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Home My WebLink About06-04-09 15056051058 REV-1500 EX 06 ( -OS) PA Department of Revenue OFFICIAL USE ONLY Bureau of individual Taxes PO BOX 280601 County Code Year File Number INHERITANCE TAX RETURN HarrLgtwrg, PA 17128-0601 RESIDENT DECEDENT 21 08 1151 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 196-14-0711 08/09/2008 09/30/1925 Decedent's Last Name Suffix Decedent's First Name MI Adams Dorothy ~ tff 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 1'~ 1.Original Retum 2. Supplemental Retum 3. Remainder Retum (date of death 4. Limited Estate prior to 12-13-82} 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate (Attach Copy of Will) " " 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) ' :` ; 9. Litigation Proceeds Received 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 T0: Name Daytime Telephone Number Wiliam C. Dissinger (717) 957-3474 Firm Name (If Applicable) Dissinger &Dissinger REGISTER OF WILLS USE ONLY First line of address ~~ -- -; 400 South State Road , ~ = o `~ ~ -' ' Second line of address ='-'' ?- ~ .~ ~ ~ ;m I J _ . City or Post Office State ' J,-~ .~ - .,..~ ZIP Code ~~~~ Marysville PA 17053 ` ~ ~ w , ,` - - =' W Correspondent's a-mail address: mville@pa.net -"' Under penakiea of perjury, I declare that I have examined this return, inGuding aaxmpanying schedules and statements, and to the best of my knowledge and belief, it is true, oorcect and complete. OeClaretkxt of preparer other than the personal re resentativ i b d p e s ase on all Information of which preparer has any knowledge, SIGNATU OF PE . Oy.R~ ON LE FOR FILING RETURN ( DATE 04/22/09 ADDRESS ~ 802 Valley Rd., arysville, PA 17053 SIGNATURE OF PR ARER OTHEH,FFTAN PRESENTATIVE _ ' ~'~ DATE 1~1~u .~~' /1 ~ 04/22/09 ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 .J 15056052059 REV-1500 EX Decedent's Social Security Number pecedant's Name: Dorothy J Adams __ 196-14-0711 RECAPITULATION 1. Real estate (Schedule A) ......................................... .... 1. 0.00 2. Stocks and Bonds (Schedule B) ................................... .... 2. 3,838.12 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3 . .... . 0.00 4. Mortgages 8~ Notes Receivable (Schedule D) ......................... .. . . 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... .... 5. 27,316.31 6. Joindy Owned Property (Schedule F) Separate Billing Requested ... .... 6. 0 00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property . (Schedule G) Separate Billing Requested.... .... 7. 0.00 8 Total Gross Assets (total Lines 1-7)........ g , , , 31,154.43 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......... 9 ......... ... . 4,539.52 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ... 10 .......... ... . 1,389.11 11. Total Deductions (total Lines 9 8 10) ...................... 11 .......... ... . 5,928.63 12. Net Value of Estate (Line 8 minus Line 11) .......... ........ 12 ......... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ... . 25,225.80 an election to tax has not been made (Schedule J) ....... . . ..... 13 ... . . 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ......... 14 ............ .. ... . 25,225.80 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) X .0 0 0.00 15. 0 00 16. Amount of Line 14 taxable . at lineal rate x .u ~ 25,225.80 16. 1 135.16 17. Amount of Line 14 taxable , at sibling rate X .12 0.00 17 0.00 18. Amount of Line 14 taxable at collateral rate X .15 0.00 18 0.00 19. TAX DUE ....................................................... .. 19. 1,135.16 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 08 1151 DECEDENTS SOCIAL SECURITY NUMBER J Adams _ 196-14-0711 801 N. Hanover Street CITY Carlisle STATE 21P PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CreditslPayments 1,135.16 A. Spousal Poverty Credit 0.00 B. Prior Payments 0.00 C. Discount 0.00 Total Credits (A + B + C) (2) 3. InteresNPenalty if applicable 0.00 D. Interest 0.00 E. Penalty 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal InteresUPenalty (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 y 1,135.16 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE . (SB) 1,135.16 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: a. retain the use or income of the property Vansferred :..................................................... Yes No b. retain the right 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 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 Juty 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 p2 P.S. §9116 (a) (1.1) (ii)]. The statute does not ex~mot 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 isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (8-98) SCI~IEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT tSiATE OF Dorothy J. Adams All property jointly~owned with right of survivershle ~,~~.~ ~ a~..~,....a __ ~_~_~..._ _ FILE NUMBER 1151 ~ """° °r°w ~° ^ow , ~~~~o~~ ~~~~~~~,a, sneers or me 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 J. Adams 1151 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 (ir more space is neeaeo, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy J. Adams SCI~IEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 1151 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION ~ A• FUNERAL EXPENSES: 1. B. ~ ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Kathy Greene 1, 869.26 Sodal Security Number(s)/EIN Number of Personal Representative(s) 168-48-2976 _ Street Address 802 Valley Rd. City Marysville .state PA zip 17053 Year(s) Commission Paid: 2009 2, Attorney Fees 1, 869.26 3. Fatuity Exemption: (If decedent's address is not the same as daimant's, attach explanation) 0.00 Claimant NONE Street Address City State ,Zip Relationship of Claimant to Decedent 4. Probate Fees 94.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 451.00 7. Patriot-News 181.02 8 Cumberland Law Journal 75.00 TOTAL (Also enter on line 9, Recapitulation) I S 4,539.54 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08j • ~ ~~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT CJIRIC VF FILE NUMBER Dorothy J. Adams 1151 Report debts incurred by the decedent prior to death that remaienA ~~,.~~ta ,..~e a,... _~ ~__.~ ,__.._,.__ •• •••°•~ ..r,..,.. ~~ ~iccucu, ~,,,~,~ nuu,UUnoi sneers or me same size. REV-1513 EX+ (11-08) ~,. '' ~ Pennsylvania SCHEDULE ,7 DEPARTMENT OF REVENUE INMERIfANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy J. Adams 1151 NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE () Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1. Virginia Mowery - 305 Doubling Gap Rd, Newville, PA 17241 daughter 113 2 Linda Brougher -1011 Teakwood Lane, Enola, PA 17025 daughter 113 3 Kathy Greene - 802 Valley Rd, Marysville, PA 17053 sd 1113 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV•1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 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. REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2008- 01 151 PA No . 21- 08- 1 151 Estate Of : DOROTHY J ADAMS (first, Middle, Lastl a/k/a : DOROTHY JUNE ADAMS Late Of : CARLISLE BOROUGH CUMBERLAND COUNTY Deceased Social Securi ty No : 196-14-0711 WHEREAS, on the 30th day of December 2008 an instrument dated November 9th 2005 was admitted to probate as the last will of DOROTHY J ADAMS (First, Middle, Lastl a/k/a DOROTHY JUNE ADAMS late of CARL/SLEBOROUGH, CUMBERLAND County, who died on the 9th day of August 2008 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi11s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: KA THY J GREENS who has duly qualified as EXECUTOR(R/X1 and has agreed to administer the estate according to law, all of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. I.N TESTIMONY WHEREOF, I have hereunto set my hard and affixed the seal of my office on the 30th day of December 2008. /~9 1 ~~ ~ , egrster o Wills p t **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TESTAMENT OF DOROTHY J. ADAMS L, Dorothy J. Adams, widow woman, of Marysville, Perry County Pennsylvania, currently a resident of an assisted living facility in Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make publish and declar~is to b my Last Will and Testament, and I hereby revoke any and all wili~~.~'nd ~; codicils previously made by me at any time heretofore. ' ;~: ~ ~_ . , . , ..__ - _ ; .,~ FIRST: I hereby direct that my personal representative, her~t~after named, to pay all of my just debts not barred by any statute of li mtia~ions, as well as my funeral and testamentary expenses, including PennsylWania w Inheritance taxes, as soon as my demise as may be practicable. ~ SECOND: I hereby give, devise and bequeath all the rest, residue and remainder of my estate to my three daughters, Virginia Mowery of Newville; Linda Brougher of Enola, and Kathy Greene, of Marysville, share and share alike, per capita. Be it known that if any one of my three daughters desires to purchase my residence at 514 Lansvale Street in the Borough of Marysville, Perry County, Pennsylvania, and/or the adjacent lot, she may do so if the other two daughters agree. In the event that there is no agreement among my daughters, or in the event that none of my daughters desires to purchase said property, the property is to be sold to a third party at fair market value and the proceeds from the sale distributed equally among my three daughters, as indicated above. THIRD: I hereby nominate, constitute and appoint my daughter, Kathy Greene, as executrix of my estate. In the event my daughter, Kathy Greene predeceases me, refuses to serve, or is incapable of serving, I hereby nominate constitute and appoint my daughter, Virginia Mowery, to serve as executrix of my estate. Neither person shall be required to post bond or surety in this or any other jurisdiction to discharge the responsibility of -,:. _i..,.:.,.~ .., ~:~.--- _..-; -, ,:.., acting as my personal representative IN WITNESS WHEREOF, I hereby set my hand and seal on this document, on this f'~ of ~),;,,~.,, .,.k~_, 2005, which I declare to be my LAST WILL AND TESTAMENT, consisting of this and one other typewritten page. T~r~r ~aA h~~ ,-„~ ~ b=~g.-~.~.de c-~f-xhe~.ge m nrP.,anr fr-a~d~-by~-repl-aeg-menL,-~~,~ '~JiC~ ~../~a..L~.~ P :~.. Doroth ~ .Adams (Testatrix) BE IT KNOWN that at the request of the testatrix, we the undersigned witnesses, in the presence of the Testatrix and each other, have witnessed her signing this document that she has declared to be her LAST WILL AND TESTAMENT consisting of this and one other typewritten page, to which she has also affixed her signature along the side of that first pale. / f o Printed name of witness ~~ ~- residing at - ~ Tcx'~.y~ v-~~ ~ of witness) r I~ _ <-1 ~~~ iTH ~.. ~~ c I~~ h r residin at 7 ~ S ~~',n~' 1 ~ r Printed name of witness (°•~7tii:slf ~'f~ ~ ~U ~ 3 ,.. i ~ ~. ~t~.~ ~: ~~~ ~a~~- ,- z~f~- of witness) COMMONWEALTH OF PENNSYLVANIA} } COUNTY OF ~ ~ ~'"~ ~ ~ ~ ~~ ~'~ } We, ~ .~ ;lc,'y 1-~, ~1~~ -~~1 ,and ~~.~; -~~r ~ it ~r~cl o,--~, i~,~ being duly sw d hereby declare to the undersigned authority that we witnessed the testatrix, Dorothy J. Adams, sign and execute this document which she declared to be her LAST WILL AND TESTAMENT, and that she did so willingly and voluntarily. We are both competent adults and in sound mind. I, Dorothy J. Adams, as testatrix, being duly sworn, do hereby declare to the undersigned authority, that I willingly and voluntarily signed and executed this document which I declare to be my LAST WILL AND TESTAMENT in the presence of the above named witnesses. I declare that I am a competent adult and under no duress, undue influence or coercion in executing this document. of the testatrix, Dorothy J. Adams) (Signature of witness) of witness) J ~ -- ~ ! I i C •?vh ~o~~,y n~~l;~ ~.._ ~x yy~~~~~~yy K~~ELLYJ NUGIEf3 ~/RDnwM/if~~~~ N1r , ~ fib 11. zoo. _. J ,r ~/ February 26, 2009 ational : . of Marysville One Centre Square • P.O. Box B • Marysville! PA 107053 EPhone: 717-957-2196 • Fax: 717-957-4578 Dissinger &Dissinger 400 South State Rd Marysville Pa 17053 RE: Estate of Dorothy J Adams 8-9-08 Here is the information requested per your letter dated 2-24-09: Checking 300071 Dorothy 1 Adams Open: 10-31-80 Int Rate:.10 DOD Bal: $20,930.18 DOD Int: 3.61 If you require any further information, please feel free to contact us. Sincerely, ~~- Barbara Recher Manager ti h. First National Bank of Marysville 26-6786005 Divi~[on of Riverview Ntl Bank Recipient's ID Number 200 Front Street Mary~vi0e PA 17053 230581420 Payer's Federal ID Number Estate Of Dorothy J Adams SOZ Valley Rosd CALENDAR YEAR 2009 Marysville PA 170530000 Total Interest Income: 52988.12 Redem. Date Series Redem. Value Redem. Interest MAR 12009 E $425.32 $350.32 MAR 12009 E $429.76 $354.76 MAR 12009 E $421.32 $346.32 MAf~ 12009 E $425.32 $350.32 MAR 12009 EE $1,999.60 $1,499.60 MAR / 2009 EE $136.80 $86.80 This is important tax inforntiation and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty may be imposed on you if this income is taxable and the Internal Revenue Service determines that it has not been reported. Cardinal Systems, little Rock. AR 72201 FORM 1099 INT -SUB. Saturday, March 07, 2009 tk S It £!, ' , +~' ~.3~} ..~^"`~ J r+ ,~,.. ~~~ P ~~ ~ • r,}~;~ .~ ~.1~