HomeMy WebLinkAbout03-09-10~ REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
15056051058
OFFICIAL USE ONLY
Countv Code Year File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
05/16/1915
w _... ~._-------___...---.__-___._ _ _.._:
Decedent's First Name
---~.._ _ _ .. ~
MI
...._ _ _ .. _ T
€ Alvin
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E
_
Spouse's First Name MI
~ ..
_ ~_._
_ _ _ _~
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return
O 4. Limited Estate
O 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH TH!E
REGISTER OF WILLS
O 2. Supplemental Retum
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)
O 3. Remainder Retum (date of death
prior to 12-13-82)
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. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Duane P. Stone 432-2089
1 ~ (717)
__ _ _ ___
Firm Name (If Applicable
___~...~__.._._ ~ _~_.. ~ __..~..__ ______ . ____ _ __
__ _
_
_. __ _ _
REGISTER OF WILLS USE ONLY
Stone, Duncan, & Assoc ~ i
_ _ _
First line of address
ra
.. _.~_ ___.______~
8 N. Baltimore Street ______ _ _ _
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~ Dillsburg Pa
17019 °-t3~-=~~ _.~
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Correspondent's a-mail address: DUaneI~StOneatlBW.COm ~,[1 '~
Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
lt is true, correct and complete. Dedaretion of preparer other tj~n the personal representative is based on all information of which preparer has any knowledge.
OF
FOR FILING
ti' 7,. /.,..~
SIGNATURE OF RER OTHER PRESENTATIVE ' - / DATE
ADDRESS G
O /V . /~/ /+~/1iOrG ~!, ~J i/~S.CJtw vf' ~ / ~1 ~~OJ%
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
~l~
15056052059
REV-1500 EX
Decedent's Name: AIVIn E BUSK
Decedent's Social Security Number
202-10-7787
RECAPITULATION
1. Real estate (Schedule A) ............................................. 1. 0.00
2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00
4. Mort a es 8~ Notes Receivable Schedule D 4. 0.00
9 9 ( ) .............................
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 91,555.65
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 0.00
7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. 0.00
8. Total Gross Assets (total Lines 1-7) .................................... 8. 91,555.65
3
9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 13,600.98
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 0.00
11. Total Deductions (total Lines 9 8 10) ................................... 11. 13,600.98
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 77,954.58
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ........................ 13. 0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 77,954.58
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_ 0.00, 15.
16. Amount of Line 14 taxable i
at lineal rate X .045 77,954.58 16, 3,507.96
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 17. ~
18. Amount of Line 14 taxable
at collateral rate X .15 18.
_.. __
19. TAX DUE ......................................................... 19. 3,507.96
~_~ -- ~---- ---a
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:
®~ Fil N m r ..~.W~.~
~L~_1 -------------- ~_.._
DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER
Alvin E Bush 202-10-7787
STREET ADDRESS
28 Palmer Drive
CITY
Camp Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 3,507.96
2. CreditslPayments 0
00
.
A. Spousal Poverty Credit
B. Prior Payments 0.00
C. Discount 0.00
Total Credits (A + B + C) (2) 0.00
3. Interest/Penalty if applicable
0
00
.
D. Interest
E. Penalty 0.00
Total InteresUPenalty (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) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,507.96
A. Enter the interest on the tax due. (5A) 0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3,507.96
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 :.................................................................................... ...... ^ ^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? ........ ...... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................. ...... ^ ^X
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 p2 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 exem~ 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)]. A sibling 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-1502 EX+ (6-98)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
All real properly owned soley or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fads.
Real properly which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. '.No Real Property owned in Pennsylvania ' 0.00
REV-1503 EX+ (6-99)
SCMEDI~LE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
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)
REV-1504 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEpVLE C
CLOSELY HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
(If more space is needed, insert additional sheets of the same size)
REV-1507 EX+ (6-98)
SCNEDt~LE D
COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
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)
REV-1508 EX+ (6-98)
SCNENYLE E
COMMONWEALTH OF PENNSYLVANIA ~SN, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
S ` Send Inqu o:
L 5000 Low Yive
PO Box 40
Mechanicsburg, PA 17055
www.memberslst.org
Main Switchboard: (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TDD: (717) 697-5312 or (800) 283-2328 ext. 5312
® TeleBranch: (800) 237-7288
MEMBERS 1St
FEDERAL CREDIT UNION
6792 1 AV 0.335 13583-6792
I~~~III~~~III~~~„~III~I~~II~~~~II~~I,I~~~II~~I~I~~~II~~~II~~I
ESTATE OF ALVIN E BUSH
8 N. BALTIMORE STREET P.O. BOX 696
DILLSBURG PA 17019
atement of Accounts
Nov 30, 2009 thru Dec 24, 2009
Account Number: 372807
Balances .at a Glance:
Checking : 77, 954.67
Savings: 5.00
Certificates : 0.00
Loans: 0.00
Money Management: 0.00
Swipe 5 YTD Reward : 0 . ~
Page : 1 of 2
1099-INT s are not included in this statement. If you earned at least $10 in
dividends on your account for 2009 you will receive your 1099-INT in a separate
mailing in early January 2010. 1099-INT information will also be available on
Members 1st Online early in January.
CHECKING ACCOUNTS
0011 -CHECKING
Date Transaction Description Additions Subtractions Balance
Nov 30 Balance forward O.Op
Nov 30 Deposit by Check 91,555.40 91,555.40
Nov 30 Deposit Dividend 0.100% 0.25 91,555.65
Annual Perrentag~e Yield Earned D. fA09b from 11/30/2009 through 11/30/2!X19
Based on Average Dady Balance of 91,565.40
Dec 08 Check 001123 Tracer 0001745579 3,662.23- 87,893.42
Dec 09 Check 001122 Tracer 0001179034 252.00- 87,641.42
Dec 14 Check 001121 Tracer 0003637641 9,686.75- 77,954.67
~+c 24 Ending Balance 77 ,954.67
CHECK SUMMARY
001121 9,686.75 Dec 14 !' 001123 3,662.23 Dec 08
001122 252.00 Dec 09 -
3 Checks C/eared for 13, 600.98
SAVINGS ACCOUNTS
0000 -REGULAR SAVINGS
Date Transaction Description - -. Additions Subtractions Balance
Nov 30 Balance Forward 0.00
Nov 30 Deposit by Check 5,00 5.00
Dac 24 Ending Balance 5.00
YTD SUMMARIES
TOTAL DIVIDENDS PAID
0000 REGULAR SAVINGS
0011 CHECKING
0.00
0.25
--- Continued on following page ---
REV-1509 EX+ (6-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDVLE F
JOINTLY OWNED PROPERTY
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
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
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 %OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1.
A. _. _ _
'None
_~__ ...
TOTAL (Also enter on line 6, Recapitulation) 13 ~ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDVLE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
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 DESCRIPTION OF PROPERTY DATE OF DEATH °h OF DECD'S EXCLUSION TAXABLE
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIDNSHIP TO DECEDENTAND
NUMBE THE DATE OF TRANSFER ATTACHACDPYDFTHEDEEDFDRREALESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
~. 'None __ __
is
TOTAL (Also enter on line 7 Recapitulation) S 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCNEDI~LE M
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:.
1' Dimon Funeral Home __ _ _ _ _ ~ 9.686.75
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)IEIN Number of Personal Representative(s) s
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 3,662.23
3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation)
Claimant _, , _. _.. . .
Street Address
City': `State ' {Zip ';
_ ,
Relationship of Claimant to Decedent
4. Probate Fees 252.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. _, _ _,., .
TOTAL (Also enter on line 9, Recapitulation) ,~ 13,600.98
(If more space is needed, insert additional sheets of the same size)
Dimon Funeral Homes, Inc.
644 E. Grand Avenue 201 E. Market Street
Tower City, PA 17980 Williamstown, PA 17098
Wanda L. Berger, Supv. Paul H. Dimon, Supv.
717-647-2741 Fax 717-647-2419 717-647-2422
°~
'~ I ~,
Friday, October 23, 2009 ~ ~ ; ~ ,`} ;.
/ C:~~,
Mrs. Carol Bixler
28 Palmer Drive
Camp Hill, PA 17011
Dear Carol,
Thank you for selecting our funeral home to provide services for your family during your time of bereavement. I hope that you found
our services, so far, to be of the highest standards that we always try to achieve. The following is a summary of the service charges as
previously explained and provided in written form on the services for:
ALVIN E. BUSH
PROFESSIONAL SERVICE, FACILITIES & AUTOMOTIVE
MERCHANDISE SELECTED
Casket: $2,450.00
Outer Burial Container $1,395.00
TOTAL MERCHANDISE SELECTED
CASH ADVANCES
Certified Copies of Death Certificate
Clergy Honorarium Rev. Natalya Cherry
Newspaper Notice
Newspaper Notice
Opening Grave
Flowers
Grandchildren Flowers
Great Grandchildren Flowers
Monument Cutting
Dayton Market
Methodist Church Donation
Vault Company Charge
TOTAL OF SERVICES
$ 48.00
$ 100.00
$ 198.75
$ 140.00
$ 950.00
$ 180.00
$ 60.00
$ 45.00
$ 120.00
$ 725.00
$ 100.00
$ 160.00
CASH ADVANCE TOTAL
BALANCE DUE
If there are any questions or concerns that remain unanswered, please call me.
Sincerely,
~~~,~
$3,015.00
$3,845.00
$2,826.75
$9,686.75
$9,686.75
The !?atriot-News Co.
812 Market St.
Harrisburg, PA 17101
Inquiries - 717-255-8213
THE LAW OFFICE OF DUANE P. STONE, P.C.
P.O. BOX 696
8 N. BALTIMORE STREET
DILLSBURG PA 17019
INVOICE
__
~~~e ~latriot•~ews
Now you know
ALL CHARGES ARE NET
4CCT # NAME AD ORDER # DATE EDITION ADDTL. INFO. TYPE OF CHARGE AMOUNT
36106 THE LAW OFFICE OF DUANE P. STC 0002032887 12/17/09 REGULAR
36106 THE LAW OFFICE OF DUANE P. STC 0002032887 12/24/09 REGULAR
36106 THE LAW OFFICE OF DUANE P. STC 0002032887 12/31/09 REGULAR
BASIC AD CHARGE $66.48
BASIC AD CHARGE $66.48
BASIC AD CHARGE $66.48
AFFIDAVIT CHARGE $5.00
TOTAL:
REMITTANCE ADDRESS
The Patriot-News Co.
23794 Network PL
Chicago, IL 60673-1237
Please include the Account # or Ad Order # (above) with your remittance--Thank You
$204.44
NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication
Dillsburg Post Office
DILLSBURG, Pennsylvania
170191210
4134870019 -0097
01/20/2010 (717>432-3035 02:43:01 PM
Sales Receipt
Product Sale Unit Final
Description Oty Price Price
ORLANDO FL 32820 tone-5 $20.70
Express Mail PO-Add
7.00 oz.
Label #: EG171616164US
Next Day 3PM / Normal Delivery
Signature Waived
Issue PVI: $20 70
Total: $20.70
Paid by:
VISA $20.70
Account #: XXXXXXXXXXXX6313
Approval #: 625681
Transaction #: 583
23 903110021
Order stamps at USPS.com/shop or call
1-800-Stamp24. Go to USPS.com/clicknship
to print shipping labels with postage.
For other information call 1-800-ASK-LISPS,
Bill#: 1000304106957
Clerk: 05
All sales final on stamps and postage
Refunds for guaranteed services only
Thank you for your business
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Customer Copy
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17613
BUSH ALVIN E
Receipt Date: 11/19/2009
Receipt Time: 09:37:51
Receipt No.: 1059008
Estate File No.: 2009-01073
Paid By Remarks: LAW OFFICES OF DUANE P STONE
CJ
----------------------- - Receipt Distribution ----- -------- ------- ----
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 210.00 CUMBERLAND COUNTY GENERAL FUN
WILL 15.00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN
JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN
Check# 1856 ----------------
$252.00
Total Received......... $252.00
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
Alvin E. Bush 2009-01073
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)
SCNEDt~LE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
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 outright spousal distributions, and transfers under
Sec. 9116 (a) X1.2)] - _
1 ~ 'Terry L. Bush, 1826 Hammock Moss Drive, Orlando, FL 32820 Son 33.4%
2. Julia Bush, 166 Mt. Eagle Trail, Tower City, PA 17980 :Daughter-in-law 33.3%
3. Thomas L. Bixler, Jr. 740 Lindenwood Ln., Steelton, PA 17113 Grandson 16.65%
4~ I '.Jane L. Bixler, 28 Palmer Drive, Camp Hill, PA 17011 Granddaughter 16.65%
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
'None
0
REV-1514 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
heck Box 4 on REV-1500 Cover SheE
ESTATE OF FILE NUMBER
Alvin E. Bush 2009-01073
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
® Will ^ Intervivos Deed of Trust ^ Other
NIA ^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
1. Value of fund from which life estate is payable ..........................................$
2. Actuarial factor per appropriate table ................................................ .
Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2) ......................................$
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
1. Value of fund from which annuity is payable ..................................... .......$
2. Check appropriate block below and enter corresponding (number) ................... ...... .
Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12)
^ Quarterly (4) ^Sem1-annually (2) ^ Annually (1) ^ Other ( )
3. Amount of payout per period ................................................. .......$
4. Aggregate annual payment, Line 2 multiplied by Line 3 ........................... ....... .
5. Annuity Factor (see instructions)
Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate
6. Adjustment Factor (see instructions) .......................................... ....... .
7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period
payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ................... .......$
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6)+ Line 3 ........................................... .......$
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through
G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18.
(If more space is needed, insert additional sheets of the same size)
Y
REV-1644 EX+(g-p4) INHERITANCE TAX
SCNEDVLE L
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT
INRESIDENTEDCEDE TRN OR INVASION OF TRUST PRINCIPAL 2009-01073
FILE NUMBER
I. ESTATE OF
Bush Alvin E
(Last Name) (First Name) (Middle Initial)
This schedule is appropriate only for estates of decedents dying on or before December 12, 1982.
This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of
Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal.
II, REMAINDER PREPAYMENT:
A. Election to prepay filed with the Register of Wills on
(Date)
B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income
or Annuitant(s) of election or annuity is payable
NIA
C. Assets: Complete Schedule L-1
1. Real Estate ...............................$
2. Stocks and Bonds ..........................$
3. Closely Held Stock/Partnership ...............$
4. Mortgages and Notes .......................$
5. Cash/Misc. Personal Property ................$
6. Total from Schedule L-1 ......................................................$
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities ...........................$
2. Unpaid Bequests ...........................$
3. Value of Unincludable Assets .................$
4. Total from Schedule L-2 ......................................................$
E. Total Value of trust assets (Line C-6 minus Line D-4) .................................$
F. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ .
G. Taxable Remainder value (Line E x Line F) .........................................$ 0.00
(Also enter on Line 7, Recapitulation)
~, INVASION OF CORPUS:
A. Invasion of corpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income
or Annuitant(s) corpus or annuity is payable
consumed
N/A
C. Corpus consumed ............................................................$
D. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ .
E. Taxable value of corpus consumed (Line C x Line D) .................................$ 0.00
(Also enter on Line 7, Recapitulation)
Y ~.
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WILL
OF
ALVIN E. BUSH
'J
.~
-S:
~~
~~
I, ALVIN E. BUSH, of Porter Township, Schuylkill County, Pennsylvania,
declare this to be my last Will and revoke any will 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, and any and all taxes and
assessments imposed by any governmental body as a result of my death, whether
on property passing under this Will or otherwise, shall be paid from my
residuary estate as soon as practicable after my death as a part of the
expense of the administration of my estate.
ITEM II. I give and bequeath all of my household goods, automobiles,
jewelry, and all other articles of household and personal use, equipment and
ornament, together with all insurance thereon and relating thereto, to the
following persons, with due regard for their personal preferences, who survive
my death by thirty (30) days, per stirpes and not per capita: my son, TERRY L.
BUSH, of Oviedo, Florida; my daughter, CAROL L. BIXLER, of Camp Hill,
Pennsylvania; and my daughter-in-law, JULIA BUSH, of Tower City, Pennsylvania.
The decision of my executor with regard to the division. of such property shall
be final, binding, and conclusive on all parties.
ITEM III. I give, devise, and bequeath all the rest, residue, and
remainder of my possessions and estate of every nature and wherever situate to
the following persons who survive my death by thirty (30) days, per stirpes
and not per capita: my son, TERRY L. BUSH; my daughter, CAROL L. BIXLER; and
my daughter-in-law, JULIR BUSH.
ITEM IV. All of the interests of the beneficiaries hereunder shall not
be subject to anticipation or to voluntary or involuntary alienation nor shall
they be subject to any execution or attachment.
ITEM V. I appoint my daughter, CAROL L. BIXLER, executrix of this my
last Will. Should my daughter predecease me or otherwise fail to qualify or
cease to serve as executrix of this my last Will, I appoint my son, TERRY L.
BUSH, executor of this my last Will.
ITEM VI. In addition to the other powers and authorities granted to my
personal representatives by Pennsylvania law and by the other terms and
provisions of this Will, I hereby give to my personal representatives the
following powers and authorities effective without court approval and until
actual distribution of all property: to compromise any claim or controversy;
to make distribution in cash or in kind, or partly in cash and partly in kind,
and in such manner as my personal representatives may determine and at
D: \L W ORK\ W IL LS\G032601 A. W PD
', J
valuations finally to be fixed by them; to invest in all forms of property,
including any stock or other securities in any corporate fiduciary or its
successor without restriction to investments authorized for Pennsylvania
fiduciaries, as my personal representatives deem proper, without regard to any
principle of risk or diversification; to retain any or all assets of my
estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease
for any period of time, any real or personal property and to give options for
sales, exchanges, or leases, for such prices and upon such terms or conditions
as my personal representatives deem proper; to allocate receipts and expenses
to principal or income or partly to each as my personal representatives deem
proper in their sole discretion; and to serve as guardian of any property
which passes, either under this Will or otherwise, to a minor or to any person
adjudged by any court of competent jurisdiction to be mentally incapacitated
to care for such property or for such person's own affairs, and with respect
to whom I am authorized to appoint a guardian and have not otherwise appointed
a guardian or trustee with the power in the guardian to use principal as well
as income from time to time for such person's education, support, and welfare
without regard to the ability of the parents of such person to provide for
such education, support, or welfare, and to make such payment for these
purposes, without further responsibility, directly to such person or to the
parent or any other person taking care of such person.
ITEM VII. When a "per stirpes" gift to a person's descendants is
provided for under this Will, gift shall be divided into as many equal shares
as there are then living children of such individual and then deceased
children represented by descendants then living, and each then living child
shall receive one share, and the share of each deceased child shall be divided
among his or her descendants in the same manner, repeating this pattern with
respect to succeeding generations until all shares are determined.
ITEM VIII. I direct that my personal representatives and fiduciaries
shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this ~ day of
~1.: 2001.
~~ G~~'.~
ALVIN E. BUSH
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:-
The preceding instrument, consisting of this and two other typewritten
pages, each identified by the signature of the testator was on the date
thereof signed, published, and declared by ALVIN E. BUSH, the testator therein
named, as and for his last Will, in the presence of us, who at his request, in
his presence, and in the presence of each other, have subscribed our names as
witnesses hereto.
~~~ ~-
GEC E A. VA[IG III
l
DIANE B. JE INS
t
D:ILWORK\WILLS\G032601A.WPD - 3 -
s
~~
COMMONWEALTH OF PENNSYLVANIA )
( SS..
COUNTY OF CUMBERLAND )
I, ALVIN E. BUSH, being the testator whose name is signed to the
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the foregoing instrument as my last
Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
ALVIN E. BUSH
Sworn or affirmed to and acknowledged
before, me by the testator named above
this y~ay of ,';~~~`}.~„i>, , 2001.
%`" ;'' ~~ jI NOTARIAL SEAL
~-~-~ "~r1=-~'- ~~ ~ - ~~? ?'~ Frances T. Yauphn, Notary public
otary Public ~ Hampden Tirp., umberlenr$ Gounry
gay Commission Expires Sept. t s, 2009
COMMONWEALTH OF PENNSYLVANIA )
( SS.:
COUNTY OF CUMBERLAND )
WE, GEORGE A. VAUGHN, III, and DIANE B. JENKINS, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw the testator sign and
execute the instrument as his last Will; that he signed it willingly; that he
executed it as his free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the testator signed the Will as
witnesses; and that to the best of our knowledge, the testator was at the time
eighteen or more years or age, of sound mind, and under no constraint or undue
influence.
Ja'r' f~~~ '~~-r
GEd1~E A. VAUG~'H•AI; III
DIANE B. JENKINS
Sworn or affirmed to and
acknowledged before me this j`
of ~.~.,~!:~.~~. 2001.
%`
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Notary Public
day
NOTARIAL SEAL
Frances T. Vaugghn, Notary Public
Hampden Twp., Cumberland County
M~- Commission Expires Sept. 15, 2009
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