HomeMy WebLinkAbout10-21-11J 1505610105
REV-1500 EX (02- 11) (FI)
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes
PO BOX z8o6ot °`""'"`"`°`""`""` County Code Year File Number
INHERITANCE TAX RETURN -
Hamsbur , PA t~iz8-0601 RESIDENT DECEDENT ~ ~ ~ ~ ~ ~ ~J
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
199-28-6677 09/29/2010 06/24/1922
__
Deaedent's Last Name
_ _. _
Suffix Decedent's First Name MI
Shelley William
_ _
__ L
_
.... _...._.......
__
___
-_
pplicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name MI
_ ..
Shelley _ __
Lucille C
Spouse's Social Security Number
196-07-4940 THIS RETURN MUST BE FILED IN DUPLICATE WITH'THE
- - - ___ REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
OD 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death
O 4. Limited Estate O Prior to 12-13-82)
4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
~ 6. Decedent Died Testate O
(Attach Copy of Wili) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(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 - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0
Name
_ :
_ _ _ Daytime Telephone Number
Robert C. Saidis, Esq. (717) 243-6222 r. -
_ _
_. __.. ....._.__. __.._ ~-..~a
First Line of Address
Correspondent's a-mail address: rS81dIS~p SSr-ati:OrrteVS.COm
REGISTER OF WIL~(L~S ONLY r
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DATE FIL~y ~`
Under pbnalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief,
it is We, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESP IBLE R FILING RETURN
~~~ ~J "~~.Q ~~ ~ 9 ~~p,C ( D/ATE
ADDRFQS ~~~tl/~~
1 Lon sdorf Way, C~1i~lg, PA 17013
OF
26
Carlisle, PA 17013
L, 1505610105
DATE
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IRIGINAL FORM ONLY
Side 1
15U56101U5
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ter) ~'rt
,J 1505610205
REV-1500 EX (FI)
decedent's Social Security Number
Decedent's Name: William L. Shelley .199-28-6677
RECAPITULATION
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 and Notes Receivable (Schedule D) .
....................... .. .
4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5.
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .. 6
..
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ...
.
- - -
(Schedule G) O Separate Billing Requested..... ... 7. 0.00
8. Total Gross Assets (total Lines 1 through 7) ...
............ .
..........
... s. 0.00
9. Funeral Expenses and Administrative Costs (Schedule H)
................ ... 9.
4,578.69
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10,
11. Total Deductions (total Lines 9 and 10) .....
......................... ... 11.
4,578.69
12. Net Value of Estate (Line 8 minus Line 11)
............................
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which .. 12.
--
an election to tax has not been made (Schedule J) ...................... .. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
.......... .
...........
..1a. 0
00
TADC CALCULATION -SEE INSTRUCTI .
ONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 -
(a)(t2) X .0 00
16. Amount of Line 14 taxable - - 15. 0.00
_ __ __
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. _ __ 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
O
Side 2
L 1505610205 1505610205
REV-1500 EX (FI) Page 3
File Number
Decedent's Complete Address:
3. Interest Total Credits (A + B - (2)
4. If Line 2 pis greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3)
Fill in oYal 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) _ 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPR OPRIATE 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 ......................................... ... ^
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" 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 property, which
contains a beneficiary designation? ............................................__ n
IF THE ANSVNER 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)].
For dates of deeath 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 depth 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 patent 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 or adoption.
Tax Paylments and Credits:
1. Tax Due (Page 2, Line 19) (1) 0.00
2. Credits/IPayments
A. Prior Payments
B. Discount
~i Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
William L. Shelley
Decedent's debts must be reported on Schedule I.
ITEM
NUMBE(t DESCRIPTION
A• FUNERAL EXPENSES:
I' Hoffman Roth Funeral Home and Crematory - Funderal Expenses
Hoffman Roth Funeral Home and Crematory -Keepsake Urn
Hoffman Roth Funeral Home and Crematory -Balance due for Flowers
Hoffman Roth Funeral Home and Crematory - Reimbursment
B. ADMINISTRATIVE COSTS:
I. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
FILE NUMBER
4,284.44
55.00
159.00
-100.00
State ZIP _
Year(s) Commission Paid:
Z• Attorney Fees:
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:
S• Accountant Fees:
6• Tax Return Preparer Fees:
~• EVP Systems, Inc. -Date of Death Evaluation
13.95
The Sentinel -Notice of Letters Testamentary
166.30
TOTAL (Also enter on Line 9, Recapitulation) I $ 4,578.69
If more space is needed, use additional sheets of paper of the same size.
rzev-1.SI.0 ex+ ,os-t?s~y
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE''OF
William L. Shelley
This schedule must be completed and filPri if rna an~wo~ ~„ ,.,., ,.a..,,,..,:___ ~ .~__.._,_ .
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MI5C. NON-PROBATE PROPERTY
FILE NUMBER
21-10-1155
_...._. _ _r_..., ,,, .,,,~„",~ w~ o~~,~,~„a, ,,,eeu or paper or me same size.
~'EB 1 7 2011
~GENERALI
Policy No.
415'329
Saidis, Sullivan & Rogers
FAO Robert C. Saidis
26 West High Street
Carlisle, PA 17013
USA
Cusl;omer Services Adliswil, 02/14/2011
Mrs!Franziska Eymann
Direict Number +1141 58 472 51 47
Poli~Cyholder: Lucille Shelley, born 01/01/1922
Insured person: William Shelley, born 06/24/1922, deceased 09/29/20.10
Dear Mr Saidis,
We thank you for your letter and the Death Certificate of William Shelley. First of all we would
like tjo express our sincere condolences to his family.
Please find below the final statement for the above-mentioned annuity policy.
This is a Deferred Life Annuity Insurance without refund in the case of the death of the insured
person. The policy has thus expired with the death of William Shelley with no residual value.
Accorrding to our General Policy Conditions for Life Annuity Insurances, we pay the annuities as
j long ~s the insured person is alive on the due payment date. Since William Shelley passed
j away/ on 09/29/2010, the quarterly annuity of 12/01/2010 (paid on 11/16/2010) was no longer
justified.
May We kindly ask you to arrange for a check for CHF 1'948.30 according to the attached
j statement. A return envelope is enclosed for your convenience.
We thank you in advance for your kind assistance.
Your sin rely,
G !~ Lllnsurance
I ~ _
Ruth Hartley ranz' ka Eymann _
Statement
Return envelope x
s
F
E
Y
I, WILLIAM L. SHELLEY, of Cumberland County, Pennsylvania, declare this
to be my Will, and revoke all prior wills and codicils.
FIRST: ENTIRE ESTATE
I give; devise and bequeath all of my property of every nature and wherever
situate to my wife, LUCILLE C. SHELLEY, providing she shall survive me b}~ th1l-ty
days.
SECOND: TANGIBLE PERSONAL PROPERTY
Should my wife, Lucille C. Shelley, predecease me or die or or before the
thirtieth da}~ following my death, I give and bequeath all of my tangible personal property
as follows:
A. I give and bequeath certain items of tangible personal propert}~ owned by me
at my death and with all insurance policies on such property to those
individuals who survive me by thirty days, and who are designated on a list or
memorandum signed by me which refers to this Will or is found with a copy
thereof, those items listed beside their names; provided that no such list or
memorandum shall be valid unless it is received by my Executor within sixty
days of my Executor's qualification.
B. My Executor shall pa}~, as an expense of settling my estate, all costs of
delivering such tangible personal property, including the costs of packaging,
delivery and insurance.
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C. The balance, including any items under subparagraph (.A) the bequest of
which has lapsed, to my residuary estate.
THIRD: GENERAL BEQUESTS
Should m}r wife, Lucille C. Shelley, predecease me or die on or before the
thirtieth day following my death, I bequeath the sum of Ten Thousand ($10,000)
Dollars to each of the following named legatees who are living at my death. Should any
of these named legatees predecease me, I direct that their share of my estate shall lapse
and be added to and distributed as a part of the residue of my estate under Article Fifth:
Residue.
A. ROBERT M. CORRIGAN
B. BETTY BOLEN
C. DOUGLAS and LORRAINE CARPENTER, or the survivor of them
D. JANE CHILTON
E. KATHLEEN DANIELS
F. MARY DEITCH
G. GINNY GOODYEAR
H. SAMAR HALABI as custodian, or ANTOINETTE HALABI as
substitute custodian, for RACHAEL HALABI under the Pennsylvania
Uniform Transfers to Minors Act.
I. ANTOINETTE HALABI as custodian, or SAMAR HALABI as substitute
~,
custodian, for SAMANTHA HALABI under the Pennsylvania Uniform
Transfers to Minors Act.
~
J. MARCIA C. KELLER
~~
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K. SALLI' KER
L. MARJORIE KOS
M. JODY LOEFFLER
N. JENNY McKENNA
O. KEITH MULLEN as custodian, or DENISE MULLEN as substitute
custodian, for DELANEY MULLEN under the Pennsylvania Uniform
Transfers to Minors act.
P. DENISE MULLEN as custodian, or KEITH MULLION as substitute
custodian, for KENNEDY MULLEN under the Pennsylvania Uniform
Transfers to Minors act.
FOURTH: CHARITABLE BEQUESTS
Should my wife, Lucille C. Shelley, predecease me or die on or before the
thirtieth da}~ following my death, I bequeath the sum of Ten Thousand ($10,000}
Dollars to each of the following charities or their successors, to be used as their
respective governing bodies deem appropriate:
A. In Memory of DR. WILLIAM L. SHELLEI' and MRS. LUCILLE C.
SHELLEY:
1. Cumberland Crossings Ketirernent Community, Carlisle, Pennsylvania,
a Pennsylvania Not for Profit Corporation.
2. Gett}~sburg College; Gettysburg, Pennsylvania, a Pennsylvania Not for
Profit Corporation.
3. Nason Hospital, Roaring Springs, Pennsylvania; a Pennsylvania
Not for Profit Corporation.
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4. West Virginia University; Morgantown, West `/irginia, a West
Virginia Not for Profit Corporation.
B. In Memory of DR. LISBETH E. SHELLEI': The First Evangelical Lutheran
Church of Carlisle, Cumberland County, Pemisylvania, a Pennsylvania Not for Profit
Corporation.
FIFTH: RESIDUE
I give, devise and bequeath all the rest, residue and remainder of my estate of
whatever nature and wherever situate to the Firsi Evangelical Lutheran Church of
Carlisle, Cumberland County, Pemnsylvania, to be used as the Congregation Council may
deem appropriate in memory of DR. LISBETH E. SIIELLEY.
This residuary gift is conditioned upon the net value of my estate for distribution
being sufficient to satisfy fully all general bequests and charitable bequests of my
diapositive scheme set forth in Articles Third and Fourth above.
Should my net estate for distribution be insufficient to provide all beneficiaries,
General and Charitable, Ten Thousand Dollars each, I bequeath to all beneficiaries,
General and Charitable, equal shares prorata of m}~ distributable estate.
SIXTH: SPENDTHRIFT PROVISION
Until distributed, no gift or bene~icial interest shall be subject to anticipation or to
voluntary or involuntary alienation.
SEVENTH: TAXES
All death taxes and interest and penalties thereon imposed upon any property
passing under my Will, but not otherwise, shall be paid out of the principal of my estate.
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EIGHTH: REASON FOR NO GIFT UNDER WILL
No provisions are made under this Will for my daughter, JODI KRONENBERG
and grandson, ANDREW KRONENBERG, or other members of the Kronenberg
family, not because of any lack of affection for them, bui because 1`hey are already
provided for.
NINTH: EXECUTOR
I appoint my wife, LUCILLE C. SHELLEY, Executrix, If my said wife fails to
qualify or ceases to act for an}~ reason, I appoint THE ORRSTOWN BANK of Carlisle,
Pennsylvania, or- its successor in business, Executor.
My executor shall not post security in any jurisdiction. My corporate executor
shall receive compensation for its services hereunder in accordance with its Schedule of
Fees in effect from time to time during the period over- which its services are performed.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this z, day
of June, ?009.
-i: ~%,~(~.~:.~ ~ '~ (SEAL
WILLIAM L. SHELLS EY
The preceding instrument, consisting of this and four other typewritten pages
identified by the signature of the testator, WILLIAM L. SHELLEY, was on the day and
date thereof signed, published and declared by WILLIAM L. SHELLEY, the testator
therein named, as and for his last will, in the presence of us, who, at his request, in his
presence, and in the presence of each other have subscribed our names as witnesses
hereto.
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COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS
I, WILLIAM L. SHELLEY, the testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; and that I signed
it willingly and as my free and voluntary act for the purposes therein expressed.
Sworn to or~ffirmed and acknowledged before me by WILLIAM L. SHELLEY,
the testator, theZZ of .Tune, 2009.
u-:' '
/WILLIAM L. SHEL , ', Testator
William S. Daniels, Esquire
PA Supreme Court No. 27735
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS
We, ~,q.r» S. /~2~5'L~q~Kj> ,and fi~E~Be°n1'~'. ~~'G°~Z..s', hn ,the witnesses
whose names are signed to the attached or foregoing instrument; being first duly qualified
according to law, do depose and say that we were present and saw the testator sign and
execute the instrument as his Last Will; that the testator signed willingly and executed it
as his free and voluntary act fo1• the purposes therein expressed; that: each subscribing
witness in the hearing and sight of the testator signed the will as a witness; and that to the
best of our knowledge the testator was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
Sworn to or affirmed and subscribed to before me by ~i9Y/~ -~. m'~~L ~'y'~
and ~ ~r''y~si~"~,d, ,witnesses, this Z?day of .Tune, 2009.
,.
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Witness
Witness
William S. Daniels, Esquire
PA Supreme Court No. 27735
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS
On this 22`~ day of June, 2009; before me, K~-srl r.EKMA of - MaK'~'a~ ,the
undersigned officer; personally appeared William S. Daniels, Esquire; 1 West High
Street, Suite 205; Carlisle, PA 17013; known to me or satisfactoril~~ proven to be a
member of the bar of the highest court of Pennsylvania, Supreme Court ID Number
27735, and certified that he was personally present when the foregoing acknowledgment
and affidavit were signed by the testator and witnesses.
In witness whereof, I hereunto set my hand and official seal.
Lary Public
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
Kristy Lehman-Manson, Notary PubNc
ChY of Cariisle Boroughs F6bruartaly 20, 2012
MY GommSssian E>~iro