HomeMy WebLinkAbout01-04-11t ~ •'
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15056041125
REV-1500 Ex (06-05) _ ~ OFFICIAL USE ONLY
PA Department of Revenue Coun
Bureau of Individual Taxes INHERITANCE TAX RETURN ~' Code Year File Number
PO BOX 280601 2 1 1 0 0 1 0 0 5
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 6 3 6, 2 4 8 6 0 9 2 1 2 0 1 0 0 2 2 1 1 9 2 0
Decedent's Last Name Suffix Decedent's First Name MI
T H O M A S AURA. L, I A A
' (If Applicable) Enter Surviving Spouse's Information Below
°` Spouse's Last Name Suffix
Spouse's Social Security Number
FILL INAPPROPRIATE 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 (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. 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. 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 T0:
Name Daytime Telephone Number
H A R D L D S I R W I N I I I E S Q 7 1 7 2 4 3 6 0 9 0
Firm Name (If Applicable)
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
Spouse's First Name
I R W I N L A W O F F I C E
First line of address
6 4 S O U TH P I T T S T R E E T
Second line of address
City or Post Office
C A R L I S L E
State
P A
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ZIP Code L
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Correspondent's e-mail address: Irwlnlawof~lce~gmallcom ~ ~ _
Under penalties of perjury, I dedare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI T (~E OF PERSO ESPONSIBL~ FOR FILING RETURN DATE
~ 12/ 3 /10
ADDRESS
1.71 WEST LISBURN-ROAD CARLISLE PA 1.7015
SI R F P T THAN REP NTATNE DATE
12/x( /10
ADDRESS ••
64 SOUTH PI T STRE T_ CARLISLE. PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
a:
15056041125 1.5056041125 J
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REV-1500 EX
Decedent's Name: AURALIA A . THOMAS
15056042126
Decedent's Social Security Number
2 0 6 3 6 2 4 8 6
RECAPITULATION
0 0 0
1. Real estate (Schedule A) ........................................ 1 •
0 0 0
2. Stocks and Bonds (Schedule B) .................................. 2.
3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. ~ 0 0 0
4. Mortgages 8~ Notes Receivable (Schedule D) ........................ 4. 0 0 0
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 8 2 6 7 2 8
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• 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 1-7) ........................... 8. 8 2 6 7 2 8
9. Funeral Expenses 8~ Administrative Costs (Schedule H) ................ 9. 1 8 0 8 2 4 1
10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) ............ 10.
~
0
0
0
11. Total Deductions (total Lines 9& 10) ........................... 11. 1 8 0 8 2 4 1
12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. - 9 8 1 5 1 3
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. - 9 8 1 5 1 3
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 .D 0 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .0 0 0 0 16.
17. Amount of Line 14 taxable
0
0
0
at sibling rate X .12 17.
1 S. Amount of Line 14 taxable
0
0
0
at collateral rate X .15 18.
19. Tax Due .................... ................... .. ..... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
.15056042126
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2i
Side 2
15056042126
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
J
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;EV-1500 EX Page 3
decedent's Complete Address:
File Number
01005
DECEDENTS NAME
AURAL/A A. THOMAS
STREET ADDRESS
801 NORTH HANOVER STREET
CITY
CARLISLE STATE
PA ZIP
17013
fax Payments and Credits:
Tax Due (Page 2 Line 19) (1) 0.00
'. Credits/Payments -
A. Spousal Poverty Credit -
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0, p0
-. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. ~ (4) 0.00
~. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 0.00
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; , ................................:..................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ Q
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q
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
~or dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
~or 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 zero (0) percent
T2 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
ling a tax return are still applicable even if the surviving spouse is the only beneficiary.
~or dates of death on or after July 1, 2000: t;
'he tax rate imposed on the net value of transfers from a deceased child twenty-0ne 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 zero (0) percent [72 P.S. §9116(a)(1.2)].
'he tax rate imposed on the net value of transfers to or for the use of the decedent's lineal_benefiaaries is four and one-half (4.5) percent, except as noted in
'2 P.S. §9116(1..2) [72 P.S. §9116(a)(1)j. -
'hetax 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)(1.3)). Asibling isdefined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. r
tEV-1502 ~JC + (6-98)
SCHEDULE A -
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
4URALIA A. THOMAS 01005
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which properly would be
exchanged between a willing buyer and a willing seller, neither being compelled tD buy or sell, both having reasonable knowledge of the relevant fads.
Real ro which is in -owned with ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE _ ..
NUMBER DESCRIPTION OF DEATH
1. NONE 0.00
~ ki
i 8
TOTAL Also enter on line 1, Recapitulation = 0.00
iu .,,...., ~ .................a,,,~ ....,,.a ..aa:.:......i ..a.,.,.... ,.i.a.,........., a_,.~
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tEV-1504 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHED UL-E C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
AURALIA A, THOMAS 01005
Schedule C-1 or C-2 (induding all supporting information) must be attached for each dosely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instrudions for the supporting information to be submitted for sole-proprietorships.
ITEM VALUE AT DATE ____
NUMBER DESCRIPTION OF DEATH
1, NONE 0,00
e
TOTAL Also enter on line 3, Recapitulation S O-oo
/lf mnro cnaro is nawlwl incort arlrii#innal chaptc of fhR cams ci~l
~.
REV-1507 EX + (8-98)•
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
avRa~~a a, rHONas
FILE NU
01005
All properly jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. NONE
VALUE AT DATE _ _
OF DEATH
0.00
b
6
!i i
TOTAL Also enter on line 4, Recapitulation) ~ 0.00
/lf mnra enarp is nocuiari incart arl~litinnal ~ha.Rh of fhR aama ¢i~al
~'
2EV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ M~~7C.
IN R SI DENTE E EDENTRN PERSONAL PROPERTY
:STATE OF FILE NUMBER
AURAL/A A. THOMAS 01005
Include the proceeds of litigation and the date the proceeds were received by the. estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. PNC BANK
Checking Account No. 5070027682
Value based on bank statement attached as Exhibit °B° "
VALUE AT DATE
OF DEATH ---
8,267.28
e
• i
TOTAL (Also enter on line 5, Recapitulation) ~ 8 267.28.
(If more space is needed, insert additional sheets of the same size)
.
REV-1509 EX + (6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
euaec~a a_ THOMAS 01005
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVNING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
q NONE
IB
IC
I ~nuuTi v_nwN~n DRr1PFRTY•
TEM
IUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET 96 OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
. A, NONE
li 0.00
b
i 0.00
.
TOTAL (Also enter on line 6, Recapitulation) a 0.00
flf more soaoe is needed. insert additional sheets of the same size)
REV-1510 EX + (6-98) ,'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS ~
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
AURAL/A A, THOMAS 01005
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
DUMBER DESCRIPTION OF PROPERTY
iNC~uoETHe-~eoFTHeTR~ws~R~,THEIRRElAT10N8HIPTODECEDENIAND
THE DATE OF TRANSFER. ATTACHACAPYDFTHEDEEDFORREALESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
pFAPPUCae~E)
TAXABLE
VALUE
1. NONE 0.00
b 0.00
TOTAL (Also enter on line 7 Recapitulation) ~ ~ 0,00
(If mnra cnarn is n~feci. inert additional sheets of the same sizel
tEV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
:STATE OF
~uRAL/a a rHONras
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Addn3ss
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
~. FUNERAL EXPENSES:
1. MALPEZZ/ FUNERAL HOME -Funeral and Burial
2. BLUE MOUNTAIN BLOOMS -Funeral Flowers
2.
3.
4.
5.
6.
7.
8.
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
FILE NUMBER
01005
City State Zip
Year(s) Commission Paid:
Attorney Fees IRW/N LAW OFFICE
Family Exemption: (If decedenCs address is not the same as claimants, attach explanation)
Claimant
. Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS
Accountant's Fees
Tax Return Preparer's Fees - J
CUMBERLAND COUNTY REGISTER OF WILLS - Flle Inventory and Appraisement
IRW/N LAW OFFICE -Attorney Fees re Church of God Nursing Home
AMOUNT
15,727.67
216,24
1,500.00 I
108.50
TOTAL (Also enter on line 9, Recapitulation) S
1
(If more space is needed, insert additional sheets of the same size)
,,
REV-1512 EX + (12-Q3)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
AURAL/A A. THOMAS 0005
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NONE 0.00
e
TOTAL (Alpo enter on line 10, Recapitulation) S
(If more space is needed, insert additional sheets of the same size)
',
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE) I
ENEFI IARIES
avRaLla a. THOMAS
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
j. TAXABLE DISTRIBUTIONS [indude out ~ sp)]usal distributions, and transfers under
Sec. 9116 a 1.2
1. AL/CE R BR/CKER
!7!0 West L/sburn Road
Carlisle, PA !TOlS
0!005
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
AMOUNT OR SHARE.
OF ESTATE
!00% Residue
~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS: ~ .
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
r a
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S
(If more space is needed, insert additional sheets of the same size)
~-
~7CHIBIT ~A"
LAST W/LL AND TESTAMENT
I, AURALIA A. THOMAS, of Upper Allen Township, Cumberland, Pennsylvania,
do hereby make, publish and declare this to be my last will and testament, hereby
revoking all wills heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interest and penalties
thereon with respect to all property, whether or not such .property passes under this
Will, shall be paid by my personal representative out of my estate.
2. I authorize and empower my personal representative to sell any realty
and/or personalty owned by me at my death and not specifically devised or bequeathed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefor, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at
my death, for such period of time after my death as seems expedient to said
representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate to my daughter, Alice R. Bricker, or if she is deceased, then to my
_~
grandson, Eric V. Bricker, or if he is deceased then to my son-ion-law. ice ~ ~~
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Bricker. ~-::'~ y ~-_
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4. I nominate and appoint Alice R, Bricker to be the personal representative
of my estate, to serve without bond. If she cannot or does not serve, then I appoint Eric
V. Bricker, or if he cannot or does not serve, Vance S. Bricker and Harold S. Irwin, III, to
be the substitute co-personal representatives, also without bond.
5. I suggest that my personal representative retain the services of Harold S.
Irwin, III, Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28th day of
October, 2003.
-r
~~j...r.~~.~-:.~:4y,.~ ~~~ ,/-.~-`~~~rc~y~ (SEAL)
AURALIA A. THOMAS
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
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ACKNOWLEDGMENT AND AFFIDAVIT
WE, AURALIA A. THOMAS, RHONDA S. IRWIN and KERI L. LEIPOLD, .the
testatrix and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that
the testatrix signed and executed the instrument as her last will and that she had signed
willingly, and that she executed it as her free and voluntary act for the purpose herein
expressed, and that each of the witnesses, in the presence and hearing of the testatrix,
signed the will as a witness and that to the best of their knowledge the testatrix was, at
that time, eighteen years of age or older, of sound mind and .under no constraint or
undue influence.
AURALIAA. THOMAS
RHONDA S. IRWIN
. ~
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KERI L. LEIPOLD
COMMONWEALTH OF PENNSYLVANIA
:ss:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by AURALIA A. THOMAS,
the testatrix herein, and subscribed aTd sworn to before me by RHONDA S. IRWIN and
KERI L. LEIPOLD, witnesses, this 28 day of Qctober, 2003.
V ~~{~ ~~-~ - t ~ _ ~ ~" ~ Notary Public
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