HomeMy WebLinkAbout12-06-11EX (01-10)
J REV-150 ~ 15D5610143
_ OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
Po Box.28osoi INHERITANCE TAX RETURN 21 11 0 9 2 2
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
07 27 2011 03 05 1917
Decedent's Last Name Suffix Decedent's First N<3me MI
ANDREWS GERALDINE S
(tf 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 APPROPRIATE OVALS BELOW
® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Retum (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Retum Required
(date of death after 12-12-82)
~
Decedent Dietl Testate
® s.
^ ~ Decedent Maintained a Living Trust
f T
t
t
h C 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) rus
)
ac
opy o
(At
^ 9. Litigation Proceeds Received ^ 10• be~ueen12--31 y91 a~dit,di tge5of death ^ 11.Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GERALD J BRINSER 717 838 6348
First line of address
6 E MAIN STREET
Second line of address
PO BOX 323
City or Post Office
PALMYRA
State ZIP Code
PA 17078
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REGISTER OF WILLS USE ONLY
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Correspondent's a-mail address: j e r ry ~ b W Z I a W. C O m
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.
SIGN OF PERSOPIRESPONSIBLE FOR FILING URN uA i t
Cynthia A. Parson // - ~ ~ - //
ADDRESS ~/
72 Maranatha Drive, Marysville, PA 17053
SIGNATURE EPARER OTHER THAN RE RESENTATIVE DATE
_ e / ~~~ _ .: Gerald J Brinser l ~~Z ~~~
6 E. Main Street, Palmyra, PA 17078
Side 1
1505610143 15D5610143 J
J 1505610243
REV-1500 EX
Decedent's Social Security Number
~ecedenrsNeme: ANDREWS GERALDINE S.
RE CAPITULATION
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 & Notes Receivable (Schedule D) ...................................................... .... 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. ... 5. 6 8 , 6 8 6.17
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .......... ... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .......... ... 7.
8. Total Gross Assets (total Lines 1-7) .................................................................... ... 8. 6 8 , 6 8 6.17
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... ... 9. 2 , 4 4 0 . 5 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 4 , 9 4 6.14
11. Total Deductions (total Lines 9 & 10) ................................................................... ... 11. 7 , 3 8 6 . 6 4
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... ... 12. 6 1 , 2 9 9 . 5 3
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. 6 1 , 2 9 9 . 5 3
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 .00 15.
16. Amount of Line 14 taxable
at lineal rate x .045 61 , 2 9 9. 5 3 16. 2, 7 5 8. 4 8
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. 2, 7 5 8. 4 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
L 15D5610243 1505610243 J
REV-1500 EX Page 3
Decedent's Complete Address:
Andrews, Geraldine S.
T ADDRESS
Messiah Village
100 Mt. Allen Drive
Mechanicsburg
File Number 21 - 11 - 0922
STATE ZIP
pA 17055
Tax Payments and Credits: (1) 2,758.48
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments 2,570.00
B. Discount 135.26
Total Credits (A + B) (2) 2,705.26
(3) 0.00
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund
(5) 53.22
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT.
.F
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
1. Did decedent make a transfer and:
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? .......................................................................................................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ 0
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 4UESTIONS 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. '§9196 (a) (1.1) (i)].
For dates of death on or((after Januarryy 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
assets and flingaa taxlretu n are stllaapplicable even hpe surviv ng spouse s1 the only benefc ary.' and the statutory requirements for disclosure of
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) . A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, wfiether by bloo~ or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Andrews, Geraldine S.
SCHEDULE E
CASH, BANK DEPOSITS, 8~ MISC.
PERSONAL PROPERTY
FILE NUMBER
21 -11 - 0922
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.
VALUE AT DATE OF
ITEM DESCRIPTION DEATH
NUMBER
8
1st National Bank of Marysville -Checking Account #100102719
49, 587.82
(Includes accrued interest of $32.53)
9 1st National Bank of Marysville -Savings Account #200125206
613.94
(Includes accrued interest of $.09)
10 PNC Bank -Checking Account #5005152882 14,185.31
570.43
11 Highmark -Refund
3,704.67
12 Brown Funeral Home -Refund
24.00
13 Cash on Hand
TOTAL (Also enter on Line 5, Recapitulation) I 68,686.17
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCFEDULE H
FUPEFtAi- E~ 8~
gpMNSTRATNE C~06TS
ESTATE OF Andrews, Geraldine S.
FILE NUMBER
21 - 11 - 0922
pebts of decedent must be reported on Schedule I.
ITEM DESCRIPTION
NUMBER FUNERAL EXPENSES:
A. 1 Rice Memorial Works -Tombstone Inscription
B. ADMINISTRATIVE COSTS:
~. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission paid
2. Attorney's Fees !Brinser, Wagner & Zimmerman -- Gerald J. Brinser
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
AMOUNT
135.00
2, 000.00
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills (Ctrs. Pd. $135.00 = $50,000 - $75,000) 200.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
8 Register of Wills -Additional Cost of Letters 75.00
TOTAL (Also enter on line 9, Recapitulation) 2,440.50
Schedule H
Funeral F~ertlses &
COMMONWEALTH OF PENNSYLVANIA ~ /+„~.b
INHERITANCE TAX RETURN VWi~
RESIDENT DECEDENT
ESTATE OF Andrews, Geraldine S.
9 Register of Wills -Filing Fees (REV-1500 & Inventory)
FILE NUMBER
;? 1 - 11 - 0922
30.00
Page 2 of Schedule H
COM.AONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
ESTATE OF Andrews, Geraldine S.
FILE NUMBER
21 - 11 - 0922
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION
NUMBER
8 Outstanding Check at Time of Death (Messiah Village)
9 Alert Pharmacy
AMOUNT
4, 887.00
59.14
TOTAL (Also enter on Line 10, Recapitulation) I 4,946.14
REV-1513 EX+ (11-08)
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
c,ncniT nct`Fr]FNT
SCHEDULE J
BENEFICIARIES
ESTATE OF Andrews, Geraldine S.
RELATIONSHIP TO
NAME AND ADDRESS OF PERSON(S) DECEDENT
NUMBER RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS[include outright spousal
f
~ ers
distributions, and trans
under Sec. 9116 (a) (1.2)]
1 Cynthia A. Parson Daughter
72 Maranatha Drive
Marysville, PA 17053
2 Carl Andrews, Jr. Son
355 Owl Hollow Raad
Millerstown, PA 1 X062-9222
3 David S. Andrews Son
705 Hominy Drive
Newport, PA 17074-8020
I FILE NUMBER
21 -11 - 0922
SHARE OF ESTATE AMOUNT OF ESTATE
(Vllords) ($$$)
1~'3 Residue
1,~3 Residue
1/3 Residue
20,433.18
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet., as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
20,433.18
20,433.18
TOTAL OF PART II - (ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-'1500 COVER SHEET( 0.00
~~~~ ~ ~~~
WILL ~ ° ~ `
~~~~,..;, ~ ~ t 4.1
OF
GERALDINE S. ANDREWS
I, GERALDINE S. ANDREWS, currently of Rye Township, Perry County,
Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all
prior Wills and Codicils made by me.
L I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence
of my death, shall be paid out of the principal of my general estate to the same effect as if
said taxes were expenses of administration and all property includable in my taxable
estate whether or not passing under this Will shall be free and clear thereof.
III. I bequeath unto my husband, Carl G. Andrews, all tangible personal property
which I own at my death.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including property over which I hold a power of appointment, I devise and
bequeath unto my husband, Carl.
V. In the event that my husband, Carl, does not survive me, I devise and bequeath
my entire estate that would have otherwise passed under Paragraphs III and IV above
equally unto my children, Cynthia A. Parson, Carl Andrews, Jr. and David S. Andrews or
their issue per stirpes. If any child predeceases me leaving no issue said share shall lapse
and be added to the shares passing to my other children or their issue per stirpes.
VI. I appoint my husband, Carl G. Andrews, Executor of this my Will. In the event
that he fails to qualify or ceases to act as Executor, I appoint my children, Cynthia A.
Parson, Carl Andrews, Jr. and David S. Andrews, Co-Executors of this my Will.
VII. I direct that no bond be required of my fiduciary for the faithful performance of
her duties in any jurisdiction.
IN WITNESS WHEREOF, I, GERALDINE S. ANDREWS, herewith set my
hand to this my Last Will, typewritten on two (2) sheets of paper inc;luding the attestation
clause and signatures of witnesses, this {~,,j~ day of T~~E , 2007.
~''7 ..~ s~~u•~~- ~ u .~ (SEAL)
h ..Z`LU~-~no f
GERALDINE S. ANDREWS
Signed by GERALDINE S. ANDREWS, by her declared t:o be her Will in our
presence, who have hereunto subscribed our names as witnesses in her presence and at
her request, this {~.,~ day of ~'~N~ , 2007.
~ residing at~~ ~~~
,1~ residing at ~ c~ i~~a~ ~,~Q
-2-
a
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF L~Q,IANON
WE, GERALDINE S. ANDREWS, C`IISS~r~ '~• PRR~~ and ~~V1'~ ~•
ANDREA ~ ,the testatrix and the witnesses, respectively, whose names are signed to the
attached or foregoing instrument, being first duly affirmed, do hereby declare to the
undersigned autharity that the testatrix signed and executed the instrument as her Last
Will and that she signed willingly (or willingly directed another to sign for her), and that
she executed it as her free and voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the testatrix, signed the Will as
witnesses and that to the best of our knowledge the testatrix was at that time eighteen
years of age or older, of sound mind and under no constraint or undue influence.
t
U'~RALDINE S. ANDREWS
~~
WI ESS
n ,
I'Va-~~ ~
WITNESS
Subscribed, sworn or affirmed and acknowledged before me by (3-~{t~R1.DlNE ~•
~NORE~S the testatrix, CyNTt1~~A ~, ~1RS4r1 and p~A~ll~ S. AND'REU)~
witnesses, this 12~day of JANE , 2007.
(SEAL)
NOTARIAL SEAL
IAARILYN K. PEIFFER, NOTARY PIIM-~ Otftry 11C
PA~IYRA BORO., LEBANON COUNTY
COMMISSION EXPIRES OCT. 6, 2007
-3-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PARSON CYNTHIA A
72 MARANATHA DRIVE
MARYSVILLE, PA 17053
fad
REMARKS: RECEIPT TO ATTY
SEAL
CHECK# 98
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
TOTAL AMOUNT PAID:
INITIALS: WZ
RECEIVED BY:
TAXPAYER
REV-1162 EX111-96)
NO. CD 015123
AMOUNT
52,570.00
GLENDA EARNER STRASBAUGH
REGISTER C-F WILLS
FAX N0. 7178968599
NOV-21-2011 MON 10 54 AM HALIFAX BANK
November 21, 201 ]
Gerald J t3rir-sar
Brinser, Wagner, d'z ZimmeiTnao
G East Main Street-Secdnd Floor
PO f3ox 323
Palmyra, PA 17078
Account Number(s)
~i~ve~vg~~ ]Q~~ll~
RE: Geraldine S Andrews
DOll: 7/27/201 l
SS#:
100102719
Type of Account Cheelcing
Date Opened December 17, 2009
Principal Balance at date of death $49,555.30
Intcrust Rate 0.5990'%
Accrued Interest not
disliursed as of date of death
Maturity Date;
Primary Owner of Account
Name of Joint Owner(s), if any
13encficiary, if ctny
Date Joint Ownership was
Estab I ishad
iF within 1 year of death of
Decedent could prior 14ccount
13e traced into a prior Joint
Account in existznce over
1 year prior to death oJ'
Dccc:dent
$32.52
N/A
Geraldine S Andrews
Nona
None
N/A
N/A
200125206
Savings
DtccmUer 17, 2009
$G13.85
0.1000°/u
$0.09
N/a
Geraldine S Andrews
None
None
N/A
N/A
P. 02
Sate Deposit Box(s) and Location
By.
T_.eslie R Miller
Sep. 21. 2011 10:40AM PNC BANK
~~
LEADfNG THE WAY
September 21, 2011
Gerald Brinser
Attorney at Law
6 E Main St 2"~ Fl
P O Box 323
Palmyra, PA 17078
RE: Geraldine C Andrews
SSN:
DOD: 07-27-2011
Deaz Mr. Bzinser:
No, 361! P, 1/'
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Checking Accounf Established: 08-09-2007
Account # 5005152882
GERALD C ANDREWS
DOD balance: $ 14,185.31 non interest bearing
CDs, Checking and
Please note that this ioffice ass an finanetal transactions oar provide ytatements~If you need assistance with
Savings). We do ndt proc y
soy of these items, please call 1-888-PNC-BANK (1-888'762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank, N.A.
lvlember FDIC
This message is irr~tended for the use of the indiviQi 1 d exem~tt~ mldisclosure underdapplicable law.
contain information that is privileged, confidentT P
If the reader of this message is not the intended recipient or the employee yr agent responsible for
delivering this merrage to the intended recipient, you are hereby notified that any dissemination,
distribution or copying of this communications ~=airtlctl~ P eo ~~ ore y telephone at 800-76211=775 and
communication in error, please notify me im Y Y P
immediately destroy this faxed document.
Page 1 of 1
si~-
~~
100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055
110702 225 07/31 /2011
CYNTHIA A~ PARSON
72 MARANA~THA DRIVE
1VIARYSVILJLE, PA 17053
Mrs. GERALDINE C. ANDREWS
TOTAL AMOUNT DUE $4 887.00
DATE DUE 08/31/2011
DATE
PTION
RATE nays/ I
units CHARGES GKtu~ ~ ~ or+~.'•..~
5,012.62
00
174 17.00 2,958.00 7,970.62
. 5,012.62 2,958.00,.
177.00 9.00 1.,593.00 4,551.00
00
-9 00
2 18.00 4,533.00
.
177.00 .
2.00 354.00 4,887.00
Balance Forward
* * * Enhanced Living * * *
07/17/2011 ELHS - ,IiTNIAT.~ SINGLE 07/01-07/17
07/18/2011 PAYMENT RECEIVED -THANK YOU!!!
* * * Enhanced Living * * *
07/26/2011 ELHS - DELAWARE SINGLE
07/18-07/26
07/27/2011 MEAL CREDIT
07/28/2011 ELHS -DELAWARE SINGLE
07/27-07/28
OVER 90 OVER 120 TOTAL AMOUNT DUE
RESIDENT # CURRENT OVER 30 DO OO 0 0.00 0.00 $4,887.00
110702 4,887.00 0.00
Form PB-Ot
NIA
RESIDENT NAME Mrs. GEgAI,DINE C. ANDREWS
'lease make check payable to Messiah Village.
~ 1% finance charge may be assessed on accountsour billlc lease addresssthem directly to Fis al Servucesaat•790-8220.oThank You!
If you have any questions on concerns about y ~ P
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