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HomeMy WebLinkAbout11-23-1015056041046 REV-1500 EX (05-04) OFFICIAL USE ONLY PA Department of Revenue Countv Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Dept. 280601 2 / n~ ~ ~ ,~ 6 3 . Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ?~ t~,S. G-423 ~ 2 02 ZooB 0~ QG 1 9 / 3 Decedents Last Name Suffix Dec edent~s First Name MI ~ ~~ ~ ~ ~~ (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 Original Return ' ~ 1 O 2. Supplemental Return O 3. Remainder Return (date of death . prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Litigation. Proceeds Received O 9 O nder Sec. 9113(A) t9 )f death O 11 ~ ( 10~ a a 1 d P . 5 p) Attach Sch d 1 1 an 2-3 9 between CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~ c--1~F~ E Y S eo ~k t~~ E~ 7 t 7 z ~-1 S3 z 1 Firm Name (If Applicable) ~ o~ L G~ f ~4 S S O<< ~-T ~~S First line of address 3 ~ o A- L ~ X A-~1 D c-2 ~S~ /~ ~- ~1~ Second line of address City or Post Office State ZIP Code REGISTER OF WILLS~E ONLY a ~~ '~ ~.-, ~' ~i'7 tV ` ~s ~-' r ~ :70-'r7 ~ i ~~ _ ~4TE FI - LE ~ N ~•'~ ~ .~ ~. a F'~ -70I~YI ~~ -- 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 and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN/kT~ O~~SQ~~V RE,SPO~1S AILING RETURN ~~./z,~/!~ ADDR~ S ~,~ ~ ' ' C P~ / ~O NATURE O RE H A R ESE I isF ' f/ ATE /' a k PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 ~~,, L-, J 1505604204? REV-1500 EX w, d T / Y ~T ~ ~ ~~ / Decedent's Name• Deceden~t/'sT~So' cial Security N~um" ber ~~~ ~ o'"~ ~'~°~'Hy"°' ~ __ RECAPITULATION ~ ~ , r k :, ~ t C 1. Real estate (Schedule A):.....:... ~ ......:.......................... a .. 1. 4 h .: 2. Stocks and Bonds (Schedule B) ..................................... .. 2 ., ,~~z -. t ~p - • ~ 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) .:. .. 3 ,1 ,y~.~~.F~,yax~~ i ~ _i~~ { ~ 4. Mort a es & Notes Receivable Schedule D 4. ., ;` m X33 ?~~+ 6=~ . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. y a,.~y~~ r ~~~~~_ 6. Jointly Owned Property (Schedule F) C Separate Billing Requested .... ... 6. = t 7. Inter-Vivos Transfers & Miscellaneous Non=Probate Property ' ~ (Schedule G) G Separate Billing Requested..... ... 7. , ,, y t ,. _ ,.,~ ,_ ~~- ~ ~ ~~ ~ 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. "~ r . 9 ~ { ©~) +~ 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule t) .... . ........ ... 10. 5 ~ '. ~ 1 t ~ ~ ; D I ~t~ !7 1 L 11. Total Deductions (total Lines 9 & 10) .................. , ............. , ... 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ~ ~ ~ ~ ~~ ~' 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which e an election to tax has not been made (Schedule J) ..................:... ... .13. ~_ , ~ ~ F 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. - - ~.-..-,. -.. i ..i.~ "rti A. .....................19. .~. - ,~. D 19. TAX DUE .................................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042047 15056042047 _~ , is :. O REV-1500 EX Page 3 Decedent's Complete Address: ----- STREET ADDRESS --- ~noo- CITY -_~~sT File Number ~ ~ ~ ~ /~~~~ -~ /Seal-n'1 Svu 7~f 57 - - _ _ _ __ Cll~l.=5 (.~ - Tax Payments and Credits: 1 • Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit __ _ B. Prior Payments - --- - ----- ---- - - C. Discount - _-__--__ _ ------------- 3. Interest/Penalty if applicable D. Interest E. Penalty _ _ ----_- _------------------ - ,-- -- ~ STATE Total Credits (A + g + C) (2) ~ ZIP _ _ _ - . ~ t?y13 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal Interest/Penalty (D + E) (3) 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. (4) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (56) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN 1. Did decedent make a transfer and: THE APPROPRIATE BLOCKS a. retain the use or income of the property transferred : Yes No ............... b. retain the right to designate who shall use the property transferred or its incom 0 e : .................................... 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 withi i w n one year of death thout 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 A ^ ..... u ccount, 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 I For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate im sed on T AS PART OF THE RETURN. is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. Po the net value of transfers to or for the use of the surviving spouse 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 survivin [72 P.S. §9116 (a) (1.1) (ii)]. The statute does n_____ of exempt a transfer to a surviving spouse from tax, and the statutory re uirement filing a tax return are still applicable even if the surviving spouse is the only beneficiary. g spouse is zero (0) percent For dates of death on or after July 1, 2000: q s for disclosure of assets and 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 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 beneficiar' the use of a natural parent, an 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. les is four and one-half (4.5) percent, except as noted in 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. Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ( )( 3)]. A sibling is defined, under REV-7508 EX . (1-97) SCHEDULE E CDMMONWEALTHOFPENNSYLVANIA CASH, BANK DEPOSITS, $c M~$C. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF - / ~NN~- V /~~jq-/y~ FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All roe ~ / _ D ~ '! ~ ~ Z 6 3 ITEM P p rty jointly-owned with the right of survivorship must be disclosed on Schedule F. NUMBER ~ DESCRIPTION VALUE AT DATE '~' ~ ~ ~','N~C L~~>~fcC-,It~lIV(r- .s~~Ca.j'" OF DEATH ~<<7' ~ 7 3 u ~6~ 3~~s ~. ~ Z' ~~ ~ IZE~t~cr,D ~q• £3 TOTAL (Also enter on line 5, Recapitulation) I $ ~.-'7(,~..~ ~ (If more snare Ic „~,.a .___1 ..... REV-1511 EX+ (10-06) t~ a COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /~71//-//~ Y ~~~/~/~ FILE NUMBER Debts of decedent must be reported on Schedule I. 2 / Q ~ ~' D /Z 6,3 ITEM NUMBER A FUNERAL EXPENSES: DESCRIPTION 1 AMOUNT /~/'c77~/~i'N 197V /~oTi~ /~I~t/e7Z.4-L l~v~! E N ~y,g~va vc-~ sr , c,a-Rc. ~ s c.E ~,a ~ ~oi3 439• sz B. ADMINISTRATIVE COSTS: 1 Personal Representative's Commissions Name of Personal Representative(s) " ~~~ E ~Ol~7G~ __ ----- - ...- .S"~O . uD StreetAddress (~ (~ ~.(J / [rc~o~ -- -- - - - - - - --- - - - - - _,/~ ST• ~-cllr~'/ City ~ l~''/~~ s ~ ----- _ -- ----- _ -- --- State ~/~}Zip ~ ~v,3 __ Year(s) Commission Paid: __ __ ~,C7~0 2• Attorney Fees 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 • Probate Fees U Od'~~ 5• Accountant's Fees 6• Tax Return Preparer's Fees ~OQt~: 7. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS TOTAL (Also enter.on line 9, Recapitulation ~~ ^^ (If more snaco ~~ .,eea,.a :---~ , .... ) $ W ~ 9_ ~7 REV-1512 EX+(12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCNEDIJLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Ar1lN~- V I~~,M ITEM Z/ ~g FILE''NU''MBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death i l ~ ~ NUMBER , nc uding unreimbu rs de me di l e p ses. 1' DESCRIPTION cSAcl~cl-~ a ~ p(~ M ~~121 a~CL N awl ~ VALUE AT DATE OF DEATH ~^' s~-r~t sT~r , cam.. ism p~. I R7.2 3 ~. I Z 3 • DicAT of f~cFs~~c. w ~~,~2E Gl..tl~,,,~ 3 2 b Zlto. 6~ 4~ ~c-~r of PuB~c w,~ 1.F~R.~E Q ~ 6 2 ~7 ~ 151. ~Z 5 R~Co/%k~EE-r°iNG- 1Z, Mar~fiEFs ~~~p/~`1oNi~ } . (o 00.00 ~ • ~tt2a rl-~ cc,.o~~ N Cr 'Z.o o . o-a TOTAL (Also enter on line 10, Recapitulation) _ ~7-~ (If more space is needed, insert additional sheets of tha ~~,,,e ~;....~ 3 ~. REV-i.513 EX+ (11-OR) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ES SCHEDULE J BENEFICIARIES TATE OF ANNA V BEAM NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J 1 ~ HOLLY E COHICK, 700 WILSON ST, CARLISLE, PA 17013 2~ DEBRA E HART (FORMERLY SHUTEK) 603 RUNNING CREEK DR, 603 RUNNING CREEK DRIVE, BALLWIN, MO 63021 RELATIONSHIP TO D- ECEpENT _Do Not List Trustee(c1 GRANDAUGHTER GRANDAUGHTER ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, ~ APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 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. If more space is needed, insert additional sheets of the same size. $ FILE NUMBER 21 0801263 AMOUNT OR SHARE OF ESTATE 50% 50% ,~ REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS lvo • 2008- 01263 PA No . 21- 08- 1263 Estate Of : ANNA V BEAM /First, Midd/e, Lastl Late Of : CARL/SLE BOROUGH CUMBERLAND COUNTY Deceased Social Securi ty No: 174-05-0923 WHEREAS, on the 18th da Februar Y of December 2008 an instrument dated y 17th 1995 was admitted to probate as the Last wi11 of ANNA V BEAM (First, Midd/e, Lastl Ia to of CARLISLE BOROUGH, CUMBERLAND County, who died on the 2nd day of December 20pg and, WHEREAS, a true co PY of the wi11 as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH for CUMBERLAND Count Register' of Wi 11 s in and y, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTAR HOL L Y E COH/CK Y to: who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate accordin fu11y appears of record in rn 9' to law' all of which y office a t CUMBERLAND COUNTY COURT HOUSE, CARL/SLE, PENNSYL VAN/A. IN TESTIMONY WHEREOF, I have hereunto set m of my office on the 18th day of December 2008, Y hand and affixed the seal v **NOTE** ALL NAMES ABOVE APPEAR (FTUe~r ~,.r,-,.._ _ '_ _ ~~~ ,. . `. LAST WILL AND TEBTAMENT OF ANNA V___. _ gEp~ z~08 OEC 18 AN 8~ 40 ~~~~~ ORPHF~'S ;pf1RT Township, CumbeNland Count a legal resident of South Middl disposing mind, memor y' Pennsylvania, bein eton y, and understandin g °f sound and publish, and declare this as and. form g' dO hereby make, hereby revoking all other wills and codicils heretoforeemaament, me. de by FIRST: I direct that all m experae~, in~lt:dirg m a Y just debts and funeral assets of my estate as sooncas~`rker~ jhall be paid from th practicable after my decease. in consequenceNof m I direct that all taxes that ma y death, of whatever nature and b be assessed jurisdiction imposed, shall be Y whatever part of the expense of the administrationmof msiduary estate as a y estate. THIRD: I devise and bequeath the residue of my estate, in equal shares, to two of m SHUTEK and HOLLY E. COHICK. y granddaughters, DEBRA E. predecease me, I devise and bequeath etheeentirearesgduedoaughters estate to the survivor. f my FOURTH: I nominate, constitute and a granddaughter, HOLLY E. COHICK, Executrix of thispoint my and Testament. In the event of the renunciation,~deathast Will resignation, or inability to act for any reason whatsoever of said HOLLY E. COHICK, I nominate, constitute, and a the E. SHUTEK Executrix of this, my Last Will and Testamentnt DEBRA hereby relieve my Executrix or her successor from the necessi of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act, ipso y as I am able by law so to do. far IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of one typewritten pa e~s, each of which bears my signature, this day of ~~~ g _c.~.g..'2 T/~ y 1995. l ~ "' Anna V. Beam SEAL) Signed, sealed, published, and declared by the above- named~Testatrix, Anna V. Beam, as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~~ i ,~/~. ~..~- ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ~ SS. I, Anna V. Beam,, Testatrix, whose name is signed to the attached or foregoing instrument, having been dul according to law, do hereby acknowledge that I signedaandied 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. Sworn or affirmed to and acknowledged before me by Anna V. Beam, the Testatrix, this 1995. -T day of ~ ^ Testatrix, Anna V. Bea Notary Public NOTARIAL SEAL SUSAN K. GUYER, Notary Public Carlisle, Cumberland County My Commission Expires Sept. 4,1995 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ~ SS. We, Edward L. Schor ~o--~~-~, ~- , the witnesses whose names arepsigned to the attached o~ ore of instrument, bein dul g ng say that we wereg y qualified according to law, do depose and present and saw Testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purpose therein expressed; that each. of_ us in the hearin the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time eiand si«ht of years of age, of sound mind, and under no constrainttornundueore influence. Sworn or yf firmed nd ubscribed to before me by Edward L. Schor p nd ~~ day o f ~ y`-~'~ ^ ~- ~ witnesses, this 1~-1~i- 1995. ~. Witness Edward Schorpp (SEAL) j~ , Witness ~ (SEAL) Notary Public W ~~"~ -. (SEAL] NOTARIAL SEAL SUSAN K. GUYER, Notary Public Carlisle, Cumberland County My Commission Expires Sept. 4,1995