HomeMy WebLinkAbout08-22-08 (2)15056041125
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Poaox2aosol INHERITANCE TAX RETURN 2 1 0 8 0 3 8 9
_ Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1. 7 8 1 6 5 2 6 4 0 3 0 8 2 0 0 8 0 3 1 2 1 9 2 1
Decedent's Last Name
Nf C C O R M I C K
Suffix Decedent's First Name
G E R A L D I N E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
F
MI
FILL IN APPROPRIATE OVALS BELOW
1. Original Retum ~ 2. Supplements{ Return ~ 3. Remainder Retum (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
Q 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of III) (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 INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
S U S A N H C O N F A I R 7 1 7 7 6 3 1 3 8 3
Firm Name (If Applicable)
R E A G E R & A D L E R P C
First line of address
2 3 3 1 M A R K E T S T R E E T
Second line of address
City or Post Office State ZIP Code
C A M P H I L L P A 1 7 0 1 1
REGISTER OF WILLS USE ONLY f
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Correspondent's a-mail address: SCONFAIR@REAGERADLERPC.COM
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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPQNSIBLE FOR FILING RETURN ,/ /G'~/~ DATE
233:1 MARKET STREET CAMP HILL PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041125 15056041125
J
ADDRESS "
141 N. 15TH STREET CAMP HILL PA 17011
SIGNATURE OF PR ARER QTHER THAN REPRESENTATIVE ATE _
15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: GERALDINE F. MCCORMICK 1 7 8 1 6 5 2 6 4
RECAPITULATION
i. 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. 9 8 5 9 • 1 1
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) ........................... 8. 9 8 5 9 • 1 1
9. Funeral Ex uses & Administrative Costs Schedule H
Pe ( ) ................ 9. 1 9 7 1 • 5 3
10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I
9 9 ( ) ............ 10. 3 4 8 9 • 2 6
11. Total Deductions (total Lines 9 & 10) ........................... 11. 5 4 6 0 • 7 9
12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 4 3 9 8 • 3 2
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) .................. 14. 4 3 9 8 • 3 2
TA:K 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 _ 0 . 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 4 3 9 8 3 2 16.
17. Amount of Line 14 taxable
0 0
0
at sibling rate X .12 17.
18. Amount of Line 14 taxable
0 0
0
at collateral rate X .15 18
19." fax Due ............... .......................... ....... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0. 0 0
1 9 7. 9 2
0. 0 0
0. 0 0
1 9 7. 9 2
Side 2
15056042126 15056042126 J
REV-?500 EX Page 3
Decedent's Complete Address:
File Number
21 08 0389
DECEDENTS NAME
GERALDINE F. MCCORMICK _
STREET ADDRESS
CITY STATE ZIP
Tax Payments and Credits:
~. Tax Due I;Page 2 tine 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
197.92
Total Credits (A + B + C) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E )
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.
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) 0.00
(5) 197.92
{5A)
(58)
Make Check Payable fo: REGISTER OF WILLS, AGENT
197.92
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 : ...................................................................... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^X
c. retain a reversionary interest; or ................................................................................................ ^ 0
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^
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? ......... ^ X^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^ 0
IF THE ANSIMER 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-0ne 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 impos~,ed 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 z~n individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INIiERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GERALDINE F. MCCORMICK 21 08 0389
Include the proceeds of I'digation and the date the proceeds were received by the estate.
All property Jointty-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PENNSYLVANIA STATE BANK - #10121846 9,098.70
PO BOX 38
EAST PETERSBURG, PA 17520
2. INSURANCE REFUND 460.41
3. ITAX REFUND ~ 300.00
TOTAL (Also enter on line 5, Recapitulation) ~ S
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + 1,12-99)
COMMONWEALTH OF PENNSYLVANIA
4NNERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
GERALDINE F. MCCORMICK 21 08 0389
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FUNERAL LUNCHEON - SOPHIA'S ON MARKET 424.53
B.
2.
3.
4.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)IEIN Number of Personal Representatives;
Street Address
City
State Zip
Year(s) Commission Paid:
Attorney Fees REAGER & ADLER, PC 1,300.00
Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 75.00
5 , Accountants Fees
6
7.
8.
9.
Tax Return Preparers Fees
SHORT CERTIFICATES -CUMBERLAND COUNTY REGISTER OF WILLS 12.00
LEGAL ADVERTISEMENT -CUMBERLAND LAW JOURNAL 75.00
LEGAL ADVERTISEMENT -THE CENTRAL PENN BUSINESS JOURNAL 85.00
TOTAL (Also enter on line 9, Recapitulation) ~ S
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES. & LIENS
ESTATE OF FILE NUMBER
GERALDIIVE F. MCCORMICK 21 08 0389
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MESSIAH VILLAGE -MONTHLY RENT JANUARY, FEBRUARY AND MARCH 3,258.90
2. IMOBILE X-RAY -MEDICAL
3. HOLY SPIRIT HOSPITAL -MEDICAL
4. (PENNSYLVANIA STATE BANK -SERVICE CHARGES
53.86
160.50
16.00
TOTAL (Also enter on line 10, Recapitulation) I S
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GERALDINE F. MCCORMICK ~~ nR n~Ra
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 [nGude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)i
1. SANDRA L. CLEMM Lineal 2,199.16
141 NORTH 15TH STREET
CAMP HILL, PA 17011
2. MARCIA ANN MCCORMICK Lineal 2,199.16
3422 BRISBAN STREET
HARRISBURG, PA 17111
EPJTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 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
1.
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TONAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 3
(If more space is needed, insert additional sheets of the same size)
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E:_~~~' LAST WILL AND TESTAMENT
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~~ =r= GERALDINE F. McCORMICK
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o ~, GERALDINE F. McCORMICK, of Camp Hill, Cumberland 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 from my estate as soon as may be convenient
after my death.
II - All the rest, residue and remainder of my estate
of whatever nature and wheresoever situate, I devise and bequeath
unto my husband, Robert F. McCormick, Jr., providing he survives
me by thirty (30) days.
III - Should my said husband fail to be living on the
thirty-f first (31st) day following my death, then I devise and
bequeath all the rest, residue and remainder of my estate of
whatever nature and wheresoever situate unto my issue living on
the thirty-first (31st) day following my death per stirpes.
IV - I appoint my daughter, Sandra Lee Clemm, guardian
of any property which passes either under this will or otherwise
to a minor and with respect to which I am authorized to appoint
a guardian and have not otherwise specifically done so. It is
my intention to appoint my said guardian, Sandra Lee Clemm, as
guardian in all of the instances listed in Section 18 (b) of the
Wi11s Act of 1947, as amended, as well as in other instances
where I am authorized by law or permitted to do so. Such guard-
ian shall have the power to use principal as well as income from
time to time for the minor's education, support and welfare
without further responsibility to the minor or minors or to any
person taking care of the minor or minors. It is my intention
ARNOLD B SLIKE ~~
ATTORNEYS AT LAW
2104 MAflEEi STREET _ //f/- ~ ~)
CAMP HILL. PEN NSTLVANIA (~ ~~_+~~~, `,f(~ , ~ ,~~ ` `~- {-~~'[c-~~F~/ Page 1
that the foregoing powers may be exercised by the guardian with-
out further court approval. The said guardianship shall termi-
nate as to each beneficiary when he or she reaches the age of 21
years, at which time his or her share of the principal and any
accumulated income shall be distributed to him or her absolutely.
The interest of the beneficiary or beneficiaries hereunder shall
not be subject to anticipation or to voluntary or involuntary
alienation. Should my said daughter fail to qualify or cease to
act, I appoint Dauphin Deposit Trust Company of Harrisburg,
Dauphin County, Pennsylvania, substitute guardian of the estate
of any minor beneficiary.
V - All taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed
shall be considered a part of the expense of the administration
of my estate, and my personal representative or representatives
shall have the absolute power in his or her discretion to pay the
same at once whether or not the law under which they are imposed
permits the postponement of all or part of them to a later time.
VI - I nominate, constitute and appoint my husband,
ARNOLD & SLIKE
ATiOPNEYS 0.T LAW
t{09 NA NNET SINE ET
CAMP M{LL. PENNSYLVANIA 1
Robert F. McCormick, Jr., Executor of this, my Last Will and
Testament. Should my said husband fail to qualify or cease to
act as such, then I appoint my daughters, Sandra Lee Clemm and
Marcia Ann McCormick, Coexecutrices of this, my Last Will and
Testament. Should both of my said daughters fail to qualify or
cease to act as such, then I appoint the said Dauphin Deposit
Trust Company, Executor of this, my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
on this, the ,~I~i day of ~G~j...~ 1967.
.M.x ~~,.-.-z ~i ~.~','Cy `L_~~.~-i'~ SEAL)
Geraldine F. McCormick
Page 2
Signed, sealed, published and declared by GERALDINE F. McCORMICK,
Testatrix therein named, on this and two (2) other sheets of
paper as and for her Last Will and Testament in our presence,
who, in her presence, at her request and in the presence of each
other, have hereunto subscribed our names as attesting witnesses.
t Name Add ss
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Name Ad Tess
ARNOLD @ SLIKE {t
RTTOPNFYS AT LAN !~ Page 3
2109 NA£K£T STREET s[S
[aNP N(LL. P£NNSY LVF NIA f~