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Home My WebLink About12-22-101505610145 RSV-1500 ~``°'-'°' PA DspeMrent of Revenue Pennsylvania OFFICIAL U: ro eoX 2~eos~ol"al T"`~ ~ INHERITANCE TAX RETURN ~~ ,~, PA 17128-0801 RESIDENT DECEDENT ENTER DECED>EMT INFORMATION BELOW Soda) Serxnity Number Date of Death MMDDYYW Date of Birth MMDDI File Nixnbsr 4 (/ `~~ 210-30-1988 12122009 09301941 ~, Decedent's Last Name Suffix Decedent's First Name III MI CONFER SHIRLEY ', A (M Applicable) Eater Surviving Spouse's Information Bslow I Spouse's Last Name Sufflz Spouse's First Name ! MI Spouse's Social Secu Number ~Y THIS RETURN MUST BE FlLED IN DUPLICA ~ITH THE REGISTER OF WVILLS FILL IN APPROPRIATE BOXES BELOW ® 1.Original Return Q 2. Supplemental Return Q 3. Bernal (date of death ., prbrto 1 -1 ) Q 4. Limited Estate Q 4a. Fufurs Interest Compromise (date of Q 5. Federal Tax Return Requirod death aRer12-12-82) ® 8. Decedsrrt Died Testate Q 7. Decedent Maintained a LNing Trust 0 8. Total of Safe Deposit Boxes (AQach Copy of WIII) (Attach Copy Of Trust) Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Crodit (date of death Q 11. Elsctlon E ~ ta under Sec. g113(A) between 12.31-91 and 1-1-95) (Attach c-~ rF,_ ~ ) CORRESPONDENT - TIfIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX tNFORMATIO Name Daytlme Teleph ROBERT G. FREY 71724358 First line of address 5 SOUTH HANOVER STREET Second line of address Gty or Post Office CARLISLE corrspond.nrs a-retail address: r f re State ZIP Code PA 17013 freytiley.com - ~, BE DIRECTED 70: per ~, R..a __ ~-- N t 2 ADDRESS ~. Sd d i. •'~D /Jlr r!•• r ' tic <~ c ~d ~ _. '' SIGNATURE OF PREPARER OTHER THAN REPRESENTATIV i i DATE ADORESS I '~ L 1505610145 PLEASE USE ORK3INA Side 1 ONLY 1505610 4~5 J sR 1505610245 REV-1500 EX DecedenFs odial Security Number oadenrsName: SHIRLEY A CONFER 210-30 988 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. NONE ', 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ...... 5. 3 92 6. 0 0 8. Jointly Owned Property (Schedule F) Separate Billing Requested ........ 6. NONE 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ........ ~, NONE 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. ~ 3 9 2 6.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 3 4 6 9 8.0 0 10. Debts of Decedent, Mortgage Liabilities, and liens (Schedule I) ............. 10. 513 711.0 0 11. Total Deductions (total Lines 9 and 10) ............................... 11. 5 4 8 4 0 9.0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................. 12. ', - 5 4 4 4 8 3 . 0 0 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 Valw Sub act to Tax Line 12 minus L'me 13 ....................... 14. - 5 4 4 4 8 3. 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 (ax1.2) X .0 0 15. 18. Amount of Line 14 taxable at lineal rate X .0 4 5 16, 1 T. 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 BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 0.00 0.00. 0.00 0.00 0.00 0 L 1505610245 150561 2415 J REV-1500 IX Page 3 File Number Decodent"s Complete Address: 21-041199 210-30-1988 DECEDENT'S NAME SHIRLEY A CONFER ' - STREET ADDRESS 700 WALNUT BOTTOM ROAD CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Dw (Page 2, Line 18) 2. Credits/Payments A. Prior Payments. B. Discount (1) Total Credits (A + B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Paps Z, Line 20 to regwst a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE (5) Make check payable to: REGISTER OF WILLS, AG PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE F 1. Did deced~t make a transfer and: a. rotain the use or income of the Property transferred : .................................... ......................................... b. rotain the right to designate who shall use the property transferred or Its income : .............................. . a 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 deoedent own an "in trust forty 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 properly, which contains a beneficiary designation? ............................................................................................................ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FI 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 0 spouse ~ 3 percent (72 P.S. §9116 (a) (1.1) (i)j. 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 surviv 172 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requ 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 fo adoptive parent w a stepparent of fhe child is 0 percent p2 P.S. §9116(ax1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percen 72 P.S. §9118(1.2) [72 P.S. §9118(ax1)). • The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent [72 P.S. §! defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by t ATE BLOCKS No ^X 0 a a AS PART OF THE RETURN, the use of the surviving to is 0 percent for disGosure of the use of a natural parent, an except as noted in 1~(ax1.3)]. A sibling is x~7 or adoption. ,, ~'~'~°`+~~' SCHEDULE E CASH, BANK DEPOSITS, & MISC. coo ~oF ~ v,4r~u- ~sioarr oECeoeNr PERSONAL PROPERTY ESTATE OF I FILE NUMBER 21-09-1199 Indude the proceeds of litigation and the date the proceeds were received by the seta e. All of with ri ht of survivorshi must be disclosed on Scired N ITEM VALUE AT DATE NUMBER DESCRIPTION ' OF DEATH 1 Forest Parts Nursing Home, personal care account I 3,926 TOTAL (Also enter on line 5, Recapitulation) ; ~ 3,926 (It more space is needed, insert additional sheets of the same size) T r ~... _ ____. _._ _- __ REV-1511 EX+(10-09) SCHEDULE H Pennsylvania DEPAtm~rrroFREVeNUe FUNERAL EXPENSES AND ~T""`M "~' ADMINISTRATNE COSTS ESTATE OF IL NUMBER Decedent's debts must bs reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. I I ADMINISTRATIVE COSTS: L Personal Reprosernatlve Commissbns: Name(s) of Personal Represer~ilve(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: ~~ I 708 3. Fartmly Exemptlon: (tf decedent's address is not the same as daimant's, attach explanation.) II i Claimant Street Address Cihr State ZIP Relatlonship of Claimant to Decedent 4. Probate Fees: 117 5. Accoumm~t Fees: 6. Tax Return Preparer Fees: 7. Commonwealth of Pennsylvania, Department of Revenue, medical expenses within 6 mon s pf 33,873 the date of death i ~I i TOTAL .Also enter on Line 9, Reca la on S 34 69E If more space is needed, use additional sheets of paper of the same size. REV-1512 EXa (12-08) pennsylvania SCHEDULE I o~~~oF~NUE DEBTS OF DECEDENT, ~ ~ ~ ~~ iiES oErrr D cE oENr MORTGAGE LIABILITIES & LIENS '~ ESTATE OF I FILE NUMBER Report debts brcurred by tM decedent prior to loth tirst romelned unpsW ~ fhe die of datlr, bxhrdbg unnh~bo ~rredksl eupeeses. ITEM NUMBER DESCRIPTION ' VALUE AT DATE OF DEATH 1. ' Commonwealth of Pennsylvania Department of Welfare, medical expenses, greater than ' 6 months from the date of death , I i i ', 513,711 TOTAL (Also eater on Line 10, Recapitrrla ~ ~ 513,711 ff m«e space is needed. insert addiao~i srleets of n,e same size. LAST WILL AND TESTAMENT ' OF SHIRLEY A. CONFER ' I, SHIRLEY A. CONFER, widow, of the Borough of Carlisle, Cumberland C ungy, Pennsylvania, being of sound and disposing mind, taemory and understanding, do hereby alge, publish and declare this as and for my Last Will and Testament, hereby revoking and makin void any and all Wills by me at anytime heretofore made. 1. I direct my hereinafter namr,~i personal re resentative to pay all of my just deb ar}d funeral expenses as soon after my death as may be found convenient to do so. I direct th t trig funeral services be conducted by Hoffman-Roth Funeral Hoag, 219 North Hanover Street, C lislb, Pennsylvania, with arrangements substantially similar to those which I made for the services f r my husband, Alvin M. Confer. I direct that my body be cremated and my urn be placed on top f m~+ the casket of my husband, Alvin M. Confer who is buried in the Mt. Holly Springs Cemetery Mt. Holly Springs, Pennsylvania 2. I give and bequeath to my friend, Linda Stamey, my wedding rings. 3. All of the rest, residue aad remainder of my estate, real; personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to Community :Baptist Ch rch, 360 Yotk Road, Carlisle, Pennsylvania 17013. 4. I hereby nominate, constitute and appoint my Attorney, Robert M. Frey, as Execut r of this my Last Will and Testament, but should he predecease me or fail to qualify or cease servi as such, then in such event I nominate, constitute and appoint his son, Robert G. Frey, as alto a o; successor Executor. I further direct that neither of them shall be required to post any bon tq secure the faithful performance of his duties in the Commonwealth of Pennsylvania or in any et jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will wd, Testament, written on one (lj page, this 16th day of October, 2000. Shirley A. onfer Signed, sealed, published and declazed by SHIRLEY A. CONFER, the Testatrix named, as and for her Last Will and Testatent, in our presence, who, in her presence, at her r and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~~~~?-, ~or~sr PMac n~urn c~R 1 Z 9 3 • r~oe~r n~usr ~casrr 116 ~. waeo.rrpo t ~~. ~n ~-8-aoio 1'AY70M ~ ~a~ ~f ~.; r~ ~~~1 ! 39 d5. ~5 ^ _ Qn rn ~^~t ttl,. ~~i ~. DOLLARS ® ~~ ~ -=,~LTBB~C w.y.ar -~q ~ Ql]Q fIPP ~:03i302955~: 9843i18820ri293 FREY & TILEY ATTORNEYS-AT LAW 5 SOUTH HANOVER STREET CARLISLE, PENNSYLVANIA 17013 ROBERT M. FREY RETIRED STEPHEN D. TILEY ROBERT G. FREY April 21, 2010 To: Estate of Shirley Confer Re: Legal Services in connection with final arrangements and settlement of estate @$175.0( Review of Living Will and consultation with Physician and Family no TELEPHONE (7i7) 243-5838 FACSIMILE (71~ 243-8441 December 29, 2009 probate of Last Will and Testament .5 hr. $87.50 January 4, 2010 Letter and Notice to Heirs, .2 hrs. $3 5.00 January 4, 2010, Letter to Forest Park Nursing Home, Hoffman-Roth Funeral Home, .3 hrs. $52.50 January 7, 2010 Letter to Heir, .2 hr. $35.00 January 8, 2010, reviewed Department of Welfare claim, .2 hr. $35.00 January 11, 2010, Prudential Insurance claim, .5 hr. $87.50 ~ January 29, 2010, Fax to Prudential ~ Claim Department, .2 hr. __ $35.00 _ _ ~ - - --~ -. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DMSION OF THIRD PARTY LUIBILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8488 January 6, 2010 FREY & TILEY ROBERT G FREY ESQUIRE 5 SOUTH HANOVER STREET CARLISLE PA 17013 Re: SHIRLEY CONFER CIS #: 410235748 SSN: 210-30-1988 Date of Death: 12/12/2009 Dear Attorney Frey: Please be advised that the Department of Public Welfare main ains a claim in the amount of $547,583.50 against the above-mentioned es ate. This claim is for restitution of medical assistance granted on behalf f'the decedent for which the Probate Estate is now responsible to reimb rye the Department according to Act 49, 62 P.S. 1412, effective August 15 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the D p~rtment's itemized statement of claim. A portion of this medical expense, namely $33,872.92, was in u~red during the last six months of the decedent's life; therefore, it s a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fid curies Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $5 3'710.58, is to be entered as a priority Class 5.1 claim against the estate Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the est to contains real estate, please provide copies of the deed, the latest tax as eslsment, and a current appraisal, if available. Sincerely, ~. Elizabeth D. James TPL Program Investigator 717-772-6397 717-772-6553 FAX ,~ Enclosure