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HomeMy WebLinkAbout10-20-11 (2)1505610101 REV-1500 EX(oi-io) PA Department of Revenue pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes ~""a.ME~ °` County Code Year File Number PO BOX 280601 pINHERITANCE TAX RETURN l Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ~ / ©J ~~ -~ !~- ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~ ~/ ~.8 2 ~ G Z, 43 ~, / Sao 9 ©~! 6 l `l /~.3~"- Decedents Last Name Suffix Decedent's First Name MI 2~r ~ L~R ~t~}gt-L ~ (If 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 FILE D IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (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 Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number First line of address ~ ti/~s t- ~f~ ~~ st Second line of address .S~l / ~ ZOO City or Post Office e-~}-,R1., ~ s~~- Correspondent's a-mail address: State Pf- ZIP Code L l ~ /.3 Under penalties 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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~ . DATE ADDRESS ~~, ~~L~ h/ ~s i SIGNAydRE OF P E ER OTHER TH ES NTATIVE DATE ADDRESS ,,.~ Lti~z3'7'` /fi c.~ Sy= -~J~-c...~P S" ~,~LL1.I'G~, ~~' l ~~ PLEASE USE ORIGINAL FORM ONLY ~ - - ~ ~-, REGISTET~~F WILLS U ON gE~ LY~`:~ ~,_' ~Tl~~ ~, =~ m tv ~2: _ .,._ _ _ ~_ _. ~ _ _. _.: _..~ ~'~ DATE FILE D .,~° -r, Side 1 1505610101 1505610101 1505610105 REV-1500 EX D/ecedent's SocialfS~ecujr~ityCN~umber Decedent's Name: Z ~T C.S ~~,~ ~l~CL. ~ ` ~'/ ~v ` / RECAPITULATION 1. Real Estate (Schedule A) ...............:........................... .. L •" 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. 2 ~ ,/ L ~ • 3 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ..... .. 6. • 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. ~j ~ ~` j . 3. 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. ~ a,~ ~.~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. ~~~~ . ~~ 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. :' ~ ~ ~ S 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. ~ ~~ ~.~'V°" TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ` 16. 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 ~"y ~'/ ~•~~' 18. , L' ~ Gj/ ~ ~~ 19. TAX DUE ...................................................... ...19. n [~ ~ ~•~~~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME STREET ADD ESS ~v~ E~~-E CITY C~ „ w~~~ -- i STATE / ~~~~ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ____ B. Discount Total Credits (A + B) (2) Interest (3) 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. (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~~~~ 3 -~- 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 of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ 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. Ditl 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 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 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) (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 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 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(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 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. D ~ ~~ ,,~ ,_ _ -. I, MABEL K. Z.EIGLER, of South Middleton Township, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any will previously made by me. I. I direct that my funeral and burial be conducted in accordance with pre- arrangements which I have made and paid for at the Hoffinan-Roth Funeral Home of Carlisle, Pennsylvania, with my interment to be in Waggoners United Methodist Church Cemetery, Carlisle, Pennsylvania. II. I devise and bequeath all of my estate of every nature and wherever situate in equal shares to my two nieces, VIONA NISLEY and DONNA MAE GRESHAM, providing they shall survive me by thirty days. III. Should either of my nieces, Viona Nisley or Donna Mae Gresham, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the share of such niece to her issue per stirpes living on the thirty-first day following my death; and should either niece leave no such issue living on the thirty-first day following my death, I devise and bequeath the share of such niece to the other niece or to her issue per stirpes living on the thirty-first day following my death. IV. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from the principal of my estate as a part of the expense of the administration of my estate. V. I appoint my niece, VIONA NISLEY, executrix of this my Last Will. Should my 'r~. ~' F~ . _!rJ a. A; n_ niece, Viona Nisley, fail to qualify or cease to act as executrix, I appoint my niece, DONNA MAE GRESHAM, executrix of this my Last 'Will. VI. I direct that my executrix or her successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /~ `f/ day of ~c.~r~~-' , 2001. ~~~ ~ 'z~~° ~~.- (SEAL) -~MABEL K. ZEI~R T'he preceding instrument, consisting of this and one other typewritten page identified by the signature ofthe testatrix, MABEL K. ZEIGLER, was on the day and date thereof signed, published and declared by MABEL K. ZEIGLER, the testatrix therein named, 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 subscribed our names as witnesses hereto. y ~-,y /~ ...._ /o G `l'+g ~rs~- ~i?ytdN.G'S'~ Pf /~ y Z -~ ~/ ~. ~ ~ ~ ~-~'i~3~~ REV-1508 EX ~ (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF l ~~~ ~L ~, FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 . ~~.. I S M1 Y« :..:. ' ~ ~.F t ~'' ~f \~» J ~-- .r. F '~~... y~ ~ WY w. S ,~ _ _ ? . ~, ,...,, TOTAL (Also enter on line 5, Recapitulation) I $ {~ ~~ ,~~ ~,;, ~' _ ~ !5 (If more space is needed, insert additional sheets of the same size) ' ~ M&T Bank ~ t ~~,; , g, ~ ~ n ~ e ~ ~sy ~~~,, ~~ ;~u~.~~~,~~~ ACCOUNT N0. ACCOUNT TYPE 14295970 RELATIONSHIP CHECKING WITH INTEREST MABEL K ZEIGLER 9 MARCELLA WAY CARLISLE PA 17015 00 0 04344M NM 017 16082 STATEMENT PERTOD PAGE MAR.21-APR.22,2009 1 OF 1 INIEREST PAID YEAR TO DATE 0.79 ACCOUNT SUMMARY SPRING GARDEN BEGINNING BALANCE DEPOSITS & OTHER ADDITIONS CHECKS PAID OTHER SUBTRACTIONS CURRENT INTEREST PD ENDING BALANCE N0. AMOUNT N0. AMOUNT N0. AMOUNT 4,763.19 0 0.00 0 0.00 1 35.00 0.21 4,728.40 ACCOUNT ACTTVTTY POSTING DATE TRANSACTION DESCRIPTION DEPOSITSINTEREST & OTHER ADDIT30NS CHECKS:~'OTHER SUBTRACTIONS DAILY BALANCE 03-21-09 BEGINNING BALANCE 54,763.19 03-25-09 COMBINED INS INS PREM 35.00 4,728.19 04-22-09 INTEREST PAYMENT 0.21 4,728.40 ENDING BALANCE 54,728.40 ANNUAL PERCENTAGE YIELD EARNED = 0.04 % 2~ ~" ~ r •l ~ M8T PARTICIPATES IN THE FDIC'S TRANSACTION ACCOUNT GUARANTEE PROGRAM (TAG), UNDER WHICH ALL BALANCES IN NON-INTEREST-BEARING TRANSACTION ACCOUNTS ARE FULLY ~~~~~'-> GUARANTEED BY THE FDIC THROUGH 12/31/09. TAG COVERAGE IS IN ADDITION TO AND SEPARATE FROM THE COVERAGE AVAILABLE UNDER THE GENERAL FDIC DEPOSIT INSURANCE ~ .~'~ 3~"' RULES. MiT WILL ALSO MAKE ALL CONSUMER NOW ACCOUNTS (OTHER THAN POWER CHECKINGI ELIGIBLE FOR COVERAGE UNDER TAG BUT TO DO S0, THE FDIC REQUIRES MiT TO COMMIT TO ~ PAY NO MORE THAN .50% INTEREST THROUGH 12/31/09. THUS, MiT WILL PAY NO MORE THAN / ~s~v .50% INTEREST ON SUCH ACCOUNTS (OTHER THAN POWER CHECKING) THROUGH 12/31/09. dq ~~~~ ,, ~- :~ _ ..~, L008A (6lQ~ ~,: J(; Page: 1 Document Name: untitled STFD 1 THE TRANSACTION STMT FORMAT 09/04/16 9.32.51 STMT CO 96 OP EBRN MS 50852 ACTION COMPLE TE ACTION COID PROD CODE DDA ACCT 14295970 SHORT NAME ZEIGLER MABG CURR CODE PAGE 1 SEARCH FROM 109/02/20 THRU 109/03/25 ACTN POST EFFECTIVE CHE CK NUMBER TRAM AMOUNT D/C BALANCE TRACE ID DESCRIPTION * 02/20 .19 C 4,798.00 I-GEN109022000024377 INTEREST PAYMENT * 02/20 10.00 D 4,788.00 I-GEN109022000024378 MONTHLY SERVICE CHARGE * 02/20 10.00 ~C 4,798.00 I-GEN109022000024379 SERVICE CHG WAIVE- RELATIONSHIP PRICING * 02/24, 35.00 D 4,763.00 020090540647659 COMBINED INS INS PREM * 03/20 .19 C 4,763.19 I-GEN109032000024210 INTEREST PAYMENT * 03/20 ~ 10.00 D 4,753.19 I-GEN109032000024211 MONTHLY SERVICE CHARGE ;~~' * 03/20 10.00 C 4,763.19 .. I-GEN109032000024212 SERVICE CHG WAIVE- RELATIONSHIP PRICING 03/25 35.00 D 4,728.19 020090832462820 COMBINED INS INS PREM PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM Date: 4/16/2009 Time: 9:33:31 AM ~,.. ~4 ~- 'ACCOUNT N0. ~ `' ACCOUNT TYPE STATEMENT PERIOD PAGE 14295970 RELATIONSHIP CHECKING MITH INTEREST FEB.21-MAR.20,2009 1 OF 1 • 00 0 04344M NM 017 44778 MABEL' K ZEIGLER 9 MARCELLA WAY- CARLISLE PA 17015 INTEREST EARNED FOR STATEMENT P€RIOD 0.18 SPRING GARDEN INTEREST PAID YEAR TO DATE 0.58 ._ _._ eccniiNT ciiMMeQw BEGINNING $ALANCE DEPOSITS>i .. : OTHER ADDTTIONS : :"CHECKS PAID OTHER SUBTRACTIONS CURRENT INTEREST PD _:ENDING:... BALANCE ' NO., AMOUNT N0. AMOUNT N0. AMOUNT 4,798.00 0 0.00 0 0.00 1 35.00 0.19 4,763.19 • ef`f`f111N.T e(^TTVTTV POSTING 'DATE' 7RANSACTION'DESCRIPTION ' OEPOSITS;INTEREST 8'-0THERiADDITIONS : CHEGKS,~ OTHER SUBTRACTIONS DAILY BALANCE 02-21-09 BEGINNING BALANCE 54,798.00 02-24-09 COMBINED INS INS PREM- 35.00 4,763.00 03-20-09 INTEREST PAYMENT = , '' 0.19 - 4,763.19 ENDING BALANCE 54,763.19 ANNUAL PERCENTAGE YIELD EARNED = 0.04 >~ .i U)08A (8107.. 39956 CUIREMONT NURSING & REHABIUTATION CENTER 1000 CLAREMONT ROAD .CARLISLE, PA 17013-8820 PAY TO THE The Estate of Mabel Zeigler ORDER OF F~41V1 TRUST so-asor~ls 4/28/2009 ~ "1,332.33 One Thousand Three Hundred Thirty-Two and 33/100+"'+'+++++++++.++++.+.+++.++++++.++++++++++.++.+++++++++++++++++++ DOLLARS The Estate of Mabel Zeigler volD AFTER so oavs C/O Viona Nisley 9 Marcella Way d.!(It=LU~.~.cr;.r~r-~ ~ ti ~rf Carlisle, PA 17015 ~~,~~ , ~~.-..-` ~ ~; MEMO ~''°'t L d41 1 rlnca P(~A ~ ~ 11'03995611' x:0 3 1 30 4 3061: 11~~~ 2848511' CLAREMONT NURSING & REHABILITATION CENTER 3 9 9 5 6 The Estate of Mabel Zeigler 4/28/2009 Date Type Reference Original Amt. Balance Due Discount Payment 4128/2009 Bill Mabel Zeigler 4911 1,332.33 1,332.33 1,332.33 Check Amount 1,332.33 Checking 4911 close PCA 1,332.33 r _ ___ 11'01392811' 1:0313150361: 146 90007111' HOFFMAN-ROTH FUNERAL HOME & CREMATORY, INC. 1 3 9 2 8 Viona Nisley 4/15/2009 Reimbursement for overpayment of funeral exp - Ma 155.40 r/~7T`IL~ ~ ~~ C~~'~ ~~~ Checking Funeral Ho Reimbursement for overpayment of funeral exp 155.40 REV-1511 EX+ (10-06) ^ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt~LE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of ecedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~ _ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) _ ~'%~ ' ~ ~ ~~ ~~ ~'° ~~' - r1 _ Street Address r ~' '' i~ City _ State Zip _ _ Year(s) Commission Paitl: _ 2. 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 - . .~» _ , ,~ 5. Arcearttants-Fees' - , 6 Tax~etum.Pceparer_s..Fses - .~_._. >,,• , ~~ ~ - ~~ .,,,,, .. .' ,; - j ~ ' i~ ~~~ ~ ~~ ~ ~% ~ ~_ a._ fy "'x ~ w,.,. ~~, ~ ems. ~ TOTAL (Also enter on line 9, Recapitulation) I $ ~ ~ ; ,' ~ .?~, (!f more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) m. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIJLE J BENEFICIARIES ESTATE OF NUMBER I 1. ~.~ ~°` , ~3 1 r:^ r J ~. II 1. 1 Z ~-~G1~~ NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] a ~~':-;1 ~; _~ ~ .~ f' :,~ -" ,~ j ., _ ' ~, X ~~ ~~~~~ ~.w .~..P i ,.. fir' .r~ f J-' 9 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) ~ ` /:,~.. ~~ .' .~ - 0,3 /.~ AMOUNT OR SHARE OF ESTATE r~ y r i.~, ~,~ ,~r ~~ ~ ,.S a C,V ti-. x w ... .-. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 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 I $ (If more space is needed, insert additional sheets of the same size)