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HomeMy WebLinkAbout08-22-08 (2)15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Coun Code Year File Number Bureau of Individual Taxes b Po sox2aosol INHERITANCE TAX RETURN Harrisburg, PA 17128-osot RESIDENT DECEDENT C~ ~ ~8 L5~ J~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth __ _ 01 /05/2008 02/15/1922 Decedent's Last Name Suffix Decedent's First Name MI CRITCHLEY JR LUTHER F (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 FgLL IN APPROPRIATE OVALS BELOW w + 1. Original Return i:.,.3 2. Supplemental Retum r':: 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate i:_:::i 4a. Future Interest Compromise (date of ~:~_;;; 5. Federal Estate Tax Return Required death after 12-12-82) _r.~ 6. Decedent Died Testate •°v~~;:~ 7. Decedent Maintained a Living Trust _ 1. 8. Total Number of Safe Deposit Boxes (Attach Copy of Wllt) (Attach Copy of Trust) 9. Litigation Proceeds Received ^M.:_~` 10. Spousal Poverty Credit (date of death "~.: 11. Election to tax under Sec. 9113(A} between 12-31-9i and 1-1-95j (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL 7AX INFORMATION SHOULD BE DIRECTED T0: !Jame Daytime Telephone Number CHERYL C SIMPSON IFiml Name (If Applicable). REGISTEF~OF WILLS US~~NLY C ~,~ _ {-~ v? (First line of address . -~ ~•;., % T ~~~ _ : ") 16 CURTIS DRIVE cv r.~ Second line of address ' `, ^•. T. _y _ ~_- ` ~ ~ City or Post Office State ZIP Code FILED :: P3A __ ,,:. EAST BERLIN PA 17316 N Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including axompanying schedules and statements, and to the best of my knowledge and belief, it is tfue, correct and complete. Dedaretion of preparer other than the personal representative is based on all infonnatlon of which preparer has any knowledge. Slq~IyTURE OF P6,RSOJV RESPONSIBLE FOR FILING RETURN oaTe 0 16 CURTIS DRIVE, EAST BERLIN, PA 17316 SIGNATURE OF PREPARER OTHER THAN REP SENTATIVE DATE ( `'` ~.~,.~ ~~~ ,y1.E,. ~~ ~~~ ~~~~ CCU ADDRESS 282 Lowt er Street ~ to 201 Lemoyne PA 7043 PLEASE U8E ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV 1500 EX Decedent's Social Security Number Decedent's Name: LUTHER F CRITCHLEY RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Prop~letorship (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) iw-'= Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) ................................... . 8. 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/Sec 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) ........................ ._____w_.._ . 14. w_ __~....._,...._.._._._....._...._ _ .____.._.._._.~__~.~.._.__ 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_. 15. 16. Amount of Line 14 taxable at lineal rate X .0~ 531,884.87 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side Z 81,000.00 0.00 0.00 0.00 39,886.66 154,626.41 271,925.17 547,438.24 11,723.52 3, 829.85 15,553.37 531, 884.87 0.00 531,884.87 23,934.82 23,934.82 15056052059 REV-1500 EX Page 3 F Ie Number ,. .... t Decedent's Complete Address: DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER LUTHER F CRITCHLEY 204-03-1662 STREET ADDRESS 714 SHADE STREET CITY STATE ZIP LEMOY'NE PA 17043 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) (1) 23,934.82 2. Credits/f ayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0 00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. . Fill in oval on Page 2, Llne 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 23,934.82 A. Enter the interest on the tax due. (5A) B. Enterr the fatal of Line 5 + 5A. This is the BALANCE DUE. (58) 23,934.82 Make Check Payable tta: 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 considerationT .............................................................................................................. ^ 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 properly 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)]. 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)J. 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. §9116(a)(1)J. 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)). A sibling isdefined, 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 DECEDENT ESTATE OF FILE NUMBER LUTHER F CRITCHLEY JR All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (It more space is needed, insert additional sheets of the same size) REV-1508 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER LUTHER F CRITCHLEY JR Include the proceeds of IRigation and the date the proceeds were received by the estate. Ail property jointty-owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE 1 M & T BANK CHECKING ACCOUNT #24647152 2 M & T BANK CERTIFICATES OF DEPOSIT #31003916808917 & #31003915823627 3 1999 LINCOLN CONTINENTAL-65000 MILES-GOOD CONDITION-KELLY BLUE BOOK VALUE 4 STAMP COLLECTION -VALUE PER APPRAISAL 5 PERSONAL FURNISHINGS 6 CASH ON HAND TOTAL (Also enter on line 5, Recapitulation) S (If more space is needed, insert additional sheets of the same size) 491.58 32,234.33 5,950.00 585.00 604.00 21.75 39,886.66 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER LUTHER F CRITCHLEY JR If an asset was made Joint within ons year of the decedenYa date of death, it must be reported on Schedule (i. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• CHERYL C SIMPSON ~ 16 CURTIS DRIVE, EAST BERLIN, PA 17316 I DAUGHTER B. CRAIG A CRITCHLEY 12250 ROCKINGHAM DRIVE, TROY, OH 45373 C. JOINTLY-OWNED PROPERTY: SON ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~' A' 06130/90 EDWARD JONES -ACCT #896-08476-1-7 463,879.23 33 154,626.41 TOTAL (Also enter ap line 6, Recapitulation) S 154.626.41 (If more space b needed, insert additional sheets of the same size) REV-1510 EX+ (g-98) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~LE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER LUTHER F CRITCHLEY JR This schedule must be completed and filed if the answer to any of questans 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY WCLWE THE NAME OF THE TRANSFEREE. THEUt RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBE THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE 1• EDWARD JONES-INDIVIDUAL RETIREMENT ACCOUNT #896-91884-1-9 32,887.59 100 32,887.59 2 HARTFORD LIFE-ANNUITY CONTRACT #712471666 87,194.28 100 87,194.28 3 HARTFORD LIFE-ANNUITY CONTRACT #710559223 19,425.77 100 19,425.77 4 LNG LIFE INS & ANNUITY CO-ANNUITY CONTRACT #00959989SP 16,689.17 100 16,689.17 5 LNG LIFE INS & ANNUITY CO-ANNUITY CONTRACT #18429999SP 33,924.64 100 33,924.64 6 LNG LIFE INS & ANNUITY CO-ANNUITY CONTRACT #18589999SP 16,215.48 100 16,215.48 7 LNG LIFE INS & ANNUITY CO-ANNUITY CONTRACT #00789989FE 57,213.40 100 57,213.40 8 AIG ANNUITY INS CO -INDIVIDUAL RETIREMENT ACCOUNT #VP222112 8,374.84 100 8,374.84 TOTAL (Also enter on line 7 Recapitulation) S I 271,925.17 (K more space is needed, insert additional sheets of the same size) REV-15111 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER LUTHER F CRITCHLEY JR Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' MUSSELMAN'S FUNERAL HOME-324 HUMMEL AVENUE LEMOYNE, PA 17043- FUNERAL SERVICES 6,712.52 2 ROLLING GREEN CEMETERY-1811 CARLISLE ROAD CAMP HILL, PA 17011- OPENING PLOT 1,295.00 3 GINGRICH MEMORIALS- 568 NORTH UNION STREET MIDDLETOWN, PA 17057- MARKER INSCRIPTION 40.00 4 FUNERAL LUNCHEON 150.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number 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 630.00 5. Accountant's Fees 450.00 6. Tax Return Preparer's Fees ~. CENTRAL PENN APPRAISAL -APPRAISAL 350.00 £t COOKSEY & ASSOC INC -APPRAISAL 300.00 Id ADMINISTRATIVE COSTS-POSTAGE 41.00 ~o ADMINISTRATIVE COSTS-TRAVEL FOR EXECUTRIX 1,755.00 TOTAL (Also enter on line 9, Recapitulation) I S 11,723.52 (If more space is needed, insert additional sheets of the same size) REV 1512 EX~ (12-03) COMMONWEALTH OF PENNSYLVANUI INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER LUTHER F CRITCHLEY JR Report debt: incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses. (If more space is needed, insert additlonal sheets of the same size) ~~_ C') ~ _, -~ a - LAST WILL AND TESTAMENT ~-~ LUTHER F . CRITCHLEY ~ _, .~„ - -- ,.-,~ I , LUTHER F. CRITCHLEY of the Borough of Lemoyne , Cum}~2rland ,~ County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II - I devise and bequeath all of my estate of whatever nature and wherever situate unto my children, Cheryl Simpson and Craig Critchley, the share of a deceased child to be paid to his or her issue per stirpes. III - I appoint my daughter, Cheryl Simpson, Executrix of thi:~, my Last Will and Testament. Should my said daughter fail to qua]_ify or cease to act as such, then I appoint my son, Craig Crit:chley, to act in this capacity. Neither of my personal represen- tatives shall be required to post bond in this or any jurisdiction. t~-.~~ ,~ I' Page 1 ARNOLT~ & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET. CAMP HILL, PA 17011 IN WITNESS WHEREOF,~I have hereunto set the / ~ /yr-- day of ~ .c,%~~v 1.. my hand and seal on this 1988. ~~~ ~ ~ ~--~~-~- . ( SEAL ) J Luther F. Critch e Signed, sealed, published and declared by LUTHER F. CRITCHLEY, Testator therein named, on this and one (1) other sheet of paper as and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the presence or each other, have hereunto subscribed ou: names as attesting witnesses. ,/ j~ ~ ~ _ V Name' ~~~ ~~~ ~ _ Address Name Add e s ARNOLI~ & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011 COA4lv!ONWEALTH OF PENNSYLVANIA ) SS. COU]VTY OF CUMBERLAND} WE, the undersigned, the testator and the witnesses, respectively, whore names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and Testament and that= he signed willingly (or willingly directed another to sign for him), and that he executed it as his free will and voluntary act for the purposes therein expressed, and that each of the citnesses, in the presence and hearing of the testator signed the will as witnesses and that: to the best of their knowledge the testator caas at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. ~~? ~• ~ Tes t for Witness Witness Su ribed, sworn to and ackno~,rledged before me by the testa and sub c ibed and sworn to be re me by both witnesses, this day of 198. ~ ~k i ~~ Iotary Public THELMA S. McCAUSLIN, N07ARY PUSLfC My Commission Expires July 3, 1988 Camp Bill, PA Cumberland County ARNOLD & SLIKF_, ATTORNEYS-AT-LAW. 210`1 MARKET STREET. TAMP HILL, P\ 170! I