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Home My WebLink About05-17-10J 1505607121 REV-1500 EX 06 ( -05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN County Code Year File Number Harrisbu , PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 0 1 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 1 1 6 5 4 0 2 1 2 3 1 2 D 0 9 0 4 2 1 1 9 2 6 Decedent's Last Name Suffix Decedent's First Name MI S T O U F F E R D O N A L D C (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security N~.Imber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required QX 6 Deced t Di d T death after 12-12-82) . en e estate ~ (Attach Copy of Will) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes A 9 Litigation Proceed R i ( ttach Copy of Trust) . s ece ved ~ 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 J A N L B R O W N 7 1 7 5 4 1 5 ,~,5 D Firm Name (If Applicable) ;-~ ~- -, J A N L B R O W N __ REGISTER pl'•I~L! LS USE ~Y 3 & A S S O C - First line of address _..w , ~i ~ ~~ ""~ ~ ~-~ J ;_ r-~- 8 4 5 S I R T H O M ~~ ,:. ; -„ . -,_~ J ~ . A S C T S T E 1 2 '~ ~'~ -- Second line of address ,_,. -~ .,. ~ _ _: !~ _ _~ City or Post Office State ZIP Code _ _ __ _ DATE FILED ,i;-+ ~T' H A R R I S B U R G P A 1 7 1 0 9 Correspondent's a-mail address: BRENDAJLBCa~VERIZON.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, rrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG T E OF PERSON PONSI OR FILING RETURN z. 1039 WALNUT ST SIGNATURE OF PREP~ER C REPRESENTATIVE PA 17043 urn i c L. ~ ~~ ,/~ ~ L l l-~ L ADDRESS ~ 845 SIR T1~01`1AS CT STE 12 HARRISBURG PA 17109 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 ~~~ ~~ LEMOYNE 1505607221 REV-1500 EX Decedent's Social Security Number oecedent'sName: DONALD C• STOUFFER 2 0 1 1 6 5 4 0 2 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2 8 0 1 0 0, 0 0 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 & 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 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 _ D . 0 D 15. 16. Amount of Line 14 taxable at lineal rate X .045 2 5 7 8 4 4 6 2 1s. 17. Amount of Line 14 taxable at sibling rate X .12 D D D 17. 18. Amount of Line 14 taxable at collateral rate X .15 D D D 18 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 3 0 6 3 8, 6 7 3 1 0 7 3 8. 6 7 5 1 1 2 5. 6 2 1 7 6 8, 4 3 5 2 8 9 4. D 5 2 5 7 8 4 4. 6 2 2 5 7 8 4 4, 6 2 0. 0 0 1 1 6 0 3. 0 1 0. D 0 0. D 0 1 1 6 0 3. 0 1 Side 2 1505607221 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0013 DECEDENT'S NAME DONALD C. STOUFFER - _ _ _ _. __ STREET ADDRESS _- _ 304 Lamp Post Lane Hampden Township CITY _ _ _ _ __ _ Camp Hill STATE Zip PA ' 17011 Tax Payments and Credits: ~ Tax Due (Page 2 Line 19) 2. Credits/Payments (1) 11603.01 A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable Total Credits (A + B + C) (2) 0.00 D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Total InteresUPenalty (D +E) (3) 0.00 . 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) 11 603.01 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE . (5B) 11 603.01 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APP ROPRIA TE BLOCKS Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ....................................................... ^ 0 ............... b. retain the right to designate who shall use the property transferred or its income; ^ 0 ............................... c. retain a reversionary interest; or .............................................................................................. d i ^ a . rece ve 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? ......... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^ a 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 exemot 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(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) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DONALD C. STOUFFER 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 pOnce~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. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. 304 Lamp Post Lane, Hampden Township, Cumberland County, PA OF DEATH See Settlement Statement dated 4/26/2010. 280,100.00 TOTAL (Also enter on line 1 Recapitulation) ~ $ 280 100 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DONALD C. STOUFFER mauae me proceeds of Iltigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. Citizens Bank Checking 610076-475-3 OF DEATH 20,176.03 2 Citizens Bank Savings 6140-186099 1,141.84 3 Real estate tax reimbursement (Paid $551.87 on 3/16/10 and received reimbursement of $755.54 on 4/26/10) 203.67 4 State Farm; auto insurance cancellation refund 81.13 5 2005 Chevrolet Malibu LS VIN 1G1ZT52895F305024 6,000.00 6 Household goods and furnishings 3,036.00 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 1n nn~s TOTAL (Also enter on line 5, Recapitulation) I $ 30 638 67 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DONALD C. STOUFFER 21 10 0013 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 7. Musselman Funeral Home Inc 2 Rolling Green Cemetery 3 Funeral luncheon B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Year(s) Commission Paid: 2. Attorney Fees Jan L Brown & Associates 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. ~ Probate Fees Register of Wills, Cumberland County 5 ~ Accountant's Fees Parks & Company 6. I Tax Return Preparer's Fees 7. Cumberland Law Journal; legal advertising 8 The Patriot-News; legal advertising 9 Attorney travel 10 Goodyear; presale automobile inspection 11 Michael Langan Treasurer Hampden Township; tax information Adm expenses incurred in order to preserve/liquidate real estate: 12 Drain Doctors 13 Dri-Way Carpet Cleaning 14 Hampden Township; sewer/trash 15 Home Paramount Pest Control 16 Landscape maintenance 17 Lebo's Home Revitalizing Co; presale repairs TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) Zip AMOUNT 6,626.00 1,345.00 509.37 4,000.00 469.50 250.00 75.00 300.41 49.68 59.52 5.00 515.00 235.00 191.21 45.00 200.00 14,620.00 51,125.62 Continuation of REV-1500 Inheritance Tax Return Resident Decedent DONALD C. STOUFFER Decedent's Name 21 10 0013 Page 1 File Number Schedule H -Funeral Expenses & Administrative Costs - 67. ITEM NUMBER DESCRIPTION AMOUNT 18 Liberty Mutual Group; homeowners insurance 19 Pennsylvania American Water 109.00 20 PPL Electric Utilities 99.47 21 UGI Utilities Inc 113.66 22 Verizon 872.38 23 Real estate settlement charges per Settlement Statement dated 4/26/10 62.92 20,372.50 SUBTOTAL SCHEDULE H-B7 I 21,629.93 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER DONALD C. STOUFFER 21 10 0013 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Bank Of America; Account *2429 balance 65.69 2 Boscov's 60.91 3 Citi Cards; Account *9757 balance 1,140.26 4 ICiti Cards; Account *6360 balance I 159.78 5 Estate Information Services Creditor name: Citicorp Credit Services 11.99 6 Pennsylvania American Water 64.33 7 PPL Electric Utiiities 35.73 8 UGI Utilities Inc 215.00 9 Verizon Wireless 14.74 TOTAL (Also enter on line 10, Recapitulation) I $ 1 768 43 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT C[~TATP A SCHEDULE J BENEFICIARIES DONALD C. STOUFFER 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. Phyllis R George, daughter 1039 Walnut Street Lemoyne PA 17043 AMOUNT OR SHARE OF ESTATE 100% residue ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV 1500 COVER SHEET II. 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 FILE NUMBER 21 10 0013 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space Is needed, Insert addltlonal sheets of the same size) LAST WILL AND TESTAiVIENT OF DONALD C. STOUFFER I, DONALD C. STOUFFER, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils that I ma hay-e Y previously made. Art_ My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after m y death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Arti_ cle III I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my will or with my valuable papers and found within 30 da s of Y the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. Article N All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my daughter, PHYLLIS R. GEORGE, of Cumberland County, Pennsylvania. If any of my beneficiaries predecease me or fail to survive me by thirty (30) days, I give, devise and bequeath his or her share to his or her issue who survive me, per stirpes, or if he or she has no issue, the share(s) are to be added equally to the other shares. Article V I nominate, constitute, and appoint my daughter, PHYLLIS R. GEORGE, as Executrix of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate, constitute and appoint my granddaughter, TAIVII~IY BENSING, as successor Executrix of my Last Will and Testament. I direct that my Executrix or successor Executrix be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares and to file any -2- qualified disclaimer I could have filed if living. My Executrix and successor Executrix shall receive reasonable compensation for services rendered to my estate. Arta- cle VI v1 addition to the powers conferred by law, I authorize my Executrix and successor Executrix, in her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all fornis of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (~ to file any federal income tax return for any year for which I have not filed such return poor to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and -3- (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. IN WITNESS WHEREOF, I, DONALD C. STOUFFER, hereby set my hand to this my Last Will and Testament, on ~' .~'~Z~. ,~ 2006. /r--' i~ l..l DONALD C: STOUFFER In our presence, the above-named DONALD C. STOUFFER signed this and declared this to be his Last ~ti ill and Testament and now at his request, in his presence, and in the presence of each other, we sign as witnesses. Name ~~ ~ ~ -, ~' c, <~ C'~ ~~ < l ~, ~~-~~ Address 84~ Sir Thomas Court Suite 12, Harrisbur , PA 17109 845 Sir Thomas Court Suite 12. Harri~bur~ PA 17109 -4- I, DONALD C. STOUFFER, Testator, who signed the foregoing instrument, having been duly quali tied according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by DONALD C. STOUFFER, the Testator, on l ~ _`~ -- , 2006. Not~y Public ~= CON1h10tIWEAlTt10f PfN'NSfLYANtA NOTARIAL SEAL JACQUELlP;E A. KELLY, NOTARY pUEtfC LOWER PA7(TON TWP., DAJPHiY COt1N1Y k1Y CDMIJlSS10Pi EtPlRES DEC.17, 2001 ~ ., ,~--, DONALD~C.~S COU~'FER We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mired, and under no constraint or undue influence. Sworn to or affrned and subsc -'bed to before me by _ C1~Z~(.i.,l~ (.c1i~~~ and .,l ~, ~ ,~f~, f+ -~ ~~: ~~~1~ witnesses, on l -~~,CC " ~~, . Zt'.~t~r-~ ~~ ~~~ ~ot ~ Public ~~-~ ~- COi!1NON~KEgyLTN OF PENNSYtY.4N1A JACAUELINE A.~ HEl 0 ARY PUBLIC LDINER PA;~(TON TVJP. DAUP,y;N COUNTY MY CO~r}MISSiON FXPiarc ter,.. _ i Witness -- 2006. C%/ Witness _S_ A Settlement Statement U.S. DEPARTMENT OF HOUSING ANn I Ipaenl nnro nnr,,r•aT to the best of my knowledge antl belief, it is a true and accurate statement of all receipts an`d disbursements made on my account a/ copy of the HUD-1 Settlement Statement. f'"- a ngs i~ WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION The HUD-1 Settlement Statemen hich I have prepay a We and accurate account of ttiis CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: transaction. I have causetl r cause the fu s to tlisbursed in accortlance with this statem f. U.S. CODE SECTION 1001 AND SECTION 1010. SETTLEMENTA / /~ DATE. ~f~/F'