HomeMy WebLinkAbout05-07-12 (2) 1505610105
REV-1500 ExtoZ_11,tFi,
l
i OFFICIAL USE ONLY
van
a
PA Department of Revenue Pennsy
of=^w.MErv,oFwE~E~~F
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 28o6oi
Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ,~ ~ l'
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
204-01-0303 ' 08/05/2011 ' 03/22/1919
Decedent's Last Name Suffix Decedent's First Name MI
McLane Rozella M
(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
OD 1. Original Return
O 4. Limited Estate
0~ 6. Decedent Died Testate
(Attach Copy of Will)
O 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
O 2. Supplemental Return
O 4a. Future Interest Compromise (date of
death after 12-12-82)
O 7. Decedent Maintained a Living Trust
(Attach Copy of Trust.)
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 Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
'.:KEITH O. BRENNEMAN (717) 697-8528
.:
~..,..
REGISTER LS USE GrNt'_Y
First Line of Address
44 West Main Street
Second Line of Address
City or Post Office
Mechanicsburg
Correspondent's a-mail address:
State ZIP Code L
PA '; ';17055
~ -s~
~-_~ ~,>
-_ ~ ~ r- -~
~~ G'T t
G,. '~) ~
'C ~~ -
•.J ~._ ,..,.
~ G
C.,.r'}
DATE FILED ~;;
r ,-
~. `
~':
r ~-
L u
-r7
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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI NATURE OF PER M RES O BLE FOR FILING RETURN DATE
jQs'~'7 ,~ ~l~,x~ Co-Executor ~L,~,`~~'+'~-Ffi Co-Executor 'S~/~Z
-ADDRESS
823 Boiling Springs Road, Mechanicsburg, PA 17055
SIGN~T~ OF PREPARER OTHER THAN REPRESENTATIVE DATE/~//Z
ADDRESS
44 West Main Street, Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM-ONLY
Side 1
1505610105
1505610105
J
._,D~ur
J
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: ROZella M. MCLane .204-01-0303
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. 10,397.96
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. 171,296.61
8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 181,694.57
9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 13,396.59
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 11,733.03
11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 25,129.62
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ' 156,564.95
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ..................... ... 13. 6,000.00
14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 150,564.95
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 _ 1 5.
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
564.95
150
22
584
74
,
at collateral rate X .15 18 ,
.
~ a Tnx nt tF ~ q 22,584.74
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610205 1505610205
O
J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number 21-11-902
DECEDENT'S NAME
Rozella M. McLane
-- -
-
----------- -------------
--------------
STREET ADDRESS
100 Mount Allen Road
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
Tax Due (Page 2, Line 19)
Credits/Payments
A. Prior Payments _
B. Discount
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Total Credits (A + B) (2)
(3)
(4)
(5)
22,584.74
22, 584.74
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 beneficiaries 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.
REV-iso8 EX+ (ii-io)
i ~ pennsylvania SCHEDULE E
~: DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Rozelia M. McLane 21-11-902
Include 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.
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
it pennsylvania SCHEDULE G
~ DEPARTMENT OFREVENUF INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
- __
ESTATE OF FILE NUMBER
Rozella M. McLane 21-11-902
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSION
(IF APPLICABLE) TAXABLE
VALUE
1~ Modern Woodmen, Life Insurance Policy No. 5851803-S, beneficiary: Estate 11,065.35 100 11,065.35 0.00
of Rozella M. McLane
2 Prudential Life Insurance Policies:
M03005455: $3,690.93
M51125014: $7,361.30 11,052.23 100 11,052.23 0.00
3 Thrivant Financial For Lutherans Life Insurance Policies:
No. 3129566: $59,696.53
No. 1403417: $15,910.31 75,606.84 100 75,606.84 0.00
Beneficiary: Estate of Rozella M. McLane
4.
Waddell & Reed Service Company, Investment account No. 1538914,
payable upon death in equal shares to the beneficiaries identified in Schedule
J, No. I (beneficiaries identified in Paragraphs 7(a), (b) and (c) of Decedent's
Last Will and Testament) 171,296.61 100 171,296.61
TOTAL (Also enter on Line 7, Recapitulation) $ 171,296.61
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
' ~ pennsytvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
--
ESTATE OF FILE NUMBER
Rozella M. McLane 21-11-902
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I' Myers-Buhrig Funeral Home 2,322.00
2. Trinty Lutheran Church -luncheon expense 54.69
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: Creedin L. Stoner
Name(s) of Personal Representative(s) Sharon M. UmhOltZ
street address 823 Boiling Springs Road _ __ __
city Mechanicsburg ___ state PA ZIP 17055 __
Year(s) Commission Paid: 2012 _ _
2. Attorney Fees:
3. Family 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:
5. Accountant Fees:
6. Tax Return Preparer Fees:
~~ Advertise Grant of Letters: Cumberland Law Journal ($75.00); The Sentinel ($221.40)
8 Mumma's Jewelry Store -jewelry appraisal
TOTAL (Also enter on Line 9, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size.
4,000.00
5,500.00
123.50
750.00
300.00
296.40
50.00
13, 396.59
REV-1512 EX+ (12-OS)
" ~ Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCETAxRETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Rozella M. McLane 21-11-902
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Rozella M. McLane 21-11-902
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
Sec. 9116 (a) (1.2).]
1• Creedin L. Stoner and Helen G. Stoner, 506 E. Marble Sreet, None $1,000.00
Mechanicsburg, PA 17055
2. Ruth Frantz, 201 Alexander Hamilton, San Antonio, TX 78228 Niece 1/12 of Residue
3. Daniel Souder, 3 Lee Anne Lane, Mechanicsburg, PA 17050 Nephew 1/12 of Residue
4. Patrick Souder, 2510 Rivington Terrace, Harrisburg, PA 17103 Newphew 1/12 of Residue
5. Donald Yorlets, 1625 Groupe Mill Road, New Oxford, PA 17350 Nephew 1/6 of Residue
6. Nancy Livingston, 5460 Davidson Road, Dover, PH 17315 Niece 1/6 of Residue
7. Larry Souder, 9 Hill Boulevard, Mechanicsburg, PA 17055 Nephew 1/9 of Residue
8. Peggy Souder, 2215 Boxwood Lane, Mechanicsburg, PA 17055 Niece 1!9 of Residue
9. Debra Diehl, 904 Schoolhouse Lane, Lewisberry, PA 17339 Niece 1/9 of Residue
10. Sharon S. Umholtz, 823 Boiling Springs Road, Mechanicsburg, PA 17055 Niece 1/12 of Residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
First United Methodist Church, 135 W. Simpson St., Mechanicsburg, PA 17055 (Paragraph 2 of Will)
2. Trinity Evangelical Lutheran Church, 132 E. Main St., Mechanicsbrug, PA 17055
(Paragraphs 3 and 4 of Will)
2.000.00
4,000.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 6,000.00
If more space is needed, use additional sheets of paper of the same size.
SCHEDULEJ
BENEFICIARIES
CONTINUED
ESTATE OF ROZELLA M. McLANE
No. Name and Address of Persons Receiving Property
1 1. John L. Chipriano and Mary Jane Chipriano, husband and wife
identified in Paragraph 5 of Decedent's Will to share $1,000.00,
both predeceased Decedent. This bequest is distributed through
the residuary clause pursuant to 20 Pa.C.S. § 2514(10).
21-11-902
LAST WILL AND TESTA1t1ENT
OF
ROZELLA M. 141cLAlirE
I, ROZELLA 10~. McLANE, of the Borough of rVIechanicsburg, County of
Cumberland and State Of Pennsylvania, being Cf SOllnd and d1spOSing I21Ind, 1T1?171o1y and
understanding, do make, publish and. declare this my Last Will. and Testament, hereby
revoking and making void any and all former Wills by me at any time heretofore made.
I direct the payment of all 1~7y just debts a?2d funeral expenses as soon after ley
decease as the same can be conveniently done; including the inscription of my date of
death nn my cemetery monument.
I give and bequeath the sum of Two Thousand ($2,000.00) Dollars to the FIRST
L~i~ i a Ev ivii, i gii~a,iS i ~:ri ui~.i ~i, of iviechanicsburg, rennsyivania, in loving
memory of my late husband's parents, ABRAHAiVi L. 1VIeLANE and PEARL ~.
1l~cLAl'iTE .
~.
r f T '~ d ~$? 00~ ~0) Dol' r"
i give and bequeat h t ~e Siliii o 1 VdG TiiGusari ~ , v.v ,ars tC i ~wll
-1-
EVANGELICAL LUTHERAN CHURCH, of Mechanicsburg, Pennsylvania, in loving
memory of my parents, ARTHUR C. SOUDER and RUTH HAMSHER SOUDER.
4.
I give and bequeath the sum of Two Thousand ($2,000.00) Dollars to TRINITY
EVANGELICAL LUTHERAN CHURCH, of Mechanicsburg, Pennsylvania, in loving
memory of my late husband, HAROLD B. McLANE and myself.
J.
I give anal bequeath the sum of Gne Thousand ($1,000.00) Dollars to ~r~y geod
friends, JOIIN L. CHII'RIAN® and MARY JANE CHIPRIAN®, his wife, share and
share alike, or to the survivor of said t<vo legatees, absolutely, should either of them
predecease me.
6.
I give and bequeath the sum of C7ne Thousand ($1,000.00) Dollars to my good.
friends, CREEI)IN L. STONER and HELEN G. STOI~TER, his wife, share and share
alike, or to the survivor of said two legatees, absolutely, should either of them predecease
me.
7.
All the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situate, shall be converted into cash and for this purpose, I authorize,
empower and direct my Executors, hereinafter named, to sel_1_ a_ny and all_ real_ estate which
L
r
..- ._..., -~ 4
I may o«~n at the time of my decease, as well as, my personal property at either public or
private sale or sales.
After my estate has been liquidated and converted into cash and upon the payment
of all my just obligations, the costs of administration of my estate and all inheritance and
succession taxes, I direct that the balance of my estate then remaining be divided into --
three (3) equal shares, and that the same be paid out and distributed as follows, to wit:
(a) I give and bequeath one (1) such equal share to the following
nal-nPd children of my late hrnther, PATTT, ~2, ~()~J~T_+',R, try ~~~ifi, Su~RO»l
U~~iOL'I`~, RU 1 ~ E+'KAl~'gZ, ~ ~1VIEL SOUI)ER and ~A'I~RiCR
SOURER, share and share alike.
(b) l give and bequeath one (1) such equal share to my sister;
il+(13~~D'~'~T~ ~; VC1RT,~'i'~~ anri i» the Py~nt that my cam Sister Sl?ni~irl
~ predecease me, then in such event, I give and bequeath said share to her tv~~o
(2) children, to wit, I)OI°vTALI3 YORLET'S and I~TAl`~CY LIVINGSTOTm1,
share and share alike.
(c j I give and bequeath one (1) such equal_ share to my brother,
GLE1~tt~1 I:. SC~UI3ER, anal in the event that my said brother should
predecease me, then in such event, I give and bequeath said share to his
three (3) children, to wit, LARRY SOU~E,R, PEGGY SOLIDER and
T1FR~2 A 1~TFHT,, ghare anti Share alil{P,
-3-
LASTLY, I nominate, constitute and appoint my niece, SILARON S~UDER, and
my good friend, CREEDIN L. STONER, Co-Executors of this my Last Will and
Testament, and I direct that my said personal representatives be excused from posting
bond or other securit<y~ for the faithfal perfo~^nance of Li~ieil duties, in any jurisdictio n.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~. `~~ day
of September, A. D. 1999.
~I ~ ~ ~ ~ ~~
~ozella M. McLane
Signed, sea]ed, published and declared by the above-named, R®ZELLA ICI.
1~~eL 41~TE, as and for her Last Will and Testament, in the presence of us, who, at her
request and in her presence, and in the presence of each other, have 1~ereunto subscribed
our names as witnesses.
-4-
COMMONWEALTH OF PENNSYLVANIA )
SS
COUNTY OF CUMBERLAND )
I, R®ZELLA 1VJi. I~eLANE, the~testatrix, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
~.r,~nn~z~led~e that I SionP~i anr~ avvriµtPr~ the Same inStrrumPnt aS my T aSt «lili anr~
~~~..,..
Testament; that I signed it willingly, and that I signed it as myfree and voluntary act and
deed, for the purposes therein expressed.
i~ f, ~
' ~ y-i~= ~ ~ >~1 ~ ~~' d-~~ ~~ (SEAL)
I'S~'vZeila ~i. lvia^,Laiie
Sworn and subscribed to before
me this ~ day of September, 1999. ______---.
C~~`'/„ ~,~ Notanal Seal
~''~'~ ~%~'"~ L /~`~~.~ pksrifyn E. Williams, Notary Public
Notary PUbllc Mechanicsburg Bora, Gumberiand County
My Commission Expires Nov. 6, 2001
Member, Pennsylvania Association of Notaries
COMMONWEALTI~ OF PENNSYLVANIA )
SS
Cn~r1~T~ry nP CLn;~riEF.I,teNm )
We, the undersigned, J. R~~3EI2'~' STALTFFER and SLTSAl°+1 A. l~'fcC~Y, the
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the testatrix,
t*~tJZ1C.LL1-`~ 1V~. iVil'Ll~~1V~~'.; S1~II d.fld eACLutC LIIC 1r15Li`ufnerlt dS r1Cr L'ct5t W 111 a15(1
Testament; that the said testatrix 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, sib ed the Wi11
aS W?tn?SSeS; and that, t0 the best of o31T knowledge, the testatri}{ `x~ac at the tlr3le,
eighteen (18) or more years of age, of sound mind, and under no constraint, duress or
undue infllgence. . -~ / ~ ~ ,//'!
r :'~Lti'
Sworn and subscribed to before
me this `~ ~ ~ day of September. 1999.
Notary`Public
Notarial Seal
AAarilyn E. Williams, Notary Public _ j _
Mechanicstwrg Boro, Cumberland County
My Commission Expires Nov. 6, 2001
Memi~er, Pennsylvania Rssociation of Notaries