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HomeMy WebLinkAbout07-29-0915056051058 REV-15 0 0 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 80X 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2I 08 I I67 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth _. _ _ _ _ _ _ 201183982 1.1/03/2008 03/04/1926 Decedent's Last Name Suffix Decedent's First Name MI Clouse liElmer E (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 ~! 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 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) ~ 6. Decedent Died Testate c"~.."" 7. Decedent Maintained a L+ving Trust _...0..._,.. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ~; 9. Litigation Proceeds Received ~ W,:~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-t-95j (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST CE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTtAI TAX INFORMATION SHOULD BE DIRECTED 70: Name Daytime Telephone Number Jerry A. Clouse ' (717) 776-5263 _ Firm Name (If Applicable) _ _ _. _ _ _ _ .::::_ ~_ _ - ~,_-~ - ._. _, - -.. REGISTER OF WfL1~5 USE ONkY - t "t.~ r First line of address =~~~ rJ _.._ _ _ ____ _ _ __.. _ __ ., , _',7 u~j 844 Doublin Ga g P Rd. _ __ '~~'~ i ", ~ , Second line of address ~ -:" _~ ' ' =" `' ~.i C,'J :l City or Post Office State ZIP Code _ _ .--- -, ------ Newville _ _ __ PA ' ~ I7241 . __. _ _._.. ! _. _ _. _ _ i Correspondent's e-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 belie(, it is true, correct and complete. Declaration of preparer other than the persona! representative is based on all information of which preparer has any knowledge. SIGNATURE OF~, ER'SON,j2E,S~ON~SIBLL~OR FILING RETURN ~D'ATE~~~ I~ 844 Doubling Gap Rd., Newville, PA 17241 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONL' Side 1 l_._. 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: '. Z Q l -18 - 3 9 8 2 RECAPITULATION __ _ _ __ __ 1. Real estate (Schedule A) . ............................................ 1. ' -Q- 2. Stocks and Bonds (Schedule B) ...............:........................ 2 ' Q _ ' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. j -0- 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. -Q- 7 ~ `' 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) '~ Separate Billing Requested ....... 6. ' -Q- m-..._. ~-_.._... _......__ _....- .., W._._.. . - 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. q ~~ ~, (7 ~~ 1 10. Debts o(Decedent, Mcrtgage liabilities, & Liens (Schedule I) ............ ,__.___. .... 10. ' _ _-_.._._.. _. _.._... ___..__._. .---__._ ~.-._-~ ~~ G ZZ, 11. Total Deductions (total Lines 9 & 10) .............................. _...- .... 11. ____ _ _ _. ..~__.___I~._.Y_...! !_-____.._.____..-_._.- 12. Net Value of Estate (Line 8 minus Line 11) ................ ........ ..... 12. ~ ~ ~ ~ ~ k ~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which h d l J d S '~ -~- 13 ' .~.._._ -~'~~'~ W. ~~-.._._~..___ ~---' -- © r'-' ) ....:.............. u e e ( c e an election to tax has not been ma ..... . , 14. Net Value Subject to Tax (Line 12 minus Line 13) ................... ..... 14. I ~ 6~ ~6Dt ~ -T~J Y 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 .O~Jr .. ~~ ~ 15 .. /~ o/ 16. Amount of Line 14 taxable at lineal rate X .0 _ ~ ~- -_____.~ -~ 16. '~° ' -°----_,___....__m__~.__.._._._...-_~...__.~._ 17. Amount of Line 14 taxable n.,....._...~__....._.._._..__- __ -`_ at sibling rate X .12 ~~- ~ ~~~~~~~~-~~~-e-~~~~~ w-~ ~~~~--~ 17. ' -~~ ~-~~~~-~~~~--~..~_._..._._.~~~~~~._- 18. Amount of Line 14 taxable al collateral rate X .15 18. 19. TAX DUE .................................................... .....19. ', 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C~7 15056052059 Side 2 L.. 15056052059 REV-1500 EX Page 3 File-Number Decedent's Complete Address: 21 08 ! 1167 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Elmer E. Clouse 201-18-3982 STREET ADDRESS 844 Doubling Gap Rd. CITY Newville STATE PA ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1} (~~ --- 2. CreditslPayments A. Spousal Poverty Credit B. Pnor Payments C. Discount Total Credits (A + 8 + C) (2) ---- 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) -- 4. if Line 2 is greater than Line 1 + Line 3, enter the difference. Tftis 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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) "'~ O -- 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)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)J. The statute does not exempt a transfer to a surviving spouse from fax, 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)J. The tax rate imposed on the net value of transfers to or for the use of the decedents 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. §91 t 6(a)(1.3)J. A sibling 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 * (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENEDECEDENTRN PERSONAL PROPERTY ESTATE OF Elmer E. Clouse 21-08-1167 FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~~ Checking Account # Jok o~ (o~(~ ©+'~~ ~~K ~~`~``- 739.00 TOTAL (Also enter on line 5, Recapitulation) I $ '~,~ ~ ~~ J 0 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) c ~, SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Elmer E. Clouse 21-08-1167 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Egger Funeral Home 15 W. Big Spring Ave. Newville, PA 17241 5,584.00 Casket spray 188.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ~ • ~ ~ Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City __ ___ _ State Zip Year(s) Commission Paid: ~ ~ ~ ~ 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) n/a Claimant Street Address City _ __ State Zip Relationship of Claimant to Decedent 4. Probate Fees (initial) Cumberland County Register of 'Wills 76.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0 . ~ ~ ~. Funeral luncheon 69.00 8. PennDot & Sollenberger's title transfer 60.00 TOTAL (Also enter on line 9, Recapitulation) $ ...~ ~ ~~a~ (If more space is needed, insert additional sheets of the same size) FEV-157.2 EXw (12-08; pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INNERCfANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Elmer E. Clouse 21-08-1167 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+(9-00) ~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Elmer E. Clouse 21-08-1167 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. 9116 (a) (1.2)] Jerry A. Clouse 844 Doubling Gap Rd. Newville, PA 17241 Carla D. Fishel 68 Pine St. Dillsburg, PA Randy E. Clouse 374 Pheasant Lane Carlisle, PA 1/4 1/4 1/4 suelyn D. Reisinger 1/4 2725 Ritner Highway Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 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 TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) ~ittst 3~ill tt'n~ ~P,StttIIiPZCt ttf Elmer E. Clouse I, Elmer E. Clouse, of 844 Doubling Gap Road, .being of lawful age, sound mind and memory, and under no restraint, do publish this, my Last Will, revoking all others previously made by me. First: All expenses, fees, costs, and taxes related to this estate shall be paid from the probate estate assets, and all gifts and bequests shall be paid from the net distributable estate. Second: I give, devise, and bequeath my entire estate, real, personal, or mixed, of every kind and nature, and wherever situated, which I may own, or hereafter acquire, or have a right to dispose of at my death, to my wife, Bessie V. Clouse. Third: In the event that my wife does not survive me, then I give, devise, and bequeath my entire estate, real and personal, to my children, share and share alike, per stirpes. It is my desire that all my children share equally in my estate. The deed to my and Bessie's property at 844 Doubling Gap Road has been transferred to my son, Jerry A..Clouse, with my desire that he maintain the property in good repair. I direct that upon the death of the second to die of myself or my spouse, Bessie, that Jerry share this gift of property with his brother and sisters, and give them each, w7thin three years of the death of the second of my spouse or myself to die, the sum of Fifteen Thousand ($1 x,000.00) Dollars each. In the event that my son, Jerry, wishes to sell the property at 844 Doubling Gap Road, I direct that he grant each sibling, in order of birth from the oldest to the youngest, a f rst right of refusal to purchase the property. Should one of my children other than Jerry become the owner of the property, I direct that the child owning the property gift the sum of fifteen Thousand dollars to each of his or her siblings. In the event that the property is sold to someone other than my children, I direct that the proceeds of the sale be distributed equally between my children, their heirs and assigns. I further direct that all- expenses incurred by any of my children in maintaining the property- be reimbursed to them upon the occurrence of any of the above. Fourth: I nominate and appoint my son, Jerry A. Clouse, to be the Executor of my Last Will, granting to him authority to sell and convey any or all of my estate, real and personal, or mixed, upon such terms and prices as he shall deem proper, without obtaining any prior order of the court therefor. I also grant him full power and authority in the settlement of my estate, to compromise, adjust, and settle any and all debts and liabilities due to or from my estate, for such sums, and upon such terms and conditions as he shall deem best. In the event that he shall for any reason decline to serve, or fail to qualify for any reason, or having qualified and been appointed, fail to complete the administration of my estate, then I nominate my son, Randy E. Clouse to be the Alternate or Successor Executor. I direct that no bond or surety shall be required of any administrator or fiduciary named herein. IN WITNESS WHEREOF, I have hereunto subscribed my name, and acknowledge and publish this instrument as my Last Will and Testament in the presence of the undersigned witnesses, Elmer E. Clouse Signed, sealed, published and declared by Elmer E. Clouse, Testator, as and for his Will, in the presence of us, who at his request, in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses hereto. ~~'i ~~~~~,.1_ ;~ . ~~C~ (? residing at ~.~~~1~~' .~~f~G~. 4~-'~-f ~ ,,~ ~-' `-_ ,~,.~ residing at ++~~z ~z,~ s ~J i~lr L- PA COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN ss We, Elmer E. Clouse, ~~~~. ~~ ~,~ and ~ ~ ~~J ~ ~ ~ ,the Testator and the witnesses whose names are subscribed to the attached Will, being duly ualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his Last Will; that he signed it willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of Elmer E. Clouse signed the Will as witnesses; and that to the best of our knowledge he was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Testator: t~Q-,--+~u c~~ ~ ~~-<~_ /•' `` Sworn and subscribed to before me, thi~~ Witnesses: r .. 9 ~ ~..~ L V day o~ ~~ , ~~ t IJotarial Sea( GdC(~r F2. Luhn III, Notary ~ ubBc W~3rri;burg, Dauphin County ~r1v icjrrrnission Expires April 24, 2000 ~die~ giber, P~;~rtsyivania Association of PJetares July 28, 2009 844 Doubling Gap Road Newville, PA 17241 Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Dear Ms. Strasbaugh: Enclosed please find an Inheritance Tax Return with the will attached and an additional copy of the Return for the Estate of Elmer E. Clouse #21-08-1161. Also enclosed is a check made payable to the Register of Wills for the filing fee. If you should have any questions, please feel free to call me at 717-540-6040 (work) or 717-776-5263 (home). Sincerely, ~~ Je A. Clouse, executor =y cJ -~ ~~c7 ~~ -: -7 C~~~ ~~ ~-i _.i7 -,~ ---~ .D _. N ,. :. GJ