HomeMy WebLinkAbout12-22-10'~ 1505610143
.REV-1500 Ex(°'-'°'
PA De artment of Revenue OFFICIAL USE ONLY
p Pennsylvania county code Year File Number
Bureau of Individual Taxes °~P^'~"""°^°~"~"E""~
Po Box.2sosot INHERITANCE TAX RETURN 21 10 0 68 9
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
177 24 6127 06 18 2010 03 15 1927
Decedent's Last Name
HOLTRY
Suffix Decedent's First Name
BRUCE
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
HOLTRY NAOMI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
L
MI
M
FILL IN APPROPRIATE OVALS BELOW
1. Original Retum ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise
(date of
death after 12-12-62) ~ 5. Federal Estate Tax Retum Required
x^ g• Decedent Died Testate
(Attach Copy of Will) ~ pp
~• Attach Copy~of Trust)a Living Trust 8. Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received ~ 10. b~tweenP2 3i ~i a ditt(dat~es~f death ~ 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL 7AX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JERRY A WEIGLE ESQUIRE 717 532 7388
N
First line of address
126 EAST KING STREET
Second line of address
City or Post Office State ZIP Code
SHIPPENSBURG PA 17257
Correspondent's a-mail address:
REGISTER O S USE l1riS1LY
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DATE FILED ~~
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Under penalties of perjury, I declare that I have examined this return, 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.
SIGNATURE OF PERSON RESPONSIBLE ,FODR`FILING RETURN DATE /')
~`1/I (~.tliinn'. , ~h~l r.4 _ 7V- ~ ~7~~ , . Naomi M. Holtry IZ- ~ ~'~(/
194 Beech Tree Street Shi ens r PA 17257
SIG TU E OF PREPARER OTHER THAN REPRESENTA DATE
/~ ~ ~ ~ _ r~J erry A. Weigle Esquire ~ 2-~>-- /Q'
126 East Kinq Street, Shippensburg, P/~ X7257
Side 1
1505610143
1505610143
J
J
REV-1500 EX
Decedents Name: HOitry, Bruce L.
Decedent's Social Security Number
177 24 6127
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 E) ............... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers 8~ Miscellaneous -Probate Property
(Schedule G) ~ Separate Billing Requested............ 7,
8. Total Gross Assets (total Lines 1-7) ..................................................................... g.
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10.
11. Total Deductions (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 0
0O 15
(a)(1.2) X .00 , .
16. Amount of Line 14 taxable 0
0 0 16
at lineal rate X .045 . .
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 18.
19. Tax Due ..............................................................................................................:... 19
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
8,432.98
8,432.98
4,865.50
34,707.59
39,573.09
-31,140.11
-31,140.11
Side 2
L 1505610243 1505610243
1505610243
0.00
0.00
0.00
0.0.0
0.00
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-10-0689
DECEDENT'S NAME
Holtry, Bruce L.
STREET ADDRESS
Green Ridge Village
210 Big Spring Road
CITY STATE ZIP
Nevwille PA 17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
(1)
Total Credits (A + B) (2)
3. Interest
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
(3)
(4)
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~.OQ
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 :............................................................................... ^
b. retain the right to designate who shall use the property transferred or its income :.................................. ^ 0
c. retain a reversionary interest; or ...............................................................................................................
d. receive the promise for life of either payments, benefits or care? ............................................................ ^
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 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 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)]. 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
sibling 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-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
F(LE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Members 1st Federal Credit Union Checking Account - 380436-11 7,584.98
Accrued interest on Item 1 through date of death 0.37
2 Members 1st Federal Credit Union Regular Savings Account - 380436-00 847.51
Accrued interest on Item 2 through date of death 0.12
TOTAL (Also enter on Line 5, Recapitulation) I 8,432.98
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
i
REV-1151 EX+(10-06)
COM ~NO,EE~I DENCEDTE~EpE NURN ANIA
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF -FILE NUMBER
Holtry, Bruce L. 21-10-0689
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N MB R
q. FUNERAL EXPENSES:
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Naomi M. Holtry
Street Address 194 Beech Tree Street
city Shippensburg state PA zio 17257
Year/s1 Commission oaid 2010
422.00
2. Attorney's Fees Weigle 8 Associates, P.C. 800.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00
Claimant Naomi M. Holtry
Street Address 194 Beech Tree Street
city Shippensburg state PA zio 17257
Relationship of Claimant to Decedent SpOUSe
4. Probate Fees Register of Wills, Cumberland County 128.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 15.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 4,865.50
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Holtry, Bruce L. 21-10-0689
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Register of Wills, Cumberland County -filing PA Inheritance Tax Return 15.00
H-B7 15.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+112-08)
SCHEDULE 1
DEBTS OF DECEDENT,
COMMONWEALTH OF PENNSYLVANIA MORTGAGE LIABILITIES, & LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bruce L.
FILE NUMBER
21_~p_naRa
Report debts incurred by the decedent prior to death that remained unoaid at the date of death Inel~ ~Hinn ...,._~...ti...l..., ..._..:__~ _.__ ___
(It more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+(11-09)
N Eq 7~{p SCHEDULE J
COMMOHERITANCE TFgqP~~ RNEET YLVANIA BENEFICIARIES
N R SIDE DECEDE~
ESTATE OF
Holt ,Bruce L.
FILE NUMBER
21-10-0689
NUMBER NAME AND ADDRESS OF
PERSON(Sl RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
Do N is to (Words} ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 1.2
1 M. Naomi Holtry Spouse
194 Beech Tree Street
Shippensburg, PA 17257
NOT RELEVANT AS ESTATE IS INSOL
Total
Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 cover sheet, as a r o riate.
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
--
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
LAST WILL AND TESTAMENT
I, BRUCE L. HOLTRY, presently residing at 111 Newville Road, Shippensburg,
Southampton Township, Cumberland County, Pennsylvania, 17257 being of sound mind, memory
and disposition, do hereby make, publish and declare this my Last Will ~aad Testament, hereby
revoking aad malvng void all Wills by me at any time heretofore made.
FIItST. I order and direct the payment of all my legally enforceable debts and
funeral expen.9es as soon as may be convenient after my decease.
SECOIgD. I give, devise and bequeath all my estate, real, personal and mixed,
whatsoever aad wheresoever situate, to my beloved wife, NAONII M. HOLTRY, absolutely.
THIRD In the event that the said NAOMI M. HOLTRY should predecease me or
is not living on the 60`~ day following my death, I then give, devise and bequeath all my estate,
real, personal and mixed, whatsoever and wheresoever situate as follows:
A. I give, devise and bequeath the grandfather's clock in my home aad any guns,
rifles or shot guns, jewelry, watches, and other personal effects that I may own
at my death to my son, LARRY B. HOLTRY, absolutely.
B. I give, devise and bequeath any jewelry, rings and other personal effects
formerly belonging to my wife, NAOMI MAE HOLTRY, to my daughter,
MELODY M. DAVIDSON, absolutely.
C. I give, devise and bequeath all the rest and residue of my estate of every nature
and wherever situate to my children, LARRY B. HOLTRY and MELODY M.
DAVIDSON, in equal shares, on a per stirpes distribution basis
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FOURTH. I nominate, constitute and appoint my wife, NAOMI M. HOLTRY, to be the
Executrix of this my Last Will and Testament. In the event that she be unable to fulfill the duties
of Executrix, I then nominate, constitute and appoint my son, LARRY B:. >~OLTRX presently of
5241 Molly Pitcher Highway, Chambersburg, Franklin County, Pennsylvania and MELODY M.
DAVIDSON, presently of 194 Beach Tree Street, Shippensburg, Franklin County, Pennsylvania
or the survivor thereof, to be the Co-Executors of this my Last Will and Testament.
c FIFTH. I direct that my personal representatives shall not be required to give bond for
o the performance of their duties in any jurisdiction.
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WEIGLE 6 ASSOCL4TE5, RC. -ATTORNEYS AT LAW _ ]26 EAST KING STREET - Sii1PPENSBURG, PA 17267-1397
SIXTH. I direct that any and all death taxes which become due and payable upon my
death shall be paid oirt of the rest and residue of my estate.
1N WITNESS WHEREOF, I, BRUCE L. HOLTRY, have hereunto set my hand and seal
to this my Last Will and Testament, written on two (2) pages, the first page signed for
identification only, this ~~,~ day of ~~~,,~,~~. , 2008.
X. ro -~ , ,~~y (sEaL>
This instrument was by the Testator, on the date hereof, signed, published and declared by him to
be his Last Will and Testament, in our presence, who at his request and in the presence of each
other, we believing him to be of sound and disposing mind and memory, have hereunto subscribed
our names as witnesses.
WEIGLE & ASSOCWTES, P. C. -ATTORNEYS AT LAW -.126 EAST FANG STREET - SHIPPENSSURG, PA 172 6 7-13 9 7
COMMONWEALTH OF PENNSYLVANIA ,
SS
COUNTY OF CUMBERLAND ,
I, BRUCE L. HOLTRY, the person whose name is signed to the foregoing instrvment, having
been duly qualified according to law, do hereby aclmowledge that I signed and executed the
instrument as my Last Will; that I signed it willingly; and that I signed it as my free aad voluntary
act for the purposes therein expressed.
.A...., ~ zip
Sworn or affirmed to and acknowledged before
me b1r~UCE L. ~OLTRY, a Testator,
this '{ day of Zpp ,
r /~ /y ~
~, . _- ~~~ Hp~,~ty Public ~
didpde b~utg, P tXxr~berlar~, aunty
Cornmissfon Fires 0'"t~ :^~': !, 2010
WEI6LE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 726 EAST KING STREET - SHIPPENSHURG, PA 17237-7397
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND ,
and ~~~~~~ ,the witnesses whose names are signed to the
foregoing instrument, being duly qualified according to law, do depose and say that we were
present and saw BRUCE L. HOLTRY, the Testator, sign and execute the instrument as his Last
Will; that he signed willingly and that he executed it as his free-and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator, signed the Will as
witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more
years of age and of. sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed before me
by
an
asses, this day of 2008.
~ ~ , ~~
NOTgFti,{;~ S
Jerry A Wefgle, I~;Gt~ry PubUc
- ~+~^s~r9. PA Cumberland
Commission ~
~i/es October 7, 2010
WEIGLE 6 ASSOCIATES. P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
St
MEMBERS 1St
FEDERAL CREDIT iJNION
Custodial Account
REGULAR SAVINGS ACCOUNT:
Account Number/ Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
380436-00
03/20/2010
$847.51
$.12
$847.63
None
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Estate of: Bruce L. Holtry
Date of Death: June 18, 2010
Social Security Number: 177-24-6127
380436-11
03/20/2010
$7,584.98
$.37
$7, 585.35
None
MEMBERS 1ST FEDE
Leigh- nne Stallings RAL CREDIT UNION
Lending Insurance Su pport Specialist
September 10, 2010
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 v«~nvmemberslst.org
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
November 8, 2010
WEIGLE & ASSOCIATES PC
JERRY A WEIGLE ESQUIRE
126 EAST KING STREET
SHIPPENSBURG PA 17257
~k, 1~ i (~ E~'~~
Re: Bruce Holtry
CIS #: 517948053
SSN: ###-##-6127
Date of Death: 06/18/2010
Dear Attorney Weigle:
Please be advised that the Department of
claim in the amount of $34,707.59 against the
claim is for restitution of medical tance
decedent for which the Pro Estate is now r
Depart t 62 P.S~;
ended by Act 20-95, eff ive June 30, 1_~~
itemized statement of claim.
Public Welfare maintains a
above-mentioned estate. This
granted on behalf of the
es Bible to reimburse the
e fe~ive August 1994, as
~fclosed is the Department's
A portion of this medical expense, namely $33,565.93, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $1,141.66, 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 estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
Sincerely,
Elizabeth M. Wilson
TPL Program Investigator
717-214-1868
717-772-6553 FAX
Enclosure
cc: Naomi M Holtry
194 Beech Tree St
Shippensburg PA 17257
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