HomeMy WebLinkAbout04-07-11 (2) 1505610140
REV-1500 EX (°'-'°'
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes Coun Code Year
ty File Number
Po Box 2sosol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601
RESIDENT DECEDENT 2 1 1 01 1 1 9 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 8 2 0 3 7 6 7 1 1 1 8 2 0 1 0 1 1 0 2 1 9 2 8
Decedent's Last Name Suffix Decedent's First Name MI
R H Y N E R J A M E S E
(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 VWITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-1:5-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estai:e Tax Return Required
death after 12-12-82)
^X 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 TO:
Name Daytime Telephone Number
R O G E R B I R W I N 7 1 7 -I~ 9 :~~_ 3 5~. 3
First line of address
6 0 W E S T
Second line of address
City or Post Office
C A R L I S L E
Correspondent's a-mail address:
P O M F R E T S T R E E T
State
P A
REGIREGI Q Q11~LLS U,sONLY"~
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DAl'E FILED
ZIP Code ~
1 7 0 1 3
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, c rect and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN RE OF P SO S IB OR FILING RETURN DQfTE
A DRESS
8229 SCENIC DRIVE SHIPPENSBURG PEA 17257
SIGNAT PREPARER~THER AN REPRESENTATIVE p~
i~ _ /~~
~~. ,~ i ~'
ADDRES ~, '7`
60 WEST~~P MFRET STREET CARLISLE P,A 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
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Oh20'C9505'C
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 10 1191
DECEDENT'S NAME
JAMES E. RHYNER
STREET ADDRESS
7 OTTO AVENUE _
CITY
CARLISLE STATE
PA ZIP
17013
Tax Payments and Credits:
~. Tax Due (Page 2, Line 19) (1) _ 423.76
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits (A + B) (2) 0.00
3. Interest
(3) _
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. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 423.76
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; .......................... ..... ^
c. retain a reversionary interest; or ........................................................................................... ..... ^
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? .................................................................................. ..... ^
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 A~S 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 four the use of the surviving spouse
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 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(x)(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(x)(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(;x)('1.3)]. Asibling is defined, undE
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)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JAMES E. RHYNER 21 10__1191
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ORRSTOWN BANK -CHECKING ACCOUNT #108005312 2,370.62
2. ORRSTOWN BANK -SAVINGS ACCOUNT #708700441 2,618.55
3. ORRSTOWN BANK -CERTIFICATE OF DEPOSIT #4000033682 2,022.88
4. ORRSTOWN BANK -CERTIFICATE OF DEPOSIT #4000035188 2,016.35
5. ORRSTOWN BANK -CERTIFICATE OF DEPOSIT #4000036921 2,009.47
6. ORRSTOWN BANK -CERTIFICATE OF DEPOSIT #4000037682 2,007.57
TOTAL (Also enter on line 5, Recapitulation) I $ 13,045.44_
(If more space is needed, insert additional sheets 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
JAMES E. RHYNE_R _ 21 10 1191
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME
B.
1.
2.
3.
4
5
6
7
City State ZIP
Year(s) Commission Paid:
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
Attorney Fees: IRWIN & McKNIGHT, P.C.
Family Exemption: (If decedent's address is not the same as claimants, attach explanation.)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees: REGISTER OF WILLS
Accountant Fees:
Tax Return Preparer Fees: PATRICIA A. ROSENDALE, CPA
REGISTER OF WILLS -FILING FEE
TOTAL (Also enter on Line 9, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size. ~
AMOUNT
377.37
ZIP
1,200.00
104.50
350.00
30.00
2,061.87
• REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
JAMES E. RHYNER 21 10 1191
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
1, WEST SHORE EMS -AMBULANCE 118.50
2. ALLAN J. MIRA, M.D. -MEDICAL 39.44
3. VERIZON -TELEPHONE 1.34
4. MOFFITT HEART & VASCULAR -MEDICAL 12.66
5. GOLDEN LIVING CENTER -NURSING 19.50
6. TRUST AMBULANCE -AMBULANCE 225.00
7. QUANTUM IMAGING -MEDICAL 32.00
8. HOLY SPIRIT HOSPITAL -MEDICAL 1,118.18
TOTAL (Also enter on Line 10, Recapitulation) I $ 1, 566.62
If more space is needed, insert additional sheets of the same size. ~
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FILE NUMBER:
.TAMES E RHYNER 21 10 1191
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. MARY SUZANNE CAMPBELL Lineal 1,883.39
8220 SCENIC DRIVE
SHIPPENSBURG, PA 17257
2. CHRISTOPHER RAY CAMPBELL Lineal 1,883.39
8220 SCENIC DRIVE
SHIPPENSBURG, PA 17257
3. COLLETTE MARIE RHYNER Lineal 1,883.39
584 OLD FORBES ROAD
STOYSTOWN, PA 15563
4. CAROLYN ADELLE RHYNER Lineal 1,883.39
584 OLD FORBES ROAD
STOYSTOWN, PA 15563
5. WILLIAM JAMES RHYNER Lineal 1,883.39
584 OLD FORBES ROAD
STOYSTOWN, PA 15563
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
I, JAMES E. ItHYNER, of South Middleton Township, Cumberland County, Pennsylvania,
being of sound and disposing mind and memory, do hereby make, publish and declare this to be my
Last Will and Testament, hereby revoking any and all former Wills or Codicils by :me made.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all
inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any
property) shall be paid from my residuary estate as soon as practicable after my decease and as part
of the administration of my estate. My personal representative shall have no duty or obligation to
obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other
property not passing under this Will.
2.
I give, devise and bequeath my antique car picture and book collection unto such of the
beneficiaries named in Paragraph 3 hereinbelow as shall express interest therein to my-personal
representative within sixty (60) days after my death, to be distributed amongst them in such fair and
equitable manner as he shall determine in his sole and absolute discretion, and should there be no
interest timely expressed, then I give, devise and bequeath said collection unto the CUMBERLAND
COUNTY HISTORICAL SOCIETY.
Page 1 of 5 Pages ,~ ~~~
JER
~/~9
3.
I give, devise and bequeath all the rest, residue and remainder of my estate, whether real,
personal or mixed property, whether tangible or intangible, and wherever situated, unto my Trustee,
in trust, for the following purposes:
a. I direct that my Trustee shall hold, invest and reinvest the same, collect the income
arising therefrom and, after paying all expenses incident to the management of the trust, distribute
the accumulated income and principal, in equal shares, unto the following of my grandchildren:
MARY SUZANNE CAMPBELL, CHRISTOPHER RAY CAMPBELL, COLLE'TTE MARIE
R:HYNER, CAROLYN ADELLE R:IiYNER, and WILLIAM JAMES R:HYNER.
b. I direct that each of my said grandchildren shall have the right of withdrawal of his or
her equal share of the principal and any accumulated income of said trust as each attains the age of
eighteen (18) years.
c. In the event any of my said grandchildren shall fail to attain the age for distribution of
any part of their share and shall be survived by issue, then his or her share shall tie held by my
Trustee for said issue and distributed to them equally as each shall attain the age of eighteen (18)
years. The share or undistributed share of any of my said grandchildren who shall not be survived by
issue shall be distributed by my said Trustee equally to those of my said grandchildren who survive
in accordance with the terms hereof.
d. To the extent that the same is permitted by law, none of the beneficiaries hereunder
shall have any power to .dispose cif or tb charge by way of anticipation any interest: given to such
beneficiary; and all sums payable to such beneficiaries hereunder shall be free and clear of the debts,
contracts, alienations and anticipations of the beneficiaries, and all liabilities for levies and
attachments and proceedings of whatsoever kind, at law or in equity.
Page 2 of 5 Pages ~' ~`~
J.E.R.
4.
I nominate, constitute and appoint my son-in-law, KEVIN R. CAMPBELL, a.s Executor of
my estate.
5.
I nominate, constitute and appoint the said KEVIN R. CAMPBELL as Trustee under the
terms of this Last Will and Testament.
6.
I direct that neither my personal representative nor my Trustee shall be requireci to file a bond
to secure the faithful performance of their duties in any jurisdiction.
7.
I authorize and empower my personal representative and Trustee, in their sole and absolute
discretion, to purchase or otherwise acquire and retain any investments or any property of any nature
which I own at my death; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant
options in regard to any or all property of any kind forming a part of my estate for such terms and
such prices as they may deem advisable; to borrow money for any purposes connected with the
protection and preservation of my estate; to mortgage or pledge any real or personal property
forming a part of my estate or to join in or secure the partition of same; to compromisc; any claims or
demands of my estate against others or of others against my estate; to make distribution in kind and
to cause any share to be composed of cash, property or undivided fractional shares in property
different in kind from any other share; to employ agents, attorneys and proxies and. to delegate to
them such power as my personal representative and Trustee consider desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition, I direct that my personal representative shall have the power to conduct an inventory of any
safe deposit box necessary to the administration of my estate.
Page 3 of 5 Pages ~ ~~
J.E.R.
IN WITNESS WHEREOF I have hereunto set my hand and seal this 12`~ day of March, 2009.
,~
' (SEAL}
J ` es E. Rhymer
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator, as and
for his Last Will and Testament, in the presence of us, who at his request, have hereunto subscribed
our names as witnesses thereto, in the presence of the said Testator and of each other.
Page 4 of 5 Pages
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
I, JAMES E. R.HYNER, Testator, 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; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
~ ~L~~ ~ ;
James .Rhymer
Sworn or affirmed to and acknowledged before me by JAMES E. RHYNER, the Testator,
this 12~ day of March, 2009.
tart' Pu he COMMO EALTH OF PENNSYLVANIA
'Notarial Seat
COMMONWEALTH OF PENNSYLVANIA ~~ s. Noel, NotaryPubiic
Carlisle Boca, Cumberland County
S S . My Commission E~ires Dec. 8, 2011
COUNTY OF CUMBERLAND ) Member, Penncv~v2nin Association of Notaries
~""`~ ...
We, \ y 1 f~ ~~ and ~ l ~ ~ ~ ~
the witnesses 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 JAMES E. RHYNER, the
Testator, sign and execute the instrument as his Last Will; that the Testator signed willingly and that
the Testator 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 that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
Sworn or affirmed to and subscribed before a this 2`~f y o ~ arch, 2009.
N tart' Public r
G:\SBloom\Office -Estate PlanningllZhyner, .Tames\will-2.doc COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Karen S. Noel, Notary Public
Carlisle eoro, Cumberland County
My Commission E~ires Dec. ~, 2011
Member, PRnncvhrania gsoriation of Notaries
Page 5 of 5 Pages
ut~-uy-~u104THU~ 15:0
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~~~~
A Tradicion of Excellence
December 9, 2010
Roger B. Irwin, Esq.
Irwin & McKnight PC
60 West Pomfret Street
West Pomfret Professional Building
Carlisle, PA 17013
Fax 249-6354
Re: Estate of James E. Rhyner
Social Security Number 188-20-3767
Date of Death November 1$, 2010
P. 001 X002
1T IS HERERB'Y CERTIFIED THAT THE ABOVE NAMED DECEDENT HA.D THE
FALLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCIJCJNT
Account No. - 1OS005312
Account 'I~rpe - 50+ Interest Check
Date Opened - 1 i 8 i 02
Joint Account (name jdate) -~ None
Balance - $2,370.62
Accrued Interest - $0
SAVINGS ACCOUNT
Account No. - 708700441
Account T~rpe -- Statement Savings
Date Opened - 1 / 8 i 02
Joint Account (name/date) - None
Balance - $2,618.44
Accrued Interest - $.11
77 East King Street
P.O. Box 250
;3hippensburg, PA 17257
1.888.ORRSTaWN
~~~ ~~ ~uiut iflu) fS:llU
C~RTrFr~TE aF DEPOSrrs
Account No. -
Account Type --
Date Opened -
Joint Account (name/date) -
Balance --
Accrued Interest -
Account No. -
Account Type -
Date Opened --
Joint Account (name /date) -
Balance -
Accrued Interest --
Account No. --
Account Type -
Date Opened -
Joint Account (name/ date) -
8alan~e -
Accrued Interest --
Account No. -
Account 'I~rpe -
Date Opened -
Joint Account (name/date) -
Balance -
Accrued Interest -
4000033682
6-11 Month Growth
7/9/09
None
$2,022.59
$.29
40000351$8
6-11 Month Growth
10/2/09
None
$2,015.91
$.44
4000036921
6-11 11~onth Growth
3/10/I.0
None
$2,009.25
$.22
4000037682
6-11 Month Growth
5f 1S/10
None
$2,007.57
$o
Best Regards,
Vicki L. Gullixon
Customer Service Specialist
2.
P. 002I002
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' f • FUNERAL HOME &~ CREMATORY INC.
- / ~ infoQhoifr"~
December 7, 2010
Catherine M. Campbell
8220 Scenic Drive
Shippensburg, PA 17257
Statement of Funeral Expenses for: James E. Rhyner
Date of Death: November 18, 2010 Account Id: 16089-265
PACKAGE:
Immediate Cremation
OPTION 5 -Cremation $ 1,890.00
• Sub Total: $ 1,890.00 •
MERCHANDISE:
Urn: Bradford Walnut -Medium $ 350.00
Register Book $ 25.00
Memorial Folders $ 25.00
Sub Total: $ 400.00
TOTAL FUNERAL HOME CHARGES: $ 2,290.00
CASH ADVANCES:
6 Certified Death Certificates at $ 6.00 each ~ $ 36.00
Newspaper Notice -Sentinel $ 188.49
Newspaper Notice - Inciana Evening Gazette $ 50.00
Newspaper Notice -Blairsville Dispatch $ 25.00
Newspaper Notice -Somerset Daily American $ 113.88
Coroner's Fee $ 25.00
- Sub Total: $ 438.37
Total Funeral• Expense: $ 2,728.37
Total Payments Made: $ 2,351.00
Payments Made:
PreNeed Disc disc Dec T, 2010 128.99
SecurChoice Check 61925 Dec 7, 2010 2,222.01
Balance:
Please return this portion with your Remittance.
$ Amount Enclosed
James E. Rhyner .
Service 1D#: 16089-265
SERVING OUR CG)MMUNITY SINCE 1 907