HomeMy WebLinkAbout03-24-0915056051058
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box zaosol INHERITANCE TAX RETURN
Harrisburg, PA 17126-0601 RESIDENT DECEDENT ' 21 08 00779
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
07/14/2008 02/01 / 1933
Decedent's Last Name Suffix Decedent's First Name MI
Carbaugh ' ' 'Dorothy
___
(If Applicable) Enter Surviving Spouse's Information 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 APPROPRIATE OVALS BELOW
°s 1. Original Return ,w'„ 2. Supplemental Return 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate :~:: 4a. Future Interes~Compromise (date of 5. Federal Estate Tax Return Required
death after 12-12-82)
~:; 6. Decedent Died Testate ~° :;':` 7. Decedent Maintained a Living Trust 0_ _. 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received "_ _ a= 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 TO:
Name Daytime Telephone Number
__ _ __
'David A. Baric, Esquire ' (717) 249-6873
_
Firm Name (If Applicable). - ., _._. _
REGISTER OF WILLS USE ON~ ';
O'Brien Baric & Scherer ~~ ~ ,~
_
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First line of address .~ ~
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19 West South Street ,
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Second line of address T
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City or Post Office DATE~.FjI~
State ZIP Code - - ~ ri
Carlisle _ _ ~
PA 17013 ~ ..
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_ __
Correspondent's a-mail address: dbariC@ObS18W.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 th rsonal representative is based on all information of which preparer has any knowledge.
SIGNA7aJRE,OF PERSON RESH B FOR~1G RETU n <, ~~ ~ ) ~ ~ DATE t
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SIGNATUR OF PARER TH ~-I~NTATIVE DATE r /~ ~/O /I
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ADDRESS
19 West South Street, Carlisle, Pennsylvania 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
J 15056052059
REV-1500 EX
Decedent's Social Security Number
__ _
~.~... decedent's Name: Dorothy I Carbaugh
__
._.~_...~_._..___.~.._...__~.~._...._~___...~._.. _._ .
RECAPITULATION ._.u....-__.....___ .._ _~_..__. ....,,.... ~,_..__.
1. Real estate (Schedule A) .......................................... ... 1. ' 112,970.00
2. Stocks and Bonds (Schedule B) .................................... ... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3.
4. Mortgages l~ Notes Receivable (Schedule D) .......................... ... 4.
5. Cash, Bank Deposits i£ Miscellaneous Personal Property (Schedule E) ..... ... 5. ' 115,570.00
6. Jointly Owned Property (Schedule F) c, Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) t" Separate Billing Requested..... ... 7.
8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ' 228,540.00
9. Funeral Expenses 8~ Administrative Costs (Schedule H) .................. ... 9. 22,296.32
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10.
11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ', 22,296.32
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ' 206,243.68
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. ' 206,243.68
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_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 45 206,243.68 '', 16. ' 9,280.96
17. __... r ..~ . ,,.,..~... n. ~.~
Amount of Line 14 taxable
at sibling rate X .12 ' 17. ',
18. Amount of Line 14 taxable
at collateral rate X .15 ', 18.
19. TAX DUE ............................................... . 19.: 9,280.96
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
File„Number
21 08 ' 00779
___. ...
DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER
Dorothy I Carbaugh 184-62-2613
STREETADDRESS
1895 Douglas Drive
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
e. Prior Payments 13,745.00
C. Discount 452.00
3. InterestlPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
(1)
9,280.96
14,197.00
4, 916.04
Total Interest(Penalty (D + E) (3)
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. (q)
5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56)
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 :.......................................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ ^x
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? .............. ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ^ ^X
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 (O) 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.
REV-1502 EX+ (6-98) ~
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA I REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy I. Carbaugh 21-08-0779
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Dorothy I. Carbaugh 21-08-0779
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Members First Federal Credit Union Savings Account; Acct. No. 108586-00 455.00
2. Members First Federal Credit Union Life Savings Account; Acct. No.108586-04 1,001.00
3. Members First Federal Credit Union Investment Savings; Acct. No. 108586-05 36,106.00
4. Members First Federal Credit Union Certificate of Deposit; No. 108586-40 26,871.00
5. M & T Bank Savings; Certificate of Deposit # 31003912752712 23,005.00
6. M 8~ T Bank Checking Account; Acct. No. 515744 2,494.00
7. M & T Bank Savings Account; Acct. No. 15004198152008 19,005.00
8. Miscellaneous personalty 5,000.00
9. USB Fiduciary Trust 60.00
10. Dish Network 16.00
11. Embarq 20.00
12. Aero Oil 364.00
13. Hancock Insurance 39.00
14. American Diagnostics 13.00
15. Federal Income Tax Refund 1,121.00
TOTAL (Also enter on line 5, Recapitulation) $ 115,570.00
(If more space is needed, insert additional sheets of the same size)
'REV-1511 EX+(12-99)
SCHEDULE N
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy I Cabaugh 21-08-0779
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t ~ Ewing Brothers
529.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
10,500.00
Name of Personal Representative(s) Marlin L. Carbaugh
Social Security Number(s)IEIN Number of Personal Representative(s) _
street address 1895 Douglas Drive
city Carlisle .state PA Zip 17013
Year(s) Commission Paid:'2009
2. Linda K. Moore, 89 East Main Street 10,500.00
2. Attorney Fees Walnut Bottom, PA 17266
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. Probate Fees 314.00
5. Accountant's Fees
6. Tax Return Preparer's Fees 100.00
7. The Sentinel 278 32
B. Cumberland Law Journal 75.00
TOTAL (Also enter on line 9, Recapitulation) $ 22 ~ L96 • 32
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
SCI~IEDt~ILE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy I. Carbaugh 21-08-0779
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
~ • Marlin Carbaugh, 1895 Douglas Drive, Carlisle, PA 17013 son 50.00
2• Linda Moore, 89 East Main Street, Walnut Bottom, PA 17266 daughter 50.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ 0.00
(If more space is needed, insert additional sheets of the same size)
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OF
Dorothy I. Carbaugh
I, Dorothy I. Carbaugh, of 1895 Douglas Drive, Carlisle, Cumberland County,
Pennsylvania, do hereby declare this to be my Last Will and Testament and hereby revoke
all Wills and Codicils previously made by me.
ITEM ONE: I direct the payment of my debts and the expenses of my last illness
~ and funeral from my estate as soon after my death as conveniently may be done. If there
i
be no cemetery lot available for my interment, owned by me at the time of my death, I
~~
authorize my personal representative to purchase such cemetery lot with a contract for
perpetual care, using, therefore, funds from my estate, and I authorize my personal
~7
~~ re resentative to cause title to or ownershi of such lot so urchased to be vested in such
~; P p p
person as my personal representative shall designate.
~~ Further, in this connection, I authorize my personal representative to expend funds
'~i from my estate, in such amount as my personal representative shall consider necessary
I~
ii
~~ and desirable, forthe purchase, erection and inscription of a suitable marker for my grave
I
I direct the payment of my debts and the expenses of my last illness and funeral from my
~~ estate as soon after m death as convenient) ma be done.
I Y Y Y
wherever situate to my children, Linda Kay Moore and Marlin L. Carbaugh, in equal
shares, per capita if they shall survive me by thirty (30) days.
!~ ITEM THREE: My Executors shall have the following powers in addition to those
.; vested in them by law and by other provisions of this Will, applicable to all property, real,
personal or mixed and wheresoever situate, including property held for minors, whether
principal or income, exercisable without court approval, and effective, with respect to each
'' item of said property until actual distribution thereof.
'~ A) To retain., as investments of my estate or trust, any or all assets of my
estate, real, personal, or mixed, without regard to any principal of diversification, and to
purchase and acquire real or personal property and to hold any or all of such real and
I
personal property retained or acquired without making the same productive of income.
_'i B) To pay all taxes, charges and expenses of maintenance, upkeep,
!j improvements, development, protection, preservation and investment of any retained or
acquired real or personal property, such payments #o be made from either principal or
income as my Executors or Trustee shall determine.
~~ C) To retain or invest any and all funds, whether principal or income, in any
I
~~ real or personal property without restriction to legal investments; to purchase investments
at premiums; to exercise all rights of a security holder or share holder in any corporation;
and to lease, mortgage, pledge, give options upon or sell at public or private sale and
without approval of any court, any real or personal property, or portion or portions thereof,
irrespective of the manner or the means by which the same was acquired by my said
Executors.
_T __-,T -_______.__.__._ _._..- - _ . _ .
in cash and partly in kind, at valuations fixed by my Executors at the time of distribution. ~~
ITEM FOUR: Any and all payment or payments of any sum or sums, whether in
cash or in kind and whether for principal or income, payable to an heir, or any of them,
shall be made upon the sole receipt of the respective individual to whom the payment is
made, and free from anticipation, alienation, assignment, attachment, and pledge, and free
from control by the creditors of any such beneficiary.
ITEM EIGHT: !appoint my children, Linda Kay Maore and Marlin L. Carbaugh,
Executrix and Executors of this my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear
my signature in the margin for the purpose of identification, this the 10th day of September,
2003.
aT' (SEAL)
orothy I. Carbau
Signed, sealed, published and declared by the above named testatrix, Dorothy I.
Carbaugh, as and for her Last Will and Testament, in the presence of us, who, at her
request, in her sight presence, and in the sight and presence of each other, hav
hereunto s s d ur names as witnesses.
? .
1~-/~dI3
~' ~ ADDRESS ~~ ~"~ I
I ADDRESS ! ~ ~~ 7 1 ~~ X7013
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
_. __ _ . .
. SS.
We, Dorothy I. Carbaugh, (~G2Ui C( /4 : ~-~C and;J~n-~~ ~~ L.t ndsa-~,~
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 of her Last Will and Testament, and
that she signed willingly and that she executed 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 witnesses, and that to the best of their knowledge, the
testatrix was at the time eighteen (18) years of age or older, of sound mind and under no
constraint or undue influence.
Sworn to and subscribed before me this the 10th day of September, 2003.
Notarial seal
Arrsanda L. Esher, Notary Public
Carlisle Boro, Cumberland County
My Commissions Expires Apr. 17, 2f~6
WtEmber, Pennsylvania Association Of Notaries
TaxDB Result Details
D.etail~ed Results for Parce129-16-1094-291. in the 2004 Tax Assessment Database
DistrictNo 29
Parcel ID 29-16-1094-291.
MapSuffix
HouseNo 1895
Direction
Street DOUGLAS DRIVE
Ownerl CARBAUGH, DOROTHY I
C/O
PropType R
PropDesc
LivArea 1305
CurLandVal 31900
CurImpVal 81070
CurTotVal 112970
CurPrefVal
Acreage .34
CIGrnStat
TaxEx 1
SaleAmt
SaleMo
SaleDa
SaleCe
SaleYr
DeedBkPage 0021N-00473
YearBlt 1965
HF File Date 10/22/2004
HF_Approval_Status A
Page 1 of 1
http://taxdb.ccpa.net/details. asp?id=29-16-1094-291.&dbselect= l 11 /21 /2008