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HomeMy WebLinkAbout06-11-121505610140 REV-1500 EX (°'_'°' PA pepartment of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO Box 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 3 6 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 1 5 9 2 4 7 6 3 5 0 2 1 3 2 0 1 2 1 1 2 9 1 9 2 7 Decedent's Last Name Suffix Decedent's First Name MI A D A M S G L E N N R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI A D A M S M A R G I E M Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 2 0 7 2 2 1 8 9 7 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) © 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number C H R I S T O P H E R E R I C E 7 1 7 2 4 3 ~3 4 1 First line of address M A R T S O N Second line of address 1 0 E A S T City or Post Office C A R L I S L E L A W O F F I C E S H I G H S T R E E T State ZIP Code REGIST ILLS U S NLY ~ ~ ' i ' ~ " x:, tJ':4 ".'~. r.,. ' tv £ ,p"'y 3s cs~ ~.. DATE FILED Q'" ~~ +. -T, P A 1 7 0 1 3 Correspondent's a-mail address: CRICEnu,MARTSONLAW.COM 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. SIGNATURE OF PE N RESPONSIBLE FOR FILING RETURN / DATE 343 D"STREET CARLISLE PA 17013 SIGIdICTr~1~F PREP9QER OTJjER THAN REPRESENTATIVE ~DA~ / 2 10 EAST HIGH STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 1505610240 REV-1500 EX Decedent's Social Security Number Decedents Name: GLENN R• ADAMS 1 5 9 2 4 7 6 3 5 RECAPITULATION 1. Real Estate (Schedule A) ...................................... ..... 1 2. Stocks and Bonds (Schedule B) ................................. ..... 2. 7 9 9 8 5 . 6 8 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) ^ Separate Billing Requested .. ..... 6. 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested .. ..... 7. 8. Total Gross Assets (total Lines 1 through 7) ...................... ..... 8. 7 9 9 8 5. 6 8 9. Funeral Expenses and Administrative Costs (Schedule H) ..... ... ... ..... .. 9• 2 2 7 4 . 0 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ... ... ..... .. 10. 11. Total Deductions (total Lines 9 and 10) .................. ... ... ..... .. 11. 2 2 7 4 . 0 5 12. Net Value of Estate (Line 8 minus Line 11) ............... ... ... ..... .. 12. 7 7 7 1 1 . 6 3 13. Charitable and Governmental Bequests/Sec 9113 Trusts for whi ch an election to tax has not been made (Schedule J) ........ .... ... .... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ .... ... .... ... 14. 7 7 ~ 1 1 • 6 3 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.o _ 7 7 7 1 1 6 3 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0. 0 0 16. 0. 0 0 17. Amount of Line 14 taxable 0 0 0 17 0 0 0 at sibling rate X .12 . . 18. Amount of Line 14 taxable 0 0 0 0 0 0 at collateral rate X .15 18. . 19. TAX DUE ........................................ .... ... .... ...19. 0 • 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610240 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 12 0362 DECEDENTS NAME GLENN R. ADAMS STREET ADDRESS 343 D STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments 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. 0.00 Total Credits (A + B) (2) 0.00 (3) (4) 0.00 (5) 0.00 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 shalt 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 December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................. ...... ^ 0 3. Did decedent own an "intrust for" or payable-upon~leath bank account or security at his or her death? ... ...... ^ ^X 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ............................................................................................ ...... ^ ^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)J. 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)J. 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)]. 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-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GLENN R. ADAMS __ 21 12 0362 All property jointty-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Carlisle Companies Inc., 1648 shares (CUSIP No. 142339100) 79,985.68 See Estate Valuation attached TOTAL (Also enter on line 2, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER GLENN R. ADAMS 21 12 0362 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: Martson Law Offices 2,000.00 3, family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: Register of Wills 137.50 5 Acx:ountant Fees: 6. Tax Return Preparer Fees: 7. Stock evaluation report 1.55 8. Register of Wills, filing fee, inheritance tax 15.00 9. Register of Wills, additional probate 120.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 2,274.05 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) Pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: GLENN R. ADAMS 21 12 0362 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. Margie M. Adams Spousal 77,711.63 343 D Street Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. ~.~ I, GLENN R. ADAMS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my last will and testament, and revoke all wills and codicils which I have previously made. I - I give, devise and bequeath my entire estate, real and personal, unto my wife, Margie M. Adams, absolutely and in fee simple if she shall survive me. II - If my wife, Margie M. Adams, fails to survive me, I give, devise and bequeath my entire estate, real and personal, as follows: A. One-half to my son, Glenn R. Adams, Jr., if living, otherwise to his surviving issue, per stirpea. B. One-half to my son, Donald E. Adams, if living, otherwise to his surviving issue, and if no issue survives, then one-fourth to my daughter- in-law, Cathy Adams, and one-fourth to the issue then living of my son, Glenn R. Adams, Jr. III - Any share of my estate which shall become distributable to a minor may be held in a savings account, certificate of deposit or similar security, in a federally insured banking or savings institution in the name of the minor and marked not to be withdrawn until the minor attains the age of 18 years. IV - I appoint my wife, Margie M. Adams, as Executrix of this will. If for any reason she shall fail to qualify or cease to act as such during the administration of my estate, I appoint my sons, Glenn R. Adams, Jr. and Donald E. Adams, as substituted executor. I direct that no bond shall be required of any fiduciary named in this will. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~.3 day of ~ 9 8'b April, ~9&5t „~e:~%C.Lw~i1T~~' (SEAL) Signed, sealed, published and declared by Glenn R. Adams, testator above named, as and for his last will and testament, written on one sheet of paper, in our presence, who in his presence, at his request, and in the presence of each other have hereunto subscribed our names as attesting witnesses: Estate Valuation - Carlisle Compani Date of Death: 02/13/2012 '•Ialuation Date: 02/13/2012 Processing Date: 05/02/2012 Shares Security or Par Description 1) 1648 CARLISLE COS INC (142339100) NYSE 02/13/2012 Total Value: Total Accrual: Total: $79,985.68 $0.00 $79,985.68 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.4.1) Estate of: Glenn R. Adams Account: 12699.3 Report Type: Date of Death Number of Securities: 1 File ID: 12699.3.adams Mean and/or Div and Int Security High/Ask Low/Bid Adjustments Accruals Value 49.04000 46.03000 H/L 48.535000 79,985.68 ~c~~e~(~.1~, f~