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HomeMy WebLinkAbout04-26-10 (2) 15056041046 J REV-1500 EX (05-04) OFFICIAL USE ONLY PA pepartrnent of Revenue County Code Year ~ Fke Number Bureau of Individual Taxes INHERITANCE TAX RETURN ' ~. ~ ~ o 0 0 ~ ~ 3 ~~• 28oso1 RESIDENT DECEDENT Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death , ~ d~3 ~~0;1°9 3~ ~ ~ 5 pecedent s First Name MI Suffix , Decedent's Last Name C ~R~'y~ ~ ~5R JoH"~-~ (ff Applicable) Enter Surviving Spouse's Information Below Spouse's First Name MI Suffix ~.,,.~.,•. _r„~,. . •,r-~^~°,,,... Spouse's Last Name . ..:, .~_ Spouse's Social security Number THIS RETURN MUST BE FILED IN DUPLICATE WIITH THE ,;e REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 2 Supplemental Retum O 3. Remainder Retum (date of death ~ 1. Original Retum prior to 12-13-82) 5. Federel Estate Tax Retum Required p 4. Limited Estate O 4a. Future Interest Compromise (date of O death after 12-12-82) rt Boxes 8. Total Number of Safe Depos' Il• 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust Q (Attach Copy of Will) (Attach Copy of Trust) 11. Election to tax under Sec. 9113(A) p 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O (Attach Sch. O) between 12-31-91 and 1-1-95) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIALDT~ytimFe Te epho eNumber DIRECTED T0: .. W , Name , DoRMAn/ Firm Name (If Applicable) REGI(~S~TER OF WILLSr USE ONLY C ~ ~- © n -~ ]a~ r. ', First line of address ¢0 2 M` r D [~ L -c Second Irne of address City Or FOSt ~6Ce Ca ~ ~ /-~o ,4 D, State W Il r~ ~^~~ .~ ~ ~~.ij . r-- i~` ,. •' cap ~ ~ r-" a ,~ .~C ~ _x't DATE Fll~r,® ~ ~- ~ ZIP Code ~ ~ ,~ ~ ~~ Z 6 8' / z Lit Correspondent's e-mail address: y and belief, schedules and statements, and to the best of m knowledge Undar penalties of perjury, I declare that I have examined this return, including accompanying it is true, coned and complete. Dedaratron of preparer other than the personal representative is based o all i rmation of w ich preDa DATE any knowkidge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Q .¢ -Z ¢ ° /O .D D R/YJlj n/ L , G o D L t~ /E JJ'~ "/ ADDRESS ,>f/ 2~o8/~e 'f-dL /h/DOLE CO1/E /~D. ~~Tir-/!/~-~ ~ DATE A SIGNATy~E OF PREPARER OTHER THAN REPRESENTATIVE kiARRISONBURG VA 22801 o f' -2 4' -/O ~ /1 ~/ i i~ I /i )r z.~e./ •- - - -- - 1~~ ZZ~'it'~ ADDRESS ~pD, f-/A~Q~Q /Sa//av~G 9 ¢''!~ PD Ft T REPv.C-3 L ! G PLEASE USE ORIGINAL FORM ONLY 15056041046 Side 1 15056041046 Jc~ ~' J 15056042047 REV 1500 EX 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 8 Notes Receivable (Schedule D) ................ t ............. 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. . 6. Jointly Owned Property (Schedule F), , O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Protate'Property (Schedule G) C Separate Billing Requested........ 7. 8. Total Gross Assets (totaLLines 1-7) ........................ • ............ 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ......:.....:.. . 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .:....... . 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. Amount of Line 14 taxable at lineal rate X .0 - 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ............... . ......................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042047 1505.6D42047 O REV-1500 EX Page 3 Decedent's Complete Address: File Number 21_10_01$3 DECEDENT'S NAME John STREET ADDRESS ---__ 38 Hathaway Drive CITY STATE ZIP ---- Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E, Penalty (1) 9 156.64 48i -- Total Credits (A + B + C) (2) 481.92 Total Interest/Penalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 0 (4) (5) 8 674.72 (5A) (56) 8 674.72 Make Check Payable fo: 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 property which contains a beneficiary designation? ...................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)], The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2~J00: 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-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE FILEFILE NUMB R John C. Drey, Sr. 21-10-0183 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 property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~' Mobile Home - No land -Located: Regency South Mobile Home Park Lot 82 Hathaway Drive Carlisle, PA 17015 -Decedent's Home (Real Estate Tax Assessment Value Attached) TOTAL (Also enter on line 1, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) 18 340.00 REV-19D8IX • (1~7/ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF -- FILE NUMf3ER John C. Drey, Sr. 21-10-0183 Include the proceeds of litigation and the date the proceeds were received by the estate. Ali property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~' Automobile - 2001 Ford Taurus (Bill of Sale Attached) 3 000.00 Household Personal Property 2 000.00 Checking Account No. 97665835 M & T Bank 13 187.78 6560 Carlisle Pike Mechanicsburg, PA 17050 Savings Account No. 15004207049021 M & T Bank 37 188.61 6560 Carlisle Pike Mechanicsburg, PA 17050 TOTAL (Also enter on line 5, Recapitulation) I a 55 376 39 (If more space Is needed, Insert additional sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER John C. Dre , Sr. Debts of decedent must be reported on Schedule I. 21-10-0183 ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT 1. Hollinger Funeral Home - Cremation 2 477.00 B• ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Name of Personal Representative(s) Dorman L. Godlove Jr. Street Address 402 Middle Cove Road City Mathias State WV Zip 268_ 1? Year(s) Commission Paid: 20 t p ____ 1 600.00 2• Attorney Fees 3• Family Exemption: (If decedent's address Is not th ' e same as claimant s, attach explanation) Claimant Street Address ---- City ---- State Zip _ Relationship of Claimant to Decedent _ 4• Probate Fees 115.50 5• Accountant's Fees 6• Tax Return Preparer's Fees 1 000.00 7. • TOTAL (Also enter on line 9, Recapitulation) $ 5 192 50 (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 ESTATE OF SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS John C . Drey, Sr . FILE NUMBER s83 Report debts incurred by the decedent prior to death which remained unpaid as of the date f d O ITEM o eath, including unreimb ursed medic I expe NUMBER DESCRIPTION VALUE AT DATE t Guardian Pharmac Y 74.14, 485.43 OF DEATH 559.57 2• Forest Park Health Center (Incl. 247.11 refund) 4 062.89 3• Graham Medical Center 61.21 4• Laurel Godlove - Cleaning Services 1 689.95 5• Potomac Power and Electric 54.38 6• Verizon 53.72 7• Suburban Propane 130.68 8• Citi Bank Credit Card (Incl. 1.46 refund) 189.54 9• Cumberland Co. Real Estate Taxes (Decedent's mobile home) 77.72 10. Lot Rent - Mobile Home Park (Decedent's residence) 600.00 TOTAL (Also enter on line 10, Recapitulation) $ I 7 479 66 (If more space is needed, insert additional sheets of the same size) 1 lawtemp LAST WILL AND TESTAMENT OF john C. Drey I. I, john c. Drey, residing at Carlisle. Pennsylvania, being of ,sound mind and in the contemplation of the certainty of death, do hereby declare this ins ~ment tube my _,I last will and testament. ~ -~*~ T-: rn ~> w :. II . ~ ~ N ,. . Y~ ..~ i hereby revoke all previous wills and codicils. ~~cn -o .. I, III. ~ IV I direct that the disposition of my remains be as follows : a ~ .~ ~ ~, ;~ Funeral arrangements shall be made by Dorman ~. Godlove, 7r. -- IV. I have compiled a list of my personal belongings and my disposition of these items and have left this with my, personal papers. I direct that these items be distributed as shown in the written disposition. v. I give all the rest and residue of my estate to the following individuals, share and share alike: Dorman L. Godlove, 7r. I give all the rest and residue If none of my designated beneficiaries survives me, fir. nor Laurel of my estate to Laurel Godlove. If neither Dorman L. Godlove, Godlove, survives me, I Qive all the rest and residue of my estate to my heirs as determined by the laws of the state of Pennsylvania, relating to descent and distribution. VI. I a point .Dorman L. Godlove, 7r., to act as the executor of this will, to serve without bond. should Dorman L. Godlove, 7r. be unable or unwilling to serve, then I appoint Laurel Godlove to act as the executor of this will. I herewith affix my signature to this will on this the /'~ day of X1.409 Page 1 lawtemp ~ _i ~ ~o ~. _, in the presence of the following at resenee. witnesses, w o witnessed and subscribed this will at my request, and in my p (~ 7ohn C. Drey ATTESTATION CLAUSE on the eat~habothisrinstrumentn C. Drey, well known to us declared to us, and in our presenc , then consisting of _~ pages, is their last will and testament and 7ohn c. Drey,. signed this instrument in our presence, and at 7ohn c. Drey s request we nowasieared to~uswtolbesof,soundemind andhlawful,agereandcunderrnoeunduetinfluenceDrey, pp ~~ Witness: '~ J J 7 o i .r'" STATE OF Pennsylvania COUNTY OF Cumberland before me, the undersigned authority authorized to take acknowledgments and administer oaths, personally appeared: 7ohn C. Drey Page Z Address: ~ S SPi-vC lawtemp who after being having duly sworn or affirmed to tell the truth stated: 1. -That ]ohn C. Drey declared this instrument to be their last will and testament to the witnesses. 2. That ]ohn c. Drey signed this instrument in their presence. 3. That the witnesses signed as witnesses in the presence of ]ohn c. Drey and each other. C. Dreattoobe of lawfulsagellofnsound mind a dnunder~nonundue influence orlieve ]ohn constraint. officer Title of Officer: ~ My Commission Expires: COMMONWEALTii OF PENNSYLVANIA Notarial Sssl Fors M. Vogt, Notary Public North Middleton 1Vvp., Cumberland County My Commiaabn Expires May 21, 201 Member, PennsyNanis AasociaUon Of Notaries Page 3 ~ O O N ~ O~ f0 0 ~z zo~ m m U o_ O UW W ~ O ~>-U J ._ "'1 d F ~ ~pp .•~M d=~~ Z ~ N J I[r ~~a~ J ~ m ~ ~~ -~~=C a ~w~ta ~cW»~a 2 po V t~0 N m N a ~ ~ ~ ~ $ 0 ~ p S p c9i O M ~_ ~ ~ . ~ ~ t _ O ~ _ ~_ C 7 r ~ r IA ~ O ~ 0 F- 8 W ~ ~ n ~ ~1y ( t9 s o R 2 ~ ~ 0 ~ $ N ~ cv E O o ~ ~ W c ~ W a' m J W F- Z O O ~ ~ a am ~. Z Z U x Q .-. O U O U ~ ~ ~ ~ a O W ~ O W = J W J J Uj ~ m ~~ $? ~ ~ F-~0 ~~ 2 ~ W r ~.- ~ F o ~: ~z~ } ~ z. O~LLIU? a~cOn dom. }W_~~ ~"' WaNO w~ ZLLK~Q=~p ~C9{-~~ a~UCNtQ¢~~~~ ~ o a mZ ~ oaf _ n a~o O ~ } Qa ~~ W a~~=' ~o~~ N D O V W Q 0 LL Z O F- '~ a y f' a W W ~a V } a a O F V W A J W J F O N V W W U7 ~ X H rl CJ' ago w F A N ~ ra r W W rn z v H O_ Q H >E-a > Q N ~ A A r W J W Vl U' W J H Vl Z }.iL H ~ Z J ~ Z W OC E- wu~a w a r9 V ~ O-V-Z85•dHd 0 ti ~' c0 ra 0 N ~ ra A 4 >- a za = 3 r O a W ~ = J F Vl r Q H } = J w ~ 0.' W Q A R1 V ~~ a m .T...G "' March 23, 201(1 This 2001 Ford Taurus is being sold in the condition "as is" to Sharon M. Miller in the amount of $3000.00. Seller ~ ~~~° ~~ Purchase -~ ~- N 0