HomeMy WebLinkAbout08-31-091505607121
REV-1500 EX (Q6-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 9 0 0 4 5
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT fNFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 3 5 1 6 3 4 9 3 0 1 0 7 2 0 0 9 0 7 1 1 1 9 2 5
Decedent's Last Name Suffix Decedent's First Name MI
K R I E G E R J O H N H
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
K R I E G E R M A R Y A N N E
Spouse's Social Security Number
0 0 2 2 0 4 2 7 8 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 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)
0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Soxes
(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 r >
I V O V O T T O I I I E S Q U I R E 7 1 7 2<
tb3 3 ^3 4
=`
Firm Name (If Applicable} REGISTER:C>~'~~ USE~NLY
M A R T S O N L A W O F F I C E S - "~-'_Yi ~"_'
~; ;, ;
First line of address r _
~ ~ <"? -~~-, `
1 0 E A S T H I G H S T R E E T ~ ~' `~;~ ~. '
_a c;? _ , .
Second line of address ?> t~
City or Post Office State ZIP Code DATE FILED
C A R L I S L E P A 1 7 0 1 3
Correspondent's a-mail address: I O T T O a0 M A R T S O N L A W• C O M
Under penalties of perjury, 1 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief.
ft is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
.,~SI'GNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
~ a ~ 1,,~ T ~ ~ ~
ADDRESS r
93 EGE DRIVE CARLISLE PA 1701,5
SIGNA~'~1R~,gF RER OTHER THAN REPRESENTATIVE ~jy y ~ .•
10 E HIGH ST CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505607121 1505607121
~~
1505607221
REV-1500 EX
Decedent's Social Security Number
decedent's Name: JOHN H• K R I E G E R 1 3 5 1 6 3 4 9 3
RECAPITULATION
1.
.......................................
Real estate (Schedule A) 1.
.
2. Stocks and Bonds (Schedule B) ................................. . 2. 1 8 7 7 4 7• 1 8
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 5 4 2 7 5 9 8
(Schedule G) ~ Separate Billing Requested ...... . 7. .
8. Total Gross Assets (total Lines 1-7) .......................... . 8. 2 4 2 0 2 3. 1 6
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) ..... ............. ..... .. 12.
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.
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 _ 9 5 5 7 9 5 3 15.
16. Amount of Line 14 taxable
1 1 9
8 5 5
5
0
at lineal rate X .045 . 16.
17. Amount of Line 14 taxable
0 0
0
at sibling rate X .12 17•
18. Amount of Line 14 taxable
~ ~
0
at collateral rate X .15 18.
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
2 6 5 7 3. 8 2
1 4. 3 1
2 6 5 8 8. 1 3
2 1 5 4 3 5. 0 ~
2 1 5 4 3 5. 0 3
0. 0 0
5 3 9 3. 5 0
0. 0 0
0. 0 0
5 3 9 3. 5 0
Side 2
1505607221 1505607221
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 09 0045
DECEDENT'S NAME
JOHN H. KRIEGER
STREET ADDRESS
93 EGE DRIVE
CITY STATE ZIP
CARLISLE PA 17015
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 5,393.50
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 4,500.00
C. Discount 236.84
Total Credits (A + B + C) (2) q ~ 3 ~ g;}
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (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) 6 5 6.6~
A, Enter the interest on the fax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 6> (i.66
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 : ...................................................................... ^ 0
b. retain the right to designate who shall use the property transferred or its income;
:::::::::::::::::::::::::::....
c. retain a reversionary interest; or ............................................................ ^ 0
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 0
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? .................................................................................................. 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 (O) percent
(72 P, S. §9116 (a) (1.1) (ii) j. 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 (O) 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)j.
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)]. 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-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JOHN H. KRIEGER 21 09 0045
All prope-ty jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Citi Smith Barney Account No. 274-09788 123.139.42
See attached
2. Citi Smith Barney Account No. 724-09789 64,~,p ,~ 7~
See attached
TOTAL (Also enter on line 2, Recapitulation) , $ 187 -; 4" ~
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE G
INTER-V/VOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
JOHN H. KRIEGER 21 09 0045
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.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACHACOPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OFDECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1. Citi Smith Barney IRA account # 724-6B150: Beneficiares: 54,275.98 100. 54,2?5.9~
Mary Christina Mattise, daughter, 33.3%; Barbara Anne Garrick,
daughter, 33.3%; John Ross Krieger, son, 33.3%
TOTAL (Also enter on line 7 Recapitulation) I $ 54,27 ~ 9 K
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
JOHN H. KRIEGER 21 09 0045
Debts of decedent must be reported on Schedule I.
1 TEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. W. Orville Kimmel Funeral Home, Harrisburg PA l 0_ l 0~3.9~#
2. Isaac's, funeral reception ?89 i5S
3. Mary Anne Krieger, reimbursement for miscellaneous funeral expenses 50(7.00
4. Christ Presbyterian Church, Camp Hill, PA, donation for funeral service 300.00
8.
1
2.
3,
4.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City
Year(s) Commission Paid:
State Zip
Attorney Fees Martson Law Offices (estimated)
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Mary Anne Krieger
StreetAddress 93 Ege Drive
City Carlisle State PA Zip 17015
Relationship of Claimant to Decedent Spouse
Probate Fees Cumberland County Register of Wills
5 Accountant's Fees
6. Tax Return Preparer's Fees
7. ~ Register of Wills, filing fee, Inheritance Tax Return
TOTAL (Also enter on line 9, Recapitulation) $
1 1,000.00
3.500.00
3 64.00
I S.OU
2(~.5?3.Y2
(If more space is needed, insert adddional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
JOHN H. KRIEGER 21 09 0045
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Heritage Medical Group, LLP, account payable 1 O.Ou
2. ~ Susquehanna Surgeons, Ltd, account payable
TOTAL (Also enter on line 10, Recapitulation) I $
(If more space is needed, insert adddional sheets of the same size)
4.31
14.31
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
JOHN H. KRIEGER 21 09 0045
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1 TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Mary Anne Krieger Spousal 9~. ~ 79.3
93 Ege Drive
Carlisle, PA 17015
2. Mary Christina Mattise Lineal 39.93 t .8=1
22 Fairway Drive
Amherst, NH 03031
3. Barbara Anne Garrick Lineal 9-9ti 1.8 3
116 Beaumont Place
Lower Gwynedd, PA 17002
4. John Ross Krieger Lineal 39.9 l ~?
17700 North Crossroads Ranch Road
Prescott, AZ 86305
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
IY, NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(I f more space is needed, insert additional sheets of the same size)
F `FILES'.ClientsU2T_9 Kiirgei°I'_'24I.h. will
LAST WILL AND TESTAMENT
t~F~IGiNAL RETAINED BY:
11~ART50N DF.ARDORFF WILLaAA3S
®TT® GIIROY ~ FALLER
MARTSON LAW OFFICES
10 EAST HIGH STREET
CARLISLE, PA 17013
71'n 243-3341
I, JOHN H. KRIEGER, of South Middleton Township, Cumberland County, Pennsylvania,
being of sound and disposing mind and memory, do hereby make, publish and declare this to be my
Last Will and Testament, hereby revoking any and all former Wills or Codicils made by me.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and
all death taxes (whether such taxes may be payable by my estate or by any recipient of any property)
shall be paid from my residuary estate as soon as practicable after my decease and as part of the
administration of my estate. My Executrix shall have no duty or obligation to obtain reimbursement
for any such tax so paid, even though on proceeds of insurance or other property not passing under
this Will.
2.
I give, devise and bequeath unto my wife, MARY ANN KRIEGER, the share of my estate
which she would receive under the intestate succession laws of the Commonwealth of Pennsylvania
had I died intestate.
3.
I give, devise and bequeath all the rest, residue and remainder of my estate, unto my children
MARY CHRISTINA MATTISE, BARBARA ANNE GARRICK and JOHN ROSS KR.IEGER, in
equal shares absolutely, provided that the share of any child who predeceases me shall be distributed
to his or her issue, per stirpes, and in default of any such then-living issue, such share shall be
distributed to my surviving children.
4.
I nominate, constitute and appoint my wife, MARY ANN KRIEGER, as Executrix of my
estate. In the event she is unwilling or unable to so act, then I appoint my children, M.aRY
CHRISTINA ~IATTISE, BARBARA ANNE GARRICK and .10HN ROSS KRIEGER, as co-
Executors of my estate. In the event any of them are unable or unwilling to act or continue to actin
such capacity then the other(s) shall act as Executor(s).
~-lL
[Initials]
Page 1 of 3 Pages
5.
I direct that all fiduciaries acting under the Will, whether or not named herein, shall not be
required to give bond for the faithful performance of their duties in any jurisdiction.
6.
I authorize and empower my Executrix, or her successors, in their sole and absolute
discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any
real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose
of or grant options in regard to any or all property of any kind forming a part of my estate for such
terms and such prices as they may deem advisable; to borrow money for any purposes connected
with the protection and preservation of my estate; to mortgage or pledge any real or personal property
forming a part of my estate or to join in or secure the partition of same; to compromise any claims
or demands of my estate against others or of others against my estate; to make distribution in kind
and to cause any share to be composed of cash, property or undivided fractional shares in property
different in kind from any other share; to employ agents, attorneys and proxies and to delegate to
them such power as my Executrix, or her successors, consider desirable and to pay reasonable
compensation for such services as maybe rendered by such agents, attorneys and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition, I direct that my Executrix, or her successors, shall have the power to conduct an inventory
of any safe deposit box necessary to the administration of my estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this Y'~" day of
,fib'
L-' ~z~~
~~ ~~ ~ ~
(SEAL)
Joh~ H. Krieger ~
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named -Testator, as and
for his Last Will and Testament, in the presence of us, who at his request, have 1ereunto subscribed
our names as witnesses thereto, in the presence of the said Testator and of each other.
~,f~,
'~ ~ ~ '~;
~~ ~i ~ 1.< ~~-~~. >> - _--
Page 2 of 3 Pages
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND
We, John H. Krieger, No V. Otto III, and ~t, Q,t,GtC-tr ~ ,the Testator
and the witnesses, respectively, whose names are signed to th oregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the Testator signed and executed the
instrument as his last Will and that the Testator has signed willingly, and that the Testator executed
it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in
the presence and hearing of the Testator, signed the Will as a witness and that to the best ofhis/her
knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no
constraint or undue influence.
` ~"~ ~---
..,ar-
Jo H. ieger, Test for
Witness
I , .< <~ / `
Witness
Subscribed, sworn to and acknowledged before me by John H. Krieger, the Testator, and
subscribed and sworn to before me by No V. Otto III
witnesses, this Y'`~day of ~{j , ~-b ~ .
. ,~~u4 a~ E,aLTH t1F PEtiNSY'LV.AN7A
~~~~~
~~~(?~I'.ARIAL SEAL
Vicr~,ri~ L. +_~tto, :ti`otary Public
i ariisie Borough, Cumberland County
11y commission expires December 20, ?010
e
Page 3 of 3 Pages
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