HomeMy WebLinkAbout01-19-11 (2)1505610101
REV-1500 IX`O1-'°' X'
OFFIC111L USE ONLY
PA Department of Revenue Pennsytvattia County Code Year Fle Number
Bureau of Individual Taxes ~"'" ~` "`~`~`
PO BOx 2i30601 INHERITANCE TAX RETURN
Harrisburg, PA i~i28-0601 RESIDENT DECEDENT ,~~ I ~ C~ ~ ~- c~-'
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1~'l•2y•~oq~, c~) •~1 •2a10 1O•~9~19z~
Decedents Last Name Sutfix Decedent's First Name MI
1~ 1 C E L ~ ~~ iUF TTE 111
(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 INAPPROPRIATE 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 12-122)
i 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of III) (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 T0:
Name Daytime Telephone Number
(~u i LLB ~~ f~. UN G ~R , v~rn1 ~ ~ y- G i ~s,~ -
First line of address
2 (~ LA 2c H ST'_
Second line of address
_ USE
C:_°'~~
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4
(:; ,,
City or Post Office State ZIP Code ~ DATE FILED
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Correspondertt's e-mail address:
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Ur~r penaltiees of perjury, I declare that 1 have examined this return, including accomparrying schedules and statements, and to the best of my knowledge and belief,
it is true, corecl and complete. Declaration of preparer other than the personal representative is Cased on all information of which preparer has any knowledge.
SIG TORE ERSON LE FOR FILIN TURN DATE I . ~~. ~'
ADDRESS
-zw i.A tLC~ s-r-- HbLu Ar~~s4~2c~ . (~A I hb ~I£~-- z ~ Z~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101
1505610105
REV-1500 EX
Decedents Social Security Number
Decedents Name: ~ IV N L ~G M - (V,~CZ-~ ~ ~~-~ 1 ~ V®7b
RECAPITULATION
1. Real Estate (Schedule A) ............................................. 1.
2. Stocks and Bonds (Schedule B) ....................................... 2. , r } ~ 2~
3. Gosely 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. G, S ~ 3 ~ 5
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vrvos Transfers & Miscellaneous Non-Probate Property
Billi
t
O S
t
R
d
7
ng
........
epara
e
eques
e
(Schedule G) .
8. Totat Gross Assets (total Lines 1 through 7) ............................. 8. ~ ~ ~ f ' 8
9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 5 ~ ~ ~
10.
Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ..............
10. ¢,
~ ~j2, S V
11. Total Deductions (total Lines 9 and 10) ................................. 11. ~ ~ ' ~~ Z
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ~ ~
4 'l
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ,
an election to tax has rwt been made (Schedule J) ........................ 13. ((j
14. Net Vatus 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
(a)(1.2) X .0_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17•
18. Amount of Line 14 taxable
18 / ~~'
r
at collateral rate X .15 . V
19. TAX DUE ......................................................... 19. ~ ~ ~,
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side Z
1505610105 1505610105
O
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
DECEDENTS NAME
~ N 1v ~ fT E ~PY1. ~ ~ ~ F (.
STREET ADDRESS
2Z.2 rn FsS ~ rod C«C - Im ass ~,q+~ v 1 Lt, G E,
~Uan1 s - f'
CITY ~ ~ ~ ~ ~ _ ` l I ~ ~ ~ /, STATE/~~ ZIP' ~ O
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments (~~ sy
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, Line 20 to request a refund.
(1) ~ ~ 2)
Total Credits (A + B) (2) ~7 5 y
(3)
(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, 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 inr~me of the property transferred :.................................................................................... ...... ^
b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^
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 wfthin one year of death
without receiving adequate consideration? ........................................................................................................ ...... ^ ~I
3. Did decedent own an "intrust for' or payable-upon~feath 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 benefaary 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 des not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure 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 benefiaaries is 4.5 percent, except as noted in
72 P.S. §9116(1.2)172 P.S. §9116(a)(1)).
• The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent [l2 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-1503 EX+ (69t3)
SCNEp1/LE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FlLE NUMBER
~N ,N E ~ ~ ~ • N ~ C~ u-~
All propeAy jointlyowned with right of s must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
,. Cr~PrrAt ~iuauc~-ac, s~~v~CES X9,155
2, ~~~CI~L ~1vERC~t~ DlU(s~~y•lv~ ~~
FxCEL E1~E2~1{ (J~~• ~ ~> ~~ 1U~ 24
~}. ~SO.Ob 5,ov~NGs t3oNA y~
R6 faff`M'1U~J
5. ~'X SEC; ~NFQC~~ sfd~JflC I 2 `f 65
ZICJUIQATIO~J
TOTAL (Also enter on line 2, Reppitt~ation) I s ~ ~~~ 23
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (11-10)
~ pennsylvania SCEIEDt1LE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS St MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Include the proceeds of litigation and the date the proceeds were received by the estate.
NI property jointly owned with right of survivorship must be disclosed on Sd~edule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DFATH
~ - t-i 14 t~ ~ ~t 21G Rc--~ ul~p 4 £s~2.
2 'Q1~ L ~E~ SIUt~ ~~~
3, r C 1 G L~ '~ VJV ~ RAt, iJU+(Y~~, '2F~U1~~ ~~
~, ~-~2~-~0~ RC~uN~ ~ ~b
s_ ~~~~3~ ~~Nu CN~c~u~4 A~cc~.- ~i,S~~
TOTAL (Also enter on Line 5, Recapitulation) ~ 12rj,3g5
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
~ N ~ ~ ~ ~ ry1. N ~ c~u~
Decedent's debts must be re on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. ~ C~/"~
B. ADMINISTRATIVE COSTS: C C
1. Personal Representative Commissions: / ~ ~ ) ~ n l ~G
Name(s) of Personal Represe~ntatinve~(s1),•~W 1 ~~ m ~ . lJr N~ ~1'~,
Street Address ~~ ~-r'`~ wl~ ~ (j~j
City I-~o1,U (~Al./5B u~2??e, State~ZIP ~ ( 0
Year(s) Commission Paid: ZU~J "- Z U~
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
4.
5.
6.
7.
City State
Relationship of Claimant to Decedent
Probate Fees:
Tax Return Preparer Fees:
ZIP
z9vv
1 ~ ~.3
~l0
TOTAL (Also enter on Line 9, Recapitulation) I $ 538 "~
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERirANCETAXRETURN MORTGAGE LIABILITIES St LIENS
RESIDENT DECEDENT
ESTATE OF ~+ ` f FILE NUMBER
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~ rn F ssl ~ v~ t-~-~4Gg , 9 U~ .~
~. m~~~c~c, s~a~~~~~ t~~Tw~r~.u, ~R, X30
~a_ r~ns~~ T>,ox ~~~ ~ 13
~ G i l'3£N t3Ap1<. SAgTI.( f~c Dl-l ES ~ 7
~. CsT~mAT~p PA, ~ N1-iftzt(Af~tCE., fiA~ (o7SC~
~. Gr~3~N ~~Atn~. s~RVU~ Ct-tl~(tG~, ~~
TOTAL (Also enter on Line 10, Recapitulation) I ~ / ~/ ~ O
If more space is needed, insert additional sheets of the same size.
. - ~ ORtG ~ ~ ,___
I I~ ~ L ~~;
~~ ~G~NA
L
LAST WILL AND TESTAMENT
OF
ANNETTE M. NICELY
I, ANNETTE M. NICELY, now domiciled in Dauphin County, Pennsylvania, declare this
to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously
made.
Article I
My just 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 reimbursement 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.
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.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath IN EQUAL SHARES to my nephews, WILLIAM A. LINGER,
of Hollidaysburg, Pennsylvania, and JOHN D. LINGER of Hamilton, Virginia.
However, if a beneficiary does not survive me by thirty (30) days, but leaves descendants
who survive me by thirty (30) days, those descendants shall receive, per stirpes, the share the
beneficiary would have received had he or she survived me by thirty (30) days.
Article V
I nominate, constitute, and appoint my nephew WILLIAM A. LINGER as Executor of my
Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason
whatsoever of my Executor, I nominate, constitute and appoint my nephew, JOHN D. LINGER as
successor Executor of my Last Will and Testament. I direct that my Executor 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 Executor or successor Executor shall receive reasonable compensation
for services rendered to my estate.
Article VI
In addition to the powers conferred by law; I authorize my Executor and successor Executor,
in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any 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 investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(fj 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 the value of ary
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
-3-
(j) to receive reasonable compensation in accordance with their standard schedule of fees in
effect while their services are performed.
•~ IN WITNESS WHEREOF, I, ANNETTE M. NICELY, hereby set my hand to this my Last
Will and Testament, on !~,~ ~~" - 2001, at Harrisburg, Pennsylvania.
:~.
ANNETTE M. NICELY
In our presence, the above-named ANNETTE M. NICELY 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
g ~ i~~c~~
-4-
~-
I, ANNETTE M. NICELY, 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
ANNETTE M. NICELY, the Testatrix
on '~, ~~_ _ 2001.
~ i ~ ~~
I of Public hNNETTE M. NICELY ~
_~~_
NOTARIAL. SEAL .
JAN L BROWN, Not"~y Public
fewer P~xeon TWp., Oau~tn Cou~y
My Commiedon Expltes uch 2~, 2~i
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 W ill 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 befor~me ,
by ~ SS i ~~ ~-~ ~Q.,
and ~ i ~-h' n Lad~a 200
witnesses, on f ~ ~
of Public
~ B~ppyy~N, Nary Public y
Lower Paxton Twp» OwPMn Coin! ,
~ ~miaelon focpires A6atcfi 29, ~uu'+
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