HomeMy WebLinkAbout09-27-10 1505610140
REV-1500 EX ~°'-'°)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Ha rg bur28PA 17128-0601 INHERITANCE TAX RETURN 2 1 1 0 0 4 0 8
ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 6 3 0 6 4 6 6 0 9 1 5 2 0 0 9 0 6 2 1 1 9 3 6
Decedent's Last Name
STAVE R
Suffix Decedent's First Name
J R J A M E S
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
STAVE R
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Return
Spouse's First Name
N E L L I E
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
H
MI
R
2. Supplemental Return ~ 3. Remainder Return (date of death
4. Limited Estate ~
4a. Future Interest Compromise (date of
d prior to 12-13-82)
~ 5. Federal Estate Tax Return Required
eath after 12-12-82)
OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Livin Trust
g
~
(Attach Copy of Will)
(Attach Copy of Trust)
9
Liti
ati
P 8. Total Number of Safe Deposit Boxes
.
g
on
roceeds Received ~ 10. Spousal Poverty Credit (date of death
b
t
11. Election to tax under Sec
9113(A)
e
ween 12-31-91 and 1-1-95) .
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION
N
ame SHOULD BE DIRECTED TO:
J OEL R. ZUL L I NGER Daytime Telephone Number
"~'
7 1 7 2~6 4 6~ 2
9 ; `';
.
G ~ z- .: ~
REGISTER; LLS USE~LY
First line of address ~- ~ _ ~ c
~~' ~ rrn N C ~.._?
`..-'-, ';-
1 4 NORTH MAI N STREET `-'r'te -°
Second line of address `-~ C.._
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1
S U I T E 2 0 0 _
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City or Post Office
State ZIP Code DATE FILED
C H A M B E R S B U R G P A 1 7 2 0 1
Correspondent's a-mail address:
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 an tion of preparer other than the personal re
resent
ti
i
p
a
ve
s based on all i
SIGNAT OF P N RESPOJZI$IBLE F R FILING RETURN ,
nformation of which preparer has any knowledge.
/ OUt/-J DATE
~
ADDRESS "'-~~, - U~ o
127 KLINE ROAD
SHIPPENSBURG PA 17257
SI E OF PR PAR OAR THAN REP ESENTATIVE
DATE
ADD S ~ ~ ~.
14 ORTH MAI EET, SUI 200 CHAMBERSBURG
PA 17201
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140
1505610140 J
l',
REV-1500 EX
1505610240
Decedent's Social Security Number
Decedent's Name: JAMES H. STAYER JR 1 8 6 3 0 6 4 6 6
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 and Notes Receivable (Schedule D) ....................... ... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 0 . 0 0
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 through 7) ........................ ... 8. 0 ~ 0 0
9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9.
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10.
11. Total Deductions (total Lines 9 and 10) ............................. .. 11.
12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 0
0 0
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. 0 . 0 0
TAX CALCULATION -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 0. 0 0 15. 0
0 0
16. Amount of Line 14 taxable .
at lineal rate x .0 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 OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
L 1505610240 1505610240 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
JAMES H. STAYER, JR
STREET ADDRESS
127 Kline Road
ciTY
Tax Payments and Credits:
~ • Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
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.
Flle Number
21 10 0408
STATE Zip
PA 17257
(1) 0 00
Total Credits (A + g) (2) 0.00
(3)
(4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 00
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 ro ert transferred;
p P Y .....................................................................
. ^
0
b. retain the right to designate who shall use the property transferred or its income; .............................. . ^ 0
c. retain a reversionary interest or ............................................................................................... . ^
d. receive the promise for life of either payments, benefits or care? ...................................................... . ^ O
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration .
......................................................................................
. ^
o
3. Did decedent own an "in trust for" or payable-upon{feath 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? .................................................................................................. ^
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)J. 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 21 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 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 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 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, unde
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RESIDENTEDECEDENT N PERSONAL PROPERTY
ESTATE OF FILE NUMBER
JAMES H. STAVER JR 21 10 0408
Include the proceeds of litigation 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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NOTATION -The decedent had no assets in his name alone. All assets were held 0.00
jointly with his surviving spouse, Nellie D. Staver. Probate was filed to obtain a short
certificate for processing of life insurance.
TOTAL (Also enter on line 5, Recapitulation) I $ 0
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+(01-10)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
tS ~ A ~ t oF: FILE NUMBER:
JAMES H. STAVER_ JR .,.
GI IV V4V0
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Nellie D. Staver Spousal
127 Kline Road entire estate
Shippensburg, PA 17257
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
u nwle spare is neeaea, use aaamonal sneers of paper of the same size.
JRZ:cb - April 13, 1993
LAST WILL AND TESTAMENT
I, James H. Stayer, Jr., of Southampton 'Township, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby declare this to be my will, hereby
~ ..
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revoking any and all former wills and codicils thereto by tae '~
heretofore made. -'~~c-~ ~~ ~'
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F I RS T i~ ~" ~~: F=~
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I direct that all my just debts and funeral expenses ~.
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
SECOND
~;~ I give, devise and bequeath the residue of my estat e of every
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w`~; nature and wherever situate to my wife, Nellie D. Stayer, providing
a
~ she shall survive me by thirty days.
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, my I RD
4 Should my wife predecease me or die on or before the thirtieth
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,,~ day following my de ath I give, devise and bequeath the residue of
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~.` my estate of every nature and wherever situate to my children,
Page 1
namely James H. Staver, III, and Kenneth R. Staver, in equal
shares, provided that the share of any child who predeceases me or
dies on or before the thirtieth day following my death shall be
distributed to said beneficiary's issue, per stirpes, living on the
thirty-first day following my death, and in default of any such
then-living issue, such share shall be added to the share or shares
of my other child.
FOURTH
In the event my wife, Nellie D. Staver, my children and their
issue predecease me or die on or before the thirtieth day following
my death, I give and devise the residue of my estate of every
nature and wherever situate to Memorial Lutheran Church,
Shippensburg, Pennsylvania, Prince Street United Bretheran Church,
Shippensburg, Pennsylvania, and the Masonic Home, Elizabethtown,
Pennsylvania, in equal shares.
.., '~
FIFTH
~;M In the event that anyone entitled to a share of my estate
y1y
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~'_'~`; should be under the age of twenty-one years at the time for
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°~~,,~ tilstribution to him ar her, :i constitute and appoint my sons, James
`~;~..
H. Stayer, III, and Kenneth R. Stayer, as trustee of any property
which passes either under this will or otherwise to said
,ti.
~~~.~'j beneficiary. Should both my said sons predecease me or fail to
~.: ~
qualify as trustee, I appoint the Mellon Bank, Shippensburg,
Pennsylvania, as trustee of any property which passes either under
Page 2
this will or otherwise to a minor beneficiary. Said trustee shall
in the trustee's sole discretion and without order of court, use
principal as well as income from time to time as may appear to be
necessary for the beneficiary's welfare, comfort, medical care,
recreation, support and education, without responsibility to the
beneficiary or to any person taking care of the beneficiary; and
the remaining balance in the hands of said trustee shall be
distributed to said beneficiary when he or she attains the age of
twenty-one years. If such beneficiary dies prior to attaining the
age of twenty-one years, said trustee is authorized in the
trustee's discretion to pay part or all of his or her funeral
expenses and the remaining balance in the hands of said trustee
shall be distributed to his or her personal representative. In the
event the funds held by the trustee for any beneficiary become in
the opinion of the trustee too small for proper and efficient
administration, the trustee, in the trustee's sole discretion, may
deposit such funds in a savings account in the name of the
beneficiary.
~, ~~'
+ S I XTH
'; a Any fiduciary under tr,is will shall-have tfl~ fallowing powers
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~~~~, in addition to those vested in them by law and by other provisions
~~,
~~ of my will applicable to all property whether principal or income,
;..~\,. including property held for minors, exercisable without Court
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approval, and effective until actual distribution of all property:
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~,, A. To retain any and all of the assets of my estate, real
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Page 3
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or personal, without regard to any. principle of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
principle of diversification of risk.
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, exchanges or
leases, for such prices and upon such terms or conditions
as they deem proper.
D. To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
F. To distribute in cash or in kind or partly in each.
G. To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
SEVLNTii
I direct that all taxes that may be assessed in consequence
of my death of whatever nature and by whatever jurisdiction
imposed, shall be paid from my residuary estate as a part of the
expense of the administration of my estate.
Page 4
EIGHTH
I appoint my wife, Nellie D. Stayer, as executrix of this my
will. Should my wife predecease me, fail to qualify or cease to
act, I appoint my sons, James H. Stayer, III, and Kenneth R.
Stayer, as co-executors of this my will. Should both my sons
predecease me, fail to qualify or cease to act, I appoint Mellon
Bank with offices in Shippensburg, Pennsylvania, as executor of
this my will.
NINTH
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this
my last will and testament, consisting of six typewritten pages,
the first four of which bear my signature in the margin for the
purpose of identification this ~ l ~ day of
19~.
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%r',.;, :~:.~_ ~~g~ ,;!.~"^:~--~.~~: ~,~~~ (SEAL)
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Signed, sealed, published and declared by the above-named
testator, as and for his last will and testament in our presence,
who in his presence, at his request and in the presence of each
other have hereunto set our hands as attesting witnesses.
Page 5
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~ ~ residing at / ~~5-` //~~ ~~~2... l=~u~c~'Gri1,~~~
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(l/~C~:6C~/~ p~~~- residing at~0 ~tJ
We, James H. Staver, Jr., ~D`2-~ ~ ~cc ~l~~l~~e~ , and
I ~~A del - Jf ~ S-~ the testator and the witnesses,
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn do hereby declare to the
undersigned authority that the testator signed and executed the
instrument as his last will and that he had signed willingly (or
directed another to sign for him), and that he executed it as his
free and voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the testator
signed the will as witnesses and to the best of their knowledge,
the testator was at that time eighteen years of age or older,-of
sound mind and under no constraint or undue influence.
-~
Testator
_ ~'~\
Witness
Witness
Subscribed, sworn to and acknowledged
before me by the above-named testator
and subscribed and sworn to before me
by the above-named witnesses this -~sfi
day of /Kh~ 19 X13
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Notary Public
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