HomeMy WebLinkAbout01-14-10 (2)1505607121
-" REV-1500 Ex (os-o5) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bur~uoiindividualTaxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 0 9 0 0 2 0 1
_ Hanisbum PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 8 5 1 0 4 7 5 5 0 2 1 5 2 0 0 9 1 2 2 1 1 9 1 1
Decedent's Last Name
SHUMAN
Suffix Decedent's First Name
MABEL
(If Applicable) Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
1. Original Retum
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
M
MI
2. Supplemental Return ~ 3. Remainder Retum (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required
death after 12-12-82)
~
0 6. Decedent Died Testate [~ 7. Decedent Maintained a Living Trust. 8. Total Number of Safe Deposit Boxes
(Attach Copy of Wilq (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 SECTWN MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTU\L TAX INFORMATION SHOULD BE~IRECTED TOr•,
Name Daytime Teleph~e Number ~, -Y :>-
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H ANTHONY A DAMS 7 1 7 ~,2 3~74~, y
Firm Name (If Applicable) ~.' ~ ~ ~ '~, ~~=.=~
~-USE O~Y
REGISTER ~
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First line of address ,__~ ~~
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4 9 WEST ORAN GE STREET
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Second line of address
S U I T E 3
City or Post Office State ZIP Code DATE FILED
SHI PPENSBURG PA 17257
Correspondent's a-mail address: htadamSlaW embargmail.com _
Under penaltles of perjury, I dedare that I have examined this return, induding aa.~ammpanying schedules and statements, and to the best of my knowledge and belief,
ft is true, cortect and complete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF P,~g~ ON RESPONSIBLE FOR FILING RETURN DATE
r
1505607121
:e, [ 71
Side 1
1505607121 J
to
V' ' l
DATE
1505607221
REV-1500 EX
Decedent's Social Security
Number
MABEL M. SHUMAN
Decedents Name:
1 8 5 1
0 4
7 5
5
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1.
2. stocks and Bonds (Schedule B)
.................................. 2. 2 4 9 2 1 6. 9 1
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. 1 8 8 1 4 0. 7 8
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-V'roos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ....... 7.
8. Total Gross Assets (total Lines 1-7) ........................... 8. 4 3 7 3 5 7. 6 9
9. Funeral Expenses & Administrative Costs (Schedule H) g. 1 2 9 7 9 , 5 6
................
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............ 10.
11. Total Deductions (total Lines 9 & 10) ........................... 11. 1 2 9 7 9. 5 6
12. Net Value of Estate (Line 8 minus Line 11) .... .............. ....... 12. 4 Z 4 3 7 8 , 1 3
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. 4 2 4 3 7 8 • 1 3
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 _ 0. 0 0 i5. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate x .045 4 2 4
3 7 8. 1
3
16.
1 9 0 9 7.
0
2
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0
17.
0 .
0
0
18. Amount of Line 14 taxable
at collateral rate X .15
0. 0
0
18
0.
0
0
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505607221
19097.02
1505607221
RE~f-1500 EX Page 3
Decedent's Complete Address:
DECEDENTS NAME
MABEL M. SHUMAN
STREET ADDRESS
120 HILLTOP ROAD
CITY
NEWBURG STATE
PA ZIP
17240
Tax Payments and Credits:
1. Tax Due (Page 2 tine 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty 'rf applicable
D. Interest
E. Penalty
File Number
21 09 00201
(1) 19 097.02
17,000.00
850.00
Total Credits (A + B + C) (2) 17, 850.00
Total InterestlPenalty (D + E) (3) 0.00
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.
B. Enter the total of Line 5 +5A. This is the BALANCE DUE.
(4) 0.00
(5) 1,247.02
(5A)
(56) 1,247.02
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 : ................................................................. ..... ^ O
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. ff death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................................................
"
" ...... ^
^ 0
0
or payable upon death bank account or security at his or her death? ....
in trust for
3. Did decedent own an .....
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a benefiaary designation? ............................................................................................ ...... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MU5T 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 exemot 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. §911fi(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) [l2 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 isdefined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX + (8-98)
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
MABEL M. SHUMAN 21 09 00201
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T SECURITIES ACCOUNT 20,997.43
AZC-026129
2. AIG. ANNUITY ACCOUNTS
AN202924
TOTAL (Also enter on line 2, Recapitulation) I ;
(If more space is needed, insert additional sheets of the same size)
228,219.48
1
REV-1508 ElE + (8-98)
. SCHEDULE E
CotuenoNVNEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MABEL M. SHUMAN 21 09 00201
Include the proceeds of Iltigatlon and the date the proceeds wen: received by the estate.
AU property lointN-owned with right of survivorship must be disclosed on &hedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T CHECKING ACCOUNT #0144 23,471.65
2. M&T PREMIUM CHECKING ACCOUNT #0021 21,202.99
3. M&T MARKET ADVANTAGE #5331 72,866.14
4. M8~T"18 MONTH CD #5759 50,000.00
5. M&T 36 MONTH CD #5767 20,600.00
TOTAL (Also enter on line 5, Recapitulation) ~ S 188,140.78
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+(10-06)
J
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES E~
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MABEL M. SHUMAN 21 09 00201
Dstrts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FOGELSANGER-BRICKER FUNERAL HOME, INC. 9,964.56
2. HOPEWELL UNITED METHODIST (FUNERAL SERVICES) 50.00
3. M. REESE (GRAVE OPENING) 400.00
4. JAY E. SHUMAN (MEAL AT FUNERAL NOME) 180.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
Ctty State Zip
Year(s) Commission Paid:
2, Attorney Fees H. ANTHONY ADAMS 1, 500.00
3, Famiy Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5 Accountants Fees 371.00
6. Tax Return Preparer's Fees
7. CARLISLE REGIONAL MEDICAL CENTER 50.00
8. FOREST PARK HEALTH CENTER 464.00
TOTAL (Also enter on line 9, Recapitulation) I S 12,979.56
(If more space is needed, insert additional sheets of the same size)
RE}f-1513 EX + (9.00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
MABEL M. SHUMAN 21 09 00201
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 [indude outrightspousal distributions, and transfers under
Sec. 9116 (a) (1. )2 ]
1. JAY E. SHUMAN Lineal
151 TURNPIKE ROAD 50%
NEWBURG, PA 17240
2. PHILIP D. SHUMAN Lineal
120 HILLTOP ROAD 50%
NEWBURG, PA 17240
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 13
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
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 of-ter my decease as a part of the
administration of my estate.
ITEM II: I bequeath those articles of my household furniture and
,furnishings and those articles of my personal effects and personal property
I, as set forth in a separate memorandum, which I shall place with my will or
deposit with mp attorney, to the persons therein designated.
ITEM III: I devise and bequeath the residue of my estate of every
nature and wherever situate to husband, ERNEST D. SflUMAN, providing he shall
',survive me by thirty days.
ITEM IV: Should my husband, ERNEST D. SHUMAN, predecease me or die on
or before the thirtieth day following my death, I devise and bequeath all of
the residue of my estate of every nature and wherever situate to my issue,
per stirpes, living on the thirty-first day following my death.
ITEM V; I appoint his or her parent or guardian, guardian of any
property which passes outright 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
lincome from time to time for the minor's support and education (including
(secondary, college education, both graduate and undergraduate, professional
and other education) without regard to his or her parent'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.. VI: 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 VII: I appoint my husband, ERNEST D. SHUMAN, and sons, JAY E.
~SHUMAN and PHILIP D. SHUMAN, or the survivor or survivors of them, executors
Hof this my last will.
ITEM VIII: I direct that my executors or guardian 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 to this my,L/ast Will
Th
and Testament, written on three (3) sheets of paper, dated this (7 - day of
~~yGu~~j~ , 1987.
~y~ rn~ r~~ i(SEAL)
Mabel Shuman
The preceding instrument, consisting of this and two (2) other
typewritten pages, each identified by the signature of the testatrix, was on
the day and date thereof signed, published and declared by the testatrix
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 n es as witnesses hereto.
`, ,
Qti(/L.t, residing at ~,~41 ~/, ~ r , ~"
L~:Lr~-~ / /~ • S~C.G~.Q~ residing at Vh, % ~IG.S !J /D
2
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, MABEL M. SHUMAN, the testatrix whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that I signed and executed the instrument as my Last Will;
and that I signed it willingly and as my free and voluntary act for the
purposes therein expressed.
" I7' ~'11. _ _~_ .._i (SEAL)
Mabel Mrhuman
-_ ___
Sworn to or affirmed -and acknowledged
before me by /r/~~g~L ~, S,t~~,¢.,r/,
the testatrix, this / 7~- day of
~erl~,cl~ e~ 1987 .
TERRA K~OE~~Aotary Public
Shippensb rg, Cumberland Co., Pa.
My Commission Expires Sept. 9, 1991
COMMONWEALTH OF PENNSYLVANIA
ss.
CUUNTY OF CUMBERLAND
We (or I) , f~»~iC_Ta,~ ~ ~:A-!/~S and ~~Z~A M _ S~,'~s~- the
witness(es) whose name(s) are (is) signed to the attached or faregoing
instrument, being duly qualified according to law, do depose and sap that we
were (I was) present and saw the testatrix sign and execute the instrument as
,.her Last Will; that the testatrix signed willingly and executed it as her
free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the testatrix signed the Will
as a witness; and that to the best of our (my) knowledge the testatrix was at
that time eighteen (18) or more years of age and of sound mind and under no
constraint or undue influence.
r ~ ..
,c
Sworn to or affirmed and subscribed to
before me by ,~,n,~-~,r/ ~, J~al and
__ _ --
dEZDsJ ir1. S-ti~74-_c,- , witness (es) ,
this -~w day of ,(J„•,/~~,c.,(~.1./ 1987.
Nota Fublic
TERESA J. QU;;iCF'OtDER, Notary Public
Shippensbur~, Cumberland Co., Pa.
My Commission expires Sept. 9, 1'XI•T 3
iat the
are