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Home My WebLink About05-04-111505611180 ---~ REV-1500 EX (02-11) (FI) Pennsylvania OFFICIAL USE ONLY PA Department of Revenue DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburu. PA 17128-0601 RESIDENT DECEDENT ~ ~ ~ ~ ~ ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 195-28-5311 06132007 01111924 Decedent's Last Name Suffix Decedent's First Name MI FOX JOHN C (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 IN APPROPRIATE BOXES BELOW QX 1. Original Return Q 2. Supplemental Retum Q 3. Remainder Retum (Date of Death Prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of Q 5. Federal Estate 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) Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (Date of Death Q 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number WEAVER S. FOX 717-445-4,56 ~..:~ ~~ ~, REGISTER ~Ij LS USE ~Y T '~, r ~`~~ ''~ Z C7 ~" ' ~'7 First Line of Address ~-~ `~ ~mJ t !_- ~ t=: ~ 622 CHESTNUT HILL RD. ~~T ~~_ Second Line of Address ~ ~ ~~ - c~ ~. • • ~ n-' G°t ~ Q C1. ~"t City or Post Office State ZIP Code DATE FILED DENVER PA 1..7517 Correspondent's a-mail address: 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 ~GN~~f,U~E.~O'F~P~ER~~RES`~~D~R FI~ RETURN ~DAT~E ADDREILS'/~S/ __'CT :T-,,r/-T 622 CHESTNUT HILL ROAD DENVER PA 17517 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE \UUKtSS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505611180 1505611180 J REV-1500 EX (FI) Decedent's Name: JOHN C F 0 X RECAPITULATION 1505611280 Decedent's Social Security Number 195-28-5311 1. Real Estate (Schedule A) ........................................ . 1. N 0 N E 2. Stocks and Bonds (Schedule B) ................................... . 2. N 0 N E 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. . 3. NON E 4. Mortgages and Notes Receivable (Schedule D) ....................... . 4. NON E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... . 5. 7 4 71 . O 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. N 0 N E 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ..... .. 7. NON E 8. Total Gross Assets (total Lines 1 through 7) . 8 7 4 71 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ............... . 9. 6 7 9 8 . 0 O 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . 10. NON E 11. Total Deductions (total Lines 9 and 10) ............................ . 11. 6 7 9 8 , 0 0 12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. 6 7 3 , O 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 Value Subject to Tax (Line 12 minus Line 13) 14 6 7 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 (a)(1.2) X .0 O 15. O, O O 16. Amount of Line 14 taxable at linealratex.o 45 673.00 1s. 30.29 17. Amount of Line 14 taxable at sibling rate X . 12 17. O . 0 O 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0 . 0 0 19. TAX DUE ...................................................... . 19. 3 0 . 2 9 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 L 1505611280 1505611280 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: ? 11(1-1137 File Number 195-28-5311 DECEDENT'S NAME JOHN C FOX STREET ADDRESS 2033 RITNER HIGHWAY CITY STATE Zip SHIPPENSBURG PA 17257 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount (1) 30.29 Total Credits (A + B) (2) 0.00 3. Interest (3) 7.05 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box 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) 37.34 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 .................................................................................................................... ...... ^ 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 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 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)J. 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(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+ (~ 1-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY CJIAICIJt: ITEM 2. 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. COMMUNITY BANK CHECKING #1835440 FULTON BANK SAVINGS #1370-55960 ON FILE NUMBER: 2110-1137 VALUE AT DATE 6, 038 1,433 TOTAL (Also enter on line 5, Recapitulation) $ I 7,471 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 2110-1137 Decedent's debts must be reported on Schedule I. ITEM A. FUNERAL EXPENSES: 1. CASKET AND SHROUD 2. FUNERAL HOME 3. EXTRA DEATH CERTIFICATES 4. GRAVE STONE B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. 3. 4. 5. 6. 7. Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: NOTARY SERVICE TOTAL (Also enter on Line 9 Recapitulation) ~ $ If more space is needed, use additional sheets of paper of the same size. ZIP 112 3,468 54 2,159 1,000 5 6 REV-1513 EX+ (01-10) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1 SUSAN MARTIN 64756 CR 3, WAKARUSA, IN 46573 DAUGHTER 1/11TH 2 LYDIA SHIRK 2033 RITNER HWY, SHIPPENSBURG, PA 17257 DAUGHTER 1/11TH 3. ELIZABETH ZIMMERMAN 3086 RT 414, CLYDE, NY 14433 DAUGHTER 1/11TH 4 VERNA NOLT W4634 WILLOW RD, OWEN, WI 54460 DAUGHTER 1/11TH 5 MARY MARTIN 509 REIDENBACH ROAD, NEW HOLLAND, PA DAUGHTER 1/11TH 6 AARON FOX 14336 SAV-SPK RD., SAVANNAH NY 13146 SON 1/11TH 7 WEAVER FOX 622 CHESTNUT HILL RD, DENVER, PA 17517 SON 1/11TH 8 EVA JANE HORST 1743 HIMROD RD, PENN YAN, NY 14527 DAUGHTER 1/11TH 9. JOHN FOX 408 HILL ROAD, DENVER, PA 17517 SON 1/11TH 10. WALTER FOX, 1104 BRIGGS SPICER RD, HINROD, NY 14548 ERVIN FOX, 1026 STEFFY RD, STEVENS, PA 17578 SONS BOTH 1/11TH ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SH EET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. 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. Chestnut Hill Hut,, Electr 717-445-9961 p,l los-~ oos7 692e1 Y -- ___- STATEMENT OF ACCOUNTS 1370-55960 X __-- STATEMENT PERIOD FROM THROUGH G-0~,-0'7 G-30-07 7 PAGE 1 OF 1 J'OIlN C 1~OlS G27. C4If;,^,TNUT HILL RD DENVER PA 17517-8968 0 i:NC1,OSURE„ 0 STATliMI:N'1' SJIVINGS :4CCOUNI': 1370-55960 PREVIOUS DEPOSITS WITFIDIiAW7ll:.N/ INTEREST ENDING STATEMENT DALANCli CItliDITS 7. DEBIT$ ' 0 PAID 13I~I.l NCE 1, 375.G I 115.00 .DO 2.OG . 1,492.73 ACCOUNT/INTEREST INt'OItMATION INTI;'ItL•'S'1` Pl~ip THIy YEAR 3.84 DEPQSITS/ WITHDRAWALS/ DATE ACTIVITY DESCRYPTYON ItL•'1'lilil:NCI CREDITS DEBITS U~;,~C~, o6-D1 >3ECINNINC aAi.nNCr :i ..~7s~.-67~ 06-01 MILLER HliSS 31ND 00077900000 57.50 . ,, PN PMTS/BC CUN 07 /~ ` 1 K486I8NIh/07152 1 433 17 05-29 MILLER HESS AND 00077900400 57.50 ~ , . PN PMTS/)3C J"UN 07 - K49618NIP/071Q0 06-29 INTEREST CREDIT 2,06 '1 492 73 06-30 ENDING DALANCI3 , . a 4`1? 73 ~~~ ANNUAL PliRCliN1'AGE YIliLD I;I~RNPp pI9CL0,9 URE FROM G -OZ-07 THROUGH G-30-07 ~+* ANNUAL PERCENTAGE YIET~D t;At2NL•'D ,CiO~ AVERAGE DAILY COLLECT);D BAI,ANCL'•" 1,437.00 INTEREST EARNL+D 71 DIRECT FUI,TON BANK DIRECT BANKING CENTL'R INQUIttYL•'S T0: PO BOX 504 F.Ii~T PETERSBURG, PA 17520-0504 TELEPIIONE: 717-SB1-3000 OR 1-aoo-rvz.TONa Chestnut Hill Auto Electr 717-445-9961 p,3 Commu~nity~anks P_q 8qx 5R0 Slur. Flan, PA 97506 Pagc ~, Primary ,Account: I f? 4i'1'10 Statement Neriod: ii r;/ [ [ /07 07/,),0/07 Number of xmagcs 1 ;.,,..,.; 1...IIL,eI,Ll~e~elll,e~iL.I~LF~.,II„I„I~~,LIe~I~I~L~II ~"~ .7oh7: C L'ax ~~ 622 Chestnut Hi 11 xit ,;,e~~ Denver PA 17517-8~E;8 Hometown /VQI~Y Account NurnY~er 1f33S440 f:t.,,r.f-~,<<e~[,i. I).,L.~..; (-i/'l7/0'/ I".f[ru 7/10/7 Previous Balance Ei,U3"/.'lei Dny:: ~[~ r.r„, st.~rrt~a,e-'r[r. I'e~r•lnil 30 Deposits/CYedits _{)U five-er:icfe~ Ha7.ar[r.N 5,~97.~9 2 Checkslbebi•ta ti3.~?:~ Av~~r.,~J~~ c:~~l 1~,,,r.,,<i 5,997.09 °b:rvitc F"ce: _i)u l;ltarre-±r:r. r:ar:nr-~c9 1.29 Intexest Paid 1.'?4 Arun~.~~l Pe~re•r'nt.:~ge~ Yic~le-t i;,;rnr~d 0.25`<s ~ridlTi~ {3alAriCE• 5,~?SS.'/~) :?00'/ 7„t.eera':~1. I?.a.i<1 8.22 • Deposits and Additions Date Description Amount 7/],0 Sh$Orost Dapq~it t,~q ti • Debits and Withclrarwats "~ ~~ Date Description Amount v 7/10 ."itdt4`YfIK3Tlt Imzigo E'c~~ 2.00 • Checks {Tn Number C?rder) Date Serial Amount D~~tc Serial Amount ;= 6/2fi 832 L'1.23 `~ * Danbtas missing check number G ~~ • Dail balance Information ~~ N Date Balance Date [5al~~nce Uate Bal~nCe • m ,.~ , u~ ~ 6/11 6,037.78 6/26 ~i,9gti ;iii 7/:1.0 5,95,5.79 > co n, ~~ ~.,, ~., r_ J r+ Thank you for banking with CommunityBanks. .Last Till and ~'estament I, JOHN C. FOX, a resident of Denver, Pa, declare that this is my Last Will and Testament. :FIRST I hereby revoke all previous Wills and Codicils that I have made. SECOND 1 direct that the disposition of my remains in the following manner. ] direct my Executor to carry out such arrangements. 7'IfI.RI~ i :a;n married to EVA S. FOX, and all. references in this Will to m}~ "wife" or "amp spouse" ar,, to her i give ali my jewelry, clothing, household furniture and furnishings, personal automobiles and other tangible articles of a personal nature, or my interest in any such property not otherwise disposed of by this Will or in any other manner together with: (a) any insurance on the property, (b) any personal life insurance proceeds, (c) any registered retirement savings plans, registered retirement income funds, pension plans and annuities, (d) any income tax deferred assets, to all of my children: WALTER, J01-IN, P_?RON, Fr TZA.RETH, eLTc e~~,r~ Evr,L,~ *,~P.i', rV,^,, WEAVER, VERNA and ERV1N to be distributed equally among them. L All references in this Will to "my child" ox "my children" include any and all children hereinafter born to or adopted by me. FOURTH I have no minor child, or children. FIFTH Tip EVA S. FOX my wife. Her r,.ee*ds co,:,P first ~ per i,;,r deaf:. estate to be cistributed. <... No other special gifts are left, any assets not directly disposed of in this Will shall be given to the surviving members in order of succession. SIXTH 1 have not adopted any specific charity and therefore do not wish to leave a gift. SEVENTfI I nominate WEAVER S. FOX as Executor of this Will, to serve without bond. I authorize my Executor to sell, with or without notice, at either public or private sale, and to lease any property belonging to .my estate, subject only to such confirmation of court as may be required by law. I authorize my Executor to invest and reinvest any surplus money in the Executor 's hands in every kind of property, real, personal, or mixed and every kind of investment, specifically including but not limited to interest bearing accounts, corporate obligations of every kind, preferred or common stocks, shares of investment trusts, investment companies, mutual funds, or common trust funds, including funds administered by the Executor, and mortgage participations, that persons of prudence, discretion, and intelligence acquire for their own account. No bequest provided for in this Will or in any codicil hereto shall beaz interest if not paid or satisfied within any period prescribed by law. EIGHTH I direct that all inheritance, estate, or other death taxes that may by reason of my death be attributable to my probate estate or any portion of it, or to any property or transfers of property outside my probate estate, shall be paid by my Executor out of the residue of my estate disposed of by this Will, without adjustment among the residuary beneficiaries, and shall not be chazged against or collected from any beneficiary of my probate estate, or from any transferee or beneficiary of any property outside my probate estate. NINTH Except as otherwise provided in this 1~(~ill, I have intentionall~r failed to provide herein for any of ,,.y heirs, and I specifically disinherit any person claiming to be my heir who is :not provided. for in this Will. If any beneficiary under this Will in any manner, directly or indirectly, contests or attacks this Will or any of its provisions, any gift or other provision I have made to or for that person under this Will is revoked and shall be disposed of in the same manner provided herein as if that contesting beneficiary had predeceased me without issue. TENTH As used in this Will, the term "issue" shall refer to lineal descendants of all degrees, and the terms child, children, and issue shall include adopted persons. However, in no event shall any of these terms include any foster child or stepchild, regardless of the existence of a pazent-and-child relationship between that person and myself. I sign my name to this Will on 11-13-99, at Denver, in the County of Lancaster, in the State or Province of Pa. '"~ ;';' i.~ ~,~ ~' JOHN C. FOX On the date written below, JOHN C. FOX declared to us, the undersigned, that this instrument, consisting of these few pages including the page signed by us, as witnesses, was his Last Will and Testament and requested us, to act as witnesses to it. He thereupon signed this Will in our, presence, both of us being present at the same time. We now, at his request, in his presence and in the presence of each other, subscribe our names as witnesses. Each states that the Testator is not a minor and appears to be of sound mind and that we have no knowledge of any facts indicating that the foregoing instrument, or any part of it, was procured by duress, menace, fraud or undue influence. We, each: for himself or herself, declare that each of us is over the age of majority, and that each of us is, and the others appear to be of sound mind. We, each for himself or herself, declare under penalty of perjury that the foregoing is true and correct and that this attestation and this declazation aze executed on the ~ ~ day of `~'I~~Z~-, , 19 Y~at Denver, in the County of Lancaster, in the State or Province of Pa. Page 2 Witness # 1 f ~y~ °~~~ cf vt ~ ~ ~+~t residing at: / -~ 1r/ y..~ V cj Print Name ~~~sa C~. Dated: // `/3 - Q~' Witness #2 1/ ~ residing at: _ ~ ~ ~ (,~ ~ ~ , Print Name Sign Dated: ~/~ - l ~ ` Gj Last Page of: THE LAST WILL AND TESTAMENT OF JOHN C. FOX Page 3 w ¢ o ¢ a - ~~ OOJO ~Z ~O _ dr..-aIAM~ QI Z~ Q o _ VI } ~ ¢ ¢ _ ~ E E 3 O m _ ~ M_ ~ o r N _ C ~ _ O O N y~ O O w - = 0 ~ n ,~ O ~ o E O q~ i O ~ ~ ~ ,~ U ~ ~~ ter, _ a., r. ~~~^ w~Voa ~ ~~a~ C7 rx 0 .. U ~ t~ y ~ti N J r r, ~'' N J Q .~ J c,.-