Loading...
HomeMy WebLinkAbout09-02-11 1505610105 REV-1500 Ex loz_,,, (FI, PA Department of Revenue Pennsylvania Bureau of Individual Taxes °"'"'"'"°' °~ '~•^ OFFICIAL USE ONLY PO Box z8o6o1 INHERITANCE TAX RETURN County Code Year File Number Harrisbur , PA 17128-0601 RESIDENT DECEDENT ,~~ ~ f ENTER DECEDENT INFORMATION BELOW i Social Security Number ~ `' ~t Date of Death MMDDYYYY Date of Birth 179-30-4225 MMDDYYYY 10/15/2009 0;7/21/1937 Decedent's Last Name Clapsadle Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below ~'ladys Spouse's Last Name M Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS REGISTER OF WILLS BELOW ~ 1. Original Return O 2. Supplemental Return O 4. Limited Estate O 3. Remainder Return (Date of Death O Prior to 12-13.82) 4a. Future Interest Compromise (date of O 5 d ~ 6. Decedent Died Testate eath after 12-12-82) . Federal Estate Tax Return Required (Attach Copy of Will) O ~ Decedent Maintained a Living Trust 0 O 9. Litigation Proceeds Received (Attach Copy of Trust.) 8. Total Number of Safe Deposit Boxes O CORRESPONDENT T 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) t - (Attach Schedule O) HIS SECTION MUST BE COMPLETED. ALL Name CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: H Anthony Adams Daytime Telephone Number (717) 532-3270 REGISTER OF WILLS USE ONLY First Line of Address 49 West Orange Street i7 _l'l ~ r~ ; -~ Second Line of Address ~ -!-, 7 , Suite 3 r"' r"~' ' ~ City or Post Office -; _- -. - Shippensburg State ZIP Code D!4TEFILED _ - PA 17257 ~- =-t `.. :.- : ~- Correspondent's a-mail address: htadamSlaW 31 embar mail com . Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statement it is true, correct and complete. Declaration of preparer other than th s, and to the best of my knowledge and belief e personal representative is based on all information of which preparer has any knowled e SIGNATURE OF PERSON St~pONSlfg~j~E,F,.OR FI NG RETURN //L' r/ aDgF3ESS / ~ ~ l ~ . ~ ~`DAT ~` i USE ORI 1..... Side 1 15D561D105 _ '~/~_~ ~~~~ DATE %~ ___L-' {J c 1505610105 / -~ ~~~"~ I ~~ f y'.~ ..J , 1505610205 REV-1500 EX (FI) Decedent's Name: Decedent's Social Securi RECAPITULATION h' Number 1 Reat Estate (Schedule A)...... . .... ............. 2 Stocks and Bonds (Schedule B 1 y P ... 3. Close) Held Cor oration, Partnershi or Sole-Pro rieto p p h 2 rs i P (Schedule C) .. , 3 4. Mortgages and Not es Receivable (Schedule D) ...... . 4 5_ Cash, Bank Deposits and Miscellaneous Personal P ro ert P y (Schedule E)„ . , 5 6. Jointly Owned Pr operty (Schedule F) O Separate Billing Requested 7. Inter-Vivos Transfers & Miscellan 6,259.56 .... , (Schedule G) 6. eous Non-Probate Property ~ Separate Billing Requested .... , 8. Total Gross Assets (total Lines 1 throw h 7 7 9 ) ......... ..... .... 8. Funeral Expenses and Administrative Costs (Schedule H) ..... 6,259.56 . . 9 10. Debts of Decedent, Mortgage Liabilities and Liens (Sch d 1,611.50 e ule I)..... 11. Total Deductions (total Lines 9 and 10).... 10 68,456.56 12 Net Value of Estate (Line 8 minus Line 11) .. 11 13. Charitable and Gov 70,068.Og .............. 12. ernmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , . , . , -63,808.50 14. Net Value Subject to Tax (Line 12 minus Line 13) 13 14 TAX CALCULATION -SEE INSTRUCTIONS FOR AppLICABLE RAT 15. Amount of Line 14 ta b 00 0 xa le ES at the spousal tax rate or . , transfers under Sec. 9116 (a)(1.2) X .0 16. Amount of Line 14 taxable at lineal rate X .0 15. 17. Amount of Line 14 taxable at sibling rate X .12 16. 18. Amount of Line 14 taxable 17 . at collateral rate X .15 8. 19. TAX DUE ... . ..... ........ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTI NG A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 REV-1500 EX (FI) Page 3 Decedent's Complete Address: r1FCGncuT~~ .~..._ File Number Gladys M. Clapsadle STREETADDRESS - .121 Walnut Bottom Road - -- _- ._..__.__. clTr ------- Shippensburg Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 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. STATE -_-_- _ _____------7-- PA ZIP 17257 'total Credits (A + g) (2) (3) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TH 1. Did decedent make a transfer and: E APPROPRIATE BLOCKS 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 ,... Yes No 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" orpayable-upon-death bank account or security at his or her death? .............. 4. Did decedent own an individual retirement account, annuity or other non-probate o erty, which ^ ^ contains a beneficiary designation? ....,.,._ p,. P IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHED For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate im ULE G AND FILE IT AS PART OF THE RETURN. 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 survivin For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for g spouse [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the sta filing a tax return are still applicable even if the surviving spouse is the only beneficiary, the use of the surviving spouse is 0 percent tutory requirements for disclosure of assets and 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 dea 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 beneficia th 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 siblings is 12 ercent under Section 9102, as an individual who has at least one parent in common with th ties is 4.5 percent, except as noted in [72 P.S. §9116(a)(1}]. P [72 P.S. §9116(a)(1.3)]. A sibling is defined, e decedent, whether by blood or adoption. 0.00 REV-iso8 EX+ (ii-io) ~ pennsylvania DEPARTMENT DF REVENUE INHERITANCE TAk RETURN RESIDENT DECEDENT ESTeTC ne. Gladys M. Clapsadle SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. 21-11-0641 ITEM All property jointly owned with right of survivorship must be disclosed on Schedule F. NUMBER 1. Refund from State Farm Insurance (Medicare Supplement) N VALUE AT DATE ----~"- OF DEATH 2 Refund from Century Tel. 511.13 3 Checking Accounty Citizens Bank #610079-829.1 17.64 5, 730.79 6 259 56 If more space is needed, use adrjitOTA sheetoof papeoof tlhEesame scize.~tulation) $ RE'v`-+51.1 EX+ ~1p-C)9; pennsytvania DEPARTM SCHEDULE H ENT DF REVENUE TURN N RESIDENT DECEDENT ADMINIST AT VE O TS ESTATE OF Gladys M. Clapsadle FILE NUMBER ITEM 21-11-0641 Decedent's debts must be reported on Schedule I NUMBER . .~ A• FUNERAL EXPENSES: 1. ~_ DESCRIPTION --------__ B• ADMINISTRATIVE COSTS: I• Personal Representative Commissions: Name(s) of Personal Representative(s) Mary Grace Gardner . Street Address 11 Carpenter Lane -- __ ____ atv ewburg _ Year(s) Commission Paid: 2011 _ - -- Skate PA ZIp 17240 z• Attorney Fees: 3• Family Exemption: (If decedent's address is not the same as claimant's Claimant , attach explanation.) Street Address _. __ _ _ __ City __ __ _. Relationship of Claimant to Decedent -- State ZIp _ 4. Probate Fees: __ 5• Accountant Fees: 6• Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 750.00 750.00 111.50 1,611.50 REG~-;..51.1 E~ +72-08,' ~ pennsyLvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT CCTeTr ~.- __ .... ~ yr 3ladys M. Clapsadle Report debts incurred by the decedent prime ITEM NUMBER I' Shippensburg Healthcare Center 2 Comm ~u aeatn that remained unpaid at the date of uding mbursed medical expenses. DESCRIPTION VALUE AT DATE ----------- OF DFATH onwealth of Pennsylvania Estate Recovery lien TOTAL (Also enter on Line 10, Recapitulation) $ If more space is needed, insert additional sheets of the sarne siz- e. ---- SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 963.57 67,492.99 68,456.56 REV-1513 EX+ (01-10) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ~_ ESTATE OF, ---- Gladys M. Clansariio NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• Mary Grace Gardner, 11 Carpenter Lane, Newburg, PA 17240 sister ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET AI II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN; ~ S APPROPRIATE. 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. SCHEDULE BENEFICIARIES FILE NUMBER: RELATIONSHIP TO DECEDENT 21-11-0641 Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 100% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, use additional sheets of paper of the same size. $ ti ~ c'~ --- ¢ rJ 01 ~ ~- -'- i. „~ ~ CAL` /]~ (~ w r .~L~ ;~ ~V~ an estamen ~`, .. ~ t o ~~~ ~ ~ -~ m ~~ _' p ~ a s `~-L. `~ y Cla `_V psad~e I, GLADYS M, CLAPSADLE, of Southampton Township, Franklin County, Penns sound mind and memory declare this to be m ylvania, being of y Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all m y just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after m de administration of my estate. Y cease as a part of the ITEM II: 1f my nephew, GREGORY CLAPSADLE is livino b with me at the time of my death then I give devise, and bequeath to GREGORY CLAPSADLE, his choice of furniture where w ~s not residing with me at the time of my death then this provision is null and void, a are both living. If my nephew ITEM III: I give, devise and bequeath all of the rest, residue, and remainder of m est and wheresoever situate tom Y ate of every nature y sister, MARY GRACE GARDNER, her heirs and assigns, living on the thirty-first day following my death, in shares of equal value, share and share alike. ITEM IV: I direct that all taxes that may be assessed in consequence of my death, of wh atever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the administration of my estate. expenses of the ITEM V: I appoint MARY GRACE GARDNER Executrix of this, rn ' y Last Will and Testament. Should she fail to qualify or cease to act then I nominate and appoint LYNNE ALWINE Will and Testament. ~ Executrix of this my Last ITEM VI: I direct that my Executors or their successor shall not be required to ive bo performance of their duties in an g nd for the faithful y jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on _ 2 _ sheets of paper, dated this ~~j T! ~1 day of May, 2005. !( /~ _? , GLADY M. /CLAPS ~EAL) A E The preceding instrument, consisting of this and signature of the testatrix, GLADYS M, CLAPSADLE, was on the day and date thereof si -__ other type~itten page(s), each identified by the declared by GLADYS M. CLAPSADLE, the testatrix herein named, as and for her Last us, who, at her request, in her presence, and in the presence of each other, have subscribed ourd published and hereto. Will, in the presence of names as witnesses ing at ~' ~ + ` ~~ ~1~ residing COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS We, GLADYS M. CLAPSADLE, the testatrix in, and the undersigned witn or foregoing instrument, who have si ned the instrument, havin > g esses to, the will, the attached b been qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed the instrument as m signed it willingly and as my free and voluntary act for the purposes therein ex y will, that I pressed; and that we, the witnesses, were present and saw the testatrix sign and execute the i her will, that she signed it willin 1 8 y and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the tes nstrument as witness and that to the best of our knowledge the testatrix was at that time 18 or of sound mind and under no constraint or undue influence, tatrix signed the will as a more years of age, Subscribed to and subscribed or afrirn-ed and acknowledged before me by GLADYS M. CLAPSADLE, the testatrix and th witnesses whose names are signed above this day of May, 2005. Notary pu is SALLY) WIN ERANOTA~ppgLlC NMRCOMM~S ON EXPO CS MARCH 6C2ppjTM 3 / ~~ GLAD M. CLAPSA E GLENDA EARNER STRASBAUGH REGISTER OF WILD AND CLERK OF ORPHANS' COURT MARJORIE A. WEVODAU FIRST DEPUTY KIRK S. SOHONAGE, ESQ SOLICITOR REGISTER OF WI>L,~s ,~Np CLERK OF THE ORPHANS' COUR COUNTY OF CUMBERLAND T ONE COURTHOUSE SQUARE CARLISLE, PA 17013 (717) 240-6345 FAX (717)240-7797 IItiIVOICE Bill To: InvoiceNo: ADAMS H ANTHONY Invoice Date: 3623 49 WEST ORANGE STREET Estate o£ ~~2/2011 GLADYS M CLAPSADLE SUITE 3 Estate No: 21-11-0641 SHIPPENSBURG, PA 17257- ~; Q Fee Descri tion 1 Additional Probate Fee Total Total: 15.00 $15.00 $15.00 Checks should be made payable to the Register of Wills. 'T'erms: Net 30. Please return one copy of this invoice with your payment. Thank you. r - - _,!_ G~ ~j~ i ` :.j i ~ F 1 `~ %V);r ~ s~iPFEr~sau~G.~A i ' ~ ~^'~' ~~~~ VNITFO SrnrFS 17257 AUG 30.' i 1 - rosrncssavrce AMOUNT IOOO ~I 68 ;7C;3 . ~eoassaa-;c ~--, ~L~~~ `( ~c~ ~ c~ ~- ~ ~`` ~_a ~~-~~~ -~ ~ U C ~ ~? ~~ r ~ ~' ' ~--~ ~. I i ~~ lilflliifi~['llfl''I-f'~ii(fli~fiiiiliii`~i'i~~'i'i~(!I"