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HomeMy WebLinkAbout11-13-09 (4)15056041046 REV-1500 EX (05-04) OFFICIAL USE ONLY PA Department of Revenue Count Code Year File Number Bureau of Individual Taxes y _ Dept.28060t INHERITANCE TAX RETURN Harisburg, PA 17128-0601 RESIDENT DECEDENT Z- ~ ~ ~ ~ ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 6 y_ o~.q9` ~ ~~3 2 00 9 ~ l i sr~9'i 3 Decedent's Last Name Suffix Decedents 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 "a',~>,.~.' ' ~' 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 O 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-1382) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. Q) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number SUSAN ~ CAA who ~ D F N If A I bl irm ame i p~ ica e) First line of address X36 Nvl~ ilk Second line of address ~ C~Go2 D S7" City or Post Office ~~}lC LT.~~E State P ~} REGISTER OF'WILLS U~ONLY ,C ~ ...., O J Cw ~ _ ~ 7~7 ~ ~ ~~ ~ ~ (~ Z ~ - FILED .. r ` ~--~ ,.~ _ -- ziP c~d~ L l X0/3 Correspondent's a-mail address: 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 compjete. Declaration of preparer other than the personal representative is based on all information of which prepaner has any knowledge. SIGN!{I~URE OF PER$O R N$t1~LE FOR FIVJNG RETURN ~ nnTF '~ SIGNATURE OF PREPAR OTHER T N EPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 J REV-1500 EX lhrvh ~~OGIGL~A Decedent's Social Securi Number RECAPITULATION _ _ -- .y { ~ -z 1. Real estate (Schedule A) ....... . ..................................... 1. ~ ~'~ s , 2. Stocks and Bonds (Schedule B) ..................................... .. 2. ,• ,~` s .~ ~: 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... . ; 3. er ~wJ,~ s~ ,~. 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. i_ ; >~ „r-ins - ~, , 5 Bank De osits & Miscellaneous Personal Pro ert Schedule E Cash 5. s ~ G . , a`,. 6. Jointly Owned Property (Schedule F) G Separate Billing Requested ..... .. 6. `~- ~zV:±i 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C Separate Billing Requested...... .. 7. ~ '~ ~ 5 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. L/ : 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. ,; _ ~: _ 3 ~.~:~ ~ ~~ ~, ~ , 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 ~ + ~- ~ ~ ~ 16 ,-+ S ~ ~ ~ / at lineal rate X .0 _ . . 17. Amount of Line 14 taxable am j at sibling rate X .12 "y 17. - t^ ~ 18. Amount of Line 14 taxable ~;,.-~- " at collateral rate X .15 « 18. ;,, ., _, !~ • ., . ~ ~' ' 19. TAX DUE .................................................... ..... 19. r-; °~-~ :.-.. r 1 ~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 15056042047 i~ 7 Side 2 15056042047 15056042047 REV-1500 EX Page 3 Decedent's Complete Address: File Number ~ ) ~ ~y v~ DECEDI=NT'S NAW1E -- - ---._ STREET ADDRESS S 3G No~~ r;e ~~,.,( S~ _ ___ ___ _._._ - ----- C a ~/ ~S/e ~i9" _ ___ __ CITY STATE ~ ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (,) ~ , 3s~y ~_ mG7 Total Credits (A + B + C) (2) ~ ~, ~ Total InterestlPenalty (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) ,~ c5) /.2 8 3 (5A) --~ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) I ~ 2 ~ 3, Make Check Payable fo: 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 :.......................................................................................... ^ 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 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? ........................................................................................................................ ^ ,~ 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 far 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. REV-1508IX+(1-9~ SCHEDULE E 'COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENTDECEDENTRN PERSONAL PROPERTY ESTATE OF fl ,/~ /~ I FILE NUMBER p / Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-0wned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER L /~ DESCRIPTION ,L ,D OF DEATH 1. / ' e (~ /'0~,-~< -Saw/n~o~ 3~fO ~ Poor /bn S~", l~r~.-ris~~~j- /.~ /7//f 2..s ~ ~~f , ~' ~}u,~ ~ US 3 67v »zz ~ Z , 17e ~'~v /~ah k - Cl, cc~C ~,,5, ~ 3gU 1 ~ab~-r 5~- ~farrisl.~~~.I°i¢ /7/I/ 3~ S ~Z. cZ~ /dcc~ ~ GG262~ 1932 ~vP~Pay~~s~R~~h~s ~~<,~ y ~ ~y (~y ~ TOTAL (Also enter on line 5, Recapitulation) _ ~ ~~ % / / - (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) SCNED~ILE M COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF ~~// / 1 FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 'CunnJnt~,~tarr F~n~~l 1~,,..... ~UV~o, '~ ~I'1 Ur/httr. fi/'/~rrL$/IYlry(L,,,~ ~j - ~Uht..q,~ SCrd%cL`KCGt~hn. ~ ~~. J~ B. 1 2 3 4. 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees -Z~p - Zip 8 3, a.~- i TOTAL (Also enter on line 9, Recapitulation) I $ ~f yb (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 ~~q, l"`iryn l~o~iy~a~ 2 ~ -d / `~~6~ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] /+ 3 6 /~JO MTh ~ ~ I~r~ S C~v'~~s1e l~/~ l74/3 ,p n~l.~. Sh ~s~~ S ~w~y~~- sv~ y~ ~~~~- yr~ ST . /Ler.~ CA.s t~L ~ '~ l / 7 ~-O ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 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 $ (If more space is needed, insert additional sheets of the same size) N ~~ LAST WILL AND TESTAMENT ~-~ o r n ..~ _~. ~~ ; -s `-_-~ KATHRYN HOAGLAND ~ - ~r' ``~ I, KATHRYN HOAGLAND, a.k.a. CATHERINE HOAGLAND;.~~,~ik.a.-;u ;n ~ ,. KATHERINE HOAGLAND, of R.D.#2, New Castle, Lawrence County,4 Pennsylvania, being of sound mind and memory, do hereby make, .publish and declare this to be my LAST. WILL AND TESTAMENT, here- by revoking any and all former Wills by me heretofore made. FIRST: I direct that all my just debts and funeral expenses' be paid as soon after my decease as may be found convenient by my Co-Executrices hereinafter named. SECOND: I give, devise and bequeath all of my personal estate to my two beloved daughters, SUSAN LOUISE CRAWFORD and SANDRA KAY SHUSTA, share and share alike, and per stirpes. If j either of my beloved daughters do not survive me, her share shall I, be distributed to her surviving issue. ~ THIRD: The house in which I now live in shall be sold and I the proceeds of the sale of the house shall be distributed to I EDWARD JACK HOAGLAND, SUSAN LOUISE CRAWFORD and SANDRA KAY SHUSTAj share and share alike. To the survivors, EDWARD JACK HOAGLAND'S share, per capita. If EDWARD JACK HOAGLAND does not survive me, ~ ROBERT D. GEORGE ATTORNEY AT LAW iUITE ]03, CENTRAL BLOB. 101 i. MERCER STREET NEW CASTLE, PA 1[101 _ ~~ then his share shall then be distributed to SUSAN LUUISE CRAWF'ORU and SANDRA KAI' SHUSTA. If either SUSAN LOUISE CRAWFORD or SANDRA KAY SHUSTA do not survive me. then their share shall be distributed per stirpes and not per capita. FOURTH: I hereby nominate and appoint my daughter, StJSAN LOUISE CRAWFORD, to be Executrix of this my LAST WILL AND TESTAMENT, hereby giving and granting unto my said Executrix full power to sell and convey any and all real estate of which I may die seized, either at public or private sale, and to make, constitute and deliver good and sufficient deed or deeds to the purchaser or purchasers thereot: The said Executrix is to serve without posting bond. IN WITNESS HEREOF, I have hereunto set my hand and seal to this, my LAST WILL AND TESTAMENT, this 7th day of June, 1995. ~~r~t~eal) l ~~ l,Llx~~R~~--- NOW, this Instrument consisting of three (3) typewritten pages, was by the above named Testatrix, KATHRYN HOAGLAND, on the date hereof, signed, published and declared by her to be her LAST WILL AND TESTAMENT, in our presence, who at her request and in her presence, and in the presence of each other, we be- lieving her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. RESIDING AT ~~ ~Q-Z~ , / mac. ~J Ut1-L~ r l 1-~-~1~ .. RESIDING AT 1 C~~.~~ 1..~ ~t'~ .~ ; C~ . ROBERT D. GEORGE ATTORNEY AT LAW i U1TE 90~, CENTRAL BLDG. 101 i. MERCER 6TREET NEW CA6TLE, PA 16101 COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF LAWRENCE ) ROBERT D. GEORGE ATTORNEY AT LAW 6 UITE 909, CENTRAL BLDG. 101 S. MERCER tTREET NEW CASTLE, PA 16101 I, KATHRYN HOAGLAND, having been duly qualified according to law, acknowledge that I signed the foregoing Instrument as my LAST WILL AND TESTAMENT, and that I signed it as my free and voluntary .act for the purposes therein expressed. Ka ry Hoagl d We, having been duly qualified according to law, depose and say that we were present and saw KATHRYN HOAGLAND sign the fore- going Instrument as her Last Will and Testament; that she signed it as her free and voluntary act for the purposes therein ex- pressed; that each of us in her sight and hearing and at her re- quest signed the Last Will and Testament as witnesses; and that to the best of our knowledge that she was at the time eighteen. (18) or more years of age and of sound mind and memory and under no constrain or undue influence. ~ ~tQ.~C ~ `_~?~.h~Q..4- ~ Subscribed, sworn to, or affirmed, and acknowledged before me by the above named Testatrix, by the witnesses whose names ap- pear opposite on June 7, 1995. Notarial Seat \~~~~_ Charlene A. Farris, Notary Pudic Notary Public New Castle, Lawrence County My Commission Expires May 21, 1998 ~ • >03361 5966077 001 092140 KATHRYN HOAGLAND 536 N BEDFORD ST CARLISLE PA 17013 Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 1-888-937-0004 We're here 7 days a week, 24 hours a day at 1-888-937-0004. 50 PLUS CHECF(ING 0536707722 Statement Balance as of OB/09!09 ! $3,091.39 Plus 1 Deposits and Other Credlte 579,538:35 .e8s `- 4 Checks and Other Debits S19,038.50 Plus Interest Pald 50.76 Statement Balance as of 08/09109 53,592.00 Transactions By Date Date Description Debit Credit Balance 08/i0/09 CUSTQMER DEPOSIT. 5!9,538.35, 522,628.74 08/10/09 CHECK # 1059 3500.00 522,129.74 08/12/09 CHECK # 7061 550.00 522,079.74 08/14/09 CHECK #1060 518,480.00 33,599.74 08!14109, CHECK # 1062 58.50 53,591.24 09!09/09 INTEREST PAYMENT 30.76 53,592.00 Check Transactions Number Date Amount Number Date Amount Number Date Amount 1059 08/10 -S500.00; 1060 08114 518,480.00 7;:061 D8h2 S50.D0 1062 08114 58.50 Items denoted with an "E" are electronic entries and will not have a check image. Items denoted with an "'" indicate processed checks out of sequence Interest Summary Beginning Interest Rate 0.15% Number of Days in this Statement Period 31 InteresYEarned this Statement Period ` 30.78 Annual Percentage Xleld Earned this Statement Period (APY1 ~ 0.15% Interest Pak) Year to Date $2.54 Statement Balance as of 081091tI9 Plus Deposits and Other Credits less 2 Checks and Other Debits Plus Interest Paid Statement Balance as of 08108108 9 Combined N(1TF • SFF REVERSE GIIIF F(1R IMPr~RTANT INFCIRMATI(1N PERS STATEMENT SAVINGS 0626211932 544,21.9.41 30.0© 520,480.00 $6:51 523,745.92 Page 1 of 6 METRO-ROLL Mamhar Fr11C: 'METRO BANK Transactions By Date Date Description Debit Credit Balance ~~" ~I8/10t09 SAVINGS WITHDRAWAL 218.480.00 525.739,41 08/25/09 SAVINGS WITHDRAWAL 52,000.00 523,739.41 08J3'f/09 INTt?REST PAYMENT 56.51 523,745.92 Interest Summary Beginningtnterest Rate or25°,G Number of Days in this Statement Period 31 Interest Earned this Statement Period 55.25 Ahnual Percentage Yield Earned thls Statemerrt Period (APY) 0.25% Interest Paid Xear to Date ~' ~ '~ 574.35 It's summertime... It's home equity time! Apply today for the cash you need. Customer Service Representatives available 2417 at 1-888-937-0004. M 0 N S 0 0 N O O O O aD t0 O O r r O ~O O1 N M M O 0536707722 METRO-ROLL Paae 3 of 6 IvW1K. Date: 09/15/2009 This Month Gross payment amount 25.33 Net payment amount 25.33 0277813 REORDER 805 • U.S. PATENT NO. 5538290. 5575508, 5647183, 5785353, 5884384, 603000 2 3 313 THE ESTATE OF KATHRYN HOAGLAND CHECK NUMBER 7 3 9 5 9 3 SATE 0 9/ 2 5/ 0 9 INVOICE NUMBER DATE DESCRIPTION GROSS AMT. DISCOUNT NET AMOUNT 5316 PRIVATE PRY REFUN 09/03/09 PRIVATE PAY REF 1588.01 0.00 1588.01 County oTCumberland - TOTALS 15 8 8.01 0 . 0 0 15 8 8.01 PLEASE ADDRESS ANY CORRESPONDENCE REGARDING THIS VOUCHER OR TRANSACTION TO T}IE OFFICE OF THE CONTROLLER, CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PA. ]7013. J~ ~u~ q©, o0 GIs . ~ ~~~ ~~ .~ ~d it I ~al~~