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HomeMy WebLinkAbout05-14-09r 150560712 ~ REV-1500 EX (OB-OS) OFFICIAL USE ONLY PA Department of Revenue county code rear Fib Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 8 12 6 9 PO 80X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date oT Birth 160 16 5355 11 29 2008 09 15 1916 Decedent's Last Name Suffix Decedent's First Name MI FREE NELSON S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Soeial Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X~ 1. Original Retum ~ 2. Supplemental Return ~ 3. pdor to d2r13 8 ~ (date of death 4. Limited Estate ~ 4a. Future Imersst Compromlae ~ 5. Fetleral Estate Tax Return Required (date or Death alter 12-1242) g Decedent Db0 Testate (Attach COpY M WJI) 9. Litigation Proceeds Received 7 Decedent MalMelned a Living Trvn (Attach Copy M Tmen ^ 1 p. Spousal Govedy Credd (data of rbeth beMeen 12.31-91 end -i-65) e. Total Number or Safe Deposit Boxes 11. Election to tax untler Sec. 9113(A) (Anach scn. o> CORRESPONDENT • THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number KENNETH H. HOWARD 717 394 0521 Firm Name (H Appllcable) APPBL & YOST LLP First Ilne of address 33 NORTH DURB STREET Second line of address City or Post Office LANCASTER Correspondent's a-mail address: I have examined this return, 3n of preparer other than the State PA S. Free 33 North Duke Street, Lancaster, PA 17602 L 1505607120 Kenneth H. Howard. Side 1 150560712U ZIP Code 17602 REGISTER OF ~LLS USE Ol~r' ?OO ,r, H 1 T ~~rv ~ ~ __'>_ m ~ v'!o _ .t-- i U~T pre r ~ D/~ F-ILED 3 schedules end statements, is based on all informanon ,/ J U,}j~ s ~~ o ~~ ~~ i~ ~ a~ ~,1 1 1505607220 REV-1500 EX Decedent's Social Security Number oeceaem~c e.me. Nelson S. Free 1 6 0 1 6 5 3 5 5 RECAPITULATION 1. Real Estate (Schedule A) ......................................................................................... . 1. 6,087.35 2. Stocks and Bonds (Schedule B) .............................................................................. . 2. 3. Closet' Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... . 3. 4. Mortgages 8 Notes Receivable (Schedule D) ......................................................... . 4. 299,205.33 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ............... . 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............ . 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............ . 7, 8. Total Gross Assets (total Lines 1-7) ...................................................................... . 8, 3 0 5. 2 9 2. 6 8 6,593.37 9. Funeral Expenses 8 Administrative Costs (Schedule H) ........................................ . 9. 1 , 8 6 0 . 8 5 10. Debts of Decadent, Mortgage Liabilities, 8 Liens (Schedule I) ............................... . 10. 11. Total Deductlona (total Lines 9 8 10) ..................................................................... . 11. 8,454.22 12. Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12, 2 9 6 , 8 3 8 . 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 SubJeet to Tax (Line 12 minus Line 13) ................................................ . 14. 296,838.46 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 .o0 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable 2 9 6, 8 3 8. 4 6 at lineal rate X .045 1s. 13 , 3 5 7. 7 3 17. Amount of Line 14 taxable () ~ ~ at sibling rate X .12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 16. 0. 0 0 19. lax Due .................................................................................................................... . 19. 1 3. 3 5 7. 7 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: FIIe Number 21-08-1269 DECEDENT'S NAME Nelson S. Free STREET ADDRESS 210 Big Springs Road CITY Newville STATE PA ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 12,312.00 648.00 Total Credits (A + g + C) (1) 13,357.73 (2) 12,960.00 (3) (4) Total InteresUPenalty (D + E) 4. It Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (sB) 397.73 397.73 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 properly tranaterred :.................................................................................. ^ b. retain the right to designate who shall use the property transferred or its income :.................................... n LXJ c. retain a reversionary interest; or .................................................................................................................. L~Ji ^x d. receive the promise for life of ekher payments, benefits or care7 .............................................................. ^ 2. If death occurred after December 12, 1962, did decedent transfer property within one year of death without receiving adequate consideretion7 ....................................................................................................................... ^ 3. Did decedent own an "in trust fof 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 designation7 ...................................................................................................................... ^ 0 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 Juy 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)). Tha statute does not exempt a transfer to a surviving spouse from tax, end the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the ony beneficiary. For dates of death on or after July 1, 2000: The tax rata 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 untler Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 12/09/2008 08:56 7172731831 BARRY FREE PAGE 03 ~~e ~~ ~~~cemb~reb~ ~I>sit 11Ve, Nelson S, Free and Bernice M. Free of 5 Poplar Drive, Manhe~m, County of Lebanon and State of Pennsylvania, being of sound mind, memory and understanding do make a publish this our last Will and Testaments..her~by revoking and making void all former Wills by us at anytime heretofore made. Sf1tt.~ ~'fi•St, x1U~e direct that our funeral be conducted in a manner icorresponding with my estate and situation in life and that all our just debts and funeral expenses by fully paid and satisfied as soon as conveniently may be after my/our decease. S~ttb to such estate as it has pleased God to entrust to me, I dispose ©f the same as follows, viz; In case of Nelson 5. Free's death, all his/my worldly goods shall be left to his/my wife, Bernice M. Free. In case of Bernice M. Free's death, all her/my worldly goads shall be I~ft to her/my husband, Nelson S. Free. In case of the deaths of both Nelson S. Free, and Bernice M. Free, all our worldly goods shall be equally divided between our two children, Carolyn L. Carling, and Barry S. Free. This will written and signed this 1st day of December, 1991. Signed 72~..~.~ ~e_. Signed ~ D ,,.. , ~~-h~!")~r Wih~ess ~/~ ~~^ ~~Q, . Witr~ess /.~r~. ~ n PGL' 12/09/2008 00:56 7172731831 HARRY FREE PAGE 04 `~ttib ~/'We appoint Barry S. and Testament. hereby nominate, constitute and Free, Executor of this my/our last Will ~ltt ~Utttl:ess iUberaot, 7U¢, Nelson S. Free and Bernice M. Free, the testators, have to this, our Will written on one sheet of paper, set our hand and seal, this 1st day of December, A.D. One Thousand Nine Hundred and Ninety ne. Signed o~•i~-e_., ~beal Signed ~~<-..;ye~,sx~ti,~. Signed, Sealed, Published and Declared by the above named, Nelson S. Free and Bernice M. Free as and for their last Will and'Testament, in the presence of us, who have hereunto subscribed our names at CI?gUeSt as witnesses thereto, in the prasenoe of eho said Testators, and of eaph other. Witness p ~.~ ~~ ~ Witness, THE AFOREGOING INDIVIDUALS, NELSCNjS. FREE, BERNICE M. FREE, IRENE STRACK, ANU~ ~~ s'~ ANTHONY SPFLUE, PERSONALLY CAME BEFORE NE-- - THIS 1ST DAY OF DECEMBER, 1991 ANO ARE a~ ~~` KNOWN TO BE T E PERSONS WHO EXECUTED THIS _ }may, { w~~ I DOCUMENT I PRESENCE. 1)i ~~{ (~ d) ~ ~!I) 1 J. F ELD TAR P 1 \~ ~ • ~ ~J7AA!dl SCnl °L J ~i;lA 1c m'PUAIie @a lc~ s( `.'.p. Lan m. Rev-0eW E%~ (BAa) SCHEDULE B STOCKS 8r BONDS COMADNWFALTH OF PENNSYLVANN INHERRANCE TAIL RETURN REamENT DECEDENT ESTATE OF FILE NUMBER Free, Nelson S. 27-08-7269 All propsny piney.ownetl vMh dgM of sunrivonhlp must as tlUeloestl on Sehstluls F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 1,055 shares of Nuveen MuItI-Strategy 5.77 6,087.35 TOTAL (Also enter on Line 2, Recapitulation) 8,087.35 Of more apace is needed, atltlitlonal pages of the same size) Copyright (c) 2002 Corm software onry The Lackner Group, Inc. Fonn PA-7500 Schedule B (Rev. 6-98) Rev-7600 EX~ (8-Ba) , SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY CONNAONWFALTN OF PENNSVLVMIIP INNERITMICE TNI RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Free, Nelson S. 21-08-1268 Indutle the prxeetls m Illlpetgn antl the tlNe iM praceetle were raceivetl Dy the estele. All properly lolntlyownstl vAtll lM dpht of survlvoeehip must W tlleeloeetl on whstluls F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Fulton Bank Certificate of Deposit #436-0300123 10,032.67 Accrued interest on Item 1 through date of death 172.14 2 Fulton Bank Certificate of Deposit #436-0313571 43,000.00 Accrued interest on Item 2 through date of death 375.60 3 Fulton Bank checking #0069-17492 12,284.23 4 Graystone Bank Certificate of Deposit #3000015583 24.158.38 Accrued interest on Item 4 through date of death 21.01 5 Graystone Bank Certificate of Deposit #3000036632 5.989.90 Accrued interest on Item 5 through date of death g,32 6 Graystone Bank Certificate of Deposit #3000083328 94,961.17 Accrued interest on Item 6 through date of death 98.16 7 Graystone Bank Certificate of Deposit #3000086731 9,091.11 Accrued interest on Item 7 through date of death 13.08 8 Province Bank Certificate of Deposit #1100184288 6,902.78 Accrued interest on Item 8 through date of death 77,g3 Total of Continuation Schedule gee attached page TOTAL (Also enter on Line 5, Recapitulation) 289,205.33 (If more space is nestled, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1600 Schedule E (Rev. 6.98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMNpNWEgLTH OF PENNBYLVr1NlN INHERITRNCE TP%RETURN continued REWOENT OECEOENT ESTATE OF FILE NUMBER Free, Nelson S. 21-08-1269 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 9 Smith Barney Account 37270293215747 1,354.20 10 Wachovia Bank Certificate of Deposit #247402053813508 64,383.83 Accrued interest on Item 10 through date of death 95.22 11 Wachovia Bank Certificate of Deposit #247402053725883 25,849.04 Accrued interest on Item 11 through date of death 35.41 12 Blue Cross -insurance refund 144.40 13 Provider Services -refund 39.85 TOTAL (Also enter on Line 5, Recapitulation) I 298.205.33 Copyright (c) 2002 form software ony The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) 1 REV-1161 EX~ (13-BB) COMMNHERITANCE TAX RETURN ANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8r ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Free, Nelson S. 21-OS-1269 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. I FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address Ciry State Zip Year(s) Commission paid 2. Anorney's Fees APPEL 8 YOST LLP 5,820.00 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 376.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 297.37 See continuation schedule(s) attached TOTAL (Also enter on line 8, Recapitulation) 6,593.37 Copyright (c) 2002 form software onty The Laekner Group, Inc. Form PA•1500 Schedule N (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Free, Nelson S. 21-08-1268 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Appel 8 Yost, LLP -reserve for final fees and costs 100.00 2 Citizens Bank checking #6222141882 -adjustment for check charge fee 0.18 3 Cumberland Law Journal -advertising expense -Estate Notice 75.00 4 The Patriot News -advertising expense -Estate Notice 122.16 H-67 SuMotal 297.37 Copyright (c) 2002 form software ony The Lackner Group, Ine. Fonn PA-1500 Schedule M (Rev. 6-98) Rsv.161Z E%~ )edla) , SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS LDNNIDNWENLTH dF PENNSYLVNNW INHERRMKE TR%RFTURN RE810ENi DECEDENT ESTATE OF FILE NUMBER Free, Nelson S. 21-08-1269 Ineluee unnimiwrsaa mMlctl sxp~nua. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Alexander Springs Emergency Physicians 31.97 2 Alexander Springs Emergency Physicians 31.97 3 Alexander Springs Emergency Physicians 21.41 4 Continuing Care RX 67.75 5 Cumberland Goodwill Fire and Rescue 92.75 6 Fulton Bank checking #0069-17492 -checks cashed post date of death 616.49 7 Green Ridge Village 74.52 8 Millennium Pharmacy Systems East 104.53 9 Pennsylvania Department of Revenue - 2008 income tax due 296.00 10 Special Event Emergency Medical Services 523.46 TOTAL (Also enter on Line 10, Recapitulation) I 1,860.85 (If more apace is needed, atltlitional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-88) REV-161J EXi (8-0O) SCHEDULE J COMMNMER TANCE~AXR TURN ANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Free, Nelson S. 21-08-1268 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY 0o Ra un rrusl. . (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. ~116(a)(1.2)] Barry S. Free Son 1/2 of residue 1803 Larch Circle Lebanon, PA 17042 Carolyn L. Carling Daughter 1/2 of residue 8354 Locust Lane Mechanicsburg, PA 77055 Total Enter dollar amounts for distributions shown above on lines 5 throw h 18, as appropri ate, on Rev 1500 cove r 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 0 00 Copyright (c) 2002 form software only The LaGrner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) N N Q~ ~ fO~ d'o~~ ~, ry N. ~_ N ~ s^ o. ~a O ~-, a ~ ~ ~~ ~~ aa~seH - ~, ~~~gyyy K j y A66 N W L K ~ ~_ W ~I ~ ~°~ 4 W=~ M .w ~ ~ I ,. rU.:,E ;;- 1~s~ ~~~4 ~ii,'~ l 4 AM I I ~:: ERK OF 0=.;~~ W'S COUR1 J J LL O W H ~ W W ~ }d' Q C3 F Z ~ ~ W ~ - 00 0 ~ ~ _ zF a Q'~O J m ~ ~ ~ ~2 W O ~ ~zOQ - UO~U t ~~~ HARRY B. V08T JAMES W. APPEL JONN L. BAMPSON KENNETH H. HOWARD WILLUIM J. CA881DY, JR. ELAINE G. UOOLNIK ROBERT W. NALLINGER PETER B. ASTORINO BRADLEY A. ZUKE LUCY F. DOWD OF COUNSEL WILLUIM R. WNEATLV MATTHEW G. OUNTNARP J. MARLIN BNREINER ,,Y . APPS ~ OSTLLP LAW OFFICES THIRTY-THREE NORTH DUKE STREET LANCASTER, PENNSYLVANIA 17802 (717) 584-0871 FAX (7771477-7864 (emaiq Jan911e~app9lyoateom May 8, 2009 Cumberland County Register of Wills One Courthouse Square Carlisle, PA 17042 Re: Nelson S. Free Estate - 2108-1269 Deaz Sir or Madam: MERRILL L. NASSEL (18H-+977) T. ROBERTS APPEL, II (+991-2009) BRANCH OFFN:E8 OFFICE AT NEW HOLLAND, PA (7+7139H++7 OFFK:E AT STRASBURO, PA (7771897.7877 OFFICE AT QUARRWILLE, PA 17+71 Taanz OFFICE AT EPNRATA, PA (7+x1733-NO4 OFFICE AT CHRISTUINA PA (91016932740 We aze assisting Barry S. Free, Executor, in the settlement of the Nelson S. Free Estate. Enclosed for filing with your office are the original Inventory and Inheritance Tax Return as well as an estate check for payment of the outstanding balance of Inheritance Tax owed. Please time-stamp the additional copies and return them to our office in the enclosed self- addressed, stamped envelope. If you have any questions or need additional information, please do not hesitate to contact me. cerely, nelle Jupi Paralegal fo Kenneth H. Howazd 57081 01 enclosures cc: Barry S. Free n o Kenneth H. Howazd ~ ~~ j a _~ N ~m ~ ~< ~ c3~ ~ o~ I '~ -- :_. -, a z f--; x, ~ -' _ - :_ N _,~ C /1