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HomeMy WebLinkAbout02-10-12 1505610105 REV-1500``°Z_11"FI' ~ enns lvania OFFICIAL USE ONLY PA Department of Revenue PEO.w,~E YFp County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX z8o6oi i Harrisburg, PA l~iz8-o60i RESIDENT DECEDENT ~ I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 208-18-7257 09/19/2011 07/04!1925 Decedent's Last Name Suffix Decedent's First Name MI McConnell Edith C (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI McConnell Jr Jay M Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW t~7 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) t~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Charles H. Diller, Jr. (717) 732-6664 First Line of Address 5616 Pinehurst Way Second Line of Address City or Post Office Mechanicsburg Correspondent's a-mail address: CDiller1945@Verizon.net State ZIP Code PA 17050 c-a ~-.~ REGISTER OF~iI~ USE ONLY ~ ~ ~ ~ ~ a~l ! t .. -=cn~ Q `~_ ~7 t--~ C~ ~..,., T.. _.~ T -J ~-1 f.. ~ . ~" DATE FILED Under penalties of perjury, 1 declare t have a 'ned this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tru rrect an comple . Declar re rer other than the personal representative is based on all information of which preparer has any knowledge. SIG T RE F ERSO R PONSI FILING RETURN DATE 02/09/2012 ADDRESS 5616 Pinehurst Way, Me anicsburg, PA 17050 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE U8E ORIGINAL FORM ONLY i S r C-'~ i a~ C':J ~, 1 i'~ Side 1 1505610105 1505610105 J J REV-1500 EX (FI) 1505610205 Decedent's Name: Edith C. MCCOflllell RECAPITULATION 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 and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. Decedent's Social Security Number 208-18-7257 0.00 0.00 0.00 0.00 71,611.05 0.00 0.00 71,611.05 9. Funeral Expenses and Administrative Costs (Schedule H) ............. ...... 9. 9,743.02 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10. 615.42 11. Total Deductions (total Lines 9 and 10) ........................... ...... 11. 10,358.44 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. 61,252.61 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 00 0 an election to tax has not been made (Schedule J) .................. ...... 13. . 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. ...... 14. 61,252.61 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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 61,252.61 16. 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 2,756.37 2,756.37 O REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Edith C. McConnell STREET ADDRESS --- -- -- 1100 Crandon Way, Suite 514 CITY STATE i ZIP Mechanicsburg ~ PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments __________ _ __ B. Discount 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. 2,756.37 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) (5) 2, 756.37 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 ........................................................................................................................ ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after Dec. 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? ........ ...... ^ 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. 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. §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 benefiaaries is 4.5 percent, except as noted in [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, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV450A EX+(L971 SCHEDULE E p ~+~+ COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MSC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER L=~ ~ TN C' /'1c C'.~,ni~V ~ e...t. 20 /l - a1 o s,~" 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. ITEM VALUE AT DATE: NUMBER DESCRIPTION OF DEATH ~. ~~dS/J /,~' Tye ~~~. /yeJ eQ~.clae' 73~.v`K CHEI..XB~G ~~,~ ~ i 8ao 7 9B~ ~~/ D d~oJ ~~~ y ro. s~ /QE7~,~c~~++/~"-=. S~~r"~~,c°~r4 toll ,f1'ir1,A ,~~`itl S eon ~L ~i~ ~,~~vtJQ - /p/'~l''~~'/ D /y~AI ~ AIL ~~ .S. ~'~ TOTAL (Also enter on line 5, Recapitulation) I $ 71 ~ / / ~ O~'> rIf mnro cnara is naa7iari inaarf atlriitinnal chPatc of tha came si~Pl REV-1511 EX+ (10.06) " SCFIEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT' DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I, ITEM - NUMBER DESCRIPTION AMOUNT _ A. FUNERAL EXPENSES: 1. /~/4S~i~L ~. ,~,~,/~J o.~J/S ~o//~i4G /,/0~-7 ~'~ - ~~FESsi~iJ.yG /t'YKt S ~p~f /~i C/i)/r~ o F= ~d Yr' Fi1L~l~ ~/~S /ylvti ~T~d'!~`~° ~, /~ ~ • ~~~ ~~4it1S/~/.~'TAr-/~/i/~ c.~Sir(~-~-~i+1~ bvr~R ,Butt/,dt. ~-IT•If.U~' ~~~~E lJ~E•~I.U~~CLvs~NG~ ~,~yE~t'T/S//JG'~' L'EM~~1~tY L-`~~,p9,wt ~' A/~D GL~~Mc,,SI /~Asr©,~ Tam/ /~eJD i'!/!~Y Aaf/ Gi'r'~+',/p•~,~ - ~E~ ~b~ovs ~~•~('~i+c~~„t 2v v. ~>~w ~7A~ySv~c ~.ty ~s'c=~i~r~ cE~-r~~' -- ~vsr ~~a~,~~L i-l~p~.. Y9~ . ,~'6 /YOI~L.~ - Ld,vE~?/JL CCo~-H/~G 2L,.~o .~'/~ /~~ n~iv~//l~ $ ~ r~, m ~3sr.~ N~ J.t/ S~ ~('i Sri es,~/ ~ 3 s> ao B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) _. _ . _ _ Street Address City ___ _ State Zi p - ---- _ Year(s) Commission Paid: Z• Attorney Fees ,~~ f t~~~~ 3. Family Exemption: {If decedent's address is not the same as claimant's, attach explanation} +t c.' Claimant Street Address City __ _. __ State _ Zip Relationship of Claimant to Decedent 4. Probate Fees ~ /~ J • G ~ 5• Accountant's Fees 6• Tax Return Preparer's Fees ~. Cv n9~~~'L Div D eovyr~' ~PE,[xl STG/1 pt" cJ i GL S -~ ~iDpi~d ~'E ~-~ ~ c,anr, y8. 5"o C'drrJl~,t''tyla~ ~v,vr-y ~r`~jsr~~ A~ ~..~~c.~ s -- rr,r.~ ,~'tr•~,e~r q 1~ J~'r`~c ~.e/ ~,, ,~ ~ ~'; rya TOTAL (Also enter on line 9, Recapitulation) $ ~ 7.3,4.2.. (If more space is needed, insert additional sheets of the same size) REV-X12.=X- (i2-G3) ,~-~~~~;~ SCHEDULE 1 y r ~~,.a," t ~ I::;r ~ ~~I ~- I ~> > , <sti ~;;,~•,H ~ DEBTS OF DECEDENT, f ')~ ~ R r, '~., , _T~ ~ ; N1©RTGAGE tiABIL1TIES, ~ LIENS N.FSiDEi~T DFGE:DEP:-. I ESTATE OF FILE NUMBER _~/.~ /T/,/ ~'- /'`7c ~oi1/~t/,C~GL __ _._ . - ____- - -- ~~_//_-.o/0...3,x"_. _. (report r_1E~E,is illcttrrctl by ~i1~; ~~;ri,dent prior to d€rath ~.hi~.h ,~^.h~~med ur.;,;:.t as of ,h~ aate of dE.xth, irtchtdin~ unr~pimbursed rnedisal expenses. ~i ~~ i I `~t~LUE HT SATE ~;UitiiCk~+~ ~ G[ SCf. ``-'i C)?,~ 0,= DCr\iM B~~l c.v.~ ,~i lJ~ L= ~ /a, 3 J` '~ SOu 1~ t C-',NT~P~L ~" i'l,S, / ~1/G t ~ o . ©t~ C.uw~,~ie::J('L/5~111 (,.av1341~tL /'i~PE ~~St~k ~~S ~8.~ by~.- ~.~ ~/S. `/Z- REV-1513 EX+ (9-00) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ~°° l~./ 7-..~// ~. !1 f ~/~.t1.t~'e~ t /__ 2 ~ ,1~"' D /15.,3 , jr" 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 [include outright spousal distributions, and transfers under i. Sec. 9116 (a) (12)) f ~~i9N G /~~9~1~E y' //~~ C s A1~ E 7~91rG NT`~`~ ~" '~/, ~"o ~. C7 ~'~ / ~ ,7 7 0 Z 1~ ~-,J~ iQ ~Sfl ~/ 1~~1~L i,~r~.~ 5o~a sG~~vstr ~~'!~~ 3 L~E~ L= ,~ ,4~~~,~'/ h Ar't~ f ~~i/D IJA~ GA,,~ ~ ~r Z S'o. ~ ~ y2 ~! ~i~r/i ~~~~ 7-~ k'~'~c ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 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 IS NOT BEING MADE 6. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) LAST WE'LL AND TESTAMENT OF EDIT~d C. MCCONNELL I, Edi#h C. McConnell, of Homer City, Indiana County, Peruisylvania, revoke my former Wills and Codicils and declare this to be my Last Will and Testament. ARTICLE I IDENTLFICATION OF FA11~III.Y I am married to Say M. McConnell, Jr. The failure of this Will to provide for any distribution to Jay M. McConnell, Jr. is intentional. The names of my children are Susan C. Harvey, Andreae M. Griffith and Charles H. Diller, Jr.. The failure of this WiII to provide for any distribution to my child Charles H. Diller, Jr, is intentional. My son has graciously requested that he not be included in my estate so that others could more fully benefit from the value of my assets. ARTICLE II PAYMENTS OF DEBTS AND EXPENSES I direct that my just debts, funeral expenses, expenses of last illness, inheritance and estate taxes due by reason of my death be first paid from my estate. ARTICLE III TANGI$LE PERSONAL PROPERTY I give and bequeath all of my tangible personal property to my daughters, Susan E. Harvey and Andreae M. Griffith, if living at my death in as nearly equal shares as they may select under the supervision of my Executor. ~~~..~ ~~~ ~ ~ 5 ., ,, - ~ ARTICLE IV DISPOSITION OF PROPERTY Residuary Estate. 1 direct that my residuary estate be distributed to the following beneficiaries in the percentages as shown: {a) Forty percent (4{l%} of such residue to my daughter, Susan E. Harvey, if she survives me, or if she does not survive me, to her issue, per stirpes, living at my death. If Susan and all of her issue die before me, the assets otherwise passing under this paragraph (a) shall be added to the assets passing under paragraph (b) of this Article. (b) Forty percent (4090} of such residue to my daughter, Andreae M. Griffith, if she survives me, or if she does not survive me, to her issue, per stirpes, living at my death. If Andreae and all of her issue die before me, the assets otherwise passing under this paragraph (b) shall be added to the assets passing under paragraph (a} of this Article. (c) Twenty percent (20%) of such residue to my granddaughter, Edee K. Herigan, now of Dauphin, Pennsylvania, if she survives me. If Edee does not survive me, this share shall be added equally to the assets passing under paragraphs (a} and (b) of this Article. I have singled out my grandchild Edee because of her significant help, support, care and love given to me during my lifetime. ARTICLE V NOMINATION OF EXECUTOR I nominate Charles H. Diller, dr., of Mechanicsburg, Pennsylvanua, as the Executor, without bond ar security. Tf such person or entity does not serve for any reason, I nominate Susan E. Harvey, of Homer City, Pennsylvania, to be the Executor, without bond or security. ARTICLE VI EXECUTOR POWERS My Executor, in addifion to other powers and authority granted by law or necessary or appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal property that maybe included in my estate, without order of court and without notice to anyone. My Executor shall have the right to administer my estate using "informal", ~- 1 ~~- ~ ~' ~ "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. A1tTICLE VII MISCELLANEOUS PROVISIONS A. Para~uh Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this Will in any gender shall extend to and include all gemders, and any singulaz words shall include the plural expression, and vice versa, specifically including "child" and "children", when the context or facts so require, and any pronouns shall betaken to refer to the person or persons intended regardless of gender or number. B. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out ofthat fiduciary's good faith actions or nonactions as the fiduciary, except for such actions or nonactions which constitute fraudulent conduct or bad faith. C. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. IN WITNESS WHEREOF, I have subscribed my name below, this ~ day of Testator Signature: ~,~~ (~~; ;~-~ G~ ~~1 ~? t~~-a-~~ '~~ _ 1/dith C. McConnell GC~ . ~~,~: ~~ s We, the undersigned, hereby certify that the above instrument, which consists of pages, including the page(s) which contain the witness signatures, was signed in our sight and presence by Fdith C. McConnell (the "Testator"), who declared this instrument to be hislher Last Will and Testament and we, at the Testator's request and in the Testator's sight and presence, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. Witness Signature: Name: city: State: 7 f , Witness Signature: ~ a~L ' L4~ Name: ~~=~C e ~. Lu-pct/~. ~ City: c~.N S 5 kt..~ ~Ca `~~ 7• gaan ~ State: ':~~x;f ruJ~L1., c~~? .~5 7U i Witness Signature: Name: City: State: ~~~ , ~~n i~-.~ ~~~4 ~~s ~_ PENNSYLLVANIA Self Provang Clause COMMONWEALTH OF PENNSYLVANIA COUNTY OF ..L-r,c~ om~ I, Edith C. McConnell, the Testator, whose name is signed to the attached or foregoing instr~nnent, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Las# Will; that I signed it willingly and as my free and voluntary act for the purposes expressed in the instrument. Sworn to or affirmed and acknowledged before me by Edith C. McConnell, the Testator, this ~_ day of ,~~~~ ~ ~ . -~ ~,.. Testator Signature X% ~ c`'~c.~~~ ~~ ~."II ~'~J~ ~ <~(~~ ~ith C. McConnell .~ 'gnature of officer ~~ce P~~S,~~ Official capacity of officer MMa wi3~urx of ~Emvsnv~+ Notarial Sea{ Susan M. St+enk, Nate Publio (Seal} N{y Commisstori EhcPires May 31,2008 Member, PonneyNanfa 1~uaool9~ ~ rles ~. ~ SG~s AFFIIDAVI~' COMMONWEALTH_OF PENNSYLVANIA COUNTY OF -I---~n .~. ~ c~..r.ca We, ~~;Pit~~ ~m ~~ 1'1 and r~ CiC~-~-~ ~,~•~ct'~~' and `~•, Win, r-1 A'1~11~ _ ,the witnesses whose names are signed to the attached ar foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as the Testator's Last Wilt; that the Testator signed wiIlingiy and executed it as the Testator's free and voluntary act for the purposes expressed in it; that each of us in the hearing and sight of the Testator signed the Will as a witness; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or off rmed and subscribed to before me by t,L~.~-~dy ~•~~1~ and L.c•~c~~~ ~J~cx.~~ and ~. )Cy...~a c~~ %~~l`~~e.,-• ,witnesses, this ~ day of ~`' '~' , 2 ~ „ . Witness .Signature: Name: City: State: Witness Signature: Name: ~C ~ L-~:~~r v~r-- City: _ay5`~ ,2~- ~.$~ ~ ' 1 ~~ State: "1-r~Gl;t.~,r-c~. Pt,'~ iS~"CI Witness Signature: Name: City: State: 1 Est: ~- -2c~-~--f -~ ~-~~.~~ Si~na~•e con~M w~rx a~ PErrNSnvr~rna Notar{et seal Susan M. Shank, Notery Publlc Seal and o~ci •, rndtana County 31, 2DU$ Member, Pennsyivonla Jtssacfatfan of Nolarie& ~-~~~ ,