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Home My WebLink About10-19-09 (4)1505607121 REV-1500 EX (os-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Y@ar File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 '0 9 0 6 3 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 1 1 6 3 2 1 4 0 6 2 6 2 0 0 9 0 7 1 7 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI C A S E Y B E T T Y' W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Se~urity Number FILL IN APPROPRIATE OVALS BELOW Q 1. Original Return 4. Limited Estate OX 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust _ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remairjder Return (date of death prior to' 12-13-82) 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach) Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORM~ITION SHOULD BE DIRECTED T0: Name Daytime Telet~hone Number C H R I S T A M A P L I N 7 1 7 4 1 $ 5 5 ,Qr~ ._ ,.~ , . `Firm`Name (If Applicable) ~ - -- Q -- ~ ~: i,--~ J A N L B R O W N & A S S O C First line of address 8 4 5 S I R T H O M A S C O U R T Second line of address S U I T E 1 2 Cit•; or Post Office H A R R I S B U R G REGIST E~WILLS U9E70NLY t' ~ ~ - i ~ r,- :_~-, --- -, C'7. .~ r. ~ ~:~ ~ ~. ~., . ~ 6 .~ == ~ -~ ~~ ~ ~t~ _ ,~ ~ ~ `._,, ~ Q f C~ State 7_IP C^de _ DATE FILED P A 1 7 1 0 9 Correspondent's a-mail address: C H R I S T A J L B a V E R I Z O N• N E T Under penalties of perjury, I declare that I have examined this return, including acx:ompanying schedules and statements, and to the bes of my knowledge and belief, it is true, conect and complete. Declaration of preparer other than the personal representative ~s based on all information of which preps r has any knowledge. SIG T RE OF PERSO RESPO IBLE FOR FILING RETURN ' DAT ~• /U-- ADD 1y9 CAMBRIDGE DRIVE MECHANICSBURG PA .17055 THAN REPRESENTATIVE REDRESS 845 SIR THOMAS COURT, SUITE 12 HARRISBURG ~ PA 17109 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 15D56~I7121 J 1505607221 REV-1500 EX Decedent's social Security Number Decedents Name: BETTY W• CASEY 2 0 1 1 6 3 2 1 4 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. ~ 6 9 7 5. 0 8 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . .... .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6. 2 8 7 4 . 3 7 7. Inter-Vivos Transfers & Miscellaneous Ng~Probate Property Billi R t d t S 7 . ng eques e epara e (Schedule G) u .... . .. 8. Total Gross Assets (total Lines 1-7) ..................... ...... 8. E~ 9 8 4 9. 4 5 9. .......... Funeral Expenses & Administrative Costs (Schedule H) .... 9. .. 4 1 7 1 . 7 3 2 2 0 0 0 10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I 9 9 ( ) ...... .... 10. .. . 11. Total Deductions (total Lines 9 & 10) ..................... .... .. 11. 4 3 9 1. 7 3 12. Net Value of Estate (Line 8 minus Line 11) ................... .... .. 12• Ep 5 4 5 7. 7 2 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............ .... .. 13• ~ 5 4 $ 7 7 2 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 0 0 0 15 0. 0 0 . (a)(1.2)x.o _ . 16. Amount of Line 14 taxable 7 6 5 4 5 7 2 2 9 4 5. 6 0 . at lineal rate x .045 16, 17. Amount of Line 14 taxable 0 0 0 17 0 . D 0 at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 0. 0 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 1505607221 Side 2 2 9 4 5. 6 0 1505607221 a REV-1500 EX Page 3 Decedent's Complete Address: File Number 0 0 DECEDENTS NAME BETTY W. CASEY STREETADDRESS 2100 Bent Creek Boulevard _____ _ _ CITY T STATE ZIP Mechanicsbur PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A, Spousal Poverty Credit B. Prior Payments 2,798.32 C. Discount 147.28 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 2,945.60 Total Credits (A + B + C) (2) 2,945.60 Total InteresUPenalty (D i• 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. (3) 0.00 (4) 0.00 (5) 0.00 (5A). B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ' 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT' i PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APF~ROPRIATE 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 deatF~ 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? .................................................................................................. ^ ^X 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 ruse 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 or younger at death to or for the use of a natural parent, an adoptive parent, a 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)], 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 + (&98) SCHEDVLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBE BETTY W. CASEY p ~ Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. Morgan Stanley Smith Barney Security Account #651-75117-1-0-247 2. Bridges at Bent Creek Refund 3. (United Healthcare Refund 66,615.53 183.87 175.68 TOTAL (Also enter on line 5, Recapiqulation) I S 66, 975.08 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER' BETTY W. CASEY 0 0 Han asset was made joint within one year of the decedents date of death, k must be reported on Schepule G. SURVNING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Kathleen Roth 119 Cambridge Drive (daughter Mechanicsburg, Pennsylvania 17055 t3 C JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH ' VALJE OF ASSET ---~- 96 OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. 05/2004 Sovereign Bank Checking Account #1681712008 2,741.116 50. 1,370.58 2. A 05/2004 Sovereign Bank Savings Account #1684012402 3,007!,58 50. 1,503.79 TOTAL (Also enter on line 6, Recapitulation) I E 2,874.37 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8r INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBE BETTY W. CASEY 0 0 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Auer Cremation Services of Pennsylvania 146.90 2. Jon Uhlinger; Clergy fee 100.00 3. Camp Hill United Methodist Church Hospitality; funeral luncheon 600.00 4. The Patriot News; obituary 231.29 5. Brian Rice; organist for funeral 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip Year(s) Commission Paid: y, Attorney Fees Jan L. Brown & Associates 2,500.00 3, Fatuity Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills, Cumberland County 181.00 5 Accountants Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal; legal advertising 75.00 8. The Sentinel; legal advertising 187.54 9. Register of Wills, Cumberland County; Inheritance Tax Return & Inventory 30.00 10. Register of Wills, Cumberland County; Family Settlement Agreement filing fee 20.00 TOTAL (Also enter on line 9, Recapitulation) ~ S (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN scHEOV~E ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBE~t BETTY W. CASEY 0 0 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unr$imbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Rosa Lucindon, final extra duty nursing 120.00 2. Odyssey Health Care, final nursing services for Betty W. Casey TOTAL (Also enter on line 10, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) 100.00 220.00 REV-1513 EX + (9-00) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUM68R BETTY W. CASEY 0 0 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECED NT Do Not List Trustees) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include ou (right spousal distributions, and transfers under Sec. 9116 a) (1.2)] 1. John W. Casey Lineal 31,291.68 23 S. Oak Street 50% of residue Ephrata, PA 17522 2. Kathleen D. Roth Lineal 34,166.04 119 Cambridge Drive 50% of residue Mechanicsburg, PA 17055 Schedule G ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRI TE, ON REV-1500 COVER SHEET n, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER (If more space is needed, insert additional sheets of the same size) __ _ - , REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 2~7~8.32 Discount: 147.28 Interest Table Year Days Delinquent Balance Due i Interest this time period this-year this period Before 1981 ___ 1982 1983 --- - --- ----- - - ---- j ~- - -- -_ - } - ----- -- - -- -- - - ~ I1984 ~ ~ 1985 1986 - -- ---- - 1987 ~ ~ 1988 through 1991 i ---------- _---...-- ---- ___ - --- _ _ _-_-_- -_------_-__-- - 1992 1993 throu h 1994 _--- -- -- ----- --- J I 1995 through 1998 -- -- --- -_-- -- ---------- ____-_--___--- - -- - -_--_ _.~ r- _ _ --- - _ ~, 1999 -_-_- ____ - 2000 _2001 ~ 2002 _ - - - --- _ l - 2004 ---- ~-_ - _ i __ - - _ 2005 ---- --- - I ~. --__ _ _ --- - - -- _ - - ~ ~' Lvus 7 - ~ 200 + ~ ~ r ---- -- -- _ . - -_ _ _ - 2008 ~ i 2009 I - ~ ---- ------- --------- _-_----- - --__ .._ -- ~, I _- - -- ---- ------ 1~ -- - ------ - -- -- - - - -1 -- -- I !~ TOTALS l._ - - - ----~ ---- -- - - -- ----~ Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: LAST WILL AND TESTAMENT OF BETTY W. CASEY I, BETTY W. CASEY, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils that I mad have previously N n C7 ca made. ~= o .~ - . ~ cY ~;~~~ ~ m Q - '- ,,-_~- -- Article I ~: ~ c ~` ~ ~ - __' :`x~ ~ _~ My just debts and expenses of my last illness, funeral, and administration', of rriyestate sh~ ' be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claiin reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. ~ i Article III I give, devise and bequeath in a ccordance w ith a ny m emorandum w Lich I h ave a ither handwritten or signed, located with my will or with my valuable papers and found) within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organisations which exist at my death, and if there is a conflict, the memorandum having the latest date shill govern. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath IN EQUAL SHARES to my daughter, KATH~.EEN D. ROTH, of Cumberland County, Pennsylvania and to my son, JOHN W. CASEY, of ~.ancaster County, Pennsylvania. If any of my beneficiaries predecease me or fail to survive me by thirty (30) days, I give, devise and bequeath his or her share to his or her issue who survive me, per stirpes, or if he or she has no issue, the share(s) are to be added equally to the other shares. Article V I nominate, constitute, and appoint KATHLEEN D. ROTH as Executri~c of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate, constitute and appoint JOHN W. CASEY a,5 successor Executor of my Last Will and Testament. I direct that my Executrix or successor Executor be permitted to serve without bond and in addition to those powers granted by law, I grant them power tm distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could hive filed if living. My Executrix or successor Executor shall receive reasonable compensation for se~rrvices rendered to my estate. Article VI In addition to the powers conferred by law, I authorize my Executrix and successor Executor, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private salel, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c} to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investrrients, (e) to compromise claims without court approval and without consent o~ any beneficiary, (f) to file any federal income tax return for any year for which I have nok f led such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my (i) to conduct alone or with others, any business in ;»tev,esr in ar rime ofmy Executor; and to pay from my estate reasonable compensation for all their servjces, (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, BETTY W. CASEY, hereby set my hand ~o this my Last Will and Testament, on U o~ 2004. BETTY W. CASEY In our presence, the above-named BETTY W. CASEY signed this andl declared this to be her Last Will and Testament and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name ~~~~ ~~L~c SC~ ~ ~' _ ~ Address n tf ysSr- 7fia~ s ~-aG~r ~ ,jy~~ / 7/D~ CJ'/ ~7 ~~i~l` ~Q ,1 ~ 7 -4- I, BETTY W. CASEY, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein ex~ressed. Sworn to or affirmed and acknowledged before me by BETTY W. CASEY, the Testatrix on ~~,/ a ~ 2004. o~f to ublic ry IM NMEIIt OF ~~~ ~~ M- COMMSRION O~NIEB ORS 11 !0~ BETTY W. SEY We, the undersigned witnesses who signed the foregoing instrument, bung duly qualified according to law, depose and say that we were present and saw the Testatrix sigh and execute this instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing signed the Wild as witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years dr more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by .. ~d ~ S~, CTx~,-~~If' and ,~~ , witnesses, on _ , 2004 U• tary P lic o MoNw~t.TMaF~ NOTMIAL SEAL ~IAI~~~Ery~Ay. NyEI~tXnN,OTA~RY/r~Uy~~1C~ TRPH {NMI 1 ~ w ~ EXPIRES o~c.17 2OW -5- =-c T<~ ~~c 5~ tness i1 Witness