HomeMy WebLinkAbout09-24-0815056D41114
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 ~' O ~ ~~gi _~
Harrisburg, PA 17128-0601 RESIDENT DECEDENT lI!
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
162-22-3909 09152007 05161929
Decedent's Last Name Suffix Decedent's First Name MI
MCCORMICK JEAN B
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL INAPPROPRIATE OVALS BELOW
1. Original Retum
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
0 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
0 2. Supplemental Retum
0 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
between t2-31-91 and 1-1-96)
3. Remainder Retum (date of death
prior to 12-13-82)
0 5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
ROBERT G. FREY
Firm Name (If Applicable)
FREY & TILEY
First line of address
5 SOUTH HANOVER STREET
Second line of address
City or Post Office
CARLISLE
717-243-5838
State ZIP Code
PA 17013
REGISTE
R
OF WILLS U~NLY
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Correspondent's a-mail address: RFREY@ FREYT ILEY . 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. Decl~ttion of preparer other than the personal representative is based on all information of which preparer has anv knowledge.
SIGN TURE OF PERSON E ONS BLE FOR FILING RETURN DATE
SIGNATU OF PREP RER R Ty~N f~E ESENTATIVE J ' DATE
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ADDRE~S 5
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PLE SE USE ORIGINAL PfORM ONLY
Side 1
15D56041114 15056041114 J
J
15056042115
REV-1500 EX
Decedent's Name: JEAN B MCCORMICK
Decedent's Social Security Number
162-22-3909
RECAPITULATION
1. Real estate (Schedule A) ........................................... 1. NONE
2. Stocks and Bonds (Schedule B) ...................................... 2. NONE
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE
4. Mortgages & Notes Receivable (Schedule D) ............................ 4. NONE
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .. ...... 5. 12 4 5 4 5 . 0 0
6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ... ..... 6. 19 0 2 . 0 0
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested ... ..... 7 NONE
8. Total Gross Assets (total Lines 1-7) ............................. ..... 8. 12 6 4 4 7 . 0 0
9. Funeral Expenses & Administrative Costs (Schedule H) .............. ..... 9. 714 0 . 0 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .......... ..... 10. 3 8 2 . 0 0
11. Total Deductions (total Lines 9 & 10) ............................ ..... 11. 7 5 2 2 . 0 0
12. Net Value of Estate (Line 8 minus Line 11) ........................ ..... 12. 118 9 2 5 . 0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .................. ..... 13. 0 . 0 0
14. Net Value Subject to Tax (Line 12 minus Line 13) 14 118 92 5 0 0
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 0 15. 0. 0 0
16. Amount of Line 14 taxable
at linealratex.0 45 118925. 00 16. 5352.00
17. Amount of Line 14
taxable at sibling rate X • 12 17, 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X . 15 18. 0. 0 0
1s. TAx DUE .................................................. ..... 1s. 5 3 5 2.0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~
Side 2
15056042115 15056042115 J
REV-1500 EX Page 3 162-22-3909
Decedent's Complete Address:
File Number
21-o~_os~n
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
JEAN B MCCORMICK 162-22-3909
STREET ADDRESS
CITY STATE ZIP
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 1725.00
C. Discount 267.60
3. Interest/Penalry if applicable
D. Interest
E. Penalty
(1) 5352.00
Total Credits (A + 8 + C) (2) 1992.60
Total Interest/Penalty (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, Line 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) 3359.40
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3359.40
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 : ........................... .
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)].
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 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)].
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.
zn
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
JEAN B MCCORMICK 21-07-0860
Include the proceeds of litigation and the date the proceeds were received by the estate.
~~~ ~~~~~~ .7FJGVC 1.1 IICCUCU, Insert aaaluonal sneers or the same size)
217
REV-1509 EX+ (6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOIN I LY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JEAN B MCCORMICK 21-07-0860
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Willis J. McCormick
B. Michele Ann Phillips
C
ADDRESS
Hearthstone Court
echanicsburg, PA 17055
411 Bernheisel Bridge Road
Carlisle, PA 17015
JOINTLY-OWNED PROPERTY:
LETTER DATE
ITEM FOR JOINT MADE
NUMBER TENANT JOINT
1. A. AB
2. AB
DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
bers 1st account 37580-00
bers 1st account 37580-11
TOTAL (Also enter on line 6 Recagitul<
(If more space Is needed, insert additional sheets of the same size)
RELATIONSHIP TO DECEDENT
Son
hter
OF
DATE OF DEATH DECD'S
1,376 33.33%
4,330 33.33%
DATE OF DEATH
VALUE OF
459
1,443
zr7
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES ~
ADMINISTRATIVE COST
r ILG 19V111GGR
JEAN B MCCORMICK 21-07-0860
Debts of decedent must be reported on Schedule 1.
ITEM
A.
B
1.
2.
3.
4.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
L EXPENSES:
---~-•
Malpezzi Funeral Home
285
Wayne Noss Flowers
32
Honorariums
270
Memorial Service and Lunch
289
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) / EIN Number of Personal Representative(s) _
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
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
Probate Fees 267
Accountant's Fees
Tax Return Preparer's Fees
Nursing home expense to Green Ridge Village 4,140
Final prescription bill to Continuing Care RX 286
Final medical bill to NeighborCare York 30
Bank Fee 15
Cleaning & removal expenses 26
Zip
1,500
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12.03)
SCHEDULEI
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT ~
ESTATE OF FILE NUMBER
JEAN B MCCORMICK 21-07-0860
Report debts Incurred by the decedent prior to death which remained unoatd as of ttiR daro ~f,~e~rti i,,,.~„a~.,,, unwni.nl.u.w~J -.-JI--~ _..____ __
217
REV-1513 EX+ (9-00)
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JEAN B MCCORMICK 21-07-0860
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [inGude outright spousal distributions, and transfers under
Sec. 9118 (a) (1.2)1
1 Cindy Lee McCormick
2 Karen Sileo
3 Michele A. Phillips
4 Willis McCormick
Daughter 2500
Daughter 2g%
Daughter 25%
Son 25%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV-1500 COVER SHEET
I I. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space is needed, insert additional sheets of the same size)
St
MEMBERS 1Stv/
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 37580-00
Date Account Established 04/26/1984
Principal Balance at Date of Death $1,375.89
Accrued Interest to Date of Death $.56
Total Principal and Accrued Interest $1,376.45
Name of Joint Owner Michele Phillips & Willis McCormick
Date Joint Ownership Established 04/26/1 984 - 0311 3/1 997
CHECKING ACCOUNT:
Account Number/Suffix 37580-11
Date Account Established 04!26/1984
Principal Balance at Date of Death $4,329.81
Accrued Interest to Date of Death $.00
Total Principal and Accrued Interest $4,329.81
Name of Joint Owner Michele Phillips & Willis McCormick
Date Joint Ownership Established 04/26/1984 - 03/13/1997
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix 37580-05
Date Account Established 06115!2000
Principal Balance at Date of Death $22,057.12
Accrued Interest to Date of Death $7.58
Total Principal and Accrued Interest $22,064.70
Name of Joint Owner None
CERTIFICATES OF DEPOSIT:
Account Number/Suffix 37580-40 37580-41
Date Account Established 12/05/2006' 05/07/2007"
Principal Balance at Date of Death $20,750.46 $81,534.02
Accrued Interest to Date of Death $39.72 $156.05
Total Principal and Accrued Interest $20,790.18 $81,690.07
Name of Joint Owner None None
'Purchased by transfer of funds from 37580-05.
"'Rollover from certifir_ate 37580-46, nricJinally established 06/07/2.006.
VISA ACCOUNT:
Account Number 4121449999375806
Date Account Opened 11/07/1986
Balance On Date of Death $381.81
Joint Cardholder None
MBERS 1sT FEDERAL CREDIT UNION
- I,IQ ~e -~.i ~
anielle A. Kline
Insurance Services Specialist
January 14, 2008
Estate of: JEAN B. MCCORMICK
Date of Death: 09!15!2007
Social Security Number: 162-22-3909
5000 Louise llrive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 www.memberslst.org
LAST WILL AND TESTAMENT
OF
JEAN B. McCORMICK
I, JEAN B. McCORMICK, unmarried, of Hampden Township (mailing address: 6015
William Drive, Mechanicsburg, Pennsylvania 17050), Cumberland County Pennsylvania, being of
sound and disposing mind, memory and understanding, do hereby make, publish and declare this as
and for my Last Will and Testament hereby revoking and making void any and all Wills by me at
any time heretofore made.
•1. I direct my hereinafter named Executors to pay all of my just debts and funeral expenses
as soon after my death as may be found convenient to do so. I direct that my funeral services be
conducted in accordance with arrangements which I have made with the Malpezzi Funeral Home, 8
Market Plaza Way, Mechanicsburg, PA 17050 and that my body be cremated and my ashes
delivered to my hereinafter named Executors for disposition by them as they may deem appropriate.
2. I direct that all inheritance, transfer, succession, estate and death taxes which may be
payable on account of my death shall be payable from the residue of my estate regardless of
whether the assets upon which such taxes are based are included in my probate estate.
3. All of the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, I give, devise and bequeath as follows:
a) One-fourth (1/4) to my son, Willis J. McCormick, II, his heirs and assigns, provided
he shall survive me by a period of ninety (90) days, but should he fail to so survive me then to such
of his legitimate issue as shall survive me by a period of ninety (90) days, per stirpes, and if there be
no such issue the same shall lapse and be added to the other shares;
b) One-fourth (1/4) to my daughter, Michele Ann Phillips, her heirs and assigns,
provided she shall survive me by a period of ninety (90) days, but should she fail to so survive me
then to such of her legitimate issue as shall survive me by a period of ninety (90) days, per stirpes,
and if there be no such issue the same shall lapse and be added to the other shares;
c) One-fourth (1/4) to my daughter, Cindy Lee McCormick, her heirs and assigns,
provided she shall survive me by a period of ninety (90) days, but should she fail to so survive me
then to such of her legitimate issue as shall survive me by a period of ninety (90) days, per stirpes,
and if there be no such issue the same shall lapse and be added to the other shares; and
d) One-fourth (1/4) to my daughter KAREN M. SILEO, her heirs and assigns,
provided she shall survive me by a period of ninety (90) days, but should she fail to so survive me
then to such of her legitimate issue as shall survive me by a period of ninety (90) days, per stirpes,
and if there be no such issue the same shall lapse and be added to the other shares.
4. The meaning of "Legitimate Issue" as used in this Last Will and Testament shall be
limited to a child or children born to a female descendent of Testatrix regardless of whether the
mother is married to the father of such a child or children, and shall be limited to a child or children
born to a male descendent of Testatrix where the father of such child or children is married to the
the mother either before or after the birth of the child or children. In any case the meaning of "child
or "children" or "legitimate issue" as used above shall NOT include any adopted child or children.
5. I hereby nominate, constitute and appoint my son, Willis J. McCormick, II, and my
daughter, Michele Ann Phillips, or either of them, as Executors of this my Last Will and Testament,
and I further direct that neither of them shall be required to post any bond to secure the faithful
performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction.
6. In addition to the powers conferred by law, my hereinbefore named Trustees and
Executors, and their successors, are authorized and empowered:
a. To invest any part of the trust corpus in such securities, investments, or other
property as may be deemed advisable and proper, irrespective of whether the same are authorized
for the investment of trust funds under the laws of any governing jurisdiction.
b. With respect to any corporation, the stocks, bonds, or other securities of which may
be held, to vote in person or by proxy on any shares of stock; to consent to the merger,
consolidation or reorganization of such corporations; to consent to the leasing, mortgaging or sale
of the property of any such corporations; to make any surrender, exchange or substitution of such
Page 1 Pages ~/
stocks, bonds or other securities as an incident to the merger, consolidation or reorganization of
such corporations; to pay all assessments, subscriptions and other sums of money which may be
deemed wise and expedient for the protection and maintenance of the proportionate interest of the
investment in such corporations; to exercise any option or privilege which may be conferred upon
the holders of such stocks, bonds, or other securities of such corporations either for the conversion
of the same into other securities or for the purchase of additional securities, and to make any and all
necessary payments which may be required in connection therewith; and generally to have and
exercise as to all such stocks, bonds and other securities, the powers of an individual owner who is
under trust obligation.
c. To hold the trust corpus in one or more consolidated funds in which separate shares
shall have undivided interests.
d. To sell at public or private sale for cash or upon credit, or partly for cash and partly
on credit, and upon such terms and conditions as shall be deemed proper, any part or parts of the
trust estate, and no purchaser at any such sale shall be bound to inquire into the expediency or
propriety of any such sale or to see to the application of the purchase moneys arising therefrom.
e. To keep on hand and uninvested such money as may be deemed proper and for
such period as may be found expedient.
f. To compromise, settle or arbitrate any claim or demand in favor of or against the
trust estate.
g. And authorized in the discharge of fiduciary duties, to employ counsel and to
determine and to pay such counsel reasonable compensation which shall be charged against the
principal or income of the trust fund, and shall further be entitled to chazge against the principal or
income such other reasonable expenses and charges as may be necessary and proper to incur for
the proper discharge of fiduciary duties and for the proper management and administration of the
trust estate.
h. In making any division of property into shares for the purpose of any distribution
thereof directed by the provisions of the trust, to make such division or distribution, either in cash or
in kind, or partly in cash and partly in kind, as shall be deemed most expedient, and in making any
division or distribution in kind may allot any specific security or property or any undivided interest
therein to any one or more of such shazes, and to that end may appraise any or all of the property so
to be allotted and the judgment as to the propriety of such allotrt~ent and as to the relative value for
purposes of distribution of the securities or property so allotted shall be final and conclusive upon
all persons interested in the trust or in the divtsion or distribution thereof:
i. And authorized to register any shazes of stock or other assets of any trust in their
own names or in the name of a nominee.
j. To retain any investments including mutual funds which I may own at the time of
my death and in addition to invest any part of the Trust corpus in such mutual fund or mutual funds
as may be deemed advisable or proper, itrespective of whether the same are authorized for the
investment of trust funds under the laws of any governing jurisdiction.
k. To retain any investments including mutual funds which I may own at the time of my
death and in addition to invest any part of the Trust corpus in such mutual fund or mutual funds as
may be deemed advisable or proper, irrespective of whether the same are authorized for the
investment of trust funds under the laws of any governing jurisdiction.
i. To determine from time to time whether all or some portion of realized capital
gains shall be treated as ordinary income for distribution to a beneficiary or treated as
principal to be retained as part of the corpus, and such designation need not be consistent
from one year to another.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
Testament written on three (3) pages, this c~G~t'day of ~~~,~~,~~~, ac~a .
~' e (S AL)
J n B. McCormick
Page 2 Pages
Signed, sealed, published, and declared by JEAN B. McCORMICK, the Testatrix above
named, 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.
NS rlG~
Page 3 Pages
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