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HomeMy WebLinkAbout08-27-12' ~ 1505610101 ~~J REV-1500 Ex `°~-~°' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes °EPAaTMEN.oFRE~EN~E County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN ~ Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT r~ t t ~' 0 ~' ? ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ~~ ~~- Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 4. Limited Estate ~~ 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received REGISTER OF WILLS O 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~ -~, REGIST~ ZSH WILLS U~6'E ONLI!,~,~ '~ ~-` f"" e- _ e_, I~ First line of address ~ c~ `~ "~ ~ ~JC_, . ~c~, t~ Second line of address -~ --f ~. ' ~~~ ~~ D City or Post Office Correspondent's a-mail address: -.J State ZIP Code DATE FILED ~~ ~ s's ~ ~ 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. SIGNA ~ ERS '' SP IBLE FOR FILING REyIJRN ~~ ~DA~/~~~~ ~, r~ ~-. ~ SIGNATURE OF PREP ER HER THAN R ESE TA IV DATE ~~ ~~ ~?% d2~Z~1L ADDRESS ~___e ~C<< --~ PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 ~~ J 1505610105 ' REV-1500 EX Decedent's Name: Decedent's Social Security Number 1 ~~ ~ ,~~! 3 ~~~r KtGAPITULATION 1. Real Estate (Schedule A) ........................................ ..... 1. - R 2. Stocks and Bonds(Schedule-B) .................................. ..... 2. (c 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. / ~ ~ ~i 6. Jointly Owned Property (Schedule F) p Separate Billing Requested .. ..... 6. ~ 6 ~ [ 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ®Separate Billing Requested... ..... 7. ~' ~> ~ 3 8. Total Gross Assets (total Lines 1 through 7) ........................ ..... 8. ~ ~ , ~ ` ~ , 9. Funeral Expenses and Administrative Costs {Schedule H) .............. ..... 9. Q ~ [ d 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... ..... 10. O' 11. Total Deductions (total Lines 9 and 10) ............................ ..... 11. ~ Q / ~~ s 12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. j © ~ (~ ~ 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. ~' ~ ~ ~ ~,,,, , 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 .0- . 15. ~- • 16. Amount of Line 14 taxable at lineal rate X .0 ~ ~ j fti (; C~ ~„ g . 16. ~ '~ T 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 • 18. • 19. TAX DUE ..................................................... .... 19. `j ~ "f~• 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 J RE`/-1500 EX Page 3 ®ecgdent's Complete Address: File Number DECEDENT'S NAME lk,-~ j 1'I ~, t~t~?~ ~L ~ ~ r __ _ __- STREETADDRESS - n ~~ ~ - __ _ - cITY _ -- L ~ ~2 ~ f .s /~. - ---- STATE ~~ i ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments 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. Total Credits (A + B) (2) (3) (4) (5) ~_ ~`f .~, Nlake check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN '°X°' IN THE APPROPRIATE BLOCi(S 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 or its income : ............................................ ^ ^' c. retain a reversionary interest; or .......................................................................................................................... ^ ^' d. receive the promise for life of either payments; benefits or care? ...................................................................... ^ [a'' 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 0 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ [~` 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ................................... (~ ^ ..................................................................................... 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)]. 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)]. 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 v~rho has at least one parent in common with the decedent, whether by blood or adoption. `~ ~ pennsy[vania DEPARTn?c:"~T iiF ReVE^:UE INHERITnfVCE TnX RETURN RESIDENT DECEDENT T $p~ p~C t ~~~~ Get L~~~VJ E .~ -- - EIf.E NUMBER All property jointly owned with ri~ht of survivorship must be disclosed on 5cheduie ~. tt more space is needed, ir;sert additional sheets of the same size REV-503 EX; (z~-lo; '_~ ~~n~SY~G~~~C~ i)E'Yitill'f~IENT' OF fiEVENUE INHERITANCE TAX RETURN RESIC)ENT DECE7ENT '~ ~ ~ CASH ~3AlVK aEPC}SITS $c MISC. PERSONAS PRORERTY ESTATE OE: FILE NUMBER: ' ~ Include the proceeds of litigation a d the date the proceeds were received by the estate. Ail property jointly owned with right of survivorship must be disclosed an Schedule F. If more space is needed, use additional sheets of paper of the same size. REV-t505 EX + (1-97, ~~ _~:di y W ~ SCHEDULE F ~~ JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENPISYLVA,NIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER / /. . If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. ADDRESS SURVIVING JOINT TENANTS; NAME a. ~y~R~~ F ~L"h2~'~E,C B C JOINTLY-OWNED PROPERTY: RELATIONSHIP TO DECEDENT ~..2-~y ~~t~ r - i r~ - LJ=1G'~ j ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH F ASSET LUE O % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ` ~~ ~ j ?~/ l f}re~,~ # TOTAL Also enter on line 6, Reca itulation $ ~ ~ .~~ (If more space is needed, insert additional sheets of the same size) REV-i~1~1 EX+ ~Q8-OQi ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTI( ESTATE OF FILE NUMBER ~, ~ <~Cll~~ ~ ~ ~ f~ ~- i r 1 ~ ~~ ~'~ This schedule must be completed and file if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE] TAXABLE VALUE r TOTAL (Also enter on Line 7, Recapitulation) $ I ~ a ~ 3 ~ If more space is needed, use additional sheets of paper of the same size. ~ ~ CG~;~IMCIV!,"JEAi_TH GF PENNSYL'yANIA ?lvl-iER-TANCE TAX RETURN RESIDENT DECEDEt~-T ~c~EDU~E ~ 1=UNERAL EXPENSES & ADIIAINISTRATIVE COSTS -_-- ESTATE ~F FILE NUMBER beats of decedent must be reported on Schedule I. _..__ TEM ~- '~~ulylSErR ~ DESCRIPTION AMOUNT A.--~~ ~~1NE,rr~~AL E~PE~ISF~Sv,, /,) 1 3 - ~~'ruur~~a Per~~ese~tatiue's ~.z~mmisscrs 9 r r~ ' ".1G~;C'i~ i( ~'F.r~G.r,e!i ~~~rR~e~rtaUV~'~j _ _ ___-__ ___ _- __-_ ___-_ __ 1 3 ~.,I''G State ~I~ . J,y ~_ __-_- 1 1 --. ~ _..i±'y~ TM;'~r`~i1p,~~ ~,{ (...6.`.v~t~ ~."i'G;"$SS 1& ri::~ ~E~3t~.:;~ri"'8 ~~S i:idE!'~eir!tS d:{a::it CX~I$i12C3orS~r i - ~" --- - --- - ~tat£' c ~elatic~I+S~tI ; C+'. ~.,lairr~~?~s }~ '~~u21~,'1t ~' . ~roLate Kees i - ... .~{;'.,'~~~htart5 t~G'e~ «. Tax Ret~:ra~ Prepar€~r's Lees a S \1 v -- - -- - --- --- -- --- i - ~.ep _ - - - ------ t ~" ,~ ~ ~ TOTAL (Also enter on line 9, Recapitulation) ~ $ ~~ ~ ~~• (if more space is needed, insert additional sheets of the same size) REV-1512 ~=X+ (12-03) ~. _~~~~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNE~u~E ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which r mained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) RE'Si-I5}.3 En+ (01-1.Oj " ®~ pennsyLv~rtf~ UEPARTh9EN1" OF I?E:/ENUE [f`dHERITANCE TAX RETURN FES[DENT DECEDENT ~E[~EFICIARIES ESTATE OF: ----- FILE NUMBER: '~ -NUMBER_. " ..~~._.~___ NAME AND ADDRESS OF PERSON(S) RECEIVIPdG PROPERTY RELATIONSHIP TO DECEDENT Da Not List Trustees} AMOUNT OR SHARE OF ESTATE I ~~ TAXABLE GISTRIBUTIOf~S [Include outright spousai distrihutior~s and transfers under _ ~~ ~~-~ __.. Sec. 911E %a) (1.2j.] 1. F3,~ ~ ~L ~ C,tn ~-.~ r ~ E. ~ ~.~ ~` ~ ~ C7 ~ ~L~.~-~` t~~~b~r .~~t /7 C ~1 (~ E?- ~ (v ~~~ ~"~ ~ ~L~ yl ~f,7~~•l~ ~'~' ~ ~~ T ~°- J ~ A ~ C7 3 ~~~ ~ >~~~ ~f~sj~ ~ -~ ~~~ d`~~ s~~~`- ~~~~ f, l ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHO."JfJ ABOVE ON LINES IS THROUGH 1S OF REV-1500 COVER SHEET, A S APPROPRIATE. II fJON-TAXABLE DISTRIBUTION5 A. SPOUSAL DISTRIBUTIONS UNDER SEC,?ION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. r~ ~(f ` v B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. ___ _ _ __ TOTAL QF 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. REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA No . 2012- 00647 Estes to Of : PAULINF l/MRFRrFR CERTIFICATE OF GRANT OF LETTERS PA No. 21- 12-0647 (First, Middle, LasU Late Of : NEWVILLE BOROUGH CUMBERLAND COUNTY Deceased Social Securi ty No: 174-24-3485 WHEREAS, on the 8th day of June 2012 an instrument dated November 24th 2004 was admitted to probate as the last will of PA UL lNE UMBERGER /l ~~st, Middle, Lastl 1 a to of NEWVILLE BOROUGH, CUMBERLAND County, who died on the 22nd day of May 2012 and, WHEREAS, a true copy of the wi 11 as probated i s annexed hereto . THEREFORE, I, GLENDA EARNER STRASBAUGH Register of_ Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: PAUL PL O VI SH who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which full y appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CA RL lSL E, PENNS YL VA NlA . IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of_ my office on the 8th day of June 2072. _,~~ * *l~TOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE', LAST) s Be it remembered that I, Pauline Umberger, of 286 Redwood Lane, Carlisle. Pennsylvania 17013, being of sound mind, memory and understanding, do make, publish anc declare this as and for my last Will and Testament, hereby revoking and making null and void any and all wills and testaments or writings in the nature thereof by me at any time heretofore made. First: I order and direct the payment of all my just debts and funeral expenses as soon k y~~~t .i':"f ~;~ conveniently may be done after my decease. . ~ - eHo e~at~, orwiraz5-vcver~7-ra-i Ui ~ ntiii wheresoever situate, be the salve real, personal or mixed, I give, devise and bequeath to my four children, Paul Plovish, Barry C. Umberger, Sandi K. Sherba and Allen J. Umberger, share and share alike. Third: In the event that any of my children shall fail to survive me, I direct that his or her share shall go to those of my children who shall survive me, share and share alike. Fourth: I name, constitute and appoint my son, Paul Plovish, as the Executor of this, my Will. In the event that my said son should, for any reason, fail to qualify as Executor, I then name, constitute and appoint my daughter, Sandi K. Sherba, as the Executrix of my Will and direct that neither of the above-named fiduciaries shall be required to post bond. IN WITNESS WHEREOF, I, Pauline Umberger, the Testatrix, have to this, my Will, written on one sheet of paper, set my hand and seal this 24`'' day of November, 2004. v. ~ :,. Seal) Pauline Umberger Signed, sealed, published and declared by the above-named Pauline Umberger as and for her last Will and Testament in the presence of us who have hereunto subscribed our names at her re nest as ~ ' ness s thereto, in the presence of the said Testatrix and of each der. ~ __. ~~ .~ z~ ~ / :~ __ _~ ~G'~ r ~ •-yFr. .~ ~_ 7 ' ' v _ _i_; ".-, _ 4- _- Lr ~ '~-? ~~, and executed the instnTment ~as my Last mill, mat ~~s~git ~ ~ tng; end that ~ signed it as my ~ free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by Pauline Umberger, the Testatrix, this 24t" day of November, 2004. ~, Commonwealth of Pennsylvania County of Bedford, ss: ~.. .~:~ _. ~~c LORI R. PRICE, NOTARY PUBLIC BEDFORD BORO~~GH.. BEDFORD CO. SAY COMMISSION' E:ynIP~S ,:r'-~.N. 24, 2t~6. _ ~S~:di We, John B. Koontz, Esquire, and Debra J. Brough, the witnesses whose names are signed to the attached or foregoing Instrument, being duly qualified according to law, do depose and say that `ve were present and saw Testatrix sign and execute the instrument as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix siggned the Will as witnesses; and that to the best of our knowled e the Testatrix was at the time 18 or more years of age, of sound mind and under no constrain or undue influenc e. i Sworn or affirmed to and subscribed before me by John B. Koontz, Esquire, and Debra J. Brough, witnesses, this 24t'' day of November, 2004. Witness ~~~1~G~ l~:~~i~ ,. .. NOTARIAL SEAL LORI R. PRICE, NOTARY PUBLIC BEDFORD gQR01.1G1-I,, BEDFORD Cp, b1Y C0~.9MfSSION EXPIRES JAN. 24, 20Q&,