HomeMy WebLinkAbout06-15-09
REV-1500 EX (D6-D5)
PA Department of Revenue
Bureau of Individual Tazes
PO BOX 280601
Harrisburg, PA 1712&0601
15056051058
OFFICIAL USE ONLY
County Code Year File Number
INHERITANCE TAX RETURN~h ~ ~~ i
RESIDENT DECEDENT 0~ ~ ~ O y
ENTER DECEDENT INFORMATION BELOW
Social Secudry Number Date of Death
_._
182-22-5964 ! 01/14/2009
Decedent's Last Name
SINGER _
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's last Name
Spouse's Social Secunry Number
FILL IN APPROPRIATE OVALS BELOW
~~} 1. Original Reurn
C„W:$ 4. Limited Estate
~:.."7 8. Decedent Dletl Testate
tAnacn l,opy of wwi
Date of Birth
09/04/ 1914
Suffix Decedent's First Name MI
FRANK R ,
Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
C.:.,: 2. Supplemental Return £„ .:i 3. Remainder Return (date of death
prior to 12-13-82)
c®~ 4a. Future Interest Compromise (date of r~ 5. Federal Estate Tax Return Required
death after 12-12-82)
C.:.;:? 7. Decedent Maintained a Living Trust _ 0.. 8. Total Number of Sate Deposit Boxes
(Anacn t,opy of oust)
__..~ 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death ~? 11. Election to tax untler Sec. 9113(A)
between 12-31-91 antl 1-1-95) (Attach Sch. O)
CORRESPONDENT - TNIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONNDENTUL TAX INFORMATION SHOULD BE DIRECTED T
Name
Daytime Telephone Number
.._ - ___ O:
CHARLENE FEUCHTENBERGER
~
(717) 530-2614 _
I
Firm Name (If Applicable) ~ _ __ _~ ,
REGISTER ILLS USE ~Y
~
ORRSTOWN BANK ~
~ `a
r-
c
Fust line of address _. I~S
7
I ;~T L
~ 7
r r
~ ~ ~~~
-
77 EAST KING STREET ~
' x - -
cn _
t~ -"'"~
3
~~
~
Second line of address O p„ ~ ~;
_, _. O`
~
- ..
.'
~
City or Post Office _
_ ~p
State ZIP Code .. _. _ DgiE FILED
__ Ey .1
"i
~
SHIPPENSBURG i IPA ' ' 17257
Correspondent's e-mail address:
Side 1
15056051058 15056051058
J~
Under penalties of perjury, I dedare that 1 Dave ezammed Mis reNm, mcludmg accompanying schedules and statements, and [o the best of my knowledge and belief,
it is true, wrtect and complete. Dedarafion of Dreparer other than the personal moresentafvx in hawf .~,. ~u :~o,..sr...., ..r ,.,.:_r. ,..,...__,-.__ __.. ~.__.,_,__
J
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: FRANK R SINGER 182-22-5964
RECAPITULATION """--"
t. Real estate (Schedule A) . ............... ... ......... .......... 1 _. __._
_ .. ..
2. Stocks and Bonds (Schedule B) ..... ............. ..... ........... 2. ', 108,500.00
3. Closely Held Corporation, Partnership or Sole-Proprtetorship (Schedule C) ..... 3. ''
4. Mortgages 8 Notes Receivable (Schedule D) ............................. 4.
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5
6. Jointly Owned Property (Schedule F) ~,P Separate Billing Requested ....... 6. I
_.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property ` `"""° °'"' `---
(Schedule G) ~ Separate Billing Requested, ....... 7. ',
8. Total Gross Assets (total Lines 1-7) .. ............ ...... ......... g -.... "... _..
9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9.
tC. CcCtc c! Ccccdcrd, "",^,^gayc Licbifticc, & Lice `cdWc' ...... ,,,
c (Ec ~). ......... ..
1,772.55
110,272.55
11,235.38 ,
ti. Total Deductions (total Lines 9 8 10) ................................ ... n. ', 11,235.38 ~'
12. Net Value of Estate (Line 8 minus Line 11) ....... ........ ........ . 12 99,037.17
13. Charitable and Governmental BequestslSec 9113 Trusts for which """~" " '°""' - ---~
an election to tax has not been made (Schedule J) ...................... .. 13. ', 0.00 ',
14. Net Value Subtect to Tax (Lme 72 minus Line t 3) .. .......... ....... 14. 99,037.17
TAX COMPUTATION SEE INSTRUCTIONS FOR APPLICABLE RATES ~__. -" ~ - ~"~~ _,._ ~.__
15. Amount of Line 14 taxable
a[ the spousal tax rate, or
transfers under Sec. 9116 - - --- - --- --- _.
76. Amount of line l4 taxable _ '~~ ~~ -`~" ~ ~""" "- -~-~-~-~- -- __.. _
.~_.."~ ~....~
at lineal rate X .0 _ ', '.. 18. '.
17. Hmounl of Line t4 taxable ~ --~--°-------
at sibling rate X .12 17. ' '..
18. Amount of Line 14 taxable '
at collateral rate X .15 ' 99,037.17 ', t6 14,855.58
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
14,855.58 '
15056052059 Side 2
15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
,_... Fite Nump@r _.
r.
DECEDENT'S NAME ".a s'_°"`' '" `" '"
DECEDENT'S SOCIAL SECURITY NUMBER
FRANK __ R SINGER ____ _ 182-22-5964 _
STREETADDRESS ---- ------~----
1 BRIDGEWATER ROAD
CITY -~- STATE ZIP
NEWVILLE i PA 17241
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicble
D. Interest
E. Penalty
11)
Total Credits (A+g+C) (2)
-- ~ ~ Total InteresUPenalty (D+ E )
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. It 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.
(3)
(4)
(5)
(5A)
(5B)
14,855.58
15,750.00
894.42
Make Check Payable to: REGISTER OF WILLS, AGENT
~,°~~
a~ „~, _ .... ... ~ ,~ v,~,~.. ,
„~ ~€
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 dght to designate who shall use the properly transfened or its income :...................................... ...... ^
c. retain a reversionary interest; oc ........................................._............__.....__.._........................_................. ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^
2. If death occurred aRer December 12, 1982, did decedent transfer property within one vear of death
witlwut receiving adequate mnsiderafien? ..................................................
3. Did decedent own an 'in Wst for' ar 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? .................................................................................................................. ...... ^ Q
IF THE ANSWER 70 ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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) (i.i) (i)].
For dates of death on or after January 1, 1995, the fax rate imposed on ff1e net value of transfers to or for the use of the surviving spouse is zero (O) 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 evenrf 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-0ne 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 benefiaaries 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.
15,000.00
750.00
REV-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDl1LE B
STOCKS 8r BONDS
ESTATE OF FILE NUMBER
SINGER, FRANK R. 2109-0154
All property jointly-owned with dgM o(survfvorship must be discbsed on Schedule F.
ITEM
NI IrsaFa _~..,._.__._.. VALUE AT DATE
~' 4000 SHS. ORRSTOWN FINANCIAL SERVICES COMMON STOCK, CUSIP 687380105;
HIlLO AVERAGE AT DOD
108,500.00
TOTAL (Also enter on line 2, Recapitulation) $ 108,500.00
(If more space is needed, insert adtlitional sheets of the same sae)
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14~ .Enter Symbol: ORRF Enter C
Orrstown Finl Svcs Inc
Wednesday. JanUa~y ;4.2009
ClOSing Price. 27.U0
open: 27.50
nigh: 27.50
I.Ow
26.75
Volume
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REV-1508 EX~ (8-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
SINGER, FRANK R. 2109-0154
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointtyowned wHh right of survivorship must he diseloeM nn s~h.n~a. r
pi nrore space is neetleq msen atltldronal Sheets 0f Me Same Slie)
Da{s~
Opened: 01/09/09 -.Term: 120 Months
Certificate of Deposit
Amount of
DeposiC One thousand seven hundred seventy two 4 55/100
Tax
Ip; _182=22_5964 Nwnber: _ 4000030728
Account Number: 4 00003 072 8
This Time Deposit is Issued [o: Issuer:
Frank R Singer
Irrevocable Burial Fund
`; Fogelsanger Bricker Funeral Home Inc.
P O Box 336
Shippensburg PA 17257
Not Negotiable -Not Transferable -Additional terms are below.
$_ 1,772.55
Orrstown Bank
77 East zing St
Shippensburg, PA 17257
~ ~ i `
By
Heather A Fisher
Additional Terms and Disclosures
This form contains the terms for your time deposit. It is also the
Truth-in-Savings disclosure for those depositors entitled t
Th Minimum Balance Requnemeot: You must make a minimum deposit to
o one.
ere
are additional terms and disclosures nn paee two of chic fnrtn
come of
'
.
wLi.,L cxp:am m e.apmau vu ,Lwe Ociuw. ]'uu should i.ery uue wpy of ?, 000.00
eper. ~Wic ac[ec^: cr?
_. _. - --._-_ --__
'
this form. ~
You must maintain this minimum balance oo a dail
basis to e
h
Maturity Date: This account matures 01/09/19 y
arn t
e
annual percentage yield disclosed.
(See below for renewal information.)
R
I
f 1i'ifbdrawals of Interesk Interest ^ accrued ®credited during a
ate
n
ormation: 7be interest rate for this account is 3 .45 % term can be withdrawn: Any Time After Crediting To
with an annual percentage yield of , 3.51 %. This rate will be The Accotmt During The Current Term
paid until the mamriry date specified above. Interest begins to accrue on Early Withtbawal Penalty: If we consent to a request for a withd
l
the business day you deposit any noocazh item (for example, a check). rawa
that is otherwise not permitted you may have [o
a
a
e
l
Th
Ineerest will be compounded
Monthly p
y
p
na
ty.
e
_
_ .
Interest will be credited p-nd Added Back to the CD penalty will be an amount equal m'
twelve months --
_ Every month
L~`J 1 he annual percentage yteld assumes [hat minces[ remauts on depostt interest on [he amoum withdrawn,
Keoewai Pohcy:
until mamriry. A withdrawal of interest will reduce earnings. ^ Si
^ If you close your account before inte
t i
di
d ngle Maturity: If checked, this account will not aummatically
res
s cre
te
, you will not
receive dte accrued interest renew. Interest ^ wdl ^ will not accrue afrer mamriry.
.
' Q Aulotnatic Renewal: !f checked, this account will automatically
t he NUMfSLH UN
LNDURSEMEN'1'S needed for wtthdrawal or any
h
1 renew on the mammy date. (see page two for terms)
ot
er purpose is: (merest Q will ^ will not accrue afrer final mamriry.
ACCOUNT OWNERSHIP: You have requested
and intend the type of accuu:.; marked belo•.v.
® Individual
^ Join[ Account -With Survivorship i,~'",,,°~`,u,(`°"
^ Joint Account - No Survivorship w=~~ ~m..~",a,i
^ Trusn Separate Agreement Dated
LJ Revocable Trust Designation as defined in this
agreement (Beneficiaries' names and addresses)
X
X
BACKUP WITHHOLDING CERTTFICATIONS
TIN: 132 ~22 5364
® Taxpayer LD. Number -The Taxpayer ^ Exempt Recipients - I am an exempt
Identification Number shown above (TiN) is recipient under the lntemal Revenue Service
my correct taxpayer identification number. Regulations.
® Backup Wkhholding _ I am not subject A Provision for my signature, certifying
to backup withholding either because I have under penalty of perjury dre statements
not been notified that I am subject to. backup checked io this section and that I am a U.S.
withholding as a result of a (allure to report person (iodudivg a U.S. resident alien , is
all interest or dividends, or the internal contained on the first copy of this
Revenue Service has notified me that i am no cer~cate.
longer subject to backup withholding.
ll ENDORSEMENTS -SIGN ONLY WNEN YOU REQUEST WITHDRAWAL
REV-1511 EXa (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDEM
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FlLE NUMBER
SINGER, FRANK R. 2109-0154
Debts of decedent must be reported on Schedule I.
ITEM _
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' FOGELSANGER-BRICKER FUNERAL HOME, INC
7,332.50
B. I ADMINISTRATIVE COSTS:
i. Personal Representative's Commissions
collie cl Feiswmi nepreaenbGve(a) ORRSTOWN SANK, AGE~IT FOP, EXECUTOR
Social Secudry Number(sIlE1N Number of Personal Representative(s) 23 0934350
Street Address 77 EAST KING STREET
City SHIPPENSBURG .State PA Zp 17257
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (if decedent's address is not the same as Gaimant's, anach explanation)
Claimant
Street Address
Cny Stale .Zip
Relationship of Claimant b Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Rehm Preparer's Fees
z. ADVERTISING LETTERS TESTAMENTARY
e ORRSTOWN BANK, LOAN DOCUMENT FEE
s ORRSTOWN BANK, INTERESTON SHORT TERM LOAN
TOTAL (Also enter on line 9, Recapitulation) ~ $
3,255.00
302.00
2sz.sa
50.00
33.34
11,235.38 '
(M more space is neetled, insen arl?tlonal sheeLS oY1Ee same size)
REV-1513 EX+ (I]-08)
Pennsylvania
DEPARTMENT OF REVENUE
INMERrigNCF TAM RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SINGER, FRANK R.
2109-0154
NUMBER NAME AND ADDRESS OF PERSONS RECENING PROPERTY RElAT10NSH1P TO DKEDENi AMOUNT OR SHARE
(1 Do NM List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).1
1. 'LARRY A.STROUSE/MELEAA.STROUSE FRIENDS 100°/DRESIDUE
1 BRIDGEWATER ROAD, NEWVILLE, PA 17241
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TA%ABIE DISTRIBUTIONS:
A.. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECRON TO TAX IS NOT TAKEN
1_ ,
B. CHARRABLE AND GOVERNMEMAL DISTRIBUTIONS
L
TOTAL.OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET.
SCHEDULE ]
BENEFICIARIES
IF more space is needed, insert additional sheets of the same size.
Rx Oatei~im? rte-~~~-~UL'yt mUNJ 'a~i~
r wr
FeE. 2~ 209 2:33?M Law 0#!i~e fores(N Mvers No2896 P. 2
v-^e-.,,¢., ..~,oc...'.Y f .n'.,>~. i ~. , .. -. ~, a,.,..~. vul,r ^, '.' 07 q.J~aly05, tl•v:
"~` ~a~t ~til[ attb ~Ce~tament "~`
I, FRANK R SINGER, of North Newton Township, Cumberland County, Pennsylvania,
revoke my prior wills and declare this to be my Last Will:
FIRST: PAYMENT OF EXPENSES - I direct that the expense of my last illness and funeral be
paid from my estate as soon as may conveniently be done.
SECOND; BEQUEST - I give, devise and bequeath my estate, real or personal, tangible or
intangible, together with all insurance policies thereon unto LARRY A STROUSE and MELBA A
STROUSE, or the survivor of them, provided they shall survive me by thirty (30) days.
THIRD: RESIDUE OF ESTATE - I give, devise and bequeath all the rest, residue and remainder
cf trey estatE un;c L,1RRY ~, $TROU~E and MELBA A ~?RC:,'Sr, Cr the sun^vCr of ;h
.. Cm,
provided they shall survive me by thirty (30) days.
FOURTH: PROTECTIVE PROVISION - To the greatest extent permitted by law, before actual
payment to a beneficiary, no interest in income or principal shall be (i) assignable to a
beneficiary or (ii) available to anyone having a claim against a beneficiary.
FIFTH: DEATH TAXES -All federal, estate and other death ,axes payable on the property
forming my gross estate, whether or not it passes under this will, shall be paid out of the
principal of my probate estate just as if they were my debts, and none o(those taxes shall be
charged against any beneficiary. This provision shall not apply to any property over which I
have a general power of appointment of federal estate tax purposes.
SIXTH: MANAGEME~\'T PROVISIONS - I authorize ~~~y Executor, as follows
A. Retain/Ingest: To retain and to invest in all forms of real estate and personal
property, Including common trust funds, mutual funds and money market deposit
accounts and certificates of deposit, regardless of any limitations imposed by law on
investments by executors or any principle o! law concerning investment diversification;
B. Compromise: To compromise claims and to abandon any property which, in my
Executor's opinion, is of little or no value;
C. Borrows To borrow from and to sell property to others, and to pledge property as
security for repayment of any funds borrowed;
D. Sell/Lease: 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 of leases;
Kx ua[eiirme ~t~-~c-ruc~tMUN~ ~u F~
Feb 2. 2009 2~~34PM~ yaw 0!!ioe Fa~est N Mvers ~ ~~~
No 2895 P. 3
~I ..h ^~Il~r ~: .'.1~.~S~N~(IY rx r:~.l. ~:( tl
+'o ~~r-•.~VOal fS.rO-67;L 1.'F, doe
E. Capital Changes: To join in any merger, reorganization, voting-trust plan or other
concerted action of security holders, and to delegate discretionary duties with respect
thereto;
F. Distribute: To distribute in kind and to allocate specific assets among the
beneficiaries (including any custodian hereunder) in such proportions as my Trustee
may think hest, so long as the total market value of any beneficiary's share is not
affected by such aHoca!ion.
These authorities shall extend to all property at any time held by my Executor or my
Trustee and shall continue in full force until the actual distribution of all such property.
All powers, authorities and discretion granted by this Will shall be in addition *.o those
granted by law and shall be exercisable without court authorization.
SEVENTH: EXECUTOR - I appoint LARRY A STROUSE, Executor of my Will. In the event of
the death, resignation, renunciation or inability of LARRY A STROUSE to act as Executor, I
appoint MELBA A STROUSE, Executors of this, my Will. Neither my Executor, nor any
successor shall be required to give bond.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this Z5h'day of JULY, 2D05.
7S~ a l/~1 Pl ISEAU
FRANK R SINGE ,Testator
In our presence, the above-named Testator signed this and declared it to be his will, and now,
at his request and in his presence and in the presence of each other, we sign as witnesses:
Nx Uate/'.:me rtn-U~-[uUy;nurvt I~._n
r uu~
Feb' 2 2009 2~34PN Law Office Forest N Mvars No.2896 P. 4
1 ]IT/(~:'1 f ~.hXY°o~. J r:...,, f -..rr..nr r ::. .....n , \,I V'iii'R 111 a)J11..)..4:: "J.e,>:
STATE OF PENNSYLVANIA
COUNTY OF FRANKLIN
SS
I, FRANK R SINGER, having been duty qualified according to law, acknowledge that I
signed the foregoing instrument as my Will, and that I signed it as my free and voluntary act for the
purposes thereinexpressed.
~n n~.h ~10.~2~Lt)',c'a.
FRANK R SINGER, Tester
We, FRANK R SINGER, the Testator in and the undersigned witnesses to the Will, the
attached or foregoing instrument, who have signed the instrument, having been qualified according
to law do depose and say:
(a) that I, the Testator, do hereby acknowledge that I signed the instrumem as my Will, that
I signed it willingly and as my free and voluntary act for the purposes therein expressed;
~rrd
(b) that we, the witnesses, were present and saw the Testator sign and execute the
instrument as his Will, that he signed it willingly and executed it as his free and voluntary
act for the purposes therein expressed; that each of us in the hearing and sight of the
Testator signed the Will as witnesses and that to the hest of our knowledge, the Testator was
at that time eighteen or more years of age, of sound mind and under no constraint or undue
influence.
Subscribed, sworn to or affirmed,
and acknowledged before me by the
above-named Testator and by the
witnesses whose names appear on
this t~day of JULY, 2005.
~-
Notary blic
NOTARIAL SF1,L
FOREST N. MYERS, NOTARY pUF1LIC
SHIPPENSBUNG BOflOUGH,000NTY OF fNANNUN
MY COMMISSION D(PIRFS OECEMBE'q } 7, 2005
~ ~ n ,~,7
FRANK R SINGER, Testat~