HomeMy WebLinkAbout03-26-09J 1505607121
REV-1500 EX
06
(
-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN County Code Year File Number
Hamsburg PA 17128-0601 R ESIDENT DECEDENT 2 1 0 8 0 0 3 7 8
ENTER DECEDENT INFORM
ATION BELOW
Social Security Number Date of Death Date of Birth
0 3 2 7 2 0 0 8 0 9 1 1 1 9 6 7
Decedent's Last Name Suffix Decedent's First Name MI
F OL T Z ME L I N DA K
(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 Return
4. Limited Estate
Q 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST EiE 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 Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sre~c. 9113(A)
(Attach~h.0) ~~~
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMIkTIQH)SHOULD ~IREC,f~F~ Tb;
Name Daytime Telephone~iV~u{nber '~~
r-
MARK A. M A T E Y A ESQ 7 1 7 2~•-~ 6`-~5 0 ~, ~,
Firm Name (If Applicable) ~ '
M A T E Y A LAW F I R M REGISTER OF Y111i~S USE:ONLY ~~
~ _ _. ~. ,~
First line of address ~ __~ ~•~ ~
-; -_.,
P O BOX 1 2 7 ~~ ~' ~~ ~'
c~ i
Second line of address i
City or Post Office State ZIP Code ____ DATE FILED
__
- _ __ -
B OI L I N G S P R I N G S P A 1 7 0 0 7
Correspondent's a-mail address: IU)AM~MATEYALAW.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 the personal representative is based on all information of which preparer has any knowledge.
SIG URE OF EgS~ R pONSIBLE FOR FILING RETURN qa
(/.~L/ ~ ° ~ 3 / rT~~ o ~-~
ADDRESS
261 LAMPLITE
P.O. BOX 127
L 1505607121
REPRESENTATIVE
CARLISLE
PA 17013
z3 d
BOILING SPRINGS PA 17007
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121
J 1505607221
REV-1500 EX
Decedent's Social Security Number
Decedents Name: M E L I N DA K. FO LTZ
RECAPITULATION
1. Real estate (Schedule A) ..................................... ... 1.
2. Stocks and Bonds (Schedule B) ............................... ... 2.
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. 1 5 2 1 0 4
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 3 0 0 0 . 0 0
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ..... .. 7.
8. Total Gross Assets (total Lines 1-7) ...... . ............ 8 4 5 2 1 0 4
9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10.
11. Total Deductions (total Lines 9 & 10) ........................... 11.
12. Net Value of Estate (Line 8 minus Line 11) ......................... 12.
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.
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 . 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 0 0 0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17
18. Amount of Line 14 taxable
at collateral 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
Side 2
L 1505607221
2 7 2 3. 8 8
3 8 5 0 5, 1 2
4 1 2 2 9. 0 0
- 3 6 7 0 7, 9 6
- 3 6 7 0 7, 9 6
0. 0 0
0. 0 0
0. 0 0
0. 0 0
0. 0 0
1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
MELINDA K. FO_ LTZ
STREET ADDRESS
261 LAMPLITE DRIVE
File Number
21 08 00378
- - - -- __
CITY
CARLISLE SPTAATE
Tax Payments and Credits:
1~ Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
- --
ZIP
~ 17013
0.00
Total Credits (A + B + C) (2) 0 00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Total Interest/Penalty (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.
B. Enter the total of Line 5 +5A. This is the BALANCE DUE.
Make Check Payab/e to.• REG/STER OFW/LLS, AGENT
(5B)
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TH E 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; ................... ............ ^ 0
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?
.................................................................... .
a
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ 0
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
0.00
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, 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.
(5A)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MSC.
IN RESIDENT DECEDENT N PERSONAL PROPERTY
ESTATE OF FILE NUMBER
MELINDA K. FOLTZ 21 08 00378
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
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1. MEMBERS 1ST FEDERAL CREDIT UNION 6.67
REGULAR SAVINGS ACCOUNT #294-00
2. (MEMBERS 1ST FEDERAL CREDIT UNION I 1,514.37
CHECKING ACCOUNT #294-11
TOTAL (Also enter on line 5 Recapitulation) I $ 1 521
(If mare space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
MELINDA K. FOLTZ 21 08 00378
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 I ADDRESS RELATIONSHIP TO DECEDENT
A. JAMES L. FOLTZ, JR
B
C
JOINTLY-OWNED PROPERTY:
EX-SPOUSE
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. FORD F-150 PICK UP TRUCK 6,000.00 50. 3,000.00
TOTAL (Also enter on line 6, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
CARLISLE, PA 17013
3
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
IN RESIDENT DECEDENT N ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
MELINDA K. FOLTZ 21 08 00378
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
AMOUNT
A• FUNERAL EXPENSES:
1. HOFFMAN ROTH FUNERAL HOME & CREMATORY, INC. 1,124.88
2. CUMBERLAND VALLEY MEMORIAL -MONUMENT 950.00
B
2.
3.
4.
5.
6.
7
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State Zip
Year(s) Commission Paid:
AttomeyFees MATEYA LAW FIRM
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
500.00
Street Address
City State
Relationship of Claimant to Decedent
Zip
Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS
Accountants Fees
Tax Retum Preparers Fees
CUMBERLAND LAW JOURNAL - ADVERTISEMENT OF ESTATE
74.00
75.00
TOTAL (Also enter on line 9, Recapitulation) I $ 2 723 88
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12.03)
SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
IN RESIDENT DECEDENTRN MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
MELINDA K. FOLTZ 21 08 00378
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VAOF DEADHTE
1. MIDWAY SELF-STORAGE 84.80
MONTHLY FEE FOR STORAGE OF DECEDENT'S PERSONAL/HOUSEHOLD ITEMS
2. VERIZON WIRELESS
TELEPHONE SERVICE 44.81
ACCT #920752062-00001
3. CARLISLE REGIONAL MEDICAL CENTER
CO PAYMENT FOR MEDICAL SERVICES 25.00
MEDICAL SERVICES #7773761
4. CAPITAL ONE
LOAN ON FORD F-150 JOINTLY OWNED WITH EX-SPOUSE 3,057.55
$6,155.10 AMOUNT OWED AT TIME OF DEATH
5. CACH, LLC
ACCT #7581 35,292.96
TOTAL (Also enter on line 10, Recapitulation) I $
38 505 12
(If more space ~s needed, insert additional sheets of the same size)
REV-1513 EX + (g_00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
wiNlt u
MELIND
NUMBER
I.
1.
2.
3.
4.
r
A K. FOLTZ
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
D. ALAN JONES
1170 LONGS GAP ROAD
CARLISLE, PA 17013
CAROLE BLACKSMITH
261 LAMPLITE DRIVE
CARLISLE, PA 17013
DEBRA SHOEMAKER
348 OLD STONEHOUSE ROAD
BOILING SPRINGS, PA 17007
DAVID F. JONES
6 PINE TREE DRIVE
MECHANICSBURG, PA 17055
FILE NUMBER
21 08 00378
RELATIONSHIP TO DECEDENT
Do Not List Trustees)
Sibling
Sibling
Sibling
Lineal
AMOUNT OR SHARE
OF ESTATE
0.00
0.00
0.00
0.00
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 I $
(It more space is needed, insert additional sheets of the same size)
.SST WILL AND TESTAMENT
OF
MELINDA K. FOLTZ
I, Melinda K. Foltz, of 1170 Longs Gap Road, Carlisle, Cumberland County, Pennsylvania,
make this my will. I revoke any other wills or codicils to wills made by me.
ARTICLE I. DISTRIBUTION OF MY ESTATE
A. I give and devise the specific bequest as follows:
1. I give my piano to my Sister, Carole Blacksmith, presently residing in Carlisle,
Pennsylvania.
2. I give any and all jewelry that I may own at the time of my death to my neices
Alexis Shoemaker, and Jessica Shoemaker, presently residing in Mechanicsburg, and Renee
Blacksmith, presently residing in Carlisle, Pennsylvania, to share and share alike, as the Executor
in his absolute discretion shall determine.
B. I give the residue of my estate to my siblings, D. Alan Jones, presently residing in
Carlisle, Pennsylvania, Debra Shoemaker, presently residing in Mechanicsburg, Pennsylvania,
Carole Blacksmith, presently residing in Carlisle, Pennsylvania and my father, David F. Jones,
presently residing in Dillsburg, Pennsylvania, share and share alike, per stirpes.
C. Whenever property is to be distributed to the descendants of a person (the "ancestor"),
such property shall be divided into equal shares, one share for each then living descendant in the first
generation below the ancestor in which at Icast one descendant is living, and one share for each
deceased descendant in such generation who has a descendant then living. Each share created for a
living descendant shall be distributed to such descendant. Each share created for a deceased
descendant shall be divided and distributed according to the directions in the two preceding
sentences until no property remains undistributed.
D. Any beneficiary or the legal representative of any deceased beneficiary shal l have the
right, within the time prescribed by law, to disclaim any benefit or power under my will and the
interest so disclaimed shall be distributed as if such beneficiary predeceased me.
E. Gifts of specific items of property mentioned in this will or any separate writing that
is binding upon my Executor shall fail to the extent that I, or any duly authorized agent of mine,
dispose of such property prior to my death. My Executor shall not substitute cash or any other assets
for any such property.
ARTICLE II. PROVISIONS FOR INTERESTS VESTI
AGE TWENTY_FIVE NG IN BENEFICIARIES UNDE
R
in a beneficiary under a eht foregoingprovisions, whenever an int
pay to the beneficia g enty-five, my Trustee may retain the interest pon a se varate bsolutely
ry as much of the net income or princi al as m
to provide for the benefici p p trust and
ary's support, other needs, or education unt I the benefic~a m appropriate
twenty-five, when the interest shall be paid outright to the benefi '
reaching that a e the interest shall constitute a rY eaches age
g ~ ciary. If the beneficiary dies before
Part of the beneficiary's estate.
ARTICLE III. PAYMENT OF EXPENSES AND O
THER CHARGES
I direct my Executor to
monument or marker over m paY my funeral and burial expenses (including the cost of a
death (including taxes on assets not
Y grave). The estate, inheritance and similar taxes assessable on
administering my estate and m passing under this will) shall also be my
tax. Y Executor shall not request an Paid as a cost of
y beneficiary to pay any part of such
ARTICLE IV. MISCELLANEOUS PROVISION
S
A• Spendthrift Trust. To the extent e
of any trust shall be liable for the debts of anp rmitted bylaw
specifically provided, to alienation or anticipation 'neither the principal nor income
y beneficiary or, except to the extent otherwise
by a beneficiary.
B• Matters ofInterpretation. rersimplicity, Ihaveex
in one number and g pressed pronouns and other to
include the other number and ut where appropriate to the context these terms shal
genders. The bold headin > rrns
interpretation. gs are for convenience and shall no aff to
ect
ARTICLE V. APPOINTMENT OF FIDUCIARIES AN
D POWERS
A• I name m
"Trustee" Y brother, D. Alan Jones, to be m
). Should he fail or cease to act, I name m Y Executor(hereinafter "Executor" and
Dillsburg, Pennsylvania to be m Y father, David F. Jones
necessary in an Y Executor. If administration of m 'Presently residing in
y jurisdiction where m Y estate or trust should be
Executor or my Trustee deems it necessaExfor an or my Trustee is unable to qualify, or if m
Trustee the power to designate any individual or co other reason I ~ Y
Executor or m rPoration with trust pokers to SeNOr and my
y Trustee or in my Executor's or m
required of any Executor or Trustee, includin Y Trustee s stead. I request that no security be
preceding sentence. References in my will to m „,
g an Executor or Trustee named
acting at the time, except where otherwise sped callcutor and m ~~ Pursuant to the
Y Trustee" are to the one or ones
y provided.
B• Any corporate Executor or Trustee shall receive for it
which it is willing to undertake similar services for others at th
evidenced by its published fee schedule in effect from time s services the compensation for
e time such services are rendered, as
to time, unless it is willing to agree upon
a fee that is less than its custom
ary fee. Any individual who serves as Executor or Trustee sh
entitled to receive reasonable compensation for his or her
individual receives compensation, shall be entitled to be rei all be
services and, whether or not such
services. mbursed for expenses incurred for such
C' I grant my Executor and my Trustee the powers set ford
and 20 Pa.C.S. §§ 7131-7143 respectively. In addition, m
will with any trust having the same trustee and substanti 11n 20 Pa.C.S. §§ 3;11_;332
any time after m Y Trustee may merge any trust under this
y death the size of any trust under this will is so smalldthatsitivc provisions. If at
Trustee, the trust is uneconomical to administer, my Truste
the assets to the p . ~ n the opinion of my
erson or e ma to
persons authorized to receive the trustrincomethn such shda distribute
Trustee may deem appropriate. No Trustee who is also an
shall exercise any discretion granted in the preceding senten es as my
distribute tangible personal propert income beneficiary of the trust at issue
Y Trustee may
resides, and that person's receipt shale be a sufficiminor to any ad ]person waitnh who
my Trustee. ei]t voucher in the accounts of m m the minor
y Executor and
ARTICLE VI. FINAL DISPOSITION
I desire to have a modest Christian burial, and direct the
come from my estate. payment of my final expenses to
ARTICLE VII. DEFINITIONS
1. The use of the masculine shall include the feminine or neut
shall include the plural, and vice versa.
er and the use of the singular
2• The term "estate," where appropriate, shall include an tr •
y ust hereunder.
Executed this ~ ~ day of ~_
~~~^
2007.
MeI da K. Foltz (SEAL)
Signed, sealed, published, and declared for and as her last will
in our presence, we all bein and testament by the testatrix
g present at the same time; and we, in her presence and at her re uest
and in the presence ofeach other, have subscribed our names as w'
1 st above written. itnesses whereof, all on the date
""_` ~ - Y - ~ 117
Race Street
/ OF Boilin S rin s PA 17007
1 .__ n
or
CUMMUN Wr,AL1H Ur ViVJ YLVF11V1H
CUMBERLAND COUNTY, to wit:
Before^^ me, the undersigned authority, on this date personally appeared Melinda K. Foltz and.
-~f~- • wT zt+ ~ and '-~
'~ ~ ~~"' known to me to be
the testatrix and witn sses, respectively, whose names are sig ed to the foregoing instrument and,
all of these persons being by me first duly sworn, Melinda K. Foltz, the testatrix, declared to me
and to the witnesses in my presence that said instrument is her last will and testament and that she
had willingly signed and executed it in the presence of said witnesses as her free and voluntary act
for the purposes therein expressed, that said witnesses stated before me that the foregoing will was
executed and acknowledged by the testatrix as her last will and testament in the presence of said
witnesses who in her presence and at her request and in the presence of each other did subscribe
their names thereto as attesting witnesses on the day of the date of said will and that the testatrix,
at the time of the execution of said will, was over the age of eighteen years and of sound and
disposing mind and memory.
~~S~worn~and~a~ owledged before me by Melinda K. Foltz, the testatrix,
this (L ,witness, and ~a~ --~~~,r~, („~,~
~_ day o , 2007 ,witness,
Mel nda K. Foltz
_~~~ - -
W1tIles$ ~
` ,~{IIIICSS
Vr
Notary Public
CO~MN!ONWEALTH OF PENNSYLVANIA
i iVotarial Seal
Frances A. Aumiller, Notary Public
South Middleton Twp., Cumberland County
My Commission Expires Mar. 16, 2010
My commission expires: M~"'t'E" """"'~wania Association a Notaries
Z:\Clients\FoltzlMelindaWi14.07.frm