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Home My WebLink About02-18-09-J REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes county cme veer File NumEer Po Box.2aosot INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 8 3 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 06 26 2008 OS 04 1922 Decedent's Last Name Suffix Decedent's First Name MI LANDSN ANNSTTS Of Applleable) Enter SurvMng Spouse'a Informatlon 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 FILL IN APPROPRWTE OVALS BELOW ~~ 1. Odginal Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of tleam ~~ 4. Limited Estate ~J pnw to 12-1 &82) as Future Interest Compomise tt 5 Feder l E t T ~ . a s ate (tlate a eeatn attar tz-t2~z) ax Return Required J 5 Decetlem Dietl iestete (Attach Copy of Wilq ^ ~ Deretlant Maintainetl a Living Tmst (Allach Copy a Trust) O a. Total Numher of Safe DeposR Boxes J 9. Litigation Proceeds Received ~ tp_ Spousal Poverty Cretlit (Cate o(Ceath behveen 12-31-91 entl 14-95) -~ t 1. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTULL TAX INFORMATION SHOULD BE DIREC Nam e TIMOTHY J BIIPP TED TO: Daytime Telephone Number 717 848 4900, Firm Name (N Appllgble) CGA LAW FIRM First Ilne of address 135 NORTH GSORGS STRSST Second Ilne of atldress Chy or Post OFRce State 21P Code YORK PA 17401 ~. ~ r~ c-_, REGISTER OFi111~LS US~ILY i-~ -r7 r:~ 'I:~ _. ~ }~ OJ 'n ?' N DATE FILED tD i ~i ~','~ i Correspondent's e~rtall address: tbupp~cgelew.com Under penalties of perjury, I tleclare that I have examined this return, including accompanying schetlules and statements, and to the best of my knowledge and belief, it is We, correct and complet .Declaration of arer other man the personal representatlve is Dasetl ll i f on a SIGNAT PERS ONSIBLE F I ETURN n ormation of which preparer has any knowledge. Ted Trout-Landen AODRESS DATE ~ ~~ 105 Palamino Way Red Lion, PA 17356 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ' ~ 3 Timothy J Bupp DATE ADDRESS 135 North George Stree York, PA 17401 L Side 1 150560 7120 1505607120 J ____~ 1505607220 REV-1500 EX Decedent's Social Security Number oecedem's Name: Annette Landen _- --- RECAPITULATION _ - - -- - 1. Real Estate (Schedule A) ..................................................................................... ..... 1. 2. Stocks and Bonds (Schedule B) ........................................................................... .... 2. 3. Closety 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. 1 6 , 7 2 5 . 1 5 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. Tofal Gross Aasats (total Lines 1-7) .................................................................... ... 8. 1 6, 7 2 5. 1 5 9. Funeral Expenses 8 Administrative Costs (Schedule H) ....... ..... ... 9. 8 , 2 5 5 . 3 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 3 , 5 3 9.13 11. Total Deduetiona (total Lines 9 & 10) ................................................................... ... 11. 1 1 , 7 9 4 . 5 2 12. Nat Value of Estate (Line 6 minus Line 11) .......................................................... ... 12. 4 , 9 3 0 . 6 3 13. Charitable and Governmental Bequests/Sec 9113 Trusts far which an election to tax has not been made (Schedule J) ............................................... .. is 14. Net Value Subject to Tax (Line 12 minus Line 13) - ...... __ __ ......................................... .. 14. 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 .00 0 . 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 4, 9 3 0. 6 3 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at wllateral rate X .15 0 . 0 0 18. 19. Tax Due .................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L Side 2 1505607220 1505607220 4,930.63 0.00 221.88 0.00 0.00 221.88 REV-1500 EX Page 3 File Number 21-08-0839 Decedents Complete Address: DECEDENT'S NAME Annette Landon STREET ADDRESS -- -.. 5225 Wilson Lane -- clTr - _ -- - T STATE ZIP - Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 221.$$ 2. Credits/Payments --.- _ _.- A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 3. InteresVPenalty if applicable Total Credits (A + B + C) (2) 0.00 p, Interest - - _ E. Penalty - -~_ Total InteresVPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check tax on Page 2 Line 20 to request arefund - - 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 221.$$ A. nter the interest on the tax due. - (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (56) Z Z 1 .88 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: a. retain the use or income of the property transferred :.............................. b Yes ~ No rJ . retain the right to designate who shall use the property transferred or its income :.................................... ~ ] L7 c. retain a reversionary interest; or .................................................................................................................. d . receive the promise for life of either payments, benefits or care? ................. . ............................................ If d th x ea 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 ro ert hi h , p p y w c contains a benefcia desi n t' ~ ry 9 a ion .... ... .... ... ... ..... ......... .. ........_. ~_ l ~XJ 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 fling 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)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEgLTH OF PENNSYLVNNW INHERITANCE TPX RETURN RESInENT OECEOENT ESTATE OF Landen, Annette LE NUMBER 21-08-0839 IntluOe Ina proceetls of Migation eiM the Gala the pmceetls were recerve0 by ine es[ale. All properly lallNyow„w whh a,s nI/II M wnMOnhIP moat M tllaGwaU an aehatlub F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Edward Jones Act 886-08073-1-8 -transferred to Merrill Lynch B/25/08 2 Edward Jones Act. 896-81080-1-1 transferred to Merrill Lynch W25/08 3 PNC Bank - Tradkional IRA Act. N0.75200025370 as of B/30/08 4,372.30 10,688.81 1,663.04 TOTAL (Also enter on Line 5, Recapitulation) I 16 725 15 (If more space Is neetletl, atltlitional pages or Ne same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) 'REV-1161 fix~(1Z-BB( COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER _ Landen, Annette 21-08-0838 Debte of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. ~ Clnuco~~ Nvsc wEoi - See continuation schedule(s) attached 8. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Repn Street Address City State Year(s) Commission paid Zip 2. Attorney's Fees CGA LeW Firm 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. I Probate Fees 5,822A7 2,000.00 111.00 6. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 321.82 See continuation schedule(s) attached TOTAL (Also enter on Ilne 9, Recapitulation) 8,255.38 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Landen, Annette FILE NUMBER 21-08-0838 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Camp Hill Presbyterian Church -funeral reception 100.00 2 Honoraria for funeral services 350.00 3 Musselman Funeral Home -Funeral 5,372A7 H-A subtotal 5,822A7 Other Administrative Costs 4 CGA Law Firm -postage and copies 10.00 5 Register of Wills of Cumberland - filing fee 30.00 6 Ted Trout-Landen -Reimburse for packing expenses for Assisted Living Apartment 281.82 H-87 subtotal 321.92 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule H (Rev. 6-98) Rsv-1613 E](t (B-Ba) SCIIIEDULE 1 DEBTS OF DECEDENT , MORTGAGE LIABILITIES, ~ LIENS C OM.gN W FAUN OF PENNSYLVPN W INNERfTgNCE TN(RETURN RESIDENT DECEDENT ESTATE OF Landon, Annette FILE NUMBER 21-08-0839 M~duES unrNmeurwa madlwl sxpsnw. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Bethany Village -Last Illness 2.479.20 2 Bethany Village -Last Illness 41700 3 Bethany Village -Last Illness 127 87 4 Continuing Care Pharmacy -Last Illness 406.57 5 West Shore EMS -Last Illness 108.49 TOTAL (Also enter on Line 70, Rewpitulatlon) I 3 539 13 (I/ mo a space s neetled, atltli6onal pages o/ Ne same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 698) REV-tN° E%a (°O°) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE iAX RETURN R S BENEFICIARIES E IDENT DECEDENT ESTATE OF Landon, Annette FILE NUMBER 21-08-0839 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE f TeYe01 a r~ierem„r~... ~.. .,. .. .. D°N°t Lbt Tru°M(s) (Words) ($$$) 1 Hal M Landon Son 50 °h Residue 8 King Philip Avenue Bristol, RI 02809 2 Ted L. Trout-Landon Rev. Son 50 % Residue 105 Palamino Way Red Llon, PA 17355 Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet ]~. 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 Q QQ Copyright (c) 2002 form software ony The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) rar u 1 nes .RING ?01 Progress Pirk~gy SENSE OF INVESTING Mdl \'hp~1 gcighrs. MU 13041 00000087 01 MB 0.369 O7 TR 00005 EJCCDD21 ~ur~~~m ~~~nn~r~u~r ~n~~ur~~u ~~~nn~~i~~~u~~~u n~~r~ ANNET7E LANDEN `'225 WILSON LN AP7304 MECHANICSBURG Pq 17055-6663 ~~r ~~ur~~~n ~~~~~~nn~~~~~r~n ~r ~~~n ~~r ~~~n ~r ~~r ~~~r ~r ~r~n ~~~~ Cheek NumhP1. 11932q~~1 Account Number 896-060'73-1-8 A ceounf Registration A NNETTE LANDEN '225 WILSON LN APT 304 MECHANICSBUP,~ pp 17055 lwar Jones Znlr,~~,e..~r.,,t.,:,y MAKING SENSE OF INVESTING M"~~""III"ehi.. Mn 6tnG1 00000093 01 MB 0.369 01 TR 00005 EJCCDD21 ~u ~~~~u~~~~nn~~~n~~~n~~u ~~~n ~~~nu~~~~~~u~~~nn~~~~ ANNETTE LANDEN 5225 WILSON L N AP7 304 MECHANICSBURG PA 17055-6663 ~~~~~n~~~~n ~~~~~~nn~~~~~~~.~~.~~~u ~~~~~~~u~~~n ~~~n~~~u ~~~~ hate 06,25/OR Descripfion REl'I REMF.N"F UISTR f Bt 7"CION A7' l°Ol Iit REQU)S"T ' xy - ('heck Number 119349163 Acrnnnt Number a96 91oao-1 1 Accmmt Re~istratiml EDWARD D SONES & CO CUSTODIAN FBO ANNETTE LANDEN IPA 5225 WILSON LN APT 304 MECHANICSBURG PA 17055 Amount 10,6R9.R 1 TOTAL CHP:CK ISSUF•,D 10,6R9.R1 ~. PNCBANK PNC BANK, NATIONAL ASSOCIATION RETIREMENT SERVICES P. 0. BOX 3499 PITTSBURGH,PA 15230 000040 Tel 1-868-762-4727 BANK FIN 22-1146430 ANNETTE L LANDEN 5225 WILSON LN RM 304 MECHANICSBURG PA 17055-6663 Plan Type: TRADITIONAL IRA Plan Number: 7200009519 Principal Balance as of 01-O1-OS Contributions Information Current Year Prior Year Rollover Interest Credited Distribution Information Principal Balance as of 06-30-OS Interest Accrued, Not Yet Credited Statement Period 01-01-08 Thru 06-30-08 Date Page 07-09-08 1 Social Security #XXX-XX-1783 1,638.32 0.00 0.00 0.00 0.00 22.35 0.00 1,660.67 2.37 SUMMARY OF INVESTMENTS Account Maturity Interest Number Rate Date Credited Current Value Interest Accrued Total Value 75200025370 2.750 07-11-09 22.35 ---------- - 1,660.67 ------- 2.37 1,663.04 Summary Totals 22.35 - - - 1 660.67 ------2.37 -- ---1,663.04 NOW IS THE PERFECT TIME FOR AN IRA CHECKUP! CALL 1-888-PNC-IRAs (1-888-762-4727) AND HAVE ONE OF OUR SPECIALISTS REVIEW YOUR IRA TODAV. MEMBER FDIC. IRPC0911/09 F0flM953fl-1005 ~~zst 3~i11 ~tt~ C~TP~tttmPttt of ANNETTE LANDEN I, ANNETTE LANDEN, of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make make, publish, and declare the following to be my Last Will and Testament, hereby revoking and making void all Wills, Codicils and testamentary dispositions by me at any time heretofore made. ITEM I: I direct my Executors, hereinafter named, to pay all just debts, funeral expenses an<; costs of administration as soon after my decease as possible. ITEM II: All the rest, residue and remainder of my estate, real, personal and mixed, I give, devise and bequeath equally to my sons, HAL M. LANDEN and TED TROUT-LANDEN, their heirs and assigns. ITEM III: I nominate, constitute and appoint my sons, HAL M. LANDEN and TED TROUT-LANDEN, as Co-Executors of this my Last Will and Testament. My Executors shall serve without bond in this or any other jurisdiction. IN WITNESS WHEREOF, I, ANNETTE LANDEN, have to this my Last Will and Testament set my hand and seal this ~~ ~" day of January, A. D., 1990. /gyp ~ ) `-" 'Lr~~ ( SEAL ANNETTE LANDEN Signed, sealed, published and declared by the said testatrix, ANNETTE LANDEN, as and for her Last Will and Testament in the presence of us, who at her request, and in her presence, and in the presence of each other have subscribed our names as witness hereto. Name Addre s ...tea , 1 ~,~.r~ Ll N~ ~~. . ~\ v ,E ~ F. Name ---~ Address ,i COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN , We, ANNETTE LANDEN, `~ ~Cl`ar- q_ /-~'t ~ and J- ~oc~ , 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 had signed willingly (or willingly directed another to sign for her) 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 Testatrix signed the Will as a witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence, and I, the said Testatrix do hereby acknowledge that I signed and executed the instrument as my Last will and Testament, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. Tes tla trrix ~yx+~'e-.~ Q . Witness Witness Subscribed, sworn to and acknowledged before me by ANNETTE LANDEN, the Testatrix and subscribed andI s~worn to before me by Vr C--<--~- Q Q C 1 and rnis l~ti day of ~, A.D., 1990. ~~,_.___ `C`am' ru~iic i nnmi.iu~r~a, e !J~ C~ .. __ _. _'x:91.