HomeMy WebLinkAbout11-06-09' 1505607121
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes OFFICIAL USE ONLY
County Code Year File Number
Po sox 2aosol INHERITANCE TAX RETURN 2 1 0 8 1 1 0 1
Harrisbum, PA 17126-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
0 1 3 0 2 0 0 8 1 2 2 3 2 0 2 7
Decedent's Last Name Suffix Decedent's First Name MI
P A G E J E A N C
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
P A G E J R L E O N A R D H
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 ~ 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 ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of VIII) (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 M A R K T H O M A S E S Q U I R E 7 1 7 7 9 6 2 1 0 0
Firm Name (If Applicable)
First line of address
1 0 1 S O U T H M A R K E T S T R E E T
Second line of address
City or Post Office
M E C R A N I C S B U R G
State
P A
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Correspondent's a-mail address: rmarkthomasCu~gmail.com
Under penalties of perjury, I declare that I have examined this return, including acxompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the perso e is based on all information of which preparer has any knowledge.
SIGNATURE OF
FOR FILING RETURN
'/,
TE
ADDRESS r / ~
30 LAUREL DRIV MECHANICSBURG PA 17055
SIGNA~~18'1~OFp~PAR THAN REPRESENTATIVE DATE
/i/,s'
101SOUTH_MARKET STREET
MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
],505607121 1505607121 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 oa 1101
DECEDENT'S NAME .
JEAN C. PAGE
STREET ADDRESS
30 Laure! Drive
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
1 • Tax Due (Page 2 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + 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) o.oo
(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
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 : ...................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^ 0
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ Q
3. Did decedent own an "intrust 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 (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)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
' 1505607221
REV-1500 EX
Decedent's Social Security Number
Decedents Name: JEAN C• PAGE
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1. 1 8 1 9 6 9. 2 0
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 8~ Miscellaneous Personal Property (Schedule E) ....... 5. 3 4 6 9 7 . 5 0
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. 2 1 6 6 6 6. 7 0
9. Funeral Expenses 8~ 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. 2 1 6 6 6 6 . 7 0
13. Charitable and Governmental BequestslSec 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 1 6 6 6 6 . 7 D
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 3 4 6 9 7. 5 0 15.
16. Amount of Line 14 taxable
at lineal rate X .0 0 0 0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 D 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 1 g.
19. Tax Due .............. ........................ ... ....... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505607221
0. 0 0
D. 0 0
0. D 0
D. D 0
0. 0 0
1505607221 J
REV-1502 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
JEAN C. PAGE 21 08 1101
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 0 Laurel Drive, Mechanicsburg, PA 17055. This value was arrived at by taking the 2009 assessed value 181,969.20
nd multiplying same by Cumberland County's common level ratio factor of 1.26. Attached hereto is a copy
f the 2009 tax bill.
TOTAL (Also enter on line 1, Recapitulation) ~ ~ 181 969 20
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RESIDENTEDE EDEN RN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
JEAN C. PAGE 21 OS 1101
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Annuity beneficiary of Joan A. Carpenter, deceased, date of death was 9/7/08, and for whose estate a 34,697.50
Form REV-1500 was filed on 4116109, under case no. 21-08-0930.
can C. Page, deceased, was a 25% beneficiary of the OM Financial Life Insurance Company, Annuity
'olicy No. 05000049 which is identified on Schedule G, item No. 1, on the Carpenter Estate Inheritance Tax
return. Since Jean C. Page predeceased Joan A. Carpenter, the $34,697.50 was given to the Estate of
can C. Page.
TOTAL (Also enter on line 5, Recapitulation) I ~ 34
(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
JEAN C. PAGE 21 08 1101
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}]
1. Leonard H. Page, Jr. Spouse 100.00
30 Laurel Drive
Mechanicsburg, PA 17055
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 TAX IS 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 $
(If more space is needed, insert additional sheets of the same size)
L A S T W I L L A N D T EST A M E N T
OF
JEAN CAROL PAGE
My name is JEAN CAROL PAGE and I am a married wanan, residing at 30
Laurel Drive, Mechanicsburg, Pennsylvania 17055. My husband's name is LEONARD
HARRY PAGE, JR., and I am the mother of five children named KIMBERLYN ANN
MINNICH, DAWN MARY WILSON, JOAN MARIE BARR, CAROL JEAN PAGE and BETH ANN PAGE.
Being of sound mind and disposing memory, full legal age, realizing
the uncertainty of this Life, and with full confidence and trust in our Lord
and Savior, Jesus Christ, in His death for my sins on the cross and in Nis
shed blood as an atonement for my soul, and knowing that by faith In His
sacrifice on the cross for me I have eternal life but not acting under duress,
menace, fraud, restraint or undue influence of any person whomsoever, I hereby
make publish and declare this instrument to be my Last Will and Testament
hereby revoking and cancelling all former Wills and Codicils made by me.
ARTICLE I
I direct my Executor to pay all of my just debts except encumbrances
on real or personal property. When such encumbered. property exists it shall
pass under the terms and conditions of this Will subject to said encumbrances,
provided however, that any installment payments, current or past due, on
either principal or interest on such encumbrances may be paid by the executor
in his discretion. I direct my executor to pay the expense of my last illness
and the cost of a Christian Funeral and burial, head stone or marker all as
may be requested by my next of kin . I further direct that alI .inheritance,
transfer, succession, estate and other such taxes or assessments levied
against my estate together with all probate cost and administration expense
shall be paid out of m y general estate and not levied against an y particular
beneficiary. Where a gift, bequest or devise is expressed as a percentage In
the following Articles, it refers to the percentage of that portion of my
gross estate available for distribution unless a contrary intention appears In
the Article. Priority for distribution of the gifts and bequestsherein made
shall follow the Article number with the lower numbered Article tak.tng
priority over an y Article appearing subsequently unless a contrary intention
appears in the Article.
This Wi11 Is not made as a result of any contract or agreement,
either expressed or Implied which would in any way restrict my right or power
as Testatrix to revoke any or all provisions of this Wi11. If any provision
of this WI11 shall be declared Inoperative or in violation of any rule of law,
such invalidity shall not affect the remaining provisions of this Will and
they shall remain in full force and effect.
i ~ ~1
TESTATRIX'S SIGNATURE
PAGE ONE OF MY ILL
ARTICLE II
I give and bequeath all items of tangible personal property used for
personal reasons, excluding all gain seeking items of personal property, and
including household effects, clothing, jewelry, furniture, china, musical
instruments, books, pictures and automobiles as follows:
First: If I am survived by my spouse, all items described above I
give and bequeath to my spouse.
Second: If I am not survived by my spouse, I give and bequeath the
above described items to such persons as may be selected by my executor. I
intend to prepare a memorandum of instructions for my executor as to my
desires concerning the distribution of the above described items.
Third: In the event that the above described items are not
distributed pursuant to First or Second subparagraphs above and I am survived
by one or more of my children, then the above described items sha11 be
distributed to said children in kind as nearly equal as is practical. The
division shall be made pursuant to agreement between the children if possible,
if not, the division sha11 be made by discretionary appointment of the
executor or executrix.
Fourth: In the event the above described items have not been
distributed under Subparagraph First, Second or Third above, then, 2 direct my
executor or executrix to sell said items and add the proceeds to my residuary
estate.
ARTICLE III
In the event that my husband above named sha11 survive me, by at
least 60 days, I hereby give, devise and bequeath all of the rest, residue and
remainder of my property, real, personal, and all assets of every kind and
description, and any interest in property which I may own at the time of my
death, to my beloved husband above named, as his absolute property. I have
intentionall y failed to make any other provisions for my children above named
~I or any children born to me or adopted by me after the execution of this Wi11,
as I have complete confidence that my husband wi11 properl y provide for my
children .
ARTICLE IV
In the event that my husband above named shall predecease me, or in
~ the event he shall fail to survive me by 60 days, or in the event that both my
said husband and I sha11 perish in mutual accident or disaster under
circumstances rendering it impossible to determine the survivor, and provided
further that I am survived by one or more of my children, then and under those
conditions and y, I give, devise and bequeath all of the rest, residue and
remainder of my property, real, personal and all assets of every kind and
TESTATRIX'S SIGNATURE y i
~ PAGE TWO OF MY WI L
description, and any interest in property which I may own at the time of my
death as follows:
• Ninety percent (90~) of my gross estate available for distribution is
to be divided into a sufficient number of equal shares to provide one such
equal share for each child who survives me, share and share alike.
Ten percent (109K) of my gross estate available for distribution
together with any residuary estate not hereinbefore disposed of is to be given
to CHRISTIAN LIFE AS5EMBLY OF GOD, Camp Hill, Pennsylvania, to be used by it
as an undesignated gift.
ARTICLE V
In the event that any person, including a devisee, legatee or
beneficiary under this Wi11 shall either directly or indirectly seek to
establish or assert any claim to my estate, or an y part thereof, not
authorized by this will, or seek to impair, invalidate, or set aside the
provisions of this will, or to have any of the trust provisions or estate
distributions limited, declared void or diminished or to defeat or change any
of the dispositive scheme of this Wi11, or shall endeavor to secure or take
any part of my estate in any manner other than through or under this Wi.Il, I
hereby give, devise and bequeath to such person or persons the sum of Ten
Dollars ($'10.00) and no more in lieu of any other share or interest in my
estate. Provided further that nothing in this Article contained shall prevent
any beneficiary hereunder from bringing an action against any fiduciary
hereunder, for an accounting, nor from enforcing any statutory share to which
the heir may be entitled.
ARTICLE VI
If any person shall be required to survive me or another person in
order to take any interes°t under this will, such person shall be deemed not
to have survived if such person shall die as a result of a common disaster or
under circumstances rendering it impossible to determine the survivor or where
there is not sufficient evidence to determine that such person survived,
except as to my husband and in order for ham to take any bequest provided for
him in this will he must survive me by sixty days.
ARTICLE VII
I hereby nominate and appoint my husband above named, as Executor of
this, my Last Will and Testament, and I further direct that no bond be
required of him. In the event that he shall predecease me, or shall be unable
to serve for any reason, I nominate and appoint KIMBERLYN ANN MINNICH, as my
Executrix hereunder and direct that she serve without surety or bond. In the
event that KIMBERLYN ANN MINNICH shall predecease me, or shall be unable to
serve for any reason, I nominate and appoint JOAN MARIE BARR, as my Executrix
~ , ~~
TESTATRIX'S SIGNATURE ~ ~
PAGE THREE OF M ~ WILL
i
hereunder and direct that she serve without surety or bond.
If the laws of the state where my estate is administered permits
independent administration; or if the Laws of the state where my estate is
administered permits any abbreviated, shortened, family, summary or other
non-formal administration, I authorize my personal representative or an y
successor, to administer my estate independently without adjudication; order
or direction of any court if so permitted, or with any abbreviated
administration if so permitted. The decision. to administer my estate
independently and unsupervised or under court supervision shall rest solely
with my personal representative or any successor.
I hereby specificall y waive any residence requirement in the event
that my domicile shall be in a different jurisdiction than that of my proposed
Executor or Executrix herein named, where allowed or permitted, and in the
event that any executor or executrix herein named shall be disqualified from
serving solel y because of the inability to meet an y residence requirement
mandated by the State of which I am a resident on the date of my death, then I
request the Court to appoint a qualifying co-executor to serve with the person
above named. The Executor or Executrix or personal representative appointed
by this Article is specifically authorized to administer any portion of my
estate which may be situated in a foreign jurisdiction, if allowed or
permitted, and the said person is hereby authorized to-post any recognizance,
pledge or bond at the expense of my estate.
The appointment of an "Executor" or "Executrix" in this will is also
the appointment of a personal representative where allowed or required and
said fiduciary is to serve without surety or bond.
In addition to the powers conferred by Zaw and within the
restrictions required by law, and the foregoing Articles of this instrument, I
hereby specifically authorize and empower any duly appointed executor,
executrix or personal representative, herein named, to do all such acts, take
a1I such proceedings and exercise all such rights and privileges, although not
hereinbefore specificall y mentioned, with relation to any property, real or
personal in the custody of said fiduciary, to take all actions required or
implied to prudentl y preserve the assets of the estate and in connection
therewith to buy, sell, pledge, mortgage, hypothecate, lease or to enter into
any covenants or agreements binding the decedent's estate.
IN WITNESS WHEREOF, I, the said JEAN CAROL PAGE, hereby declare this
instrument to be my Last Will and Testament and to the same as such and to
every page thereof I have subscribed my name and to the last page thereof have
subscribed my name and affixed my seal this ~(~~ day of ,
19~.
-~
~Cvt / -~....._
TATRIX
We the undersigned do hereby certify and attest that JEAN CAROL PAGE
TESTATRIX'S SIGNATURE ' C ~)
PAGE FOUR OF MY WILLv
Testatrix, on the day and year above written, signed and sealed the within and
foregoing instrument consisting of five (5) pages, including the witness
clause, and signed each and every page thereof in our presence and published
and declared the same to be her Last Will and Testament, and we immediately
thereafter, at her request, in her presence and in the presence of each other
have hereunto set our hands as subscribing and attesting witnesses hereto and
we further certify that at such time she was of full Legal age and sound and
di sing mind and memor
mess ignature) address
,c
City State - r
(Witness signature)
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( fitness signature)
City c:"' State
~~o~~' ~v~C~~~~~~ Ly~,~e
address
p%rl~e~G1~aP'~r~=,1~~'i~ 1''~'~ ~
City Sta e
TESTATRIX'S 5YGNATURE
IFTH AND FINAL PAGE O Y WILL
A F F I D A V I T
State, of ~,~.Y1,Y1cc.. )
County of ~l...
9efore me, the .undersigned, an officer authorized to administer
oaths, on this day appeared ,S~~P Q,y~ ~in~ ~~~.,~_ (Testatrix) to me
known to be the Testatrix and the t~itnesses whose names are hereinafter
subscribed as witnesses and who appeared together before me and after being
duly sworn upon. their oath and UNDER PENALTIES FOR PERJURY declared that they
signed the annexed or foregoing LAST WILL AND TESTAMENT as Testatrix and
Witnesses respectively. I certify that the Testatrix declared to me, and to
the Witnesses in my presence, that said instrument was executed by her as her
LAST WILL AND TESTAMENT and that she had willingly made and executed it as her
free and voluntary act and deed for the purpose therein expressed; and the
said Witnesses, each on their oath stated to me, in the presence and hearing
of the Testatrix, and in the presence and hearing of each other, that said
Testatrix had declared to them that said ,instrument is the Testatrix's LAST
WILL AND TESTAMENT and that she executed the same as such and requested each
of them to sign it as Witness. Upon their oath each Witness stated that they
did sign the said instrument as Witnesses, in the presence of and at the
request of the Testatrix and in the presence of each other Witness. Each
Witness states upon their oath that they saw the Testatrix sign the
instrument; and that they saw the Testatrix affix her signature to each and
every page of the instrument at a space provided near the bottom of each page
of the instrument; that they saw each other Witness sign the instrument; that
at the time Testatrix signed the instrument she was of full legal age and of
sound mind and memory] that they make this affidavit at the request of the
Testatrix.
TESTATRI
Wi the
~a~~~'C~
Witness
witness
Subscribed, sworn and acknowledged before me by the said
~"3o~n~fO~ P~q~ Testatrix, and subscribed, sworn and
acknowledged before me by the Witnesses whose names and signatures appear
above as Witnesses.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my
official seal this ~~ day of ~~ 19 ~.
(Seal)
Notary P is
UWAYNE 0. HECKERT, Notary Public
My commission expires: r Cumberland Co., Pa.
'ny Commission Expires une ,
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