The URL can be used to link to this page

Home My WebLink About03-15-12 1505610101 REV-1500 ex ~°1.1°' 4~! OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~EPARTMENTOF NEVENUE INHERITANCE TAX RETURN County Code Year File Number PO BOX z8o6o1 ~ Harrisburg, PA 1128-06oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW ~. ~ ~ ~ , ~ ~ ~ , .~:" ~-,., z,~,.. x~ ~~~ _.a-.~, Decedent's Last Name Suffix Decedents First Name MI {~I#~;~ t.t L 1. 'y ... ~ - ~ ., ~~'~ ~.~rt11t°'T~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number ~. FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return • THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return O 4. Limited Estate O 4a. Future Interest Compromise (date of • death after 12-12-82) ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 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 T0: Name Daytime Telephone Number ,. Th om/~s R. MeC,,~ LL ~~2: ~r ? a~yl~.~~ ~d'`~ First line of address .3 I ~ ~ ~ ~ C~ E~ c ~' -~ 12 c,) . Second line of address C,it/yam or Post Office l_ A- Q L t s l ,E State ZIP Code P a t~ REGISTER OF WILLS USE ONLY n c` a _ C ~ 7J ~ ,, . ~-, ~` ~ , ~ ~ ~~ c:I ` , ; SATE FILE D ~ ~ !~ ..P:--. cxa -__ c t 5 "~ t.) ~`~ .~- Correspondent's a-mail address: 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 prepare~ther than the personal representative is based on all information of which preparer has any knowledge. PERSON ADDRESS ///~~ /) SIGNATURE OF PREPARER HER THAN REP SENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J 1505610105 REV-1500 EX Decedent's Name: ~ (1 O ~ ~-1 ~ • ~ ~ ~ ~~ I Decedent's Social Securi-ty-~! Number ~ ~ "~~ ~ ~ ~ /'~ RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. ~~ ? b 2. Stocks and Bonds (Sct~dule B 2. 1 A 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3 Z r ~ ~ ~` . = '5~ ~ ~~ ~ ~ j . q ~ '~ - q 4. 9 9 ( ) ............. ........... Mort a es and Notes Receivable Schedule D 4. 5 ~(S~chedule E ert and Miscellaneous Personal Pro it h B k D C 5 Rot ~ d 9 '~ ~ . ..... y p epos s as , an . 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~ "'''"`''` `"'~`` ~ ~ °TM. (Schedule G) p Separate Billing Requested........ 7. ;, y 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ~ ,'~' .: ~c= g , ~.... . ... Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ry - . - - i •~ ~ t p ~ ~; ~ ' 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. $ r Total Deductions (total Lines 9 and 10) ................................. 11 ~ Fjk' ~"~VV~7~~ ~1 ~ V <_ vas ~, ir~~f~: ~a& ~~ Net Value of Estate (Line 8 minus Line 11) .............................. 12. 4 ~ , f k ~ ~; i "'~~' ` '~'"~~'~ ~''~ ~~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 ~ ~ an election to tax has not been made (Schedule J) ........................ ..- . ~ .~ 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~ 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 _ 16. 17. Amount of line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable r at collateral rate X .15 18. 1~TAX DUE .........................................................19. 20. FILL.IN T~iE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 O REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME __ Igo 20~-`-~-__~~___~[1~ ~-~ l 1, STREET ADDRESS -- ---- clTV -- ---- -_ - 1 ~ STATE ,~ ZIP `~ ~~s I 1F~/~ I ~v t S Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 2. Credits/Payments A. Prior Payments __ __ ______ B. Discount Total Credits (A + Et) (2) 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. ~~i If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) (4) (5) 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; or .................................................................................................................... ...... ^ ^ 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 or dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of trans>fers 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 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)j. 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. c R. SCOTT CRAMER ~ttomey at Law 5 S. Market ST. P. O. Grower 159 Duncanran, PA 17020 I, DOROTBY J. KaCOLLY, of 315 Hickory Raad, Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior Wills and Codicils. FIRST: I direct ghat the expenses of my last illness and funeral be paid out of my estate as soon after my death as is convenient and expeditious in the judgment of my Executor, hereinafter named. SECOND: It is my intent that my funeral expenses be paid from the proceeds of any life insurance policies which I may own at the time of my death. THIRD: I give and bequeath all my certificates of deposit to my two sons, John D. McCully and Donald L. McCully, in equal shares, share and share alike. FOURTH: I give, devise and bequeath the rest, residue and remainder of my estate to my three children, Thomas R. McCully, Jr., John D. McCully and Donald L. McCully, or their then-living issue, in equal shares, share and share alike. FIFTH: All estate, inheritance and other death taxes, together with any interest and penalties payable with respect to property or interests therein subject to taxation by reason of my death and whether passing under my will or any codicil thereto, or otherwise including jointly held and other non- testamentary property shall be psid c;:t of tYie principal of my residuary estate without apportionment. SIXTH: I hereby nominate, constitute and appoint my son, Thomas R. McCully, Jr., Executor of this my Last Will. I further direct that he shall not be required to post any bond to secure the faithful performance of his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. n ~: ". _ ~~ _._ - - ~,~' ~~j ~ ~ ;=C7 i.:: ~=±fi1 1 `- ~ ;,,n ~7 ;rte C ~.J _,,, -` CJ „1 - J ;,~ _~, ~~ •:'C -- t IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will, which consists of two (2) sheets of paper, dated this tit"day of May, 2000. '~-~ ~~ ~I,~ ~ "- -•, (SEAL) Doro~ y~.J. ::cCUll The writing contained on this and the one preceding page was signed and sealed by DorotDy J. McCully, and by her publishied and declared as her Last Will, in the presence of us, who have hereunto subscribed our names as witnesses at her request, in her presence, and in the presence of each other. ,~ r~ ~ •~ R. SCOTT CkAMER Attorney at Law 5 5. Market St. P. O. Drawer 159 Ouncannon, PA 17020 COMMONWEALTH OF PENNSYLVANIA) SS COUNTY OF PERRY ) I, Dorothy J. MaCUlly, testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. SWORN or affirmed to and acknowledged before me by, Dorothy J. McCully, testatrix, this (~~'~~day of May, 2000. '~!T}i EIE.».;;f%~ <i+~w~SiiliA, i~~[tti~ry Fb,,167: ~1:f7 :7'77i7n '~l+l'l, r+My r;: vrMi G~ !~y l~:mr~x)crn :°~~ina 1^,rr~• 1 £!, Z+:CJ r.,., ...... ~....~...,.......J R. SCOTT CRAMEIt Attorney at Law 5 S. Market St, P. O. Drawer 159 Ouricannon, PA 17020 COMMONWEALTH OF PENNSYLVANIA) )SS COUNTY OF PERRY ) ,~ ~_ ,~ 1 1 WA ~ J1_ ...'~~c' LC ~ ~ :t~l~ ~ ~ and ~-- ~ =,h.~~ ~ ~'1 • ~ ~~u~,`~ ~~. I ~ , the witnesa~es whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depcise and say that we were present and saw testatrix sign and execute the instrument as hgr Last Will; that Dorothyr J. MaCUllp, signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the c~ill as witnesses; and that to the best of our knowledge the testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ;~ . '~ ~ ; ,. ~r~` c+~.,1 .~ R. SCOTT CRAMEIt Attorney at Law 5 S. Market St. P. O. Drawer 159 Duncannon, PA 17020 SWORN ar affirme to and. subscribed to before me by Ott (i,:~~„ r, and ~ r'.-1et,t r i~'l {",?,1,i,r,..:i~ witnesses, t;:is ~ c~-+-, day of i~iay, i0uo. i --- ,' - . - ~. ~ ~' -'~' "~~ REV-1503 EX+ (6-5~8) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNED~ILE B STOCKS & BONDS e~iAit ur FILE NUMBER All property jointly-owned Wlth rlOht of survivnrshin muc+ i.n .i~Q..~..Qea ..., e_w_~..~_ ~ ~omputershare Computershare Investor Services 250 Royatl Street Canton Massachusetts 02021 www.computershare.com THOMAS R MCCULLY JR 315 HICKORY RD CARLISLE PA 17015 March 7, 2012 Company: Registration: Holder Account Number: Document I.D.: Our Reference: PRUDENTIAL FINANCIAL INC DOROTHY J MCCULLY 00002642468 12061WF00130657 PRU/0002833858/4/vs/66229 Dear Sir/Madam: Thank you for contacting Computershare, Prudential's transfer agent. We appreciate the opportunity to be of service to you. On June 23, 2011, account number 00002642468 held 36 shares. On that date, the closing price was $60.40 per share. Should you have other account related questions, please call us at 1-800-305-9404 between the hours of 8:30 AM and 6:00 PM pastern US time, Monday through Friday. Please note that any available representative can assist you. A to%ommunications device for the hearing impaired (TlY/Tpp) is a/so availab/e at 1-800-619-2837. Sincerely, Service Representative Enclosure: None ~~ c '- Rev-~soe e;. h-e» COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of IitigaGon 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 NUMBER DESCRIPTION VAO EDA~T DHTE t . C I~GC~G ~ Iu ~ f~CC.O ~,t N ~ ~' '~ J 3 ~ O '7 17 9~T-e .. q-T t3 A ~ v '7 . ~ F 12s T- Jul /~Ti o,v,>.-I ~ .4N K °`r ~ ~4rcc1s V i ~ ~€ 1-, 1~ ~ Fit a~ 1~ ~lte»~ ~ ~ u~K~ ~ ~ a ~ .a o m +G ~ I~ ~~o 7 a TOTAL (Also enter on line !i, Recapitulation) I $ ~p~c.~ , ag (If more space is needed, insert additional sheets of the same size) C s Beg_ Dep< Chec End: V I ? i LLI I_ p I T 2 I_ D T ~ I - LL V Dat ~ 6/ V 6/ W F- Check# Date Amo}~nt cnecx~ Ua~e 219 6/06 1,859,00 ~I 17053 i7-2196 Account Number 313807 Statement Date 6/20/11 Page 1 wn Checking mmary 2 Credits 1 Debits N ITEM FEES it for Period 107.57 1,859.01 1,859.00 107.58 Total 5'ear to Date 1 .00 I .00 I .00 I .00 posits :asury 303Waxxxxx3418 1 Irawals Amount Check# Date MEMBER F.D.LC. Amount _ _ REV=1511X+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDVLE M FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF State Zip Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. t FUNERAL EXPENSES: G,5 ~ 3 . (~ '~ B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address 2. 3. "4~ 5. 6. . 7. City Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees FILE NUMBER Zip ft` ~ q . sv T_OT_A4.(>d11so enter on line 9, Recapitulation) $ (p~ b 3. (If more space is needed, insert additional sheets of the same size) ~ RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 MCCULLY DOROTHY J Receipt Date: 7/08/2011 Receipt Time: 12:26:33 Receipt No.: 1066230 Estate File No.; 2011 -00757 Paid By Remarks: THOMAS R MCCULLY JR DB ------------------------ Receipt Distribution ----- -------- ------_ ____ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 30.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 15.00 16.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN JCS FEE AUTOMATION FEE 23.50 5.00 BUREAU OF RECEIPTS CUMBERLAND COUNTY & CNTR GENERAL M.D FUN Check# 2926 $89.50 Total Received......... $89.50 M Michael J. Shalonis Funeral Home 206 Maple Avenue Marysville, Pennsylvania 17053 Fax (717)-957-20'77 Michael J. Shalonis, Owner Phone (717) 957-3451 We Care About Service To You Thursday, July 7, 2011. Mr. Thomas R. McCully, Jr. 315 Hickory Road Carlisle, PA 17013 Dear Thomas, Thank you for selecting our funeral home to provide services for your family during your bereavement I . hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summ ary of the service charges as previously explained and provided in written form and herein indicated asl PAID-IN-FULL. Dorothy Jean McCully SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED $6,513.67 LESS: Credits granted 200.00 LESS: Total Payments 13,632.87 LESS: Refund of Overpayment i',319.20 CURRENT BALANCE $0.00 Credits Granted: $200.00 Discount allowed If there are any questions or concerns that remain unanswered, please call me. Sinc erel y, h ~ M~.~ Michael J. Shalonis Owner