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Home My WebLink About05-17-12J 1505610143 REV-1500 Ex(°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania a _ _ _, coumy code veer File Numoer Bureau of Individual Taxes pEppXiMEHL°RF1ENVE Po eox.zaosol INHERITANCE TAX RETURN 21. 11 0212 Harrisburg, PA 17728-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02 10 2011 02 22 1929 Decedent's Last Name WILLIAMSON (If Applicable) Enter Surviving Spouse's Information Below Suffix Decedent's First Namet ALICE Spouse's Last Name Suffx Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum 4. Limited Estate 5 Decetlent Oietl Testate (Attach COpy o(Wil1) 9. Litigation Proceeds Received ^ 2. Supplemental Return qa Future Interest Compromise ( Cate of tleath aXer 12-12-82) ^ p ~' (Att ch RGopy i~7 ed~a Living Trust ^ 10. b~tiveen 7231 ~J1 anCit~aatge5~rdeath ^ 3. Remainder Return (date of death ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) MI R MI prior to 12-13-82) ^ 5. Federal Estate Tax Return Required e. Total Number of Sate Deposit Bozes CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number FOREST N MYERS 717 532 9046 REGISTER OF WILLS USE pNLY ~} ~~ Cd , ~ First line of address ^+-t ~'''~ `:o: i r_'~ %-~ 137 PARK PLACE WEST ~ L , ~"~ ~ ~ r- ~ ~ ~ , Second line of address ' "u -' ~ -.. CJ;-,. - ' DA~_rr~ED -~~' ` City or Post Office State ZIP Code a--~ -'-r ~ D SHIPPENSBURG PA 172579212 c.a `~~~ Correspondent's a-mail address: fnmyers@lawofficeforestmyers.com Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statement. , antl to the best of my knowledge antl belief, it is true, correct and complete. Declaration of preparer other than the personal representatve is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN OATS Y ,-,t..f... t', ~./ii~~„_,.,... 2 Foster C WILLIAMSON Jr S ~\S-20 \Z ADDRESS 908 Petersburg Rd. Carlisle, PA 17015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE PATE ~~ ~~ Forest N Myers ~ _\S_'~i~2. ADDRESS 137 Park Place West, Shippensburg, PA Side 1 L 1505610143 1505610143 1505610243 REV-1500 EX Decedent's Social Security Number oeceaem•s Name: WILLIAMSON, Alice R RECAPITULATION 1. Real EState(Schedule A) ....................................................................................... 1. 45,000.00 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 7 ,170.94 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous f~oq-Probate Property (Schedule G) a Separate Billing Requested............ 7. 8. Total Gross Assets (total Lines 1-7) .................................................................... . 8. 52 , 170.94 9. Funeral Expenses & Administrative Costs (Schedule H) ........ ........................... 9. 18 , 661.21 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 2 , 870 • 99 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 21 , 532 . 2O 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 30 , 638.74 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14. 30 , 638 .74 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 O • OO (a)(1.2) X .00 16. Amount of Line l4 taxable 30,638.74 1s. 1,378.74 at lineal rate X .045 17. Amount of Line 14 taxable O OO 17 O • OO . at sibling rate X .12 . 18. Amount of Line 14 taxable 0 00 i6 0.00 . at collateral rateX.15 . 19. Tax Due ................................................................................................................. . 19. 1,378.74 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11-021;t DECEDENT'S NAME WILLIAMSON, Alice R STREETADDRESS 105 N Penn St CITY Shippensburg STATE PA ZIP 17257 Tax Payments and Credits: 1. Taz Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 (1) Total Credits (A + B) (2) 3. Interest q. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund (3) (4) 1,378.74 0.00 21.37 5, If Line 1 + Line 3 is greater than Line 2; enter the difference. This is the TAX DUE. (5) 1 400.11 r Make Check Pa able 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 :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ ^x d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ ^x 3. Did decedent own an "in trust for' or payable upon death bank accounLOr security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which i b f i d i i ? ^ ^ conta ns a ene ic ary es gnat on .................................................................................................................. x 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 January 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. §9t 16 (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)]. A sibling is deftned under Section 9102, as an individual who has at least one parent in common with the deicedent, whether by blood or adoption. Rev-1502 EXi (11-09) SCHEDULE A REAL ESTATE COMMONWEALTH OFPENNSVLVANIA INHERITANCE TA%RETURN RESIDENT OECEOENT ESTATE OF FILE NUMBER WILLIAMSON, Alice R 21-11-0212 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is de(netl ae'~ the price a[ which pro erty woultl be euchangetl between a willing buyer and a willing seller, neither being compelletl to buy or sell, both having reasonable knrnvletlge of the relevant facts. Reel property which is jointly-owned with right of survivorship must ba disclosed on schedule F. Akach a copy of the seklement sheet if the property has been sold Include a copy of the deed showing tlecatlent's interest if owned as tenant in common. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Residence -located at 105 N Penn St, Shippensburg, Borough of Shippensburg, Cumberland 45,000.00 County, Pennsylvania; Sold on May 07, 2012 (see attached HUD1 Settlement Statement) TOTAL (Also enter on Line 1, Recapitulation) I 45,000.00 (If more space is needed, adtlitional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1506 EX* (6-9a) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIAMSON, Alice R 21-11-0212 Include the proceeds or litigation and the date the proceeds were receivetl by the estate. All property Jointly-owned with the right of survivorship must be dlaclosetl on schedule F ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Orrstown Bank 103000347 -checking account; date of death balance 1.00 2 Orrstown Bank 661309 -checking account; date of death balance 1,815.48 3 Orrstown Bank 703005297 -savings account; date of death balance 3,176.43 Accrued interest on Item 3 through date of death 0.27 4 Personal Property-gross proceeds from auction 495.50 5 CenturyLink -refund 5.68 6 Comcast -refund 29.03 7 Department of Revenue - 2010 Property Tax Rebate 650.00 8 Shippensburg Borough Tax Office -Refunds of unrealized Real Estate Taxes 375.92 9 Suburban Heating Oil Partners -refund 97.63 10 US Dept of Veterans Affairs -Pension 524.00 TOTAL (Also enter on Line 5, Recapitulation) I 7,170.94 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Iric. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 Exi (10-06) pp SCHEDULE H COMINHEWppITANTgqETqFxRETgu RryVANIA FUNERAL EXPENSES & RESIDENT pECEpENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WILLIAMSON, Alice R 21-11-0212 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 8,080.00 Street Address City State Zip Yearfsl Commission Daid 2. Attorney's Fees Law Office Forest N Myers 3,076.00 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 269.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 7,235.71 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 18,661.21 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 70-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER WILLIAMSON, Alice R 21-11-0212 ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Expenses Fogelsonger-Bricker Funeral Home -funeral bill (partial payment) 4,000.00 2 Fogelsonger-Bricker Funeral Home -funeral bill (partial payment) 2,420.00 3 Fogelsonger-Bricker Funeral Home -funeral bill (partial payment) 1,000.00 4 Fogelsonger-Bricker Funeral Home -funeral bill (partial payment) 660.00 H-A 8,080.00 5 Other Administrative Costs Chamberlin Pest Control -treatment for Termites 637.59 6 Checks-reorder checks for estate account 12.00 7 Cumberland County Recorder of Deeds -Transfer Tax 450.00 8 Cumberland County Recorder of Deeds -Record Satisfaction of Mortgage 50.50 9 Cumberland County Register of Wills -filing fee; Inheritance Tax Return 15.00 10 Grace Keiter, Tax Collector - 2011 County & Boro Real Estate Taxes 586.66 11 Grace Keiter, Tax Collector - 2011 School District Real Estate taxes 369.70 12 Grace Keiter, Tax Collector - 2011 School pistFjct Real Estate taxes 369.70 13 Grace Keiter, Tax Collector -21111 SchooF District Real Estate taxes 369.70 14 Hershey Auctioneer -trash fees 50.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER WILLIAMSON, Alice R 21-11-0212 ITEM NUMBER DESCRIPTION AMOUNT 15 Irwin Law Office -legal fees 350.00 16 JaLex Real Estate Svcs./ReMax Homefinders -Realtor's commission 2,700.00 17 Penelec -utility; electric 34.12 18 Penelec -utility; electric 23.85 19 Penelec -utility; electric 14.17 20 Penelec -utility; electric 10.34 21 Penelec -utility; electric 10.29 22 Penelec -utility; electric 10.12 23 Penelec -utility; electric 10.38 24 Penelec -utility; electric 20.81 25 Penelec -utility; electric 11.60 26 Penelec -utility; electric 10.35 27 Penelec -utility; electric 13.03 28 Penelec -utility; electric 13.12 29 Penelec -utility; electric 11.82 30 Penelec -utility; electric 10.52 31 Salzmann Hughes -Tax Certification 20.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER WILLIAMSON, Alice R 21-11-0212 ITEM NUMBER DESCRIPTION AMOUNT 32 Shippensburg Borough Tax Office -Real estate taxes 327.00 33 State Farm Insurance -homeowner's insurance 652.00 34 Tim Gruver Plumbing -repairs to plumbing at decedent's property 71.54 FN-B7 7,235.71 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rav-1572 E%* (72-g8) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONW£4LTH OF PENNSYLVANIA INHERITANCE TA%RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WII I IAMRnW Alico R 71 _11 J1919 Report debts Incumetl by Ma dacetlent pdorto death that remainetl unpaid at tha tlate of tleath, including unreirtlbureed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Anesthesia of Franklin County -medical bill of decedent 31.26 2 Borough of Shippensburg -utility; water/sewer/trash 136.00 3 Borough of Shippensburg -utility; water/sewer/trash 28.00 4 Borough of Shippensburg -utility; water/sewerltrash -final bill 59.84 5 Borough of Shippensburg -utility; water/sewer/trash 25.00 6 CenturyLink -utility; telephone 46.67 7 Chambersburg Hospital -medical bill of decedent 176.09 8 Chambersburg Hospital -medical bill of last illness 175.52 9 Chambersburg Hospital -medical bill of decedent 77.02 10 Chambersburg Pathology Assoc -medical bill of decedent 25.36 11 Dan Hershey, Auctioneer -auctioneer's commission 198.20 12 Deduction -for check No. 1638 written on decedent's OB checking account which cleared 67.80 post-death 13 Fry & Brannac Ophthalmology Assoc -medical bill of decedent 78.14 14 Shippensburg Area EMS -transport 93.21 15 Summit Physician Services -medical bill of decedent 75.05 16 US Dept of Veterans Affairs -return of Pension (per VA recapture of benefit) 524.00 17 West Shore EMS -outstanding bill 1,053.83 TOTAL (Also enter on Line 10, Recapitulation) I 2,870.99 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Fonn PA-7500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-88) Cr~H;{ gqXXE~RN~EgqTgG~^J SCHEDULE J COMM NW DENTEDECEOENTRNANIA BENEFICIARIES ESTATE OF FILE NUMBER WILLIAMSON. Alice R 21-11-0212 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S1 RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal . distributions, and transfers under Sec. 9116 a 1.2 Foster C WILLIAMSON Jr Son One-half (1/21 of 908 Petersburg Rd the net Carlisle, PA 17015 distributable estate Jerry L WILLIAMSON Son One-half (7/2) of 12422 Forge Hill Rd the net Orrstown, PA 17244 distributable estate Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TfU( IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 farm software only The Lackner Group, Inc. form PA-1500 Schedule J (Rev. 11-08)