HomeMy WebLinkAbout09-12-11Ex (o,-,t, 15056
REV 1500 ) ,_ 10143
PA Department of Revenue
Bureau of Individual Taxes oPen~nsy~l vanNa OFFICIAL USE ONLY
PO BOX.280601 County Code Year
Harrisburg, PA 17128.0601 INHERITANCE T File Number
ENTER DECEDENT INFORMATION BELOW RESIDENT D EDENTRN 2 1 1 1 0 6 9 0
Social Security Number
1 6 8 2 2 Date of Death
'7 '] 1 g Date of Birth
06 04 2011 11 18
Decedent's Last Name 1 ~ 2 6
G E I B Suffix Decedent's First Name
LOUISE MI
(If Applicable) Enter Surviving Spouse's Information Below M
Spouse's Last Name
Suffix Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS
1. Original Return
^
2
~ Supplemental Return
^ 4. Limited Estate
^ 4a. Future Interest Compromise
(date of death after 12-12-82
®
6. Decedent Died Testate )
(Attach Copy of Will) [~ 7_ Decedent Maintained a Living Trust
(Attach Copy of Trust)
^ 9. Litigation Proceeds Received
^
10. Spousal Poverty Credit
d
(
ate of death
between 12-31-91 and 1-1-95)
CORRESPONDENT -THIS SECTION M~ icr or ..,..._
~i.,.Y _ . __
^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
-__ £~. Total Number of Safe Deposit Boxes
^ 11. Election to tax under Sec. 9113(A)
(Attach Sch n~
•-~-~~~ - - - -- ..v~arLC 1 CU. ALL CORRESPONDENCE AND CONFIDENTIAL 7AX INFORMATION SHOULD BE DIRECT
THOMAS N COOPER ED TO:
Daytime Telephone Number
717 866 5737
First line of address
36 WEST MAIN AVE
Second line of address
City or Post Office
MYERSTOWN
Correspondent's a-mail address:
Under enalties of eru I declare that t ha"o e.,.,.,..:__, .. .
it is true CArrcM ....p ~ ry~ .
REGISTER OF WILLS USE ONLY
C7
~ C7 ..~.~
..
. f;l7~~:
!r`..)
State ZIP Code C1,4IL D
P A 1 7 0 6 7 ~~ `'` --"-'
:~ --I _... =T=
.... 1. ~ f'-~.
E
- r.,. ~ ~r~~«. veclaratlon of prepares other than the personal representative is based on all information of which re ar
c u Ing accompanying schedules and statements, and to the best of my knowledge and belief,
i0N SPONSIBLE FOR FILING RETURN
- P p er has any knowledge.
Margaret Irene Miller DAT
7 Plymouth Dr've, Jonestow ~ ~
SIGNATURE OF P n, PA 17038
ER OTHER AN REPRE NTATIVE
C .1_
Thomas N Cooper
36
DA
Main Ave, Myerstown, PA 17067
L 1505610143
Side 1
1505610143 J
J 1505610243
REV-1500 EX
Decedent's Name:
GEIB, LOUISE MAE Decedent's Social Security Number
RECAPITULATION 168 22 7718
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 & Notes Receivable (Schedule D) .............
..........:.
................................. 4.
5
• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5,
7,510.81
6. Jointly Owned Property (Schedule F
^ Separate Billing Re
ue
7
t
d
I
q
s
.
e
.............
nter-Vivos Transfers & Miscellaneous Non-Probate Property 6.
(Schedule G)
^ Separate Billing Requested .............
7.
13,581.53
8. Total Gross Assets (total Lines 1-7) .................
.... 8.
9. Funeral Expenses & Admini
t 21, 0~2 . 34
s
rative Costs (Schedule H) .........................................
9.
1,857.04
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..............
1 92
187
..................
0.
11. Total Deductions (total Lines 9 & 10) ...............
.
.65
....
................................................... 11.
12. Net Value of Estate (Line 8 mi
9 4. 0 4 4. 6 9
nus Line 11)...... .
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12
an election to tax has not b
- 7 2 ~ 9 5 2 3 5
een made (Schedule J) ....
..................
........................... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
.................................................
14
TAX COMMUTATION -SEE INSTRUCTIONS FOR APPLIC
_ 7 2 ' 9 5 2 3 5
ABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate
or
,
transfers under Sec. 9116
(a)(1.2) X .00
16. Amount of Line 14 taxable 15.
at lineal rate X .045 13 , 5 8 1 5 3
17. Amount of Line 14 taxable 16.
6 1 1 1 7
at sibling rate X • 12
18. Amount of Line 14 taxable 17.
at collateral rate X .15
18.
19. Tax Due .............
......
.......................................................................................... 19.
611.17
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OV
ERPAYMENT.
L 1505610243
Side 2
1505610243 J
REV-1500 EX Page 3
Decedent's Complete Address:
Geib, Louise Mae
STREET ADDRESS
1000 W. South Street
File Number 21 _ 11 _ 0 6 9 0
cITY -
Carlisle STATE ZIP
PA
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments (1)
A• Prior Payments
B. Discount 30.56
Total Credits (A + B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check 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.
(5)
17013
611.17
30.56
0.00
580.61
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A
N "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;....... Yes No
b. retain the right to designate who shall use the property transferred or its income :.................................... ~ a
c. retain a reversionary interest; or ...................... ~ ~]
receive the promise for life of either payments, benefits or care? .............................................................. x
2. If death occurred after December 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 praperty which ^
contains a beneficiary designation?. .
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A
• ,r S PART OF THE RETURN.
.. _
c A'rt~ `Ri s~""~x... ~,.r ~fT~, ~•.Z~.A;j ~"r'K~: p.~ .~. 4.:s ~°`S ~ ~~ f ~
For dates of death on or after Jul 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value`of transfers to or f
spouse is 3 percent [72 P.S. §91 6 (a) (1.1) (i)], or the use of the surviving
For dates of death on or after Januarryy 1, 1995, the tax rate imposed on the net value of transfers to or for the
[72 P.S. §9116 (a) (1.1) (ii)]. The stafute does not exempt a transfer to a surviving spouse from tax, and the statuto re
assets and filing a tax reffurn are still applicable even if the surviving spouse is the only beneficiary, use of the surviving spouse is 0 percent
ry quirements for disclosure of
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 ears of age or younger at death to or for the use
adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (~ 2 .
. )] of a natural parent, an
• 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 exce
72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)j.
pt as noted in
• 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 )~
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w~ether b )bl .3 A
y ood~or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF Geib, Louise Mae FILE NUMBER
21 - 11 - 0690
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
NUMBER DESCRIPTION VALUE AT DATE OF
DEATH
1 Wells Fargo, Checking Acct. No. 1000035707623 1,643.93
2 Wells Fargo, Savings Acct. No. 3114200956106 5,839.88
3 Coventry Management Services, Premium Refund 27.00
TOTAL (Also enter on Line 5, Recapitulation) I 7,510.81
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Geib, Louise Mae
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21 - 11 - 0690
This schedule must be completed and filed if the answer to any of questions 1 through a ~n nano ~ ~Q .,eQ
ITEM
NUMBER
DESCRIPTION OF PROPERTY
Include the name of the transferee, their relationship to decedent
and the date of transfer. Attach a copy of the deed for real estate.
DATE OF DEATH
VALUE OF ASSET
DECDFS
INTEREST
EXCLUSION
(IF APPLICABLE - ~ ---
~
I TAXABLE VALUE
)
1 Allianz Life Insurance Company of North America ~s
581.53
,
Annuity Contract No. 5236358; Beneficiaries , 13,581.53
,
Margaret I. Miller, JoAnn Geib and Edward Geib
,
Children of Decedent
i
i
i
I
i
i
i
I
I
i
i
i
TOTAL (Also enter on line 7, Recapitulation) 13,581.53
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
S~ChIEDULE H
AF~UN~ERA~L EwXPENSES &
/`'11../lY~~ 1 IW~ ~~
~~ ~ •, ~ ~ •.•~ VCIU, LUUIS~ IVIa@
FILE NUMBER
21-11-Of9D
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Margaret Irene Miller 750.00
Street Address 7 Plymouth Drive
city Jonestown state PA zip 17038
Year(s) Commission paid
2. Attorney's Fees Thomas N. Cooper, Esquire 750.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills, Letters Testamentary 92.50
5. ~ Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Cumberland Law Journal, Estate Notice 75.00
TOTAL (Also enter on line 9, Recapitulation) 1 857.04
,.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Geib, Louise Mae
2 ~ The Sentinel, Estate Notice
Schedule H
Funeral E~q~enses &
A~ninisfiafivle Costs cron6nued
FILE NUMBER
21 - 11 - 0690
Page 2 of Schedule H
189.54
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMHERI~TANCETAXRETURNANIA LIABILITIES, & LIENS
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Geib, Louise Mae 21 - 11 - 0690
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Alan C. Huff, DDS, Medical Bill 45.00
2 ~ Sarah A. Todd Memorial Home, Nursing Home Care ~ 568.89
3 I PA Department of Public Welfare, Medical Assistance ~ 91,573.76
TOTAL (Also enter on Line 1p, Recapitulation) ~ 92,187.65
REV•1513 EX+ (11-08) _ ~
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Geib, Louise Mae FILE NUMBER
21 - 11 - 0690
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Margaret I. Miller Daughter 1/3 of Residue
7 Plymouth Drive
Jonestown, PA 17038
2 JoAnn Geib Daughter 1/3 of Residue
302 N. Baltimore Ave., Apt. 4
Mt. Holly Springs, PA 17065
3 Edward Geib Son 1/3 of Residue
P. O. Box 86
Coal Creek, CO 81221
Enter dollar amounts for distributions shown above on lines 1 5 through 18 on Rev 1500 cover sheet, as appropriate.
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV••1500 COVER SHEET 0.00
WILL OF LOUISE MAE GEIB
I, LOUISE MAE GEIB, of 496 Kutztown Road, Myerstown,
Pennsylvania, 17067, being of sound mind, memory and understanding,
do declare this to be my Last Will, and hereby revoke any Will or
Codicil previously made by me.
ARTICLE I: I order and direct that all my just debts and
funeral expenses, as well as the costs of administration and
settlement of my Estate, shall be paid by my hereinafter named
Executor/Executrix as soon after my decease as the same may be
conveniently done.
ARTICLE II: I give, devise and bequeath my entire Estate,
both real and personal, wherever situate, unto my husband, RAYMOND
B. GEIB.
ARTICLE III: In the event, however, that my said husband,
RAYMOND B. GEIB, predeceases me, or dies in a common accident or
disaster with me, or dies within thirty (30) days of the date of my
death, then my entire Estate, both real and personal, wherever
situate, shall be divided into equal shares and distributed among
all my surviving children.
ARTICLE IV: In ,the event ar~y of may children predecease me,
such deceased child' s share shall be paid unto hi.s or her surviving
issue, per stirpes . In the event any of my children predecease me,
not survived by issue, such deceased child's share shall lapse.
ARTICLE V: I hereby nominate, constitute and appoint my
husband, RAYMOND B. GEIB, to be the Executor of this, my Last Will.
In the event RAYMOND B. GEIB is unable to act, o:r ceases to act as
-1-
Executor for any reason, then it is my desire that my daughter,
MARGARET IRENE MILLER, be appointed to serve in his place and
stead. In the event MARGARET IRENE MILLER is unable to act, or
ceases to act as my Executrix for any reason, then it is my desire
that my son-in-law, LARRY E. MILLER, be appointed to serve as
Executor in her place and stead.
ARTICLE VI: No bond or surety shall be required of my
Executor or alternate Executrix/Executor in any jurisdiction.
IN WITNESS WHEREOF, I, LOUISE MAE GEIB, the Testatrix, have to
this, my Last Will, set my hand and seal this day of
1994.
(SEAL )
-2-
CO1~Il~IONWEALTH OF PENNSYLVANIA:
SS.
COUNTY OF.: LEBANON
We, LOUISE MAE GEIB, Testatrix; and two (.2) witnesses, whose
names are signed to the foregoing instrument, being duly affirmed
according to law, do hereby declare to the undersigned authority
that the Testatrix signed and executed the within instrument as and
for her Last Will, and that she signed willingly, and that she
executed it as her free and voluntary act for the purposes herein
contained, and each of the witnesses in the presence and hearing of
the Testatrix signed the Will as witnesses, and that to the best of
their knowledge the Testatrix was at the time eighteen (18) years
of age or older, of sound mind, and under no constraint or undue
influence .
~-~~-- '~J (SEAL )
LOUISE E
(SEAL )
WI NESS
(SEAL)
W TNESS
Affirmed and subscribed before me this
day o f ~~~ C~ ~,Lk~,~ 19 9 4.
~~
L1n;U
ry.~ F^
_,
STEINER, SANDOE & COOPER
Attorneys at Law
KENNETH C. SANDOE
THOMAS N. COOPER
WILLIAM H. STURM, JR.
Of Counsel: HENRY J. STEINER
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
September 9, 201'_
Re: Estate of Louise M. Geib
Dear Ms. Strasbaugh:
36 West Main Avenue
Myerstown, PA 17067
Telephone: (717) 866-5737
FAX: (717) 866-7162
Enclosed with this letter is the original and one copy of
the inheritance tax return for filing with your office in regard
to the above estate, together with a check in the sum of $15.00
for your filing fee.
Very truly yours,
tZ
Encl.
STEINER, SANDOE & COOPER
,,_.._ C7
Tina Zellers, Secr_etary~ _ ,._
~~~`
•
~:r-±i t
---
.::~ :~
t ~ ~
.
~
'1 - ~
j ~ ~'~ i _ i-'G i
'
T> .,.,V .. ~~
Cf- "`rs
_,~ ~ ,,, s...
,- its
T
a
~~~r~
sw`''
~ ~
~, • ~
~ ~ r~ ~
} r Q"
;.~ ~- ;~ ~
~~ ~°~`~
.,r
.~
N
N
R
V
w ~ c~c
=} ~ `//
-
._
-
-
,
N .
~~~
~~_
J
_ ~~
~-
Li _ ..
•` 4.~
i U~ ~~
. ~~ ~
~ c .. Q
:
W
~.
O
O
V
O
D
w ~
0
¢~~
Qa~
z
w~~
z,~o
a~
~~
o~
U ~ ~_
~ ~ (nom C^
v` l
~ ~ N ~.
~ U ~ ~~
~ ~ ~~
O '~ .~
~ ~
~a ~ ~ U)
~ ~ ~ ri
~~ ~ O c,~
v~ N U - -~
•r~ .~ r ~
is ~ N ~
~ U O ~~