The URL can be used to link to this page

Home My WebLink About07-29-0915056051058 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 280601 21 0,~' 01216 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 11 /26/2008 04/07/1913 Decedent's Last Name Suffix Decedent's First Name MI MARTIN DONALD E (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 OVALS BELOW ;~~; 1. Original Return 2. Supplemental Return 3. Remainder Return (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) ;:r 6. Decedent Died Testate 7. Decedent Maintained a Living Trust _._....... 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received .:,. 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 AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name _ _ _.. Daytime Telephone Number _ _ ._ _. _ STEPHANIE E. CHERTOK _ na ~! ' (717) 249-1 Q727 ~-~ -_~ ~ Firm Name (If Applicable) ~ ~ - `- - ~, REGISTEt2 dF_QDI~.1~5 USE~NLY J ,;- r; ~ N First line of address v. ~) ~ - ~ 61 W. LOUTHER STREET ~i .-~,~ ~~ ~ .) ,<.~~;~ ~ -_~ - -_ , Second line of address . .. -~~~ ~~ CO _ rTz .. O , C7 City or Post Office State ZIP Code ' _ DATE FILED CARLISLE PA ' 17013 __ ___ __ __ __ __ 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 complete. Declaration of preparer other than the personal representative is based on all information of w r has anv knnwlarina Side 1 15056051058 15056051058 PLEASE USE ORIGINAL FORM ONLY 15056052059 REV-1500 EX Decedent's Social Security Number ~ Decedent's Name: DONALD E MARTIN .............._.. _,, .~_.., _.. ..._ RE . ~............~_....._._...._.~...._ ..._~~__ _ r ._.._,.__. CAPITULATION 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. 91,571.18 6. Jointly Owned Property (Schedule F) Separate Billing Requested .... ... 6. 38,415.98 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property "" (Schedule G) Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ! 129,987.16 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ' 5,485.02 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ! 915.27 __..__ __ 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 6,400.29 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 123,586.87 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. .. , ..~~.,. ..u., ,.....,~~ ..,-...... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ~., .,, ....,_: 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable '_ at lineal rate x .0 45 123,586.87 16. ' 5,561.41 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. , 5,561.41 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number _. 21 08 01216 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER DONALD E MARTIN STREET ADDRESS 128A WEST WILLOW STREET CITY CARLISLE STATE j ZIP PA ' 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 4,200.00 C. Discount 221.05 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 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. (3) (4) (5) (5A) (56) Make Check Payable to: REGISTER OF WILLS, AGENT 5, 561.41 4,421.05 0.00 1,140.36 0.00 1,140.36 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? ........ ...... ^ ^X 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)]. 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 exemot 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Donald E. Martin 21-08-01216 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M & T Bank -account no. 374161-6894 $79593.63 2. Garnet Management Co.- security deposit $585.00 3. Comcast Cable- refund $7.94 4. Embarq- final credit $10.93 5. Nationwide Insurance Co.- cancellation, credit refund $139.20 6. Nationwide Insurance Co.- cancellation, credit refund $37.00 7. Garnet Management Co.- interest on security deposit $1.48 8. IRS- 2008 tax refund $2081.00 9. 2000 Suburu Outback $8065.00 10. Misc, furniture (no antiques) -curio, small t.v., dresser, 3 chest of $1050.00 drawer, dining room table and chairs, lamps and radios, nightstands, etc. TOTAL I $91571.18 SCHEDULE F col~oNwEAI.Tx of PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald E. Martin 21-08-01216 Joint tenant(s): NAME ADDRESS RELATIONSHIl' TO DECEDENT A. Linda M. Hartley 101 Wilson Lane, New Bloomfield, Daughter PA 17066 B. C. Jointly-owned property: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSETS DECD' S % INT. DOLLAR VALUE OF DECEDENT' S INTEREST 1. A 12/06/00 Members l St -C.D. No. $46405.85 50% $23202.93 199447-49 2. A 12/06/00 Members 1St- C.D. No. $30410.71 50% $15205.36 199447-50 3. A 12/06/00 Members 1st- checking $7.85 50% $3.93 Acct. no. 199447-11 4. A 12/06/00 Members 1St- savings $7.51 50% $3.76 Acct no. 199447-00 TOTAL (Also enter on line 6, Recapitulation) $38415.98 SCHEDULE H FUNERAL EXPENSES, coIVINIONwEAI.Tx of PENNSn,vaNlA ADMINISTRATIVE COSTS AND INxExIT.ANCE TAX RETURN MISCELLANEOUS EXPENSES RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald E. Martin 21-08-01216 ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: 1. Lunch for Honor guard and Family after funeral ($350.00), $450.00 Pastor ($100.00) B. Administrative Costs: 1. Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees: Stephanie E. Chertok, R.N., Esq. $4500.00 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees: Cumberland County Register of Wills- opening estate X264.00 Cumberland County Register of Wills- filing inheritance tax return $15.00 C. Miscellaneous Expenses: 1. Cumberland Law Journal -adv. of estate $75.00 2. Patriot News Co. -adv. of estate $181.02 TOTAL ~ $5485.02 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald E. Martin 21-08-01216 ITEM NUMBER DESCRIPTION AMOUNT 1. Pennsylvania Power Light- final electric bill $21.54 2. Embarq- final telephone bill $31.71 3. FIA Card Services- VISA $220.02 4. Garnet Management Services- rent for December 2008 $642.00 TOTAL ~ $915.27 SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald E. Martin 21-08-01216 RELATIONSHIP AIvIOUNT OR NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TO DECEDENT SHARE OF Do No List Trustee(s) ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 ~ Linda M. Hartley- 101 Wilson Lane, New Bloomfield, PA Daughter 50% 17066 Elaine M. Phillips- 68 Phillips Lane, Forksville, PA 18616 Daughter 50% 2 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNEMENTAL DISTRIBUTIONS TOTAL OF PART II- ENTER TOTAL NON-TAXABLE $ DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET WILL OF DONALD E. MARTIN I, DONALD E. MARTIN, of Carlisle, Cumberland County, Penn- sylvania, declare this to be my last Will and hereby revoke all prior wills and codicils. 1. I direct that all my just debts, funeral expenses, grave- marker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, success- ion and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be divided as follows: A. I leave my entire estate of whatever nature and wherever situate to my two daughters, LINDA HARTLEY and ELAINE PHILLIPS. B. Should either of my daughters predecease me, then that daughter's share shall pass to her children equally. 4. I appoint my daughter, LINDA HARTLEY, as Executrix of this my last Will. If she should predecease me or cease to act in such capacity, I name my other daughter, ELAINE PHILLIPS to so serve. 5. The Executrix of this Will shall have the power to distri- bute my estate in kind or in cash, or partly in either. 6. I direct that no Executrix acting under this Will shall be required to enter bond in any jurisdiction. IN WITNESS WHEREOF, of , 1991. I have hereunto set my hand this ~ day /; ` ~ -~`` DONALD E. MARTIN LAW OFFICES OF STEPHEN J. HOGG 401 E. LOUTHER STREET CARLISLE, PA 17013 ~ ~"~y, C. __ ~-;~~ The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and de- clared by DONALD E. MARTIN, as and for his last Will in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. ~^ _~~ ~~;-\ G:ti~, t- ~L%l'~4:, ,r. -~J-~c~-' ~~ ~~C.GC.CYJ 2Y~ i' I ~ ~ !C/~.~-~~- LAW OFFICES OF STEPHEN J. xoGG 401 E. LOUTHER STREET CARLISLE, PA 17013 ACKNOWLEDGEMENT Commonwealth of Pennsylvania County of Cumberland ss I, DONALD E. MARTIN, the testator whose name is signed to the attached or foregoing instrument, having been duly qualified accord- ing to law, do hereby acknowledge that I signed and executed the in- strument as my last Will; that I signed it willingly and as my free and volutary act for the purposes therein expressed. j, ~_ i~. DONALD E. MARTIN Sworn to or affirmed and acknowledged before me by DONALD E. MARTIN, the testator, this /S~- day of , 1991. -~-( - hat~,~ Stephen J. Hn ' R' ~ ~ Y'~,/~%~- %~~~- F° ,~;,,, r,c ,~ ;:,~ s ~~~ ~ ~ ~-' Notary public/Atto ney AFFIDAVIT Commonwealth of Pennsylvania County of Cumberland ss -. ~ ,. '~~ , S and ~'G~s , LAW OFFICES OF STEPHEN J. HOGG 401 E. LOUTHER STREET CARLISLE, PA 17013 the witnesses whose names are signed to the attached or foregoing in- strument, being duly qualified according to Iaw, do depose and say that we were present and saw the testator sign and execute the instru- ment as his last Will; that the testator signed willingly and execu- ted it as his free and voluntary act for the purposes therein ex- pressed; that each subscribing witness in the hearing and sight of the testator signed the Will as a witness; and that to the best of knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirme and s bscribed to before me by witnesses, this / 5-~- day of , 1991 . ~~, '~ / ~.~ . F 4 Notary,~PLiblic/Attorney ~//" - ~/"'/