HomeMy WebLinkAbout09-16-11-~ REV 1500 1505611180
~ FJC (02-11) (FI)
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes ~EPARTMENTOFREVENUE County Code Year
PO BOX 280601 INHERITANCE TAX RETURN E%1 File Number
Harrisbur , PA 17128-0801 RESIDENT DECEDENT //~. ~ ( P~C~7
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
MMDDYYYY Date of Birth MMDDWYY
174-20-7674 01092011
Decedent's Last Name 12121919
Suffix Decedent's First Name
NICKEL MI
(If Applicable) Enter Surviving Spouse's Information Below VIOLET F
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 BOXES BELOW REGISTER OF WILLS
Qx 1. Original Return
Q
2. Supplemental Return
Q 3
R
Q 4. Limited Estate
Q .
emainder Return (Date of Death
f Pnor to 12-13-82)
4a. Future Interest Compromise (dat
Q 6. Decedent Died Testate
Q e o
death after 12-12-82) ~ 5. Federal Estate Tax Return Required
7
D
(Attach Copy of Will)
~] 9
Liti
i .
ecedent Maintained a Living Trust Q
(Attach Copy of Trust) --_ 8. Total Number of Safe Deposit Boxes
.
gat
on Proceeds Received Q 10. Spousal Poverty Credit (Date of Death
~ 11
El
.
ection to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL T
e O)
Name
AX INFORMATION SHOULD BE DIRECTED 70.
Robert G. Frey Daytime Telephone Number
?172435838
.._...... ~.. vr, ~v~~ USE ONLX_ _ :lam
~;
First Line of Address ~ =r
-- ~_7 ~ -
5 South Hanover Stree __- ~~ry
ri ,
Second Line of Address - ,~ ; ,
.. ,
-__ - -~
_ _ ~ .___
~c ,-;-i
:: - _. --
':-~ __:
City or Post Office
State ZIP Code DATE FILED `' ~ ~ ~r
Carlisle PA 17013
Correspondent's a-mail address: R F R E Y a9 F R E Y T I L E Y. C O M
Under penakies 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 D~claretion of preparer etnn~ rti
an the personal rr+nroe tative is based nn ~u .s,.«.._.:__ _r._ ~. .
CIf AlA ~rtG L,e.rf'c.~,w. CCl~ J
'! 1
5 South Hanover Street CaY].isle PA
PLEASE USE ORIGIN
Side 1
L 1505611180
1505611180
J ~i
~1
G!
J
REV-1500 EX (FI)
Decedent's Name: VIOLET F
RECAPITULATION N I ~ K E
Decedent's Social Security Number
17~=7674
1 • Real Estate (Schedule A) ... .
............ ... 1. NONE
..........
2• Stocks and Bonds (Schedule B) ... , .
3• Closely Held Corporation, Partnership or Sole-Proprietorshi 2• N 0 N E
p (Schedule C) ... 3. NON E
4• Mortgages and Notes Receivable (Schedule D) .... .
P
5. Cash, Bank De osits and Miscellaneous Personal Pro ert 4• N 0 N E
P y (Schedule E) ... 5
6• Jointly Owned Property (Schedule F) OSeparate Billing Requested ..... .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ 6. N 0 N E
OSeparate Billing Requested .... .
3• Total Grnc~ ,,..__._ ,. ' ~ ~. N 0 N E
9. Funeral Expenses and Administrative Costs (Schedule H) .. .
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) .. 9
11 • Total Deductions (total Lines 9 and 10) . • ~ ` ' " ' • ~ ~ 10.
......
................... 11.
12• Net Value of Estate (Line 8 minus Line 11) . .
13• Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ... , 12
~4. Nof v,~.._ .._ .. ....... .... 13.
TAX CALCULATION _ `~~" "minus Line 13 .... .
SEE INSTRUCTIONS FOR APPLICABLE • ~ 14.
15. Amount of Line 14 taxable at RATES
the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 0
16. Amount of Line 14 taxable
at lineal rate X .0 4 5 15.
17. Amount of Line 14 6 3 312.6 7 16.
taxable at sibling rate X . 12
18. Amount of Line 14 taxable
at collateral rate X . 15 1 ~~
31656.33 18.
19. TAX DUE ..... .
......
............. ....... 19.
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
113273.00
113273.00
5866.00
12438.00
18304.00
94969. p0
0.00
94969.00
0.00
2849.07
0.00
4748.45
7597.52
L 1505611280
Side 2
1505611280
1505611280 J
REV-1500 EX BFI) page 3
Decedent's Complete Address:
r1C nr r..-.._. _
4
viCJLtT F NICK
STREET ADDRESS
91
CITY
B. Discount 4000.00
0.00
3. Interest
Tax Payments and Credits:
1 • Tax Due (Page 2, Line 19)
2~ Credits/Payments
A. Prior Payments
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAx pUE.
ZIP
174-20-7674
1
(1)
7597.52
(2)
(3)
(4)
4000.00
0.00
(5)
3597.52
Make check payable to: REGISTER OF WILLS ADEN
T
b. retain the right to designate who shallrtuser thefproperty transferred or its income ...........
c. retain a reversionary interest ........ ~~~~"~~'~~' ^
d. receive the promise for life of either a ~~~~~~~~~•~~ ^
P yments, benefits or care? ...................................................................
2. If death occurred after Dec. 12, 1982, did decedent transfer prope ^
without receivin ade uate consideration? ...,.. rtY within one
..............................
3• Did decedent own anpin trust for" or year of death
payable-upon-death bank account or security at his or her death? .....
Did decedent own an individual retirement account, annuity or other non-probate prope ^
contains a beneficia •~~~•~• []
ry designation? .........................................
rtY, which
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING
Did decedent make a transfer and: AN "X" IN THE APPROPRIATE BLOCKS
a. retain the use or income of the pro
. .... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SC
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate im HEDULE G AND FILE IT AS PART OF THE RETURN.
spouse is 3 percent [72 P.S.
§9116 (a) (1.1) (i)]. posed on the net value of transfers to or for the use of the surviving
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers t
[72 P.S. §9116 (a) (1 1) (ii)] The statute does not exempt a transfer to a survivin s
assets and filing a tax return are still applicable even if the survivin ° or for the use of the survivin s
For dates of death on or after July 1, 2000: g Pouse from tax, and the statuto r g Pouse is 0 percent
9 spouse is the only beneficiary, ry equirements for disclosure of
The tax rate imposed on the net value of transfers from a deceased child 21
adoptive parent or a stepparent of the child is 0 percent 72 P.
The tax rate imposed on the net value of transfers to or for the use of the decedent's I Heal ben ge or younger at death to or for the use of a natural parent, an
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblin s is
defined, under Section 9102, as an individual who has at least one parent in common efoiaries is 4.5 percent, except as noted in
9 12 percent 72 P. [72 P.S.§9116(a)(1)].
with the decedent, whether b §9116(a)(1.3)j. q sibling is
y blood or adoption.
File Number
21-11-0072
STATE
PA
Total Credits (A + g )
REV-1508 EX+ (~ 1.10)
Pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS
INHERITANCE TAX RETURN PERSONAL PROPERTY ISC.
RESIDENT DECEDENT
ESTATE OF:
Violet F Nickal ~_
ITEM Include the proceeds of litigation and the date the proceeds were received b
All Property jointly owned with ri
ht F1LE NUMBER:
21-11-0072
DUMBER g
of survivorshi
P must be disclosed on Schedule F.
1
2 M&T Bank checking account 63666901 DESCRIPTION VALUE AT DATE
3 Members 1st Federal Credit Union savings account no
Members 1st F
14 OF DEATH
4 .
8211-00
ederal Credit Union c.d. account no. 148211-40
Members 1st Federal Credit U
i 29,434
3
5
6 n
on c.d. account no. 148211.42
Members 1st Federal Credit Union
9
33
042
7 c.d. account no. 148211-44
Members 1st Federal Credit Union c.d. account no. 148211-46
Federal Income ta ,
15,000
8 x refund
Pennsylvania inc 30,011
9 ome tax refund
Security Deposit ref 5,003
10
11 und
Reimbursement from Hoffman Roth Funeral Home
Mountain Senior A 338
26
partments refund 345
25
10
TOTAL (Also enter on line 5, Recapitulation) $
If more space is needed, use additional sheets of paper of the same size,
113,273
REV-1511 EX + (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE Tqx RETURN
RESIDENT DECEDENT
ESTATE OF
ITEM
A. I FUNERAL EXPENSES:
1.
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Decedent's debts must be reported on Sched
FILE NUMBER
B• ADMINISTRATIVE COSTS:
~' Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address 3, 000
City
Years State _~ ZIP
()Commission Paid: 2011
2.
Attorney Fees:
3' Famil
Y Exemption: (If decedent's address is not the s
2500
ame as claimant's, attach explanation.)
Claimant
Street Address
City
State ~ ZIP
Relationship of Claimant to Decedent
4' Probate Fees:
5' Accountant Fees:
6 366
Tax Return Preparer Fees: inClUded W/ 8tty fee
7.
included w/ atty fee
If more space is needed, use additionalOsheets of paper of the sames I Re
REV-1512 EX+ (12-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~.._---
w~r~~t OF
Violet F Nickel
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, includin unr • FILE NUMBER
ITEM 21-11-0072
NUMBER 9 eimbursed medical expenses.
1 DESCRIPTION VALUE AT DATE
February 25 Medical Bill to Millenium Pharmacy OF DEATH
2• Final Medical Bill to Presbyterian Homes 516
3• Final electric bill to PPL 11,197
4• January 25 Medical Bill to Millenium Pharmacy 81
5• March 25, Medical Bill to Millenium Pharmacy 442
6• Green Ridge Village Co Pay 40
162
TOTAL (Also enter on Line 10,
If more space is needed, insert additional sheets of the same size. Recapitulation) $
12,438
REGULAR SAVINGS ACCOUNT: MEMBERS 1N
Account Number/Suffix
Date Account Established 148211-00
Principal Balance at Date of Death 01/18/1995
Accrued Interest to Date of Death $38.94
Total Principal and Accrued Interest $•00
Name of Joint Owner $38.94
N/A
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established 148211-40
Principal Balance at Date of Death
Accrued Interest to Dat 12/20/1994"
$33
025
00
e of Death
Total Principal and Accrued Interest
Name of Joint Owner ,
.
$17.88
$33,042.88
N/A
"Opened by Transfer of Funds From the Regular Savings Account 148211-00
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CERTIFICATES OF DEPOSIT
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
148211-42
02/04/2005
$15, 000.00
$8.45
$15, 008.45
N/A
148211-44
05/06/2010
$30,000.00
$11.44
$30, 011.44
N/A
148211-46
02/13/2006
$5, 000.00
$3.24
$5, 003.24
N/A
MEMBERS 1ST FEDERAL CREDIT UNION
~~~ ~ _
Leigh-A ne Stallings
Lending Insurance Support Specialist
January 24, 2011
Estate of: Violet Nickel
Date of Death: 01/09/2011
Social Security Number: 174-20-7674
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 •
(800) 283-2328 wwwmemberslst.org
~~~
499 Mitchell Road, Millsboro, DE 19966 Adjustment Services
Frey and Tiley
5 South Hanover Street
Carlisle, PA 17013
Re: Estate of Violet F Nickel
Social Security 174-20 ~6~4
Date of Death: January 09 2011
Phone 888-502-4349
F ax (302) 934-2955
January 27, 201(
Dear Sir or Madam:
Per your inquiry on January 21, 2011, please be advised that at the time of death, the above-named decedent had
on deposit with this bank the following:
~ • Type of Account
Checking Account
Account Number 63666901
Ownership (Names o, fl
Violet F Nickel
Opening Date 01/2$/72
Balance on Date of Death
$29,433.65
Accrued Interest $ ~
Total _.$29,433.71 _ _ __
For further account information, closures and/or reimbursement of funds please call the Carlisle West Office at #717-2A0-6717.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts in which the decea,~ may have been listed as Power of Attorney, Custodian of Uniform Transfe
Representative Payee, or Trustee under a Written A~'eement
Sincerely,
~-~ ~•~~
a
/ ~ ,~. ,~
'" I~ vnvn ' ~ ~ r1 ~~ ~ l
~1
Tammy Spencer
Adjustment Services
LAST WILL AND TESTAMENT
OF
VIOLET F. NICKEL
I, VIOLET F. NICKEL, widow, of West Pennsboro Township (mailing address: 1.708
Newville Road, Carlisle, Pennsylvania 17013), 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 and making void any and all Wills and
Codicils heretofore made.
1. I direct my hereinafter named Executor to pay all of my just debts and funeral expenses
as soon after my death as may be found convenient to do so.
2. All of the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, I give, devise and bequeath as follows:
a. Two-thirds (2/3) in equal shares to my six (6) children, their heirs and assigns, the
share of any deceased child to pass to his or her issue, per stirpes, and if there be no such issue
then such share shall lapse. My six (6) children are Winifred F. Webber, born July 3, 1940;
Donald G. Hummel, bom December 21, 1941; Barry L. Hummel, born August 7, 1944; Beverly
J. Russel, born October 4, 1945; Kenneth L. Hummel, born June 23, 1950; and Joan L. Hummel,
bom January 13, 1954.
b. The other one-third (1/3) in equal shares to the nieces and nephews of my late
husband, John T. Nickel and his fast wife, Helen B. Nickel, nee Burkholder, who are living at the
time of my death, the share of any deceased niece or nephew to lapse. At the present time the
following eleven (11) persons constitute said nieces and nephews:
(1) The one (1) child of John T. Nickel's late wife's brother, Robert Burkholder,
who is Robert Burkholder, Jr., of Shippensburg, Pennsylvania;
who are Ronald)Burkheolder 2of Ph~delphian errsykvaniaat a d Kay B,~ir~~hejd 1 Burkholdef
Pittsburgh, Pennsylvania; * Shild
(3) The three (3) children of John T. Nickel's late wife's brother, William
Burkholder, who are Anne Louise Burkholder, Mark Burkholder, and Amy Burkholder, all of
R.D. #2, Carlisle, Pennsylvania;
(4) The twin daughters of John T. Nickel's late wife's brother, John Burkholder,
who are Kim Burkholder and Karen Burkholder, both of R.D. #4, Carlisle, Pennsylvania.
(5) The three (3) children of John T. Nickel's brother, Cameron A. Nickel, who
are David Alfred Nickel, of 3809 Montevista Street, Cleveland, Ohio 44121; Paul Edward Nickel,
11 Burghers Mill Road, P. O. Box 31, Plainfield, Pennsylvania 17081; and Jay Alvin Nickel, of
509 North Olive Street, Seguin, Texas 78155.
3. Should any person less than 21 years of age share in my estate, I nominate, constitute
and appoint the Dauphin Deposit Bank and Trust Company, Carlisle Office, 2 West High Street,
\~' Cazlisle, Pennsylvania, and its successors and assigns, as Guardian of the estate of such minor
~~ person, and I authorize and direct said Guardian to invest the same and to pay so much of the
mcome arising therefrom together with so much of the principal thereof as in the opinion of said
Guazdian is necessary or desirable to be expended for the proper maintenance, support and
education of such minor person, to the person having custody of such minor person, and i,pen
such person attaining 21 years of age to pay him or her the then remaining principal together with
any undistributed income.
4. I hereby nominate, constitute and appoint Kenneth L. Hummel and Joan L. Hummel
and Winifred F. Webber, or any of them, as co-Executors of this my Last Will and Testament, and
I further direct that none of them shall be required to post any bond to secure the faithful
performance of his or her duties in the Commonwealth of Pennsylvania or in any other
jurisdiction.
Page 1 of 2
IN R'ITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Wi
and Testament, written on two (2) pages, this 1st day of June, 1994.
11
Violet F. Nickel (SEAL)
as and for h~er~~' published and declared b
in the presence of ea h other have hereunto subscri OLET F. NICI{EL, the Testatrix
~ m our presence, who, in her above named,
~ our n presence, at her request, and
awes as attest~injg witnesses.
Page 2 of 2