HomeMy WebLinkAbout09-08-09 (2)15056051047
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
Harrisburg, PA 17128-0601 d. ~ RESIDENT DECEDENT ~ ~ ~ ~ ~ ~ 7
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
l d s ~ 9 3~ 8 t o ~3 t~ o`o ~ o ~-- ~ 3 ~ 9 t S
Decedent's Last Name Suffix Decedent's First Name MI
(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 O 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 TO:
Name Daytime Telephone Number
~Ay~E F~~ ~a R ~-~~ 96~ 5~~~
Firm Name (If Applicable)
REGISTER OF W
ILLS USE ONl~i
Q
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First line of address C ~
p
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a- $ 3 ~- fJ. ~ fZ o N 2 S T
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Second line of address ~ r sr
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~- P ~' 2 0 ~. ~~4, ~ ~r
~~
City or Post Office State ZIP Code DAT ;, ~ "~
}~ ~ R R T 5 g a- 2~ ~.
P A-, ~ ~-- I g o ~ c.~
Correspondent's a-mail address: W ~ MO'-Q ~~-.S~ c~ 0~ ~ q{,~pp, tr 0 ~
Under penalties of penury, 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 comp te. eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ,
SIGN T OF PERSO ES OR FILING RETURN DATE,n
~Of Z06
A<D,~DRESS ` _
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 15056051047 15056051047 J
15056052048
REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
( ~ ~ O
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. •
~ 1 3 S
~ b ~
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. •
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
~
~ 6 b 6 ~
(Schedule G) O Separate Billing Requested...... .. 7.
8 8 ~ ~ 6 ~ • 3 ~
8. Total Gross Assets (total Lines 1-7) .................................. ..
.
9. Funeral Expenses & Administrative Costs (Schedule H) ................. .... 9. ~ ~ b ~
~ .
~
u
b ~ r G
t
l ~
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ .... 10.
11 1 ~- °~` ~ ~ ~O 3
11. Total Deductions (total Lines 9 & 10) ............................... ....
.
12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. ~" ~ a ~ 3
13. Charitable and Governmental BequestslSec 9113 Trusts for which
11
~ C O
D D
an election to tax has not been made (Schedule J) ................... ..... 13. -
14 ~
~ I a' a ~ • } Z
14. Net Value Subject to Tax (Line 12 minus Line 13) ................... .....
.
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 _ 16. •
17. Amount of Line 14 taxable
at sibling rate X .12 17. •
18. Amount of Line 14 taxable
at collateral rate X .15 • 18. •
3 ~ I a.~~
19.
.................................
TAX DUE ..................
..... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
15056052048 15056052048 ,J
REV-1500 EX Page 3
Decedent's Complete Address:
ac,oq - o~~ z~
File Number
DECEDENT'S NAME
~e~~~ ~ , ~~a~LoR
STREET ADDRESS \ `
Y-'--'l ~N(3'ct
l~-oo CY'1 ~~` S~ ,
CITY ~ ~~ ll `` n ~ ~ ~ + 'STATE ZIP
Tax Payments and Credits:
1. Tax Due (Page 2 tine 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 1(0 ~ , I
Total Credits (A + B + C) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total InteresUPenalty (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.
A. Enter the interest on the tax due.
3,34, ~-
1b3,1 `~
(5) ~. )~5- (~3
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3 ~ 1 ~ ~ ~~
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
^ N-o
"
a. retain the use or income of the property transferred :.................................................................................... ...... L~
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 Ilfe 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? ....................................................................................................... ....... L ~
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)].
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 ar 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 isdefined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
~ , !
4FJ-1509 FX ~ i A71
SCHEDULE F
CON<t~AG~i1t'EALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INi1ERlTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
'KCA-~~~ ~~q;~Lo (Z 2anQ-- pow z~--
N anasset was made joint within one year of th decedents date of death, it must be reported on Schedule G.
SURVIVNG JOINT TENANTS; NAME ADDRESS RElAT10M1SHIP TO D=CEGNT
A. jYYI /{4t r ~y L E 17 fi N ~~ 381 c A rN r r~ N S-i . ~ p,,,.~~.'t~
v, ~; E2S, P te. c~- 3 ~ g
N . Fri ~~' ~'
B. ~A~Ne ~r ~~Lo~. a83~ p~ ~o~
t-} f}RR ~ S~ u/L L*1 1
ll t~j1t~
c.
JalNTLY-0WNEO PROPERTY:
ITEM
NUMBER LETTER
FOR JOR7T
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
Include name bf financial instltufion and Dank account number a sirtilar identifying number. Attach
deed for jointly-held real estate.
7ATE Gf DEATH
VALUE OF ASSET 56 OF
DECC'S
~NTEREST GATE CF DE: T-1
VAIL'E Of
CECEDEt•.T'S !NTERE5
1 A. Q(tr ~R. s-}a~2ly,~.,.~yd~Ra3 G,.~F tA,,.^;6~
~ Zoao g~u~ Pte-.
t-} a a~ ~. '~ t
~
~~~~ ~ ~
~cco u~ r1o , l~E ~roae_ ~^r+'
~+~~-
ew ~ ,~ z 3 0 {~ 3 ~07. o
~/kr' ,y~1~
af...l
v
~~
g3az l~
3s~
~
a8 y
3 ~ ,ao.99
~
S~~~a.
c ~s~ ~
zt~ ~~ z.
-~ 0~, r-~
,K
~
i t~o~ 908, ~ `l3 S~, 0.b9. ~ I
d
o
rR~~g ~S ~0s
~ ~3 4o~f ,9,`•
~S
~E FU^'~1°' yb a~
,
~ l
t~3 ~. 9~ ~ b 5 , 3
~ ~~-- ~ d : N~ ~ASS~ ~;3~~ bai,, 0 5
~,
~,~
TOTAL {Also enter on line 6, Recapitulation) , S ~-°) t ~ ~O`~ . 3
RCvr ii~Cz•tL5' ( 1
~ SGHEDUL~
{NTER-V{V4S TRANSFERS &
C~'+U.1C'4'N"AI T~ ,^,f PFt+VSYI'JAN4"
„~.rw,F„~;: ,~ K~,I,kti M{SC. NON-PROBATE PROPERTY
[SID-N"f?~CcDENT _ ~ _ __.~. -- ~_-- -.__,_~ . -
_ , ~__
._-~._~ __. __._____ FILE NUMBER
ESTATE OF 1/ ~ Z~
This s.^hedule rr.st be completed enC E rEC 'C ~e answer b ~ of questbns ", ttlrough 4 ~ i t~s reverse side of the R E J-15th CO'v F R SH EET i? yss
DESCRaPTiOty OF PRflPER'Y
it l.~ ~ ,..- t~ ~~ ~ t:.y!C d f rq.u; ~f+CC E ^ U •.S~F- .:F:7 "f tit N"' iM'^.a~ ~- rsal.~.:FTF
i .: 'G_• r•U_FY n• IH^ I tFf.'Oi H: q fSUL..
C ,~sl-
T/~~
' i
1
j
~~ ~ ~
I ___.___~,___.___.__--_--~---
8 ,obb .
REV-?511 EX+ i 10 Ofil
`' .~
COMNiONYJ=ACTH OF PENNSYLVANIA
!NHFR;TANCE TAD: RETURN
Rf_StDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
__
ESTATE dF FILE NUMBER
E)etrts of decederrt must be reported an Schedule I.
iTEfvi ____ --- _-
NUMBER ~__ DESCRIPTION, ___ AMOUNT
A. FUNERAIEXPENSES:
p~rab-~- ww~...-s _O~~t
P.~.c..,~r=r~.
~ag~.o-st_ F-+ee
~~o >~~
S.
1
2
3
a
5
6
z
6~zfl ,
~, b , ~~.
t~ ~. zz . 43
Leo ~ ao
~~-3, 0.S'
-!'
ADM!N{STRATfVE COSTS:
~ Personal Represenlafive's Commissions 1 ,,
Name o' Personarrl~~Reoresentafve(sj W ~ Nom- ~'~ti `'-~
Street Address d~~ 7~- I~ ~ ~AA~ ~ ~~ i~ 20~
GitV ~Q~~ ~' 7~ ~ ~~O _ _ .State __
Year(sl Commission Pa cl:
Zip
Attorney Fees
=amity Exemptron: jlf decedent's address is nct the same as daimanfs. attach explanation]
Claimant
Street Addre55
C ty -_V_-_ _- State _. Zip
Relatonship of Claimant to Decedent
Probate gees
Acco~sntants Fees
Tax Ret.:rn Prenparers Fees` ~. C~
QonSo ~ s.Q 1 ~.~aO~~~,veit r~^~ : ~-°~6•.~.a-f ~ ;
8,z.z z , s o
3~eo~,~
15 ~,~F~
t33,o~
t3~•~ 9
---- - . --
- -- --
_., -... ._ ... ...... rt ~~ -s ._,-, ... r 7
.~ ~ ,
C~t>?1?ONYJEALTH GF REVNSYLYAV .4
INFERITANCE TAX RE"URN
RCS ~EhT 7E~EGEhT
SCNEDt~LE i
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE 4F FILE NUMBER
__ -----
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses
ITFtv1 4 VALUE AT CATS
_NUh16ER I DESCR•.PTION Qf DEA?H
~., ` gyp' 1,., _ ._~~ 1 ~oe~ ~.2Sos q t o , 0 3
o-~C
~~ ~ Q6. s:can~.s ~-~c: ~e5 ~ .6 ~+
~,
~.
~-
~R~ ~ 7
v9~S7 t'•~ e~~.,~~11 G~P..viCFS
V
(op,06
~o,AO
~~,~1
TOTAL (Also enter on line 10 Fecapitulatior;i 5 t to ~ ~, I ~
~_a__~._ ------- _-----. _ _ _
(If more space is -.ceded, inset. add~tieral s°eets cf the s2me sizei
• .REV-1513 EX+ (9-00)
x
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
~r--_ t~-l,, p ~aa : I ,. ~ 2ooQ -- ~ ~2~
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not LiatTrugtae(s} AMOUNT OR SHARE
_ OF ESTATE
t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Ser,. 9116 (a) (t.2)]
1/
1. ~ (~„~ N
Y ~f-1.t,L
-oC
Z- 5O N
LL
n
n
eA~L.:s1c I Pa• l~o~~
~ ~~et~sr Q.A. l~-''~
'3 . W py re- ~+4i~ ~.o ~
~
~ ~ -
4{
I
o h7P...
R
~$3~ N
~o'J
I
/
~~ 2 o Z_
\x'1(0
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE. ON REV-1500 COVER SHEET
tt NON-TAXABLE DISTRIBIIffONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
I
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I
t . II -,_ n/I
Q i r~ ~`~ L.u`-~J~d~ ~ ~L
~ A o o,
r
,/~
~09 ~IAr~Mr~ t-fJe.
~~ M`a M~sC I ~A- ,
TOTAL OF PART !1-ENTER TOTAL NON-TAXABLE DISTRIBUT10N5 ON LINE 13 OF REV-1500 COVER SHEET S ~-~ oo~
(II more space is needed, insert additional sheets of the same size) ~`
LAST WILL AND TESTAMENT OF KEATHE G. FAILOR
I, KEATHE G. FAILOR, of Cumberland County, the State of Pennsylvania, being of sound and disposing nand,
memory and understanding, do make, publish and declare this my Last Wilt and Testament, hereby revoking and
making void arty and all prior Wills by me at anytime heretofore made.
1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be
conveniently done, including the payment aut of the principal of my general estate, of all inheritance, estate
and succession taxes which maybe assessed in consequence of my death.
Am outstanding debts owed to me (except those, if arty, of my children) shall be collected and deposited
into my estate account. Any debt owed to me by any of my children shall be settled against their share of my
estate.
3. Am- real property, and my automobile, that I own shall be sold and the rtet proceeds deposited into my
estate account.
I direct that my personal property bedistributed/liquidated as follows:
a) 1n accordance with my separately provided hand written instructions, certain personal property shall
be distributed to my children, grandchildren, and great grandchildren. These instructions shall be
attached to my original copy of this will.
b) Any other personal property not so identified in 4. a) above shall be distributed to any of my three
children who requests such a piece of property. In the case of more than one of my children
wanting the same piece of property, straws shall be drawn to determine receipt.
c) All other personal property shall be sold and the proceeds deposited in my estate account,
except that there shall not be a public sale at my residence.
5. From my estate account, I hereby gift 51,000.00 to the Trinity Evangelical Church of Lemoyne.
6. My children arc: Eugene L. Failor of Carlisle, Marigaylc Danner of Etters, and Wayne G. Failor of
Harrisburg, all three being Pennsylvania residents.
7. At the sole discretion of the Executor, any stocks, bonds, mutual funds or other securities that I own at
the time of my death (excepting those securities for which I have directed a beneflciary(ies}) shall be
either distributed ar liquidated and the proceeds distributed in equal, one third shares to each of my
children. Securities for which I have directed a beneficiary(ies) shall be distributed in accordance
with such instructions.
8. The net value of my estate account shall be distributed in one-third shares to each of my children.
If my son, Eugene should predecease me, and his wife, Linda, should survive him by 30 days, then Linda
shall receive Eugene's one-third share of my estate. if Linda should not so survive Eugene, then Eugene's one-
third share shall be distributed in equal shares to each of his five children if any of Eugene and Linda's children
should predecease them, then that child's one-fifth share shall be evenly distributed to that son or daughter's child
or children (Eugene and Linda's grandchildren). If the deceased son or daughter (of Eugene and Linda) has no
children, or if their childlchildren do not survive their parent by 30 days, then the son or daughter's one-fifth share
shall be distributed in equal shares to their surviving siblings.
If my daughter, Marigayle, should predecease me, and her husband, David, should survive herby 30 days,
then David shall receive Marigayle's one-third share of my estate. If David should not so survive
Marigaylc, then Marigayle's one third share shall be distributed in equal shares to her two sons. If either of
Marigayle and David's sons should predecease them, then that child's one-half share shall be distributed to
that son's child or children (Marigayle a~ David's grand child/children), If the deocased son has no
children or if their child/children do not sunrive their parent by 3(1 days, then that son's one-half share shall
be distributed to the remaining sibling.
if my son, Wayne, should predecease tne, then his one-third share of my estate shall be distributed in equal
shares to his two children. If either of his children shall predecease him, then that child's one half share
shall be distributed to that child's childlchildren (Wayne's grandchildren). If the deceased child has no
child/children, then the deceased child's one half share shalt be distributed to the remaining sibling.
8. For the purpose of facilitating the settlement and distnbution of my estate, I authorize and empower my
personal representative to sell any and all real property and personal property.
9. Lastly, 1 nominate, constitute and appoint Wayne G. Failor, my son, Executor of this my Last Will and Testament,
and that he serve with for a flat fee of $3,000.00 and be reimbursed for expenses for the execution of his duties.
10. i further direct that my said personal representative be excused from posting bond or other security for
the faithful performance of their duties in any jurisdiction.t .~,
In witness whcrcoC 1 have hereunto set my hand and seal this l9' 'day ~ 2001.
~ .: ~J,/~ ~-~,~ X ~f.- L (SEAL)
I{E~CTHE G. FAILOR
(SEAL)
Wi ss '
~~ ~ (SEAL)
~tncss