HomeMy WebLinkAbout12-20-10~ REV-1500`(01-10) 1505610143
PA De artment of Revenue OFFICIAL USE ONLY
p Pennsylvania county code veer File Number
Bureau of Individual Taxes OERAR/MENT Oi REVENUE
PO BOx.2sosot INHERITANCE TAX RETURN 2 1 0 9 0 9 4 3
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
161 34 1841 09 20 2009 O1 06 1943
Decedent's Last Name Suffix Decedent's First Name MI
EBERSOLE CAROL ~J
(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 ^ 2. Supplemental Return ^ 3, Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date W death after 12-12.92)
® 8, Decedent Dwd Testate ^ T Decedent Maintained a Living Trust O 8. Total Numberof Safe De
(Attach Copy of Will) (Attach Copy of Trust) -~-- _ pOfiit BOxe3
^ 9. Litigation Proceeds Received ^ 1 D, Spousal Poverty Credit (date of death 11, Election to tax under Sec. 9113 A
between 12-3151 and i-1-95) ^ ( )
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
Daytime Telephone Number
NORA F BLAIR 717 541 1428
First line of address
5440 JONESTOTtVN ROAD
Second line of address
PO BOX 6216
City or Post Office
HARRISBURG
State
PA
ZIP Code
REGISTER ~L3 USP~LY
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Correspondent'se-mailatlaress: NFBLAW@COmcast.net
Under penalties of perjury, I deglare that I have examined this return includin~ accompanying schedules and statements, and to the best of my knowledge and belief,
k is true, corre~l_and complete. eGaretlon of preparer other than the persona representative is based on all information of which preparer has any knowledge.
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Allison J. Ebersole
236 Walnut Street, Highspire, PA 17034
BGN E OF PREPARER OTHER T}!AN REPRF~rerrVE
~.J Nora F Blair
DATE
_ „
5440 Jonestown Road, Harrisburg, PA 171120216
Side 1
1505610143 1505610143
~~
J 1505610243
REV-1500 EX
oeeaeern'sName: EBERSOLE, CAROL J.
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 & Notes Receivable (Schedule D) .................................................... ... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule Ej ............. . 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested........... . 7.
8. Total Gross Assets (total Lines 1-7) .................................................................. . g.
9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................................... . 9.
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............................. .. 10.
11. Total Deduetlons (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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 0. 0 0 1 g.
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.
Decedent's Social Security Number
161 34 1841
7,907.88
0.00
7,907.88
7,859.65
38,828.01
46,687.66
-38,779.78
-38,779.78
0.00
Side 2
L 150561U243 150561U243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 2 ~ _ 09 - 0943
A
Ebersole, Carol J.
STREET ADDRESS - -
46 Erford Road
-
CITY
Camp Hill STATE ZIP
PA
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 0.00
2. Credks/Payments
A~ Prior Payments
B. Discount
Total Credits (A + g) (2) 0.00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. (q)
Check box 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 theTAX DUE {5) Q, 0
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 property transferred :.................................... 7
.. .......................................
b. retain the right to designate who shall use the property transferred or its income :................................
c. retain a reversionary interest; or ........................................................................................................... ^ 0
d. receive the promise for life of either payments, benefits or care? ............................................ x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ........................................................................................... ^ ^
...................... x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death3....... ~^ ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designatian2 .............................
.................................................................................. I] ^
IF THE ANSVYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR
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 January 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 ears 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) (y.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
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by bloo~or adoption.
~ SCHEDU4E E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TA% RETURN
RESIDENT DECEDENT
ESTATE OF Ebersole, CarOI .I. FILE NUMBER
21 - 09 - 0943
Include the proceeds of litigation and the date the proceeds were received by the estate9~ll property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM -
NUMBER DESCRIPTION VALUE AT DATE OF
_ DEATH
1 PSECU Savings 6,889.35
2 PSECU Checking 75.53
3 2007 Federal Tax Return 551.00
4 2008 Federal Tax Return 392.00
I TOTAL (Also enter on Line 5, Recapitulation) I 7 907.88
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERRANCE TAx RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Ebersole, Carol J
FILE NUMBER
21 - 09 - 0943
This schedule must be completed and filed if the answer to any of questions 1 through 4 on oaae 2 is ves
ITEM
NUMBER DESCRIPTION OF PROPERTY
InGutle the name of the transferee, their relationship to decedent
end the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST F~(CLUSION
(IF APPLICABLE)
TAXABLE VALUE
1 SERS retirement -not taxable 70,603.00 10000% 70,603.00
I 0.00
TOTAL (Also enter on line 7, Recapitulation) 0.00
St~mULE H
COMMONWEALTH OF PENNSYLVANIA /~r'y~~p~'~'r~//~/~~~
INHERITANCE TAX RETURN /YAfN~a71 rW I IYG VW 1 ~7
RESIDENT DECEDENT
ESTATE OF Ebersole, Carol J. i FILE NUMBER
21 - 09 - 0.943
Debts of decedent must be reported on Schedule t.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Matinchek Funeral Home 518.00
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Allison J. Ebersole
street Address 236 Walnut Street
City Highspire state PA Zip 17034
Year(s) Commission paid 2010
2. ~ attorney's Fees Nora F. Blair, Esquire
3. ~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
3,925.00
2,995.00
Street Address
City State Zip
Relationship of Claimant to Decedent
a. Probate Fees Cumberland County Register of Wills Office 112.00
Inheritance tax return fee 25.00
5. Accountant's Fees
6. Tax Return Preparer's Fees Kim Edman I 70.00
7. i Other Administrative Costs
1 Executor Expenses--postage, mileage, etc. 214.65
TOTAL (Also enter on line 8, Recapitulation) 7,859.65
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
LOM NiENR~ANCE TAX R"ETURNVA"IA LIABILITIES, ~ LIENS
RESIDENT DECEDENT
ESTATE OF Ebersole, Carol J.
FILE NUMBER
21 - 09 - 0943
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Verizon 2 59
2 Pharmerica 34.14
3 Golden Living Center-Camp Hill 11.50
4 Department of Public Welfare--Class 3 Claim 23,173.51
5 Department of Public Welfare-Class 5.1 Claim 15,606.27
TOTAL (Also enter on Line 10, Recapitulation) 38 828.01
REV-1611 EX+ (11-08)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ebersole, Carol J.
SCHEDULE)
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S)
REGEIVING PROPERTY
I, TAXABLE DISTRIBUTIONStinclude outright s usal
II.
distributions and transfers
under Sec. X116 (a) (1.2)]
1 Allison J. Ebersole
236 Walnut Street
Highspire, PA 17034
2 David L. Ebersole
662 Sylvan Court
Caledonia, NY 14423
3 Wesley Ebersole
662 Sylvan Court
Caledonia, NY 14423
RELATIONSHIP TO
DECEDENT
Do Not List Tlueteata)
Daughter
Son
Grandson
FILE NUMBER
21 - 09 - 0943
SHARE OF ESTATE ' AMOUNT OF ESTATE
(Words) ($$$)
Forty percent of the
net estate.
Forty percent of net
estate.
fen percent of the
tet estate.
Enter dollar amounts for distributions shown above on lines 15 through 16 on Rev 1500 cover sheet, as appropriate.
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
CHARITABLE AND GOVERNMENTAL DISTRIBUT. IONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER
0.00
Rev-ts~s ex.ls-oo)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ebersole, Carol J.
SCHEDULE)
BENEFICIARIES continued
FILE NUMBER
21 - 09 - 0943
SHARE OF ESTATE AMOUNT OF ESTATE
NAME AND ADDRESS OF PERSONS RELATIONSHIP TO
NUMBER RECEIVING PROPERTY () DECEDENT
Do Not List Trustee(s)
I, TAXABLE DISTRIBUTIONS[include outright spousal
distributions and transfers
~ under Sec. X176 (a) (1.2)]
4 Rebekah Ebersole
662 Sylvan Court
i Caledonia, NY 14423
Granddaughter Ten percent of the
net estate.
Page 2 of Schedule J
~tt~Y mill rzn~ ~P~tttmEnY
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I, CAROL J. EBERSOLE, of Dauphin County, Pennsylvania, declare this
to be my Last Will and Testament hereby revoking all prior Wills and Codicils.
ITEM I. I direct that the expenses of my last illness and funeral be paid
from my estate as soon as practicable after my death.
ITEM II. I hereby reserve unto myself the right to make a list disposing
of items of personal property. If I make such a list, from time to time, it will be
signed and dated, will describe the items to be devised and the individual
devisees thereof. If no such written statement or list is found and properly
identified by my Executor within thirty (30) days after the issuance of Letters
Testamentary or Letters of Administration, it shall be presumed that there is no
such statement or list and any subsequently discovered statement or list shall be
ignored. Any reasonable distribution expenses incurred with respect to tangible
personal property, including but not limited to packing, shipping, storage and
insurance expenses, shall be paid by my Executor as an administrative expense
PAGE I OF N
~Str
of my estate. These items are of negligible value and are being distributed as a
remembrance of my life.
ITEM III. I give, devise and bequeath all of the rest, residue and
remainder of my estate of whatsoever kind and wheresoever situate as follows:
A. 40% to my daughter, ALLISON J. EBERSOLE, per stirpes;
B. 40°10 to my son, DAVID L. EBERSOLE, per stirpes; and
C. 20% in equal shares to my grandchildren born prior to or within nine
months of the date of my death, per stirpes.
ITEM N. If a beneficiary under this Will has not attained the age of
twenty-five (25), the share of that beneficiary shall be placed in separate Trust, for
the benefit of that beneficiary.
ITEM V. In the event that a Trust is created by or as a result of any part
of this Will, the duties of the Trustee shall be to administer the terms and
conditions of the Trust as follows:
A. To expend and apply so much of the net income and so much of the
principal of the trust as Trustee shall consider advisable for the
support, care and education of the child until the child attains the age
of eighteen (18) years.
B. To pay, after the beneficiary attains the age of eighteen (18), the net
income together with so much of the principal thereof as Trustee
shall consider advisable for the beneficiary's support and education
PAGE II OF IV
after taking into consideration all other readily available assets,
sources of income and other resources.
C. To distribute to the beneficiary the entire balance of principal and
accumulated income then remaining, upon the beneficiary's request
at or after the beneficiary reaches age twenty-five (25). Distribution
at or after age twenty-five (25) shall be made only in the event the
beneficiary requests such distribution by a writing intended to take
effect during the beneficiary's lifetime, executed by the beneficiary
upon or after attaining age and delivered to Trustee.
D. If a beneficiary shall die before receiving final distribution of his or
her entire share, the undistributed balance shall be distributed
outright to his or her surviving issue, per stirpes, and in default of
any such issue then to my residuary beneficiaries, per stirpes. The
share of any child whose original share is then being held intrust to
be added to and treated as part of that trust.
ITEM VI. I nominate and appoint my daughter, ALLISON J.
EBERSOLE, to serve as Trustee for any Trust established in or created by this
Will. If my daughter, ALLISON J. EBERSOLE, is unable to serve or continue
serving as Trustee, I nominate and appoint my son, DAVID L. EBERSOLE, to so
serve.
PAGE III OF N
t?..
ITEM VII. I nominate and appoint my daughter, ALLISON J.
EBERSOLE, Executrix of this my Last Will. If my daughter, ALLISON J.
EBERSOLE, is unable to serve or continue serving as Executrix, I nominate and
appoint my son, DAVID L. EBERSOLE, to serve as Executor.
ITEM VIII. I direct that my Executrix, Trustee or their successors shall not
be required to give bond for the faithful performance of the appointed duties in
any jurisdiction.
ITEM IX. I direct that all taxes due at my death or as a consequence of my
death shall be paid from my residuary estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of , 2006.
,.-,
CAROL J. ERSOLE
---
WITNE S
,~
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WI SS
.~ _
O F. BLAIR
ATTORNEY
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SS
I, CAROL J. EBERSOLE, the 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
and that I signed it willingly and as my free and voluntary act for the purposes
therein expressed.
Sworn to or affirmed and acknowledged before me by CAROL J.
EBERSOLE, the testatrix, this ~ day of ~~, 2006.
~$ '
C~ s
CAROL J. ERSOLE
-! LtEStAI~ 7 ~ A . 1'
Notary Public
0 RiAL Eq~ N
MELISSA A POLING, NOTARY PUBLIC
MYCOMMf~ON~pj'r,ESSEPT CO 200
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUN'T'Y OF DAUPHIN
We,
SS
Nora F.
Blair, Esquire, thewitnesses 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 CAROL J. EBERSOLE, the testatrix, sign and execute the
instrument as leer Last Will; that the testatrix signed willingly and executed it as
her free and voluntary act for .the purposes therein expressed; that each
subscribing witness in the hearing and sight of the testatrix signed the Will as a
witness; and that to the best of our knowledge the testatrix was at the time
eighteen (18) or more years of age, of sound mind and under no constraint or
undue influence.
Sworn to or affirmed and subscribed to before me by the above-named
witnesses, this ~ day of ~ ~~~,,,«,,, 2006.
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NOR,A F. I~IR
5440 Jonestown Road
Post Office Box 6216
Harrisburg, PA 17112-0216
WITNESS
Notary Public
MMON L H 0 PEN V NI
NOTARIAL SEAL
MELISSA A. POLING, NOTARY PUBLIC
MYCOMMI~ON EWXPIRES SEPT 30 20 7
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NORA F. BI~AIl3,
Post Office Box 6216 Attorney at Law FAX (717) 541-1429
Harrisburg, Pa 17112-0216 5440 Jonestown Road (717) 541-1428
'. II NFBLAWCC•?paonline.com ~ ` q /
TO: ' ~M(~l l~ ~~~~ v~ ~.~'~ U DATE: -Ie l ~ ~~L~
CLIENT: 1, Ct,rO` ~ . ~ I~P~.So~~2. ~ ~ ~ -'b (- O g`~
ENCLOSED PLEASE FIND THE FOLLOWING DOCUMENT (S)
Deed ~ Inventory _ Matrix
Quit Claim Deed Inheritance Tax Return _ Chapter 7 Petition
Mortgage Status Report _ Chapter 13 Petition
Satisfaction Piece Answer _ Bankruptcy Schedules
Petition Motion _ Filing Fee Application and Order
_ Objection to Plan
Other:
ALSO ENCLOSED:
Self-addressed Stamped Envelope for Return of Order/decree
_ Self-addressed Stamped Envelope for Return of Copies and Order/decree
Self-addressed Stamped Envelope for Return of Copies
Self-addressed Stamped Envelope
Stamped Envelope Addressed to Grantee(s)
_ Stamped Envelope Addressed to Debtor(s)
Check for additional probate fees
Check for inheritance tax
X Check for filing fees
Other:
Amount $
Amount $
Amount ~ c~ ~ ~ • "
PLEASE TIME STAMP AND RETURN THE COPIES TO MY OFFICE.
PLEASE RETURN SIGNED ORDER/DECREE TO MY OFFICE.
YOUR ASSISTANCE IS GREATLY APPRECIATED.
IF Z'~IEfZE TS A Lam, ~ ~,~' ~°~T-2~8 OR 177-233-9540.