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Home My WebLink About11-04-091505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Yaar File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 h 2 Harrisburg, PA 17128-0601 RESIDENT DECEDENT toC-~~ ~ l UJ ENTER DECEDENT INFORMA Social Security Number ~w Date of Death 04 03 2009 Date of Birth ~/~aZ Suffix Decedent's First Name MI BEULAH R Decedent's Last Name SHEAFFER (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 DUPLICATIE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-1~-82) 4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-12-t32) X^ g Decedent Died Testate (Attach Copy of Will) ~ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe De sit Boxes ~ 9. Litigation Proceeds Received ~ 1 p, Spousal Poverty Credit (date of death between 12-31-91 and i 1 95 ~ 1 t ,Election to tax under Sec. 9113(A) - - ) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA ION SHOULD BE DIRECTED T0: Name Daytime Telepf(one Number Firm Name (If Applicable) First line of address Second line of address City or Post Office Correspondent's a-mail address: State ZIP Code r. REGISTER LLS US NLY.~_ t t: ~ :. ~ f r rr ~ 4..: _'~' s M z ~~~ «;, ' r T`i E FILED p ~~° r Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the b st of my knowledge and belief, it is true, correct and complete. DeGaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATU OF PERSON R PONSIBLE FOR FILING RETURN DATE ~~„~~ , Lana Forconi ~~ /~ ~ h q 512 Haldeman Boulevard, New Cumberland, PA 17070 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 15D5607120 Side 1 150560720 J ~~ PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF I FILE NiUMBER I Sheaffer, Beulah R 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 prepares other than the personal representative is based on all information of which prepares has any knowledge. Signature #2 ~~ I" f Name Karen Mohler Address1 ~ 7, am n ~.cJ Address2 City, State, Zip f~ / 7~3~39. Date iv -a ~-0 9 1505607220 REV-1500 EX Decedent's Social Security Number ~ecedenrs Name: B e u l a h R S h e a f f e r ~~ ~_ 1 g_~~~ J 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. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 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. 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. 2,248.92 7,738.83 1,847.72 11,835.47 12,147.12 1,821.19 13,968.31 -2,132.84 -2,132.84 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 .00 0 . 0 0 15. 16. Amount of Line 14 taxable 0 . 0 0 16 at lineal rate X .045 . 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 150560720 0.00 0.00 0.00 0.00 0.00 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Beulah R Sheaffer STREET ADDRESS ~ ~,, ~~ J.~~ ~ 3 a, CITY L ~~ STATE PA ZIP / 7 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 0.00 Total Credits (A + B + C) (1) 0.00 (2) 0.00 Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. Make Check Payable to: REGISTER OF WILLS, AGENT (3) (4) (5) 0.00 (5A) (56) ~ . ~ ~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRpP~RIATE 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 reveprsionary interest; or......•p••yments, benefits or care? .............:...:.................. ~ ^ d. receive the romise for life of either a ......................... 2. If death occurred after December 12, 1982, did decedent transfer property wdhin one year of death without receiving adequate consideration? ....................................................................................................................... ^ x^ 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? ...................................................................................................................... ~ ^ 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 tb 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 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)]. 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-1608 E7(+ (g_gg) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COIriMONWEALTH OF PENNSYLVANIA I I INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Beulah R InGude the proceeds of IiOgation end the date the proceeds were received by the estate. All property Jolydly-owned whh the right oT survivorship must be disclosed on schedule F. pT more space Is nestled, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PAI.1500 Schedule E (Rev. 6-98) Rev-1609 t:x+ (9-98) SCHEDULE F COMdONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Beulah R tt an asset was made Joint within one yosr of the decedent's date of death, tt must be roported on schedule G, SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Lana Forconi B. Karen Mohler c. ,~/oZ t~r4 /G~G~m.~ itJ /~~t/G~ „~~u.~ ~ ~ 7339 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 VALUE OF ASSET % OF pECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A,B 1/1/1999 NCFCU -Checking Account 6,615.44 5p.000% 3,307.72 2 A,B 1/1/2001 NCFCU -Savings Account 11,917.99 33.333% 3,972.66 3 A,B 1/112001 Prudential Financial Inc -Com, CUSIP 250.14 33.333% 83.38 #744320102 4 A,B 111!2001 PSECU -Account Checking 14.47 33.333% 4.82 5 A 111/2001 PSECU -Account Savings 179.43 33.333% 59.81 6 A, B 5/111987 Sovereign Bancorp -Com, CUSIP 876.54 33.333% 292.18 #845905405 7 A, B 5/1/1987 Sovereign Bancorp -Com, CUSIP 54.78 33.333% 18.26 #845905405 TOTAL (Also enter on Line 6, Recapitulation) I 7,738.83 - (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form Pa-1500 Schedule F (Rev. 6-98) Estate Valuation Date of Death: 04/03/2009 Valuation Date: 04/03/2009 Processing Date: 10/22/2009 Shares Security or Par Description 1) 11 PRUDENTIAL FINL INC (744320102) COM New York Stock Exchange 04/03/2009 2) 4 SOVEREIGN BANCORP INC (845905405) PFD 1/1000PP C New York Stock Exchange 04/03/2009 3) 64 SOVEREIGN BANCORP INC (845905405) PFD 1/1000PP C New York Stock Exchange 04/03/2009 Total Value: Total Accrual: Total: $1,181.49 Estate of: Forconi Report Type; Date of Death Numlaer of Securities: 3 File ID: fOrCOnl Mean and/or Div and Int Security High/Ask Low/Bid Adjustments Accruals Value 23.84000 21.64000 H/L 22.740000 250.14 13.97000 13.42250 H/L 13.6Si6250 13.97000 13.42250 H/L 13.696250 54.79 876.56 $0.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.1) Rev1510 EX~ (5.98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANN INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Beulah R 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 COVEF2 SHEET is yes. ITEM NUMBER I I INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST Ex~LUSION (IF APPLICABLE) TAXABLE VALUE 1 PSECU -IRA Account -Beneficiaries: Lana 1,847.72 1.847.72 Forconi and Karen Mohler, Decedent's Daughters TOTAL (Also enter on Line 7, Recapitulation) I 1,847.72 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA+7500 Schedule G (Rev. 6-98) REV-1151 EX+ (12.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF - I FILE NUMBER Sheaffer, Beulah R Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) ! EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2, Attorney's Fees. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip _ Relationship of Claimant to Decedent 4. I Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 12,061.92 30.00 7. Other Administrative Costs 55.20 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 12,147.12 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA:1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUN76ER Sheaffer, Beulah R ITEM NUMBER DESCRIPTION AMOUNT Funeral Exaenses 1 Flowers for Funeral 265.00 2 Funeral Reception 300.00 3 Gravemarker 150.00 4 Opening of Grave 750.00 5 Parthemore Funeral Home 10,596.92 H-A Subtgtal 12,061.92 Other Administrative Costs 6 Cumberland County Register of Wills Office -Filing Fees for Inheritance Tax Return 30.00 and Inventory 7 Stamps 25.20 H-B7 Subtdtal 55.20 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA~1500 Schedule H (Rev. 6-98) Rev1612 Exf (6-88) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS COMMONWEALTH OF PENNSYLVANIA - INHERRANCE TAX RETURN RESIDENT DECEDENT - ESTATE OF -I,FILE NUMBER Sheaffer, Beulah R ~~ Include unrelmburesd medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9.00) SCHEDULE J COMMNHERITANCE TAX RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF Sheaffer, Beulah R FILE NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustes s I TAXABLE DISTRIBUTIONS [include outright spousal . distributions, and transfers under Sec. 9116(a)(1.2)] Lana Forconi Daughter 1/2 of Estate PA Karen Mohler Daughter 1/2 of Estate PA Total Enter dollar amounts for distributions shown above on lines 5 through 18, as appropri ate, on Rev 1500 c' ve r sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTA L OF PART II -ENTER TOTAL NoN-TAxAai_F nisTRiRUrinnls nni i wF 13 nF tzt=v_lann cnvGO suGGT n nn Copyright (c) 2002 form software only The Lackner Group, Inc. Form PAr1500 Schedule J (Rev. 6-98) WELL OF BEULAH R. SHEAFFER I, BEULAH R. SHEAFFER, of the Borough of Lemoyne, Cumberland County, Pennsylvania, declare this to be my last will and revoke any wall previously made by me. Item I. I devise and bequeath all my possessions and estate of every nature and wherever situate to my husband, G. KENNETH SHEAFFER, provided he survive my death by sixty ( 60 ) days. Item II. Should my husband, the said G. Kenneth Sheaffer, predecease me or be deceased on the sixty-first day following my death, I devise and bequeath all my possessions and estate of every nature and wherever situate to be divided equally among such of my issue, per stirpes, as survives my death by sixty ( 60 ) days. Item III. I appoint my husband, G. KENNETH SHEAFFER, executor of this my last will. Should my husband fail to qualify or cease to serve' as executor, I appoint my daughter, LANA FORCONI, of New Cumberland, Pennsylvania, executrix of this my last will. Should both my husband and my daughter, Lana Forconi, fail to qualify or cease to serve as executer or executrix of this my last will, I appoint my daughter, KAREN MOHLER, of New Cumberland, Pennsylvania, executrix of this my last will. Item IV. I direct that my personal representatives, as we'll as their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. T' ,.. ~' r yL_.. . l Beulah R. Sheaffer IN WITNESS WHEREOF, I have hereunto set my hand this ~~•r day of ~':.~ 1976. Beulah R. Sheaffer r The preceding instrument, consisting of this and one other typewritten page, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by Beulah R. Sheaffer, the i~estatr'ix therein named, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. ;., -- ( ~ // ~ ~` /f ~~ t / ~ ~ i~