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Home My WebLink About09-29-11 1505610105 REV-1500 ~ ~°~-31't~, PA Department of Revenue OFFICIAL USE ONLY Penraylvarda Bureau of IndfvidualTaxes PO BOX 28o6oi dMR.M1.10..MI1K Cou Code Year File Number INHERITANCE TAX RETURN '~ I HaMSIwrD, PA i7sz8-o6oi I RESIDENT DECEDENT O~~ l ENTER DECEDENT INFOR#AATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 20&28-6558 01 /13/2011 06/06/1918 Decedent's Last Name _ Suffix Decedent's First Name MI _.. Martin ' ' ' Dorothy E (H 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 APPROPRUITE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return {Date of Death Prior to 12-13-82) O 4. Limited F~tate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12.82) 0)p 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Wap (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THB 8ECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX tNFORMATX)N SHOULD BE DIRECTED T0: Name Daytime Telephone Number P. Daniel Altland, Esq. First Line of Address 350 S. Sporting Hill Rd Second Line of Address City or Post Office Mechanicsburg State PA ZIP Code 17055 REGISTER OF 'SOUSE ONLY`;'_ *j ~ 7] ~ ~ <;'a '' f -" ~7 c~, x - _, l ) - - ~ n . . -a _._i DAT~FILED j~,,. • ~; T, ~", ._~,, r, ~~~: -~•, `i `, __ ~ ,r r -' 1`I ~:n ~ T~ Comspondent's e-mail address: dan(~pdalegal.com Under penalties of pery'ury, l deGare that 1 have examined thle return, inducting accompanying schedules and atatemenb, and to the best of my knowledge and belief it is true. correct and oompkM. DerJaretlon d preparer other than the personal retx'eeentatlve is based on all informatlon of which preparcr has any knowledge. SIGN!'~~ AT~t1gF OF P~ ~ PONSI~- gL~E FOR FILING RETURN ADDRESS ,,,` //'(~[~•s _' D~E t ~' // 1272 W. Lisburn Rd, Mechanicsbum. PA 17055 . r8. 350 S. Spotting Hili Rd, Mechanitsburg, PA 17050 Side 1 _ 1505610105 1505610105 J J 1505610205 REV 1500 EX (FI) I~ent•s name: Dorothy E. Martin Decedent's Social Security Number 208-28-6558 RECAPITULATION 1. Real Estate (Schedule A) ........................................ ..... 1. 2. Stocks and Bonds (Schedule B) .................................. ..... 2. 3. Closely Held CorporaBon, Partnership or Sole-Proprietorship (Schedule C) ..... 3. '', 4. Mortgages and Notes Receivable (Schedule D) ...................... ..... 4. 5. Cash, Bank Dep~its and Miscellaneous Personal Property (Schedule E).. ..... 5. ', 462.35 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .. ..... 6. 3,813.18 7. Inter-Vivos Transfers 8 Miscellan~us Non-Probate Property (Sdiedule G) O Separate Billing Requested... ..... 7. 8. Total (cross Assets (total Lines 1 through 7) ........................ ..... 8. 4,275.53 9. Funeral Expenses and Administrative Costs (Schedule H) .............. ..... 9. 3,783.77 10. Debts of Decadent. Mortgage Liabilities and Liens (Schedule I) .......... ..... 10.. 1,940.10 11. Total Daductiona (total Lines 9 and 10) ............................ ..... 11. ', 5,723.87 12. Net Value of Estab (Line 8 minus Line 11) ......................... ..... 12. 13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which " ' an election to tax has not been made (Schedule J) ................... ..... 13. ' 14. Net Value Subject to Tax (Line 12 minus Line 13) ................. ....... 14. -1,448.37 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) X .0- 15. . 76. Amount of Line 14 taxable at lineal rate X .0 - 16. ' 17. Amount of Line 14 taxable _ __ _ at sibling rate X .12 17. 18. Amount of Line 14 taxable _' at collateral rate X .15 18 ' 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT S1de 2 L 1505610205 0.00 O 1505610205 REV-1500 EX (FI) Faye 3 Flle Number Decedent's Complete Address: Nrs Dorothy E. Martin srReEraDatESS --._,..__.___ ..-._..-- _.__.... 100 Mt. Allen Drive clrr - ---.._....._. Mechanicsburg srnre ziP_. PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19} 2. Gedits/Payments A. Prior Payments _ B. Discount 3. Interest (t) 0.00 rota) credits (a + B) (2) 4. N Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) FlN in oval on Page Z, Line 20 to request a refund. (4) 5. N Line 1 + Line 3 is greater than Line 2, enter the difference. This Is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. _: .. ~ .was , t- .. ^Y..tia ~k ~ .. , ~ ,. t' .. 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 a insane of the Property transferred .......................................................................................... ^ b. retain the right b 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 a care? .............. 2. If death oa.urred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideretion? .............................................................................................................. ^ 3. Did decedent own an 'in trust for a dyable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement atx;ount, annuity a other non-probate property, which contains a beneficiary designation? ................................................................. IF THE ANSYMER 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. §9116 (a) (1.1) (i)). Fa 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) (iii]. The statute does not exempt a transfer 14 a surviving spouse Iran tax, and the statutory requirements for disclosure of assets and filing a fax return are still applicable even if the surviving spouse is the only benefiaary. Fa 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 fax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneftaaries 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 decedents siblings is 12 percent p2 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-15Df3 EX+ (11-10) Pennsylvania DEPARTMENT pF gEVENUE INNERRANCE TAX RETURN RESIDENT DECEDENT SCIiEpYLE E CASH, BANK DEPOSITS 8F MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Dorothy E. Martin Inauae the proceeds of litigation and the date the proceeds were received by the estate. All Pr~rtY ~~Y owrbd with right of wrvivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Cash on hand 78.71 2. Refund healtli insurance premium from Capital Advantage Insurance Company 383.64 TOTAL (Also enter on Line 5, Recapitulation) ¢ I 462 35 If more space is needed, use additional sheets of paper of the same size. REV-flog EX+ (Of-fo) Pennsylvania OEFARTMENT OF REVENUE INXERITANCE TAX RETURN RESIDENT DECEDENT SCNEpYLE P JOINTLY-OWNED PROPERTY e5rA7E vF: _ FILE NUMBER: Dorothy E. Martin ~ an east became jointly owned within one yaer of ehe decadsnCs data of deetll, it mart ba reported on Schedule G. SURVMNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Glenn C. Martin B. C. 1272 W. Lisburn Road Mechanicsburg, PA 17055 Son ~oINnY orvNEO PROPERrr: LERER ~~ ~~~~ ~ ~ % OF DATE OF DEATH ITflI iDR 701AIT MADE NKIUDE NAME OF FAWINCTAL a15TITUiIDN AND BANK ACCOUM NUMBER OR SIMRAR DATE OF DEATX DECEDENTS VAWE OF NtBABER TENANT N)BrT IOENrItYING NUMBER. ATTAGt DEED FOR ]OBYTIY XELD RFAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST i. A. PNC Bank: Chedci aocoouMnumber 50-7008-2163 ~ g ~ 6 ~ 7,626.35 50 3,813.18 TOTAL (Also enter on Line 6, Recapitulation) I # 3,813.18 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Dorothy E. Martin Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMDUNT A• FUNERAL EXPENSES: 1. Malpezzi Funeral Home 3,118.77 8 Market Plaza Way Mechanicsburg, PA 17055 2• Shepardstown United Methodist Cfiurch -funeral luncheon 150.00 B. i. ADMINISTRATNE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State Z1P z• AttomeyFees: P. Daniel Altland, Esquire 500.00 350 S. Sporting Hill Rd, Mechanicsburg PA 1705 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 i 4• Probate Fees: 5• ~ Accountant Fees: 6• ~ Tax Retum Preparer Fees: ~• I Inheritance Tax Realm filing fee I 15.00 TOTAL (Also enter on Line 9, Recapitulation) I s 3 783 77 if more space Is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08} Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER E. Martin Report defKa inwrred bir the daadeM prior to death that remained unpaid at the date of death, indudiny unreimbunxd medical expanses. ITEM NUMBER VALUE AT DATE ~w~niriivn OF DEATH 1. Messiah allege 1,940.10 100 Mount Allen Drive Mechanicsburg, PA 17055 Skilled Nursing Patient Liability for December 2010 and for January 1, 20111hrough January 13, 2011 TOTAL (Also enter on Line 10, Recapitulation) ~ $ 1,940.10 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN Re51DE1R DECt~ElR ESTATE OF: FILE NUMBER: Doroth E. Martin RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Tnadae(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• Glenn C. Martin son 100% 1272 W. Lisburn Road Mechanicsburg, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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. If more space is needcd, use additlonal sheets of paper of the same size. LAST WILL AND TESTAR4ENT OF DOROTHY E. MARTIN I, Dorothy E. h4artin, of the Township of Upper Allen, County of Cumberland and State of Pennsylvania, being of sound and dis- posing mind, memory and understanding, do make, publish and declare this to be my last will and testament, hereby revoking and making void all former wills by me at any time heretofore made. 1. I direct the payment,.of all my just debts and funeral ex- penses as soon as conveniently may be after my decease. 2. All the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, I give, de- vise and bequeath to my beloved husband, Lester J. P,7artin, to his own use and benefit absolutely. 3. In the event, however, that my said husband should pre- decease me, or as the result of a disaster common to both of us should die at about the same time as I do or within thirty days from the date of my death, I give, devise and bequeath my estate to my son, Glenn C. Martin. LG.. Lastly, I nominate, constitute and appoint my said husband, Lester J. P.4artin, to be the executor of this my last will and testa- ment. If he should predecease me, or for any other reason fail to qualify as such executor, then I nominate, constitute and appoint my son, Glenn C. P.Rartin, to be the executor in his place and stead. IN WITNESS ~.NHERE OF, I have hereunto set my hand and seal this a Q-~, day of March A.D. 1963. (SEAL) Signed, sealed, published and declared by the above-named Dorothy E. Martin as and for her last will and testament, in the presence cf us who have hereunto subscribed our names at her request as witnesses thereto, in the presence of the said atrix and of each other. ~f, o !~~~ 6 3 !" 7 ~1 j{/( ~ ` { y ~~~y q 0 {~ i~ U o~s e00n ~, ~ M ~ ~ ~ ru ~ y O .. V ~ ~ ~ ~ 3 p ,~ e o_ta, ~~ y y e.°.? ~~U ~°~ca CCUOU ,:., ~. ~: w ..~.. ,. ,. .= .... .;- _.. =.. 1 i `mom