HomeMy WebLinkAbout04-26-12 (2)1505611180
J REV-1500 Ex,02-,,,IFI)
OFFICIAL USE ONLY
PA Department of Revenue o~ ~NyoF xa~eae County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280801
Hamsburg, PA 17128-0801 RESIDENT DECEDENT 21-1z-0012
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
204-01-7273 12062011 03/05/19
Decedent's Last Name Suffix Decedent's First Name MI
BLOSSER MABEL I
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffx Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
0 i. Odginal Return 0 2. Supplemental Return Q 3. Remainder Return (Date of Death
Prior to 12-13-82)
0 4. Limited Estate 0 ba. Future Interest Compromise (date of ~ 5. Fede21 Estate Taz Return Required
death after 12-12-82)
Ox 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Tmst ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (Date of Death Q 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-93) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
STEPHEN D. TILEY 717-243-5838 rv
First Line of Add2ss
5 SOUTH HANOVER STREE
Second Line of Address
Ciry or Post Office State ZIP Code
CARLISLE PA 17!113
REGISTER LS USE ONhY
Ta )s -I
i
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77 r N
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zcn~ Crl )
O~n
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~ W E-
~ -7
DATE FILED
Correspondent's a-mail address:
Under penalties of perjury, I tleclare that I have examined this return, inUuding accompanying schedules and statements, and to the best of my knowletlge and belief,
ADDRESS T
STEPHEN D. TILEY, 5 SOUTH HANOVER STREET, CARLISLE, PA 17013
PLEASE USE OR: 3INAL FORM ONLY
Side 1
L 1505611180 1505611180 J
;"~/J°v
Robert C Wetzel 1436 Walnut Bottom Road: Edward L Snvder 11 Greenview Drives Bath Carlisle PA
SIGNATSJfiE OF P~tEPARER OTHER THAt~tEPRESENTATIVE DATE
J 1505611280
REV-1500 EX (FI)
Decedent's Social Security Number
Deceden4s Name: MABEL I BLOSSER 204-01-7273
RECAPITULATION
1. Real Estate (Schedule A) ..........:.............................. 1. N 0 N E
2. Stocks and Bonds (Schedule B) .................................... 2. N 0 N E
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. N 0 N E
4. Mortgages and Notes Receivable (Schedule D) ........................ 4. N 0 N E
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... 5. 6 010 $ . 0 0
6. Jointly Owned Property (Schedule F) Separate Billing Requested ...... . 6. 38014.58
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) OSeparate Billing Requested ...... . 7. N 0 N E
8. Total Gross Asseta (total Lines 1 through 7) ......................... . 8. 9 8119.5 8
9. Funeral Expenses and Administrative Costs (Schedule H) ................ 9. 3760.00
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ 10. 8.00
11. Total Deductions (total Lines 9 and 10) ............................. 77. 3768.00
12. Net Value of Estate (Line 8 minus Line 11) ........................... 12. 9 4 3 51.5 8
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ..................... . 13. 10 0 0 . 0 0
14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... . 14. 9 3 3 51.5 8
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable at
the spousal tax rate, or
transfers under Sec. 9116
(a>(t.2)x.o 0 is. 0.00
16. Amount of Line 14 taxable
at linealrateX.O 45 t6. 0.00
17. Amount of Line 14
taxable at siblingratex >e>R>t 55337.00 t7. 6640.44
18. Amount of Line 14 taxable
at collateralratex ppp 38014.58 1s. 5702.19
19. TAX DUE ....................................................... 19.
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
12342.63
0
L 1505611280 1505611280 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
21-12-0012
File Number
204-01-7273
DECEDENTS NAME
MABELIBLOSSER
STREET ADDRESS
1000 CLAREMONT ROAD
CITY
CARLISLE STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments 11700.00
B. Discount 615.77
3. Interest
Total Credits (A + B )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box 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.
(1) 12342.63
(2) 12315.77
(3)
(4)
i (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 transfened 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 tmst 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 benefciary 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.
3,
For dates of death on or after July 1, 1994, and before Jan. i, 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. t) (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
defned, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+(11-10) SCHEDULE E
Pennsylvania CASH, BANK DEPOSITS, 8r MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Mabel 1. Blosser 21-12-0012
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.
1 M & T Bank Checking Account No.: 403649 (See Exhibit "A") 32,296
Accrued Interest to DOD ($0.13) 0
2 Orrstown Bank Checking Account No.: 106001629 (See Exhibit "B") 21,360
Accrued Interest to DOD ($0.62) 1
3 Refund, Claremont Nursing and Rehabilitation Center 6,400
4 Final Pension (Net of Medical Ins.), State Employees Retirement System 48
TOTAL (Also enter on line 5, Recapitulation) $ I 60,105
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX4 (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEF
JOINTLY-OWNED PROPERTY
FILE NUMBER:
Mabel 1. Blosser 21-12-0012
If an asset became join0y owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) I ADDRESS I RELATIONSHIP TO DECEDENT
A. Robert C. Wetzel
B.
C.
Walnut Bottom Road, Carlisle, PA 17015 brother-in-law
JOINTLY OWNED PROPERTY: ,
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND SANKACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET %OF
DECEDENr
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
Orrstown Bank CD #: 4000042189
1 A 76,000.00 50.00% 38,000.00
Accrued Interest to Date of Death
29.15 50.00% 14.58
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL (Also enter on Line 6, Recapitulation) g art ntd sa
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(19-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Mabel I. Blosser 21-12-0012
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t. Ewing Brothers Funeral Home 166
2. Carlisle Memorial Services, Inc. 185
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Sheet Address
City
Year(s) Commission Paid:
2.
3.
a.
5.
6.
7.
Attorney Fees: Frey 8 Tiey
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City Stale
Relationship of Claimant [o Decedent
Probate Fees:
Accounwnt Fees: Frey 8 Tiley
Tax Return Preparer Fees: Frey 8 Tiley
Orrstown Bank -Check Printing Fee
8. Cumberland Law Journal
9. The Sentinel
10. Register of Wills- Filing Fee for Inheritance Tax Return
State ZIP
ZIP
3,000
116
Above)
Above)
13
75
190
15
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+(12-06)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
Mabel 1. Blosser 21-12-0012
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, Including unreimbureed medical expenses.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RFSIOFNT DECEDENT
ESTATE OF: FILE NUMBER:
Mabel I. Blosser 21-12-0012
RELATIONSHIF'TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llat Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Inclutle outright spousal distributions and t2nsfers under
Sec. 9118 (a) (1.2).[
Robert C. Wetzel
1 1436 Walnut Bottom Road, Carlisle, PA 17015 Brother-In-L.aw 50 Percent
Edward L. Snyder
2~ 11 Greenview Drive, Carlisle, PA 17015 Brother 0.08333 Percent
3 Sylvester R. Snyder
. 99 Garfield Drive, Carlisle, PA 17015 Brother 0.08333 Percent
Betty R. Shuler
4. 7 Alliance Drive, Carlisle, PA 17013 Sister 0.08333 Percent
5. Annabelle M. Wetzel
1436 Walnut Bottom Road, Carlisle, PA 17015 Sister 0.08333 Percent
6. Shirley K. Kauffman -
96 Greenview Drive, Carlisle, PA 17015 Sister 0.08333 Percent
7 Ray G. Snyder
700 Route US 9 N., Marmora, NJ 08223-1841 Brother 0.08333 Percent
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II I NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.~Brethern In Christ Church, 1155 Walnut Bottom Road, Carlisle, PA 17015
1,000.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I S 1.000.00
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
OF
MABEL I. SLOBBER
4 MABEL I. SLOBBER, widow, of South Middleton Township (mailing address: 1422
Walnut Bottom Road, Cazlisle, PA 17015), Cumberland County, Pennsylvania, being of sound
and disposing mind, memory and understanding, do hereby make, publish and declare this as and
for my Las[ Will and Te_s[ameut hereby revoking and making void any and all Wills by me at any
time heretofore made.
1. 1 direct my hereinafter named Executor [o pay all of my just debts and funeral
expenses as soon after my death as may be found convenient to do so. I direct that my funeral
services be conducted by Ewing Brothers Funeral Home, 630 South Hanover Street, Carlisle,
Pennsylvania, in accordance with arrangements which I have made there, and that my body be
interred beside that of my husband Glenn L. Blosser on [he burial lot of his parents who were
Robert and Henrietta Blosser, which lot is located in Trindle Springs Cemetery, near the
Borough of Mechanicsburg, Pennsylvania. I bring to [he attention of my Executor that I have
prepaid for the funeral service which I have arranged at Ewing Brothers Funeral Home.
2. I direct that all inheritance, Vansfer, succession, estate and death taxes, including
interest and penalties thereon, which may be payable on account of my deathshall be payable
from the residue of my estate regardless of whether the assets upon which such taxes are based
are included in my probate estate.
3. I give and bequeath [he sum of $1,000.00 m the Carlisle Brethren In Christ Churcb,
Walnut Bottom Road, Carlisle, Pennsylvania, [o be used for such purpose or purposes as the
Trustees of said Church shall deem appropriate.
4. All of the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, I give, devise and bequeath in equal shares as follows:
(a) One share [o my brother-i^-law ROBERT C. WETZEL in appreciation fcr his many
kindnesses and helpfulness which he has extended to me.
(b) One share to each of my following named brotlters and sisters who shall swvive me by
a period of ninety (90) days, but should any of them fail [o so survive me then the share which
such deceased brother or sister of mine would have received shall lapse and be divided equally
among the remaining shares. My presently living brothers and sisters provided for herein are:
VIVIAN M. TIBBO, ROSE M. BITNER, MARIAN J. CALAMAN, SYLVESTE:R R.
SNYDER, BETTY R, SHULER, ANNABELLE M. WETZEL, SHIRLEY A. KAUFFMAN,
EDWARD L. SNYDER and RAY G. SNYDER.
5. 1 have made no provision herein for my sister DORIS J. MIXELL, not because of any
want of affection for her, but because I am confident [hat she is already adequately provided for.
6. I hereby nominate, constitute and appoint my brother-in-law ROBERT C. WE'fZEL
and my brother, EDWARD L. SNYDER, and the survivor of [bent, as Executors of this m7 Last
Will and-Testament, and I further direct that neither of them shall be required to post any bond to
secure the faithful performance of his duties in the Commonwealth of Pennsylvania or in any
other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
Testament written on two (2) pages, this ~(ptt" day of ~i~it-un , 2007.
l'/i E•- /~_ 0 ~- ~~~ v )(SEAL)
MABE-~FBLOSSER
Signed, sealed, published, and declared by MABEL I. BLOSSER, the Testatrix above
named, as and for her Last Will and Testament, in our presence, who, in her presence, at her
request, and in the presence of each other, have hereunto subscribed our names as attesting
witnesses.
~--
p ~s~
499 Mitchell Road, Millsboro, DE 19966 Adjustment Services
Phone 888-502-4349
F ax (302) 934-2955
January 30, 2012
Stephen D Tiley
5 south Hanover Street
Carlisle, PA 17013
Re: Estate of Mabel I Blosser
Social Security: 204-0]-7273
Date of Death: December 6, 2011
Deaz Sir or Madam:
Per your ingiriry on January 23, 2012, please be advised that at the time of death, the above-named decedent had
on deposit with this bank the following:
Type of Account
Account Number
Ownership (Names ofJ
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
403849
Mabel I Blosser
Robert C Wetzel (POA)
09/01/67
$32,295.72
/3
$32,295.72
For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds,
please ®11 the Ffigh Shell Catiisle Office at 8717-7AO-0536.
We were unable to locate any safe deposit box [or the above•mentioned decedent.
This triter does not inelude any acrounts in which the deceased may Gave been listed as Power of Attorney, Custodian of Uniform Tranders,
Representative Payee, or Trustee ands a Written Agrtement
Sincerely,
Tammy Spencer
Adjustment Services
~~N
Vltt(J 1 V VV 1V
BANK
ATrnditian oJExceQence
January 25, 2012
Frey & Tiley Attorneys At Law
Stephen D. Tiley
5 S Hanover Street
Carlisle, PA 17013
Fax: 243-6441
Re: Estate of Mabel I. Blosser
Social Security Number 204-O1-7273
Date of Death 12/6/2011
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account No.-
Account Type-
Date Opened-
Joint Account (aame/date)-
106001629
Relation Interest Checking
9/20/2000
No
Accrued Interest- $0.62
CERTIFICATE OF DEPOSIT
Account No.- 4000042189
Account Type- 06-11 Month Income CD
Date Opened- 7/8/2011
Joint Account (name/date)- Robert C. Wetzel, 7/8/2011
Balance- $76,000.00
Accrued lnterest- $29.15
Rollover from earlier CD account that was originally established 4/4/2008.
Best Regazds,
~ G~~~~~GY'v~
] R. Worthington
Deposit Processing Clerk
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2695 Philadelphia Avenue
Chambersburg, PA 17201
1.a88.ORRSTOWN
www ®rrstown.com