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HomeMy WebLinkAbout95-0145~{ 50056805 ~s-~~_~ v RE\ 1500 E..+ In-nli .•~''-~ FORDAYESOF c>...<<~; ~ .-~1'I~IHERITANCE TAX RETURN IF A s~-ouswi ~s~.'~~.~ /'" POVERTY CRE ~° '~ ;~,>w .e/ RESIDENT DECEDENT FILE NUMBER COMMONWEALTH OF PENNSYLVANIA CTO BE PILED IN DUPLICATE '1 t DEPARTMENT OF REVENUE WITH REGISTER OP WILLS) O~ DEPT. 280601 _ HARRIS6URG, PA 17128.0601 COUNTY CODE r- Z a, ca w u r~ ~- a- ui d tJ ~~ a. Q I ~ rii Z ac w oe a ~~ rs. ADAMS, WILLIAM LEROY 204-03-9336 1. Original Return ^ 4. Limited Estate b. Decadent Died Testate (Attach copy of Will) WILLIAM A. DUNCAN, E fELEPHOfJE NUMBER 717 1 249-7780 ^ 4a. Future Interest Compromise (for dates of death after 12-12-82) ^ 7. Decedent Maintained a Living Trust _ (Attach copy of Trust) ~l'fAL T/kX 1 ^ 3. Remainder Return (for dates of death prior to 12-13-82 ^ 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxe 1 IRVINE ROW CARLISLE, PA 17013 1 t- a Q w of Z O Q a O u a r 1. Real Estate (Schedule A) - ~ 4, 700.00 2. Stacks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages and Notes Receivable (Schedule D) (4) ' 5. Cash, Bank Deposits & Miscellaneous Personal Property(5 , 300.00 (Schedule E) 6. Jointly Owned Property (Schedule F) (b) 7. Transfers (Schedule G) (Schedule L) (7) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneou s ) ' R, 9F,5. 75 Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 11. Tatal Deductions (total lines 9 & 10) ~ „~ 12. Net Value of Estate (line 8 minus line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) l~ DEATH AFTER 12131 Jt91 CHECK HERI 1S ©~~v! YEAR NUMBEI 45 EAST LOUTHER STREET CARLISLE, PA 17013 15. Amount of line 14 taxable at b% rate ~ (15) (Include values from Schedule K or Schedule M.) . 16. Amount of line 14 taxable at 15% rate (16) (Include values from Schedule K or Schedule M.) 17. Principal tax due (Add tax from line 15 and from line 1 b.) 18. Credits Spousal Poverty Credit Prior payments + + Discount Interest 81 8000.00 (11) 8.965.75 (12) -965.75 (13) ^ (14) 0 x .Ob x.15= (1~) (18) (19) (20) (20A) (208) none 19. If lime 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. ^ 20. If lino 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. A. Enter the interest on the balance due on line 20A. B. Enter the total of line 20 and 20A on line 208. This is the BALANCE DUE. Make Cheek Payable to: Register of Wills, Agent _ ~-- r-' a~ auto ty ANSWER ~Ll QifESAi~Nfe 01~~$E StE APfD TO RECHECK'MATH ~ 4E Under penalties of porjury, I declare that I have examined fhrs return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is bawd on all information of which preparer has any knowledge. SIGNATURE OF PEIJSOM RESPONSIBLE FOR FILING RETURN ADDRESS DATE William A. Duncan, Esq. 1 Irvine Row Carlisle, PA 17013 SWIG/NATUF;tNOi FREITARLR O'rHER THAN REPRE NTATIVE ADDRESS } ~ REV•1502 EX + (12.85) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ______ 'ATE OF FILE ADAMS, WILLIAM LEROY _ __ _ _ (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported of fair market value which is defined as the price at which property would be exchonged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. _ ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. I Lot at 217 Longs Gap Road Carlisle, PA 17013 $4,700.00 TATeI IAlen nn~nr nn (inR 1 RPrnniti~I~tinnl ~ S 4a 70~• 00 REV~i~508 CX+ 12-971 SCHEDULE E CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS INHRE (DENTED CEDENTRN PERSONAL PROPERTY ESTATE OF ADAMS, WILLIAM LEROY (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM NUMBER DESCRIPTION 1. Personal Effects 2. Vehicle FIL Please Print or Type VALUE AT DATE OF DEATH $300.00 $3,000.00 TOTAL (Also enter on line 5, Recapitulation) I $ (Attach additional B'/z" x 11" sheets if more space is needed.) REVJSII EX t p•88; Y COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or ITEM NUMBER DESCRIPTION AMOUNT ~-• Funeral Expenses: 1. Hoffman Roth Funeral Home 5,352.00 2. Carlisle Memorial Service Grave Marker 798.75 3. Grave Opening 300.00 B. 2. 3. 4. C. 2. 3. 4. 5. 6. 7. 8. Administrative Costs: Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid ,Attorney Fees 400.00 Family Exemption Claimant _ Mari a~ A~..,,,G Relationship Wi fP 2 000.00 ~ Address of Claimant at decedent's death ~~Y~ M°T" ~~ .~ Street Address City State Zip Code Probate Fees Miscellaneous Expenses: Appraisal Fee for Lot Phil Ruegg App. 65.00 Filing Fee 50.00 TOTAL (Also enter on line 9, Recapitulation) , < ~ $ (If more space is needed, insert additional sheets of same size.) COMMONWEALTH Of PENNSYLVANIA INHERITANC! TAX !!THlN ESTATE OF ADAMS, WILLIAM LEROY ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: 1' Marian M. Adams 45 East North Street Carlisle, PA 17013 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: 1. FILE NUMBER RELATIONSHIP I AMOUNT OR SHARE OF ESTATE wife TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I $ (If more space is needed, insert additional sheets of some size) SCHEDULE J BENEFICIARIES 100 AMOUNT OR SHARE OF ESTATE • t nls )s to ceruty that the information here given is correctly copied from an original certificate of death duly filed with me as . LrJCaI Regastrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It Is, illegal to du~ticate this copy by photostat or pho#ograph. Fee for this certificate, ,#2.1}0 n~ ~- , )~EpITN FPF , I` F ~. L ;.;, : ~. ~ Local Registrar `~ ` ,t. a No. Date N,OS.,•3 Rev. anT COMMONWEALTH OF PENNSYLVANIA •:DEpARTMENT OF HEALTH • VITAL RECORDS "T CERTIFICATE OF DEATH 'NT NAME Of DECEDEM (Fro, Miyyli, Lko) ... ~ 6TREPAE NUMBER ,K 1. 8EX SOGAL BECURRY NUMBER AOE(lio ~ L DREOF DEATH IMmfl, D7Y.1Mr( UN R t UNDER t OAY DRE OF &RTN L ~ ~ ~. MonRri ~ DAyi Hours MMOa IMOan,DM', Ml.rl SIO•or R71YAnE PUKE 6F DEATH 71 Yn I I r••r.gnCpnky) 0^•-7••orrmoMyr YOh In~poN~nl4 E LATHER: oPOEAn, I V.26,1922 Cer11s1e,PA ~( ~wn.a^ DoA^ 11•m'""'w^ R•.^ Soar .SOf10.TWPOF DERH FACILITY NAME(M nd hMMlon,Sw•fUM indrkrMw) (SPrcyyl^ MMB OECEDEM OPNISMNIC ORgIN7 RACE-AmMGnlnEyn.Ehell, Wnk•, stc. ~, ~ Cumberland Car '318 "°~ ~•^Rr••.kP.aryak.n, (soar) ceNrE uauAL ar i e o it • ~•~••. Pwrb Rlan. „~. kNtl Glwork dolls gNDOR BUSINEBSRNDUETRY DECEDENT EVERW ~ 10. White avraklnE iq; ae rglur r.5rai~ U. .ARMeD PCRCEtt'/ S MARRALSTiQUB•MarME SURVMNO 8POUBE • „ Truck Driver Fuel it "•~ "°^ ~" (o-~" D°''•' ~~ nl»•..ow.m.ld.,,,„M . DECEDENraM~,uNeADa+Eaa(slr.«.c~Y~w~rn.aw.rocoak) oECEDENre , . n~°`s•) •Married ' AcTUa +~• ~„• o ,. Marian M. Gibb 45 East North St. ~ A ,To.^Mb, aeadoM iwdln Carlisle Pa 17013 onah.r.do) iwM. '~ " Cumberland b•,MAwt No,a.«e.,».,.a PRNER'B NAMe (Fro. MkklN, u,q ,~• 1Td.~wMb•auM ilalia Carll$le Geor a Adams MDTNER'SNM,E(FWI,MkIt7o,MOdylsurnimq Anro INFORMANT'S NAMERypNPrinE Hazel F Stet '~ INFORMANT'S MAILMq ADORE88 f9u.M,CMWbWn.&W.IIPCod•)- METHOO . .4 eudr crr«,ruwn^ R.mowltrom eln^ max »v) aatla ~P,iok. ~'"•'"•0)c•"""'[c^""bn LDCRION•ciyrtam, &kl•,npCodo . EOonobn o old ^ June 30, 1994 Kutz's Cemetery 'ddlesex Twp.Cumb.Co.PA EUCN LICENSE NUMBER NAME AND ADDRESS CF FACILRY ~ a Hoffman-Roth Funeral Home okrrn~a. wel.° Ma"""^n.ae..mw ,,,a ~•«Imarar abuaa.o.awe. aireyorrwaaMn, r - ~~~ ~, r»AE oE,v ~ /~ oEAO ~ ~ Rn! 322~t9 ~ ~ `~ G ~G 4 ~ ~` CASE D ME E%AWNE n.rlu,rl: ~ r~"r"«u' «w~. ~,a»'lo""kNe^o w.e' n»a..ll. lat.l~n»ROa.aalna~k m halo / q 1~ _ . ~r. ^ N,~ _ _ r77pkkbry u,iM, ill«kaApRliiloo, . krtorvN~•' pjboo, PARTm - °IMr.gNnew oerlauar IMMPoIATeC111MEffhkl aorMrlboRpbMkE,, kul MeiiAat;~tl~~:LUng (C~noer.:, iapoukMOh n°I"w~,°"'""R,aryb°alw'a"•^In"tRrl. DUE ro (OA AS A CONBEOUENCE OF7: ^Md.MM ~ Small Bowel Obstruction 7"A•';k;~,„b ~ ouemronAEACtxsEauEl+cEO~: ~ Dehydration. I ;,~„o"'~"'~"'~ ~ Duero(oRAEACONEEDUeNCEO~: ' d I MME AN AUTOPSY WERE AUTOPSY FEtlDNJ06 MANNER OF DERN r PERFORMEDT AMULARI.E PRgRro ORE OFINAlRY TIME CF IWURY INIURYR WORK? DESCRIBE HOW INJURY OCCURRED. COMPLETION OF CAUSE (A1ortl11, D•Y.+k•r) M OF DERN7 r,yY WNrkl ~ . H•rnleldk ^ Mw ^ No ICI 1t•7 ^ No LO Buktldo ^ Prrrd4p kn'7ol0oien ^ Mn ^ t1o ^ ~ OorAd nolMdoormkl•d ^ ~« k•m•.,•rm, M. ~. ~, or••L holory, aRp LOCRION IShro. Ciryrtown, SuN) CE7RIFIEIIlGr•ek qtly wrpN ]a. NYEIM yYpen rnryYq er..aa.M.Nwrknq„k, 70f• ~.. To~ ktmykrlbMtl.~p . C•kM eoaurnA Lw b 1M MYKkn Iw PraaurcW AaEl.nd wnPMW INm 27) BgNRURE ANO OF eR ~ . wuMpiknalnkmrawtw .......................... ^ /1_u '~PR~~ NO ~CERTIFYMO PNYSK7ANIPnY•M~.n Ddn prmounokq eYkM rM prlMykpbpuwa WN:) ••••••••••••••••••••••••••• LICENSE NUMBER my •••dE•• e..qr eeewro• n Sro shoo, d•b, iM pkbo, and tlrrk b S,o DRE BgNED IMortlR D•Y. Yekr) • ••+~••h)•nd mnln•rp•t•MM ........................ .. S O 0 ) l~ O rG 27 • ` ~ NAME ANDADORE&40F PERSON WIIO COMPLETED CAUSE OF UDERNe 94 D„M,•e°M~of o7MOitlon aM/w Nlw.tlp.Eon. In mYnWnbn,d.Mh xeunrMMth. URN.dtl.. AndWw..uWAW totM ew ... (Sam 2~TYp. to Print ,~ h Pion ~, Rr•^n•rp•ul•d...... ..................................... DD' .. . REDI ................~............. "al•^° ^ 10 ~S. High', si° Bet • ................... ai. srRAR'ssroNR"REA"pkpIMB~R ewvi 1 le PA 17241 S ~l ~ ~ DRE FlLED(MyWr, tyr) b. C~ Q `~.>C_. 7.. v.ue. `iS 9q LAST WILL AND :PESTAMENT OF WILLIAM LEROlt ADAMS I, WILLIAM LEROY ADAMS, of 45 Ea;.t North Street in the Borough c Carlisle, Cumberland County, Pennsylvania, being of sound and dis ing mind, memory and understandin po. Clare this as and for my Last WillganddTestamentmakhereby revokin r making void any and all Wills by me at an time publish and de Y heretofore made. g a 1• I direct my hereinafter named Executrix or Executors to a all of my just debts and funeral expenses as soon after m may be found convenient to do so. Y death pa be conducted by Hoffman-Roth Funeral Homerec219hNorth Hanover sStrece Carlisle, Pennsylvania, and that my body be interred on the°burial lc of my wife located in Kutz's Church Cemetery along Claremont Road i Middlesex Township, Cumberland County, Pennsylvania. My wife on ir. ally took title to said burial lot as Marian M. Hall and her mothe and first husband are also interred on that lot. 2• All of the rest, residue and remainder of my Estate, rea] personal and mixed, and wheresoever the same may be situate, I give devise and bequeath to my wife,• Marian M. Adams, her heirs ar. assigns, to the exclusion of my children, born and unborn, provided n said wife 'shall survive me by a period of ninety (90) days. 3• Should my said wife, Marian M. Adams, to survive me by the aforesaid pre-decease me or fai such event all of the rest, residueoandfremainder9of myaEstatehereal personal and mixed, and wheresoever the same may be situate, I give devise and bequeath in nine (9) equal shares as follows: One (1 share to the three (3) children of my deceased son, Larry L. Adams who are Kimberly Adams, Connie Finke to my son Donald E. Adams; one ly' and Terry Adams; one (1) shat Clark; one (1) share to my son Gar )Wshare to my daughter Susan I daughter Bonnie L, Y Adams; one (1) share to n Barbara L. Keck; one (1)fshare tonmy(wifehsrdaughter Joice,s daughte one (1) share to my wife's daughter Charlotte A. Jakomase andSonel(1 share to my wife's son Douglas L. Hall. ~, Adams6~ I hereby nominate, constitute and a as Executrix of this m Ppoint m pre-decease me or fail to Y Last Will and Testamentwbut-shouldnshe such event I nominate, constituteyand cease servin ppoint m g as such, then in and my wife's son Douglas L. H 11 Y son, Donald E. Adams, direct that none of them shall beare~uiredctoExecutors and I the faithful q post any bond to further Pennsylvania, orrinrannce of•his or her duties in the Commonwealthcuof Y other jurisdiction. IN WITNESS WHEREOF, I have hereunto set m my Last Will and Testament, written on two ~2~ Y hand and seal to this August , 1984. Pages this 24th day of Wi~1 am Leroy, ~s : ~ .. ~. ~ ~~~~~+) .. ..rya Signed, sealed, published and declared by WILLIAM LEROY the Testator above named, as and for his Last Will and Te ADAMS, our presence, who ire his presence, at his request, and in themere~ in of each other, have hereunto subscribed our names as witnesses. P sence attesting -!.*~