HomeMy WebLinkAbout03-12-09 / ~` 'r i
J 1505607121
REV-1500 EX
0
(
6-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Tazes ~
Po Box 2sosot INHERITANCE TAX RETURN County Code Year File Number
Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 8 8 2
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 9 0 2 8 0 6 9 4 0 8 1 9 2 0 0 8 0 4 1 3 1 9 3 2
Decedent's Last Name Suffx Decedent's First Name
H A V E N S
O A K L
E Y MI
p
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
MI
H A V E N S S Y L V I A 9
Spouse's Social Security Number
1 9 1 3 2 8 3 1 6 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
^X 1. Original Return ~ 2. Supplemental 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 0 8. Total Number of Safe De osit Boxes
(Attach Copy of Will) (Attach Copy of Trust) p
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to taz 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 TO:
Name
Daytime Telephone Number
I V O V, O T T O I I I 7 1 7 2 4 3 3 3 4 1
Firm Name (If Applicable)
REGISTER OF~LS USE ~Y
M A R T S O N L A W O F F I C E S ;;_a `a
First line of address ;,~~) ~ -- ~~I
ATE
1 0 E A S T H I G H S T R E E T ." ti ri,
r 5
Second line of address . , ~ ' .._J
_y 1
n ~ ~
City or Posf Office State ZIP Code DATE FILED ~ ~ - '..rl'
C A R L I S L E
P A 1 7 0 1 3
Correspondent's a-mail address: I O T T O a M A R T S O N L A W• C O M
lnder penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my kr
is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has ar
IIGNATURE OF PERSON RESPANSIBt~Ff~R FILING RETURN
3
and
Side 1
L 1505607121 1505607121 ``ll
J1~~
1^ EAST HIGH STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
,J 1505607221
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: OAKLEY P- HAVENS 1 9 0 2 8 0 6 9 4
RECAPITULATION
1. Real estate (Schedule A) ......
..............................
1.
... .
•
2. Stocks and Bonds (Schedule B) .............................. .... 2. 3 6 9 2 , 7 1
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 9 $ ~ , 5 1
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested 6
...
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) ~ .
....
•
Separate Billing Requested .... ... 7.
8. Total Gross Assets (total Lines 1-7)
............... ... 6. 1 3 6 4 3, 2 2
9. Funeral Expenses & Administrative Costs (Schedule H) .. 9 1 4 7 ~
........... .
... 9 , 3 7
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
, , , , .... , . 10
11. Total Deductions (total Lines 9 8 10)
........................ ... 11. 1 4 7 0 9, 3 7
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 - 1 ~ 6 6 . 1 S
an election to tax has not been made (Schedule J)
................
.. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) , , , , , .. , . , 14 - 1 ~ 6 6 , 1 5
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.000 ~ . ~ ~ 15
16. Amount of Line 14 taxable .
~ • ~ ~
at lineal rate X .0 _ E 0 O
17. Amount of Line 14 taxable 16. ~ ' ~ ~
at sibling rate X .12 0 . ~ 0
18. Amount of Line 14 taxable 17
0 • ~ ~
at collateral rate X .15 0 ~ ~
18
0. ~ ~
19. Tax Due
............................................... . 19. ~ . ~ 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505627221 1505607221
REV-1500 EX Page 3
Decedent's Complete Address:
HA
l27
CITY
CARLISLE
Tax Payments and Credits:
t ~ Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit _
B. Prior Payments
C. Discount
3. InteresVPenalty ifapplicable
D. Interest
E. Penalty
File Number
21 08 0882
STATE
PA
ZIP
'17013
(1) 0.00
Total Credits (A + B + C) (2)
00
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.Total InteresVPenalty (D + E) (3)
0.00
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) 0.00
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5+ 5A. This is the BALANCE DUE.
(SB) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THH APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;
b Yes
. retain the right to designate who shall use the property transferred or its income : .............
c
r
t
i 0
............
.
e
a
n a reversionary interest; or
......................................................................
d
i ......
................
. rece
ve 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 A
.,, ^
ccount, annuity, or other non-probate property which
contains a beneficiary designation? ......
.............................................
IF THE ANSWER TO ANY OF THE ABOVE pUESTIONS IS YES,
No
0
X^
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 exemot 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, ora stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)j.
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)], gsibling isdefined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH Of PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
OAKLEY P. HAVENS FILE NUM
21 OS
All property )olntty-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1 71 shares, Me[Ltfe, common (7a,52.01/sh
VALUE AT DATE
,692.71
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Inclutle the proceeds of litigation and the
All property jointly-owned with dght of z
ITEM
UMBER DESCRIPT
1. Conseco Sr. Health Insurance Co., long term care b
by the estate.
on Schedule F.
VALUE AT DATE
9
2 • (United Health Care, reimbursement of premium
420.00
TOTAL (Also enter on line 5 Recapitulation) I $
(If more space is needed, insert addl6onal sheets of the same size)
REV-1511 EX+(10-08J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
OF
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
DESCRIPTION
A FUNERAL EXPENSES:
1~ Hoffman-Roth Funeral Home, Carlisle
PA
2~
3 ,
Carlisle Memorial Service, gravemarker and inscription
~ Mt. Zion Cemetary, burial plot
4• Georges Flowers
5•
6 Carlisle Church of Christ, reception and ministerial donations
. B. Warner Catering, funeral reception
B. ADMINISTRATIVE COSTS:
~ ~ Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Ciry
State Zip
Year(s) Commission Paid:
AMOUNT
3,783.37
4,124.00
800.00
106.00
325.00
954.00
2. Attorney Fees MARTSON LAW OFFICES (estimated)
3. Family Exemption: (If decedents address is no(the same as claimants, attach explanation) 1,000.00
Claimant Sylvia B Havens 3,500.00
Street Address 1127 Oak Street
Ciry Cazlisle
State PA Zip 17013
Relationship of Claimant to Decedent Spouse
4. Probate Fees Cumberland County Register of Wills
98.00
5. Accountants Fees
8. I Tax Return Preparer's Fees
7. I Cumberland County Register of Wills, Short Certificate
8. Cnmberland County Register of Wills, filing fee, Inheritance Tax return fl 4.00
15.00
TOTAL (Also enter an line 9. Rar•anlfid~~~.,.,~
(If more space is needed, insert additional sheets of the same size)
08
REV-1513 EX r (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE)
BENEFICIARIES
ESTATE OF
OAKLEY P. HAVENS FILE NUMBER
21 OS 0882
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
TAXABLE DISTRIBUTIONS (include outri ht spousal distributions, and transfers under Do Not List Trustee(s)
I. QQ
Sec. 9116 (a) (1.2)]
1. Sylvia B. Havens
1127 Oak Street Spousal
Carlisle, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIB
UTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON
I. 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
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV 1500 COVER SHEET
(If more space Is needed, insert adddlonal sheets of the same slzel
OF ESTATE
SHEET
0.00
LAST WILL AND TF~,.g~,..,
I, OAKLEy P. HAVENS of the Borough of Cazlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and
declare this to be my Last Brill and Testament, hereby revoking any and all former Rills or
Codicils by me made.
1.
I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance
taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall
be paid from my residuary estate as soon as practicable after my decease and as part of the
administration of my estate. My Executor shall have no duty or obligation to obtain
reimbursement for any such tax so paid, even though on proceeds of insurance or other property
not passing under this Will.
2.
If my wife shall survive me by thirty (30) days, then I give, devise and bequeath all of
my estate, both real and personal property, unto my wife, SYLVIA B. HAVENS absolutely.
3.
In the event my said wife, SYLVIA B, HAVENS, shall predecease or fail to sun•ive me
by more than thirty (3p) days, then I give, devise and bequeath all of my estate, both real and
personal property, in equal shares, unto my children, JEFFREY HAVENS and GAII. HAVENS
4.
I nominate, constitute and appoint my said wife, SYLVIA B. HAVENS, as Executrix of
my estate. In the event she shall be unable or unwilling to serve in such capacity, then I appoint
my children, JEFFREY HAVENS and GAIL HAVENS, to act in such capacity.
5.
I direct that my Executrix or Executors shall not be required to file a bond to secure the
~r ~.
,-
Page 1 of 3 Pages O.P.H.
faithful performance of their duties in any jurisdiction.
6.
I authorize and empower my personal representative(s), in their sole and absolute
discretion, to purchase or otherwise acquire and retain any investments of which I die seized or
any real or personal property of any nature; to sell, ]ease, pledge, mortgage, transfer, exchange,
dispose of or grant options in regard to any or all propert of an
estate for such terms and such prices as they may deem advisable; two borroq,nmoney forf ar~y
purposes connected with the protection and preservation of my estate; to mortgage or pledg: any
real or personal property forming a p~ of my estate or to join in or secure the partition of
same; to compromise any claims or demands of my estate against others or of others against my
estate; to make distribution in kind and to cause any share to be composed of cash, properly or
undivided fractional shares in property different in kind from any other share; and to execute
and deliver such instruments as may be necessary to carry out any of these powers.
IN aVITNFSS ~REOF I have hereunto set my hand and seal this ~ ~ day of
~y~,'-~. , 1992.
1 c~.~ l~
-'~~ ~+ (sEAL~
Oakley P. Havens
SIGNED, SRAT FT), pUg~S~D ~D DECLARED by the above-named Testator, as and
for his Last Will and Testament, in the presence of us, who at his request, have hereunto
subscribed our names as witnesses thereto, in the presence of the said Testator and of each
other.
F.
~ ~ _
J Y
_r ~~ ~--
Page 2 of 3 Pages
COMMONVyEgLTH OF PENNSYLVANIA
COUNTY OF CUI~~F_RLAND SS.
I, O~eY P• Havens, Testator, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereb
and executed the insavment as my Last Will; that I signed it will$yi jcknowledge that I signed
my free and voluntary act for the purposes therein expressed g Y' and that I si
geed it as
i ~
Oakley P. Havens
Sworn or affumed to and acknowledged before me by pakle p•
this ~ 7i~, day of y Havens, the Testator,
-~C-c.L! , 1992.
Notary Public •-----
COMMONWFAi'tH OF PENNSYLVANIA
COUNTY OF C>;JMBERLAND : SS. ~ ~
,,,,,,// ) ~r Commission E~ires Dec. z3.
the witnesses whose names are signed to the attached or foregN moment, bein
quahfied according to law, do depose and say that we were present and saw Oakle p.
the Testator, sign and execute the instrument as his Last Will; that the Testator signed willin lY
and that the Testator executed it as his free and volun Y Havens,
that each of us, in the hearin ~'Y act for the purposes therein expressegdY
to the best of our knowledge~he Testato~fwas atethat time 1 orhmore~ as witnesses; and that
mind and under no constraint or undue influence. Years of age, of sound
~-'~ i %,
Address ,Zi3 ~~.., ~.,
l~ -i ~s/ /' /7C/
~~ ~~~i
Address ,- ~,~~ ~.--! sf
/~ i it ~ ,
Sworn or affirmed to and subscribed before me this il~n day of /~~~~~ y
1992. %"`
---~t ~ Wit; ~' C~<<.~«:
Notary Public
1V~y JCdI
Page 3 of 3 Pages c~ ee~roc
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