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Home My WebLink About06-08-0915056041147 RE1/- / 5OO EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 8 0 4 9 5 PO BOX.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 04242008 01151913 Decedent's Last Name Suffix Decedents First Name MI MARTIN RACHEL W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Sortial Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Retum Required (date of death after 12-12-82) ® g, Decedent Dled Testate ^ T Decedent Maintained a Ltving Trust 0 8. Total Number of Safe De sit Boxes (Attach Copy of Will) (Attach Copy of Tnrst) ~ MI ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit date of death 11. Election to tax under Sec. 9113 A between 12J1-91 and -~-9s) ^ (Attach Sch. O) ( ) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number LINDA M. BADMAN 6102655688 Firm Name (If Applicable) tr.a ~_, . REGISTE 1~ILLS UBEbNL1~,,. ~ tom'-~[7 ,~, ~_. ~ ~ ~~ t 7 -~ c ,_ ~ C~ `~ ~D --~ .. w. ~ ,:.. - D~iTE FILED -- ```- ~s _~ '~7 ~. ,, r~~ r""} p.~..i :~ First line of address 347 COVERED BRIDGE ROAD Second line of address City or Post Office State ZIP Code KING OF PRUSSIA PA 19406 Correspondents e-mail address: Under penalties of perjury, I dedare that I have examined this return, including accompanying schedules and statements, and m the best of my knowledge and belief, it is true, and complete Declaration of preparer other than the personal representative is based on all info ~e e ~~ JVI,Ufi, J w( ~--loo--~,~~ Linda M. Bauman r~ - ~ ~. m ADDRESS 347 Covered Bridge Road, King of Prussia, PA 19406 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Linda M. Bauman ADDRESS Side 1 L 15056041147 15056041147 J REV-1500 EX oecedenPs Name: MARTIN RACHEL W . 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ................................................................ 8. 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, of transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable 13 9 , 15 4 . 9 4 at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 , a 19. Tax Due ............................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15056042148 38,484.38 84,633.36 46,200.00 169,317.74 10,748.04 9,308.66 20,056.70 149,261.04 10,106.10 13 9 , 154.94 6,261.97 6,261.97 Side 2 15056042148 15056042148 REV-1500 EX Page 3 File Number 21 - 08 - 0495 Decedent's Complete Address: Martin, Rachel W. STREET ADDRESS 222 Messiah Circle 80W _ .. _ _ _. STATE 'ZIP Mechanicsburg _ PA ~~ 17055 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 6,010.00 290.00 Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE A, Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is theBALANCE DUE Make Check Payable to: REGISTER OF WILLS, AGENT (1) 6,261.97 (2) 6,300.00 (3) 0.00 (4) 38.03 (5) (5A) (5B) ~ . 0 ~ 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 ............................._.........................................................._................. ^ d. receive the promise for life of either payments, benefits or care? ................ _ ~ j_X . ......................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideraGon? ............................................................ -- ................................................... ~1 CI 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 RETUR --__ 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 statutedoes not exemota 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)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. coa+r~oNwen~ni of ~NNSnv~ww iw ieRrrnacE rnx r~s~oErrr oeceo~rt SCHEDULE B STOCKS & BONDS ESTATE OF Martin, RaCF1eI W. FILE NUMBER 21 - 08 - 0495 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 1875 shares Susquehanna Bancshares 20.525 38,484.38 TOTAL (Also enter on line 2, Recapitulation) 38,484.38 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Martin, Rachel W. ILE NUMBER 21 - 08 - 0495 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Certificate of Deposit -Lehman Brothers Bank FSB, Wilmington DE, CUSIP 52519HSN8, held 30,247.50 in PNC Investments Account No. 49286942, including accrued interest of $247.50 2 I Certificate of Deposit -Treasury Bank, Alexandria, VA, CUSIP 89465A2S6, held in PNC I 40,586.67 Investments Account No. 49286942, including accrued interest of $586.67 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 3 ~ Vanguard Prime Money Market Account No. 03114541025 including accrued interest of $5.15 ~ 3,106.99 4 ~ PNC Investors Preferred Account No. 49286942 -cash account ~ 10,021.42 5 ~ PSERS pension for April 1 to April 24 ~ 370.78 6 ~ US Treasury Economic Stimulus payment, paid 5/8/08 ~ 300.00 7 ~ Clothing and personal items in room - no value -- TOTAL (Also enter on Line 5, Recapitulation) 84,633.36 SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & IN RESIDENTDECEDENTRN MISC. NON-PROBATE PROPERTY ESTATE OF Martin, Rachel W. FILE NUMBER 21 - 08 - 0495 Thies scrrauute trtusr Ue completed ahd filed if the answer zo any or ques~fons ~ mrou gn 4 on page 1 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Indude the name of the transferee, their relationship to decedent DATE OF DEATH VALUE OF ASSET % OF DECD'S EXCLUSION TAXABLE VALUE and the date of trensfer. Attach a copy of the deed for real estate. INTEREST (IF APPLICABLE) 1 See attached schedule 46,200.00 100% 46,200.00 TOTAL (Also enter on Tine 7, Recapitulation) 46,200.00 SCHEDULE G TRANSFERS . Estate of Rachel W. Martin, Deceased File No. 21-08-0495 Description Date of Death % of Decedent's Taxable of Property Value of Asset Interest Exclusion Value 1. Cash gifts -Transferee: Marilyn M. Forbes, daughter a. Date of transfer: 09/21/2007 10,000.00 b. Date of transfer: 11/22/2007 3,500.00 c. Date of transfer: 12/22/2007 1,000.00 Total for 2007: 14,500.00 100% 3,000.00 11,500.00 d. Date of transfer: 01/2/2008 3,500.00 Total for 2008: 3,500.00 100% 3,000.00 500.00 2. Cash gifts -Transferee: Charles a. Date of transfer: 11/22/2007 b. Date of transfer: 12/22/2007 Total for 2007: c. Date of transfer: 01/2/2008 Total for 2008: P. Forbes, son-in-law 3,500.00 1,000.00 4,500.00 100% 3,000.00 1,500.00 3,500.00 3,500.00 100% 3,000.00 500.00 3. Cash gifts -Transferee: Linda M. Bauman, daughter a. Date of transfer: 09/21/2007 10,000.00 b. Date of transfer: 11/22/2007 3,500.00 c. Date of transfer: 12/22/2007 1,000.00 Total for 2007: 14,500.00 100% 3,000.00 11,500.00 d. Date of transfer: 01/2/2008 3,500.00 Total for 2008: 3,500.00 100% 3,000.00 500.00 4. Cash gifts -Transferee: David . a. Date of transfer: 11/22/2007 b. Date of transfer: 12/22/2007 Total for 2007: c. Date of transfer: 01/2/2008 Total for 2008: A. Bauman, son-in-law 3,500.00 1,000.00 4,500.00 100% 3,000.00 1,500.00 3,500.00 3,500.00 100% 3,000.00 500.00 SCHEDULE G TRANSFERS Estate of Rachel W. Martin, Deceased File No. 21-08-0495 Description Date of Death % of Decedent's Taxable of Property Value of Asset Interest Exclusion Value 5. Cash gifts -Transferee: Carolyn M. Thomas, daughter a. Date of transfer: 09/21/2007 10,000.00 b. Date of transfer: 11/22/2007 3,500.00 c. Date of transfer: 12/22/2007 _1,000.00 Total for 2007: 14,500.00 100% 3,000.00 11,500.00 d. Date of transfer: 01/2/2008 3,500.00 Total for 2008: 3,500.00 100% 3,000.00 500.00 6. Cash gifts -Transferee: Dwigh a. Date of transfer: 11/22/2007 b. Date of transfer: 12/22/2007 Total for 2007: c. Date of transfer: 01/2/2008 Total for 2008: t W. Thomas, son-in-law 3,500.00 1,000.00 4,500.00 100% 3,000.00 1,500.00 3,500.00 3,500.00 100% 3,000.00 500.00 7. Cash gifts -Transferee: LeRoy B. Walters, son-in-law a. Date of transfer: 12/22/2007 1,000.00 Total for 2007: 1,000.00 100% 3,000.00 0.00 8. Cash gifts -Transferee: Sue M. Walters, son-in-law's wife a. Date of transfer: 12/22/2007 1,000.00 Total for 2007: 1,000.00 100% 3,000.00 0.00 9. Cash gifts -Transferee: Craig P. Forbes, grandson a. Date of transfer: 12/22/2007 150.00 Total for 2007: 150.00 100% 3,000.00 0.00 b. Date of transfer: 03/22/2008 1,000.00 Total for 2008: 1,000.00 100% 3,000.00 0.00 SCHEDULE G TRANSFERS Estate of Rachel W. Martin, Deceased File No. 21-08-0495 Description Date of Death % of Decedent's Taxable of Property Value of Asset Interest Exclusion Value 10. Cash gifts -Transferee: Jay H. Forbes, grandson a. Date of transfer: 12/22/2007 150.00 Total for 2007: 150.00 100% 3,000.00 0.00 b. Date of transfer: 03/22/2008 1,000.00 Total for 2008: 1,000.00 100% 3,000.00 0.00 11. Cash gifts -Transferee: David M. Walters, grandson a. Date of transfer: 11/22/2007 3,500.00 b. Date of transfer: 12/22/2007 100.00 Total for 2007: 3,600.00 100% 3,000.00 600.00 c. Date of transfer: 01/2/2008 3,500.00 d. Date of transfer: 03/22/2008 1,000.00 Total for 2008: 4,500.00 100% 3,000.00 1,500.00 12. Cash gifts -Transferee: Robert A. Walters, grandson a. Date of transfer: 11/22/2007 3,500.00 b. Date of transfer: 12/22/2007 100.00 Total for 2007: 3,600.00 100% 3,000.00 600.00 c. Date of transfer: 01/2/2008 3,500.00 d. Date of transfer: 03/22/2008 1,000.00 Total for 2008: 4,500.00 100% 3,000.00 1,500.00 13. Cash gifts -Transferee: Karin B. Cross, granddaughter a. Date of transfer: 12/22/2007 150.00 Total for 2007: 150.00 100% 3,000.00 0.00 b. Date of transfer: 03/22/2008 .1,000.00 Total for 2008: 1,000.00 100% 3,000.00 0.00 SCHEDULE G TRANSFERS Estate of Rachel W. Martin. Deceased File No. 21-08-0495 Description Date of Death % of Decedent's Taxable of PropertX Value of Asset Interest Exclusion Value 14. Cash gifts -Transferee: Matthew A.M. Thomas, grandson a. Date of transfer: 12/22/2007 Total for 2007: b. Date of transfer: 03/22/2008 c. Date of transfer: 03/22/2008 d. Date of transfer: 03/22/2008 Total for 2008: 100.00 100.00 100% 3,000.00 0.00 1,000.00 1,000.00 150.00 2,150.00 100% 3,000.00 0.00 15. Cash gifts -Transferee: Michael D. Bauman, grandson a. Date of transfer: 12/22/2007 100.00 Total for 2007: 100.00 100% 3,000.00 0.00 b. Date of check*: 03/22/2008 1,000.00 Total for 2008: 1000.00* 100% 3,000.00 0.00 TOTAL TAXABLE VALUE 46,200.00 *lost check replaced 7/19/08 SC~IEDULE H R1N~tAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA ~~~ INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Martin, Rachel W. 21 - 08 - 0495 Debts of decedent must be reported on Schedule 1. ITEM ~--- NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Miller-Sekely Funeral Home -including honoraria for funeral service, flowers, funeral 9,716.33 luncheon and headstone engraving 2 Elizabethtown Brethren in Christ Church -audio services 150.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Stn:et Address City State Zip Year(s) Commission paid 2. Attorney's Fees 3. Family Exemption: (If decedents address is not the same as GaimanYs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 314.00 5. I Accountants Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 PA Inheritance Tax filing fee 15.00 2 Mileage and tolls to probate and to clean out nursing home room for three executrices 464.41 3 Postage and photocopies 88.30 TOTAL (Also enter on line 9, Recapitulation) 10,748.04 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Martin, Rachel W. FILE NUMBER 21 - 08 - 0495 Include unreimbursed medical expenses. -- - ---- - ITEM DESCRIPTION AMOUNT NUMBER -_ 1 PNC Investors Preferred Account No. 49286942 -outstanding checks cleared after the date of 1,528.51 death: check # date cleared amount 1350 4/29/08 150.00 1381 4/28/08 183.60 1388 4/28/08 1000.00 1399 4/25/08 70.12 1400 4/29/08 61.72 1403 5/1 /08 19.87 1404 4/30/08 43.20 2 Messiah Village -balance due 5,498.68 3 Alert Pharmacy -balance due 51.31 4 Michael Bauman -replacement of lost check (see Schedule G) 1,000.00 5 PA Department of Revenue -period of life income tax for 2008 1,133.00 6 Capital Area Health Associates -balance due 97.16 --- TOTAL (Also enter on Line 10, Recapitulation) 9,308.66 REV-1513 EX+ (9.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Martin, Rachel W. SCHEDULE J BENEFICIARIES 7 NUMBER I'I NAME AND ADDRESS OF PERSON(S) _ __ RECEIVING PROPERTY j. TAXABLE DISTRIBUTIONS[inGude outright spousal distributions and transfers under Sec. 5116 (a) (1.2)] 1 2 Marilyn M. Forbes 13408 Bladon Road Phoenix, MD 21131 Linda M. Bauman 347 Covered Bridge Road King of Prussia, PA 19406 FILE NUMBER 21 - 08 - 0495 - --,- __. RELATIONSHIP TO SHARE OF ESTATE I AMOUNT OF ESTATE DECEDENT (Words) ($$$) Do Not Lbt Trusteels) Daughter One-quarter (1/4) share of residuary estate after ITEM FOURTH (C,D & E) distributions Daughter See Continuation Schedule(s) alts hed Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, of One-quarter (1/4) share of residuary estate after ITEM FOURTH (C,D & E) distributions I Rev 1500 cover sheet jj, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 it Elizabethtown Brethren in Christ Church, 996 E. High St., Elizabethtown, PA 17022 j 5,053.05 2 I, Brethren in Christ World Missions, 431 Grantham Road, Grantham, PA 17027-0390 III 5,053.05 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER 10,106.10 REV-1513 EX+ (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Martin, Rachel W. SCHEDULE J BENEFICIARIES continued NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ TAXABLE DISTRIBUTIONS[inGude outright spousal distributions and transfers under Sec. X116 (a) (1.2)] 3 Carolyn M. Thomas 430 N. Spruce Street Elizabethtown, PA 17022 5 6 4 I~ David M. Walters 824 Quince Orchard Blvd #824/T-2 Gaithersburg, MD 20878 Robert A. Walters 2222 Q Street NW, Apt. 32 Washington, DC 20008 Craig P. Forbes 1245 Meadow Sweet Drive Madison, WI 53719 FILE NUMBER 21 - 08 - 0495 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) Do Not Lbt Trustee(s) ----~ __ Daughter Grandchild Grandchild Grandchild 7 ~ Jay H. Forbes 2421 Plainhurst Way Reisterstown, MD 21136 8 Karin B. Cross 23 Landmark Malvern, PA 19355 9 ~ Michael D. Bauman 347 Covered Bridge Road ' King of Prussia, PA 19406 10 Matthew A.M. Thomas 430 N. Spruce Street Elizabethtown, PA 17022 _' Grandchild Grandchild Grandchild Grandchild One-quarter (1/4) share of residuary estate after ITEM FOURTH (C,D & E) distributions One-eighth (1/8) share of residuary estate after ITEM FOURTH (C,D & E) distributions plus $2500.00 cash legacy One-eighth (1/8) share of residuary estate after ITEM FOURTH (C,D & E) distributions plus $2500.00 cash legacy $2000.00 cash I~ legacy $2000.00 cash legacy $2000.00 cash legacy $2500.00 cash legacy $2500.00 cash legacy Page 2 of Schedule J ~-~'~ ~d a ~. v .~ ~10~ ~c~