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Home My WebLink About12-10-101505610101 REV-1500 Ex ~°1.1°' ' PA Department of Revenue pennsylvania OFFICIAL USE ONLY DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes PO Box z8o6oi INHERITANCE TAX RETURN Harrisburg, PA 1yi28-o601 RESIDENT DECEDENT ~ ~ ~ D ~~ ~ ~ ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number r Q Date opf Death 7 MMDDYYYY Date o~f7Birth MMDDYYY/Y Decedent's Last Name Suffix Decedent's First Name MI ~~ ~ ~ ~ ~ ~ i~ ~ ~ n ~z. ~" (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 Return 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) fi1~ 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) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 D aytime Telephone Number '~ ~ S ~. Y1 ~ ~ ~ d ~' +~ a / ~ ~ GJ ~ ~ ~ • r ! REGISTER LLS USE LY ~ .,:~ {-~-~ First line of address :,~ rn~.. ~ ""'- r.. ~ _ E ~"~ -~ +--i-t ~ ~~C ~ i~ t,., CJ ~ ~ ~ ~ ~~a ~ ~' t'~ ' -~- Second line of address O ~ = ",n ~D ,.,.,~ ~ .. ~ J'1 ,_ ``" 1 Cit or Post Office State ZIP C d DATE FILED -- y o e ~~ ~.. ~.. 1~ 0..1/ 1 ~ 5 U i~ ~ q J 1 l~ ~ ~ ~ ~~ -S Correspondent's a-mail address: ~: Under penalties of perjury, I declare that I have examined this eturn, 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. SIGNAT RE OF PERSON RESPON IBLE FOR FILING RETURN D TE SS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRE 1! ~~ e h ~ v^d . I-'i4 t '7D DATE PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: `o ,- ~, ~, e ~! 3 4 9 7 8 3 1 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. _-.----+~--' 2. Stocks and Bonds (Schedule B) ....................................... 2. --m--~=-- 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. ~ t~ .s ~ ~~I / 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. ---~----- 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested........ 7. --T'- 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ~, ~ ~ 0 . ,j ./ 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ~ v ~ 3 v /10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. ~ ~ ~ C~ Q .~~ 11. Total Deductions (total Lines 9 and 10) ................................. 11. ~j~ 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. v . D L`~ 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 CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or ..transfers under Sec. 9116 16. Amount of Line 14 taxable . at lineal rate X .0 _ '• 16. _.-s-- 17. Amount of Line 14 taxable at sibling rate X .12 . 17. ~- 18. Amount of Line 14 taxable ` at collateral rate X .15 # 18. -~... 19. TAX DUE ......................................................... 19. ~`~ ~-~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side Z 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: File Number dO~ `~r DECEDENT' NAME STREET ADDRESS J~ ~~ ~ ~ / CITY STATE ZIP tA. ~ .J Tax Payments and Credits: 1. 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, Une 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) - Q ._. Total Credits (A + B) (2) (3) - ~~ "' (5) Make check payable to: REGISTER OF WILLS, AGENT. ,.., '~.~'g.,b~~~.~-fit .. 'a~-trF. ~3 ~,'',j~`~`jr- ~>.... ~. ~ .. ., .Pr. ...~ .. i, .~~c _.. .. ~~~~oi; ~> ~13r ,s~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes N~o,/ a. retain the use or income of the property transferred :.......................................................................................... ^ li iJ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ , - .,/ Lam" 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 of 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 adaptive 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, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. •• REV-t508EX+(1-97} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship rnust be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ~~r~~„ 4' ~Cyht !{'-Y'~4"Nc~I C.Q~'fr ~GtG~~.tY1 T 1 ~~~°Jr ~t . 1 . A . ~ C ~' ~ t; ~ ~ ~ (~ +iii n e ;r S h ~ p (~ ~. L L` Ci h ~' ~ ~G' ~ C C ~ d ~ ,~,---'"~- ,~ ~ ' i~ w v ~ ~ c~. v' ~ Gt D h }''2 •A~~. ~~ ~ ~ P ~ ~f r~i~ ~~2 - ~'C{~ ~ CiCLL` U Ott) TOTAL (Also enter on line 5, Recapitulation) 1 $ ~ ~,,~~ ~' ,, 3 !t (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) ~, SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF 1 FILE NUMBER ~ c~ I ~ c~ t~ 9 '~~ Debts of decedent must be reported on Schedule I. __ ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: ~~ ~'° ~ ~ ~c ~ ~; ~- ~ ~n ! ~ 1 l.,t.) ~ y ~,~ e ~ f 1 fh~~w~s U ~y,~~ - F~~d zx~c:o~1~t-~) g. ADMINISTRATIVE COSTS: ~ , Personal Representative's Commissions J l r1 Name of Personal Re resentative s b ~ ' ' ~', Street Atltlress ~~ State ~_ Zip j 7Q.~ ~ ~ ~~ city ___ ~ Year(s) Commission Paid: N~~ 2. Attorney Fees ~~~ 3. Family Exemption: (If decedent's address is not the same as c{aimant's, attach explanation) ~( Claimant Street Address City ___ State `_ Zip Relationship of Claimant to Decedent a ~ ~ ~ ~~ j(' `1( ~ ~C'_L u~ ~ ~ ~ d 1 4. Probate Fees _ ._..__ __ _...____~__ _ ~~, 5. Accountant's Fees ~~~ 6. Tax Return Preparer's Fees 7 TOTAL (Also enter on line 9, Recapitulation) $ ray y3 ~ , f (If more space is needed, insert additional sheets of the same size) RED/-1512 EX+ (12-03) SCHEDULE 1 COMMONWEALTH OF~PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT FILE NUMBER ESTATE OF Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE ITEM OF DEATH NUMBER DESCRIPTION ~~ .~ ,, ~.u,~ ~.J e~ )~, r , /,U ~ 1,~~ ~(,~," . ~` e u) ~~ ~--~~ ~ ~ .~l~ <~. ~~~~~ r ~~~ ~~ a i0 TOTAL (Also enter on line 10, Recapitulation) $ ~ ~~ ~ ~~• ~~~ (If more space is needed, insert additional sheets of the same size} J` COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS TPL SECTION -CASUALTY UNIT PO BOX 8486 HARRISBURG PA 17105-8486 November 6, 2010 STATEMENT OF CLAIM SUMMARY NAME Estate of BEAGLE, VERNA ID 150 195 417 MEDICAL CLASS 3 `CLASS 5.1 TOTAL` INPATIENT .00 .00 .00 OUTPATIENT .00 .00 .00 LONG TERM CARE 32,826.94 31,211.25 64,038.19 DRUG 26.35 25.98 52.33 REIMBURSEMENT TO DPW 32,853.29 31,237.23 64,090.52 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF_PUBLIC WELFARE EIN - 23-6003113 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I , GL ENDA FA RNER S TRA SBA UGH Register for the Probate of Wi 11 s a.nd Granting Letters of Administration in and fo.r CUMBERLAND County, do hereby certify that on the 21st day of September, Two Thousand and Ten Letters TESTAMENTARY in common form were granted by the .Register of said County, on the estate o f VERNA TERESA SL A GL E late o f UPPER A L L EN T O W,NSH/P (First, Middle, Last) in said county, deceased, to SUSAN M SNYDER (First, Middle, Lastl and that same has not since been revoked . IN TESTIMONY WHEREOF, I have hereunto set my hand and af~Fi~:ed the seal of said office a t CARLISLE, PENNSYLVANIA, this 21st day of September Two Thousand and Ten . Fi 1 e No . 2010- 009 7 ~ PA File No. 21- 10- 0971 Date of Death 9/14/2010 S . S . # 213-09-7839 ~, ear f Wills _, 'r 1 ,~ ~ i+ ~~ i d~ ~ i. ` t~ a 1 ' Deputy NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No. 2010- 00977 PA No. 2~- ~0- 0977 Estate Of : VERNA TERESA BEAGLE (First, Middle, Last) Late Of : UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 213-09-7839 WHEREAS, on the 21st day of September 2010 an instrumenf~ dated January 4th 2005 was admitted to probate as the last will of VERNA TERESA SLA GL E (First, Midd/e, Lastl late of UPPER ALLEN TOWNSHIP, CUMBERLAND County, who died on the 14th day of September 2010 an WHEREAS, a true copy of the wi I1 as probated i s annexed hereto . THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: SUSAN M SNYDER who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, a1 i of which fully appears of record in my office a t CUMBERLAND COUNTY CC)URT HOUSE, CA RL lSL E, PENNS YL VA NlA . IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 21st day of September 2010. ~ ~ ~ ~~~ _ t {{r i ~ - -_~'~/~ egis~e~ of Wills ;, , r .. r ~ .. t ~ s' I` ° ~ ~"~ y Deputy , * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TESTAMENT OF VERNA T. SLAGLE I, VERNA T. SLAGLE, now domiciled in Adams County, Pennsylvania, de~;,lare this to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously made. Article I My j ust 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 my 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 reimburserrient 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. ,~ `- ~ -- r-, _? r : ~ ` -_ W} ~ _ __ ~> r`~ t (~ ~ ' C , ~? ~.7 ~ "-1~1 ~ ~, - --v ~7 _~ _. J -, ~ ~ -~ - - --r Article 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 days of 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. A ,.~; ,., ,. ,-~ T All the rest, residue and remainder of my estate, of whatsoever nature and. wheresoever situate, I give, devise and bequeath to my daughter, SUSAN M. SNYDER, of Cumberland County, Pennsylvania. If SUSAN M. SNYDER predeceases me or fails to survive me by thirty (30) days, I give, devise and bequeath her share to her issue who survive me, per stirpes. Article V I nominate, constitute, and appoint SUSAN M. SNYDER 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 son-in-law, TERENCE L. SNYDER, of Cumberland County, Pennsylvania as successor Executor of my Last Wili and Testament. I direct that my Executrix or successor Executor 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 qualified disclaimer I could have filed if living. My Executrix or successor Executor shall receive reasonable compensation for services rendered to my estate. -2- Article VI In addition to the powers conferred by law, I authorize my Executrix and successor Executor, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, an.y real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms 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 investmem:s, (e) to compromise claims without court approval and without consent of an.y beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine th.e 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 (j) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. -3- r ' TNESS WHEREOF, I, VERNA T. BEAGLE, hereby set my hand to this my Last Will ~ -- .~ . Zoos. ~' ament, on ,• ;~ ~. ! ,,`~. V~ A . SLAG~LE ~ In our presence, the above-named VERNA T. BEAGLE signed this and declared this to be her Last Will and Testament and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name Address ~,; '.__~-; , t~_` _ ~~.. ' J _ ~c SC`-~ _845 Sir Thomas Court, Suite 12, Harrisburg, PA 17109 ~~ ~. ~;~ ~ ,jq ~,~~~~- _845 Sir Thomas Court, Suite 12, Harrisburg, PA 17109 -4- I, VERNA T. BEAGLE, Testatrix, who signed the foregoing instrument, having been duly qualified 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 VERNA T. SLAGLE, the Testatrix on ~~' 2005. ~~ ~ ,, r / .l~l~~: ,~ `;~Nota~ Public ,' tXfMMOtIwEALTN ol: PElINS~LYAlUA NOTARIAL SEAL 1ACCUELIIIE A. KELLX NOTARY PUBLIC LDWER PAXTON TWP., DAUPHIN COUN1r MY COMMISSION EXPIRES DEC. 17, 2007 7 . ~~~ . ,. VERNA T. SLAGLE~~- 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 Testatrix sign and execute this instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me and 1~~~.~~.,::~ rC ~~ ~..: , witnesses, on t' -- ~` 2005 ~ ~ - ? .~ ~. ota Public a ai COMMONWEALTH OF PENNSYI.YANIA NOTARIAL SEAL IACQUELINE A. KELLX NOTARY PUBLIC LOWER PAXTON TWP., DAUPHIN COUNTY MY COMMISSION EXPIRES DEC. 11, 2007 -5- /~ ~~--~ fitness ~f Witness