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Home My WebLink About06-22-05 (3)REV•1500 Ex + (600) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER -0 5 0 3 2 7 SOCIAL SECURITY NUMBER H Z Goodlin Amber J 1 9 6- 1 8- 6 2 3 3 W DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W REGISTER OF WILLS v 03/26/2005 08/08/1919 lJ.l (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER F o 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (aamordeampnwm ~z-r~-az- a ~ a x ~ 4. Limited Estate ~ 4a. Future Interest Compromise (dam ordeath army rz-12-82) ~ 5. Federal Estate Tax Retum Required ~ a m ~ 6. Deodent Died Testate (Atlacn copy orw~q ~ 7. Decedent Maintained a Living Trust (ABacn copy ot7rust) _ 8. Total Number of Safe Deposit Boxes a 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (aam ordeaM heNreen ~z-3~-s~ ana ~-~-asf ~ 11. Election to tax under Sec. 9113(A) (Anacl, scb o) w NAME COMPLETE MAILING ADDRESS °z Jan L Brown N FIRM NAME (If Applicable) ~ Jan L Brown & Associates 845 Sir Thomas Court Suite 12 p TELEPHONE NUMBER 717-541-5550 Harrisbur RA' 17109 OFFICIAL-USE ONLY - 1. Real Estate (Schedule A) (1) } t.., 2. Stocks and Bonds (Schedule B) (2) 287,556.95 _ • ' " ; r.,~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ~ ,Ws 4. Mortgages & Notes Receivable (Schedule D) (4) ~ ~~` - 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 19, 879.03 _ ~ !'_•a , , -- (' _. (Schedule E} ..._ ' . `' 7 ~ ~ O 6. Jointly Owned Property (Schedule F) (6) Separate Billing Requested ~ 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (7) 4,202.54 fF- (Schedule G or L) G. Q 8. Total Gross Assets (total Lines 1-7) (8} 311,638.52 ~ 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 17,891.10 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 12,714.77 11. Total Deductions (total Lines 9 & 10) (11) 30,605.87 12. Net Value of Estate (Line 8 minus Line 11) (12) 2$1,032.65 13. Charitable and Governmental BequesLS/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 281,032.65 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z O F- H a V X H 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 0.00 x (15) 0.00 281,032.65 x .045 (16) 12,646.47 0.00 x .12 (17) 0.00 0.00 x .15 (1b) 0.00 19. Tax Due 20. ~ • ~ • • ~ ~ • • • . > > BE SURE TO ANSWER ALL QtIESTIO~IS' O (19) 12,646.47 Decedent's Complete Address: STREET ADDRESS 100 Mt Allen Drive Up er Allen Townshi CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 12,646.47 2. Credits/Payments A. Spousal Poverty Credit B, Prior Payments C. Discount 632.31 Total Credits (A + B + C) (2) 632.31 3. Interest/Penalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 12,014.16 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 12,014.16 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 : ........................................................................... ^ Q b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ c. retain a reversionary interest; or ...................................................................................................... ^ 0 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 'intrust for" or payable upon death bank arxount 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. Under penalties of perjury, I declare that l have exami is return, includir~ accompanying schedules and statements, and to the best of my knowledge and belief, it is We, correct and complete. Declaration of preparer other than the person ve is bas all infomiabon of whx:h preparer has any knowledge. SIGNATURE SO ESP S F ILIN URN DATE .~ ti ~~ / 2a®~ ADDRESS 2622 Outerbridge Crossing 845 S(r ll~omas Court Suite 12 .~0 ~ ~5 17 For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imry+~a+ ^^ +r,o ^o+ ~~~t~~o „r+~~^~+or~ +^ ^*+^~ +he use of the surviving spouse is 3°k [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value o N ~~ \ pouse is 0% [72 P.S. §9116 (a} (1.1} (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutor I '~ !~ fling 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 twenty-one y ..~ use of a natural parent, an adoptive parent or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. f h X15 ~ The tax rate imposed on the net value of transfers to or for the use of the decedent's lit t 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°h [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, whether by blood or adoption. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Goodling Amber J 21 05 0327 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Community Bks Inc Millersburg (CMTY) 126,262.50 5,250 shs/$24.05 sh 2 (Evergreen Adj Rate Fund CI C (ESACX) I 127,609.47 13,648.071 shs/$9.35 sh 3 IPNC Financial Services Group (PNC) l 21,974.40 1436 shs/$50.40 sh 4 IWachovia Corp 2nd New (WB) I 11,710.58 233 shs/$50.26 sh TOTAL (Also enter on line 2, Recapitulation) ~ ~ 287, (If more space is needed, insert addfional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Soodling Amber J 21 05 0327 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SmithBarney FMA Account 724-02143-17; cash account 18,586.30 2 Sovereign Bank Account 1711063215 1,251.18 3 Community Banks check 25.30 4 2004 PA-40 refund 16.25 TOTAL (Aiso enter on line 5, Recapitulation) S 19 879.03 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNeou~E ~ INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ca ~ h i ~ yr rILC IVUMt3CK Goodling Amber J 21 05 0327 This schedule must 6e completed and filed ff the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIDNSHIP TO DECEDENT AND THE DATE OFTPANSFERATTACHACDPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET °k OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. Community Banks IRA Account 38100002838 4,202.54 100. 4,202.54 Michael D Goodling, son, beneficiary TOTAL (Also enter on line 7 Recapitulation) ~ S 4, 202.54 (If more space is needed, insert additional sheets of the same sizel REV-1511 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Goodlinq Amber J 21 05 0327 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Jesse H Geigle Funeral Home Inc 6,190.10 2 Prospect Hill Cemetary; open/close grave 655.00 3 Funeral luncheon 475.00 4 Memorial; bronze scroll 147.00 B. ADMINISTRATIVE COSTS: ~, Personal Representative's Commissions Name of Personal Representative (s) Soaal Security Number(s)1EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Jan L Brown & Associates 9,750.00 3. Famiry 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 Register of Wills, Cumberland County 436.00 5 Accountant's Fees 6. Tax Return Preparers Fees H&R Block 218.00 7. Manifold & Bankenstein; subscribing witness fee 20.00 TOTAL (Also enter on line 9. Recapitulation) I S ~ ~ o,,. ~ ., (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (B-98) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER in Am r 1 7 Include unn:imbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Alert Pharmacy Services 186.07 2 Philhaven Behavioral Healthcare Services 101.00 3 Messiah Village; Feb and March bills 10,978.70 4 PA Department of Revenue; 2004 PA-40 tax liability 1,449.00 TOTAL (Also enter on line 10, Recapitulation) I ; (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (c.nm COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER C~nnrtlinn Amhor .I 71 n~ AA77 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 pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Michael D Goodling, son Lineal 281,032.65 2622 Outerbridge Crossing Harrisburg PA 17112 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX !SNOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ; (If more space is needed, insert additional sheets of the same size) r LAST WILL AND TESTAMENT OF AMBER J. GOODLING I, Amber J. Goodlinq, of York County, Pennsylvania, being of sound and disposing mind, memory and understanding and considering the uncertainty of life, do therefore make, publish and declare this to be my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments or writings in the nature thereof by me at any time heretofore made. ARTICLE ONE I direct the payment out of my estate of the expenses of my last illness if any, my funeral expenses, and my just debts, the same to be paid out of my estate by my Executor hereinafter named, - _, .~ as soon as conveniently may be after my demise. -,~; ~.: ARTICLE TWO I give, devise and bequeath all of the rest, residue and remainder of my estate and property, real, personal or mixed, of whatsoever nature and character and wheresoever situate, of which I may die seized or possessed, or to which I am in any way entitled at the time of my death, or over which I have any power of testamentary disposition unto my son, Michael D. Goodling, if he survives me; unless there has been created by the time of my death a non-support trust naming my said son as beneficiary which is intended to be used only. as a supplement to, and not as a replacement of, any statutory or other governmental benefits to 1 ~ ~ , i, ~ ,~ -, which my said son may be or become entitled, including, but not limited to, medical assistance, public assistance, supplemental security income, or the like, in which event, I give, devise and bequeath all of the rest, residue and remainder of my estate, in trust, unto such trust as part of that trust for the uses and purposes therein contained so long as my said son survives me. ARTICLE TIiREE In the event my son, Michael D. Goodling, does not survive me, I give, devise and bequeath all the rest, residue and remainder of my estate as follows: A. One-half (1/2) thereof unto my daughter-in-law, Fay L. Goodling, if she survives me; unless there has been created by the time of my death a non-support trust naming my said daughter- in-law as beneficiary which is intended to be used only as a supplement to, and not as a replacement of, any statutory or other governmental benefits to which she may be entitled, as indicated above, in which event, I give, devise and bequeath this one-half (1/2) portion of the remainder of my estate, in trust, unto such trust as part of that trust for the uses and purposes therein contained so long as my said daughter-in-law survives me. In the event my daughter-in-law, Fay L. Goodling, does not survive me, I give, devise and bequeath this one-half (1/2) portion of the remainder of my estate unto the Pinnacle Health System, currently located at 17 South Market Square, Harrisburg, Pennsylvania, or its successor, to be used for physical medicine and rehabilitative 2 1, _ 1, ., services. B. One-half (1/2) thereof unto the Pinnacle Health System, currently located at 17 South Market Square, Harrisburg, Pennsylvania, or its successor, to be used for physical medicine and rehabilitative services. ARTICLE FOUR I nominate, constitute and appoint my son, Michael D. Goodling, to be the Executor of this my Last Will and Testament. In the event my said son should predecease me, or is unwilling or unable to serve as Executor for any reason, I nominate, constitute and appoint my nephew, Samuel Herman, as Executor. ARTICLE FIVE All federal, state and other estate, inheritance and death taxes payable because of my death, with respect to the property passing under this Will, including any interest or penalty which may be imposed thereon, shall be considered a part of the expense of the administration of my Estate and shall be paid out of the residue of my Estate before distribution of the residue is made, so that all residuary beneficiaries, whether charitable or otherwise, shall proportionately share in the payment of the same. ARTICLE SIX I direct and request that any fiduciary under this my Last Will and Testament, shall not be required to enter bond or security of any nature whatsoever in any jurisdiction in which such fiduciary may act. IN WITNESS WHEREOF, I have hereunto set my name and affixed my 3 seal to this my Last Will and Testament which consists of four (4) pages this u ~` day of !~`~ .~~?~ 1996. i ~~, /'.-: ,/~... y;`~ `, ,~ I ,~~:=~ ~~G~-t~ (SEAL ) ~Ainber J. /Gbo~ling S.S.# j~~~ ~" ~U' ~- ~? ~~ SIGNED, sealed, published and declared by the above-named Testator as and for the said Testator's Last will and Testament in the presence of us who have hereunto subscribed our names at the Testator's request as witnesses thereto, in the presence of the said Testator and of each other. 4 :4 A ~~,