HomeMy WebLinkAbout04-26-10 (2)REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
15056041158
OFFICIAL USE ONLY
County Code Year File Number
INHERITANCE TAX RETURN 21, 0 9 0 7 4 8
RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
206-1,0-8650 07212009
Decedent's Last Name Suffix
GOUFFER
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Social Security Number
FILL IN APPROPRIATE BOXES BELOW
1. Original Return
^ 4 Li
i
. m
ted Estate
^ 6. Decedent Died Testate
(Attach Copy of Will)
^
9. Litigation Proceeds Received
Date of Birth
021,71,920
Decedent's First Name M I
VERONICA A
Spouse's First Name M I
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
^ 2. Supplemental Return
^ 4a. Future Interest Compromise (date of
^ 7. death after 12-12-82)
Decedent Maintained a Living Trust
^ 10. (Attach Copy of Trust)
Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
^ 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
BRIDGET NI- WHITLEY, ESQUIRE 717-233-1,000
-..,
Firm Name (If Applicable)
SKARLATOS & ZONARICH LLP
First line of address
1,7 S• 2ND STREET, 6TH FLOOR
Second line of address
City or Post Office State ZIP Code
HARRISBURG PA 1,7101
Correspondent'se-mail address: BMWOSKARLATOSZONARICH • COM
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REGISTER'~Ty~(~LLS USE OlOLY
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DATE FILED .
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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,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
51GNA1 UFZE OF PERSON RESPONSIBL OR FILI RETURN DATE
~~~ _.~.~, .~~ ~I .~ .c~~'s~,~~(~ LEONARD A - GOUFFER ~I --~ ~~ `Zf?l~
ADDRESS - -- /ry
792 SANDY HOLLOW ROAD NEW BLOOMFIELD, PA 1,7068
SIGNATUR F PREPARER OTHER THAN REPRESENTATIVE DATE
BRIDGET M - WHITLEY 3 ,~a/U
ADDRES
1? S• 2ND STREET, 6TH FLOOR HARRISBURG, PA 171,01
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041158 6M46473.000 15056041158
J
15056042159
REV-1500 EX
Decedent's Social Security Number
206-10-8650
DecedenYSNarne:000FFER VERONICA A
RECAPITULATION
1. Real estate (Schedule A) 1. 0 • 0 0
2. Stocks and Bonds (Schedule 6) . 2. 0 • 0 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3. Q . Q Q
4. Mortgages & Notes Receivable (Schedule D). 4. 0 • 0 0
5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) . 5. 3 5 0 3 6.0 0
6.
7. Jointly Owned Property (Schedule F) ~ Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested 6.
7. 0 • 0 0
0 • 0 0
8. Total Gross Assets (total Lines 1-7). s. 3 5 0 3 6.0 0
9. Funeral Expenses & Administrative Costs (Schedule H) . 9. 616 9.0 0
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) . 10. 7 9 7 2 6 •0 0
11. Total Deductions (total Lines 9 & 10) . 11. 8 5 8 9 5.0 0
12. Net Value of Estate (Line 8 minus Line 11) 12. - 5 0 8 5 9.0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) . 13. 0 • 0 0
14. Net Value Subject to Tax (Line 12 minus Line 13) 14. - 5 0 8 5 9.0 0
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 .OIL Q. Q Q 15• 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .0'4.5 0. 0 0 16. 0. 0 0
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 1 g. 0. 0 0
19. TAX DUE 19. 0 • 0 0
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
15056042159 sMasaa2.ooo 15056042159
REV-1500 EX Page 3
~Deredent's Complete Address'
File Number
~1, (19 f174~
DECEDENTS NAME
OUFFER V R N CA A
STREET ADDRESS
COMB R AND
CITY
CARLISL STATE ZIP
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit 0 • 0 0
B. Prior Payments 0 • 0 0
C. Discount 0 • 0 0
(1)
•0
3. Interest/Penalty if applicable
D. Interest 0 • 0 0
E. Penalty 0 • 0 0
Total Credits (A + B + C) (2) 0 • 0 0
Total Interest/Penalty (D + E) (3) ~ . Q
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Line 20 to request a refund. (4) Q • ~ Q
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAx DUE. (5) 0 • 0 0
A. Enter the interest on the tax due. (5A) 0 • 0 0
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0 • 0 0
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; ^ ^X
b. retain the right to designate wha shall use the property transferred or its income; ^ 0
c. retain a reversionary 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
i
h
i
i
d ^ ^
w
out rece
v
ng a
t
equate 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 [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 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 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.
6M4671 1.000
REV-1508 EX+ (8-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
VERONICA A. GOUFFER 21 09 0748
Include the proceeds of litigation and the date the proceeds were received by the estate.
3W46AD 1.000 (If more space is needed, insert additional sheets of the same size)
REV_,s„Ex+~,aos> SCHEDULE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VERONICA A. GOUFFER 21 09 0748
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~ . None
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions 1 , 750
Name of Personal Representative(s) Leonard A. Gouffer
Street Address 7 92 Sandy Hollow Road
City New Bloomfield State PA Zip 17068
Year(s) Commission Paid:
2. Attorney Fees 3 , 000
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 8 3
5. Accountant's Fees
6. Tax Return Preparer's Fees
900
7.
1 Cumberland Law Journal - Estate Notice 75
2 The Sentinel - Estate Notice 209
Total from continuation schedules ~ 152
TOTAL (Also enter on line 9 Recapitulation) ~ $ 6 , 16 9
~wasac ~.ooo (If more space is needed, insert additional sheets of the same size)
Estate of: VERONICA A. GOUFFER
Schedule H Part 7 (Page 2)
21 09 0748
3 Register of Wills - Fee to take Executor Oath 20
4 Skarlatos & Zonarich LLP - Misc. Costs (postage,
photocopies, etc.) 132
Total (Carry forward to main schedule) 152
REV-1512 EX+(~2_pg~ SCHEDULE
pennsylvania
DEPARTMENTOF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8c LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VERONICA A. GOUFFER 21 09 0748
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
swasAH 2.00o If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (11-08)
' pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
___
ESTATE OF FILE NUMBER
[TL~Dl1ATT!'~T T /~l1TTL~L~L+D n~ nn ~~ w n
~ua~va~ivr a n. vvviLUa~ Gl V J V /5k0
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 2116 (a) (1.2).j
1. Elaine V. Dougher
332 5th Street
New Cumberland, PA 17070 Daughter 0
2 Beverly A. Leo
621 Carrington Court
Hummelstown, PA 17036 Daughter 0
3 Leonard A. Gouffer
792 Sandy Hollow Road
New Bloomfield, PA 17068 Son p
ENTER DOLLAR AMOUNTS FOR DISTRIBU110NS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE.
~~ NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ Q
swasAi z.ooo it more space is needed, insert addlUOnal sheets of the same size.
SKA~LATOS & ZONARICH
, ATTORNEYS AT LAW
LAST WILL AND TESTAMENT
OF
VERONICA A. GOUFFER
I, VERONICA A. GOUFFER, of Oberlin, Dauphin 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 the cost of a suitable gravemarker and
perpetual care for my burial plot, shall be paid from the assets
of my estate as soon as practicable after my decease.
ITEM II: I give, devise and bequeath all of my estate,
real, personal and mixed, wheresoever situated, to my husband,
LEONARD C. GOUFFER, if he survives me by thirty (30) days. If
my husband, LEONARD C. GOUFFER, does not so survive me, I give all
of my estate to my children, ELAINE V. DOUGHER, BEVERLY A. LEO and
LEONARD A. GOUFFER, in equal shares, per stirpes. Particular
items may be allocated among my children as they may agree or, in
the absence of agreement or if any of them is a minor, as my
Executor may think appropriate.
It is my specific request that the option to
purchase the house at 191 Spring Street, Oberlin, Pennsylvania,
and the adjacent lot be given to my son, LEONARD A. GOUFFER. In
the event that my son, LEONARD A. GOUFFER, does not wish to exer-
Page One (1) of Six (6) Pages
cise the option to purchase this property, the property shall be
offered next to any member of the family. In the event no member
of the family desires to purchase the property, the property
shall be offered to the general public for sale by my Executor.
ITEM III: No interest in income or principal shall be
assignable by or available to anyone having a claim against a
beneficiary before actual payment to the beneficiary.
ITEM IV: Ail f ederai, state, and other death taxes
payable on the property forming my gross estate for tax purposes,
whether or not it passed under this Will, shall be paid out of
the principal of my residuary estate just as if they were my
debts, and none of those taxes shall be charged against any
beneficiary.
ITEM V: I authorize my Executor:
(a) to retain and to invest in all f orms of
real and personal property, regardless of (i) any limitations
imposed by law on investments by executors or trustees,
(ii) any principle or law concerning delegation of investment
responsibility by executors or trustees, or (iii) any principle
of law concerning investment diversification;
(b) to compromise claims and to abandon any
property which, in my Executor's opinion, is of little or no
value; to borrow f rom, and to sell property to others, and to
pledge property as security for repayment of any funds borrowed;
Page Two (2) of Six (6) Pages
(c) 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 or leases;
(d) to join in any merger, reorganization,
voting-trust plan or other concerted action of security holders,
and to delegate discretionary duties with respect thereto;
(e) to use administrative or other expenses
of my estate as income tax or estate tax deductions and to value
my estate for tax :purposes by any optional method permitted by
the law in force when I die, without requiring adjustments
between income and principal for any resulting effect on income
or estate taxes; and
(f) to distribute in kind and to allocate
specific assets among the beneficiaries in such proportions as my
Executor may think best, so long as the total market value of any
beneficiary's share is not affected by such allocation.
These authorities shall extend to all real and
personal property at any time held by my Executor and shall con-
tinue in full force until the actual distribution of all such
property.
Ail powers, authorities, and discretion
granted by this Will shall be in addition to those granted by law
and shall be exercisable without leave of court.
!~
t
Page Three (3) of Six (6) Pages
..,..,~..~.__._. __. _ .. _ _.-,--,ter ~
ITEM VI: I appoint my husband, LEONARD C. GOUFFER,
Executor under this Will. Should my husband, LEONARD C. GOUFFER,
fail to qualify or cease to act as Executor, I appoint my son,
LEONARD A. GOUFFER, Executor under this Will. I direct that any
fiduciary acting hereunder shall not be required to enter bond or
other security in any Court or jurisdiction in which said fidu-
ciary may be called upon to act.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
and caused this my Last Will and Testament, consisting of six (6)
typewritten pages, including this attestation clause and the
following Acknowledgment and Affidavit, to be executed, declared
~ ~ ~i
and published this ~LsL`-day of , 1988,
at 'VL-J , Pennsylvan' a.
~ ~ ~, .
Veronica A. Gouf f
Page Four (4) of Six t6) Pages
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA)
SS:
COUNTY OF ~C~ C~ t~~ ~ ~ ~ )
I, VERONICA A. GOUFFER, the 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.
V. ~ ,
Veronica A. Gouf f er
Sworn or affirmed to and acknowledged before me by
VERONICA A. GOUFFER, the Testatrix, this ~ ~~~~ day of
~~~~,-~~ ~~ 19 8 8 .
~ %~
otary Public
(SEAL)
My Commission Expires:
LINDA A. LENTZ, Notary ~~,~~e~
Harris5urc~, ~3aup9~ir ~;;r~.
l111y Domrnis:~~an ~x~i~ f~4 Se~t~rr~~;~:r ~~ 1, ~ ~~~
Page Five (5) of Six (6) Pages
2~Fi'Ti'Til ~VTT
COMMONWEALTH OF PENNSYLVANIA)
SS:
,
r~ )
COUNTY OF ~LZ,L' ~
~~
/~~
-~ ~ 1.
d
a n ~~//Ylr
the witnesses, whose i
names are
L,~
signed to theVattached or foregoing instrument, being duly quali-
fied according to law, do depose and say that we were present and
saw VERONICA A. GOUFFER sign and execute the instrument as her
free and voluntary act for the purposes therein expressed; that
each of us in thae 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 twenty-one (21) or more years of age, of
so n d n er no c straint or undue influence.
Residing at ~-~~
,~ ~ . ~~-~ s--
", r _~:~.~ ~', ~, ,;; , ~'= ~ Resitting at ~ ,~~.. 'a ~-; _~'~
~. ~-
- -; -~ - ~ ~
~ ,.,~ ~ ; ~~ ! , ~7 i' . ,~
-------r
Residing at /(,~~17 q~~ ~~`'~ ~~
,-
Sw f f i rmed and .'acknowledged bef ores me by
,r, -'~ %( fir ~~ i ~~ ~ ~ /~ ,.~~-~ _ ~ r and
.~'
~..~ ,d~ ~,~~~ , the witnesses, this ~~~'~~' day of
Page Six (6) of Six (6) Pages
1988.
L/7`~.~` ..C ' '~
Notary Public
(SEAL)
My Commission Expires:
LINDA A. LENTZ, Notary Pr~blic
Harrisburg, Dauphin Co.
filly Commission Expires September t >f ' ~'`~
':STATEMENT PERIOD ;:PAGE
AUG.OS-SEP.08,2009 1 OF 1
00 0 06106M NM 017
`l1=RONICA A GOUFFER
1^~2 SANDY HOLLOW RD
f~F_W BLOOMFIELD PA 170(8
16176
INTEREST PAID YEAR "fCl DATE ~ 18.56 EAST PARK
ACC[ll1NT Sl1MMARY
~~GTI~I~NG:'
BALANCE DEP05IT5 $ <
~OtHE~i~;.A~~ItIbNS ~
CHECKS PAID OTHER
SUBTRACTIONS CURRENT
INTEREST PD ENDING
BALANCE
N0. AMOUNT NO. AMOUNT NO. AMOUNT
31,915.67 _ 0 0.00 0 0.00 1 31,916.41 0.74 0.00
Af'f'f111NT ArTT V TTV
POSTING
DATE ~~
_ fiRANSACTION DESCRIPTION DEPOSITS,INTEREST
8 OTHER ADDITIONS CHECKS 8 OTHER
SUBTRACTIONS DAILY
BALANCE
08-08-04 BEGINNING BALANCE S31,915.67
08-25-04 INTEREST PAYMENT 0.74
OS-25-09 CLOSEOUT 31,916.41 0.00
ENDING BALANCE 50.00
ANNUAL PERCENTAGE YIELD EARNED = 0.04
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