HomeMy WebLinkAbout02-06-09
1505607121
REV-1500 ~ (06-05) OFFICIAL U8E ONLY
PA Department of Revenue County Code Year File Number
Bureau Individual Taxes INHERITANCE TAX RETURN
PO BOX 80601 2 1 0 8 1 1 6 6
Harrisbu , PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 6 8 2 6 ? 4 2 0 1 1 0 9 2 0 0 8 0 8 2 6 1 9 3 3
Decedent's Last Name Suffix Decedent's First Name MI
K A U F F M A N N A N C Y S
(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
4. Limited Estate
® 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
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 12-31-91 and 1-1-95)
3. Remainder Retum (date of death
prior to 12-13-82)
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 INFORMAfiION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number ~
J O E L R Z U L L I N G E R 7 1 7 ~~ 4 6~ 2~
Firm Name (If Applicable) '~ ~ . '~'t ' '~ Q
REGISTE ~ L~3 US LY i_ .~Q
Z U L L I N G E R- D A V I S P C r~~ rn ~Y~'
First line of address
1 4 N O R T H M A I N S T R E E T p~ w ~~ ~>
Second line of address -~ --{ •• ~ ~
~ W -~
S U I T E 2 0 0 ~
City Or Post Office State ZIP Code DATE FILED
C H A M B E R S B UR G P A 1 7 2 0 1
Correspondent's e-mail address:
Under penaltles 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 b true, con cn} 3 and compk~te. Dedaratlon of prepares other than the personal represerrtaUve~based on all infomiatbn of whk;h prepares has an kn
y owledge.
SIGNP~TIJRE OyyERSO~YJtESPON BLE tiOR FILING RETURN _ Wert / _
P•0•BOX 6010 ~ CHAMBERSBURG PA 17201
SIGtyATgR~ IP,REPT T ~l~Y //~ SENTATNE DATE
1}~ ~iVORTH MAIN 5~1`REET
L 1505607121
1`TE 200 CHAMBERSBURG
PLEASE USE ORIGINAL FORM ONLY
Side 1
A 17201
1505607121
J
1505607221
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: NANCY S• K A U F F M A N 1 6 8 2 6 7 4 2 0
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1. •
2. StodcsandBonds(ScheduleB} ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 2. •
3. Closet' Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. •
4. Mortgages 8~ Notes Receivable (Schedule D) ........................ 4.
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ....... 5. 2 2 7 5 8. 6 5
6. Jointy Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 5 3 ? 5. 5 2
7. Inter-Vrvos Transfers 8 Miscellaneous N n-Probate Property
(Schedule G) ~] S
t
Billi
R
d
epara
e
ng
equeste
....... 7.
8. Total Gross Assets (total Lines 1-7) ........................... 8. 2 8 1 3 4. 1 7
9. Funeral Expenses ~ Administrative Costs (Schedule H) ................ 9. 2 9 1 7. 7 5
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ............ 10. 1 9 4 . 9 6
11. Total Dsductioruz (total Lines 9 8 10) ........................... 11. 3 1 1 2. 7 1
12. Nat Value of Estate (Line 8 minus Line 11) ....... .................. 12. 2 5 0 2 1. 4 6
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. 2 5 0 2 1. 4 6
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.o _ 0. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate x .oa5 2 5 0 2 1. 4 6 16. 1 1 2 5. 9 7
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18. 0• O Q
19. Tax Due ................................................ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1 1 2 5. 9 7
Side 2
L 1505607221 1505607221
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 08 1166
DECEDENTS NAME
NANCY S. ICAUFFMAN
STREET ADDRESS
206 East Buns Street
CITY
Shi nsbur STATE
PA ZIP
17257
Tax Payments and Credits:
1• Tax Due (Page 2 Line 19) (1) 1,125.97
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 56.30
Total Credits (A + g + C) (2) 56.30
3. InteresUPenalty 'if ap~icable
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.
FNI In oval on Page 2, Line 20 to request a refund. (4) 0.00
5. N 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.
(5} 1,069.67
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 1.069.67
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. ff death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^
3. Did decedent own an 'intrust 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 benefirary 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 exemct a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
tiling 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) [/2 P.S. §9116{a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedents 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 1508 EX + (8-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RES DENTEDECEDENT N PERSONAL PROPERTY
ESTATE OF FILE NUMBER
NANCY S. KAUFFMAN 21 08 1166
Include the proceeds of litigation and the date the proceeds were received by the estate.
AH property joi owned wtth fight of eurvhrorehip must be dlecb:ad on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Checking Account #103800129, Orrstown Bank, 20,897.32
including interest accrued to date of death
2. Refund, Episcopal Home 1,733.30
3. Cash 4.60
4. Refund, Comcast Cable 38.44
5. Refund, Amerihealth 14.99
6. Personal property appraised by Carl E. Ocker, 70.00
Auctioneer
TOTAL (Also enter on line 5, Recapih~lation) ~ S 22 758 65
(If more space GS needed, insert additional sheets of the same sine)
REV-1509 EX + (8.98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
NANCY S. KAUFFMAN 21 08 1166
Han asset wee made joint wkhln one year of the decedent's dab of death, k must be reported on Schedule G.
SURVMNG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Gregg E. Kauffman 413 Sunset Lane son
Shippensburg, PA 17257
s
C
JOINTLY-0WNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCU-L 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 INTERESI
1. A. Checking Account #696684, Orrstown Bank 10,751.05 50. 5,375.52
TOTAL (Also enter on line 6, Recapitulation) I ;
(If more space is needed, Insert addGional sheets of the same size)
REV-1511 EX + (10-08)
SCHEDULE H
CodMAON4VEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~
IN RES DENTEDECEDENT N ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
NANCY S. KAUFFMAN 21 08 1166
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1 • Personal Representative's Commissions
Name of Personal Representative (s) Farmers and Merchants Trust Company 2,000.00
street address P.O. Box 6010
city Chambersburg glele PA 7~p 17201
Year(s) Commission Paid: 2009
p, Attorney Fees Joel R. Zulinger 600.00
3. Famiy Exemptbn: (If decedents address s not the same as claimants, attach explanatan)
Claimant
Street Address
City State Zip
Relationship of Claimant ~ Decedent
4• probate Fees Letters - 60.00; will -15.00; short certificates - 8.00; JCP fee - 10.00; 113.00
automation fee - 5.00; filing return 15.00
~ Aoosuntant's Fees
6. Tax Return Preparers Fees
7. Carl Ocker, Auctioneer, appraisal of personal property 25.00
8. Cumberland Law Journal, advertise letters 75.00
9. News-Chronicle, advertise letters 104.75
TOTAL (Also enter on line 9, Recapitulaation) I :
(If more space ~ needed, Insert addHional sheets of the same size)
7.75
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
scNeou~E ~
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
NANCY S. KAUFFMAN 21 08 1166
Report debt Incurred by the decadent prior to death which remained unpaid as of the date of death, including unrNmbun>ied medical expenasa.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Continuing Care RX, balance due 145.67
2. Discover Card, balance due ~ 49.29
TOTAL (Also enter on line 10, Recapihllation) I ; 1 ~ ~
(If more space b needed, Insert additlonal sheet of the same size)
FtEV-1513 EX + (9-00)
SCHEDULE J
COIbNiIONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBE
~lealrv c kel Iccl-ael~ ~, nQ „cc
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Lint Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [indude ou ' ht s I distributans, and transfers under
Sec. 9116 (~a (1. )2 ]
1. Gregg E. Kauffman Lineal 5,375.52
413 Sunset Lane
Shippensburg, PA 17257
2. Ron N. Kauffman Lineal 19,645.94
645 South Fourth Street
Chambersburg, PA 17201
ENTER 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 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 s
pt more space is nestled, insert additional sheets of the same size)
JRZ - 5.1 kauffman.2 January 16, 200.7
_p
Q Cb -. '
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Uj ~ .`
LAST WILL AND TESTAMENT ~`~~ ~ ~ ~ ~`
c_7 ~ ~
~ w
I, Naacy L. Rauffmaa, of 19 Hollar Avenue, Shippensburg,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby declare this to be my will,
hereby revoking any and all former wills and codicils thereto by me
heretofore made.
I.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
II.
I give, devise and bequeath the residue of my estate of every
nature and wherever situate to my grandson, Ron N. Kauffman,
providing he shall survive me by thirty days.
`~,~
r ',.~
III.
Should my grandson, Ron N. Kauffman, predecease me or die on
or before the thirtieth day following my death I give, devise and
bequeath the residue of my estate of every nature and wherever
situate to my son, Gregg E. Kauffman.
IV.
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or
personal, without regard to any principle of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
~ / fiduciaries as they deem proper, without regard to any
~' principle of diversification of risk.
C. To sell at public or private sale, to exchange or to
lease for any period of time any real or personal
property and to give options for sales, exchanges or
leases, for such prices and upon such terms or conditions
as they deem proper.
D. To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
Page 2
F. To distribute in cash or in kind or partly in each.
G. To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
V.
I direct that all taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
VI.
I appoint the Farmers and Merchants Trust Company of
Chambersburg, Chambersburg, Pennsylvania, as executor of this my
will.
~~
~/ VII.
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WSEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
first three of which bear my signature in the margin for the
Page 3
purpose of identification this _/3~ day of
`t' (~L~1~4~N~I~C. 2 i C7
~~ (SEAL)
Signed, sealed, published and declared by the above-named
testatrix 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 set our hands as attesting witnesses.
X53 ~' /t~ ~ C .+6 ~ ~~
We, Naacy L. Rauffmaa, /y~l ~ Zulu and
~ ~~ ~~ ~ - T~C./l Y~ ~ the testatrix and the witnesses
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the testatrix signed and executed the
instrument as her last will and testament and that she executed it
as her free and voluntary act for the purposes therein expressed
and that each of the witnesses, in the presence and hearing of the
said testatrix, signed the will as witnesses and to the best of
their knowledge, said signer was at that time eighteen years of age
Page 4
or older, of sound mind and under no constraint or undue influence.
T atrix
Witness
Ya ~ 6• ti...c.k._
Witne
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the
abov -named witnesses this /~ day of
c
COMMONyVE~q~TwN Q`F p~NNSYLV
Mc11o)e J Sew
~ PUblic
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end
M~mbsr, pen ~ 3,
Ywanle Aeso~atlo~ p f idea
Page 5
CARL E. OCKER
AUCTIONEER
4401 Philadelphia Avenue
Chambersburg, PA 17201
(717) 264-6578
Personal Property Appraisal for
Nancy Kauffman Estate
~ Episcopal Square
Shippensburg PA 17257
PLYWOOD CABINET ..............................................................................................10.00
CHEST OF DRAWERS 1960'S .................................................................................20.00
PINE DESK ................................................................................................................15.00
COLOR TV ................................................................................................................20.00
RECLINER, FLOOR LAMP, LUGGAGE, SMALL ITEMS ......................................5.00
TOTAL .....................................................................................................................$70.00
I, DO I4EREBY CERTIFY that I have examined the tang~bk personal property of
Nancy Kauflinan Estate, Episcopal Square, Shippensburg PA 17257
And do vaiue and appraise the same at 570.00 as being fair market
Vahie of said property on this date of November 14, 2008
Date ~~ l `~ D g Carl E. Ocker v
Appraiser
CJ~sTOwN
B~~
A Tradition of Excellence
December 1, 2008
To: Farmer & Merchants Trust Co
Trust Department
PO BOX 6010
Chambersburg Pa 17201
From: Traci Yohe
Orrstown Bank
Customer Service Center
PO BOX 250
Shippensburg, Pa 17257
Re: Estate of Nancy S Kauffman
Date of death November 09, 2008
IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE
ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account # Title of Account Date opened Principal Accrued Interest
696684 Nancy S Kauffman 02/12/97 10750.37 0.68
Gregg E Kauffman
Rate of 0.1
Established jointly prior to 06!2000.
103800129 Nancy S Kauffman
Rate of 1.39%
SAVINGS ACCOUNT
Account # Title of Account
CERTIFICATE OF DEPOSIT
Account # Title of Account
03/07!06 20879.03 18.29
Date opened Principal Accrued Interest
Date Opened Principal Accrued Interest
P.O. Box 250 • Shippensburg, PA 17257 • 717.530.3530. 717.532.4143 fax