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HomeMy WebLinkAbout07-05-11J 1505610105 REV-1500 EX (oz-ii) (FI) LiJ; enns lv OFFICIAL USE ONLY PA Department of Revenue P y ania _ Bureau of Individual Taxes ~"~A~r.,E"' of Rr,.E"°; County Code Year File Number PO Box 28o6oi INHERITANCE TAX RETURN Harrisburg, PA lyT_28-0601 RESIDENT DECEDENT .~ ~, ~ ~ ~~~ ENTER DECEDENT INFORMATION BELOW _ Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 182-22-8949 02/06/2011 08/19/1929 Decedent's Last Name Suffix Decedent's First Name MI BROLLY HELEN M (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 OVALS BELOW G~ 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 12-12-82) ~ 6. Decedent Died Testate (Attach Co f Will O 7. Decedent Maintained a Living Trust ~ 8. Total Number of ;iafE; Deposit Boxes py o ) (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 Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Nurnber ANDREW J. BENDER, ESQ. (717) 249-1177 First Line of Address Second Line of Address 61 W. LOUTHER STREET City or Post Office State ZIP Code CARLISLE PA 17013 Correspondent's a-mail address: ajbender.law mail.com REGISTER OF WILLS USE ON~Y,~ `.y"" :; ~~ .z-~ ~_. r---- = p"r-t ~ ~~ ~ ~. t`_~ <:~ ~~`~ ~"i tJ -n - DA{E-~4~U __. ,_ --'~ _ ... ~, :~- ~,, ~~-~ ~~~ ~. ,, :> ~ . ~._, . . r , f•., -,_`'~i ~ _~ --ro unaer penalties or penury, 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 n the personal representative is based on all information of which preparer h:as any knowledge. SIGNAT E PER N ESPONSIB R FILING URN A'fE fP r ~' AD ESS 624 GUTSHALL ROAD, BOILING SPRINGS, A 17007 SIGNA F E HER THAN REPRESENTATIVE DAl-E c~'~ ~c> s` i i ADDRESS 61 W. LOUTHER STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 REV-1500 EX (FI) Decedent's Name: HELEN M. SHOLLY Decedent's Social ;5ec;urity Number 182-22-8949 zECAPITULATION - 1. Real Estate (Schedule A) ........................................... .. 1. 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 106,765.09 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property - - -- (Schedule G) O Separate Billing Requested...... .. 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 106,765.09 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 24,042.74 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 264.35 11. Total Deductions (total Lines 9 and 10) ................................. 11. 24,307.09 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 82,458.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which - an election to tax has not been made (Schedule J) ................... . .... 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 82,458.00 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 0 0.00 15 16. Amount of Line 14 taxable at lineal rate X .0 45 82,458.00 16. 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 18. Amount of Line 14 taxable at collateral rate X .15 0.00 18. 19. TAX DUE ....................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 150561,0205 1505610205 ],50561,0205 0.00 3,710.61 0.00 0.00 3,710.61 O J REV-15b0 EX (FI) Page 3 Decedent's Complete Address: HELEN M. SHOLLY .. STREET ADDRESS 624 GUTSHALL ROAD CITY BOILING SPRINGS Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments _ _ 3,400.00 B. Discount 178.94 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. File Number STATE PA ZIP 17007 Total Credits (A + B) (2) (3) (4) (5) 3,710.61 3,578.94 0.00 0.00 131.67 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)]. 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 noised 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)]. Asibling 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-~5o8 EX+ (11-SO) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: HELEN M. BROLLY 21-11-0275 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 schpd~~ip F ~~ nwre space is neeaea, use aaditional sheets of paper of the same size. REV-1.511 EX-+- {10-09) ~ ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT City ,.BOILING SPRINGS, PA 17007 State PA ZIP 17007 ESTATE OF HELEN M. SHOLLY FILE NUMBER 21-11-0275 ITEM NUMBER A• FUNERAL EXPENSES: 1' MYERS FUNERAL HOME, INC. 2. GINGRICH MEMORIALS 3. FUNERAL RECEPTION B. 1 Year(s) Commission Paid: 2011 2. Attorney Fees: 3• Family Exemption; (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4. 5. 6. ~. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS Decedent's debts must be reported on Schedule I. DESCRIPTION ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) .KATHLEEN S._ DALY Street Address 624 GUTSHALL ROAD Street Address City __...... _.__._ _.__..__ __ _ _.... _ .... State - _.... Relationship of Claimant to Decedent ZIP Probate Fees: Accountant Fees: Tax Return Preparer Fees; MISCELLANEOUS EXPENSES FROM ATTACHED SCHEDULE TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. AMOUNT 11, 365.30 160.00 200.00 5,270.60 5,075.00 315.50 0.00 0.00 1,656.34 24, 042.74 REV-x.512 EX•+- (12-08) ~~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF ~ECE~ENT~ INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN M. BROLLY 21-11-027;5 Report debts incurred by the decedent prior to death that remained unpaid at the date of death. including unreimhursed modiraf aYnoncae ~~ rnvre space is neeaea, insert additional sheets of the same size. ATTACHMENT TO SCHEDULE H -MISCELLANEOUS EXPENSES Waste Management (Dumpster Rental) Advertise Opening of Estate Nationwide Insurance Automobile Repair PP&L Electric United Water Bank Fees Sewer & Refuse (Mechanicsburg Borough) 'x402.00 '~2fi9.73 >1:L3.70 ;i 186.40 ;1487.15 $21.06 $33.50 142.80 $1,656.34 LAST WILL AND TESTAMENT OF Helen M. Sholly I, Helen M. Sholly, of 405 Valley Street, Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it: might be proper and more advantageous to retain or renew and pay as they become due and. payable. If I do not own a burial plot or a grave marker at the time of my death, I authorize my pers~.~al representative, in his, her or its sole discretion, to purchase a burial plot and to erect a suitable grave marker at my grave, and to expend sums from my estate for this purpose. 2 I give, devise and bequeath the following property with all insurance proceeds thereon as follows: Any and all items of my personal property which my daughter Kathleen S. Daly and my son William R. Sholly may desire to have may be taken by them and kept as their o~vn. The rest, residue and remainder shall be sold ,either publicly or privately, by my personal representative Page 1 of 8 ~/ '~ e and the proceeds of the sale shall be divided as stated herein after payment of my estate debts, without taking into account the tangible personal property otherwise provided to them. 3 I give, devise and bequeath the rest, residue and remainder of my estate together with all insurance proceeds thereon of whatsoever nature and wheresoever situate in equal shares of one third each to my children Kathleen S. Daly and William R. Sholly who survive me by ;sixty (60) days per stirpes. The remaining one third share is to be divided between my granddaughters Josette D. Fought and Jaime Fought, with Jaime receiving either 2% of the one third share, or $500.00, whichever is the lesser amount. 4 Any devise or distribution under this Last Will and Testament which is payable to any beneficiary who may be under 25 years of age or, in the judgment of my personal representative, mentally disabled, shall be held in a separate trust by my personal representative as trustee until such beneficiary reaches 25 years of age during such period of disability. In the case oi' a beneficiary under 25 years of age, the Trustee may distribute the entire remaining balance of principal and accumulated interest at or after attaining 25 years of age. During the terms of any trust created pursuant to this Paragraph, the Trustee is authorized to expend and apply so much of the net income and principal of each such trust as the Trustee shall consider advisable for the health, maintenance, support, and education (including college education, undergraduate and graduate) of each such beneficiary until he or she attains 25 years of age, or until all such Page 2 of 8 ~. ame =. amounts are paid out of trust. I direct that no Guardian shall be required to give or post bond for the faithful performance of the Guardian's duties in this or any other jurisdiction. 5 I grant my personal representative the following powers in addition to and not in. limitation of such powers as my personal representative shall hold by law: (a) To retain all property received including the stock of any corporate fiduciary acting hereunder, provided such property remains productive. (b) To join in any corporation, partnership, recapitalization, merger, reorganization or voting trust plan; to delegate authority with respect thereto; to deposit investments under agreements and pay assessments; and generally to exercise all rights of investors, including but not limited to, the voting of shares. (c) To manage, operate, repair, improve, mortgage or lease on any terms any real estate held or owned by my estate. (d) To operate any business that I may own at my death. (e) To invest any funds of my estate in any stocks, bonds, notes or other sec;ui•ities or property, real or personal, without regard to the principle of diversification or any other statute or general rule of law in his, her or its absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. Page 3 of 8 ~ ~ v r e (fl To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my personal representative shall see fit in his, leer its absolute discretion. (g) To borrow money for the payment of taxes of for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as :~ec;urity. (h) To compromise claims without court approval including, but not limited t;o, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests ghat may pass under this my Last Will and Testament. (i) To distribute in cash or in kind upon any division or distribution of my estate. (j) To undertake any and all acts deemed necessary and proper by my personal representative for the proper, advantageous and prompt management of the settlement of my estate. (k) In general, to exercise all powers in the management of my estate which anw individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to him, her or it may seem best ands to execute and deliver all instruments and to do all acts which he, she or it dee~ns~ necessary or proper to carry out the purposes of this, my Last Will and Test~iment. Page 4 of 8 ly N e 6 No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have the power in any manner to charge or encumber his interest either in :income or principal, nor shall the interest of any beneficiary be liable or subject in any manner w:hil.e in the possession of my personal representative for the liability of such beneficiary. 7 I nominate, constitute and appoint my children, Kathleen S. Daly and William ]f~. Sholly as co-executors of this my Last Will and Testament. In the event that one of my children are deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint the other child as personal representative of this my bast Will and Testament. I direct that my personal representative shall not be required to give or post bond for the faithful performance of his, her or its duties in this or any other jurisdiction. 8 I hereby declare it to be my expressed desire that my personal representative employ the law firm of Stephanie E. Chertok, Esquire, of Cumberland County, Pennsylvania, for legal advice and assistance regarding this my Last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate Page 5 of 8 ~~ ~ r Name of this instrument, the administration of my estate, and the execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will a~ncl ~~ Testament this day of v~~, 2002. WITNESS: , 7 ,,/ ~ JJ~J,/) P ~ ' ~ ~ j~ v./! it 4 J ~ ~~ f Y • !'~ ~ Helen M. Sho y 1 {~ (J^~ / Page 6 of 8 ~ ~ ~ e z~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND '" ~ = ~ ,. WE, ~~ ~ ~ ~• ~-~_ and ~~1~~~Ir~~r.x--e. ~ L~~fiv~ ,the witnesses whose names are attached to the foregoing document, being duly qualified according too law, do depose and say that we were present and saw testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Last Will and Testament as witnesses and that to the best of our knowledge the testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ,,~ ,~/ _ _ S ~ ~_._ . ~~ ~ _ Sworn or affirmed and subscribed before me by -.-"~?~'"~~'-.: r~ x•_~~_,:-r~'_ ,~'~ ~,~G ,.. f,~~.~ and ~ ~ ~ -- ~~_~ .~~~ ~ ,<_.~. /~-', ~~-~. ~~'%~--- this ,~ ,~~~:---day of __-- _.__~::~_ ~ 'L- ~ x_002. ~teph r Lipson ~ - ~---= !3. r ,Notary Public -~' ~. ~.~,-~--%~ •,r"~ ~-4 - ;- Carii~ie Bc~rcu~h, ~dun#y of Cumberland " ?~1y Corr~n7iv ;ion ~'xpire~ Jan, 15, 2QlJ~ Page 8 of 8 ,ame .11~Iessicrh Villa e I-~C~ME CASE, ~~~,~ 100 MT. ALLEN dR., MECHANICSBURG, PA 17055 KATHY DALY 624 CRUTSHALI.1 RA4D BOWLING SPRINGS, PA 17007 1 ~y, f - ~ ~~~~ Farm P6-01 QUESTIONS? CALL: 717 697-4666 RESIDENT # UNIT STMT. DATE 900440 02/28/2011 RESIDENT(S) Ms. HELEN SFIOLLY TOTAL AMOUNT DUE ~ $19.55 DATE DUE _ 03/31/2011 S DATE DESCRiIsTIflPI RATE ~~~ CHARGES (:REDITS BALANCE Balance Forward 0.00 *** Nonsident *** OZ/28/1 l Emergency Cali Lease 02/01-02/17 0.3b 17.00 6.12 02/28/1 l Emergency Call Monitoring 0.79 17.00 13.43 02/01-02!17 RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 ~ TOTAL AINOUNT DUE 900440 19.55 0.00 0.00 0.00 0.00 $19.SS r1~o~vciv i ivnmc 1VLS. t~~.Lr,PI ~riVLLY F«mPe-01 Please make check payable to Messiah Village Home Care, LLC. A I% tnance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! ~'l~C L>rADIN~ THE WAY Apri 1 12, 2011 Kathleen S Daly 624 Gutshall Rd Boiling Springs, PA 17007 RE: Helen M Sholly SSN: 182-22-8949 DOD: 02-06-201 ~ Dear Ms. Daly: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account # 5005851923 Established: 08-17-2009 HELEN M SHOLLY DOD balance: $ 16,154.41 + 0.53 accrued interest Savings Account Account # 5004021696 Established: 09-13-2002 1-IELEN M SHOLLY DOD balance: $ 84,001.44 + 1.16 accrued interest Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). V'Ve do not process any financial transactions or provide statements. lfyou need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch officc. Sincerely, National Financial Services Center PNC Bank, N.A. 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