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Home My WebLink About06-15-11 (2)1505610148 REV-1500 EX (01-10) PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth 159-26-6988 09282010 Decedent's Last Name Suffix KEYSER (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number OFFICIAL USE ONLY County Code Year Fife Number 21 10 1 ^23 MMDDYYYY 12311932 Decedent's First Name M I ANNA T Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES 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 TO: Name Daytime Telephone Number RICHARD C• SNELBAKER 717-697-8528 First line of address 44 WEST MAIN STREET Second line of address P•0• BOX 318 City or Post Office State ZIP Code MECHANICSBURG PA 17055 Correspondent's a-mail address: REGISTER OF WILLS USE ONLY ~ r-:~ ~..' _ ~ ~ c,._ ~ ~ ~ ~~~ ~ O~n C7C _r? ~" . ~ ': ~,"~ ,; -, rn C~ `~ c~i 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. SI TIJRE OF~R~N S~;E ~r9~ LING ET~ ~a3~~ ADDRESS (- ROBI K• SCHADE, EXECUTRIX 26 STONE RUN DRIVE, MECHANICSBURG SIG O ER OTHER THAN REPRESENTATIVE DATE RICHARD C• SNELBAKER 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 1505610148 Side 1 9M4647 4.000 1505610148 J~ 1505610248 REV-1500 EX Decedent's Social Security Number 159-26-6988 Decedent's Name K E Y S E R ANNA T RECAPITULATION 1. Real Estate (Schedule A) 1. O . O 0 2. Stocks and Bonds (Schedule B) ......................... 2. 6 7 , 5 5 2 • 5 8 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. O • 0 0 4. Mortgages and Notes Receivable (Schedule D) 4. 0 , 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5, ], 3 , 812.12 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. O . O O 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 6 5 , 0 3 9.3 5 8. Total Gross Assets (total Lines 1 through 7) 8. 14 6 , 4 0 4 •0 5 9. Funeral Expenses and Administrative Costs (Schedule H) • , g. 8 , 4 4 5.5 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 7 , 4 0 8.2 5 11. Total Deductions (total Lines 9 and 10) , 11. ], 5 , 8 5 3.7 9 12. Net Value of Estate (Line 8 minus Line 11) 12. ], 3 O , 5 5 0 • 2 6 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. ], 3 O , 5 5 0.2 6 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a)(1.2) x .o - 0.0 0 15. 0.0 0 16. Amount of Line 14 xable ~ at linealratex.o 4 130,550.26 is. 5,874.76 17. Amount of Line 14 taxable at sibling rate X .12 0.O O 17 0 • 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. O• 0 0 19. TAX DUE 19. 5, 8 7 4 •7 6 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 1505610248 9M4648 4.000 REV-1500 EX Page 3 rlacarlan+'c Cmm~la4a Orldra_cc' File Number DECEDENTS NAME KEYSER ANNA T STREET ADDRESS TOWNSHIP M AND NTY GTY STATE ZIP MECHANICSBURG PA 17055- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 5, 0 0 0. 0 0 B. Discount 2 5 0. 0 0 3. Interest (1) 5,874.76 5,250.00 Total Credits (A + B) (2) 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. (3> 0.00 (a) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 6 2 4 • 7 6 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; i f d it ^ 0 ncome; erre or s b. retain the right to designate who shall use the property trans 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 within one year of death without receiving adequate consideration? . " " or payable-upon-death bank account or security at his or her death? in trust for 3. Did decedent own an 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)]. 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. 9M4671 2.000 REV•1503 EX+ (6-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER Anna T Keyser 21 10 1023 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1.Amerprise Financial Services 67,552.58 mutual fund, account #01013905750 8 002 TOTAL (Also enter on line 2, Recapitulation) ~ $ 67,552.58 3wasss ~.ooo (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Anna T Keyser 21101023 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 MemberHealth 20.51 refund on RX plan 2 PNC Bank, N.A. 9,973.21 checking account #5140125158 3 Riversource 3,818.40 final benefit on long term care policy 3W46AD 1.000 TOTAL (Also enter on line 5, Recapii (If more space is needed, insert additional sheets of the same size) 13,812.12 REV-1510 EX + (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDEM SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF ri~~ rvumo~rc Anna T Keyser 21 10 1023 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBS DESCRIPTION OF PROPERTY INCLIDETFEf.NMEOFTFETRMISFEREE,TFEIRREIATIONSHIPTODECEDEMAt~D TFEDATEOFTRM&FERATrOGHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD~S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~• Allstate Life Insurance Company 13,307.11 100.0000 0.00 13,307.11 annuity #GA19362330. Beneficiaries are decedent's children in equal shares 2 Amerprise Financial Services 51,732.24 100.0000 0.00 51,732.24 annuity, account #93002829310 6 004. Beneficiaries are decedent's children in equal shares. TOTAL (Also enter on line 7, Recapitulation) $ 65,039.35 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+ (10-09) Pennsylvania DEPARITAENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Anna T Keyser 21101023 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Robin Schade funeral luncheon B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s)Robin K. Schade Street Address 26 Stone Run Drive City Mechanicsburg State PA ZIP 17050 Year(s) Commission Paid: 2. Attorney Fees: SNELBAKER & BRENNEMAN, P.C. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 525.64 4,068.00 2,100.00 Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 198.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal advertising Executrix Notice 75.00 Total from continuation schedules 1,478.40 TOTAL (Also enter on Line 9, Recapitulation) $ 8 , 445.54 swasA~ 2.000 If more space is needed, use additional sheets of paper of the same size Estate of: Anna T., Keyser Schedule H Part 7 (Page 2) 21 10 1023 2 Greenawalt & Company, P.C. preparation of Final Individual Income Tax Returns 230.00 3 PNC Bank, N.A. service charges 14.00 4 Register of Wills filing fee for Inheritance Tax Return 15.00 5 The Sentinel advertising Executrix Notice 219.40 6 Reserve filing fees, accountant fees and other miscellaneous costs associated with the administration of the Decedent's estate. 1,000.00 Total (Carry forward to main schedule) 1,478.40 REV-1512 EX+ (12-08) Pennsylvania DEPARTMENiOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER _Anna T. Keyser 21 10 1023 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 ~• Alert Pharmacy prescription medicine 184.34 2 Blue Shield check number 461 written prior to death for health insurance premium 560.70 3 Messiah Village nursing home care 6,583.21 4 Messiah Village Home Care transport and aide 80.00 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8~ LIENS TOTAL (Also enter on Line 10, Recapitulation) ~$ 7 , 408 awasAH 2.00o If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTA~NTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Anna T. Ke ser 21 10 1023 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1, Charles E. Keyser, Jr. 315 West Siddonsburg Road Dillsburg, PA 17019 25~ of Residue: 32,637.56 Son 32,637.56 2 I 3 1 Garry M. Keyser, Sr. 420 West Keller Street Mechanicsburg, PA 17055 25~ of Residue: 32,637.56 Terri A. Ritter 34 South Baltimore Street Dillsburg, PA 17019 25~ of Residue: 32,637.56 Son Daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 S OF REV-1500 COVER SHEET, AS APPROPRIATE. 32,637.56 32,637.56 NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ $ 0 . 0 0 If more space is needed, use additional sheets of paper of the same size. 9W46AI 2.000 Estate of: Anna T. Keyser Schedule J Part 1 (Page 2) Item No. Description 4 Robin K. Schade 26 Stone Run Drive Mechanicsburg, PA 17050 Relation 21 10 1023 Amount 25$ of Residue: 32,637.56 Daughter 32,637.56 LAST WILL AND TESTAMENT I, ANNA T. KEY SER, of the Borough of Mechanicsburg, County of Cumberland, and wealth of Pennsylvania, being of sound and disposing mind, memory and do make, publish and declare this as and for my Last Will and Testament, hereby 4 ig and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my rix, hereinafter named, as soon as conveniently may be done after my decease. SECOND. In my lifetime, I purchased several burial lots in Rolling Green Memorial s, Lower Allen Township, Cumberland County, Pennsylvania, and I direct that my > be interred there next to my deceased husband. THIRD. I give and bequeath the following items of personal property to my children in following manner: all of my Hummel figurines, Hummel plates and Norman Rockwell shall be assembled together in one location and each of my four children, CHARLES WOOD KEYSER, GARRY MARTIN KEYSER, TERRY ANN BITTER and ROBIN K. who survive me, shall be given ne opportunity to select one item each, in turn, and such selection process until no items remain. The children shall select said items in order of their birth starting with the eldest. FOURTH. My children who survive may select from among any household goods or furnishings that they may desire to retain for themselves as they can agree. In the event there are any questions to this procedure, the decision of the Executrix shall be final. I order and direct that the remaining items of household goods or furnishings be sold or otherwise disposed of at the discretion of the Executrix. FIFTH. I order and direct that any automobile which I may own at the time of my death shall be sold. SIXTH. I give my interest in remaining interment spaces at Rolling Green Memorial LAW OFFICES SNELBAKER & Gardens, Lower Allen Township, Cumberland County, Pennsylvania, to my daughter, ROBIN BRENNEMAN, f .C. SCHADE, if she survives me, with the express desire that she retain and use said spaces for interment of family members as needed. In the event ROBIN K. SCHADE does not survive I give said interment spaces to my daughter, TERRI ANN BITTER, subject to my desires above. SEVENTH. I give and bequeath my jewelry to my daughters, TERRI ANN BITTER and OBIN K. SCHADE; whp survive me, to select from and retain for themselves as they can In the event there are any questions as to this procedure, the decision of the Executrix be final. EIGHTH. I give, devise and bequeath all the rest, residue and remainder of my Estate, personal and mixed, whatsoever and wheresoever situated, in equal shares unto my namely, CHARLES ELWOOD KEYSER, GARRY MARTIN KEYSER, TERRI ANN and KOBIN K. SCHADE, who survive me, share and share alike, and not to the issue ~. of any child who shall not survive me. I_,ASTLY. I nominate, constitute and appoint my daughter, namely, ROBIN K. SCHADE, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint my daughter, namely, TERRI ANN BITTER, to be the Executrix hexeof. Any individual Executrix shall serve without compensation. I further direct that no person serving as Executrix shall be required to post any bond or other security to secure the faithful performance of her duties in the Commonwealth of Pennsylvania or in another jurisdiction. IN WITNESS WHEREOF, I, ANNA T. KEYSER, have hereunto set my hand and seal to this my Last Will and Testament, which consists of three (3) typewritten pages to each of which I have affixed my signature this:°~day of June, A.D., Two Thousand Five (2005). _~,~, v,--vc„~e~`.~°--°~' (SEAL) ANNA T. KEYSER LAW OFFICES SNELBAKER & _ BRENNEMAN, P.C. _G The preceding instrument, consisting of this and two (2) other typewritten pages, each lentified by the signature of the Testatrix, was on the date thereof signed, sealed, published and ~clared by ANNA T. KEYSER, the Testatrix therein named, as and for her Last Will and estanzent, in the presence of us, who, at her request ' her presence and in the presence of each ;her, have subscribed our names as witnesses he to. f' A ~,1 ,, OMMONWEALTH OF PENNSYLVANIA) LINTY OF CUMBERLAND SS. We, ANNA T. KEYSER, RICHARD C. SNELBAKER and JANE J. GOONEY, the estatrix and the witnesses, respectively, whose names are signed to the attached or foregoing istrument, being first duly sworn, do hereby declare to the undersigned authority that the estatrix signed and executed the instrument as her Last Will and Testament and that she had gned willingly, and that she executed it as her free and voluntary act for the purposes therein cpressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the gill as a witness and that to the best of his or her knowledge, the Testatrix was at that time ghteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix ss fitness Subscribed, sworn to and acknowledged before me by ANNA T. KEYSER, the Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. GOONEY, the witnesses, this ~;°' " ...day of June, 2005. 3"'.~`~..-.. . w L,IvE,~ ~:~'~t;~.t_`~~t`aLTFI JF rEi`3~~~; a ti.;:~~~i.~~ Notary PuYSlic y i\iotarial Seal Susan L. Matra7s, No+ar~ Public 1~ie~'~aniasburg Boro, Cumberland County ;::~v Commission Expires PJov. 24, 2007 ~.~ ter~~ber, P~nnsyNania Association Of Nataries LAW OFFICES SNELBAKER & ?RENNEMAN, P.C. -3 -