HomeMy WebLinkAbout06-03-09M1
J 15056051047
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN '`
Harrisburg, PA 17128-osol RESIDENT DECEDENT 2 1 0 9 0 0 2 8 6
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 8 2 4 0 2 4 8 0 3 1 9 2 0.0 9 0 7 0' 1 1 9 3 3
Decedent's Last Name Suffix Decedent's First Name MI
F I S H E L DOROTHY L
(If 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
F
I IN APPROPRIATE OVALS BELOW
~
1. Original Return ~y 2. Supplemental Return C 3. Remainder Retum (date of death
" prior 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
(Attach Co
of Will 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
py
) (Attach Copy of Trust)
9. Litigation Proceeds Received C`? 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 ANO CONFIDENTIAL TAX INFOR
Name MATION SHOULD BE DIRECTED TO:
Daytime Telephone Number
KEITH 0. BRENNE MAN ESQUIRE '
7 17 697 852 8 rra
Firm Name If A licable 4"''
--~
r
REC4STEli ~`~-S LtSE O?~!` -;
SNELBAKER & BR ENNEMAN PC ~
-
First line of address ,, c
t= n :.i:: , ',
~~
rTt i '
44 WEST MAIN ST
REET ,
f~ ;;, _ ,
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Second line of address _ _.
I ~ `- J ~--~ ~ ~ ` i
City or Post Office
State ZIP Code r~ ..
.........- D FliEra ~-~-
M E C H A N I G S B U R G P A 1 7: 0 5 5
Correspondent's a-mail address:
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, corcect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
~GNATURE OF PERSON RESPQNSIBLE FOR FILING RET ,,...~
~_ Executrix 4/~
. _~..~.,.. _-------r----~--~----_..._.__
1059 F Allendale Road, Mechanicsburg, PA 17055
SIGNATU[r2~F R PARER OTHER THAN REPRESENTATIVE DATE
ADDRES//S ~ 3 ~?
44 West Main Street, Mechanicsburg, PA 17055
15056051047
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051047
J
15056052048
REV-1500 EX
Decedent's Social Security Number
Decedents Name: Dorothy L. Fishel 2 0 8 2 4 0 2 4 8
RECAPITULATION
1. Real estate (Schedule A) ............................................. L
2. Stocks and Bonds (Schedule 8) ....................................... 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. •
1 7 7, 6 1 2 •9 9
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ... .... 6.
•
7. Inter-wos Transfers & Miscellaneous Non-Probate Property
(Schedule G) C.7 Separate Billing Requested.... .... 7. 1 2 6, ~ 6 $ . 1 4
8. Total Gross Assets (total Lines 1-7) ................................ .... 8. ; 3 'O 3, 6 $ 1 ! 1 3
9.
Funeral Expenses & Administrative Costs (Schedule H) ........
9 a~~
......... ....
. 4 , 6 Q 8 • 0 0
10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) ............ .... 10. 2 6 ' 8 8
• 2
11. Total Deductions (total Lines 9 & 10) ............................... .... 11. 4,' 8 7 6 .8 2
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 Sub'ect to Tax Line 12 minus Line 13
~ ( ) ....................
.... 14.
2 9 8,
8 '0 •
4 .3
1
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 .o _ 2 9 8 8 0 4. 3 1 16. 1 3, 4 4 6 .1 9
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. 1 '3,' 4 -4 6 ;'1 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ;
Side 2
15056052048 15056052048 J
REV-1500 EX Page 3
Decedent's Complete Address:
FIIeNumber 21_09-00286
DECEDENT'S NAME
Doroth L. Fishel
STREET ADDRESS
1061 F Allendale Drive
ciTY Mechanicsburg STATE PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit _
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
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 the OVERPAYMENT.
Fill in oval 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.
(1) 14,446.19
(2) 722.31
(3)
(4)
(5) 13, 723.88
(5A)
(5g) 13, 723.88
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 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? ....................................
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)J. 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.
REV-1508 EX+ (6_g8~
CDMMONVVEALTfi OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
CJIHIt Ur
Dorothy L. Fishel
Include the proceeds of litigation and the date the proceeds were received by the estate.
Afl property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. Members 1st Federal Credit Union, savings account
No. 315279-00
2. Members 1st Federal Credit Union, Certificate of Deposit
No. 315 279-40
3. PNC Bank, Certificate of Deposit No. 21001012221
4. PNC Bank, checking account No. 5004754531
5. Miscellaneous personal property and furnishings
6. IRS 2009 personal income tax refund
7. United America Insurance refund
8. AGIA, Inc, cancer insurance refund
9. Verizon telephone refund
10. Part D insurance refund
11. Comcast refund
12. Apartment security and pet deposit refund
13. American Recovery and REinvestment Act one-time payment
FILE NUMBER
21-09-00286
AT DATE
$ 20.00
83,596.06
62,005.55
28,335.30
250.00
242.00
1,769.79
43.31
14.64
381.60
22.74
682.00
250.00
TOTAL {Also enter on line 5, Reoaoitulationl S ~ 177 , 612.99
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (e-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
es7a7e of FILE NUMBER
Dorothy L. Fishel 21-09-00286
I ms scneoule must oe completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is ves.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THETRANSFEREE, THEIR RELATIONSHIPTO DECEDENT AND
THE DATE OF TRANSFER.ATTACHACDPYOFTHEDEEDFDRREALESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
INTEREST
EXCLUSION
(IFAPPLICABLE)
TAXABLE
VALUE
~~ PNC Bank, IRA account No. 65001005892, $8,815.34 100
-0-
$8
815
3
Beneficiaries: Diana L. Olson and Robin L. ,
.
Pechart, daughters of Decedent
PNC Annuity account No. 100 -0-
Beneficiaries: Diana L. Olson, daughter of
Decedent and Robert L. Pechart, grandson of
Decedent
TOTAL (Also enter on line 7 Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
t51Alt ur FILE NUMBER
Dorothy L, Fishel 21-09-00286
Debts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
t.
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
waived
State Zip
2• AttomeyFees to Snelbaker & Brenneman, P. C. 3,000.00
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 to Re ister of Wills ($99.00} ; additional probate
fee (215.00) 314.00
5• Accountant's Fees and tax preparer's fees 500.00
s. ~cFi~~~~ Reserve for miscellaneous probate expenses 500.00
~• Advertise grant of letters
a, Cumberland Law Journal $ 75.00
b. The Sentinel 219.40
Total: 294.50
TOTAL (Also enter on line 9, Recapitulation) $ 4 , 608.00
(If more space is needed, insert additional sheets of the same size
REV-i5i2. EX+ (12-08`
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dorothy L. Fishel 21-09-00286
Report debts incurred by the decedent prior to death that remained unpaid at the date of death_ In~I~~dI,.,, ~~~.aL..ti...~ea __~:__~ __.______
~~ uwre space is neeaea, mserl aaaiaonai sheets DF the same size.
REV-1513 EX+ (11-OB)
:~~. Pennsylvania SCHEDULE ~
~! DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
tJIAIt or FILE NUMBER
Dorothy i,_ F;ehcl ~i_na_nn~Qti
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY REDoTNat List T~ustee(s~NT AMOOF ESTATE ARE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Diana L. Olson Daughter 50~ of residue
1059 F Allendale Road
Mechanicsburg, PA 17055
2. Robin L. Pechart Daughter 50~ of residue
1264 West Lisburn Road
Mechanicsburg, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 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. $
~~ more space is neeaea, insert atlditional sheets of the same size.
LAST WILL AND TESTAMENT
OF
DOROTHY L. FISHEL
I, DOROTHY L. FISHEL, of Upper Allen To~mship, Cumberland County, Pennsylvania,
of sound and disposing mind, memory and understanding, do hereby make, publish and
re this as and for my Last Will and Testament, hereby revoking and making void any and all
by me at any time heretofore made.
1. I direct that all my debts and fitnera] expenses be paid as soon as practical after my
by my Executrix hereinafter named.
I direct that all taxes that may he assessed as a consequence of my death shall be paid
my residuary estate as part of the expenses of the administration of my estate.
2. All the rest, residue and remainder of my estate, real, personal and mixed, and
the same may be situate, I give, devise and bequeath as follows:
A. I give to fifty percentum (50%) thereof to my daughter, DIANA LYNN
OLSON;
B. I give fifty percentum (50%) thereof to my daughter, ROBIN LEEANN PECHART.
If either of my daughters above named shall predecease me, I give the share of my
that she would have received hereunder to her issue surviving me, per stirpes.
3. I hereby nominate, constitute and appoint my daughter, DIANA LYNN OLSON, as
trix of this my Last Will and Testament. I fiu•ther direct that my Executrix shall not be
;d to post pond to secure the faithful performance of her duties in the Commonwealth of
or in any other jurisdiction.
5. It is my expressed request and direction that my Executrix employ the legal services of
0. Brenneman, Esquire of Mechanicsburg, Pemisylvania, in the administration of m}~
I~state, said attorney having an intimate lulowledge of my assets and business affairs as well as
LAW OFFICES
SNE LBAKER 8c ^
BRENNEMAN. P.C.
intentions in the settlement of my estate.
IN WITNESS WI~EREOF, I have Hereunto set my hand and seal to this my Last Will and
written on two (2) pages this 13~' day of August, 2008.
f~~~~s't1~~ f9~~ ~..~.~'~:~'..-~ ('SEAL)
Dorotl~ iy L. ~'p~hel
Signed, sealed, published and declared by DOROTHY L. FISHEL, the Testatrix above
ed, as and for her Last Will and `testament, in our presence, who, in her presence, at her
est, and in the presence of each other, have hereunto subscribed our names as attesting
esses.
If1 ~I,~•---'~~
(SEAL)
~""~ (SEAL)
LAW OFFlCES
SNE LB AKER SC
BRENNEMAN, P.C.
-2-
TH OF PENNSYLVANIA)
OF CUMBERLAND
foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority
We, DOROTHY L. FISHEL, KEITH O. BRENNEMAN, ESQUIRE and JANE J.
Y, the Testatrix and the witnesses, respectively, whose names are signed to the attached
the Testatrix signed and executed the instrument as her Last Wil] and Testament and that she
signed willingly, and that she executed it as her free and volmrtary act for the purposes
°in expressed, and that each of the witnesses, in the presence and hearing of the Testatrix,
ed the Will as witness and that to the best of his or her knowledge the Testatrix was at that
eighteen years of age or older, of sound mind and under no constraint or undue influence.
SS.
v Testatrix
I~~~
Witness
Witnes
subscribed, sworn to and aclaiowledged before me by DOROTHY L. FISHEL, Testatrix, and
and sworn to before me by KEITH O. BRENNEMAN, ESQUIRE and JANE J.
, witnesses, this 13"' day of August, 2008.
.~ ,..
,._..~. /
Notary Pu lic
LAW OFFICES II
SNELBAKER
BRENNEMAN. P.C. COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Susan L Matraa, Notary Public
Medtanicsburg Barn, Cumberland County
My Commission Expires Nov. 24, 2011
Member, PennSylvanla Association of Natgries
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