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Home My WebLink About02-04-1015056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 09 :1142 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth _ _ _ 166-12-5223 ' 11 /27/2009 03/08/1923 _ __ ___ Decedent's Last Name Suffix Decedent's First Name MI _ _ __ _ Kerlin `Pauline C '. (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 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 Retum Required death after 12-12-82) x::11':= 6. Decedent Died Testate ,,,,.,,..,. 7. Decedent Maintained a Livin Trust "'°°"'° g 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 TO: Name Daytime Telephone Number :John M. Eakin (717) 766-3172 Firm Name (If Applicable) _ _ .................. ..mss _ . _ _ REGISTE~F WILLS USE-eNLY ~? __........ _.___. .....__. First line of address ..._._. i ~ ~ ~ ~ r ~-~ . ~ r-- ~ 1, e :C~ ~ 'Market Square Building __ _ r ~ rn t ~' = ~->~ -~' i s '~ r _ ~~~ ~~ Second line of address 1 ;~-~-~ Z" ~. 30~ ' ~ ~_~ - - ~ :. _~.. _.. City or Post Office __ _ _ __..... _.._ _... ~TE FILED .l~' .. State ZIP Code _ _ ............ _.. r- `~c,r ~ Mechanicsburg PA ! 17055 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 complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUI~ OF PERSON RESPONSIBLE FQR FILIN~RETURN DATE -3-~ u 773 Lancaster Bou rd #5, Mechanicsburg, PA 17050 REPRESENTATIVE DATE SIG (9 ADDRES V - ' Mark Square Building, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number _ __ _ __ Decedent's Name: Pauline C Kerlin 166-12-5223 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. 1,103.03 6. Jointly Owned Property (Schedule F) ~~:~'~:~ Separate Billing Requested ....... 6. 7. Inter-wos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) ~""'""~ Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. ; 1,103.03 9. Funeral Expenses 8~Administrative Costs (Schedule H) ..................... 9. 2,518.50 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ................ 10. 568.49 11. Total Deductions (total Lines 9 ~ 10) ................................... 11. 3,086.99 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. `1, 983.96 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. 0.00 TAX COMPUTATION,...,,SEE"INSTRUCTIONS FOR APPLICABLE RATES .........................,.,.....,..... .,.,.,...,..~,..,~..r.. ~..~.,.,...,~ ..,,..,.. ..,....,. .,..,.... „ „w,... ,., ,.,... ......... 15. Amount of Line 14 taxable at the spousal tax rate, or trans ers under Sec. 9116 _ _ _ _ _ _ _ 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 ', ' ___: 1 g. 19. TAX DUE ......................................................... 19. 0.00 _ __ __ _ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 ` Decedent's Complete Address: File Number 21 09 !::1142 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Pauline C Kerlin 166-12-5223 STREET ADDRESS 1053 Allendale Road CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 0.00 Total Credits (A + B + C) (2) Total InteresUPenalty (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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (56) 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 :.......................................................................................... ^ 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? .............. ^ ^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 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. REV-1508 EX+ (6-98) ~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDVLE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Pauline C. Kerlin 21-09-1142 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. fir more space is needed, insert additional sheets of the same size) .~.~~d Soverei n Bank - ~~~;;... ~ g STATEMENT OF ACCOUNTS to "ment s o ~# x 2 . ' 1-877-SOV-BAND (1-$77»758-22t^i5) .-. , www,sQVereignbank.com SOVEREIC3N INTEREST CH~CKINQ ` >-.~ . r. ,. PAUL/NE C KERLIN t .. Account # ~3 ~ x$865 'Balances ~ - .:. .. , t .: ~. , Deposits/~r~dit~ .} ~. + $1,Q11.01 ~ Average Daily Balance'; ~$1,7$69fi .,.. ;~Ir~t~rest ,. _ . - , ~ ._ - #.r ._~ ' 1 ~y~ ~ ~ , t~ ~ ~ ~ ~ " ~ ~ `!Hi ~r u% w.'Y~a~;. ~ ~'. ,, k' u ~.e.. `<~'L' h ~E'i4. L.. `' _. : . .:h w ~ ' .; z. " - ~ "Famed this Period " f- .. ' 80:.00 °. ;". $ 0.01: Paid Last Year ~ .R ~„ . r. 'Tile interest e~amed and the interest paid may differ depending on when interest is credited to your, accounf. . - ~ - _ I era ~ ' r Service Fe>BS .. } + " r Date # Transactions r~~ F~ ~ s M ~ TQtat l ~ p - p. Fi=~aCJ ~/A~Vi=~ 1~2, /0' << r E ~,}'> ~~r~~ ~{} `c c,«Fj~.,~Cf, ~.~,. ~.~r s '~3i.'° r~.t~~ ~; ; f -eYr Total ,, - -. _: .. ... .. ~ ;~z.. , , ,r, , M ... ~ - - - "saoo` `Account Activity - .. ". ,. Date Description A~idlttons` Subt>~lcttorts' Balance 1'1-23 ~ .8 inrt[n Baian~ ~ix ~r_ 'C . .. 12-43" "US' EA6U Y Q3 ~ r~ J ~852:Q0 ~. r. .~F .. X2,114:03 '.: . ~ `SQC SEC 120309 . :. " ~ A SS t ~ _ ~- - 12=22 En ing Balance.....,, . 2,11~.Q~3 ;, , ,~ . ,. .- ., ~ ~. ~, ~. "~~ - ,. ; , ,- - 4 - ~ .. " ., ', - . -.. .. . 3 .. -. .' . , r. .. page 3 of 3 931078865 REV-15II. Ex+ (I.0-o~~ , ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Pauline C. Kerlin 21-09-1142 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1' Stone & Murray Funeral Home 2 232.00 2. Minister 100.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2• Attorney Fees: 3• 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 4. Probate Fees: 5• Accountant Fees: 6• Tax Return Preparer Fees: ~• Register of Wills -Filing Fee ZIP 100.00 76.50 10.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 2,518.50 If more space is needed, use additional sheets of paper of the same size. REV-15I2 EX+ (12-08) , ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Pauline C. Kerlin 21-n9-1142 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical pYnaneaa ~~ more space is needed, insert additional sheets of the same size. REV-1513 EX+ (1.1-08) , ' ~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Pauline C. Kerlin 21-09-1142 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).] 1. Sandra Brouwn 753 Ironstone Road, North Carolina 17070 Daughter 1/2 of net residue 2. Sargent Bankert 773 Lancaster Boulevard #5, Mech., PA 17050 Son 1/2 of net residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 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. • } ~~,.,_. LAW OFFI(_ES MARLIN R. McCALEB LAST WILL AND TESTAMENT ,. i; I, PAULINE C. KERLIN, of the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. .. EIR.ST. I order. and__di by my Co-Executors, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest,, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, in equal shares unto my children, namley: SANDRA BROWN and SARGENT BANKERT, share and share alike, absolutely and in fee simple. Provided, however, that if either of my said children shall predecease me leaving lawful issue to survive me, then and in that event I order and direct that the share provided above for such deceased child shall be paid over and distnbuted unto his or her said lawful issue per stirpe~; _~~.~s~'~~; ~ Y ~,~,~a~~;t ancestor's share by representation and not per capita. LASTLY. I nominate, constitute and appoint my children, .SANDRA BROWN and SARGENT BANKERT, Co-Executors under this, my Last Will and Testament, each to serve without bond in this or any other jurisdiction. IN WITNESS WHEREOF, I, PAULINE C. KERLIN, have hereunto set my hand rind seal to this, my Last Will and Testament which consists of two (2} typewritten pages to each of which I have affixed my signature this _~ day of A.D., One Thousand Nine Hundred Ninety-Five (1995). f ~z.~.c~-~ ~ i~°~ (SEAL) ,..._...~,. ,.....m ~~w~+w'~~u~I~wmdYYW~iWBl~zuiM~Y rlwr .L li it ~~~.m,~,rd..w, ~ ~ .. The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by PAULINE C. KERLIN, the Testatrix therein named, as and for her Last Will and Testament, 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. ~.~__ LAW OFFICES MARLIN R. McCALEB ~~ ~~- ao ~~ ~i cL 2v.cx~ (1~.~ c~.