this return, inducting accompanying schedules and statements, and to the best of my knowledge and belies, ft is d m ete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any Imowledge. SIG F R ESPONSIBLE FOR FILING RETURN DA E ---, ~ / ADD S 10565 Longfellow Trace Shreveport LA 71106 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEA8E USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number ~aCgUeiyn Y Crissman 184-24-2729 Decedents Name: RECAPITULATION 1. ..................... Real estate (Schedule A) ....................... . 1. 155,000.00 2. Stocks and Bonds Schedule B 2, 291,758.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. 9 ( ) ............................. Mortga es & Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 18,730.00 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property 7 881 00 123 (Schedule G) Separate Billing Requested........ . . , 8. Total Gross Assets (total Lines 1-7) .................................... 8. 5$9,369.00 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 1,670.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 0.00 11. Total Deductions (total Lines 9 & 10) ................................... 11. 1,670.00 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 587,699.00 13. Charitable and Governmental BequestsiSec 9113 Trusts for which 00 0 an election to tax has not been made (Schedule J) ........................ 13. . 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 5$7,699.00 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 45 26,446.00 15. 26,446.00 16. Amount of Line 14 taxable at lineal rate X .0 ~ 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. 26,446.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ 15056052059 Side 2 15056052059 REV-15o0 EX Page 3 File Number Decedent's Complete Address: 21 07 o5ss DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Jacquelyn Y Crissman 184-24-2729 STREET ADDRESS _- --- -- _~ ~ -- -- _ ~ - 18Garland Court CITY STATE _---! ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 26,446.00 2. Credits/Payments 0.00 A. Spousal Poverty Credit B. Prior Payments 26,203.00 C. Discount 1,379.00 _. _-_____- _ __- __._ _._ Total Credits (A+ B + C) (2) 27,5$2.00 3. IMeresUPenatty if applicable D. Interest E. Penalty 0.00 0.00 - Total Interest/Penalty (D + E ) 4. If Une 2 is greater than Une 1 + Line 3, enter the drfference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 0.00 (4) 1,136.00 (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" !N 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? ...................................................................... ^ Z. If death occurred after Decemt~er 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 Aaxwnt, annuity, or other non-probate property which contains a beneficary 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)]. 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 (O) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemut 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. Far dates of death on or after July 1, 2000: Ttle 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. §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. REV-1502 EX+ (6-98} SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEpEN7 ESTATE OF FILE NUMBER Jacquelyn Y. Crisman 21-07-0568 All real property owned solely or ss a tenant in common must be reported at fair market value. Fair market value is defined as the price a1 which property would be {If more space is needed, insert additional sheets of the same size) REV-1503 EXi (6-98} scNE~u~E s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jacquelyn Y. Crissman 21-07-0568 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~ ~ American Funds - Euro Pacific Growth 69,434.00 (1,366 shares (symbol AEPGX) @ $50.83) 2 American Funds -American Mutual Funds 105,258.00 (3,310 shares (symbol AMRMX) @ $31.80 3 American Funds -Capital Growth l Income 84, 997.00 (1,853 shares (symbol CWGIX) @ $45.87 4 Met Life (MET) 35 shares @ $68.50 2,398.00 5 ALLTEL (AT) 97 Shares @ $69.60 6,751.00 6 Prudential {PRU) 63 shares @ $103.17 6,500.00 7 Embarq (EQ) 29 shares @ $64.84 1,880.00 8 Windstream (VIIIN)121 shares @ $14.93 1,807.00 9 Sprint (S) 595 shares @ $21.40 12,733.00 TOTAL {Also enter on line 2, Recapitulation) I; 291,758.00 (If more space is needed, insert additional sheets of the same size) REV-150$ EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Jacquelyn Y. Crissman 21-07-0568 Indude the proceeds of Idigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disdosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Citizens Bank Account # 6100727297 (Carlssle, PA Phone # 888-910-4100} 4,418.00 2 American Funds Cash Management Trust of America (Account # 62545312 (7,121 shares @ $1)) 7,121.00 3 1999 Ford Taurus SE sedan 4,000.00 4 Miscellaneous personal /household items 3,191.00 Estate sale 8/17/2007 @ Kenny's Auction House Chambersburg, PA (717)-264-6578 TOTAL (Also enter on line 5, Recapitulation} $ I 18,730.00 (If more space is needed, insert additional sheets of the same size) REV-1516 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA fNHERfTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 6 INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Jacquelyn Y. Crissman 21-07-0568 This schedule must tie completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV 15(10 COVER SHEET is yes. ITEM NUMBE INCLUDE THE NAME OF THE RITRANSfEREEOIHE RRaELA ONSHIP TO DECEDEHr AND THE DATE OF TRAN6FER ATTALFI ACOPY aF THE DEED Foft REU E6TATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION pf APPI,ICAa1.E) TAXABLE VALUE ~ ~ IRA -American Funds Account # 58331772 -Fundamental Investors 105,522.00 100 0.00 105,522.00 2 IRA -Prudential Life Insurance Company Account # E0201057 18,359.00 100 0.00 18,359.00 TOTAL (Also enter on line 7 Recapitulation) S ~ 123,881.00 (If more space is needed, insert additional sheets of the same size) REV•1511 EX+ (12-99) SCHEDULE N COMMONWEALTH of PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jacquelyn Y. Crissman 21-07-0568 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ ~ Paid in full by pre-paid funeral aax?unt through Allianz Insurance Company Contract # 20606499 dated 08/0911999 -Paid to Hoffman Roth Funeral Home Carlisle PA B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Kelth A. CfISSman Sodal Security Number(s)/EIN Number of Personal Representative(s) 191-46-1095 Street Address 10565 Longfellow Trace city Shreveport .state LA Zip 71106 Year(s) Commission Paid: 2. Attorney Fees 3. Fatuity Exemption: (If decedent's address is not the same as daimant's, attach explanation) Glaimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) f S (If more space is needed, insert additional sheets of the same size) 1,020.00 650.00 1,670.00 REV-1513 EX+ (9-00) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNED~ILE J BENEFICIARIES ESTATE OF FILE NUMBER Jacquelyn Y. Crisman 21-07-0568 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE { TAXABLE DISTRIBUTIONS pnGude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1 Brenda K. Brewbaker 439 Himesville Road Shelbyville, TN 37160 Daughter 34% 2 Denise A. Green 16 Brian Drive Carlisle, PA 17015 Daughter 32% 3 ~ Keith A. Crisman 10565 Longfellow Trace Shreveport, LA 71106 Son 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 TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 34% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S (If more space is needed, insert additional sheets of the same size) ~~~ KNOW ALL MEN BY THESE PRESENTS, that I, Jacquelyn Y. Crissman, 18 Garland Court, Carlisle, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare, and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I direct that all my just debts and expenses of my last illness and funeral expenses shall be paid by my Executor, hereinafter named, from ;ray estatc as soon after my decease as shall be found convenient. SECOND: (a) I give personal gifts of the item named and to the individual listed on the Listing of Personal Gifts attached to this Will. (b) I give, devise, and bequeath all the rest, residue, and remainder of my estate, whether real, personal or mixed, of any nature whatsoever and wherever situated, including any lapsed or void legacy, to my three children, Brenda ICay Brewbaker, 11634 Sadler Court, Wintergarden, Florida 34787; Denise Ann Green, 14 Brian Drive, Carlisle, PA 17013; and Keith Alan Crissman, 6119 Audubon Manor Boulevard, Lithia, Florida, 33547, each of the three to receive aone-third share. J~ If Brenda predeceases me, the percentage share that would otherwise be distributed to her shall lapse, and the share that she would have taken shall go in equal shares to these other devisees who survive me. Should either Keith or Denise predecease me, their share(s) shall go to their issue per stirpes. THIRD: I hereby nominate, constitute, and appoint my son Keith Alan Crissman, 6I I9 Audubon Manor Toulevard, Lithia, Florida-33547 as Executor of this my Last Will and Testament. If my Executor fails to serve, or for any reason fails to continue to serve, I then appoint my daughter, Brenda ICay Brewbaker, 11634 Sadler Court, Wintergarden, Florida 34787, to serve as Executrix. FOURTH: I direct that my Executor, or his successor, shall not be required to furnish any bond or other security for the faithful performance of his duties, notwithstanding any provisions of law to the contrary. FIFTH: My Executor shall have, in addition to the powers and authority conferred upon him by law, the following additional powers and authority: 1 1. To gift, sell at public or private sale, exchange, lease, mortgage, or pledge any property, real or personal, constituting a portion of this estate, at any time, and upon such terms and conditions as he shall deem wise. 2. To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities, or other securities, or such property, real or personal, as he shall deem wise, without being limited by any statute or rule of law regarding investments by the Executor. 3. To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as he deems it wise, and even though such property is not the kind of property he would purchase as an investment, and even though to retain such property might violate sos~nd diversification prir+_ciples. 4. To cause any security or other property which may at any time constitute a portion of my estate to be issued, held, or registered in his own name, or in the name of a nominee, or in such form that title will pass by delivery. 5. To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to take any action with reference to such securities which, in the opinion of my Executor, is necessary to obtain the benefit of any such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to him as the owner of any securities constituting a , portion of my estate; to accept and hold as a portion of my estate securities resulting from any reorganization, consolidation, readjustment, sale, conversion, or subscription. 6. To pay all costs, taxes, charges and expenses in connection with the administration of my estate. 7. To determine what is "Income" and what is "Principal" hereunder, and his decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as he may determine. 8. To gift, transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by him, at public or private sale, or otherwise. 9. To borrow money from any person, firm or corporation, for the purpose of protecting and preserving or improving my estate or to execute promissory notes or other obligations for amounts so borrowed. 2 10. To employ legal counsel, accountants, brokers, investment advisors, custodians, managers, and other agents and employees and to pay them reasonable compensation out of my estate or out of any fund held hereunder to which said compensation is attributable. 11. To do all other acts in his judgment necessary or desirable for the proper and advantageous management, investment, and distribution of my estate. SIXTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property, or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate just as if they were my debts and none of those taxes shall be charged against any beneficiary; that my Executor pay, or provide for payment of all such taxes at such time or times, and in such manner as my Executor deems best. SEVENTH: All questions as to the validity of this, my Last Will, or the administration of the Will shall be governed by the laws of the Commonwealth of Pennsylvania. EIGHTH: Should my children, and the issue of my children, all fail to survive me, then I give, devise, and bequeath all the rest, residue, and remainder of my estate of whatsoever nature and wheresoever situate to Marsha L. Forster, 735 S. West Street, Carlisle, PA 17013, fifty (50) percent, and to the First United Church of Christ, 30 North Pitt Street, Carlisle, PA 17013, fifty (50) percent. NINTH: Except as otherwise provided in this Will, I have intentionally failed to provide for any other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. IN WITNESS WHEREOF, I, Jacquelyn Y. Crissman, the Testatrix to this, my Last Will and Testament, typewritten on three (3) sheets of paper which I have identified in the margin of each page by my signature, hereunto set. my hand and seal. this 28th day of March, 2002. Jac elyn . C sman The preceding instrument consisting of three (3) typewritten pages, each identified by the signature of the Testatrix, Jacquelyn Y. Crissman, was on this day and date signed, published, and declared by her, the Testatrix therein named, as and for her Last Will, in the presence of us, who at her request, in her presence, and in the presence of each other have subscribed our names as witnesses. COMMON~J`.'EALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND ) I, Jacquelyn Y. Crissman, 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 on the 28th day of March, 2002; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Jac el . C ssman Sworn or affirmed to and acknowledged before me, by Jacquelyn Y. Crissman, the Testatrix, this 28th day of March, 2002. c ~ , Notary Public i .... ..... •r:,:pYi3i Seal Nlven J. Burr: iJOtary Public Carlisle Boro, Cumberland County _ My Commission Expires Nov. 2, 2002 Member, Pennsylvenr Asswciat.on of Notaries 4 COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) We, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Jacquelyn Y. Crissrnan sign and execute the instrument as a codicil to 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 Jacquelyn Y. Crissrnan signed the codicil as witnesses; and that, to the best of our knowledge, Jacquelyn Y. Crissman was at the time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. /~' ~- vC ~ ICY C 1 .. ~l~t c. ~G cs~- L/ (_. Sworn or affirmed to and subscribed to before me by the above-named witnesses, this 28th day of March, 2002. ~ c ' .~ Notary Public ~ Notarial Seal Niven J. Baird, Notary Public Carlisle Boro, Cumberland County nny Commleslon Expires Nov 2, 2 Member, Pennsylvania Assodation of Notaries 5 f2d8X.COfT1 1.800.GoFedEx 1.800.463.3339 !. 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