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Home My WebLink About08-23-12~ REV-1500 Ex(°'-'°' '~' PA Department of Revenue pennsylvanta Bureau of Individual Taxes ^~'"TMp1i0f"~'°~1° Po Box.zaosol INH Harrisburg, PA 17128-0601 i 1505610143 OFFICIAL USE ONLY County Code Vear Fila Number I 21 12 ~~ Date of Birth 08 21 1928 Decedent's First Name MI NANCY M ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death O5 30 2012 Decedent's Last Name Suffix MARTIN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix MARTIN Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW Spouse's First Name MI JOHN L THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS a 1. Original Return ~ 2. Supplemental Retum 4. Limited Estate ~ 4a. Future Interest Compromise data of death seer 2-12E2) ( x^ 8' ~ ) to ^)< p ~ i n tai nre~)a Living Trust ~tta~ heat 7' 1A o t T (A Copyy of WII 9. Litlgeti0n Proceeds Received ~ r t C O 0 1 anr]tt(O~~es~f tl6ath 1°~ bblween PZ~~ 1- ~ 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Taz Return Required 8. Total Number of Safe Deposit Boxes 11.Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL Name EDWARD P SEEBER First line of address SUITE C400 Second line of address 555 GETTYSBURG PIKE City or Post Office MECHANICSBURG AND CONFIDENTIAL TAX INFORMATION SHOULD DIRECTED TO: Daytime TeleQ~ne Number,, ~ 717 53~~280 ~"' c '~' tub O m -r <. ~ Cb ti ~ -raj ~-, n REGISTER .CS USEGaNLY r ~- . n - ' ~-~ C` .} ~~ F ' ' ') ~ ~ f" r 1 ' N N State ZIP Code PA 17055 Correspondent's a-mall address: vpa~suc.cvm Under penalties of perjury, I declare that I have examined Mis return, inUUding accompanying schedules and statements, and to the bast of my knowledge antl belief, it is true, correct and complete. DeUarotion of preparer other than the pereonel reproaentetive Is based on ell information of which preparer has any knowledge. ctL . ~'1~1 John L. Martin 8 ~ al 1, >ti Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number oe~aanra r,ama: Martin, Nancy M. 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. 5 , 665.91 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous I~(oq Probate Property (Schedule G) u Separate Billing Requested............ 7. 154 , 555.42 g, Total Gross Assets (total Lines 1-7) ................................................................... .. 8. 160 , 221.33 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 15.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10. 11. Total Deductions (total Lines 9 & 10) .................................................................. . 11. 15.00 12. Net Value of Eatate (Line 8 minus Line 11) ......................................................... . 12. 160 , 206.33 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................................. . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. . 14. 160 , 20 6.33 TAX COMPUTATION -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 .o0 160 , 20 6.33 15. 0.00 16. Amount of Line 14 taxable 0 0 0 16 0 0 0 . at lineal rate X .045 . . 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 0.00 16. Amount of Line 14 taxable at collateral rate X. t 5 0. 0 0 16. 0. 0 0 19. Tax Due ................................................................................................................. . 19. 0.00 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: File Number 21-12 DECEDENT'S NAME Martin, Nancy M. STREET ADDRESS 2624 North Rosegarden Boulevard CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits (A + B) (2) 0.00 3. Interest (3) q. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check 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. (5) O.DO Make Check Pa able to: REGISTER OF WILLS, AGENT. II~~NN 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 properly 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 I'rfe of either payments, benefts or care? ........................................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ ^x 3. Did decedent own an "in trust 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 contains a beneficiary designation? .................................................................................................................. ~ ^ IF THE ANSW ER 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)]. 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) (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 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)l. 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. Rav-teoa EX+IB-aej SCHEDULE E CASH, BANK DEPOSITS, SL MISC. PERSONAL PROPERTY COMMONWEALTH OF>ENNSVIVANIA INHERITANCE TAX RETURN REBIpENi OECEOENT ESTATE OF M. FILE NUMBER Inclutle the proceetls oflitigation end the tlate the praceetls were receivetl by the estate. All property Jolntlyownstl wIM the light o/ survivorship moat ba dlselosetl on schstluls F. Copyright (c) 2002 torn software only The Lackner Group, Inc. Forth PA-1500 Schedule E (Rev. 6-98) (If more space is needed, additional pages of the same size) Rev-1610 EX~ (8-99) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY INHERITANCE TFJI RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Martin, Nan~M.__ 21-12 This schedule must be completetl entl filetl iRhe answer to any of questions 1 through 4 on the reverse aide of the REV-151]0 COVER SHEET is yea. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATENOF TRANSFERSATTACViTA COPV OF THE DEED ~OR REAL EST TE. DATE OF DEATH VALUE OF ASSET %or oeco~s INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 TD Amertrede IRA No. '6371 -beneficiary is spouse; 47,734.04 100.000% 0.00 47,734.04 valued per broker's statement 2 15 shares of Apple Inc. common stock held by TD 8,599.05 100.000% 0.00 8,599.05 Ameritrade Account No. '8344 -titled in the Nancy M. MaRin Revocable Trust; valued per broker's statemen 3 315 shares of FiretEnergy common stock held by NPC 14,669.55 100.000°/a O.oa 14,669.55 Brokerage Account No. `8331 -titled in the Nancy M. Martin Revocable Trust; valued per broker 4 Members 1st Federal Credit Union Certificate of 3,056.78 100.000°/a 0.00 3,056.78 Deposit No. 167` -titled in the Nancy M. Martin Revocable Trust; valued per bank statement 5 Members 1st Federal Credit Union Certificate of 22,852.81 100.000°k 0.00 22,852.81 Deposit No. 167' -titled in the Nancy M. MaRin Revocable Trust; valued per bank statement 6 Members 1st Federal Credit Union Money Market 8,588.90 100.000°/a o.00 8,588.90 Account No. 167' -titled in the Nancy M. Martin Revocable Trust; valued per bank statement 7 Members 1st Federal Credit Union Savings Account 74.34 100.000% 0.00 74.34 No. 167" -titled in the Nancy M. Martin Revocable Trust; valued per bank statement 8 185.641 shares of MFS Emerg Mkts Debt A held by TD 2,753.06 100.000°/a 0.00 2,753.06 Ameritrade Account No. "8344 • titled in the Nancy M. Martin Revocable Trust; valued per broker's statemen 9 Money Market held by NPC Brokerege Account No. 15,074.00 100.000°/a 0.00 15,074.00 '6331 -titled in the Nancy M. Martin Revocable Trust; valued per broker Total of Continuation Schedule ee attached page TOTAL (Also enter on Line 7, Recapitulation) ~ 154,555.42 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Ina. Fonn PA-1500 Schedule G (Rev. 6-96) Rev-1510 Ex. (8-98) SCHEDULE G INTER-VIVOS TRANSFERS 8r MISC. NON-PROBATE PROPERTY MON W EALTM OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF Martin. Nancv M. FILE NUMBER ITEM NUMBER DESCRIPTION OF PROPERTY THE SATE OF TR~ANSFERSAITACNTA COPVEOF THE DEED ~OR REAL ESTATE. DATE OF DEATH VALUE OF ASSET w of oeco•s INTEREST ExcLUSION (IF APPLICABLE) TAXABLE VALUE 10 Money Market held by TD Ameritrade Account No. 18,062.84 100.000% 0.00 18,062.84 '8344 -titled in the Nancy M. Martin Revocable Trust; valued per brokers statement 11 221.244 shares of Oppenheimer Global Allocation A 3,075.29 100.000% 0.00 3,075.29 held by TD Ameritrade Account No. '8344 -titled in the Nancy M. Martin Revocable Trust; valued per brokers statement 12 216.676 shares of Permanent Portfolio Fund held by 10,014.76 100.000% 0.00 10,014.76 TD Ameritrade Account No. '8344 -titled in the Nancy M. Martin Revocable Trust; valued per brokers statement TOTAL (Also enter on Llne 7, Recapitulation) 154,555.42 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1161 EX~t10-0B) SCHEDULE H coN11 OFPF~ANIA FUNERAL EXPENSES & TE€PLGxEE. ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Martin, Nancy M. 21-12 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. ~ FUNERAL EXPENSES: B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address Citv Yearfs) Commission Daid State 2, Attorney's Fees 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 Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 15.00 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 Martin, Nancy M. 21-12 ITEM NUMBER DESCRIPTION AMOUNT 1 Register of Wills, Cumberland County -filing fee for Return 15.00 H-87 15.00 Copyright (c) 2002 Corm software only The Lackner Group, Inc. Forth PA•1500 Schedule H (Rev. 6-98) RNd51] EYt H1-09\ SCHEDULE J COMM~Q(~W~~~~la/ANIA BENEFICIARIES ESTATE OF FILE NUMBER Martin, Nanc M. 27-72 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 John L. Martin Spouse Residue - 160,206.33 2624 North Rosegarden Boulevard Bypass Trust Mechanicsburg, PA 17055 distributed to spouse Total 160,206.33 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 cover sheet as a r o riate. 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 SHEETI Copyright (c) 2009 form software only The Lackner Group, Inc. Forth PA-1 S00 Schedule J (Rev. 11-Ot3) JAMES SMITH D>E'rlvat[IX & CONNELLY LLP Cheryl L. Bakes, CP Certified Paralegal clb@jsdc.com August 22, 2012 Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse 1 Courthouse Square Cazlisle, PA 17013 Re: Nancy M. Martin, deceased Dear Ms. Farner Strasbaugh: Enclosed aze an original and two (2) copies of the Pennsylvania Inheritance Tax Return to be filed on behalf of Mrs. Martin, along with a check for $15.00 representing the filing fee. Please time-stamp the extra copy and return it to me in the enclosed self-addressed, stamped envelope. If you have any questions, please feel free to contact me. Sincerely, JAMES, SMITH, DIETTERICK & CONNELLY, LLP C L. aker, CP ert' ed Pazalegal Enclosures c : N •John L n~8rtin g _ L ~QQ L L_ ~ C~V `. ~~-~~ .: <" u`j ~ r ` ~(Y: ~ m !Y 2 0 ~ ~ c., Reply to: Suite C-400 555 Gettysburg Pike Mechanicsburg, PA 17055 Direct Dial: 717-298-2094 Direct Fax: 717-298-2095 P O. BOX 650 HERSHEY. PA 17033 Gowier Atltlr~s. 13~ SIPC-AVENUE FUMMELSTOWN. P~ I /V36 I r l. n i s:>3-J~eo WVJNLJSDQCOM GARY L JAMES MAx J. $MITR, JR. JOHN J. CCNNELLV, JR. Scow A. DIEITERICK JAMES F. SPADE MATTREw CHA&1L, III NEIL W. YArIN EDWARD P. SEEBER RONALD T. TOMASKO SUSHI M. KADEL CWRTNEY K. POWELL KIMBERLY A. BONNER KAREN N. CONNELLV CHRISTINE T BRNJN JESSICA E LOWS GREGORY A. Kocur, JR. THOMAS J. CAR RALPH M. SALVIA TERESA M. REIFSNYDER JAMES D. YOUNG CAVLA B. HENN OF CWNSEL: GREGORY K. RICHAROS BERNARD A. RYAN, JR. ANDREW H. BRIGGS ,,; ;_s~~ sn~ ,r, O i ,~ o ~- oa I ~ ,~ a ~3lSVH CJ U? N Lt.: _~ ~ ~J ~ , O _ ~i i..~ ._~ ~` ;!~U - C~ _ ~ ~ - c-~ nZ v~ ~ ~m <., O c~ ~~ 0 ~W~ a a a. W ~~ Q a '~a m~ ~~aWa ~~`7+ U~U ~~., ~U~vv'i~ W 0 U ~~~M ~oao w~ pa~~a W W~ O~ U R:U-~U