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Home My WebLink About05-15-0915056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Countv Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN PO BOX 280601 ~ ~ Q Harrisbur , PA 17128-0601 °~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth o .~ 3 ~i ~ ~ t ~ 1 a ~ ~ z e ~ ~ 1 ~. ~ ~ ~ ~~ '~ ~ Decedents Last Name Suffix Decedents First Name MI w't1I St LEIS .~ -4 N ~ ~ w (If Applicable) Enter Surviving Spouse's Inform ation Below Spouse's Last Name Suffix Spouses 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 O 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 ,_. Firm Name (lf Applicable) REGISTER CF ILLS USE`,~1LY _-- -. i 7 _. ,. - .. ;- ~ -~"' -~_ r-- "~ -:~ ..~ First line of address „- ~ - ,- _ _ , Second line of address ~ -- fV y- -. ~ '-~ DATE FILED G's - City or Post Office State ZIP Code Correspondent's a-mail address c~ Y e v'ro. ~(~ .'~-.r', ,. f"i ~Vc~ t_ ~ , (~ 4~ 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. SI NAT RE OF ~EQ~1 RESPONSIBLE FOR FILING RETURN DATE ADDRESS f ~~fS.~ \71i ~1~ C~ ~r~«-,v~c-~ Via- ~~,.'~~Sk- ~~~ -«: rs '~"'- DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~ (~ ,~ 3 ~' ~ ~ t RE CAPITULATION 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. R ~ 7 ~ 5 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. ~ 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ~ , ~ ~ 5 ~ 6 ~} 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. ~ ~ ~ ~ ~ b 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. Cj ~ 7 ~ ~ a 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. ~ ~ 7 ,~ ~ a 4 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 _ 7 ~ . ~ ~) 16. 17. 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c~ 5 I ~ ~.~ '1 a~~.o~ O Side 2 15056052048 15056052048 Rev-i soo ex Page a File Number Decedent's Complete Address: DECEDENTS NAME j c~~n e ~ 1. , w to , 5-f!~ ~-- STREETADDRESS ~a ~ I~~~{~~y ~~- CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) ~~,Q `d~' 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) ~ 3. Interest/Penalty if applicable D. Interest E. Penalty 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. (4) 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. (5B) ~~(~ ~ O~ Make Check Payable fo: 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 :.................................................................................... ...... ^ ~. b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ [~ c. retain a reversionary interest; or .................................................................................................................... ...... ^ tl. 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? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ 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 (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 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. REVd508 EX + (L97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER far ~ ~ ° ~`w~.s} 1~ r-- a i - ~'~~~- ~~`~ C5 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER ~,q DESCRIPTION ~ # OF DEATH Ste. v , n y.S /7 ~ ~ . /~`~ ~ 7 ~ci' :~0 a~/~~~~ ~ ~L% I',! ~ ~ ~~ f a/~ ~~o~ 3 ~~}. fy c:; ~ ~~~ TOTAL (Also enter on line 5, Recapitulation) $ ~ ~ ~~ (If more space is needed, insert additional sheets of the same size) ' REV-1512 EX+ (12-03) ~~ scNE®u~E ~ COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH iluc, ~~e $ ~-~,~~' At~~.,,r~ `5 . t-~> I Cam=" `' {-~y,~.1`cta`cin Lace' ~~~i~y ~~'~' 6 - i ~''` L'~_ hls7 1 ~ r ~ U f'.-c;, tea Y~ 2ad~. ( [~! ~. ~' _ r ~ ~J ~ IM// fJ!G:Yafrt'S . Ctl~"C°P ~' ~~• d 5't'e'~Icyrr-e~k1V~ (~,~-~ ~~kr-~ti c _.1.-~~~c~d~nC~ ~~ •Ct~ ~~~, da. ,~,~~;~ ~~,~~~ TOTAL (Also enter on line 10, Recapitulation) $ ~ ~(~~`~ 7 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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 [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. ~ LI (r~~' ifs 1r: ~G . t'7Q1.~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, Janet Whistler, of Dickinson Township, Cumberland County, Pennsylvania, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my demise. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such propertypasses under this mill, shall be paid bymypersonal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personally owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. MY representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. c7 ~~ ~-~ ~~ 3. I give, devise and bequeath the following: ~ o ~ `-' A Work watch and new watch to Brianna KaufflT~~ - `~ ~'' ~= ~ ; `? B. "n'i ~~ '57~-` Crystal dolphin and heart bracelet to K~-Kauffman. - -= ~ ' %~ ,- , _ N ~ ri N -- ' `~ C. . _ ~..: o Train nicknack and train bracelet to Kenzie Kauffman. :~. ~ -~ -. ' ~l : -.- ,:-~~ D. Ceramic dolphins and star bracelet to Kyrstin Kauffman. ~ _ N ~ = ~:.,~ E. Safe to Travis G. Kauffman. N F. Mother's hanky box and Florida nicknacks to Drema Altice Kauffman. G. Wedding engagement ring from first marriage to Gleason J. Kauffman. I-L Grandmother's dresser, mountain picture and cross necklace to Bonnie Kauffman I. Cubic zirconium ring to Kaitlyn Spurlock J. Wolf touch lamp to Benjamin N. Kauffman. K. Blue stone tennis bracelet to Jessica C. Kauffman. L. Mother's picture, Texas salt and pepper shakers and lk of CDs to Randy E. Kauffman. M. Pictures of last supper and Elvis mugs to Kori Kauffman. N. Gold necklace to Allyssa Kauffman. yoU~ ~;v~ ,~~„~ n .~'~,'w O. Set of owls, Alamo picture and mug with ~ name to~~~avffman. P. Bible to Jeshua Kauffman Q. Wedding rings from second marriage and mother's painting to Jason M. Kauffman. R Oval stone necklace to Jeanette Kauffman. S. Brown bead bracelet to Jolene M. Kauffman. T. 'k of CDs and Lorretta Lynn mug to Kenneth R Kauffman. `~ U. Cream fleece pajamas, Lorretta Lynn ashtray and their house picture to ~i Debbie Kauffman. ~~ '~, V. Avon square necklace and coal miner's bell to Kandi Allison. `~ W. Picture of the two of us and camel back mug to Michael Kauffman. X. Blue mug from Dallas to David Allison. ~ Y. House with pink roof and ceramic baskets to Stephanie Allison. 4. I give, devise and bequeath the rest, residue and remainder of my estate of whatever nature and wherever situate to my son, Travis G. Kauffman. 5. If Travis G. Kauffman.does not survive me by a period of at least thirty (30) days, then my estate I give, devise and bequeath the rest, residue and remainder of my estate to Randy E. Kauffman. 6. I herebynominaxe and appoint my son, Travis G. Kauffman, individually, to be my personal representative of my estate, to serve without bond. If, Travis G. Kauffman, cannot or does not serve, then I appoint Randy E. Kauffman and Drema A. Kauffman to be my substitute personal representatives also to serve without bond. 7. I suggest that my personal representative retain the services of Wolf & Wolf, Attorneys at Law of Carlisle, Pennsybania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this f ~ day of November, 2008. ~~~~`~ 1~r.~t~J (SEAL) Signed, sealed, published and declared bythe above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscnnbing witnesses. ACKNO~ F'DG ENT AND AF.F~DAVIT WE, ,JANET WHISTLER, STAGY B WOLF, AND Ma ~ ~1 ~+ Ti1=,~' n > the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly swom, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ ~'~~~~ , J ET WHISTLER TACY B. OLF ~'' ~ ~ ,L ^ ~ ~~~ COMMONWEALTH OF PENNSYLVANIA . ss: COUNTY OF CUMBERLAND - Subscribed, swom to and acknowledged before me byJANET W~IISTLER, the testatrix herein, and subscribed and sworn to before me by STAGY B. WOLF, AND R r ~l n~ s~'~~. , witnesses, this (I day of November COMMONWEALTH OF PENNSYLVANfA NotaAal Seal Nathan C. Wolf, Notary PubNc Cartisls Baro, Curnbsrland County Cor,xnisslon Expk~s AprY 19, 2012 POnnsyNanla Aasodation of Notaries