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Home My WebLink About12-12-11 (2) REV-1500 ~ ~°~-,°, PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 1505610140 OFFICIAL USE ONLY _ INHERITANCE TAX RETURN County Code Year File Numt~er ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT 2 1 1 1 Social Security Number 0 9 3 0 Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 8 7 0 3 9 8 6 4 0 8 2 0 2 0 1 1 0 6 1 1' Decedent's Last Name .~ 9 1 1 O L S O N Suffix Decedent's First iName A N D MI (If Applicable) Enter Survivin R E W S Spouse's Last Name g SP°use's I°f°rrnation Below Suffuc Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN AppROPRIATE OVALS BELOW REGISTER OF WILLS ^X 1.Original Return ^ 2. Sup?lemental Return ^ ^ 4. Limited Estate 3. Remainder Return (date of death ^ 4a. Future Interest Compromise (date of Prior to 12-13-82) ® 6. Decedent Died Testate death after 12.12-82) ^ 5. Federal Estate Tax Return Required (Attach Copy of Will) ^ ~• Decedent Maintained a Living Trust ^ 9. Litigation Proceeds Received (Attach Copy of Trust) -- 8. Total Number of Safe ^ 10. Spousal Poverty Credit (date of death Deposit Boxes CORRESPONDENT -THIS SECTION MUST BE COMPLETED.. AFL CORRESPONDENCE AND ^ 11 Election to tax under Sec. 9113(A) Name (Attach Sch. O) CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: M A R C U S A M c K N I G H T III D7 "ie Telephone Number 7 2~ 9 2~5 3 REGISTER ~ -~ r~ First line of address -; ~ ^~LS USE ~1~ I ~ ~ ~M. } __. - R W I N 8 M c K N I G H T P C ~, Second line of address ~" ~ y ~~ W E S T P O M F R E T S T R E E T ~ ~-~-' City or Post Office ~' ~' ~ <- State ZIP Code DATE FILED C: - C A R L I S L E P A 1 7 0 1 3 Correspondents a-mall address; Under penalties of pery'ury, I declare that I have examined this return, including accom n it is true, correct and complete. Declaration of re SIGNATURE OF Flit P parer other than the ~ ~"~ s~edules and statements, and to the hest of my knowledge and belief, ~/! Personal representative is based on all information of which SON RE PONSIBLE FO FI NG RETURN ~,L„ A'~t,~ "T ~ f.~ ~~ P-eparer has any knowledge. ADDRESS DATE n ~ . u.upJ RyU~I"E 22 SIGNATURE OF PREPA TbIEp T~I• qN REPRESENTATIVE HUGHES V ~ ~ 4DDRESS ~0 WEST POMFRET E PLEASE USE ORIGINAL FORM ONLY I L Side 1 1505610140 ~I PA 17737 DATE !~ 'A 17013 1505.610140 ~,./ tN J 1505610240 REV-1500 EX ' Decedent's Social Security Number Decedents Name: ANDREW S• O L S O N 0 8 7 0 3 9 8 6 4 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 2. Stocks and Bonds (Schedule B) ...................................... 2. 3. Closely Held Corporation, Partnership or Sole-Propriatorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 5. Cash, Bank De osits and Miscellaneous Personal Pro e P p rty (Schedule E)....... 5. 6 5 6 8 7. 4 9 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ S t Billi R epara e ng equested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 6 5 6 8 7. 4 9 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ...... 9. 8 1 3 8. 0 2 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 1 5 5. 1 9 11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 8 2 9 3. 2 1 12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. $ 7 3 9 4 . 2 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................ .... .. 13. 5 7 3 9 4 . 2 8 14. Net Value Subject to Tax (Line 12 minus Line 13) ................ .... .. 14. 0 . 0 0 TAX CALCULATION -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 .o _ D. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0. 0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0, 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. 0 0 19. TAX DUE ................................................ .... .. 19. 0 • 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 - ~ 1505610240 1505610240 J ` ~ Continuation of REV-15001nheritance Ta x Return Resident Decedent ANDREWS. OLSON Decedent's Name ' Page 3 21 11 0930 File Number Correspondents Name M A R C U S A M c K N I G H T Daytime Telephone Number I I I 7 1 7 2 4 9 2 3 5 3 First line of address I R W I N & M c K N I G H T Second line of address P C . 6 0 W E S T P O M F R E T S T R E E T City or Post Office C A R L I S L E State ZIP Code °P A 1 7 0 1 3 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, indudin accom n 'n s it is true, correct and complete. Declaration of preparer other than the 9 ~ ~ 9 chedules and sta~ments, and to the best of my kr SIGNATURE OF PE RESPO IB Fp personal representative is based on all Infonhation of which re IN ETURN P Parer has ar ADDRESS I 103 CHIPp~~n,n o..... //- REV-1500 EX Page 3 Decedent's Complete Address: ncnrnr-.~~....... __ STREET ADDRESS '70 S. HANn~. CITY CARLISLE Tax Payments and Credits: 1 • Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest 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. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLAC 1. Did decedent make a transfer and: ING AN "X" IN THE APPROPRIATE BLOCKS a. retain the use or income of the property transferred; Yes b. retain the right to designate who shall use the property transferred or its income; No 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~feath bank account or security at his or her death? ^ X 4. Did decedent own an individual retirement account, annuit or other non- robate ro y ......... [] contains a beneficiary designation? ............................................ P P party, which ..................................... a F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate im o AND FILE IT AS PART OF THE RETURN. 3 percent [72 P,S. §9116 (a) (1.1) (i)]. P sad on the net value of transfers to or for the use of the su For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or rviving spouse [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the s filing a tax return are still applicable even if the surviving spouse is the only beneficiary. for the use of the surviving spouse is 0 percent tatutory requirements for disclosure of assets and 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 dea adoptive parent or a stepparent of the child is 0 ~ The tax rate imposed on the net value of transfers toeortfor the usegof the )decedent's lineal th to or for the use of a natural parent, an 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. beneficiaries is 4.5 percent, except as noted in ~ The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent 72 P ~' Section 9102, as an individual who has art least one parent in common with the decedent, whether by blood(or a ••>. §9116(a)(1.3)]. Asibling is defined, undE dopfion. File Numh~er 21 11 0930 STATE PA ZIP 17013. (1) 0.00 Total Credits (A + B) (2) 0.00 (3) (4) 0.00 REV-1508 EX + (g_gg COMMONWE,gLTH OF PENNSYLVANIA CASH, ANK DEpULE E INHERITANCE TAX RETURN OSITS, a MASC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF 4NDREW S. OLSON FILE NUMBER Include the proceeds of lidgatbn and the date the y 21 11 0930 ITEM All properly jointly.oWAed ~ fight of survhrorshipmd~ ~ dhocl cn ~ ~ ~ F. NUMBER ~• VANGUARD -PRIME MONEY MARKET FUND 0030-88012655452 VALUEAT DATE OF DEATH 59,095.64 2• PNC BANK _ CHECKING ACCOUNT #5003811274 6,591.85 --~_ (If more space is needed, insert addfional sheets of thAe same size) Ilse 5, Recapitulation) $ REV-•IS~t Ex+(~aosl ATE OF Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL FJ(pENSES AND ADMINISTRATIVE COSTS Decedents debts must be reported on Schedule I, t ITEM NUMBER ---~_ A. FUNERAL EXPENSES: DESCRIPTION 1. HOFFMAN-BOTH FUNERAL HOME ~- ADMINISTRATIVE COSTS: ` 1 • Personal Representative Commissions: Name(s) of Personal Representative(s) DAVID NELSON Street Address 8165 ROUTE 220 --__ cry HUGHESVILLE .__~ Year(s) Commission Paid: ~~ PA ZIP 17737 2• AttomeyFees: IRWIN & McKNIGHT, P.C~ 3• Family Exemption: (If decedents address is not the same as daimanPs, attach explanation.) Claimant Street Address ~_~_ City ~~ Relationship of Claimant to Decedent State -~---- ZIP _ _~- 4' Probate Fees: REGISTER OF WILLS ~ ~- B. 5. 6. Accountant Fees: Tax Retum PreparerFees: PATRICIA A. ROSENDALE, CPA ~• REGISTER OF WILLS -FILING FEE 8• CUMBERLAND LAW .JOURNAL -ESTATE NOTICE 9• THE SENTINEL -ESTATE NOTICE . 10. NOTARY FEES If more space is needed, use additional sheets ofT~ Also enter on Line 9, Recapitulation) ~ paper of the same size. AMOUNT 81.36 1,600.00 4,000.00 141.50 375.00 30.00 75.00 200.16 35.00 1 • Continuation of REV-1500 Inheritance Tax Return Re sldent Decedent ANDREW S. OLSON Decedent's Name Pagel 21 11 0930 File Number Schedule H -Funeral Expenses 8 Administrative Costs - B1 ITEM • NUMBER B• ADMINISTRATIVE COSTS: DESCRIPTION AMOUNT Personal Representative Commissions: 2' Name(s) of Personal Representative(s) ANN MCMAHAN Street Address 103 CHIPPEWA ROAD 1,600.00 City PENNSDALE state PA Zlp 17756 Year(s) Commission Paid: SUBTOTAL SCHEDULE H-81 1,600.00 REV-1512 FJC+ (12.08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SDHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS NDREW S. OLSON FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreOm ursed medical ex ITEM NUMBER penses. DESCRIPTION VALUE AT DATE 1• MILLENNIUM F'HCY. SYSTEMS MECHANICST -MEDICAL OF DEATH 155.19 TOTAL (Also enter on Line 10, Recapitulation) I $ If more space is needed, insert additional sheets of the same size. 155 1 REV-1513 EX+ (01-10? pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ~~~~,~~ ter: ANDREW S. OLSON NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY j, TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under Sec. 91 6 (a) (1.2).) 1. :?1 4TIONSHIP TO Do Not Ltst Tn Collateral 1 )UNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER MEET, AS APP NON-TAXABLE DISTRIBUTIONS: ROPRIATE. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 1 2 3. i B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: GOSPEL ASSOCIATION FOR THE BLIND PO BOX 62 DELRAY BEACH, FL 33447 1,000.00 FIRST ALLIANCE CHURCH BOX 8204 HENDERSON, NC 28793 1,000.00 AMERICAN CANCER SOCIETY 1500 NORTH 2ND STREET HARRISBURG, PA 17108 1,000.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. 57 • Continuation of REV-1500 Inheritance Tax Return Reside nt Decedent ANDREW S. OLSON Decedent's Name Page 2 21 11 0930 File Number Schedule J -Beneficiaries - 26 II• B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 4• AMERICAN HEART ASSOCIATION 1019 MUMMA ROAD WORMLEYSBURG, PA 17043 1,000.00 5• CHAPEL POINTE HONOR SOCIETY -ALLIANCE HOME 700 NORTH HANOVER STREET 53,394.28 CARLISLE, PA 17013 SUBTOTAL SCHEDULE J•26 54,394.28 LAST SILL AND TESTAMENT f' ANDREW SVEN OLSON, of the Bomugh of Carlisle Penns lvaau ' Cumba'land County, Y a, declare this instrument to be my Last Will and T' revoking all Wills and estament, hereby expressly Codicils heretofore made by me. ONE: I direct my Executrix to pay all of my debts, funeral and as soon as may be done conveniently after my decease. strative expenses TWO: I give, devise, and bequeath all of my estate of every nature ~ aherevei, si tO my wife, ~V7LMA MARY OLSON. ~~' TxR___.F.: If my wife, WII,~ ~Ry OLSON, lass predeceased me, I specifically give, devise, and bequeath all of the coins and military patches to DERiCK OLSON. FOUR: If my wife, WII,,~j May OLSON has r P edeceased me, then I specifically give, devise, and bequeath to the following: a. To the GOSPEL ASSOCIATION FOR TIRE BLIND P. O. Box 62 Delray Beach, Florida 33447. . .............. S 1,000.00; b. To the FIRST ~LIANCE CHURCH BOX $20t~ Henderson, North Carolina 28793.. . ......... S 1,000.00; c• To the AMERICAiv CANCEg SOCIETY 1500 North 2°~ Street H~b~, PennsYlvania 171 ............... $1,000.00; d. To the AMERICAN BART ~~IATION 1019 Mumma Road Wormleysburg, pennsYlvania 17(?43 ..... . ... $1,000.00; FIVE: If my ~, WII,MA MARY OLIN, ~ Posed me I devise, and ' glue, bequeath all the rest, residue, and remainder of my estate of every nahue wherever situate to the CHAPEL PO ~ 1Q11TE HONOR 30CIL'Ty at the Alliance Home, 700 North Hanover Street, Carlisle, Pennsylvania 17013. SIX. I aP~int my fie' 'B'MA MARY OLSON, to serve as Executrix Last Will. If she has °f this mY Predeceased me, failed to quali fj;, or c eased to serve as Exec DAVID NELSON of 8165 Route 220, Iiu~~ville P ~' I appoint M ~ ennsylvania 17737 and A1~TN ~MAHAN, of 103 Chippewa Road, Pennsdale, Pennsylv~a 17756 tp be the C _ of this my Last Will. o Executors 2 5=~. x: M ~ Y ecutrix maY, at her discretio n, compromise claims, borrow money, retain P~P~y for such length of time as she may deem Proper, lease and sell prices, on such terms at ublic or p1Op~Y for such ' P Private sales, as she ma deem ProP~Y and income without restriction to le Y per' ~ invest estate gal investments, -~: No Executrix or Executor, ac ~ ~'eunder shall be required to post bond or enter security in this or any jurisdiction. IN WITNESS WHE , pF, I have hereunto set my hand and seal this ~d~ August, 2000. day of 0 'Man' ~) ~,~,, (SEAL) ][tEW SVEN OLSON Signed, sealed, published and declared by A1VD , q, S~ O~ON, the abov named Testator, as and for his Last Will and Testament, in the e Presence of us, who, at his request and in his presence and in the presence of each other have subscribed our names as wi hereto, tresses 3 ACKNpWI,EDGMEIVTRND AFFIDAVIT WE, ANDREW SVEN OLSON, CHERYL L. CLELAND and MARTHA L. N the testator and witnesses re OEL, spectively, whose names are signed to the foregoing instnuent, being first duly sworn, do hereby declare to the undersigned authority that the testator si executed the instrument as his Last Will, and that he had si ~ geed and g`n willingly, and that he executed it as his free and voluntary act for the P~pose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to knowledge the testator was, at that time, eighteen years of a or old the best °f then ge er, of sound mind and under no constraint or undue influence. ~N~ESw A ~rtM ~ ~q e,~, AND w svEN oLSON CHER L.CLELAND ~~ - ~ THA L. OEL COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: Subscribed, sworn to and acknowledged before me b testator herein and subscribed and sworn to before me bye CHERYLW L VOLE SON' the MARTHA L. NOEL, witnesses, this 10~ day of August, 2000. LAND and ~' Notary lc Betzi A Mo~so , NotaFy Public Carlisle Boo, Cumberia~d MY Commisstor: Expires Dec. 15, ~0(lIdIOR Of IIOfBAlB ~~ tt_aa~ r~ w~-Y September 28, 2011 Marcus A McKnight lu Esq. kwin & McKnight P.C. 60 W Pomfret St Carlisle, PA 17013-3222 RE: Andrew Olson SSN: 087-03-9864 DOD: 08-20-2011 Dear Mr. McKnight: iuo, 4U~4 r, ~~ ~ In response to your request for Date of Death (DOD) balances for the customer noted above, our records sk~ow the following: Checking Account Account # 5003811274 Established: 05-OS-2001 ANDREW OLSON DOD balance: ~ 6,591.85 non interest bearing Please note tbat tbas o~tce provides date of death batances for deposit accountSR (IRAs, CDs, Checking and Savings). We do not process any Fnancial transactions or provide statements. If you need assistance with any of these items, please call .1-888-PNC-BAIVZC (1-888-762-2265) or stop by yon local pNC Bantc branch office. sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileger~ confidential and exemptfrom disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strict! y prohibited. If you have received this communication in'error, please notify me immediately by reply or by telephone at 800-76Z-1775 and immediately destroy this faxed document. Dr,rto 1 of 1 Jul 31 Y , 2011, monthly transaction statement Page > ~ of ~ .--, 1 ANDREW OLSON & JT TEN WROS ~, ~"' ~~~ 770 S HANOVER ST `~ \`~~ ~ ~~ CARLISLE PA 17013-4105 ~~ Vanguazd• Voyager Services > 800-2847245 www.vangusrd.com ups Prime Money Mkt Fund ~0-~12B55462 7-day SEC yield as of 07/29/2011 * 0.02% Date Transaction Beginning balance on 6/30/2011 Amount Share Price Shares Transacted Total Shares Owned 07/08 Checkwriting 1035. $1.00 Value 07/29 Income dividend '$8,822.05 1 00 67,916.150 $67,916,15 -8,822.050 59,094.100 Ending balance on 7/81/Z011 1.54 1.00 1.540 59,095.640 $1.00 *Average annualized income dividend over the past 7 days. For updated information, visit v 59,095.640 x.095.64 anguard.com. 0 N N W N O ~,~a~e ~ S~aalu I .~~~. ~+~~cl~znd. G~O~,~-a ~~ ~~lr~ec~ Qtr ~ ~C~'~~1~ ir~~w~ww~w~r~w~wi~w~ ,, FUNERAL HOME ~ CREMATCIRY, INC. Dorothy Hostetter 5 Alliance Drive, Apt. 304 Carlisle, PA 171013 Statement of Funeral Expenses for: Andrew S. Olson Date of Death: August 20, 2011 . v~~r1V C. Immediate Cremation OPTION 5 -Cremation TOTa~ ~~ ~u~e-' ~ " 219 North Hanover Street Carlisle, Pennsylvania 17013 717.243.4511 toll free 1.866.451.4511 fax 717.243.3723 wwwhoff~m,~ if~narroth.corp September 9, 2011 Account Id: 16320-185 $ 1,890.00 Sub Total: $ 1,890.00 - ----~..~.~ ~~mc ~rrARGES: CASH ADVANCES: Germonds Cermetery 6 Certified Death Certificates at $ 6.00 each Shipping Of Cremains To Cemetery Coroner's Fee Payments Made: SecurChoice Check Irwin & McKnightVEstate Of Check $ 230.00 $ 36.00 $ 20.16 $ 2.5.00 Sub Total: ~otat Funeral Expense: Total Payments Made: $ 1,890.00 a - 3--1L16 $ 2,22,2 110. 8 $ 2,201.16 63980 Sep 1, 2011 2,119.80 30836 Sep 9, 2011 81.36 Balance: ~~ ------------- -------------- ___________ Please return this'portion with your Remittance, $ Amount Enclosed Andrew S. Olson Service ID#: 16320-185 S E R V,I N G OUR C O M M UNITY S~r.i~~ , ~.,,