HomeMy WebLinkAbout11-24-10 1505610148
REV-1500 EX (01-10)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box 2sosol INHERITANCE TAX RETURN 21, 10 10 31
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYW
209-12-6844 08272010 0809],91,5
Decedent's Last Name Suffix Decedent's First Name M I
SHAMBAUGH MARGARET R
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
- - REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-8?.)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate T.ax Return Required
® 6
Decedent Died Testate ^ death after 12-12-82)
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. 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. 91,1~(A)
between 12-31-91 and 1-1-95) (Attach Sch. ~b ~,
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION DBE DIRE~TED Tf3''
"'
Name L
Daytime Telephone ~~~ C:~ _~~
JEFFREY C • GOSS, ESQUIRE :., ~ r
717-299-7'~5~ ~
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x
.,.
First line of address
HARTMAN UNDERHILL ET AL
Second line of address
221 E• CHESTNUT ST•
City or Post Office State ZIP Code
LANCASTER PA 17602
Correspondent's a-mail address: J E F F G a~ H U B L A W• C O M
. ~!
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FILED
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of rriy knowledge and belief,
it is true, correct and comp) te. D clar 'on of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA O~ E BLE FOR FILING RETURN DATE
tl~3to
ADDRESS
C/0 221 AST CHESTNUT STREET LANCASTER, PA 17602
SIGNATURE OF P P R O AN REPRESENTATIVE DATE
o» (l )23~Lo
221 EAS CHES NUT STREET LANCASTER, PA 17602
PLEASE USE ORIGINAL FORM ONLY
Side 1
15 0 5 61014 8 annasa~ a.ooo 15 0 5 61014 8
J
~~
J
1505610248
REV-1500 EX
Decedent's Social Security Number
209-12-6844
Decedent's Name: SHAMBA H MAR GARE T R
RECAPITULATION
1. Real Estate (Schedule A) 1 $ 0 • 0 0
2. Stocks and Bonds (Schedule B) . 2. $1, 6 5 7.10
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. $ 0 • 0 0
4. Mortgages and Notes Receivable (Schedule D) 4 $ 0 • 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. $ 2 4 , 5 3 7.2 5
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g, $ 0 • 0 0
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested 7. $ 0 . 0 0
8. Total Gross Assets (total Lines 1 through 7) 8 $ 2 6 ,19 4 .3 5
9. Funeral Expenses and Administrative Costs (Schedule H), , 9 $ 2 , 9 0 9.9 7
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. $ ], Q . Q Q
11. Total Deductions (total Lines 9 and 10) , 11 $ 2 , 919.9 7
12. Net Value of Estate (Line 8 minus Line 11) 12. $ 2 3 , 2 7 4.3 8
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. $ 2 3 , 2 7 4.3 8
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers un~er Sec. 9116
16. Amount of Line 14 t xable
0 4~
at lineal rate x
. $ 2 3, 2 7 4 •3 8 1 s.
17. Amount of Line 14 taxable
at sibling rate X .12 $ Q • Q Q 17.
18. Amount of Line 14 taxable
at collateral rate X .15 $ Q . Q Q 18.
19. TAX DUE 19.
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610248
Side 2
1505610248
$0.00
$1, 047.35
$0.00
$0.00
$1, 047.35
J
9M4648 4.000
REV-1500 EX Page 3
.,---~__.~_ .._.__~_~_ ~aa_,......
Fils Number
~i. i.n i.nai.
DECEDENTS NAME
R T
STREET ADDRESS
A
CITY
A STATE
P ZIP
7
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments $ ~ • ~ 0
B. Discount $ 5 2 • 3 7
3. Interest
Total Credits (A + B) (2)
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.
(1) $1, 047.35
$52.37
(3) $ 0 • ~ ~
(4) $~ • ~~
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $ 9 9 4 • 9 8
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: 0
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 Dec. 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?
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 oi` the surviving spouse is
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)]. 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)]. A :>ibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
9M4671 2.000
REV-1503 EX + (s-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shambaugh, Margaret R 21 10 1031
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
3wasss ~.ooo (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
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Shambaugh, Margaret R. 21 10 1031
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-1511 EX+(10-09) SCHEDULE H
pennsylvania
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shambaugh, Margaret R. 21 10 1031
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~. Oak Leaf - Funeral Meal $75.58
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
State PA ZIP
2.
3. Attorney Fees:
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant $ 2, 5 0 0 .0 0
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
$123.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
1 Cumberland Law Journal - Estate Advertising Notice $75.00
2 The Patriot News - Estate Advertising Fee $135.89
TOTAL (Also enter on Line 9, Recapitulation) ~ $ $2 , 909.97
swasAC 2.00o If more space is needed, use additional sheets of paper of the same size.
Year(s) Commission Paid:
REV-1512 EX + (12-08)
pennsylvania SCHEDULE I
DEPARTMENTOF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shambaugh, Margaret R. 21 10 1031
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unrelmbursed medical expenses.
swasAH 2.00o If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF:
FILE NUMBER:
5namnau n roar aret R. 211 0 1031
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Chad E. Shambaugh
213 North Lime Street
Lancaster, PA 17602
50~ of Residue: $11,637.19 Grandson
$11,637.19
2 Wendy L. Etter
55 Zeigler Road
Dover, PA 17315
50$ of Residue: $11,637.19 Granddaughter $11,637.19
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE.
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. $ $ 0 . 0 0
9W46AI 2.000 ~~ ~iivic aNa~.C is IICCUCU, usC auunwndi sneers vi paper or me same slze.
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LAST WILL AND TESTAMENT -, c~
- ~,
BE IT REMEMBERED THAT -_-_ ~ - --
- -, ~+ - ,
I, MARGARET R. SHAMBAUGH, a resident. of Cumberland Comity,` `-?
~, ;
Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my LAST
WILL and TESTAMENT, hereby revo~:ing any and all Wills and Codicils
previously made by me.
s
I declare that I am married to CHARLES E. SHAMBAUGH, and that
my son, CHARLES E. SHAMBAUGH, JR., has predeceased me and that I
have a granddaughter, WENDY L. ETTER, and a grandson, CHAD E.
SHAMBAUGH.
II
I direct that all my just debts and funeral expenses shall be
paid from my residuary estate as soon as pract=icable after my
decease.
III
I cirect that all taxes that may be assessed in consequence
of my death, of whatever nature and by whatever jurisdiction
imposed, shad be paid from my residuary estate as a part of the
expense of the administration of my estate.
IV
I give, devise and bequeath all my property, whether real or
personal, wherever situate, including any property cover which I
may have a power of appointment to my husband, CHARLES, provided
that he survives me by thirty (30) days.
V
If my husband, CHARLES, shall predecease or fail to survive
me by thirty (30) days, I give, devise and bequeath all of my
property, whether real or personal, wherever situate, including
any pro~~erty over which I may have a power of appointment, to my
granddaughter, WENDY, and my grandson, CHAD, in equal shares, per
stirpes.
VI
I ~~~ominate, constitute and appoint my husband, CHARLES E.
SHAMBAliGH, as Executor of this LAST WILL, to serve without bond.
If my husband is unable or unwilling to act in that capacity, then
I nominate, constitute and appoint my grandson, CHAD E. SHAMBAtJGH,
as Executor of this LAST WILL, to serve without. band.
IN WITNESS WHEREOF, I, MAPGARET R. SHAMBAUGH, have set my
hand to t=his LAST WILL this 4th day of November, 2003.
r t XXX///
MARGAR ~' R. SHAMBAUGH
~.
Signed, sealed, published and declared by the above-named
MARGARET R. SHAMBAUGH, as and for her Last Will ,and Testament, in
the presence of us, who, at r~er request and in~her presence, and
in the presence of each other, have hereunto /'subscribed our names
as witnesses. %~
i~
~~ ~ ~~
t
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
I, MARGARET R. SHAMBAUGH, 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 as
my free and voluntary act for the purposes therein expressed.
} ;, ~.` n
MARL ~ T R. SHAMBAUGH
Sworn or affirmed to and acknowledged before me b}' MARGARET R.
SHAMBAUGH, Testatrix, this 4th day of November, 2603.
'i
//~/.~
I ~, /
Notary Public~~
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L~EE30AA.1 I L. 1?'?'P,'~. (~~GlF,~Y -'~JBLiC t'
CITY OF l~;i ;N?.h'!C5r!'RG. CUh?EFnLP.PJJ %OLIN i Y r
A9ti' COl'.Qti11SSI0~d F~(PinrS .iUti% i 1, i0+~!6 i4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We , ~ i~ 1 -' r- =~ -- and ~ ~ ~¢.-z~'f~/
the witnesses whose names are signed to the attached or foregoing
instrument being duly qualified according to law, do depose and
say that we were present and saw Testatrix sign and execute the
instrument as her LAST WILL; that MARGARET R. SHAMBAUGH signed
willingly and that she executed it as her free anal voluntary act
for the purposes therein expressed; that each of u;~ in the hearing
and sign of the Testatrix. signed the Will as witnesses; and;-that
to the best of our knowledge, the Testatrix was, at the t<ime 18
years of age or more, cf sound mind a and r n co t air~t or
undue influence . ~ ,' ~~
- w~
Z
~ ~~~
Sworn or affirmed to and acknowledged before me
this 4th day of November, 2003.
Notary Public ~i~
3 lJo7ARl.4L SEAL ~~ '
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~ MY COi\~A?iS5i0N EXPELS Jlr~NE t 1, 20G6
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res-ncwecmfax3-1'L
lU/ Lei/ "LUlU ti : ~tS : 11 AM E'Alir.
1 / UUL t" aX ~O1'~v~'Y
1` ~~y ~.,~~~~ Reference ID 319 S 190
Wachovia Bank
Balance Confirmation Services
P O Box 40028
Roanoke, VA 24022
October 28, 2010
HARTMAN UNDERHIl,L & BRUBAKER LLP
SUBJECT: Verification /Confirmation of Aooount and Balance Information provided for:
Customer; MARGARET R SHAMBAUGH (SSNt~ XXX-XX~844)
Date of Death: August 27, 2010
Deposit Account Information
Acoourrt Aooount Dais of Death Average Balance Date Maturity Interest Accaved YTD Date
Type Number Balance Opened Date Rate Irfcrest Interest Paid Closed
CHECKING ?~'?~J~D~2485 $24,536_SS 8/1/2006 $0.70 $18.24
LEGAL TITLE: MARGARET R SHAMBAUGH
WENDY ETTER POA
Page 1 of 2
res-ncwecmfax3-12
WACH~e~
+ Date of death balance does not include accrued interest.
Refcrenoe ID: 3195190
~ If date of death occurts on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period
Audrey Troutt
Servicenter Associate
Phone' (540)63-7323
at; at
By accepting this information, the recipient thereof represents and warrants to Wells Fargo Bank, N.A ("Wells Fxgo'~, that the recipient is authorized by the customer to receive lawfully this information
The recipient agrees that it will not disclose this information to arty third party, unless oompel]ed to do so by legal process, and that it will lawfully use this information The recipient acknowledges that
Wells Fargo does not represent and warant that the information is cormplete and accurate. The recipient further acknowledges that the information may not dixlose the entire relationship between customer
and Welk Fargo. The information is subject to change without notice to the recipient The recipient agrees to inderrstif'y, delEnd, and hold LVells Fargo hartnks4 from and against arty c]aim resulting from the
d.isclostue and use of the information by the recipient or from the breach by the recipient of arty agreement, representation, or warranty contained herein
Wachavia Bank and Wachovia Bank of Delaware are divisions of Welk Farms Bank, N.A
10 / 28 / 2010 8:38:11 AM l~A(.it:: 'L i UU'L r ax Server
Page 2 of 2