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Home My WebLink About04-08-1015056051058 REV-1500 Ex (06-05) OFFICL4L USE ONLY PA peparUrlent of Revenue County Code Year File. Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN 21 10 0015 Hamsburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death Date of Birth 191-18-4836 09/24/2009 10/06/1924 Decedent's Last Name Suffix Decedent's First Name _ MI Fry.... _ _ __ Jr. Lucian B '' __ __ (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 Retum 2. Supplemental Retum °"""°~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate a,;.; 4a. Future Interest Compromise (date of 5. Federal Estate Tax Retum Required death after 12-12-82) H!~ 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 C` : 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 DIREGTeo lu: Name Daytlme Telephone Number Lisa Marie Coyne, Esq. (717) 737-0464 ra Finn Name (If Applicable) __ _ ........... REGISTER~fj WILLS USE ~Y ^,~r ~- Coyne & Coyne, P.C. ' ~ .~'~, ~. ~, r' ,... ~ ' r First line of address 3901 Market Street - -- i CA ~ _ ~ f,,,:.. • ». _. F ""~ ,~ , Second line of address _ p ~ a .,,c.; . .,, ~ City or Post G~ffice State Camp Hill PA V ~ '~ •~ ., '.` ZIP Code _ ~ . _ _D ~ •-ri 3 17011 ~ ' ~ Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this retum,lnGuding accompanying schedules and statements, antl to the best of my knowledge and belief, it is true, correct and complete. Declaretbn of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIG RE OF PERSOfIhR PONSIBLE FOR FILING RETURN C ~ ~~ ~~ h Lucian B. Frv.lll 315 2nd Street, Summerdale, PA 17093 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE uAi t ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~~ 15056052059 REV-1500 EX Dec:edent's Social Security Number Decedent's Name: LUCiBn B Fry 191-18-4836 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. 7. Inter-Vivos Transfers 8 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. 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 13. Charitable and Governmental BequestslSec 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. 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 0 00 . at collateral rate X .15 18 19. TAX DUE ....................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 4,825.00 6,626.85 11,451.85 13,578.78 1,109.99 13,674.77 -2,222.92 0.00 0.00 15056052059 Side 2 15056052059 REV-1500 EX Page 3 , _. -_-.. 21 10 x:0015 Decedent's Complete Address: F ~ ..._ __r .._._. DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Lucian B Fry 191-18-4836 STREET ADDRESS 315 2nd Street ZIP I CITY I PA I 17093 Summerdale Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit _- B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest o.oo 0.00 (1) Total Credits (A + B + C) (2) E. Penalty Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the diffference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (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? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly 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(x)(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(x)(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(x)(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. SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. COMMONWEALTH OP PENNSriVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FRY, JR., LUCIAN B 21 - 2009 - 0015 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 2004 Chevrolet Blazer --- As Per Kelly Blue Book 4,525.00 2 Misc. Personal Property and Furniture 300.00 TOTAL (Also enter on Line 5, Recapitulation) I 4,825.00 i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FRY, JR., LUCIAN B FILE NUMBER 21 - 2009 - 0015 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. Lucian B. Fry, III 315 2nd Street Nephew Summerdale, PA 17093 InwTl v nwNEn PRnPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE I JOINT o DESCRIPTION OF PROPERTY nclude name of financial institution and bank account number r similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET t o /o OF DECD'S NTERES DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A. 04/08/1997 _ Marysville National Bank 13,253.69 50% 6,626.85 ~ i i i Savings Acct. No. XXXXXX99 TOTAL (Also enter on une 6, RecapltwanonJ o,o~o.a~ s, .._._ c Checking Accounts: Number: Date Opened: Balance at Date of Death: Name of Joint Owner, if any: Savin¢s Accounts• Number: 18020399 Date Opened: 4~8-97 Balance at Date of Death: $13, 253.69 LUCIAN B FRY JR OR Name of Joint LUCIAN B FRY II I Owner, if any: Certificates of Deposit: Number: Date Opened: Name of Joint Owner, if any: Balance at Date of Death: Maturity Date: Interest Rate: Interest Paid Quarterly, Semi-Annual, etc. Debts: Estate o£ Lucian F. Fry, Jr. Date of Death: Sept. 24, 2009 Name of Bank: Marysville National Bank Signature of Bank Official ~ _ f ~ _ ~ a ' Sq-~DULE H FIAVERAL. EXPENSES & COMMONWEALTH OF PENNSYLVANIA ~wTA /C INHERITANCE TAX RETURN X71 fV1~ ~YG RESIDENT DECEDENT ESTATE OF FRY, JR., LUCIAN B Debts of decedent must be reported on Schedule I. ITEM I DESCRIPTION NUMBER' A, FUNERAL EXPENSES: 1. Shalonis Funeral Home 2. Reception 3. Honorarium 4. Flowers B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip i Year(s) Commission paid 2. Attorney's Fees Coyne 8c Coyne, P.C. 3, 'I Family Exemption: (If decedent's .address is not the same as claimant's, attach explanation) Claimant Street Address ~i City State Zip ~I, Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 5. I' Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Cumberland Law Journal-- Legal Advertisement 2 Patriot News-- Legal Advertisment FILE NUMBER 21 - 2009 - 0015 AMOUNT Total of Continuation Schedule(s) 9,558.97 500.00 100.00 200.00 2,500.00 76.50 75.00 134.31 434.00 TOTAL (Also enter on line 9, Recapitulation) 13,578.78 C Sched~,ie H p COMMONWEALTH OF PENNSYLVANIA Funeral 19eS « INHERITANCE TAX RETURN ~'~ ~'~ RESIDENT DECEDENT - ESTATE OF FILE NUMBER FRY, JR., LUCIAN B 21 - 2009 - 0015 3 Filing Fee-- Inheritance Tax Return 15.00 I 4 Postage 44.00 5 I Income Tax Prep Fee 125.00 6 Mileage Reimbursement for Executor @ $.50/mile 50.00 7 Reserves ~ 200.00 Page 2 of Schedule H COMMONYJEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FRY, JR., LUCIAN B ' SCHEDULEI OF DECEDENT MORTGAGE DEBTS , LIABILITIES, & LIENS FILE NUMBER 21 - 2009 - 0015 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER _ _ 1 Overpayment of Pension 1,109.99 TOTAL (Also enter on Line 10, Recapitulation) I 1,109.99 REV-1513 EX+ i. i.-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 7 BENEFICIARIES ESTATE OF Lucian B. Fry, Jr. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Lucian B. Fry, III LATIONSHIP TO DECEDEI Do Not List Trustee(s) nephew 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. FILE NUMBER 21-10-0015 AMOUNT OR SF OF ESTATE 100% TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, insert additional sheets of the same size. ~~c~f %II ttn~ ~P~fttrttPnk I, LUCLAN BANDS FRY,, JR., of .the Township of East Pennsboro, County of Cumberland and State of Pennsylvania, make, piablish- and declare this to be my Last Will and Testament, hereby revoking and making void any and all former Wills by meat any time heretofore made. 1. I direct the payment of my just debts and funeral - expenses as soon after my death as may be convenient to my Executor hereinafter named. 2. I give; devise and bequeath all the rest, residue and remainder of my estate to my nephew, Lueian Banks Fry, III. 3. If my nephew, Lucian Banks Fry, III, .should be a minor 4 at the time~for distribution, I appoint Dauphin Deposit Trust Company to be the guardian of the estate of Lucian Banks Fry, III. 4. I nominate and appoint Dauphin Deposit Trust Company to be Executor of this, my Will. IN WITNESS WHEREOF, I hereunto set my hand and-seal this ~-~ day o f ~`2~+~ 19 7'~~"~,~ `. - ~~ ,(SEAL) ~~; ~~-, a3i.gned; csealed, published and declared by the above named ~'~esta~or a~fiis Last Will and Testament in the presence of us who +-~-a~ hi:~ r~g}~, in his presence and in the ese a of each other, ~` , , `it . ~~~~k~.ve '~ier~ ea subscribed our names a ~~w s es ~ ,~. -~ ~ S ~- =: ~ ~- o d ~ , c.: n U ~, CV ~