HomeMy WebLinkAbout03-04-101505607121
REV-1500 EX (D6-05)
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PoBOx2aosol RESIDENT DECEDENT 2 1 D 9 0 6 9 0
Harrisbur , PA 17128-0601
ENTER DECEDENT INFORMATION BELODate of Death Date of Birth
Social Security Number
2 0 0 2 2 6 1 0 2 0 7 0 7 2 0 D 9 1 0 1 3 1 9 2 8 MI
Decedent's Last Name Suffix Decedent's First Name
B E L V A ~
G I L L
(If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name MI
Spouse's Last Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
tum
l R
t ~ 3. Remainder Return (date of death
1. Original Retum ~ e
a
2. Supplemen prior to 12-13-82)
O
te
E
t
4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required
O
a
s
4. Limited death after 12-12-82)
Total Number of Safe Deposit Boxes
8
0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust
(Attach Copy of Trust) .
(Attach Copy of Will)
Received ~
d 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
h
O
S
s
9. Litigation Procee between 12-31-91 and 1-1-95) .
)
c
(Attach
BE DIRECTED T0:
IS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIA
L ~ I eFO
oU
o
CORRESPONDENT -TH D
ber
e Nu
elepho
Name
H R A D
C L I F F E S Q
7 1 7 2 3 6 9 3 1 8
D A V I D
Firm Name (If Applicable) REGISTER OF WILLS USE ONLY
R A D C L I F F L A W O F F I C E, P C
First line of address ~
1 0 1 1 M U M M A R O A D ~ _~
Second line of address ~_~
Z~ C7 ;~
S U I T E 2 0 1 i-^. t I
DATE FILED - ~~;, ~'
City or Post Office State ZIP Code ----
' ; ~~~ -17
L E M O Y N E P A 1 7 0 4 3 ~~ »,., .:
~-
Jl ie~
....I . .
Correspondent's a-mail address: DHRAD
IX.NETCOM.COM :/: L.J
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,
e.
ed
y kTE
ther than the personal representative is based on all information of which preparer has an
it Is true, correct and complete. Declaration of preparer o ~
~
D
~~''SON ESP N BLE FOR FI
SI ATU E OF P~~E LING RETURN ~ CI
~
ADDRESS ~ MECHANICSBURG PA 17050
3900 TRAYER ROAD DTE
SIGN~'~F PREPAR OT,bF~R T~-IA/N,R
l ~• ~. ~SENTATIVE ~ Z ~~~
ADDRESS
1011 MUMMA RD ST 0 LEMOYNE PA 17043
PLEASE USE ORIGINAL FORM ONLY
1505607121
Side 1
1505607121
~:~
t_
~:
^~.
_;~,
~ % i
.~~
1505607221
REV-1500 EX Decedent's Social Security Number
2 0 0 2 2 6 1 0 2
DecedenPs Name: B E L V A J G I L L
RECAPITULATION
1 9 8 3 4 3. D O
1. Real estate (Schedule A)
2. •
2. Stocks and Bonds (Schedule B)
3. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .
4. •
4. Mortgages & Notes Receivable (Schedule D)
9 1 0 4. 4 6
5.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)
3 8 0 3 9. 0 1
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7 Inter-Vivos Transfers & Miscellaneous Non-PSepa ester Bill ng Requested ....... 7. •
(Schedule G) ^
1 4 5 4 8 6. 4 7
......... ........ 8.
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10- Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10.
..................
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 13.
................
an election to tax has not been made (Schedule
..
................
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 0 ~ D D 15.
(a)(1.2) X.0
16. Amount of Line 14 taxable 1 3 3 2 6 2. 7 8 1s.
at lineal rate X .045
7. Amount of Line 14 taxable D D D 17.
at sibling rate X .12
18. Amount of Line 14 taxable D D 0 18
at collateral rate X .15
..... 19.
...
19. Tax Due .....................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505607221
Side 2
9 3 5 9. 1 D
2 8 6 4. 5 9
1 2 2 2 3. 6 9
1 3 3 2 6 2. 7 8
1 3 3 2 6 2. 7 8
D. D 0
5 9 9 6. 8 3
0. D 0
0. 0 0
5 9 9 6. 8 3
1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
nFr.FnFNT'S NAME
File Number
21 09 0690
BELVA J. GILL _
STREET ADDRESS
805 ORRS BRIDGE ROAD
CITY
MECHANICSBURG
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit 4,500.00
B. Prior Payments
C. Discount 236.84
3. Interest/Penalty if applicable
D. Interest
E Penalty Total Interest/Penalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Filt in oval on Page 2, Line 20 to request a refund.
STATE I ZIP
PA X117050
(1) 5 996.83
Total Credits (A + g + C) (2) 4,736.84
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3) 0.00
(4)
0.00
(5) 1,259.99
(5A)
A. Enter the interest on the tax due.
(5B) 1,259.99
B Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
n~ EASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
'
I . Did decedent make a transfer and: Yes
^ No
X
P P Y .............................................................
a. retain the use or income of the ro ert transferred; .....
^
b. retain the right to designate who shall use the property transferred or its income; ~ ^ ^
X
ry .................
c. retain a reversions interest; or ~ -~ ~ ~~ ~ ~ ~
^ X
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? .................................................................................
Did decedent own an "intrust for" or payable upon death bank account or security at his or her death?
3 ..
^
.
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
^
X
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(12) [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)J. 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
FILE NUMBER
ESTATE OF
21 09 0690
BELVA J. GILL
All real property owned solely 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 facts.
Real roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F. VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER 98, 343.00
1. RESIDENCE AT 805 ORRS BRIDGE ROAD, HAMPDEN TWP
PARCEL ID #10-18-1314-040
($78,050 X 1.26
TOTAL (Also enter on line 1 Recapitulafion) ~ $ 98,343.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT FILE NUMBER
ESTATE OF
21 09 0690
BELVA J. GILL
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.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER 245.00
~, NATIONWIDE MUTUAL FIRE INS CO -REFUND
303.00
2. NATIONWIDE MUTUAL FIRE INS CO -REFUND
2.46
3. VERIZON -REFUND
I 8,000.00
4. 2004 CHRYSLER SEDAN
I 554.00
5. PERSONAL PROPERTY (SEE ATTACHED LISTING)
TOTAL (Also enter on line 5 Recapitulation) I $ 9 104.46
(If more space is needed, insert additional sheets of the same size)
ESTATE OF BELVA J. GILL
ATTACHMENT TO PA 1500 & INVENTORY
PERSONAL PROPERTY
Bedroom suite $ 75.00
L,oveseat 20.00
Swivel rockers & footstools 30.00
Entertainment center 35.00
End table, side tables 20.00
Wall shelf with dishes 35.00
Mirror & shelf 10.00
Wicker stand & hamper 6.00
Vacuum 10.00
Desk 10.00
Coffee table & end table 20.00
Folding chairs & table 10.00
Standing shelf 15.00
Foot stool & step stool 8.00
Miscellaneous shelves 15.00
Pictures/frames 29.00
Books 20.00
Floor light 5.00
Miscellaneous household 14.00
Clock & radio 1.0.00
Refrigerator 20.00
Small kitchen table & chairs 25.00
Dishes, glasses & flatware 30.00
Toaster, blender, toaster oven, coffee pot 17.00
Microwave 10.00
Crockpots, indoor grill, 15.00
Pots & pans, cooking utensils 1.5.00
Baking pans & measuring cups 15.00
Light 1.0.00
$554.00
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY•OWNED PROPERTY
FILE NUMBER
ESTATE OF
BELVA J. GILL 21 09 0690
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
3900 TRAYER ROAD
MECHANICSBURG, PA 17050
DAUGHTER
ADDRESS
TO DECEDENT
SURVIVING JOINT TENANT(S) NAME
A. DEBORAH A STONER
13
C
rl']TV.
JVII\ 1 L 1 'v~~~~~v ~ ~~v. ~... ..
% OF -
DATE OF DEATH
ITEM LETTER
FOR JOINT DATE
MADE DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH
VALUE OF ASSET DECD'S
INTEREST VALUE OF
DECEDENT'S INTERESI
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
1. A. 4/12/99 SOVEREIGN BANK 6,979.93 50. 3,489.97
ACCT #2331046689
2. A. 7/26/05 SOVEREIGN BANK 29,317.98 50. 14,658.99
MONEY MARKET #2334085820
3. A. 1/1/05 MEMBERS 1ST FEDERAL CREDIT UNION 80.09 50. 40.05
ACCT #348084 (SAVINGS)
A /1/05
1 MEMBERS 1ST FEDERAL CREDIT UNION 39,700.00 50. 19,850.OC
4. . . ACCT #348084 (CERTIFICATE)
TOTAL (Also enter on line 6, Recapitulation) I $ 38.039.01
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+(10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BELVA J. GILL 21 09 0690
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION
A, FUNERAL EXPENSES:
1. MYERS FUNERAL HOME
B.
2.
3.
4.
5.
6
7.
8
9
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State _,
Year(s) Commission Paid:
Attorney Fees RADCLIFF LAW OFFICE, P.C.
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
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
FILIING FEES -INHERITANCE RETURN & INVENTORY
ADDL SHORT CERTIFICATE
DEED RECORDING
TOTAL (Also enter on line 9, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
Zip
AMOUNT
5,381.60
3,600.00
Zip
294.00
30.00
4.00
49.50
9,359.10
REV-1512 EX + (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
21 09 0690
BELVA J. GILL
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
NUMBER DESCRIPTION OF DEATH
54.13
1, PPL
122.96
2. WFNNB CREDIT CARD
68.14
3. COMCAST
4. MICHAEL LANGAN, TAX COLLECTOR 699.44
408.93
5. H B MCCLURE
g. WINTERSTEEN FOOT & ANKLE ASSOC 30.00
7. M S HERSHEY MED CENTER 300.00
7.20
g. HARRISBURG PHARMACY
90.29
g. PPL
418.00
10. CAREGIVER (PRISCILLA)
11. CAREGIVER ABENA YEBOAH 264.00
401.50
12. VISITING ANGELS
TOTAL (Also enter on line 10, Recapitulation) I $ 2
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
BELVA J. GILL 21 09 0690
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 [include outri ht spousal distributions, and transfers under
Sec. 9116 (a~ (1.$)]
1. DEBORAH A. STONER Lineal 133,262.78
3900 TRAYER ROAD
MECHANICSBURG, PA 17050
I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE, ON REV-1500 COVER SHEET
I1. 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
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)
LAST WILL AND TESTAMENT
OF
BELVA GILL
I, BELVA GILL of Hampden Township, Cumberland
County, Pennsylvania, being of sound mind and memory, do make
publish and declare this my last will and testament, hereby
revoking and declaring null and void any and all wills and
codicils made by me at any time heretofore made.
FIRST: I direct my Executor hereinafter named to pay my
legal debts, the expenses of my last illness, my funeral expenses
and the administration expenses of my estate.
SECOND: I give, devise and bequeath all of my property,
real, personal and mixed of whatever nature and wheresoever
situate, which I may own or have the right to dispose of at the
time of my death, to my daughter, DEBORAH ANN STONER of
Mechanicsburg, Pennsylvania to have and to hold the same for her
own use absolutely and forever.
THIRD: In the event that my daughter, DEBORAH ANN STONER,
should predecease me or fail to survive me for a period of sixty
;60) days, I give, devise and bequeath all of my property, real
~~ersonal and mixed of whatever nature and wheresoever situate, in
equal shares, to my grandson, MICHAEL EUGUNE STONER II of
Hummelstown, Pennsylvania and my grandson, MATTHEW PAUL STONER of
Mechanicsburg, Pennsylvania. In the event that either grandsc~
shall predecease me or fail to survive me for a period his
share of my estate shall pass to his issue per stirpes and not
per capita.
FOURTH: I name, constitute and appoint my daughter,
DEBORAH ANN STONER, Executor of my estate. If she shall not
survive me, shall not serve as Executor for any reason, or shall
cease to serve as Executor for any reason after appointment, I
appoint my son-in-law, MICHAEL EUGENE STONER, as Executor of this
Will. None of the individuals named in this paragraph shall be
required to furnish a bond for the faithful performance of his
du des as Executor.
FIFTH: In addition to all of the powers conferred by law
upon my Executor and not in limitation thereof, I hereby
authorize my Executor to sell any stocks, bonds, or other
personal property and any and all real estate which I may own at
the time of my death, without the order of authority of any Court
being required, at public or private sale, upon such terms as may
in the discretion of my said Executor seems to be in the best
interest of my estate. In pursuance of her power, my Executor
shall execute and deliver all documents of conveyance, including
deeds or bills of sale or any other instruments which may
effectively transfer title. I further authorize my Executor to
settle and compromise any and all claims in connection with the
administration of my estate herein and to do any and ail tY:ings
in her discretion that shall be conducive to the best in~erest of
my estate.
SIXTH: Any individual who has not been included as
receiving a distribution from my estate has been intentionally
excluded and is not to receive any of the proceeds of my estate.
SEVENTH: All pronouns referring to an Executor and the
term "executor" shall be construed to mean any person acting as
my Executor as the case may be.
IN WITNESS WHEREOF, I have set my hand and seal at
Cumberland County, Pennsylvania this ~`~~t~ day of ~ ` ~°.~~'~~ ~'~~
1999.
f ~~1
`,_ f
l_
Belva Gill
SIGNED, sealed, published and declared by the abo~:~e named
Testatrix, Belva Gill, 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 hereunto
sub fe-r.}b~d p;ar names as witnesses.
,'
Name
~/~ A r`
.1
Nam
~_ .; ~ ~ . ~
-~
Address
~/~ ~ ~
\ ~
Address
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF CUMBERLAND )
I, Belva Gill, 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; that
I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
~~ _; L..x _~ ;
Belva Gill
SWORN or affirmed to and acknowledged before me by
~h
Belva Gill, the Testatrix, this
d a y o f__ 7~ i t= k- i3~~~- _ ~ 19 9 9 .
~~~ `~
,~ (~,~,L ~,t.,
Notar Public
Notarial Seal
Mary McKnight, PJotary Public
Lemoyne Boro, Cumberland County
My Commission Expires Dec. 18, 2000
Member, Pen~~syhrama Association of Notaries
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA ~ SS:
COUNTY CF CUMBERLAND
-; , ~: ~~~, :.j ~. _~ ~ and ~ ~ ~~- ~ --------
witnesses whose names are signed to the attached or
foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw the
Testatrix sign and execute the instrument as her Last Will,
that she signed it willingly and that she executed it as
her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the
Testatrix signed the Will as witnesses and that to the best
of our knowledge, the Testatrix was at the time eighteen
\18) or more years of age, of sound mind and under no
constraint or undue influence.
.--~ _ _~---;1 _
~ ~ ~ ~ ~''~. Address: 3 ''~
r"
Address: Y~-,~_%r.~_ ,u~: ~ ~~
~ ~ r _ r,_~ , '~ ~ .ti ~,~~ J
- ` ---=
N or affirmed to and subscribed to before me by
SWOR
and ~~}~`-~-~ ~'~~~~' ~~ ~~ witnesses,
~ ~ --r-~-i ~J ~-~i t3 t: f ~ 19 9 9 .
this (~ ~ day of ~ -
~A
~~
~ Notarial ~aai pub 1 i c
~ Mary McKnight. ~ Jotary Public N O t a
Lemoyne 5oro, Cumberland County
My Commission Expires Dec. 18, 2000
tilPmber. Pennsv!varnz Association of Notariee.