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Home My WebLink About10-26-11 (3)15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 21 11 0 9 5 $ Harrisburg, PA17t28-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth, 192-14-6111 07/30/2011 X02/19/1924 Decedent's Last Name Suffix Decedent's First Name MI _ _ ~ _.. _.. ___ _ . _ _ .. ~ ~._.__z FISHBURN Mrs. MARY R( (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI deceased ~ ~ ~ I _ _._.. Spouse s Social Security Number - - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return C=7 2. Supplemental Return C~ 3. Remainder Return (date of death prior to 12-13-82) •~; 4. Limited Estate ~_.,; 4a. Future Interest Compromise (date of ;.-;a 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate 7. Decedent Maintained a Living Trust __ _.. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~....'.'. 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) • between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name ^aytime Telephone Number 717) 448 1204 Edgar R. Luhn III, .Esq. ~ Firm Name If A plicable ~- ( P ) _.. _......_.. _... ____. ' REGISTER OF WI~~SE ONLY Law Office of Edgar R. Luhn, I.II -;';-~~ `-? First line of address 480 Doubling Gap Road Second line of address ZIP Code ~ ' DATE i 17241 ~ t........ _..___ __.._ __ . _:.. _ :_ i _ L..:7 ..-... _ - ,~ O•' ~; ~ -~. -, ~-~ C.7 -°~ ~~•.. a -,~ -.L~_ Correspondent's a-mail address: edluhnCaol . COICt Under penalties of rjury, I declare at I Piave examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it i ,correct rid omplete. Dec ration of prepay r other than the personal representative is based on all information of which preparer has any knowledge. NA URE O P SON R 8LE F FI G RETURN ATE DR S~ 10 5 s. 49th st., Philadelphia, PA 19143-3405 - -- - -- -- ----...~.......~ ~.-.~-,,,.~ ncr~occrr.iTnnvG DATE _ A48~ssD~ /bling~Gap Rd. , Newville, PA 17241 d1z PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 _.rj , P T -r; ~ 7 C~ _m J~ REV-1500 EX Decedent's Name: RECAPITULATION 15056052059 M. Romaine Fishburn Decedent's Social Security Number __ ......_....... . 192-14-6111 1. Real estate (Schedule Aj .. . .......................................... 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. 5 8 ~ 6 9 8 . Q Q , -_._.....~. _._e.___-.-._..~__....~~,._..~. .. i 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. , 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c._._, Separate Billing Requested........ 7.: ; 8. Total Gross Assets (total Lines 1-7)... • ....................~............. 8. 58 , 698 . QQ 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9• '~ 1 Q , 9 2 5 . Q Q 10. Debts o(Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. ', 11. Total Deductions (total Lines 9 & 10).' .............:.................... 11.', 1 Q ~ 925 QQ i - 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental 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. ': [}'] , '7'J 3 , Q Q TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 .(a)(1.2) X .0_ a......--.._.v-~..w._..~...._.. 15. 16. Amount of Line 14 taX~le ~~2 15 Q ~ 16 at lineal rate X .0 _ ~~ ~~TM -_ w._._._._-~- 17. Amount of line 14 taxable _.-~ at sibling rate X .12 .-,..__. ~~ ~.v~p.~ 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 15056052059 Side2 15056052059 L REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 1 0958 DECEDENT'S NAME M. Romaine Fishburn DECEOENTS SOCIAL SECURITY NUMBER 192-14-6111 STREETADDRESS 770 S. Hanover St. CITY Carlisle STATE~A ZIP 1703 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount 3. Interest/Penalty ifapplicable D. Interest E. Penalty (1} Total Credits (A + B + C) (2) Total Interest/Penalty (D + E ) 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) (4) 2,150 .(107.00) (5) 2 , 043.00 (5A) B. Enter the total of Line 5 ~~ SA. This is the BALANCE DUE. (58) 2 , 043.00 Make Check Payable to: REGISTER OF WILLS, AGENT 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 or income ofthe-property transferred :................................................................................ .......... ^ ^X b. retain the right to designate who shall use the property transferred or ils income :...........:...................... .........: ^ c. retain a reversionary interest; or ..............................................................................::..:............................. .......... ^ [~ d. receive the promise for life of either payments, benefits or care? ............................................................ .......... ^ 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 property which contains a beneficiary designation? ....................................................................................:........ .................. ......... ^ [~ IF THE ANSWER 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 January 1, 1995, the fax race imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)}. For dates of death on or after January 1; 1995, the tax rate imposed on the net value of lransfers to or for the use of the surviving spouse is zero (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 dealh on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one 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 zero (0) percent (72 P.S. §91t6(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5} percent, except as noted in 72 P.S. §9116(1.2) [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 Twelve (12} percent [72 P.S. §91 f6(a)(1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. aev-isoe ex . p e» SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, R MSC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary R. Fishburn, a.k.a. M. Romaine Fishburn 21-11-0958 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM NUMBER DESCRIPTION OF DEATH 1. Chapel Point~770 S. Hanover St., Carlisle PA 56,722.00 Apartment Entrance Fee Refund 2. Adam's County National Bank Newville, PA Checking Account 116750 1,057.00 3. Adam's County National Bank Newville, PA Savings Account 9633642 199.00 4. Adam's County National Bardk Newville, PA Savings Account 5567343 360.00 5. Adam's County National,Bank Newville, PA Savings Acoount 5567394 360.00 TOTAL (Also enter on Tine 5, Recapitulation) I S 5 8 , 6 9 8.0 0 (If more space is needed, insert additional sheets of the same size) REV-1571 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER M. Romaine Fishburn, a.k.a., Mary R. Fishburn 21-11-0958 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Egger Funeral Home 15 Big spring Ave. Newville, PA 17241 7,450.00 e. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City _. State Zip Year(s) Commission Paid: 2. Attorney Fees Law Office of Edgar R. Luhn, III 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 Cumberland County Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees ~~ Cumberland Law Review 8. Carlisle Sentinel Legal Advertisem ent 9. Postage to and from Philadelphia, PA 0.00 2,950.00 209.00 75.00 236.00 5,00 TOTAL (Also enter on line 9, Recapitulation) I $ 10 , 9 2 5.00 (lf more space is needed, insert additional sheets of the same size) REV-1513 F~C+ (~00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mar Fishburn a.k.a., M. Romaine Fishburn 21-11-0958 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Jo Ann Fishburn daughter 100% 1005 S. 49th St., Philadelphia, PA 19143 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET [I NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 15 (If more space is needed, insert additional sheets of the same size) ~ ~~~t mill ttn~ ~~,st~rnent of M. ROMAINE FISHBURN I, M. Romaine Fishburn a/k/a Mary R. Fishburn, of 32 Mt. Rock Road, Newville, Cumberland County, Pennsylvania, being of lawful age, sound mind and memory, and under no restraint, do publish this, my Last Will, revoking all others previously made by me. First: All expenses, fees, costs, and taxes related to this estate shall be paid from the probate estate assets, and all gifts and bequests shall be paid from the net distributable estate. Second: I give, devise, and bequeath my entire estate, real, personal, or mixed, of every kind and nature, and wherever_ situated, which I may own, or hereafter acquire, or have a right to dispose of at my death, to my beloved daughter, Jo Ann Fishburn, absolutely. Third: In the event that my daughter does not survive me, then I give, devise, and bequeath my entire estate, real and personal, to my Trustees, to hold, to distribute the principal, and to pay the net income of said trust, to my grandson, Harry Abinash Joy Fishburn, as follows: (a) If Harry Abinash Joy Fishburn is under the age or twenty-one (21) at the time of my death, to hold the principal i~, trust for a trust term to last until Harry attains age twenty-one (21) or sooner die, and to pay to Harry quarterly or more frequently so much of the entire net income in such proportion:, ut: my Trustees, in their absolute discretion, deem advisable. ~':`~e distribution of income on any distribution date shall nog establish a pattern for any other distribution date. All net income not so paid shall be accumulated and added Lo principal. (b) Upon the expiration of the trust term under subparagraph (a), or upon my death if Harry has attained age twenty-one (21), I direct my Trustees to pay to Harry the entire principal of the trust created in this Last Will. Fourth: I appoint G. William Hemminger, III, and Krista H. Zeigler as Co-Trustees of any trust created hereunder. Ir. the event that one of either G. William Hemminger, III, or Krista ~i. Zeigler, is unable to act as Trustee, then the individual remaining who is able to act shall remain appointed as Sole Individual Trustee. In the event that both G. William Hemminger, III and Krista H. Zeigler, are unable to act as Trustees, then I appoint my brother, G. William Hemminger, as successor or alternate Trustee of any trust created hereunder. Fifth: In the event that neither my daughter, Jo Ann Fishburn, nor my grandson, Harry Abinash Joy Fishburn, survives me, then I give, devise, and bequeath my entire estate, real and personal, in four (4) equal shares to the following: 1. I give, devise, and bequeath one -fourth of my entire estate, real, personal, or mixed, of every kind and nature, and wherever situated, which I may own, or hereafter acquire, or have a right to dispose of at my death, to my nephew, G. William Hemminger III, his heirs and assigns. 2. I give, devise, and bequeath one-fourth of my entire estate, real, personal, or mixed, of every kind and nature, and wherever situated, which"I may own, or hereafter acquire, or have a right to dispose of at my death, to my niece, Rrista H. Zeigler, her heirs and assigns. 3. I give, devise, and bequeath one-fourth of my entire estate, real, personal, or mixed, of every kind and nature, and wherever situated, which I may own, or hereafter acquire, or have a right to dispose of at my death, to the Zion Lutheran Church o£ Newville, Pennsylvania. 4. I give, devise, and bequeath one-fourth of my entire estate, real, personal, or mixed, of every kind and nature, and wherever situated, which I may own, or hereafter acquire, or have a right to dispose of at my death, one-half of this one-fourth share of my estate to my dear friend, Sharon Thueson her heirs and assigns, and one-half of this one-fourth share of my estate to my dear friend, Debra Behnke. Sixth: The Trustees hereunder shall have the following powers in addition to, and not in limitation of, those granted by law: 1. Management of Trust Property - The Trustees shall with respect to any and all property which may at any time be held by them in trust, have the power, exercisable at the Trustees' discretion at any time and from time to time on such terms and in such manner as the Trustees may deem advisable to: (a) sell, convey, exchange, convert, improve, repair, manage, operate and control such property. (b) lease for terms within or beyond the term of said trust and for any purpose, including the exploration for removal of gas, oil and other minerals; and enter into any covenants and agreements relating to the property so leased or any improvements which may then or hereafter be erected on such property. (c) encumber or hypothecate real or personal property for any trust purpose by mortgage, pledge or otherwise. (d) carry insurance of sucr. kinds and in such amounts at the expense of the trust as the Trustees may deem advisable. (e) commence or defend at the expense of the trust such litigation with respect to such trust or any property of the trust estate as the Trustees may deem advisable. (f) invest and reinvest the trust estate funds in such property as the Trustees may deem advisable, whether or not of the character permitted by law for investment of trust funds. (g) vote any securities having voting rights held by the Trustee in trust, in person or by proxy, in favor of or against management proposals. (h) pay any assessment or other charges levied on any stock or other security held by the Trustees in trust. (i) exercise any subscription, conversion, or other rights or options which may at any time attach, belong or be given to the holders of any stocks, bonds, securities or other_ instruments held by the Trustees in trust. (j) participate in any plans or proceedings for the foreclosure, reorganization, consolidation, merger or liquidation of any corporation or organization that has issued securities held by the Trustees in trust, and incident to such participation to deposit securities to any protective or other committee established to further or defeat any sucr_ plan or proceeding. (k) enforce any mortgage or pledge held by the Trustees in trust, and at any sale under any such mortgage or pledge to bid and purchase for the trust created herein, at the expense of the trust, any property subject to such security instrument. (1) compromise, submit to arbitration, release with or without consideration, and otherwise adjust any claim iri favor of or against the trust. (m) subject to any limitations expressly set forth Herein and the faithful performance of her fiduciary obligations, to do all such acts, take all such proceedings, and exercise all such rights and privileges as could be done, taken or exercised by an absolute owner of trust property. 2. The Trustees shall have the power to borrow money from any person, firm or corporation, for any trust purpose, on such terms and conditions as the Trustees may deem proper and obligate the trust to repay such borrowed money. 3. Except as otherwise specifically provided herein, the Trustees shall have full power and authority to determine, in the Trustees' discretion, what shall constitute principal of the trust estate, gross income of the trust estate, and net income of the trust estate. 4. All property taxes, assessments, fees, charges, and other expenses incurred by the Trustees in the administration or protection of the trust shall be a charge on the trust estate and shall be paid by the Trustees prior to final distribution of the trust estate in full out of the principal or in full out of the income of the trust estate, or partially out of principal anti partially out of income of the trust estate, in such manner and proportions as the Trustees may deem advisable. 5. On any final or partial distribution of the assets of the trust estate, the Trustees may distribute such assets in kind, may distribute an undivided interest in such assets or may sell all or part of such assets and make distribution in cash or partly in cash and partly in kind. 6. In the event that a beneficiary of a trust created herein dies before final distribution, the trust shall terminate, and the Trustees shall distribute the principal and any accumulated income thereof pursuant to the terms of paragraph Fifth of this Last Will. 7. No interest in income or principal of any trust created herein shall be assignable by, or available to any one having a claim against, a beneficiary before actual payment to said beneficiary. Seventh: I nominate and appoint my daughter, Jo Ann Fishburn, to be the Executrix of my Last Will, granting to her authority to sell and convey any or all of my estate, real and personal, or mixed, upon such terms and prices as she shall deem proper, without obtaining any prior order of the court therefor. I also grant her full power and authority in the settlement of my estate, to compro- mise, adjust, and settle any and all debts and liabilities due to or from my estate, for such sums, and upon such terms and condi- tions as she shall deem best. In the event that she shall for any reason decline to serve, or fail to qualify for any reason, or having qualified and been appointed, fail to complete the administration of my estate, then I nominate my brother, G. William Hemminger to be the Alternate or Successor Executor. I direct that no bond or surety shall be required of any administrator, trustee, executor or fiduciary named herein. IN WITNESS WHEREOF, I have hereunto subscribed my name, and acknowledge and publish this instrument as my Last Will in the presence of the undersigned witnesses, on March 31, 1999. l '~' f M. Romaine Fishburn ., -~ ~ ; ..~ ,-- N~ry R. Fishburn SIGNED, sealed, published and declared by M. Romaine Fishburn a/k/a Mary R. Fishburn, the above-named Testatrix, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. r COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS We, M. Romaine Fishburn a/k/a Mary R. Fishburn, ~S~ri~F,~.r11.1~ ~~ ~6'.'~~ and ~~l~Q~~/ ~ y t h e Testatrix and the witnesses whose names are subscribed to the attached Will, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of M. Romaine Fishburn a/k/a Mary R. Fishburn signed the Will as witnesses; and that to the best of our knowledge she was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. /J ~ ~ ]~~ J T e s t a t r i x: ~' /° /~-~!--,1~:a~,i,~ . :~'r.~ , UzL:>?..-~ ~~ ~ Sworn and subscribed to before me, ~~ CJ~ 19 9 9 . Witnesses: z r ~~~ i ~ f r"- this ~ 5ir day of lic Notarial Seal Edgar R. Luhn III, Notary Public Harrisburg, Dauphin County My Commission Expires April 24, 2000 Member, Pennsylvania Association of Notaries