HomeMy WebLinkAbout07-11-11J 1505610140
REV-1500 EX ~°'_'°'
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN County Code Year File Number
Harrisburg PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 3 8 0
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY
1 8 2 4 0 8 3 3 3 0 3 1 4 2 0 1 1 0 1 1 1 1 9 4 9
Decedent's Last Name Suffix Decedent's Firs t Name MI
S I M M O N S B A R B A R A q
(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
0 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)
QX 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 T0:
Name Daytime Telephone Number
W I L L I A M A D U N C A N 7 1 7 2 4 9 ? 7 8 0
First line of address
1 I R V I N E
Second line of address
R 0 W
City or Post Office
C A R L I S L E
State ZIP Code
REGISTEIj.QF WILLS USC~i~ILY
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Correspondent's a-mail address: b 1.11 d U n C 8 n a~ p e• n e t
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,~lnder Wallies of perju are a examined this re , in ding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and plete. a .lion parer other n the nal representative is based on all information of which preparer h any nowledge.
SIGNAT R OF PER ON R PONSIB FILING RETU SATE /
AD SS ~ tee'
1 YOUNG DRIVE CARLISLE PA 17015
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
150561014D
1505610140
J
1505610240
REV-1500 EX
Decedent's Social Security Number
~ecedent'sName: BARBARA A• SIMMONS 1 8 2 4 0 8 3 3 3
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1.
2. Stocks and Bonds (Schedule B) ...................................... 2.
3. Closely 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.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6.
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) ~ Separate Billing Requested .... ... 7.
8. Total Gross Assets (total Lines 1 through 7) ........................ ... 8.
9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9.
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10.
11. Total Deductions (total Lines 9 and 10) ............................ ... 11.
12.
13.
14. Net Value of Estate (Line 8 minus Line 11) ..................
Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............
Net Value Subject to Tax (Line 12 minus line 13) ............ ........
........
........ .. 12.
.. 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 _ D D D 15.
16. Amount of Line 14 taxable
at lineal rate X .045 1 7 2 5. 4 4 1s.
17. Amount of Line 14 taxable
at sibling rate X .12 D D D 17
18. Amount of Line 14 taxable
at collateral rate X .15 D D D t8.
19. TAX DUE ...................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610240
2 4 1 0. 2 8
2 4 1 0. 2 8
5 9 4. 5 0
9 0. 3 4
6 8 4. 8 4
1 7 2 5. 4 4
1 7 2 5. 4 4
D. o D
7 7. 6 4
o. D o
0. D 0
7 7. 6 4
15O561O24D J
<EV-1500 EX Page 3
Decedent's Complete Address:
BARBARA_ A_•_
STREET ADDRESS
i1 WEST PENN
File Number
21 11 0380
SIMMONS
STREET, APT• 106
CITY
CARLISLE STATE
PA ZIP
17013
Tax Payments and Credits:
~ Tax Due (Page 2, Line 19) (1)
2. Credits/Payments 77 • 6 4
A. Prior Payments
B. Discount
Total Credits (A + B) (2)
3. Interest
0.0 0
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2, Line 20 to request a refund. (4)
0 • 0 0
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
7 7 • 6 4
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 ro rt transferred;
P Pe Y .....................................................................
^
Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ 0
c. retain a reversionary interest; or ............................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................
...........................................................
^
a
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ......... ^ Q
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? .................................................................................................. ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RET URN.
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(aj(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-1506 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, ~ MISC.
PERSONAL PROPERTY
FILE NUMBER
BARBARA A• SIMMONS 21 11 0380
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be discbsed on Schedule F_
ITEM
NUMBER DESCRIPTION
~. FULTON BANK
[SEE DOD LETTER ATTACHED]
VALUE AT DATE
OF DEATH
2,410.28
TOTAL (Also enter on line 5, Recapitulation) I S 2 410 2 8
(If mon; space ~ needed, insert addthonal sheets of the same s¢e) ~
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
BARBARA A• SIMMONS 21 11 038D
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A• FUNERAL EXPENSES:
1.
B.
~~ State ZIP
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
SVeet Address
C'
Year(s) Commission Paid:
2. AttomeyFees: DUNCAN & HARTMAN, PC
3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation.)
Claimant
4.
5.
6.
7
SVeet Address
C~' State ZIP
Relationship of Claimant to Decedent
Probate Fees: REGISTER OF WILLS PROBATE FEE
Accountant Fees:
Tax Retum Preparer Fees:
REGISTER OF WILLS FILING FEE
AMOUNT
500.00
79.50
TOTAL (Also enter on Line 9, Recapitulation) I s
If more space Is needed, use add~6onal sheets of paper of the same s¢e.
15.00
594.50
REV-1512 EX+ (12-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8~ LIENS
FILE NUMBER
BARBARA A• SIMMONS 21 11 0380
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM I
NUMBER DESCRIPTION
PPL
TOTAL (Also enter on Line 10, Recapitulation)
Ii more space is needed, insert additional sheets of the same size.
VALUE AT DATE
OF DEATH
90.34
90.34
REV-1513 EX+(01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
~aiH~~ur:
BARBARA A• SIMMONS
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
[ TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).J
1, DEVIN K• SIMMONS
10 GREEN MEADOW DRIVE
CARLISLE, PA 17013
2- KORRIN N• NEWMAN
10 GREEN MEADOW DRIVE
CARLISLE, PA 17013
3• ANTHONY E• NEWMAN
10 GREEN MEADOW DRIVE
CARLISLE, PA 17013
0380
AMOUNT OR SHARE
OF ESTATE
1/3 SHARE
1/3 SHARE
1/3 SHARE
~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV 1500 COVER SHEET AS APPROPRIATE
fl. 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
FILE NUMBER:
21 11
RELATIONSHIP TO DECEDENT
Do Not List Trusteelsl
Lineal
Lineal
Lineal
TOTAL OF PART i l -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I s
If more space is needed, use additional sheets of paper of the same size.
LAST WILL
TESTAMENT
I, BARBARA A. SIMMONS , of 10 Greenmeadow Drive, Carlisle, N. Middleton Township,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding,
do hereby make, publish and declaze this as and for my Last Will and Testament, hereby revoking
any and all other wills and codicils heretofore made by me.
FIRST. I direct that all my just debts and funeral expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be cremated and interred within my family's burial
plot in Cumberland Valley Memorial Gardens and all funeral arrangements be made through
Ewing Brothers in accord with my expressed wishes.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a suitable mazker for my grave.
FOURTH. I give, devise and bequeath all of my estate of whatever nature, be it real,
personal or mixed, and wherever situate in accord with the provisions of Pazagraph Seventh:
( A.) One-Third (1/3) share unto my grandson, DEVIN KRISTOPHER SIMMONS, per
stirpes;
( B.) One-Third (1/3) shaze unto my granddaughter, KORRIN NOEL NEWMAN, per
stirpes; and
( C.) One-Third (1/3) shaze unto my grandson, ANTHONY EDWARD NEWMAN, per
stirpes.
FIFTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my
estate passing under my will or otherwise, shall be paid out of the principal of my residuary
estate.
SIXTH I hereby nominate, constitute and appoint my brother, JAMES N. TANNER,
JR., as Executor of this my Last Will and Testament. In the event of renunciation, death,
resignation or inability to act for any reason whatsoever of JAMES N. TANNER, JR., I
nominate, constitute and appoint my sister-in-law, JANICE M. TANNER, as Executor of this
my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for
any reason whatsoever of JANICE M. TANNER, I nominate, constitute and appoint my niece,
NICOLE L. MASCHMEYER, as Executor of this my Last Will and Testament. I hereby
relieve my Executor from the necessity of posting security in connection with his duties, as such,
in any jurisdiction in which he may be called upon to act insofaz as I am able by law to do so. In
addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to
retain in the form received, and to sell either at public or private sale any real or personal
property owned by me at the time of my death.
SEVENTH. If any of the beneficiaries of this, my Last Will and Testament, shall be
under the age of Twenty-Three (23) at the time of my death, then any portion of my estate in
which they share shall be held in trust for them with JAMES N. TANNER, JR. as Trustee. In the
event of renunciation, death, resignation or inability to act for any reason whatsoever of JAMES
N. TANNER, JR., I nominate, constitute and appoint JANICE M. TANNER as Trustee, if she is
unable or unwilling to serve as Trustee, I name NICOLE L. MASCHMEYER. The trusteeship
shall end when the child attains the age of Twenty-Three (23) years. The Trustee shall provide
for the caze, maintenance and education of said beneficiary and shall from time to time use either
principal or income from the inheritance to provide for these needs. If any beneficiazy by Trust
dies prior to attaining the age of Twenty-Three (23) years, the Trust terminates and all such funds
shall be paid over to the beneficiary's legal heirs. As Trustee, JAMES N. TANNER shall
provide for the caze, maintenance and education of said children and shall from time to time use
either principal or income from the inheritance to provide for these needs.
EIGHTH. I have made, or may from time to time make, a written memorandum
expressing my desire to give certain items of personal property to specific persons. I urge my
Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be
stored in conjunction with this Will.
IN WITNESS WHEREOF, I have hereunto set my hand and se to this, my L t Will and
Testament, consisting of two typewritten pages this j ~ day of
2009. l
~~
BARBARA A. SIMMONS
Signed, sealed published and declared by the above named Testatrix BARBARA A. SI'VIIVIONS
as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight
and presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
COMMONWEALTH OF PENNSYL VANL4
COUNTY OF CUMBERLAND
. SS.
I, BARBARA A. SIMMONS, Testatrix 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. ~
RBARA A. SIMMONS
Sworn or affirmed to and
acknowledged before me, by
BARBARA A. SIMMONS this ~ ~ ~(N
of M ~ 2 G~-1
~~~w n,
Notar~Public
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
COMMON\YEALTH OF PENNSYLVANIA
day NOTARIAL SEAL
JOAN D. ADAMS, Notary Public
2009. Carlisle Boro., Cumberland County
My Commission Expires March 7, 2011
:SS.
We, w ~ w~ a ~ A. ID I~IV ~ N and ~~ y ~, ,~/~i1iG1 ~1 ~~
the witnesses whose names aze signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw BARBARA A.
SIMMONS sign and execute the instrument as her Last Will; that she signed willingly and that
she executed as her free and voluntary act for the purposes therein expressed; that each of us in
the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our
knowledge, the Testatrix was at that time eighteen (18) or more yeazs of age, of sound mind and
under no constraint or undue influence.
Sworn or affirmed to and
subscribed before e b !/G~ N
vv ~ w~ ~,n~ ,~. ~ ~
this ~ ~.,rj.~ day of it/!Lt-jZCda
and
witnesses,
2009
D~
Notary blic
OCMMONWEALTH OF PENNSYL /ANIA
NOTARIAL SEAL
JOAN D. ADAPAS, Notary Public
Carlisle Boro., Cumberland County
Commission Expires March 7, 2011
July 1, 2011
Duncan & Hartman, P.C.
Attorneys at Law
One Irvine Row
Carlisle, PA 17013
Dear Mr. Duncan,
~~~
LISTENING IS JUST THE BEGINNING.'"
RE: Barbara Ann Simmons, deceased Mary 14, 2011
In response to your recent inquiry concerning the accounts maintained in the name of
the decedent, please be advised that the following account was open at the date of death:
Checking #8649-28706
Date of death balance $2,410.28, opened 7/13/06,
titled in her name alone
If you have any other questions, please feel free to contact me at (717) 291-2436.
Sincerely,
~~~~
Joshua A. Groff
Credit Confirmation Processor
CONFIDENTIAL
This iMaawtlon it fwMfhed as a mMNr d Auainsr oowray
in ~tsrvar b y011r i11(~n-, And id fo- ypW COnfldir~i W! 01My.
1'h6 tlMlc htMflfllill~ M11>S infOrrili{ti0r1 dDM -IOt 1'arl~K Or
guarantN ffw accuracy, completertass a raliaNMly d Mte
infOrlflatiOn prOVldad, No rlatpOnaidil!!y i~ aaM~iaO by aY1a
tk1rlk Or ~ d Ita ofllv«s, arnpbyAN or ~11r, ~ ~~
heroin ezpreasad fa suMact to change arllhout notice
1.800.FULTON.4 fultonbank.com
Fulton Bank, N A Member FDi< !Aember of the Futon F~.nancal Family