HomeMy WebLinkAbout01-13-12
1505610140
REV- V OO ~ (01 10) OFFICIAL USE ONLY
PA Departure t of Revenue County Code Year File Number
Bureau of Ind vidual Taxes INHERITANCE TAX RETURN
Po Box 2so 01 2 1 1 1 1 0 7 3
Harrisbur P 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORM ION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW
1 9 2 1 4 7 3~3 6 0 9 2 8 2 0 1 1 0 5 0 6 1 9 2 2
Decedent's Last Name ' Suffix Decedent's First Name MI
D U N K L E B~ R G E R D O R O T H Y W
(If Applicable) Enter Survivinr~ Spouse's Information Below
MI
'
Spouse's Last Name s First Name
Suffix Spouse
D U N K L E B ~ R G E R P A U L B
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
i
B
~
6. Decedent Died Testae ~ oxes
t
8. Total Number of Safe Depos
7. Decedent Maintained a Living Trust
(Attach Copy of Wilq l
9. Litigation Proceeds D
eceived
~ (Attach Copy of Trust)
10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
h
O
h S
A
.
)
c
ttac
between 12-31-91 and 1-1-95) (
CORRESPONDENT-THIS:
Name
C H R I S T O
N MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
H E R E R I C E 7 1 7 2 4 3 3 3 4 1
First line of address
M A R T S O N ', L A W
Second line of address
1 0 E H I',G H S T
City or Post Office
C A R L I S L',E
O F F I C E S
State
P A
ZIP Code
REGISTER OFy111LLS USE O~R~I
~ .:;.i
, -
;-~
- ~-- ,
r' c .,
_~
_ ~., ,
. -,-,
DATE AILED "-
1 7 0 1 3
Correspondent's a-mail ad rasa: C R I C E a~ M A R T S O N L A W• C O M
Under penalties of perjury, I declar that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief
sentative is based on all information of which preparer has any knowledge.
l
it is true, correct and complete. D repre
laration of preparer other than the persona
SIGNAT E OF P RSON R NSIBL LING RETURN DA
ADDRESS
643 W FIRST ST
EET BOILING SPRINGS PA 17007
SIGNATJdRj€ OF PA ER OT
~ ~ ER'THAN REPRESENTATIVE ` ' I A~~
ADD
10 E HIGH STRE T CARLISLE PA 17013
I
PLEASE USE ORIGINAL FORM ONLY
~i
Side 1
L 15056110140
1505610140
~~
.,~~
J
1505610240
REV-1500 EX Decedent's Social Security Number
1 9 2 1 4 7 3 3 6
De~denYsName: DOROTHY W • DUNKLEBERGER
RECAPITULATION
0 •
0 0
1. Real Estate (Schedule A) .......................................... . 1.
0. 0 0
2. Stocks and Bonds (Sched ule B) ..................................... . 2•
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. •
4. Mortgages and Notes Re ceivable (Schedule D) ........................ .. 4. •
3 8 4 6 5. 3 3
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5.
6.
Jointly Owned Property (
chedule F) ^ Separate Billing Requested .....
.. 6. 0. 0 0
7. Inter-Vivos Transfers & iscellaneous N-Probate Property
~ Separate Billing Requested .....
.. 7. 3 8 2 6 0. 4 3
(Schedule G)
i 8 7 6 7 2 5. 7 6
8. Total Gross Assets (to .
I Lines 1 through 7) .............
..............
9 5 6 5 2. 5 0
9. Funeral Expenses and A dministrative Costs (Schedule H) ................
.
. .
and Liens (Schedule I) ...........
bilities
Li
~ .. 10. •
10. Debts of Decedent, Mort ,
a
age
11. Total Deductions (total Lines 9 and 10) ............................. .. 11.
5 6 5
2.
5 0
12. Net Value of Estate (Li
..........................
e 8 minus Line 11)
..12. 7 1 0 7 3• 2 6
13. Charitable and Govem ental Bequests/Sec 9113 Trusts for which
13 0 • 0 0
an election to tax has n t been made (Schedule J) .................... .
..
14. Net Value Subject to T
....................
ex (Line 12 minus Line 13)
..14. 7 1 0 7 3 • 2 6
TAX CALCULATION - SEE I STRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxa le
at the spousal tax rate, r
transfers under Sec. 91 6
7 1 0 7 3. 2
6
15.
0.
0
0
(a)(1.2) x.o _.
16. Amount of Line 14 taxa ~le 0 0 0 16 0 ' 0 0
at lineal rate X .045 i .
17. Amount of Line 14 taxab le 0 0 Q 17. 0 • 0 0
at sibling rate X .12 I
18. Amount of Line 14 taxal ple 0 0 0 18 0 ' 0 0
at collateral rate X .15 II, .
' 19.
0.
0
0
19. ;
TAX DUE ......... . .......... ........................... ..... ..
20. FILL IN THE OVAL IF ~(OU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
i
Side 2
150561240 1505610240
I_
REV-1500 EX Page 3 File Number
21 11 1073
Decedent's Complete Address:
DECEDENT'S NAME
DOROTHY W. DUNKLEBERGER
STREET ADDRESS
643 WEST FIRST STREET
CITY STATE ZIP I
(BOILING SPRINGS PA 17007
Tax Payments and Credits:
~ • Tax Due (Page 2, Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount Total Credits (A + B) (2) 0.00
3. Interest (3)
4. If Line 2 is greater than Line 1 + Line 3, ~nter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, ine 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, tenter 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 ir{ come of the property transferred : ...................................................................
...
d or its income;
f
t ...
... ^ ^
b. retain the right to d .........................
erre
rans
esignate who shall use the property
.....................
•••••••••• •~• ^
c. retain a reversiona
d. receive the romi ..............................................................
jry interest; or
e for life of either payments, benefits or care? .................................................... ... ^
th occurred afte
2. If dea ~ December 12,1982, did decedent transfer property within one year of death
^ ^
X
without receiving ad uate consideration? ....................................................................................
? ...
^ ^X
3. Did decedent own and ......
.intrust for' orpayable-upon-death bank account or security at his or her death ...
4. Did decedent own a ~ individual retirement account, annuity or other non-probate property, which
0
^
contains a beneficia designation? ............................................................................................... ...
IF THE ANSWER TO ANY OF THE A~OVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,194, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse i;
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan.1, 1 95, 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 statut 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 eve, if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2 00:
• The tax rate imposed on the net val a 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 val a 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( )(1 )].
• The tax rate imposed on the net val a 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 as at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
1~nRnT'HY W. DUNKLEBERGER
ITEM
NUMBER
t, Wells Fargo,
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 11 1073
Include the proceeds of litigation and the date the proceeds were receNed by the estate.
II property jolnUy-0wned with rl ht of survivorship must be disclosed on Schedule F.
VALUE AT DATE
DESCRIPTION OF DEATH
Account No. 1010233359122 ($38,462.96 + $2.37 accrued interest) 38,465.33
I
i
TOTAL (Also enter on line 5, Recapitulation) a 38 465.:
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (08-09)
penns~lvania
DEPARTMENT OF REVENUE
INHERrTANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
FILE NUMBER
ESTATE OF
DOROTHY W. DUNKLEBERGER 21 11 1073
This schedule must be completed and filed 'rf the answer to any of questions t through 4 on page three of the REV•1500 is yes.
DESCRI TION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
ITEM
NUMBER INCLUDE THE NAME OF THE TRAM
THE DATE OFTRANSFER. A FEREE, THEIR RELATIONSHIP TO DECEDENT AND
ACHACOPYOFTHEDEEDFORREALESTATE.
VALUE OF ASSET
INTEREST
(IFAPPUCABLE)
VALUE
2 00
100 82
443
1
1, Wells Fargo IRA Account N .8498 1,443.8 . .
,
Beneficiary Paul B. DunkleU! erger, husband
DOD value $1,443.82 (see at ttached)
16
082
1
100.00
1,082.16
2. Wells Fargo IRA Account Nl o. 9258 .
,
Beneficiary Paul B. Dunklel~ erger, husband
DOD value $1,082.16 (see aj
tional Life Insur
N
W
t ttached)
~nce Company
35,659.96
100.00
35,659.96
3. a
ern
es
Annuity Contract No. W22 9220 (see attached)
Beneficiary Paul B. Dunklel~ erger, husband
49
74
4. Wells Fargo Savings, Acco t No. 9754 (see attached) 74.49 100.00 .
Made joint on 2/22/2011 wif h Paul B. Dunkleberger, husband
TOTAL (Also enter on Line 7 Recapitulation) ~ $ 38,260.43
If more space is needed, use additional sheets of paper 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
FILE NUMBER
ESTATE OF
DOROTHY W. DUNKLEBERGER 21 11 1073
Decedent's debts must be reported on Schedule I.
ITEM AMOUNT
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
1.
g, ADMINISTRATIVE CONS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Addres$
City ' State ZIP
Year(s) Comr>hission Paid:
2 Attorney Fees: Marton Law Offices
g. Fatuity Exemption: (If d~cedenYs address is not the same as claimants, attach explanation.)
ClaimantPaul B Dunkleberger
Street Address 643 W First Street
City Boiling Springs State PA ZIP 17007
Relationship ~f Claimant to Decedent spouse
4. Probate Fees: Register of Wills
5 Accountant Fees:
g. Tax Return Preparer Fees:
7, Register of Wily, filing fee of inheritance tax return
TOTAL (Also enter on Line 9, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size.
2,000.00
3,500.00
137.50
15.00
.50
REV-1513 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
DOROTHY W. DUNKLEBERGER
SCHEDULE J
BENEFICIARIES
NUMBER NAME AND ADDRES OF PERSON(S) RECEIVING PROPERTY
1 TAXABLE DISTRIBUTIONS [I clude outrigh~spou j ;distributions and transfers under
i Sec. 9116 a)) 1.2.
1. Paul B. Dunlcleberger ',
643 W First Street
Boiling Springs, PA 170107
FILE NUMBER:
21 11 1073
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Spousal
AUNT OR SHARE
OF ESTATE
71,073.26
'' I I
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
H, NON-TAXABLE DISTRIBUTI NS:
A. SPOUSAL DISTRIBUTIO SUNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - EN~ER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
h If more space is needed, use additional sheets of paper of the same size.
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WESTERN J NATIONAL
Life Insurance C o m p a n y
P.O. Box 871
Amarillo, TX 79105-0871
1.800.424.4990
November 17, 2p11
PAUL DUNKLE~ERGER
643 W 1ST ST '',
BOILING SPRI~JGS PA 17007
Re: Contract ~: W229220
Deceased: D nkleberger
Dear Mr Dunkl~berger:
Thank you for y ur recent inquiry regarding the referenced annuity contract. It is our
pleasure to be c~f service to you.
The value of the contract as of 09/28/2011 was $35,659.96.
Should you have any questions or require further assistance, please contact our Client
Care Center at x,800-424-4990.
Sincerely,
~ ~~~
Brandon Pollre~isz
Annuity Claims Dept.
xl~d~~~e C~-3
~. F:\F1LES\DAiAFILE\Fstate Planning\10565.1.w.wi11.2000
r~, ~
LAST WILL AND TESTAMENT
I, DOROTHY W. DUNKI,EBERGER, of South Middleton Township, Cumberland
County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish
and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or
Codicils made by rrie.
1.
I direct thatall my legally enforceable debts, funeral expenses, testamentary expenses and
all death taxes (wh~ther such taxes may be payable by my estate or by any recipient of any property)
shall be paid from my residuary estate as soon as practicable after my decease and as part of the
administration of ~y estate. My Executor shall have no duty or obligation to obtain reimbursement
for any such tax so (paid, even though on proceeds of insurance or other property not passing under
this Will.
2.
I give suchitems of personalty as are itemized in a certain list, if any, attached hereto to the
persons named thereon, which list is signed and dated by me at the end thereof.
' 3.
If my husband shall survive me by thirty (30) days, then I give, devise and bequeath all of the
rest, residue and remainder of my estate, both real and personal property, unto my husband, PAUL
B. DjJNI{LEBER~ER, absolutely.
4.
In the evejnt my said husband, PAUL B. DUNKLEBERGER, shall predecease or fail to
survive me by mode than thirty (30) days, then I give, devise and bequeath all of the rest, residue and
remainder of my estate, both real and personal property in the following manner:
a. Forty-five percent (45%) thereof unto my daughter, NETTIE M. RHODERICK,
provided, however, that should she predecease or fail to survive me by thirty (30) days, her share
shall be distributed to her issue, per stirpes, and in default of any such then-living issue, such share
shall be distribut d to my surviving daughter named in this Item 4, b;
b. F rty-five percent (45%) thereof unto my daughter, CHARMAINE L. BAILEY,
~~
', [Initials]
Page 1 of 4 Pages
.~
,~
provided, however,'', that should she predecease or fail to survive me by thirty (30) days, such share
shall be distributedlto my surviving daughter named in this Item 4, a;
c. Five percent (5%) thereof unto my daughter-in-law, PAMELA DUNKLEBERGER,
provided, however, that should she predecease or fail to survive me by thirty (30) days, such share
shall be distributed` in equal shares, to my daughters named in this Item 4, a and b; and
d. Fiv~ percent (5%) thereof unto the CHURCHTOWN CHURCH OF GOD, located
at 351 Old Stonehc~use Road, Monroe Township, Boiling Springs, Pennsylvania.
5.
I nominate,'i constitute and appoint my husband, PAUL B. DUNKLEBERGER, as Executor
of my estate. In the event he is unwilling or unable to so act, then I appoint my daughters, NETTIE
M. RHODERICK ~nd CHARMAINE L. BAILEY, as co-Executrices of my estate. In the event that
either of my said d~ughters shall be unwilling or unable to act as Executrix, then the other may serve
as sole Executrix.
6.
I direct that my Executor, or his successors, shall not be required to file a bond to secure the
faithful performan~Ce of their duties in any jurisdiction.
7.
I authorize ~nd empower my Executor, or his successors, in their sole and absolute discretion,
to purchase or otherwise acquire and retain any investments of which I die seized or any real or
personal property ~bf any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or
grant options in rel~ard to any or all property of any kind forming a part of my estate for such terms
and such prices as (they may deem advisable; to borrow money for any purposes connected with the
protection and preservation of my estate; to mortgage or pledge any real or personal property forming
a part of my esta~e or to join in or secure the partition of same; to compromise any claims or
demands of my es~ate against others or of others against my estate; to make distribution in kind and
to cause any sha~e to be composed of cash, property or undivided fractional shares in property
different in kind From any other share; to employ agents, attorneys and proxies and to delegate to
them. such powe~ as my Executor, or his successors, consider desirable and to pay reasonable
Page 2 of 4 Pages
[Initials]
compensation for s~ZCh services as maybe rendered by such agents, attorneys and proxies; and to
execute and delive#~ such instruments as may be necessary to carry out any of these powers. In
addition, I direct that my Executor, or his successors shall have the power to conduct an inventory
of any safe deposit Ibox necessary to the administration of my estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this ~/'~~' day of
~~cTv~ ~~
i
SEAL)
', Dorothy W. leberger
SIGNED, ~EALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for her Last Will aid Testament, in the presence of us, who at her request, have hereunto subscribed
our names as witn~sses thereto, in the presence of the said Testatrix and of each other.
~...--
Page 3 of 4 Pages
.~
~ .
COMMONWEAL'~H OF PENNSYLVANIA )
. SS.
COUNTY OF CUN~IBERLAND )
We, Dorothy W. Dunkleberger, Christopher E. Rice, and ~~~t~ ~- C~~n~ h
the Testatrix and tl~e witnesses, respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and
executed the instn~ment as her last Will and that the Testatrix has signed willingly, and that the
Testatrix executed it as her free and voluntary act for the purposes therein expressed, and that each
of the witnesses, ix~ the presence and hearing of the Testatrix, signed the Will as a witness and that
to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of
sound mind and u~der no constraint or undue influence.
Dor~othy~W. D leberger, Testa
Witness
Witn ss
i
Subscribed, sworn to and acknowledged before me by Dorothy W. Dunkleberger, the
Testatrix, and sub$cribed and sworn to before me by Christopher E.Rice and /~~r cc z, ~ C~~°~'`
the witnesses, thi$ ~/'day of GAL f~ , ~c~~
~c~
Notary Public
NOTARIAL SEAL
VICTORIA L. OTTO, NOTARY PUBLIC
CARLISLE BORO. CUMBERLAND COUNTY
MY COMMIS I01~ EXPIRES DEC. 2 2006
Page 4 of 4 Pages