HomeMy WebLinkAbout07-07-09 (2)J 7,5056041,1,14
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box 2sosol , r ,
Harrisburg, PA 17128-osol RESIDENT DECEDENT ~ ~ ~~ ` ~ Ci~~`i~`
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
174-05-1334 01152009 08091917
Decedent's Last Name Suffix Decedent's First Name MI
KELLER DORCAS M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
0 L Original Return
4. Limited Estate
0 6. Decedent Died Testate
(Attach Copy of Will)
[~ 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
0 2. Supplemental Return
0 4a. Future Interest Compromise (date of
death after 12-12-82)
0 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12.13-82)
5. Federal Estate Tax Return Required
0 8. Total Number of Safe Deposit Boxes
0 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
STEPHEN D. TILEY 7172435838
Firm Name (If Applicable) REGISTER OF WILLS USE ONLY
FREY AND TILEY ,-,,
~r~ -E,.
,.~
First line of address ~ ~, . T ~:
(y ~ c_... _ 1.
5 SOUTH HANOVER STREET ~~ ~ ::}
Second line of address :;. ! ~y r~ t , ~ ,t :'' r
City or Post Office
CARLISLE
~ _..
s ~
DA ~ ~ ,, , .. j - ~
State ZIP Code
CiC:. ~ ~. r-:.,
PA 17013 =D~
~
~ ~:~` -;,
. Ca
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, correct and com fete. Declaration of arer other than the ersonal re resentative is based on all information of which re arer has an knowled e.
SIGNATURE OF S BLE FO~} FILING RETURN DATE
__ ~ "'.d' . . ~/a .s/ 7 / ~ CJ
EARL R. KELLER, 46 TUNBRIDGE LANE, CARLISLE, PA 17013
SIG U REPAR R OTH~.,R THAN REPRESENTATIVE DATE
l ~ ~, '~ ~; ~ ~-
ADDRES
STEPHEN D. TILEY, S SOUTH HANOVER STREET, CARLISLE, P 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
`„~ 150560411,14 1,5056041,],14
J
REV-1500 EX
15056042115
Decedent's Social Security Number
oecedent'sName: DORCAS M KELLER 174-05-1334
RECAPITULATION
1. Real estate (Schedule A) ........................................... 1. NONE
2. Stocks and Bonds (Schedule B) ...................................... 2. 12 3 3 . 7 6
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE
4. Mortgages & Notes Receivable (Schedule D) ............................ 4. NONE
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 3 8 7 7 1.62
6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... . 6. NONE
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) OSeparate Billing Requested ....... . 7 NONE
8. Total Gross Assets (total Lines 1-7) ................................. . 8. 4 O 0 0 5. 3 8
9. Funeral Expenses & Administrative Costs (Schedule H) .................. .. 9. 13 3 0 6 . 2 6
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. . 10. 9 3 3 . 0 3
11. Total Deductions (total Lines 9 & 10) ................................ . 11. 14 2 3 9 . 2 9
12. Net Value of Estate (Line 8 minus Line 11) ........................... .. 12. 2 5 7 6 6 . 0 9
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .................... . . . 13. 0 , 0 0
14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... . 14. 2 5 7 6 6 . 0 9
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 0 1 5. O. O O
16. Amount of Line 14 taxable
at lineal rate X .0 4 5 16. 0. 0 0
17. Amount of Line 14
taxable at sibling rate x - 12 $17 , 17 7 . 3 9
17,
2 0 61.0 0
18. Amount of Line 14 taxable
at collateral rate x. 15 $ 8, 5 8 8. 7 0 18. 12 8 8. 0 0
19. TAX DUE .......................................................19.
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
3349.00
0
L 15056042115 15056042115
REV-1500 EX Page 3 174-05-1334
Decedent's Complete Address:
File Number
21-09-00065
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
DORCAS M KELLER 174-05-1334
STREET ADDRESS
801 NORTH HANOVER STREET
CITY
CARLISLE STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments $3,000.00
C. Discount $157.89
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(1) 3349.00
Total Credits (A + B + C) (2)
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)
3157.89
0.00
0.00
191.11
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 191.11
Make Check Payable fo: REGISTER OF W/LLS, 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 : ................ ~ ~X
c. retain a reversionary interest; or ..................................................... . ~ ^X
d. receive the promise for life of either payments, benefits or care? ............................ . ~ ^X
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? .. ~ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................................................... ~ ~X
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.
zn
REV-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Keller Dorcas M. 21-09-00065
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 44 shares Metlife common stock at $28.04 per share.
See Exhibit "A" attached $1,233.76
TOTAL (Also enter on line 2, Reca
(If more space is needed, insert additional sheets of the same size)
z1 ~
REV-15o8EX+(6-98) SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COM NDHERTANCECTAXRETURNANIA PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Keller Dorcas M. 21-09-00065
Include the proceeds of litigation and the date the proceeds were received by the estate.
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS _
ESTATE OF FILE NUMBER
Keller, Dorcas M. 21-09-00065
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION annul tNT
A.
B
1
1
2
3
4.
5.
6.
7.
FUNERALEXPENSES~
Hoffman-Roth Funeral Home
JlINISTRATIVE COSTS:
Persona{ Representative's Commissions
Name of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State
Attorney Fees Frey and Tiley
Family Exemption: (1f decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees Frey and Tiley
Tax Reiurn PreparePs Fees Frey and Tiley
Short Certificates
Zip
Zip
$10,673.26
$2,500.00
$125.00
$0.00
0
$8.00
TOTAL (Also enter on line 9, Recapitulation) ~ $ 1
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ ~ 12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
Keller Dorcas M. 21-09-00065
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
REV-1513 EX+ (11-OS)
pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE ~ BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Keller. Dorcas M
FILE NUMBER
~ ~ nn nnnc c
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. 2116 (a) (1.2).]
Lois A. Davis Niece 1/12th share
84 Winchester Gardens, Carlisle, PA 17013
2. Doris A. Fraker Niece 1/12th share
1341 Georgetown Circle, Carlisle, PA 17013
3. William Paul Keller Nephew 1/6th share
1 Meadowview Drive, Carlisle, PA 17013
4, Minnie K. Knouse Sister 1/6th share
205 Todd Circle, Carlisle, PA 17013
5. Emma K. McBride Sister 1/6th share
1913 Esther Drive, Carlisle, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ O
If more space is needed, insert additional sheets of the same size.
SCHEDULE J
BENEFICIARIES
(Continued)
A. Taxable Bequests: Relationship
g. Lillian K. Hocker sister
825 N. Hanover St., Apt. 203
Carlisle, PA 17013
7. Earl R. Keller brother
46Tunbridge Lane
Carlisle, PA 17015
Amount
share of esta
1{6th
1/6th
LAST WILL AND TESTAMENT
OF
DORCAS M. KELLER
I, Dorcas M. Keller, of North Middleton Township (801 North Hanover Street),
Cumberland County, Pennsylvania 17013, being of sound and disposing mind, memory
and understanding, do hereby make, publish and declare this as and for my Last Wilf
and Testament, hereby revoking and making void any and all Wills and Codicils
heretofore made.
FIRST
1 direct the payment of my just debts and funeral expenses as soon after my
death as may be convenient.
I direct that all federal and Pennsylvania estate taxes, Pennsylvania inheritance
taxes, and generation-skipping transfer tax payable as a result of my death, not limited
to taxes attributable to property passing under this Will, shall be paid by my Executor
from my residuary estate, including any part of my residuary estate that otherwise
qualifies for a deduction for federal estate tax purposes. I direct my Executor not to
seek reimbursement for any tax so paid from any beneficiary under this Will, heir of
mine, or other transferee of property included,in my gross estate.
SECOND
f declare that I am unmarried and that I have no children.
THIRD
All the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, l give, devise and bequeath as follows:
(a) One-sixth (1/6) to be divided equally between Lois Davis and Doris Fraker,
daughters of my sister, Hilda K. Arnold.
(b) One-sixth (1/6) to the son of my brother, H. Paul Keller, to wit: my nephew
William Paul Keller.
(c) One-sixth (1/6) to my sister, Minnie K. Knouse:
(d) One-sixth (1/6) to my sister, Emma K. McBride.
(e) One-sixth (1/6) to my sister, Lillian K. Rocker.
(f) One-sixth (1/6) to my brother, Earl R. Keller.
I direct that the share of any brother or sister or niece or nephew who predeceases me
shall be distributed to his or her issue, per stirpes. I have made no provision for my
sister, Hilda K. Arnold, not out of any less lover for her, but rather because of her
current circumstances. In the event any such brother or sister or niece or nephew
should predecease me without leaving issue, that share shall lapse and be added to the
other shares.
A
Lnst Wil! and Testament of Dorcas M. K¢ller Page 1 of 3
FOURTH
!, ~ I hereby nominate, constitute and appoint my said brother, Earl R. Keller, as
Executor of this my Last Will and Testament. In the event of the renunciation, death,
resignation or inability to act for any reason whatsoever of my said brother, I nominate,
constitute and appoint my nephew, Jay W. McBride, Jr., as Executor of this my Last Will
and Testament. I further direct that no bond or other security shall be required of any
Executor or Executrix appointed in this Will for the performance of his, her or its duties
in any jurisdiction in which he, she or it may be called upon to act. The terms Executor
or Executrix may be used interchangeably in this Will and shall refer to any Executor or
Executrix appointed in this will, or any other Administrator appointed by a court of
~~ competent jurisdiction.
FIFTH
In addition to, and not in limitation of, the powers conferred by law or by other
provisions of this Will, my Executor shall have the following powers, each of which may
be exercised from time to time by my Executor in his sole discretion:
i-
~,
`' ! (a) To retain in the form received, and to sell either at public or private
sale, or to distribute in kind, any real or personal property.
E':
I (b) To manage both real and personal property.
(c) To invest and reinvest in all forms of property, notwithstanding the
fact that any or all of the investments made are of a character or size
which but for this expressed authority would not be considered
- a proper for an Executor.
(d) To exercise any option or rights arising from the ownership of
~,
~1 IVe$tFliel~l$..
E '' (e) To compromise claims without court approval and without the
consent of any beneficiary.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last
Will and Testament, written on three (3) pages (including notary page), this 18th day of
September, 2006.
ya,
°~zwr ~ 1 ,C~ (SEAL),
Dorcas M. Keller
Signed, sealed, published, and declared by Dorcas M. Keller the Testatrix above
named, as and for her Last Will and Testament, in our presence, who, in her presence,
at her request, and in the presence of each other, have hereunto subscribed our names
as attesting witnesses.
-~;
>~
i
i Lasl Will and Testament of Dorcas M. Keller Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF CUMBERLAND )
We, Dorcas M. Keller, the Testatrix in, and --~~~~~~' ,= %-'~~
and /y,,~/ ~• 6~e~~ ,the witnesses, to the Last Will and
Testament, the attached or foregoing instrument, who have signed the instrument,
having been duly qualified according to law do depose and say:
a. that I, the Testatrix, do hereby acknowledge that I signed and executed
the instrument as my Last Will and Testament, that I signed it willingly and
as my free and voluntary act for the purposes therein expressed; and
that we, the witnesses, were present and saw the Testatrix sign and
execute the instrument as her Last Will and Testament, that she signed it
willingly and executed it as her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testatrix
signed the Last Will and Testament as a witness and that to the best of
our knowledge the Testatrix was at that time eighteen (18) or more years
of age, of sound mind and under no constraint or undue influence.
~~9-0~~ `~rJ,~'~
Dorcas M. Ke!!er
'o -~<
/7 CL_~
Subscribed, sworn to and acknowledged before me by the Testatrix and the
witnesses above-named, this 18th day of September, 2006.
Notary Public
NOTARlA1 SEAL
ROBERTG FREY NOTARY PUBLIC
®0~9h ~ Carlisle CumbeAand County PA
My commission Expires June 4 2010
+'. _: ,
Last Will and Testament of Dorcas M. Keller page j of 3
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QUANTITY ITEM DESCRIPTION I TEMS BROUGHT AFTER ADMISSIO N
AFGHANGr~,,,5 ,~je/ DESCRIPTION OF ITEM DATE SIGNATURE
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RAZOR DONATED R STORED DATE SIGNATURE
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LEVEL OF CARE CHANGE
RESIDENT
RESPONSIBLE PARTY
STAFF
FINAL INVENTORY
RESIDENT SIGNATURE-
~
EXECUTOR/RESP. PARTY
~
_
~
INVENTORY TAKEN BY
~cti GUu-c l~
~
ADMISSION
RESIDENT SIGN.
RESPONSIBLE PARTY
INVENTORY TAKEN BY SOCIAL WORKER SIGN.
ORIGINAL INVENTORY LEVEL OF CARE CHANGE FINAL INVENTORY
DATE DATE % /S-v~ DATE
he lie ~ IJaVec1S
CHURCH OF GOD NOME, INC
INVENTORY OF PERSONAL EFFECTS
0~ G6~@f
ORRSTOWN
s~
A Tradition of Excellence
June 16, 2009
To: Frey & Tiley
5 South Hanover Street
Carlisle PA 17013
From: Traci Yohe
Orrstown Bank
Customer Service Center
PO BOX 250
Shippensburg, Pa 17257
Re: Estate of Dorcas M Keller
Date of death January 15, 2009
IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE
ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account # Title of Account Date opened Principal Accrued Interest
106003914 Dorcas M Keller 07/19/05 37,332.85 0.00
Earl R Keller
SA VINGS ACCOUNT
Account # Title of Account Date opened Principal Accrued Interest
CERTIFICATE OF DEPOSIT
Account # Title of Account Date Opened Principal Accrued Interest
~~
P.O. Box 250 •Shippensburg, PA 17257 • 717.530.3530 • 717.532.4143 fax