The URL can be used to link to this page

Home My WebLink About07-21-09 (2) 1505607121 REV-1500 EX {06-05) PA Department of Revenue Bureau of Individual Taxes Poeox28oso1 County Code Year File Number INHERITANCE TAX RETURN Hamsbu PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 1 4 8 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 1 0 2 6 4 7 7 0 1 1 0 5 2 0 0 8 0 5 2 5 1 9 1 6 Decedent`s Las4 Name Suffix Decedent°s First Name Z E R B Y MI J A N E M {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 FILL IN APPROPRIATE Oi~ALS BELOW 1. Original Return ® 2. Supplemental Return ® 3. Remainder Return (date of death ® 4. Limited Estate ® prior to 12-13-82) 4a. Future Interest Compromise (date of ® 5. Federal Estate Tax Return Required d ® 6. Decedent Died Testate ® eath after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Will) ~ 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) b t . e ween 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD N ame BE DIRECTED T0: Daytime Telephone Number r D A V I D H R A D C L I F F E S Q 7 1 7 ~ .~6 9`3 1 ~8 Firm Name (If Applicable) `._~~ ~ ^: R A D C L I F F L A W ® F F I C E ~ i REGISTER {~ L,~ USE ~?I~+ LY' P C First line of address :' c1=° ~ ~ ~ • .. _ -- "` 1 0 1 1 M U M M A R O A D j _~~_ "" ~ Second line of address ,i-~ ~~ ~ ~ --" -. - -1 ~ S U I T E 2 0 1 ~ City or Post Office L E M O Y N E State ZIP Code DATE FILED P A 1 7 0 4 3 Correspondent°s a-mail address: DHRAD(Ct)IX.NETCOM COM 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, corm and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI(~NATURF /DF PFRSif]Ri occonucm. ~ae~.~4 66 Id`t'Z DR HANOVER PA 173 ADDRESS ~G O 1011 MUMMA RD #20 LEMOYNE PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 .1505607121 1505607121 1505607221 REV-1500 EX Decedent's Social Security Number Decedent's Name: JANE M Z E R B Y 2 1 0 2 6 4 7 7 0 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) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........ 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ 12. .. 13. .. 14. 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 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 1 4 9 6 0 4. 9 2 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17_ 18. Amount of Line 14 taxable at collateral rate X .15 1 0 0 0 0. 0 0 18 19. Tax Due 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 9 8 7, 4 9 1 7 7 0 7 3. 5 5 1 7 8 0 6 1, D 4 1 8 2 4 8, 4 2 2 D 7, 7 0 1 8 4 5 6, 1 2 1 5 9 6 0 4, 9 2 1 5 9 6 0 4, 9 2 o. 0 0 6 7 3 2. 2 2 o. 0 0 1 5 0 0. 0 0 8 2 3 2. 2 2 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME JANE M. ZERBY - -- __ __ -- - __ STREET ADDRESS 5225 WILSON LANE __ CITY _ - --- - _ _ __ MECHANICSBURG Tax Payments and Credits: 1 Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 7 200.00 C. Discount 378.94 3. InteresUPenalty if applicable D. Interest E. Penalty File Number 21 09 0148 - __- . STATE - _ ZIP - PA 17055 (1) 8 232.22 Total Credits (A + B + C) (2) 7, 578.94 Total InteresUPenalty (D + E) (3) 0 00 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) 0 00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 653 28 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 653 28 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APP ROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ^ ^X b. retain the right to designate who shall use the property transferred or its income; .......................... . ^ O c. retain a reversionary interest; or ............................................................................................... . ^ 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? ....................................................................................... ^ O 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................. ............................................................ 0 ^ 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)J. 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. REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MSC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER JANE M. ZERBY 21 09 0148 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. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. OHIO CASUALTY INSURANCE (REFUND) 9.00 2. IPA INCOME TAX REFUND (2008) I 31.00 3. IPA UNCLAIMED PROPERTY ( 88.17 4. ELECTRIC CHAIR 200.00 5. PA TREASURY DEPT 252.71 6. (REFUND -BETHANY HOMES I 406.61 TOTAL (Also enter on line 5, Recapitulation) I $ 9$7 49 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER JANE M. ZERBY 21 09 0148 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIRRELATIONSHIPTODECEDENTAND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IIFAPPUCAELeI VALUE 1. JANE M ZERBY LIVING TRUST, DATED MAY 15, 2000 177,073.55 100. 177,073.55 TOTAL (Also enter on line 7 Recapitulation) ~ $ 177 073 55 (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 JANE M. ZERBY 21 09 0148 Debts of decedent must be reported on Schedule 1. ITEM -- NUMBER _ DESCRIPTION A. B. FUNERAL EXPENSES: 1. MYERS HARNER FUNERAL HOME 2. FUNERAL LUNCHEON 3. REFRESHMENTS 4. ASHLAND CEMETERY (OPENING) 5. GINGRICH MEMORIALS (ENGRAVING) ADMINISTRATIVE COSTS 7. Personal Representative's Commissions Name of Personal Representative (s) JOHN G. ZERBY JR. Street Address 66 UTZ DRIVE City HANOVER State PA 17331 Zip Year(s) Commission Paid: 2009 2. Attorney Fees RADCLIFF LAW OFFICE, P.C. 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 5. ~ Accountant's Fees 6. I Tax Retum Preparer's Fees MICHAEL T. NOEL, CPA 7. REGISTER OF WILLS (FILING FEES) 8. PERSONAL REP'S TRAVEL EXPENSES 9. ELMER MURRY AUCTIONS (COMMISSION ON AUCTION SALES) 10. ACCT MANAGEMENT FEE TOTAL (Also enter on line 9, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) AMOUNT 3,832.00 473.60 69.93 650.00 130.00 5,000.00 7,122.44 228.00 15.00 94.45 508.00 125.00 1 42 REV-1512 EX + (~2-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER JANE M. ZERBY 21 09 0148 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. HOLY SPIRIT HOSPITAL 5.00 2. PERSONAL TAX (2008) 3. CONTINUING CARE RX 4. WEST SHORE COUNTRY CLUB TOTAL (Also enter on line 10, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 11.00 51.66 140.04 207. REV-1513 EX + )g_00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE D JANE M NUMBER I. 1. 2. 3. 4. 5. SCHEDULE J BENEFICIARIES F ZERBY NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] META MCCLEARY 730 CHENANGO AVENUE #6 BINGHAMTON, NY 13901 SUZAN PATAKY 60 WAID STREET GOUVENEUR, NY 13642 MARK DAVIS 5201 AUBURNDALE ROAD CHARLOTTE, NC 28205 FLORENCE A. DAVIS 1501 DALWEN GREEN COURT MATTHEWS, NC 28105 JOHN G. ZERBY, JR. 66 UTZ DRIVE HANOVER, PA 17331 FILE NUMBER 21 09 0148 RELATIONSHIP TO DECEDENT Do Not List Trusteelsl Collateral Lineal Lineal Lineal Lineal AMOUNT OR SHARE OF ESTATE 10, 000.00 5, 000.00 3,500.00 73,277.46 67, 827.46 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART I I -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (It more space is needed, insert additional sheets of the same size) Last Will of JANE M. ZERBY I, JANE M. ZERBY, of Mechanicsburg, Cumberland County, Pennsylvania, make this Will and revoke all of my prior wills and codicils. Articie One My Family I am married and my spouse's name is J. GARDNER ZERBY. All references to "my spouse" in my Will are to him. The names and birth dates of my children are: JOHN G. ZERBY, JR., born October 30, 1939 FLORENCE ANN DAMS, born November 4, 1942 All reverences to my chiiuren in my will are to these children, as well as any children subsequently born to me, or legally adopted by me. ,~. . - - Page 1 Article Two Distribution of My Property Section 1. Pour-Over to My Living Trust All of my property of whatever nature and kind, wherever situated, shall be distributed to my revocable living trust. The name of my trust is: JANE M. ZERBY, J. GARDNER ZERBY, and JOHN G. ZERBY, JR., Trustees, or their successors in trust, under the JANE M. ZERBY LIVING TRti~T, dated May l~, 2Q~0, and any amendments thereto. Section Z. Alternate Disposition If my revocable living trust is not in effect at my death for any reason whatsoever, then all of my property shall be disposed of under the terms of my revocable living trust as if it were in full force and effect on the date of my death. Section 3. Testamentary Trust If my spouse survives me, 1 authorize my personal representative to establish, with the assets of my probate estate, if any, or with any property distributed to my personal representative from my Trustee, a testamentary trust (or trusts) for the -benefit of my spouse and my other beneficiaries under the same terms and conditions of my revocable living trust as it exists at the date of my death. I appoint the Trustee and successor Trustee named in my revocable living trust as the Trustee and successor Trustee of my testamentary trust(s). The Trustee of my testamentary trust(s) shall have all the administrative and investment powers given to my Trustee in my revocable living trust and any other powers granted bylaw. My Trustee shall be under no obligation to distribute property directly to my personal representative, but rather may distribute such property directly to the Trustee of the testamentary trust(s). Any pmperty distributed to my testamentary trust(s) by the Trustee of my revocable living trust shall be ~~ ~~ ~- ~'~`_ ~- Fags; 2 distributed by the Trustee of my testamentary trust(s) in accordance with the terms and conditions of my revocable living trust as it exists un the date of my death. Article Three Powers of My Personal Representative My personal representative shall have the power to perform all acts reasonably >>ecessary to administer my estate, as well as any powers set forth in the statutes iri the Commonwealth of Pennsylvania relating to the powers of fiduciaries. Article Four Payment of Expenses and Taxes and Tax Elections Section 1. Cooperating with the Trustee of My Living Trust I direct my personal representative to consult with the Trustee of my revocable living trust to determine whether any expense or tax shall be paid from my trust or from my probate estate. Section 2. Tax Elections My personal representative, in its sole and absolute discretion, may exercise any available elections with regard to any state or federal tax laws. My personal representative, in its sole and absolute discretion, may elect to have all, none, or part of the property comprising my estate for federal estate tax purposes qualify for the federal estate tax marital deduction as qualified ~= rnKe .~ terminable interest property under Section 2056(B)(7) of the Internal Revenue Code. My personal representative shall not be liable to any person for decisions made in good faith under this Section. Section 3. Apportionment All expenses and claims and all estate, inheritance, and death taxes, excluding any generation-skipping transfer tax, resulting from my death and which are incurred as a result of property passing under the terms of my revocable living trust or through my probate estate shall be paid without apportionment and without reimbursement from any person. However, expenses and claims, and all estate, inheritance, and death taxes assessed with regard to property passing outside of my revocable living trust or outside of my probate estate, but included in my gross estate for federal estate tax purposes, shall be chargeable against the persons receiving such property. Article Five Appointment of My Personal Representative I appoint J. GARDNER ZERBY to be my personal representative. If J. GARDNER ZERBY cannot act, or is unwilling to act, I appoint, in the order named, the following successor personal representatives: First, JOHN G. ZERBY, JR.; then Second, FLORENCE ANN DAMS. I direct that my personal representatives not be required to furnish bond, surety, or other security. I have initialed all of the pages of this Will, and have signed it on September 12, 2002. .~ ~~ E M. ZER1~Y ~ 7 ~" i t ~ \" rage ~+ SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testator, JANE M. ZERBY as and for her Last Will and Testament in the presence of us who, at her request, in her presence and in the presence of each other, all being present at the same time, have hereunto set our hands as witnesses. ~.,c~ Name ~ ~ `J ~ ~/, / ~/ / , -- Name t !-'~ ~' . !' c ~ i! , , ~1~ ` , "., ~J `' ~ Page 5 COMMONWEALTH OF PENNSYLVANIA ) ss. COUNTY OF CUMBERLAND ~ I, JANE M. ZERBY, Testator, whose Warne is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed this instrument as my Last Will ~!,rl T~~r~,,,~,,,,. that 1 signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. JADE M. ZERBY Sworn or affirmed to acknowledged before me by JANE M. ZERBY, Testator, the '~ ~1,. day of September, 2002. (SEAL) ... , _ i ~ ', Notary Public ,~ ,i i~~ • w.. -•rr NOTARIAL SEAL RobsM L R~ddiH, Notary f'uDtir WamieysDtrs Borough, Caurrty of Gu~r~ia}.: ; My Cdnmlasbn Expirws ~+an. ?r.~: 2i)Ob COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. We.( ~,~.u~ _ J ~''~ / ,and _~ ~,. , ~ ,. ,the witnesses whose names are signed t ie foregoing insh~ument, bein« a duly q~ialified according to law, do depose and say that we were present and saw JANE M. ZERBY, Testator, sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight cf the Testator signed the V!~il! as witnesses; and that to the best 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. /~ // - Asa 4 !~ ~~"'"~" i r . ,~~ Sworn or of armed to and subscribed to before me by ;;;.1, ;, and =t __i~~ `~~: , ~; t._~~ ~; the ~~~itnesses this !. ' ;'~ __ _ ,day of September, 2002. • ' (SEAL) ~~ ~ ;, ~ !I 1 ~-- L.! X ! ~ /, J r:! l " Notary Public 4.. _s r ;, ~ :~r" ., Page b }w,- ,.~., c .. ~, ~ ~~ ~. ~ ~ "fIr