HomeMy WebLinkAbout03-03-10 (2)15056051058
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue Coun Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN b
PO BOX 280601 21 10 0026
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
058-22-7480 01 /08/2010 03/05/1925
Decedent's Last Name Suffix Decedent's First Name MI
BARSOHN HELEN
(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
C>~: 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 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
THOMAS E. FLOWER (717) 737-3405
Firm Name (If Applicable) __ __:_ _ ___._ _. ___ _ __ _ _ _____- _.. __.____,
REGISTER OF WILLS USE ONLY
SAIDIS, FLOWER, LINDSAY
First line of address
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2109 MARKET ST
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Second line of address ~Y.l
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Cit or Post Office
Y State ZIP Code t ~:' ,-
DATE.FJC {~
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CAMP HILL
PA 17011 ~`-' ~~
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Correspondent's a-mail address: TFLOWER@SFL-LAW.COM Q
Under penalties of erjury, 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 d mplete. Declaratio of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU SON RESPO E FOR FILING RETURN ner~
LISA BAR~OHN, 12009 CAMAS ST., BOISE, ID 83709
OF
REPRESENTATIVE
~./_~s~!/~ i vim/ l t l O
ADDRI=SS
SAIDIS, FLOWER & LINDSAY, 2109 MARKET ST., CAMP HILL, PA 17011
PLEASE USE OR161NAL FORM ONLY
Side 1
15056051058 15056051058
C~ V
J
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: HELEN BARSOHN , 058-22-7480
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.
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. 4
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~'~~~~~~ "~ ~ "~~
(Schedule G) ~ Separate Billing Requested........ 7. !:
8. Total Gross Assets (total Lines 1-7) .................................. . . 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. ip
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.
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. ....... .....:::......::.:....:...::.... ,:....~,......_....w.~........_...,:.,,............_:....~_~...:....~..:...~~._:M.~_..~..H
Amount of Line 14 taxable
at lineal rate X .0 45 402,471.94: 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
121, 330.91
51,722.68
237,858.29
410,911.88
8,114.11
325.83
8,439.94
402,471.94
0.00
402,471.94
15056052059 Side 2
15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 ~ 10 0026_.~.~.~....._~.~..._......~..~.._~._._..H.~..
DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER
HELEN BARSOHN 058-22-7480
STREET ADDRESS
36 SUMMERFIELD DRIVE
South Middleton Township
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 18,111.24
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 16,989.56
C. Discount 894.16
Total Credits (A+ B + C } (2} 17,883.72
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (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. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 227.52
A. Enter the interest on the tax due. (5A) 0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 227.52
Make Check Payable to: REGISTER OF WILLS, AGENT
A~ ~ .., .. ~,...
,~;
f, y
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 : ............................................ ^
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? .............. Q ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 ^
lF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
,..
+ :~ s a.d asre. , ,.,. ,. ~. o~5 w, e~b~ ._..:.' ~ ~:sa ~ .:~ . .. §~s~ ,s~,.
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 exemt,t 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
SCMEDVLE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
HELEN BARSOHN 21-10-0026
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.
(If more space is needed, insert additional sheets of the same size)
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REV-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCI~IEDVLE F
JOINTLY OWNED PROPERTY
ESTATE OF FILE NUMBER
HELEN BARSOHN 21-10-0026
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A• KAREN EARLY 12009 CAMAS STREET DAUGHTER.:
:BOISE, ID 83709
B' LISA BARSOHN 12009 CAMAS STREET DAUGHTER
"BOISE, ID 83709
C.
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET °h OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
~' A' 09/08/04 DWELLING HOUSE AND LOT, 36 SUMMERFIELD DR., SOUTH
'
^ 155,168.05 33.' 51
722
68
Mlnnl FTt7N TWP t
,I IMRFRI ANf~ Gnl INTY PA ,
.
NET PROCEEDS OF SALE, SEE ATTACHED HUD-1 (Line 603: cash
to Seller + Line 518: inheritance tax paid from settlement funds)
TOTAL (Also enter on line 6, Recapitulation) I Z 51,722.68
(If more space is needed, insert additional sheets of the same size)
A`M,r... u,c
~~,. I~ `~ ~oGZ OMB Approval No. 2502-0265
~ ft ~ ~ I tic w
~G I~~I1~~I Q~*z A• Settlement Statement (HUD-1)
9d~N o ~ J ~\'~
Type of Loan
6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
~X FHA 2. ~ RHS 3. ~ Conv. Unins. 10061 0073222507 446-0023754-703
VA 5. ~ Conv. Ins.
Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
Name and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender:
honda L. Seigle Karen H. B. Early and MetLife Home Loans, A Division
West Locust Street Lisa Nancy Barsohn of MetLife Bank N.A.
echanicsburg, Pa. 17055 4000 Horizon Way
Irving, TX 75063
~. Property Location: H. Settlement Agent: 25-1878915 I. Settlement Date:
5 Summerfield Drive Keystone Land Transfer, Ltd.
arlisle, PA 17015 3421 Market Street March 2, 2010
umbertand County, Pennsylvania Camp Hill, PA 17011 Ph. (717)731-4200
Place of Settlement:
3421 Market Street
Camp Hill, PA 17011
Summary of Borrower's transaction K. Summary of Seller's transaction
10. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller:
11. Contract sales rice 176,000.00
12. Personal ro ert
13. Settlement Char es to Borrower Line 1400 10,433.07
14.
15.
401. Contract sales rice 176,000.00
402. Personal ro ert
403.
404.
405.
j'ustments for items aid b Seller in advance Ad'ustments for items aid b Seller in advance
)6. Cit /Town Taxes to 406. Cit /Town Taxes to
l7. Count Taxes to 407. Count Taxes to
)8. School Tax 03/02/10 to 07/01/10 474.30 408. Schoo{ Tax 03/02/10 to 07/01/10
)9.
10.
11.
12.
20. Gross Amount Due from Borrower 186,907.37
~u. Amounts Najd by or to Behalf of Borrower
]1. Deposit or earnest money
]2. Principa{ amount of new loan(s)
]3. Existing loan(s) taken subject to
a4.
05.
06.
07.
08.
09. Seller Assist
(Lb/L9006/L9001)
l-af1H
2,000.00
172,812.00
474.30
409.
410.
411.
412.
420. Gross Amount Due to Seller ~ 176,474.30
500. Reductions in Amount Due Seller:
501. Excess de osit see instructions
502. Settlement char es to Seller (Line 1400) 14,343.50
503. Existin loans taken subject to
504. Payoff First Mortgage
505. Payoff Second Mortgage
506. _
507. De osit disb. as roceeds
508.
6,900.00 509. Seller Assist
£ ~o Z abed
6.900.00
tua6y;uauaal '~a sued p s~(a
abed ony s~y3 ~o Z abed ~o Fdoa pa~e~dwo~ a;o ~diaoa~ a6pe~MOU~e sauo~eu6ls ®y~ '~uewaae~s s}y~ }o ~ a6ed 6uw6~s ~8
L. Settlement Charges
700. Total Real Estate Broker Fees $ 10,560.00 Paid From Paid From
Division of commission (line 700) as follows: eorrower~s Sellers
701. 5 305.00 to Geor a L. Ebener & Associates Funds at Funds at
702. $ 5 255.00 to Re/Max Realt Associates Inc. settlement settlement
703. Commission aid at settlement 10 560.0
704. Broker Fee to Re/Max Realty Associates, Inc. 395.00
stns Ifomc Pavahla in [`nnnar_tinn with t nan
801. Our on ination char a Includes Ori ination Point % or $ 2,233.40 from GFE #1
802. Your credit or charge (points) for the specific interest rate chosen $ -1,698.40 (from GFE #2)
803. Your adjusted origination charges from GFE #A 535.00
804. A raisal fee to Julie Stoller from GFE #3 425.00
805. Credit Re ort - to Total Credit Service from GFE #3 20.00
806. Tax service to (from GFE #3)
807. Flood certification to (from GFE #3)
gpg, (from GFE #3)
809. (from GFE #3)
810. (from GFE #3)
811. (from GFE #3)
901. Daily interest charges from 03/02/10 to 04/01 /10 30 @ $24.857000/day (from GFE #10) 745.71
902. Mort a e insurance remium for months to HUD from GFE #3 2,972.20
903. Homeowner's insurance for 1.0 ears to Fetrow Insurance Associates, Inc. from GFE #11 Rhonda L. Sei le 395.00 ,"
904. from GFE #11
905. (from GFE #11)
1000. Reserves Deposited with Lender
1001. Initial deposit for your escrow account (from GFE #9) 1,061.53
1002. omeowner s insurance 0 mont s 32.92 per mont 98.76
1003. Mort a e insurance months $ er month $
1004. Property taxes $
County Taxes months @ $ per month
Assessments months $ er month
1005. $
1006. City Tax months @ $ per month $
1007. County Tax 2.000 months @ $ 32.46 per month $ 64.92
1008. School Tax 10.000 months @ $ 119.23 per month $ 1,192.30
1009. Aggregate Adjustment $ -294.45
11 nn Ti+lo f _harnac
1101. Title services and lender's title insurance (from GFE #4) 1,475.38
1102. Settlement or closin fee $
1103. Owner's title insurance to First American Title Ins. Co. from GFE #5 4.50
1104. Lender's title insurance to First American Title Ins. Co. $ 1,310.38 Re-Issue .
1105. Lender's title olic limit $ 172,812.00 PAL#107079342
1106. Owner's title olic limit $ 176,000.00 PAO#106983447
1107. A ent's ortion of the total title insurance remium to Ke stone Land Transfer. Ltd. $ 1,117.65
1108. Underwriter's onion of the total title insurance remium to First American Title Ins. Co. $ 197.23
1109. Notary Fee Keystone Land Transfer, Ltd.
1110. Tax Certification Keystone Land Transfer, Ltd.
1111. Wire Fee -Proceeds to Keystone Land Transfer, Ltd. 15.Oi
1112. Overnight Fee -Sellers Docs to Keystone Land Transfer, Ltd. 28.Oi
1113. Document Preparation -Deed to Keystone Land Transfer, Ltd. 125.Oi
1114. Attorney Fees to Saidis, Flower 8~ Lindsay 1 500.0
1115. Filing Fee -Inheritance Taxes to Register of Wills 15.01
1116. Plumbing Repairs to Jones Plumbing, Inc. Inv.# 065938 87.4:
1117.
1118.
~ inn (:nvornman+ Rar•_nrdinn and Transfer Charges
1201. Government recordin char es to Cumberland Count Recorder of Deeds from GFE #7 146.00
1202. Deed $ 62.00 Mortgage $ 84.00 Releases $ Other $
1203. Transfer taxes to Cumberland County Recorder of Deeds (from GFE #8) 1,760.00
1204. City/County tax/stamps Deed $ 1,760.00 Mortgage $
1205. State tax/stains Deed $ 1,760.00 Mort a e $ 1,760.0
1206. Record Release to Cumberland Count Recorder of Deeds 50.0
1207.
1.7VV. I'+uu~uv~~a~ vcu~c~~ic~~a v~~w. ...~
1301. Re uired services that ou can sho
for
from GFE #6
116.00
1302. Water/Sewer 10!1109-3/2/10 to SMTMA Act# 02510 203.1
1303. 2010 Count Taxes to Robert C. Cairns, Tax Collector 36 Summerfield Driv 381.75 _.
1304. Tax Service Fee to Total Mort a e Solutions $ 90.00 __ _
1305. Flood Determination to Federal Flood $ 26.00
. ,.,.. ~-_~_~ e_aa~_..._..a n~,.,.,a~ re.,+e~ .,., tinny 4 n't Spr•_tinn _1 and 502_ SeCtlorL Kl ~ -
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REV 1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDVLE 6
INTER-VNOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
HELEN BARSOHN 21-10-0026
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME DF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
°!° OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1. SOVEREIGN BANK IRA C/D #2898244179, PAYABLE TO LISA BARSOHN, 28,528.65 100 28,528.65
DAUGHTER
2. WACHOVIA BANK C/D #247402062145738, PAYABLE TO LISA BARSOHN, 104,664.82 100 104,664.82
DAUGHTER
3. WACHOVIA BANK CID #247402062145756, PAYABLE TO KAREN EARLY, 104,664.82 100 104
664.82
DAUGHTER ,
TOTAL (Also enter on line 7 Recapitulation) ~ I 237,858.29
(If more space is needed, insert additional sheets of the same size)
~ACH~v'1A
TIME DEPOSIT WITHDRAWAL CONFIRMATION
Office Name
NE'CNT PA /SILVER SPRING SQU
PA
Date
01 /11 /2010
CURRENT BALANCE : $104,634.85
+ ACCRUED INTEREST : $29.97
Avail lnt WD/PenFree: $892.41
- PENALTY AMOUNT : $0.00
-FEDERAL W/HD DUE : $0.00
-WITHDRAWAL FEE : $0.00
-OUTSTANDING PYMT : $0.00
PAID TO CUSTOMER : $104,664.82
Customer Name(s), Address and Taxpayer ID Number
HELEN BARSOHN
POD LISA KINNEAR
36 SUMMERFIELD DRIVE
CARLISLE PA 17013
S~JCXXX7480
FULL REDEMPTION
CD ACCOUNT NUMBER: 247402062145738
wA,cxovr~,
Opening Date
TIME DEPOSIT
Account Number
This Receipt Adcno~wle~ es That The Depositor Named **"'~`***"`VOID**#'~
Sum ~ as Deposited With This Bank The
Depositor
Name And
Address
Term Maturity Date
Interest Payment Dlsposiflon Account to Crodit
is:~ed by WACHOVfA BANK, N.A.
ba0694
X
X ~r~~-ZVIO
Date
Taxpayer ID Number
NOT TRANSFERABLE
Interest Rate Per Annum Annual Percentage Yield Interest Payment FrequencylPeriod
PROD-TYPE: PROMO CD:
~~4aCHt~VIA
TIME DEPOSIT WITHDRAWAL CONFIRMATION
Office Name
NE'CNT PA /SILVER SPRING SQU
PA
Date
01 /11 /2010
CURRENT BALANCE : $104,634.85
+ ACCRUED INTEREST : $29.97
Avai! Int WD/PenFree: $892.41
- PENALTY AMOUNT : $0.00
-FEDERAL W/HD DUE : $0.00
-WITHDRAWAL FEE : $0.00
-OUTSTANDING PYMT : $0.00
PAID TO CUSTOMER : $104,664.82
Customer Name(s), Address and Taxpayer iD Number
HELEN BARSOHN
POD KAREN EARLY
36 SUMMERFIELD DRIVE
CARLISLE PA 17013
S~U~CXX7480
FULL REDEMPTION
CD ACCOUNT NUMBER: 247402062145756
~^tta~
W1~CHOVIA
Opanfng Date
TIME DEPOSIT
Account Number
This Receipt Adaw~Medges That The Depositor Named '~'~*'~"~`**'''VOID*""'"'t
Bekrnr Hes Daposded With TMs Bank The
Sum Of
Depositor
Name And
Address
Term Maturity Date
Interest Payment Disposition Account to Credit
Issued by WACHOViA BANK, N.A.
Taxpayer ID Number
NOT TRANSFERABLE
Interest Rate Per Annum Annual Percentage Yield Interest Payment Frequency/Period
PROD-TYPE: PROMO CD:
X~~-~~"20io I
L
REV-1511 EX+ (12-99)
SCI~IEDt~LE M
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HELEN BARSOHN 21-10-0026
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' EWING BROTHERS FUNERAL HOME, PROFESSIONAL SERVICES 1,858.62
2. TRAVEL EXPENSES FOR DECEDENT'S CHILDREN AND GRANDCHILDREN FROM BOISE, IDAHO 4,388.82
TO ATTEND FUNERAL, PAID FROM ESTATE
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City _ State
Year(s) Commission Paid:
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's Fees
6. Tax Return Preparer's Fees
~. JONES PLUMBING -REPAIRS TO PREPARE HOUSE FOR SALE
Zip
.Zip
1, 500.00
226.50
140.17
TOTAL (Also enter on line 9, Recapitulation) I $ 8,114.11
(If more space is needed, insert additional sheets of the same size)
REV 1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
HELEN BARSOHN 21-10-0026
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
(If more space is needed, insert additional sheets of the same size]
REV-1513 EX+ (9-00)
SCNEp1~ILE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HELEN BARSOHN 21-10-0026
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 [nclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
~ KAREN EARLY, 12009 CAMAS ST, BOISE, ID 83709 DAUGHTER 1/2
2 LISA BARSOHN, 12009 CAMAS ST., BOISE, ID 83709 DAUGHTER 1/2
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)
I, HELLfiT BAItSOHN, residing at 735 Haven Place, in the City
.. of Linden, County of Union and State of New Jersey, being of sound mind,
memory and understanding, do make, publish and declare the follocaing to be shy.
Last Will and Testament, hereby revoking all prior Wills by me shade.
FIRST: I do order and direct that all my just debts and
funeral expenses be duly paid as soon as may he convenient after my decease.
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SECOND: All the rest, residue and remainder of my estate,
of ~Jhatever nature, real, personal or mixed, I give, device and bequeath unto
my beloved daughters, LISA NANCY BAItSOH~1 and I:A1~EN' HELENE BARSOHN, of 735
1~Iaven Place, Linden, New Jersey, in equal shares, share aced sham alike.
Should any of my daughters predecease me, then the survivor shall take the
share of the deceased daughter provided, that should any of my daughters pre-
decease me leaving issue surviving, said issue shall take their parent's
share, per stirpes and not per capita.
THIP~: No beneficiary under the terms of this my Last
Will and Testament shall be deemed to have survived me unless they shall be
living four months after s-3' decease. If they should die during such period,
then it shall be considered that they had predeceased me.
FOURTH; I hereby give unto my Executrix herein named, or
her substitute, the full uncontrolled right to retain any and all investments
held by me during my lifetime and the power and right to sell any or all of
my assets, including my real estate, at public or private sale, at such times
and upon such terms as may be deemed advisable for the best interest of the
estate, and to execute such instruments and documents as may be necessary to
effect the purpose of the same.
I, HELEN BARSOHN, residing at 735 Haven Place, in the City
of Linden, County of Union and State of New Jersey, being of sound mind,
memory and understanding, do make, publish and declare the follotaing to be my
Last Will and Testament, hereby revoking all prior Wills by me made,
gIgST; I do order and direct that all my just debts and
funexal expanses be duly paid as soon as may he convenient after my decease.
SECOND: All the rest, residue and remainder of my estate, .
of whatever nature, real, personal or mixed, Y give, devise and bequeath unto.
my beloved daughters, LISA NANCY BARSQHN and KAREN HELENS BARSOHN, of 735
Haven Place, Linden, New Jersey, in equal shares, share and share alike.
Should any of my daughters predecease me, Chen the survivor shall take the
share of the deceased daughter provided, that should any of my daughters pre-
decease me leaving issue surviving, said issue shall take their parent's
share, per stirpes and not per capita.
~~ THIRD: No beneficiary under the terms of this my Last
~, Wi1I and Testament shall be deemed to have survived me unless they shall be
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~.,~•`1 living four months after my decease, If they should die during such period,
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then it shall be considered that they had predeceased me.
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...~ ~ FOURTH: I hereby give unto my Executrix herein named, or
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~ her substitute, the full uncontrolled right to retain any and all investments
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~'~,`' held by me during my lifetime and the power and right to sell any or all of
my assets, including my real estate, at public or private sale, at such times
and upon such terms as may be deemed advisable for the best interest of the
estate, and to execute such instruments and documents as may be necessary to
effect the purpose of the same.
LASTLY; I hereby nominate, constitute and appoint my
beloved daughter, LISA NANCY BARSOHN, as Executrix of this my Last Will and
Testament. In the event my daughter, LISA NANCY BARSOHN, pr~eceases die or
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fails to qualify or dies before the estate is terminated, th~~~omi~te,;; .: :_ ~'
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~1 I
constitute and appoint my beloved daughter, KAREN HELEN BARSOHN, as Executrix
of this my Last Will and Testament.
Such Executrix as shall qualify under the provisions of
this Will shall serve without bond or other security, unless othez~~rise
required by law.
IlV idITNLSS WHEREOF, I publish and declare this instrument,
consisting of two pages, as my Last Will and Testament, and I have hereunto
set my hand and seal in the presence of the subscribing witnesses, this ~~'~j°~t~
day of ~rj~~/.~~~ , ]975.
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%' ~G~~ 1:x.1 ~•~°_.. _; .~--_ . (L. S. }
• HELEN BARSO~t
The foregoing instrument, consisting of two typewritten
pages was on ~;'~~T'i~~r'r,~~i~ '~ ~- , 1975, signed, sealed, published and
declared by
HELEN BARSOHN
the Testatrix therein named, as and for her Last Will and Testament, who, in
our presence, and in her presence, at her request, and in the presence of
each other (all three being present and the Testatrix signing first} have
hereunto subscribed our names as witnesses,
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