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Home My WebLink About07-02-12 (5)J 1505610143 REV-1500 Ex(°'.'°' PA Department of Revenue Pennsylvania Bureau of Individual Taxes «".am"°1R«"~"""'• Po Box.z5o6o1 INHERITANCE TAX Harrisburg, PA 17125-0607 RESIDENT DECE ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 171 28 3544 12 09 2011 Decedent's Last Name Suffix ADAMS (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number OFFICIAL USE ONLY County Cade Vear File Number 121 12 0101 Date of Birth 12 20 1921 Decedent's First Name MI ELSIE P Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t. Original Retum ^ 2. Supplemental Retum ^ l2' (date of death 3. p 3e tl2 r e rior to l ^ 4. Limited Estate ^ ba. Future Interest Compromise (tlate of deem amer 12-12-82) ^ 5. Federal Estate Tax Return Requiretl g Decedent Died Tealate (At1eM Copy of Wil° ~ pecede tMain~~jnatla Livirg Trust (Attach RGOPYO mag a. Total Number oP Safe De Sit Boxes PD ^ 9. Litigation Proceeds Received ^ 10, belwaen 72 3191 endt{daleeSpi deem 11 ^ 11, Election to tax untler Sec. 8113(A) (Attach Sch. O) CORRESPONDENT • THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAN M WILEY 717 432 9666 First line of address 3 N BALTIMORE ST Second line of address City or Post OfFlCe State 21P Code DILLSBURG PA 17019 Correspondent's e-mail address: REGISTER O ImS USE ONLY m,-° - , , xt ~- ~- r I f_ t V+=~r N +: ~ , ? ~ - _n DAT~'FILED N r, c> a C'? r'Tl r_7 -~, -r~ C~ rn Under penalties of peryury, I deGare mat I have examinetl Nis return, including accompanying schedules and statemems, entl to the best of my knowledge and belief, it is true, coned and complete. DeGaretion of preparer other man me personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE / Bessie 1. Minnich y'~e.~~ ~ - 7ya,~.i,r.~ ~ y~W~i~ ADDRESS Side 1 L 1505610143 1505610143 J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF 12t 12 0101gER Adams, Elsie P. Under penalties of perjury, I declare that I have examined this return, including acwmpanying schedules and statements, and to the best of my knowledge and belief, h is true, correct and wmplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Signature #2 Name Address? Address2 City, State, Zip Date Peggy L. Hinke 770 Sunhaven Circle Mechanicsburg, PA 77055 c~a~i~ 1505610243 REV-1500 EX oa~cam•a ruame. Adams, Elsie P. Decedent's Social Security Number 171 28 3544 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 & Notes Receivable (Schedule D) ....................................................... . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .............. . 5. 83 , 697.04 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous t~nq-Probate Property (Schedule G) u Separate Billing Requested............ 7. 69 , 515.37 8. Total Gross Assets (total Lines 1.7) .................................................................... . 8. 153 , 212.41 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 24 , 946.59 t0. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11 , 2 65.2 7 t t. Total Deductions (total Lines 9 & 10) .................................................................. . t t. 3 6 , 211.8 6 12. Net Value of Estate (Line 8 minus Line t 1) .......................................................... 12. 117 , 0 00.55 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... t 3. 14. Net Value 3ubjeet to Tax (Line 12 minus Line 13) .............................................. . 14. 117 , 000.55 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0 00 (a)(1.2) X .00 . . 16. Amount of Line 74 taxable 117 000.55 i6 5 265.02 at lineal rate X .045 r . ~ 17. Amount of Line 14 taxable 0 00 17 0 00 . at sibling rate X .12 . . 18. Amount of Line 14 taxable 0 00 i6 0 00 . at collateral rateX.15 . . ts. raxDue ................................................................................................................. . 19. 5,265.02 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: Flle Number 21-72-0101 DECEDENT'S NAME Adams, Elsie P. STREET ADDRESS 100 Mt. Allen Drive CITY Mechanicsburg STATE: PA ZIP 17055 Tax Payments and Credits: t. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 0.00 q, If Line 2. is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Cheek box on Page 2 Llne 20 to request a refund 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 5,265.02 0.00 (5) 5,265.02 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 :.................................. ^ c. retain a reversionary interest; or ............................................................................................................... ^ ^x 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 death 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 ^ ^ wntains 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. t, 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) (7.1) (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) (7.1) (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)]. (1) Total Credits (A + B) (2) (3) (q) . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is q.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9176 (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. §91 t6 (a) (1.3)]. A sibling 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-7li08 EXi (8-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALIN OFPENNEYLVRNIA INHERITANCE Trl%RE1LWiN REEIOENT DECEDENT ESTATE OF (FILE NUMBER InGUtle the pproceetls of lilipanon antl the tlata the pnxsetle ware reoeivetl by the estate. All propsny jointly-owned with Me dght of survivorship moat ba dlseloeetl on eehedula F. (If more apace is neetled, adtlitional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1800 Schedule E (Rev. 6-98) Rev-1510 EX+ IB-99) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY LOMMONWEALTHOF HENNBYLVANIA INHERITANCE TAX RETURN RE6IDENT DELEDEM ESTATE OF (FILE NUMBER Adams, Elsie P. 21-12-0101 This schetlule must be wmpleletl entl tiletl if the answer to any of questions 1 NrouOh 4 on the reverse sitle of the REV4500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATENO~F TRCANSFERSATfACIi ACOPY OF THE DEED FCOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST FxcLUSioN (IF APPLICABLE) TAXABLE VALUE 1 North American Company Annuity #8000000623 69,515.37 89,515.37 (Beneficiaries: Peggy L. Hinke and Bessie Minich): TOTAL (Also enter on Line 7, Recapitulation) I 69,515.37 (It more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev, 6-98) REV-7767 Ex*170-0e) COM~~D~f~SV~ANIA SCHEDULE H FUNERAL EXPENSES & ESTATE OF FILE NUMBER Adams, Elsie P. 21-12-0101 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER , A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: t. Personal Representative's Commissions Name of Personal Representative(s) Bessie I. Minnich Peggy L. Hinke street Address 254 Colonial Drive chy Mechanicsburg state PA zin 17050 Year(s) Commission paid 2. Attomev's Fees The Wiley Group, PC 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached 9,048.59 7,500.00 7,500.00 323.50 195.00 379.50 TOTAL (Also enter on line 9, Recapitulation) I 24,946.59 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA•1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Adams, Elsie P. 21-12-0101 ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Expenses Clothing for decedent for funeral: 122,84 2 Funeral Luncheon & Food - Shepherdstown United Methodist Church: 261.68 3 Jeanne Hershey (funeral luncheon help): 100.00 4 Malpeui Funeral Home: 8,564.47 H-A 9,048.59 5 Other Administrative Costs Cumberland Law Journal (advertise estate): 75.00 6 Register of Wills (filing fee): 30.00 7 The Sentinel (advertise estate): 274.50 H-B7 379.50 Copyright (c) 2002 forth software only The Lackner Group, Inc. Forth PA-1600 Schedule H (Rev. 6-98) Rev-7673 EX+17209) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8 LIENS INNENITRNLE TW(RETURN RESIDENL DECEDENT ESTATE OF FILE NUMBER Report tlebta Incurted by Me tlacaEent prior to death Mat remelnetl unpaltl at the tlate o/ tlsaM, Inclutling unrelmbureaE medial expenses. (If more apace is needed, additional pages of the same size) Copyright (c) 2009 form software only The Laekner Group, Inc. Form PA-7500 Schedule I (Rev. 12-OB) REV467J EX~117-0l) SCHEDULE J COM~~T~(,~f~~ANIA BENEFICIARIES ESTATE OF FILE NUMBER Adams, Elsie P. 21-12-0101 NAME AND ADDRESS OF RELATIONSHIP TO SHARF. OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 a 1.2 1 Jessica Bowers Grandchild 1,970.63 c/o Dianne McGowan 18 Dove Court Dillsburg, PA 17019 2 Hanna Cams Grandchild 1,970.63 c/o Leslie Carns 175 Romberger Rd. Millersburg, PA 17061 3 Leslie K. Cams Granddaughter 1,970.83 175 Romberger Rd. Millersburg, PA 17081 4 Ryan Carns Grandchild 1,970.83 c/o Leslie Carns 175 Romberger Rd. Millersburg, PA 17081 5 Cassandra M. Courtney Grandchild 1,970.83 c/o Christine Lynn Courtney 324 Southview Drive Mechanicsburg, PA 17055 See continuation schedule attached Continuation 107,147.34 Total 117,000.49 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 cover sheet as a ro date. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX 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 form software only The Lackner Group, Inc. Forth PA-1500 Schedule J (Rev. 11-OB) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Elsie P. Adams 12I08I2011 171-28-3544 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($SS) 6 Caitlyn E. Courtney Grandchild 1,970.63 c/o Christine Lynn Courtney 324 Southview Drive Mechanicsburg, PA 17055 7 Carleigh T. Courtney Grandchild 1,970.63 clo Christine Lynn Courtney 324 Southview Drive Mechanicsburg, PA 17055 8 Christine Lynn Courtney Granddaughter 1,970.63 324 Southview Rd. Mechanicsburg, PA 17055 9 Claudia R. Courtney Grandchild 1,970.63 c/o Christine Lynn Courtney 324 Southview Drive Mechanicsburg, PA 17055 10 Peggy L. Hinke Daughter 46,676.46 710 Sunhaven Circle Mechanicsburg, PA 17055 11 Dianne C. McGowan Granddaughter 1,970.63 18 Dove Ct Dillsburg, PA 17019 12 Jared McGowan Grandchild 1,970.63 c/o Dianne McGowan 18 Dove Ct Dillsburg, PA 17019 13 Bessie L. Minnich Daughter 46,676.47 254 Colonial Drive Mechanicsburg, PA 17050 1 SCHEDULE J BENEFICIARIES (Part 1, Taxable Distributions) ESTATE OF: Elsie P. Adams 1210912011 171-28-3544 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 14 Darryl L. Paulus Grandson 1,970.63 2147 C. Newville Rd. Carlisle, PA 17013 Total 1f17.1a7.34 099999-00005/November 23, 1994lHA]/PAR/39846 ~~~~t i11 ~n~ C~I~~Z~rrtPrc~ OF ELSIE P. ADAMS I, ELSIE P. ADAMS, of East Pennsboro Township, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and all previous Wills or Codicils made by me at any time heretofore. ARTICLE I I direct the payment of my debts and funeral expenses as soon after my death as may be convenient to my Executor hereinafrer named. ARTICLE II I make the following bequests: A. My three guns to my grandson, DARRYL L. PAULUS, provided he survives me. If he does not survive me I give the guns to my great grandsons as follows: the oldest great grandson shall select which gun he wane, the next oldest great grandson shall select the gun he wants and the remaining gun shall go to the youngest great grandson. If I only have two great grandsons the gun not selected by the next to oldest great grandsor. shall also ge to the oldest great grandson. If I have more than three great grandsons, the youngest great grandson shall receive no gun. B. My gold necklace with cluster of small diamonds to my granddaughter, LESLIE K. MINNICH. C. My engagement ring, aone-half cazat diamond in gold setting, to my granddaughter, CHRISTINE HINKE~ou'2ne~. ~ ~a 099999-001105/November 23, 1994/H AJlPAR/39846 D. My grandfather's clock to my daughter, BESSIE 1. MINNICH. E_ My diamond necklace to my granddaughter, DIANNE C. MCGOWAN. F. My set of rose patterned china to my daughter, PEGGY L.. HINKE. ARTICLE 111 1 give, devise and bequeath all the rest, residue and remainder of my estate, including any property over which I have a power of appointment, as follows: A. One-half thereof in equal shazes to my children, BESS E 1. MINNICH and PEGGY L. HINKE, and [heir then living issue, per stirpes. B. One-half to be divided equally among all my grandchildren and great grandchildren, provided that the share of any great grandchild who has not yet attained the age of twenty-one (21) years to be distributed to the parents or surviving parent of said child to beheld and invested for said great grandchild and to be distributed when he or she attains the age of twenty-one (21) years. ARTICLE IV I name, nominate and appoint my daughters, BESSIE I. MINNICH and PEGGY L. HINI{E, OR the survivor thereof, to be the Executrixes of this my Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this /3 day of .~a.a-t/ , 1994. z„~a/ (SEAL) ELSIE P. ADAMS 099999-00005lNovember 23, 1994/HAJ lPAR/39846 Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who. at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. 099999-00005/November 23, t994/HAJ/PAR/39846 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. We, EISIE P. ADAMS, the Testatrix, and ~~.~;~~ ~~ °7~5`"~`-_~,_~ ,and _ ~ _~<w..~ ~?..'~ ~ -~'~-} the witnesses whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix acknowledges the foregoing. Witness Sworn to or affirmed to and subscrihed to before n-,e by'~yW-.~ i"a _ ~v«_.,~ ~ and s~~ L,lrcw.-=~- tom. ~ .t~... n~ , witnesses, this t ~~day of .~~t,.r,a„2.-,, ~ , 1994. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public ~ Nt?if`.RIAL St%:L DIAh1tE i.FNiG, iv:._~r~;t'U~i c Lemoyne "r, ~ ~;'~ " ~;! Co. My Commis>~ar? t*~, :as u° .l. ?S9i ELSIE P. ADAMS ~'t, 2t. ~Jlt 9:4ilA~M~ ~fuC cANK P1VC t Fsnltit3THE WAY February 21, 2012 Jan M. Wiley, Esq. The Wiley Group 3 N. Baltimore St. Dillsburg, PA 17019 RE: Elsie Adams SSN: 171-28-3544 DOD: 12-09-2011 .Dear Ms. Wiley: °J:. 21ar~ f'. '; In zesponse to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account # 5140113245 ELSIE ADAMS DOD balance: $49,580.09 + 0.35 accrued interest lnterestpaid Ol-O1-2011thru 12-09-2011 $21.47 YTD Savings Account Account # 5130209904 ELSIE ADAMS DOD balance: $34,114.17 + 2.43 accrued interest Interest paid Ol-Ol -2011 tbxu 12-09-2011 $31.30 YTD Established: 02-O1-1970 Established: 04-O1-1978 Please note that this office provides date of death balances for deposit accounts (IItAs, CDs, Checking and Savings). We do not process any 5aancial transactions or provide statements. If you need assistaaee with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 2 feu. 21. 2u~2 ~?F~1 r~C BAf;K No. 2i;13 2 2 This message is intended for the arse of the i~ulividual or entity to which it i,s addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error, please notify me immediately by reply or by telephone at 800-762-7775 and immediately destroy this faxed document. Page 2 of 2 5154405599 February 28, 2012 The Wiley Group Attn: Jan Wiley 3 N Baltimore St. Dil(sburg, PA 17019 Re: Elsie P. Adams, 8000000623 Beneficiaries: Peggy Lou Hinke & Bessie Minnich Dear Ms. Wiley: 11:00:49 a.m. 02-29-2012 1 /1 /ICA North American Company for Life and Health Insurance Since 1886 _~ ~~ruit~ S~fxi~v a~a~te~ This contract is an Annuity. Enclosed is the information that is needed to complete the estate tax return. Decedent - Elsie P. Adams SS# - XXX XX 3544 Date of Issue - 5-29-2001 Type of Contract -Non-Qualified Annuity Date of Death Value (as of 12-9-2011)- $69,515.37 If you have questions, please call us toll-free at 877-880-6367. We are available Monday through Thursday from 7:30 am to 5:00 pm (CST) and Friday from 7:30 am to 12:30 pm (CS'f). A service professional within the Claims and Benefit Department will be happy to take your important call. Sincerely, Connie Baker, ACS, ALHC, AAPA Sr. Claims and Benefit Specialist Claims and Benefit Department cc: file ~a ~`g~m!!~f72,"3i ifeG' ,G+6t7itaf0AT.•: 7"F!.'!{L.'wf :ie vUu __'.__- a,., .ti.~,...Trf .: ~tx,4So5 It<~.. .' S1~~>Jn its. ~~ ...._ ux ;:,5 9t ~n, n,.a~~ ~ ,~