HomeMy WebLinkAbout05-07-10 (3)15056051058
REV-1500 Ex (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 10 00200
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
567-36-1898 02/11 /2010 06/25/1917
Decedent's Last Name Suffix Decedent's First Names MI
SHEAFFER VERNA S
(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 Return (date of death
prior to 12-13-82)
4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate 7. Decedent Maintained a Living Trust 1 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 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 DIRECTED TO:
Name Daytime Telephone Number
BARBARA A SHADE (717; 774-7398 r.,,
Finn Name (If Applicable ) ~--- ~
REGISTER E7~ BLS USE (]~Y _ "C=~;
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First line of address ~ '? ~= t~~'I I r-- ~.-:..i
311 8TH ST `= ~~ r~ `J - ' ' ~ ~
Second line of address c ; -v
~-~ C1 "i'~ -~ 1::,
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City or Post Office
State ZIP Code _~ --I '.
DA~E FILED ~ .._ '~
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NEW CUMBERLAND PA 17070-1303
Correspondent's a-mail address: BSHADE311@COMCAST.NET
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.
~GNATUR~.OF PERSON RF,\~,P~ONSIBL FOR FILI~NGR-ETURN ATE\
ADDRESS - _ _ _ - -- - ---
.` ~ ~ t
~~
-- -- - ---
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
- -- _
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 ].5056051058
°~
J
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: VERNA S SHEAFFER
.
. 5fi7-36-1898
.
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. Mortgages 8~ Notes Receivable (Schedule D) .......................... ... 4. 0.00
5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ..... ... 5. 113,518.57
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested .... ... 6. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested..... ... 7. 0.00
8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 113,518.57
9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 13,277.42
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............. ... 10. 1,213.74
11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 14,491.16
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 99,027.41
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. 99,027.41
.
_, _ _
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. 0.00
16. Amount of Line 14 taxable
at lineal rate X .0 45 16. 4,456.23
17. Amount of Line 14 taxable
at sibling rate X .12 17, 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 1 R 0.00
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
4,456.23
15056052059 Side 2
15056052059
REV-150D EX Page 3 File Number
Decedent's Complete Address: 21 10 00200
VERNA S SHEAFFER
STREET ADDRESS
311 8TH ST
cm
NEW CUMBERLAND
DECEDENTS SOCIAL SECURITY NUMBER
567-36-1898
_--- -_
STATE ZIP
PA 17070-1303
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 4,456.23
2. CreditslPayments 0.00
A. Spousal Poverty Credit
B. Prior Payments 0.00
C. Discount 222 81
- _ Total Credits (A + B + C) (2) 222.81
3. InteresUPenalty if applicable 0.00
D. Interest
E. Penalty _ 0.00
Total Interest/Penalty (D + E) (3) 0.00
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) 4,233.42
A. Enter the interest on the tax due. (5A) 0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 4,233.42
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 properly 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? .............. ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................... ..,,.,,, ^ 0
.................................................................................
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(1.2) [72 P.S. §9116(aK1)].
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 feast one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (6-98)
SCI~IEDULE E
p
CASH
BANK DEPOSITS
8
MISC
COMMONWEALTH OF PENNSYLVANIA ,
c
,
.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VERNA S. SHEAFFER 2110-00200
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 M 8~ T BANK (CHECKING), 344 S 10TH ST., LEMOYNE PA 17043 #77382153 /CLOSED 3112/10 7,285.91
2 M & T BANK (CD) 344 S 10TH ST., LEMOYNE PA 17043 ACCT 31003917682899 /CLOSE[) 3/5!10 31,996.25
3 FULTON BANK (CHECKING)132 OLD YORK RD., NEW CUMBERLAND PA 17070 I CLOSED 319/10 15.00
4 FULTON BANK (CD) 132 OLD YORK RD NEW CUMBERLAND PA 17070 #0520276089/CLOSED 3/9/10 31,931.46
5 MEMBER'S 1ST FED CREDIT UNION PO BOX 40 MECHANICSBURG PA #337388 / CLOSI.D 3/9/10 10,250.88
6 METRO BANK (CD)1130 CARLISLE RD, CAMP HILL, PA #12001680 /CLOSED 3/12110 32,039.07
TOTAL (Also enter on line 5, Recapitulation) ; I 113,518.57
(If more space is needed, insert additional sheets of the same size)
LAW OFFICES
~~I~T ~a ~a~~'~~~~IE~
317 THIRD STREET
°'NEW CUMBERLAND, PENNSYLVANIA 17070
LAST WILL AND TESTAMENT
OF
VERNA S. SHEAFFER
r
I, VERNA S. SHEAFFER, of New Cumber:Land Borough, Cumberland
County, Pennsylvania, being of sound mind, memory and understanding,
do hereby make, publish and declare this as and for my Last Will
Nand Testament hereby revoking and making void any and all other
.wills by me at any time heretofore made.
~.
I.
7
7.
I direct that my Executors hereinafter named shall pay all
7
Wmy just debts and funeral expenses as soon as conveniently may be
done after my decease.
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x II.
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I hereby give and bequeath my grand:Eather clock unto MELVIN
SHEAFFER, or if he is not living, then unto his children.
7
° III.
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~~^\\\.~ ; All the rest, residue and remainder of my estate, whether
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`~jv cereal, personal or mixed, and wheresoever s_Ltuate, I hereby give,
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\~ devise and bequeath unto my three children,, DAVID LAMBERT, DOREEN M.
SHULER and BARBARA A. LILLEY, in equal shares, per stirpes.
IV.
I hereby nominate, constitute and appoint DOREEN M. SHULER,
!?BARBARA A. LILLEY and DAVID LAMBERT as Co-Executors of this, my
;'Last Will and Testament. If any of these persons are unable or
'unwilling to serve, then the remainder sha]_1 serve.
Page one of two Pager
V.
No fiduciary acting under this Will shall be required to
,;post bond in this jurisdiction or in any jurisdiction in which he
'may act.
IN WITNESS WHEREOF, I, VERNA S. SHE?.,FFER, the Testatrix,
have unto this, my Last Will and Testament, set my hand and-seal
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'this ~~' day of October, A. D., 1987.
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SIGNED, SEALED, PUBLISHED and DECLAF;ED by VERNA S. SHEAFFER,
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the above-named Testatrix, as and for her Last Will and Testament,
in the presence of us who have hereunto subscribed our names as
witnesses at her request, in the presence of the said Testatrix
and in the presence of each other.
Page
LAW OFFICES
BARBARA SUMPLE-SULLIVAN
549 BRIDGE STREET
NEW CUMBERLAND, PENNSYLVANIA 17070-1931
PHONE (717) 774-1445
FAX (717) 774-7059
March 12, 2010
CERTIFIED MAIL -RETURN RECEIPT REQUESTED
CERTIFICATE NO. 7007 2680 0002 4649 5581
Pennsylvania Department of Revenue
Harrisburg District Office
Lobby, Strawberry Square
Harrisburg, PA 17128-0101
Re: Estate of Verna S. Sheaffer
Social Security No. 567-36-1898
Cumberland County No. 21-10-0200
Dear Sir/Madam:
In accordance with the Letter of Authority issued to me by the Department on
March 3, 2010, I am filing the Inventory of the Decedent's safe deposit box. Entry was
made into the box on March 12, 2010. Should you have any que~ctions, please contact the
undersigned.
Barbara Sumple-Sullivan
BSS/lh
Enclosure /
cc: Mrs. Barbara A. Shade, Executrii:'
Mrs. Doreen M. Shuler, Executrix
Mr. David R. Lambert, Executor
for the Estate of Verna S. Sheaffer
,REV-485 E ~+ (g_00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
SAFE DEPOSIT BOX
INVENTORY
Please Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS i_OCATED AND RETURNED TO ABOVE ADDRESS
CCUNTY CODE ~FI/LE NUMBER /y /~~ SOCIAL SE/C~URITY OR DEATH /CE {R~TI/F~ICAT~EjNUMBER
DECEDENT'S NAME (LAST, FIRST, MIDDLE) DATE OF DEATH
Sheaffer Verna S. February 11, 2010
ADDRESS OFD CED NT (STREET) ITY) (STATE) (ZIP CODE)
3 ~~ ~ ~ ~T ~ /~~'~ (~1 ~•~'~~C~ ~ / 7~ 2 c~
NAME AND ADDRE~ OF~~~~ UEST~ THE OP~N~ING OF THE SAF ~~ P,pSIT~QX / „~ ~n ~_
(NAME) ~ i~Cl..~ //Y~,/~ J /L7/~~~ /~J\',JQ~;~ >°•1V(I,~ ~ L,Ff rxcis'J`
(STREET NAME) (CI ) (STATE) (ZIP CODE)
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' NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
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DATE AND TIME OF LAST ENTRY
DATE OF CONTRACT TO RENT BOX NUMBER OF BOX ~ T TLE UNDER WHICH BO)~ISaREQ~~~~ ~~~_,
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
a. (N
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(STREET ADDRESS) (STREET ADDRESS)
(CITY) (STATE) (ZIP CODE) (CITY)
(STATE) (ZIP CODE)
NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY ry~~
WAS A WILL IN THE BOX? ^ YES [~#O If yes, a. Date of will:
b. Name and address of personal representative, if named in the will
(NAME)
(STREET NAME) (CITY
(STATE) (ZIP CODE)
~. Name and address of attorney, if any
(NAME)
(STREET NAME) (CITY
(STATE) (ZIP CODE)
~7+~~ ~~~~~~ ~.J ~~~~' ~ Page of
Il~f:s I F211GT1®IVS
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be
I designated by name of company, certificate number, date of certificate, name in which stock is registered, and
number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and
type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer E3onds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book,
name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as `ully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully
as possible.
(8) All other contents.
ITEM
NO.
ITEM DESCRIPTION
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I CERTIFY UND NALT ' PERJURY THAT THE ABOVE RECORD IS
CORRECT MPL T TH ~ EST OF MY KNOWLEDGE AND BELIEF. PERSt"SN F:ECEIVIP+iG COPY CIF
SAFE DEPOSIT BOX IiVVENTIJ~'Y:
' SIGNATU, SIGNATURE Oti~pr~ ~ i`'`ce'-~
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PRINTPRINT TITLE
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~~~~~~~ CHECK APPROPRIATE BOX:
~xecutorltnx)~ ^ Administrator(tnx)
J ~ _ ^ Estate Representative ^ Joint owner of sate deposit box
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IdC)TE: Frttach additional 8'/z" x 11" sheet(s) if necessary or use dupticatES of this page csf form.
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499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888)502-4349
Fax (302)934-2955
March 23, 2010
Verna S Sheaffer
311 8`h St.
New Cumberland, PA 17070
Re: Estate of: Verna Sheaffer
Social Security: 567-36-1898
Date of Death: February 11, 2010
Dear Sir or Madam:
Per your inquiry, please be advised that at the time of death, the above-named decedent had on deposit with this bank the
following:
1. Type of Account Certificate of Deposit
Account Number 31003917682899
Ownership (Names of) Verna S Sheaffer
Opening Date 08/05/08 closed 03/05/10
Balance on Date of Death $ 30000.00
Accrued Interest $ 1996.25
Total $ 31996.25 _ __
2. Type of Account Checking Account
Account Number 77382153
Ownership (Names o, fl Verna S Sheaffer
Opening Date 0628/79 closed 03/12/10
Balance on Date of Death $ 7285.69
Accrued Interest $ 0.22
Total $7285.91.._._..
Please be advised, there was no safe deposit box found for the above decedent.
* If upon reviewing the information above, you believe there are additional accounts not referenced, please provide
us with an acrnunt number and/or name of any possible joint account holder. For any additional information on the
above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact
our Highland Park branch, 344 South 10"' SVeet, Lemoyne, PA 17043 Call #717-737322.
Sincerely,
~~L
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No issa Sears
Adjustment Services