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Home My WebLink About07-25-11 1505611185 EX (02-11) (FI) REV 1500 - OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN 21, 1, 1, 0 2 2 0 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 209-12-7081, 021,02011, 1,21,81924 Decedent's Last Name Suffix Decedent's First Name M I SHEIBLEY RUTH E (If Applicable) Enter Surviving Spous e's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number 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 Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number KEITH 0• BRENNEMAN 71'7-697-8528 First Line of Address SNELBAKER & BRENNEMAN Second Line of Address 44 WEST MAIN STREET City or Post Office State ZIP Code MECHANICSBURG PA 17055 Correspondent's a-mail address: REGISTER C~-MILLS USE OM:.~fi ~:.~ ~~ ..Q C... ~~ ~~ ~ ~ U1 ~ p ti ~ -~ ,-~ ~ ~• ~. . :X7 F W' ILED ET rn ~._ `ice ~. J '~ l~ i` ='T'1 _r ~~ t'*`~ ~~ 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. SIG RE OF PERSON RESPOAFSIBLE FOR FILII~ RETURN DATE ~ ~~ 02 ~j !~ ADD SS KATHLEEN HOFFMAN, EXECUTRIX 929 BONNY LANE, MECHANICSBURG, PA 17055 SI E OF PREPARER OTHER THAN REPRESENTATIVE DATE ~"7 2`~ !i ADDRESS KEITH 0- BRENNEf1AN 44 WEST f1AIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 1505611185 Side 1 OM4647 3.000 1505611185 J ~ ~J 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 209-12-7081 Decedents Name: S H E I B L E Y RUTH E RECAPITULATION 1. Real Estate (Schedule A) 1. Q . Q Q 2. Stocks and Bonds (Schedule B) . 2 0 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. 0 . 0 0 4. Mortgages and Notes Receivable (Schedule D) 4. 0 • 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 13 , 4 6 0.9 4 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. Q . Q 0 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 0 • 0 0 8. Total Gross Assets (total Lines 1 through 7) g. 13 , 4 6 0.9 4 9. Funeral Expenses and Administrative Costs (Schedule H). g, 5 , 3 5 7.9 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 919.5 6 11. Total Deductions (total Lines 9 and 10) , 11. 6 , 2 7 7 • 4 6 12. Net Value of Estate (Line 8 minus Line 11) 12. ~ ,1, 8 3.4 8 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, 7 ,18 3. 4 8 TAX CALCULATION -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 t xable 4~ at lineal rate x .0 7 ,18 3.4 8 1 s. 3 2 3.2 6 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. Q• Q Q 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. Q• Q Q 19. TAX DUE 19. 3 2 3.2 6 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 J OM4648 3.000 REV-1500 EX (FI) Page 3 1'lnrnrlnnt'c (_mm~loto Arlrlrpcc• File Number ai. i. i. Haan DECEDENT'S NAME SHEIBLEY RUTH E STREET ADDRESS CARLISLE BOROUGH CUMBERLAND COUNTY CITY STATE ZIP CARLISLE PA 1701,3- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 3 9 0.0 0 B. Discount 19.5 0 3. Interest 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) _ 323.26 409.50 (3) _ 0.0 0 86.24 (5) _ 0.00 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: 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? Yes ^ ^ ^ ^ No 0 0 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? ^ ^ 0 0 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. §91 16 (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(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 ~~r adoption. Total Credits (A + B) (2) OM4671 2.000 REV-1508 EX+ (11-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Ruth E. Sheibley 21 11 0220 Include the proceeds of litigation and the date the proceeds were received by the estate. All property iointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Bankers Life and Casualty Company 114.78 refund unused health insurance premium due the decedent 2 Member's 1st Federal Credit Union 6,179.32 savings account #224207-00 3 Member's 1st Federal Credit Union 4,603.91 savings account #224207-01 4 Member's 1st Federal Credit Union 1,562.42 checking account #224207-11 5 Member's 1st Federal Credit Union 0.51 money management account #224207-05 6 Woodlawn Memorial Gardens, Inc. 1,000.00 two gravesites TOTAL (Also enter on line 5, Recapitulation) $ ~ 13 , 4 60.94 owa6AD 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AN D INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Ruth E. Sheibley 21 11 0220 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ None B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Kathleen Hoffman Street Address 92 9 Bonny Lane City Mechanicsburg State PA ZIP 17055 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 Street Address 4. 5. 6. 7. 1 City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Cumberland Law Journal advertise Executrix Notice Total from continuation schedules . 750.00 3,500.00 123.50 175.00 75.00 734.40 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 5 , 357.90 swasA~ z.ooo If more space is needed, use additional sheets of paper of the same size. Estate of: Ruth E. Sheibley 21 11 0220 Schedule H Part 7 (Page 2) 2 Register of Wills filing fee for Inheritance Tax Return 15.00 3 The Sentinel advertise Executrix Notice 219.40 4 Reserve for filing fees, accoutant fees and other miscellaneous costs associated with the administration of the decedent's estate 500.00 Total (Carry forward to main schedule) 734.40 REV-1512 EX+ (12-OS) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ruth E. Sheibl SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21 11 0220 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. awasAH 2 00o 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: Ruth E_ Sheiblev 21 11 0220 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. Debra Ann Wheeler 1261 High Street Boiling Springs, PA 17007 29$ of Residue: 2,083.21 Daughter 2,083.21 2 Alicia K. Deardorff 8170 Evelyn Street Hummelstown, PA 17036 29$ of Residue: 2,083.21 Granddaughter 2,083.21 3 Kathleen Hoffman 929 Bonny Lane Mechanicsburg, PA 17055 13~ of Residue: 933.85 Daughter-in-:Law 933.85 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. ([ 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. $ 0.00 If more space is needed, use additional sheets of paper of the same size. 9W46AI 2.000 Estate of: Ruth E. Sheibley 21 11 0220 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 4 Milton K. Sheibley 1300 York Haven Road Lot 49 York Haven, PA 17370 29~ of Residue: 2,083.21 Son 2,083.21 LAST WILL AN.D TESTAI`~~IENT OF RU7~H E. SHEIBLEY .AW OFFICES ~NELBAKER. IRENNEMAN 8c SPARE I, IZU'i H E. SHEIBLEY, of Cramp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and. understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. ~I 1. I direct that all my debts and funeral expenses be paid as soon as practical after my death by my Executor or Executrix, whichever the case may be, hereinafter named. I direct that all taxes that may be assessed as a consequence of my death shall be paid from my residuary estate as part of the. expenses of the administration of my estate. 2. All the rest, residue and remainder of my estate, rE:al, personal and mixed, aid wheresoever the same may be situate, I give, devise and begtaeatl~ as follo~.vs_ A,. I give to my son, DANIEL R. HOFFMAN, twenty-nine percentum (29%) of my Estate; B. I give to my daughter-in-law, KATHLEEN HOFFMAN, thirteen percentum (13%) of my Estate; C. I give to my daughter, DEBRA ANN WHEELER, twenty-nine percentum (29°10) of my Estate; and D. I give to my son, MILTON K. SHEIBLEY, twenty-tune percentum (29%) of my Estate. In the event any of my children above named should predecease me, I direct that the share II that such deceased clvld would have received hereunder shall be given to his or her issue i surviving me per stirpes. In the event my daughter-in-law, KATHLEEN HOFFMAN, should predecease me, I direct that the share she would have received hereunder bF: given to her husband, DANIEL R. HOFFMAN and if he should also predecease me, I direct 1:hat her share will be given to the issue of my son, DANIEL R. HOFFMAN, surviving me per stirpes. 3. I hereby nominate, constitute and appoint my son, DANIEL R. HOFFMAN, as Executor of this my Last Will and Testament. Should my said son, DANIEL R. HOFFMAN, predecease me or fail to qualify, then in such event, I nominate, constitute and appoint my daughter-in-law, KA"rHLEEN HOFFMAN, as Executrix of this my Last Will and Testament. Should both my said son, DANIEL R. HOFFMAN and my daughter-in-law, KATHLEEN HOFFMAN, predecease me or fail to qualify, then in such event, I nominate, constitute and appoint my daughter, DEBRA ANN WHEELER, as Executrix of this my Last Will and Testament. I hereby direct that no person serving as Executor or Executrix hereunder shall be required to post bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction.. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on two (2) pages this 3"' clay of September, 2004. ~A iJ,l ~ fi~'~~. ~~ .~i~ - ~-~C.~~.~ (SEAL) `, uth E. Sheibley ~ ~'` r Signed, sealed, published and declared by RUTH E. SHEIBLEY, the Testatrix above named, as and for her Last Will and Testament, in our preserce, who, in her presence, at her request, and in the presence of each other, have herewito subscribed our names as attesting witnesses. `~~' (SEAL .AW OFFICES iNELBAKER, ~RENNEMAN & SPARE '-^~- ~ ` (SEAL} -2- COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) We, RUTH E. SHEIBLEY, KEITH O. BRENNEMAN, ESQUIRE and JANE J. GOONEY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that tiie Testatrix signed and executed the instrument as Tier Last Will and Testaune~it and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. .~ ,~%' J %.- rte-. {~ .-;. J Testatrix ,,~ j ~~ ~ ~~~+ Witness Witness ( Subscribed, sworn to and acknowledged before me by RUTH E. SHEIBLEY, Testatrix, and subscribed and sworn to before me by KEITH O. BRENNEM AN, ESQUIRE and JANE J. GOONEY, witnesses, this 3`d day of Septeixiber, 2004. ~~ ...~s,....,_._. G . Notary Public f OFFlCES l9AKER. NNEMAN SPARE COMMONWEALTH Oi' pENNSY~VANIA fJotarial Seal Susan L Mahazl, ldotary PubAc Mechanicsburg Born. Cumberland County My Commissicm Expires Nov. 24, 2007 Member, Pennsylvania Association Of Notaries