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Home My WebLink About12-23-09~ 1 ~ ~ .. ~ r 15056041125 REV-1500 Ex (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ - D ~/ "-~ ~ O`er ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 8 2 4 2 5 3 2 1 2 1 0 2 0 0 6 0 7 1 8 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI Ma r t i n Ju l i a M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number TFiiS RETtll~iv Mf1ST BE Fi~EfS iFi ®Ui=LiCATE YUi7ii TiiE 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) ^X 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (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 H A n t h o n y A d a m s 7 1 7 5 3 2 3 2 7 0 Firm Name (If Applicable) '""°-' First line of address 4 9 W e s t O r a n g e Second line of address S u i t e 3 City or Post Office S h i p p e n s b u r g S t r e e t State P A ZIP Code ~, REGIST . ILLS USA NLY / ~ ~ ~' 7 ~~~~~ r~ ~ . ~ , '~_ ,.~~ yip ~ r~~ ~.Ad _ . ~r . ~a ~..- -~bATE FILED „~ ~ ~"~ 1 7 2 5 7 Correspondent's a-mail address: htadamslawt~embaromail.com c3~ "'~M7 -~ 7 .°.~ r't ,,;1 :~^~ i '~"~i t"`~ Under penalties of perjury, I dedare 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 preparer other than the personal representable s based on all information of which preparer has any knowledge. SIGNAT E OF PERSON~SP E FOR FILING RET RN ~~TE ADDRESS SIGNATIURE OF REP ATNE DATE ~"""~~ ADDRESS ~~ ~(/ PL SE(ORIGINAL F ONLY ~ r-- ~~ C 1 Side 1 15056041125 15056041125 • t 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: Jll 11 a M. Martin 1 6 8 2 4 2 5 3 2 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. 0 • 0 0 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ....... 5. 3 8 4 2 • 8 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-~vos Transfers ~ Miscellaneous N~ Probate Property (Schedule G) S t Bill epara e ing. Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 3 8 4 2 • 8 3 9. Funeral Expenses 8 Administrative Costs (Schedule H) ................ 9. 1 5 2 1 • 1 1 10. Debts of Decedent Mort a e Liabilities, & Liens Schedule I 9 9 ( ) ............ 10. 7 3 1 7 7. 0 9 11. Total Deductions (total Lines 9 & 10) ........................... 11. 7 4 6 9 8 • 2 0 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. - ~ 0 8 5 5 • 3 7 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. - ~ 0 8 5 5 • 3 7 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 .0 15. 16. Amount of Line 14 taxable at lineal rate X .0 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042126 15056042126 J FtEV-1500 EX Page 3 File Number Decedent's Complete Address: ~ 0 0 DECEDENTS NAME Julia M. Martin STREET ADDRESS 115 South Fa ette Street CITY STATE Zlp Shippensbur PA 17257 Tax Payments and Credits: ~ • Tax Due (Page 2 Line 19) (1) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of lane 5 + 5A. This is the BALANCE DUE. (5B) 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; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ 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? ....................................................................................... ^ 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an !ndividual 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 a, ~.... ~ ,, 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)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 childtwenty-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)J. 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)J. 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-1507 EX + (8-98) v ' ' ~ SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES IN RESIDENTEDECEDENT N RECEIVABLE ESTATE OF FILE NUMBER Julia M. Martin 0 0 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Commonwealth of Pennsylvania Department of Public Welfare Estate Recovery Program 73,177.09 P. O. Box 8466 Harrisburg, PA 17105 TOTAL (Also enter on line 4, Recapitulation) ~ ~ 73,177.09 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) , • COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Julia M. Martin _ 0 0 Indude 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 NUMBER DESCRIPTION 1. M&T Bank account #97378283 Checking 2. Shippensburg Healthcare Center Refund 3. Fogelsanger-Bricker Funeral 4. Refund from IRS of income tax TOTAL (Also enter on line 5, Recapitulation) ~ S (if more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 1,232.65 883.33 19.41 1, 707.44 842.83 1 REJ-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN , SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Julia M. Martin 0 0 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 2. Church of the Brethren (Luncheon for service) 144.17 B. ADMINISTRATIVE COSTS: ~ . Personal Representative's Commissions Name of Personal Represen~tive (s) Paula D. Hancock Sodal Security Number(s~EIN Number of Personal Representative(s) Street Address 213 Walnut Dale Road City Shippensburg state PA zip 17257 Year(s) Commission Paid: 2008 2, Attorney Fees H. Anthony Adams 3, Family Exemption: (If decedenCs address is not the same as daimant's, attach explanation) Claimant Street Address _ 4. 5. 6. 7. City State Zip Relationship of Claimant to Decedent Probate Fees Acxountant's Fees Tax Return Preparers Fees WSEMS-Ambulance Service (not paid) TOTAL (Also enter on line 9, Recapitulation) I ~ (If more space is needed, insert additional sheets of the same size) 150.00 500.00 83.00 20.00 623.94 1,521.11 ~V-1512 EX + (12-03) , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER .STATE OF Julia M. Martin 0 0 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1, Commonwealth Of Pennsylvania 73,177.09 Department of Public Welfare Assistance Reimbursement Claim TOTAL (Also enter on line 10, Recapitulation) $ 73 177. (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, JULIA M. MARTIN, of the Borough of Shippensburg, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I give, devise and bequeath my kitchen clock to my daughter, Paula D. Hancock. ITEM III: I give, devise and bequeath my living room clock to my son, 4 Joseph H. Martin. ITEM IV: I give, devise and bequeath two pictures hanging in the living room and the dining room table and four (4) chairs to my daughter, Shirley P. Stine. ITEM V: I give, devise and bequeath my curio cabinet and Precious Moments collection of glass figurines to my granddaughter, Kelly Jo Ile. ITEM VIM give, devise and bequeath my cedar chest to my daughter-in-law, Polly Martin. ITEM VII: I give, devises and bequeath the sum of One Tlhousand ($1,000) Dollars to each of my grandchildren who survive me. ITEM VIII: I give, devise and bequeath all of the residue of my estate of every nature and wheresoever situate to my three childre Paula H~:~ ,~ `~ ,, Hancock, Joseph H. Martin and Shirley P. Stine, in equal sha~~~ per~s~irpes,' _r,_ ~~ .%;7 ~ - -_~.~ ~.. __ _ .. • -- ;:r; r. ... .. , __ Q ITEM IX: I appoint the parent or parents of any minor, guardian of any property which passes either under this Will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and 'have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such ~ guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her patent's ability to provide for such support and education, or to make payment ;for these purposes, without further responsibility to the minor or to the minor''s parent or to any person taking care of the minor. ITEM X: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the administration of my estate. ITEM XI: I appoint Paula D. Hancock executrix of this npy Last Will and Testament. Should she fail to qualify or cease to act as executrix, I a oint PP Joseph H. Martin executor of this my Last Will and Testamentj. ITEM XII: I direct that my executors or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal tc~ this my Last Will and Testament, written on three sheets of paper, dated this 18th day of June, 1993. (SEAL) ulia M. aL in The preceding instrument, consisting of this and two other typewritten pages, each identified by the signature of the testatrix, J~lia M. Martin, was on the day and date thereof signed, published and decla~ed by Julia M. Martin, the testatrix herein named, as and for her Last Wi1~1, 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. `-~ r esiding at Gr~ residing at ~~ COMMONWEALTH OF PENNSYLVANIA: SS COUNTY OF CUMBERLAND : \ r f We, Julia M. Martin, J~~n ~~A- ~. and ~ _ (~~ Qf the testatrix and the witnesses, respectively, whose names ~re signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and (executed the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another person to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledgej, the testatrix was at that time eighteen years or older, of sound mind and~l under no constraint or undue influence. lia M: Martin Subscribed, sworn to and acknowledged, by Julia M. Martin, the to tatrix and rn to before me by,~D ~n ~[' , ~~ and , ., witnesses, this 18th da of une, 1993. ~. ^~ ~'~ Notary ub is Notarial NSN N~cy L Grove,...., Public Twp., Ot~B~ County ~ A~tssi0n Expn~-0~-;1~,1995