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HomeMy WebLinkAbout05-15-09 (2)J 1505607121 IH3 REV-1500 Ex 05 ( - ) PA DepadmeM of Revenue OFFICIAL USE ONLY Bureau of Indlvldual Taxes PDeox2eo6ot INHERITANCE TAX RETURN County Code Year File Number Hardsbum PA 17128.0601 RESIDENT DECEDENT 2 1 D 9 0 2 0 0 ENTER DECEDENT INFORMATION BELOW Social Seamy Number Date of Death Date of Binh 0 0 1 3 0 5 3 5 4 0 2 1 5 2 0 0 9 0 9 2 7 1 9 0 7 Decedent's Last Name Suffuc Decedent's First Name MI C A U F F M A N I S A B E L H (U Applleable) Entsr Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffer Spouse's First Name MI Spouse's Social Seadty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death pdor to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ B. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 70. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-37-91 and 7-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTX)N MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATKIN SHOULD BE DIRECTED T0: Noma Daytime Telephone Number J O E L R Z U L L I N G E R 7 1 7 2 6 4 6 4 2 9 Firm Name (If Applicable) Z U L L I N G E R First line of address D A V I S P C 1 4 N O R T H M A I N Second line of address S U I T E 2 0 0 City or Post Office C H A M B E R S B U R G Correspondent's a-mail address: S T R E E T State ZIP Code L P A 1 7 2 0 1 _y DATE FILED a --c _.~ C.rT '~i J x. ~: -= 3 'r Side 1 L 1505607121 1505607121 USE ~' ~~~~~I~ ~ ~~ ~~ S ~~~,~s .,~ 1505607221 REV-1500 FJC Decedent's Social Securtty Number Decedents Name: ISABEL H• CAUFFMAN 0 0 1 3 0 5 3 5 4 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. 4. Mortgages ii Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointy Owned Property (Schedule F) ^ Separate Billing Requested ....... 8. 7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 6 9 9 6 9 1, 4 1 5 2 4 2 1. 8 0 7 5 2 1 1 3, 2 1 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 8. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 11. Total Deductlona (total Lines 9 & 10) ........................... 11. 12. Net Valw of Eshte (Line 8 minus Line 11) ......................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which en election to tax has not been made (Schedule J) .................. 13. 14. Net Valw 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, ar transfers under Sec. 9118 (a)(1.2)X.0 _ ~ . ~ ~ 15. 18. Amount of Line 14 taxable at lineal refs x .045 6 9 9 7 6 1. 9 0 16. 17. Amount of Line 14 taxable et sibling refs X .12 ~ 0 ~ 17. 18. Amount of Line 14 taxable at colleterel rate X .15 2 7 ~ 0 ~ ~ 0 18. 19. Tax Due ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 2 1 9 6 3, 9 8 2 3 8 7. 3 3 2 4 3 5 1, 3 1 7 2 7 7 6 1, 9 0 1 o a o. a o 7 2 6 7 6 1. 9 0 o. o a 3 1 4 8 9. 2 9 a. a o 4o5a.oa 3 5 5 3 9. 2 9 Side 2 L 1505607221 1505607221 J REV-1500 EX Pege 3 Decedent's Complete Address: File Number 21 os ozoo DECEDENTS NAME ISABEL H. CAUFFMAN STREET ADDRESS 129 Walnut Bottom Road CITY Shi ensbu STATE PA ZIP 17257 Tax Payments and Credits: t• Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1.776.96 3. InteresUPenalty if applicable D. Interest E. Penalty 4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Pepe 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Une 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. (1) 35.539.29 Total Credits (A + B +C) (2) 1,776.96 Total InteresVPenalty (D + E) (3) 0.00 (4) 0.00 (5) 33.762.33 (5A) (5B) 33.762.33 Make Cheek Payable top:~µ~REGISTER OF WILLS, AGENT ~ l~~~~~i~ll ~ ..: ~~i hid°iu~ i ~ i II a II i i I ~ ~I ...~C... ~,`k~4' i ~ r` ~~~~~~~~~ ~ ~,,, ..,. ,~`%, 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 a income of the properly transferred : ................................................................. ... ^ b. retain the dght to designate who shall use the property transferred or its income : .......................... .. ..... ^ c. retain a reversionary interest; or ........................................................................................... ... ^ d. receive the promise for life of either payments, benefits or cere7 .................................................. .. ..... ^ 2. If death orxurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate considerafion? .................................................................................. ..... ^ 3. Did decedent own an'in trust for' or payable upon death bank account or secudty at his ar her death? .... ..... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation7 ............................................................................................. ..... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~ .}~ ..,~ ..,,.. 'S '~ ,.t _ . ,.. ' .. ~€. IIIO,RT, ~' ~ . ~ii .. I ~ p i ~'. P i iuulll~iR' ~ ji i i uVUp i i i ~~I i , ;""~'~~ i~x' III ill For dales 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 [/2 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 far 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 filing a tax return are still applicable even ii the surviving.spouse is the only benefciary. For dates of death on or otter July 1,2000: The tax rate imposed on the net value of transfers from a deceased child twentyane years of age or younger at death to or for the use of a natural parent, an adoptive parent, a a stepparent of the child is zero (0) percent [/2 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 beneflclades is four and one-haH (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 [/2 P.S. §9116(a)(1.3)]. A siding is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adop8on. REV•1503 EX + (8-9e) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INNERRANCE TAX RETURN RESIDENT DECEDENT ISABEL H. CAUFFMAN 21 09 0200 All property Jolntyawned with dpM of survNOnhip must be dlsebsed on Sehedub F. ITEM DESCRIPTION nith Barney Account #73H-00432-11 5LP, consisting of assets shown on attached valuation, including interesVdividends accrued date of death VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, (If more space b needed, Insert edditlonal sheers of the same size) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN ESTATE SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Indude the proceeds of ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Checking Account #33-11139, Farmers and Merchants 45,670.20 Trust Company, including interest accrued to date of death 2. Checking Account #70-58349, Farmers and Merchants 6,331.40 Trust Company, including interest accrued to date of death 3. State Teacher's Retirement of Ohio, prorated benefit 31.20 payment 4. U.S. Treasury, refund of tax 389.00 TOTAL (Also enter on line 5, RecapRulation) ~ S apace Is needetl, insen additlonal sheets of the same size) REV-1511 EX+(10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS ISABEL H. CAUFFMAN 21 09 0200 Dabls of decedent must be roported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Auer Cremation Services 2,080.00 2. Homewood Cemetery 1,045.00 3. Meal for funeral attendees 819.36 4. Rental fee for chapel, Homewood Cemetery 275.00 5. Honorarium to Reverend John Piper 125.00 6. Homewood Cemetery, engraving marker 285.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) S1reelAddresa City Year(s) Commfssbn Peld: Stale Zip 2, AtiomeyFees Joel R. Zullinger 3. Femiy Exemptlon: (If decedenra address is not the same as dalmanrs, attach explanatbn) Claimant Sheet Address CnY State Zlp Reletlorehip of Claimant to Decedent 4• prohere Fees Letters - 510.00; will - 15.00; automation fee - 5.00; short certificate 24.00; JCP - 10.00; filing retum -15.00 6 Accoumanrs Fees 6. Tax Realm Preparefs Fees 7. Travel expenses for executor's attendance at memorial service and estate work 8. Cumberland Law Journal, advertise letters 9. STRS Ohio, return of prorated benefit payment 15,500.00 579.00 886.62 75.00 294.00 TOTAL (Also enter on line 9, Recapitulation) I S more space b needed, Inaed additlonal sheet of Me same size) RSV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS ISABELH.CAUFFMAN 21 09 0200 RapoR debb Incurred by the decedent prior to death which remalnad unpaid ea of the data of death, Ineluding unrelmbureed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Hartzell Eye MDS, medical services 138.40 2. I~sa Card, balance due on account 3. Choice Critical Care, medical services 4. ~Embarq, telephone services due at death 5. PA Department of Revenue, personal income tax due 6.Kinetic Imaging, medical services 7. IElmcroft of Shippensburg, balance due for nursing home care 212.58 251.97 49.50 101.50 3.98 1,629.40 TOTAL (Also enter on line 10, Recapitulation) I S (If more apace N needed, Insert additlonel shoals of the same size) REV-1513 EX ~ (B-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAx RETURN SCHEDULE) BENEFICIARIES ESTATE OF FILE NUMBER ISABEL H. CAUFFMAN ~~ nfl mnn RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS pndude ou ' ht sppoousal distrlbutlons, and transfers under Sec. 9116 (e (12)] 1. Sara Ekart Collateral 5,000.00 440 Oakdale Drive Manhattan, KS 66502 2, Ruth Abbott Collateral 5,000.00 4001 Marlott Avenue Manhattan, KS 66503 3. Pamela Martin Collateral 5,000.00 201 Morlyn Road Bryn Mawr, PA 19010 4. Judith Dann Collateral 5,000.00 3199 Bennington Chapel Rcad Utica, OH 43080 5. Anne Baber Wallis Collateral 2,000.00 2041 Rochester Court Iowa City, IA 52245 6. William Baber, Jr. Collateral 2,000.00 201 Seiwa, 126 Kamino-cho, Nishishinyashiki shimogyo-ku 600-8826 Kyoto-shi, Japan 7. Arlene & Roscoe Keller Collateral 1,000.00 P.O. Box 62 Jones Mills, PA 15646 ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 16, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHAPoTABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Eleanor Morris Scholarship Fund 1,000.00 P.O. Box 154, 329 Route 31 East Donegal, PA 15628 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S 1 000.00 llr more space is needed, Insert adtliaonal sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent ISABEL H. CAUFFMAN Decedents Name Schedule J - Beneflciarles -1 21 09 0200 File Number NUMBER NAME AND ADDRESS OF PERSON S RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Llst Tru s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (indude outright spousal distdbutions) 8. Anna Isabel Gerbic Collateral 2,000.00 1640 Ansonborough Drive Chesterfield, MO 63017 9. George Christian Ehemann Lineal 349,880.95 1725 Susquehannock Drive McLean, VA 22101 10. Jane H. Ehemann Lineal 349,880.95 125 Willow Drive Shippensburg, PA 17257 JRZ - 5.1 cauffman.2 January 25, 2007 LAST WILL AND I, Isabel H. Cauffman, of 125 Willow Drive, Shippensburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby declare this to be my will, hereby revoking any and all former wills and codicils thereto by me heretofore made. I. I direct that all my just debts and funeral expenses, including all expenses of my last illness, shall be paid from my estate as soon as practicable after my decease as a part of the expense of the administration of my estate. II. In the event my net estate after the payment of all expenses and taxes exceeds the sum of $450,000.00, I give the sum of $5,000.00 cash to each of the following individuals: Sarah Ekart, Ruth Abbott, Pamela Marlin, and Judith Dann, if they survive me. In addition I give the sum of $2,000.00 cash to each of the following: Anne Wallis, William Baber, Jr., and. Anna Gerbic. Finally, I give the sum of $1,000.00 cash to each of the following: Arline Keller and Roscoe Keller, jointly or to the survivor of them, and the Eleanor Morris Scholarship Fund, Jones Mills, Pennsylvania. III. I give, devise and bequeath the residue of my estate of every nature and wherever situate to my son, George Christian Ehemann, and my daughter, Jane H. Ehemann, in equal shares. IV. In the event my son, George Christian Ehemann, predeceases me or dies on or before the thirtieth day following my death, I give and devise the residue of my estate as follows: A. One-fourth thereof to my daughter-in-law, Angela P. Ehemann, provided she survives me by thirty days. In the event my daughter-in-law predeceases me or dies on or before the thirtieth day following my death, her share shall be distributed under subparagraph B herein. B. Three-fourths thereof to my daughter, Jane H. Ehemann. V. In the event my daughter, Jane H. Ehemann, predeceases me or dies on or before the thirtieth day following. my death, her share shall be distributed to my son, George Christian Ehemann. Page 2 vx. In the event both of my children, George Christian Ehemann and Jane H. Ehemann, predecease me or die on or before the thirtieth day following my death, I give and devise the residue of my estate of every nature and wherever situate as follows: A. The sum of $10,000.00 cash to each of the following individuals: Sarah Ekart, Ruth Abbott, Pamela Marlin, and Judith Dann, if they survive me. In the event each of the aforementioned beneficiaries receive the sum of $10,000.00 cash they will not be paid the sum of $5,000.00 cash under the teens of paragraph II of this my will. B. The sum of $50,000.00 cash to my daughter-in-law, Angela P. Ehemann, provided, however, should my daughter-in-law predecease me or die on or before the thirtieth day following my death, her share shall be distributed equally among the beneficiaries named in subparagraphs C and C of this paragraph VI. C. The sum of $100,000.00 cash to Shippensburg University Foundation, Inc. , Shippens~urg, P~nnsy vania~o ~s.. adr.~ed~ -i{c, '1'(,u--Jati~E~nen..e~n.v~ ,S~e ars ~~ w D. T~'nn nnn nn teach rn E. The sum of $10,000.00 cash to each of the following named individuals or organizations: 1. William Baber, Sr., 1083 Route 711, Stahlstown, Pennsylvania; Page 3 2. Jeanie Gardner, 5315 River Aire Road, Godfrey, Illinois; 3. Marty Hinebaugh, 166 Jones Mill Road/Stahlstown Road, Jones Mill, Pennsylvania; 4. Kay Hummel, 115 Manhattan Street, Manhattan, Kansas; 5. Steven Hummel, Londonderry Road, Manhattan, Kansas; 6. Elizabeth Lash, 1604 Powder Mill Lane, Wynnewood, Pennsylvania; 7. Jessica Ditto, 845 Staffordshire Road, Cockeysville, Maryland; 8. Josiah Blackmore, 7629 Clark State Road, Blacklick, Ohio; 9. Dorothy Gardner, 5145 Portland Avenue South, Minneapolis, Minnesota; 10. William Baber, Jr., Kyoto, Japan; 11. Anne Wallis, 225 Fairview Lane, Iowa City, Iowa; 12. Ruth Abbott, 4001 Marlott Avenue, Manhattan, Kansas; 13. Sarah Ekart, 440 Oakdale Drive, Manhattan, Kansas; 14. Pamela Marlin, 201 Morlyn Road, Bryn Mawr, Pennsylvania; 15. Shippensburg Public Library, West King Street, Shippensburg, Pennsylvania; 16. Cumberland Valley Animal Shelter, 2325 Country Road, Chambersburg, Pennsylvania; Page 4 17. Swissvale Presbyterian Church, Swissvale, Pennsylvania; 18. Shippensburg University Foundation, Inc., Shippensburg, Pennsylvania, to be added to the Paul and Elizabeth Cauffman Scholarship Fund; 19. Carnegie Mellon University, 5017 Forbes Avenue, Pittsburgh, Pennsylvania; 20. Allegheny College, 520 North Main Street, Meadville, Pennsylvania; F. In the event any of the aforementioned beneficiaries from subparagraph E 1 through 14 predecease me, their share shall be distributed equally to Allegheny College, 520 North Main Street, Meadville, Pennsylvania, and Carnegie Mellon University, 5017 Forbes Avenue, Pittsburgh, Pennsylvania. VII. Any fiduciary under this will shall have the following powers in addition to those vested in them by law and by other provisions of my will applicable to all property whether principal or income, including property held for minors, exercisable without Court approval, and effective until actual distribution of all property: A. To retain any and all of the assets of my estate, real or personal, without regard to any principle of diversification of risk. Page 5 B. To invest in all forms of property including stock, common trust funds and mortgage investment funds without restriction to investments authorized for Pennsylvania fiduciaries as they deem proper, without regard to any principle of diversification of risk. C. To sell at public or private sale, to exchange or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. D. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. E. To compromise any claim or controversy. F. To distribute in cash or in kind or partly in each. G. To hold property in their names without designation of any fiduciary capacity or in the name of a nominee or unregistered. VIII. I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. Page 6 IX. I appoint George Christian Ehemann and Jane H. Ehemann, my children, as co-executors of this my will. Should both of my children predecease me, fail to qualify or cease to act, I appoint Josiah Blackmore as~ executor of this my will. Should Josiah Blackmore predecease me, fail to qualify or cease to act, I appoint William Baber, Sr., as executor of this my will. X. No bond shall be required of any fiduciary hereunder in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my last will and testament, consisting of eight typewritten pages, the first six of which bear my signature in the margin for the purpose of identification this ~~ay of r ZDn?, 1J n . ~1 ~ v ~„~ Signed, sealed, published and declared by the above-named testatrix as and for her last will and testament in our presence, who in her presence, at her request and in the presence of each Page 7 other have hereunto set our hands as attesting witnesses. /Y5~/ ~o~Ca ,Oi~o We, Isabel H: Cauffmaa, ;~~ ~- 7awM r~ _,N and SAvQa-~ E. ~,C~1 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 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 said testatrix, signed the will as witnesses and to the best of their knowledge, said signer was at that time eighteen years of age or older, of sound mind and under no constraint or undue 'nfluenc n ~. ~l> 1? ~~^ .mil _ p Tac Subscribed, sworn to and acknowledged before me by the above-named signer and subscribed and sworn to before e by the above-n mad witnesses this day of Notary"Publi ff~~~~`"-- " ~- - ~' OF PENNSYLVANiF. 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