HomeMy WebLinkAbout11-15-11 (2)•
J 1505610140
REV-1500 ~` `°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box 2aasol 2 1 1 1 0 9 4 8
Harrisburg PA 17128-0601 RESIDENT DECEDENT _
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW
2 0 1 1 8 5 1 0 2 0 8 0 6 2 0 1 1 0 3 3 1 1 9 2 6
Decsdent's Last Name Suffuc Decedent's First Name MI
E B E R L Y D O R O THY L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Nam® Suffuc Spouse's First Name
Spouse's Social Security Number
FILL INAPPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
® 1.Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
pnor to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 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 ^ 'I 1. 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 T0:
Name Daytime Telephone Number
R O G E R B I R W I N E S Q U IRE 7 1 7 2 4 9 2 3 5 3
First line of address
I R W I N &
Second line of address
6 0 W E S T
City or Post Office
C A R L I S L E
REGISTER ~ C 1 USE (ZNtY
r '7 ,,. _
7
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M c K N I G H T, P C' c.`' ;, u l
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P O M F R E T S T R E E T ~ ~~~+ ~=':' --
-~° ' .•~
State ZIP Code ~7E FILED ._m
P A 1 7 0 1 3
3
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a
ComespondsnYs e-maH address:
UrWer penalties of perjury, I declare that I have examined this return, induding aocomparrying schedules and statements, and m the hest of my knowledge and belief,
k is true, aorreet and canplete. Dedaretion of preparer otiier than fjte personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PER,90N RESP04jSIBLEf~Fj/fILIN~ RETU DATE ~
ADDRESS l/ ~
16 N• CORPORATION STREET
SIGNATURE OF PREPpF~RpTHER THAN fjEPRES
60 WEST POMFRE'I~.~TREET CARLISL
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140
PA 17241
DAT
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PA 17013
1505610140
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REV-1500 EX Page 3
pecedent's Complete Address:
Flre Number
21 11 0948
DECEDENTS NAME
DOROTHY L. EBERLY
STREET ADDRESS
16 N. CORPORATION STREET
CITY
NEWVILLE STATE
PA ZIP
17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1)
2. CreditslPayments 676.39
A. Prior Payments
B. Discount 35.60
Total Credits (A + B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Llne 20 to request a refund:
711.99
711.99
(4) 0.00
5. If Une 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 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 December 12,1982, did decedent transfer property within one year of death
^
without receiving adequate consideration? .......................................................................................
?
' ^
.........
or payable-upon~ieath bank account or security at his or her death
3. Did decedent own an "intrust for
Did decedent own an individual retirement acx:ount, annuity or other non-probate property, which
4
.
contains a benefaary 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
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, unde
Section 9102, as an individual who has at feast one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (8-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOROTHY L. EBERLY 21 11 0948
Include the proceeds of litigation and the date the proceeds were received by fhe estate.
All propel'ty 7oirMlyAwned with fight of survivorship must be dkcbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2002 DODGE CARAVAN SE 4,100.00
VIN: 164G P253026667146
2. M&T BANK -CHECKING ACCOUNT #7080383 2,873.25
3.
M8~T BANK -SAVINGS ACCOUNT #15004218082523
14,880.14
TOTAL (Also enter on line 5, Recapitulation) ~ S 21
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DOROTHY L. EBERLY 21 11 0948
l~cedeM's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
S4eet Address
City State 21P
Year(s) Commission Paid:
Z, AttomeyFees: IRWIN & MCKNIGHT, P.C~ 1,600.00
3, Family Exemption: (If decxidents address is not the same as claimants, attach explanation.) 3, 500.00
Claimant JOHN H. EBERLY, JR.
Street Address 16 N. CORPORATION STREET
c;ry NEWVILLE state PA zIP 17241
Relationship of Claimant m Decedent SON
4. probate Fees: REGISTER OF WILLS 117.50
5 Accountant Fees:
6. Tax Retum Preparer Fees: PATRICIA A. ROSENDALE, CPA 375.00
7. REGISTER OF WILLS -FILING FEE 30.00
8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
9. THE SENTINEL -ESTATE NOTICE 189.54
10. NOTARY FEES 20.00
TOTAL (Also enter on Line 9, Recapitulation) I S ~ nn~ ne
If more space is needed, use additlonal sheets of paper of the same size.
REV-1512.FJC+ (12-OB)
• Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8~ LIENS
ESTATE OF FILE NUMBER
DOROTHY L. EBERLY 21 11 0948
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbun>;ed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. QUANTUM {MAG{NG AND THERAPEUTIC -MEDICAL 57.71
2. PINNACLE HEALTH EMERGENCY -MEDICAL 62.06
3. SPIRIT PHYSICIAN SERVICES, INC. -MEDICAL 4.50
TOTAL (Also enter on Line 10, Rec~ituVation) f S 124.27
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FEE MBER:
DOROTHY L. EBERLY 21 11 0948
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Indude ought s usal distribut]ons and Uansfers under
Sea 91 i6 (a~1.2).]
1. JOHN H. EBERLY, JR. Lineal 5,274.03
16 N. CORPORATION STREET 1/3 REMAINDER
NEVWILLE, PA 17241
2. KAREN L. KARATHANASIS Lineal 5,274.03
230 N. BALTIMORE AVE. 1/3 REMAINDER
MT. HOLLY SPRINGS, PA 17065
3. MICHAEL E. EBERLY Lineal 5,274.02
PO BOX 69, 105A RICE LANE 1/3 REMAINDER
BENDERSVILLE, PA 17306
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
jI, NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I S
ff more space is needed, use additional sheets of paper of the same size.
~.
LAST WILL AND TESTAMENT
I, DOROTHY L. EBERLY, of Penn Township, Cumberland County, Pennsylvania,
declare this to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils
heretofore made by me.
1. I direct my Executors to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my Executors to sell any realty owned by me at my death and
not specifically devised herein, at either public or private sale, and to give good and sufficient
deeds therefor, in fee simple, as I could do if living.
3. I devise and bequeath all of my estate of every nature and wherever situate to my three
children, share and share alike, the child or children of any deceased child taking the share their
parent would have taken if living.
4. I nominate and appoint JOHN H. EBERLY, JR., MICHAEL E. EBERLY and
KAREN L. KARATHANASIS to be the Executors of this my Last Will and Testament; they are
to serve as such without bond.
5. I hereby suggest that my personal representative retain the services of Irwin &
McKnight as attorneys in the settlement of my estate. ~? ~ '
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n --._ 1 r-', r"~
r.~m
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-~°' ~•~ G
ACKNOWLEDGMENT AND AFFIDAVIT
WE, DOROTHY L. EBERLY, MARTHA L. NOEL and SHARON L. SCHWALM,
the Testatrix and witnesses respectively, whose names are signed to the foregoing instrument,
being fast duly sworn, do hereby declare to the undersigned authority that the Testatrix signed
and executed the instrument as her Last Will and Testament, that she had signed willingly, that
she executed it as her free and voluntary act for the purpose herein expressed, and that each of
the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that
to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of
sound mind and under no constraint or undue influence.
/~L~.d_s~.l~ ~.
. SHA N L. S ALM
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by DOROTHY L. EBERLY, the
Testatrix herein, and subscribed and sworn to before me by MARTHA L. NOEL and
SHARON L. SCHWALM, witnesses, this 13th day of October, 2004.
~.~
Public
Wolar~l seal
Roper B. IrvNn, ~Y Public
Carlisle Bao. CumaeAar,d Cournp
AM Corn Expkes Oct. 3, 2008
lutember, Pennsylvania Assnciatinn nr N~-s.;o~
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J.~1a1
499 Mitchell Road, Millsboro, DE 19966 Adjustment Services
Irwin and McKnight PC
60 West Pomfret Street
Carlisle, PA 17013-3222
Re: Estate of Dorothy L Eberly
Social Security: 201-18-5102
Date of Death: Au>?ust 6.2011
Phone 888-502-4349
Fax (302) 9342955
August 29, 2011
~~~~~
AUG 31 2011
~~w~r~ ~ Me~tN16Ff i
s~AW DFFICE~
Dear Sir or Madam:
Per your inquiry on August 16, 2011, please be advised that at the time of death, the above-named decedent had
on deposit with this bank the following:
1. Type of Account Checking Account
Account Number 7080383
Ownership (Names o, fl Dorothy L Eberly
John H Eberly Jr (POA)
Opening Date 09/01/67
Balance on Date of Death $2,873.25
Accrued Interest $ .00
Total $2,873.25 ---------------
2. Type of Account Savings Account
Account Number 15004218082523
Ownership (Names o, fl Dorothy L Eberly
John H Eberly Jr (POA)
Opening Date 08/14/08
Balance on Date of Death $14,879.94
Accrued Interest $ .20
Toral $14,880.14