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HomeMy WebLinkAbout08-03-121505610101 REV-1500 ~t°'-'°' '~' OFFII~AL USE ONLY PA Department of Revenue P~!?Y~ Coun Code Year File Number Bureau of IndiNdual Taxes b Po BOX z806oi INHERITANCE TAX RETURN © ! ~ ©+I Harrisburg, PA i71z8-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY ~1T~T~oT~TT1 ~ ~ ~ 9 Detx3deM's Last Name Suffix L /8 ID Applicable) Enter Surviving Spousa'a IMormation Below Spouse's Last Name L ,~ Spouse's Socal Security Number Date of Birth MMDDYYYY ~z/~/9 6 Decedent's First Name MI L L / N7 Suffix Spouse's First Name MI ®~, N ~~rrrm ® THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW i 1. Original Retum O 2. Supplemental Return O 3. Remainder Return (date of death priarto 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10, Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Nama Daytime Telephone Number ~~~4 / ~a5 ,,, ~,~~I"GT3dT'T91 REGI OF MILLS ~ ONLY C ~, First line of address ~ -• ~„ 6 C L o u s K o ~~~-' ~ ~~ ~~ -_ w x~ Second line of address ~-'~;'" ~ ~`Yr^~ ` City or Post Olfice State ZIP Code Correspondant'se-mailaddress: C~r$Fliel~s3~(~j~B~~,/~ef Under penalties of per)ury, I declare that I have examined this return, including accompanying sdiedules 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 PERSON ~SPOtjSIBL~ Ff~R FILING RETURN DATE ADDRESS f~Rm E, ~E'i6 •~3 P~easa~f oSf:, Mec~lan~esbar>, A9 /7oso '~ DATE OIJJ~y AuuHess C1N~Rt..~'S E. SH/EtAS ~ L CtlouSer /Pia/, /1~eChan~esbu~, iP~ ~7oSS' PLEASE USE ORIGINAL FORM ONLY Slde 1 15D561D1D1 1505610101 J REV-1500 EX Decedent's Name: ~t//LL/~ ~. 1505610105 1. Real Estate (Schedule A) .........................:................. .. 1. 2. Stocks and Bonds (Sdtedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnen;hip wSole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Rec~iveble (Schedule D) ........................ ... 4. 5. Cash, Bank Deposits and Misoellaneous Personas Property (Schedule E).... ... 5. 6. Jointly Owned Property (Schedule F) O ~n9 Requested .... ... 6. 7. Inter-Vrvos Transfers & Miscellaneous Non-Probate Properly (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7} .......................... ... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. f0. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ............... ~ ..... ... 13. 14. Net Value Subjec['fo Tax (Line 12 minus Line 13) ........................ 14. 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 .OfL 16. Amount of Line 14 Eaxable at Tineal rate X .0 ~ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. i8. 19. TAX DUE ...........................:.........._......,.....:::... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Sodas Security Number Side 2 1505610105 1505610105 O .J REV-1500 EX Fgge 3 Decedent's Complete Address: file Number pZ /r ~/ .. ~3~ / oEC s r~ 1vJL~tA~/1- ~E; LE/B sTREETAOORESs ~3 PflE~45.Er-'T STieEc~'T CITY ~~g„A/Y`L~SO~~ STATE P~7' ~ 17~7S~S" Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Carts D A. Prior Payments ___~ B. Discormt 3. Interest 4. If Line 2 is greater them Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FR{ M ova on Page 2, Lore 2D to troquest a refund. (1) O Total Credits (A + B) (2) ~ (3) (4) O 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (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 transferred w its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise fw 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? .............. ^ ~f 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a benefiaary designation? ........................................................................................................................ ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS iS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 17 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 [!2 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 beneficlary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased cllild 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent w 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)]. A sibNng is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood w adoption. REV•55pi EX+ (E9B) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIpENT DECEDENT ESTATE OF FILE NUMBER Atl propery joiMiy-ow-ted whh rfgM of survivorship must be dbdoaed on Schedule F. (Ii more space is needed, insert additional sheets of the same size) PFE Historical Prices ~ mazer, Inc. Common Stock Stock -Yahoo! Finance 7/23/12 4:00 PM New Use:r? F•:,a.<iar Sign fn .!o~p Make Y! My Honwpspe Mail F.`.}' Y' Y:aiitru' Search __.-,? Swreh YWb ~~ ~~ _._._- .__ .:_: -_.-.._._. .. ._.__.. _....__.i HOME ( 3NV6S71NG I NEWS ~ PERSONAL FFNAHCE I MY PORt'FOUOS ~ E](ClUS4VE6 .. ' r t3e< Quot9f~ Finance Search Mon. Jul 23, 2012, 4:OOpm EDT - US Markets are dosetl Dow 10.7956 N _.. _...... aodaC iL205G .. -..._ _... _ ,....___ .._.......... ~.~ r.raax muraiaz ue aweYrw ® PFE ...__....~------- fine. (PFE) -NYSE , Adtl to Porttdlo ' ' Like < 213 23.61 1O.~8~d.38%~ 3:58PM EDT-NeWaq RmlT4na Price Historical Prices o.t ~.tor,~r P.lew ror: ~----- Set Deb Ranpa SbR ~~ - ~ ~ ~ 29 2011. ,,,~ Ep. Jan 1, 2010 ' a0 Da9y ~h' End Dab: . .,. ZB^--: ,zOI Il ? (~MaMAfY ~Olvltlenda Only First ! Prevbua ~ Next ! Last Prlus _____- Dete Open High Low Close Yahstls Ad) Cktee' Nov 29, 2071 19.07 19.18 19.09 19.40 39,700,200 19.01 di sand spas. ~~44 Ekst ! Prevbus ! Next !Last rlDOwnload W Sproatlshaet Cwroncy M USD. l~~ l6~ ~ti ~ ....yYfl~a~ O2D22 YekWl aK. AB n0!IIe reSOlYed, P', .ryCy P: ±ICS' - ryJV( J:T f:CS - 1`Xrgn pi ;;;r.ir; - ~.rpyrignVlF s;,h} - S~:rni i'crcdiac* - Yah001 -ABC NeYy3 NelwOtk S~eeo ~br NYSE, NasWq antl NYBEAmsx an ReN41ms and sourced hem Nsstleq Lest Sak when eratlafMe. rc not avalede tmm NLS, qudes wW sppex dsleYed from pnrnary Iletlrq sounds. dally tlmas for other e.;.Fmrpres. Quotes ante Oltter Intwmetion supplied M' kWepsrxlent providers identified on ere YYwo! Finance pannm pagr..Quolea ue updated autanshcahy, but vAp lm fumed oR atfaf 25 mkwtas d MadNty. Ouolas are dslayad N leset 15 rlliMRae. All irlMnnation provided "as ill for lntdrrnerconBl pulpOSSS Doty, rqt edMMetl tar tredirlp purposes a aWke. NeaMr Yahool na any d iMepanOsrd Provldera Is kaDle for e+lY Mfoffltatlorml arras, InrnrnWelenees, or dNeye, a for ery aetrons Idren in raWnce on intormetlon WMainsd herein. OY aocessnp the Yafxrnl We, You spree rot b redieblDUte tlw informatlon found therein. Furxlwrranbl comparry data prpvldsd DY C(iys!ta! iq. HIalDrkal dart date end Gaily updates provided DY <%e+n!!otlrty uycterrs. L,r.. ji: ~! i. InfematlonN hhlorical Bran decd daily updates, full arxnrrtafY. fund parfarmence, Oivlderq dale end Momirpebr InMx defy provided DY M1irxrt:n,rsiar. ;nc http:(/finance.yahoo.com/q/hp?s~PFEba~lOdrb~296o-20116d~106e~296f-2011&g6d Page lot REV-7S08IX a (197) SCHEDULE E COMMONVVEALTNOFPENNSYLVaNIA CASH, BANK DEPOSITS, & MISC. ~ ~~ Tax ~"R" PERSONAL PROPERTY ESTATE OF ~lt,~Q GIl4LJA~M F FILE NUMBER ~ ,Z t, //-136/ Include the proceeds of NOigation and the deb the proceeds were reoehred by the estate. All property joNkht-ownW wNh tM right of wrvNorsMip must be discbsed on ScAeduN F. ITEM VALUE AT DATE NUMBER DESCRIPTIDN OF DEATH t . : M 4 T ~wX~ ChautGitd tray S,r.~;n's /feeoknts 6aat' ,yaen r~~~' Q.s ?ew,t~rfs 6~. ~ .Fn1Ki~tfieS. a. PXe i3,~,x, CtieeK.:oy ~ o`av.:~js ~9Ct~ant h~ b~, Yer: ~, cd ac TeaaCslf .dj. !~ ~nfirrlr"es. 3 t;r~rstoaa wank I?~rf;fi~~e of >~ios.f' hds bum Yeri ~Sed ss Teya~,t~ 6/ ~ .Fnti~{iGS. ~• 4~r31~lvn ,dark C'orf:~irare ~ ?>cps.'t fias bun Ysri ~i~ as ~es~r~r 6y ~ wit tirel~ie^ s. TOTAL (Also enter an line 5, Recapitulation) I ; ~ g. Dd (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF .CE/B~ W/GC/A~A1 ~, FILE NUMBER a~- ~~- J3~i+ Thls schedule must be completed and filed if the answer to any of questions 1 through 4 on page [hree of the REV-1500 is ves. 1TEM NUMBER DESCRIPTION OF PROPERTY INCUbE n~E NanE or T~ TnArr,R aEE, TREIR uaAnaNSNIF m oECEOENr ANO TXE DATE of T~tANSFER ATDLIt A COP'( OF Tf1E DEED FOR REAL ESrATE. DATE OF DEATH VALUE QF ASSET % Of DECD'S INTEREST EXCLUSION IF APPLIOIaLE TAXABLE VALUE 1. -r~J} ,~i,7; -ra~Z.t,s ~AQGo ~`i'.Sbo•pO Ice~v -a- ~9,~.a Paymbin -}3v Skrvi~~l~ S/~ou5¢- ~t~,t~+ E. Lw b TOTAL (Also enter on Line 7, Recapitulation) ~ I ~ q' ~ p • °`~ If more space is needed, use additional sheets of paper of the same size. REV-t 511 EX+(1fY06} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCMEDYLE N FUNERAL EXPENSES & ADMfNISTRATNE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule L A. I FUNERAL EXPENSES: t. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ,p ~/ J Name of Personal Representative(s) Mf QTq ~, tG~6 A.~.iY~• 3Veet Address a3 1 ~~t[sa~t st _ cdy meeli4n; e3b NrR state zip 17y~ Years} Commission Paid: 2• 3. AttomeyFees C/i4R'YES E. d~fi.tla/s ~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant vt,r,~t ~. LGib. 4.nc~ettx~ntne.~ t JIOI' C~Q.;bJ~. $treetA~reSS .73 P/caa~.r:f Sf: C;ty ~~~r~,~„ ; ~S 6K~ State RF Zip ~,a ~ Relationship of Claimant ro Decedent It// ~InrJ 4. 1 / L~ Probate Fees (,~ Ot7q,n~ rSSGt 1f ~t~ CLJ~Ti/yC~t,fa;S (! x'74 S-D 5. e. Accountant's Fees .p ~ i~' C4t'~15C~~ pI'r 8tl~(Gd ~. LG/Y10M f rO~•00 6. Tax Retum Preparei s Fees ~. Addy ~'aw./ ~onbats ~lv. o0 ~ /¢d~liLiow~t! .~l..,f< l~tr~i~'csrts ~ `~~ Fie. Flin a0, o0 g '/S, eo /v /PGiitT6irrSUXds fs ~ ~wr~es ~`, ~i. v./~ ,t f~i' nlosl~~ ~ plr.i~~p;es, ~- Luq;YecJ~ TOTAL (Also enter on line 9, Recapitulation) S v~ 2 (If more space is needed, insert addftional sheets of the same size) REV-1513 EX+ (11-08) '~ i~ Pennsylvania SCHEDULE J DEPARTMEN70F REVENUE INHERrrANCe rAx RETUaN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER L.~i6, wlcUg~ E. al- ~.-~sbl RftATIONSFQP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not <Jst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1. I~•~.~i E Leib spous ~ /o©~o a3 ~iwGISQ.tit ~~ A?ec/rarc; cs~iKr1, ~~ t ~o so ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18 OF REV-1500 COYER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ¢ If more space is needed, insert additional sheets of the same size. LAST WILL AND TESTAMENT OF WILLIAM E. LEIB I, WILLIAM E. LEHi, currently of 23 Pheasant Street, Mechanicsburg, Silver Spring Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills and Codicils by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can convenienlly be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise, and bequeath to my wife, RUTH E. LEIB, to her own use and benefit absolutety. 3. In the event, however, that my said wife, RUTH E. LEIB, should predecease me or die at about the same time as T die, such as from an accident or disaster common to both of us, I give, devise and bequeath my said Estate to be divided and distributed as follows: A. The sum of Ten Thousand and No1100ths ($10,000.00) Dollars is to be given to each of my grandsons who survive me, to wit: WILLIAM GEORGE LEIB, ANTHONY JAMES CLAY, and ANDREW DALEY CLAY. B. The balance is to be divided equally among my three (3) children, to wit: ROBERT E. LEIB, PATRICIA E. LEHi, and ROXANN E. CLAY. 4. In the event my said son predeceases me then his share is to go to my said two daughters or to the survivor of them if one of them has predeceased me. In the event both of my said daughters have predeceased me then my said son's share is to go to the issue of my daughter ROXANN. In the event my daughter PATRICIA predeceases me I direct that the first ten thousand and No/l OOths ($10,000.00) dollars of her share is to go in two (2) equal parts of five thousand and No/100ths (55,000.00) Dollars to the MT. ZION LUTHERAN CHURCH and to the now incorporated MT. ZION CEMETERY OF CHURCHTOWN, currently located at 325 Old Stone House Road, Boiling Springs, Cumberland County, Pennsylvania. The balance of her share shall go to h~er/Jsis~ter RO~XA~N~N.yor~,her said sister's issue, as the case may be. / / ~%i(~' - _ " ' ° ~. Page t In the event my daughter ROXANN predeceases me her share is to go to her issue, Mgr stiroes. In the event she is not survived by issue, then to her siblings who do survive her. 5. I nominate, constitute and appoint my wife, RUTH E. LEIB, to be the Executrix of this my Last Will and Testament. In the event that she is unable or unwilling to act as Executrix, I appoint my daughters, PATRICIA E. LEIB and ROXANN E. CLAY, to be Co-Executrices in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. I WITNESS WFIEREOF,1 have hereunto set my hand and seal this a0/Y'1 day of A.D. 2010. t' r ` ~ C ela.vfi (SEAL) WILLIAM E. LEIB Signed, sealed, published and declared by the above-named WILLIAM E. LEIB, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~ ~.~~~~ Page 2 1V,~`~ '-b\ `yam ~~ l CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M.HOUCK (1912-1991) August 2, 2012 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of William E. Leib No. 21-11.1361 r= Dear Register of Wills: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the William E. Leib Estate as well as Check No. 3316 in the amount of $15.00 for the filing fee and Check No. 3317, in the amount of $10.00 for additional Probate. Thank you for your kind attention to this matter. Very truly yours, ~~ ~ ~ ~ Chazles E. Shields, III Attorney-At-Law CES/mjj Enclosures r., ~~~'~ a ~; r~ ~ C7G>-ry' W Q ti~ V~ ~ --t .C" Vi ~. ,~'~ r ~ ~° ,. ~ r ^5 '.