HomeMy WebLinkAbout08-31-12 (2)J 1505610140
REV-1500 EX (°'.'°'
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes Crlunty Code Year File Number
Po BOx 2806ot INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 1 3 7 9
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDVYVV Date of Birth IHMDDVVVv
2 2 2 2 0 1 1 1 1 1 5 1 9 4 5
Decedent's Last Name Sutx Decedent's First Nlame MI
R U S S E L L B U C K WA S H P A T R II C I A J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
4. Limited Estate
QX 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust ~
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 91 i 3(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST SE COMPLETED. ALL
Name
C H A R L E S E P E T R I E
First line of address
3 5 2 8 B R I S B A N S T R E E T
Second line of address
City or Post Office
AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Daytime Telephone Number r,,
i' 1 7 1 1~ 3 ~9 ~~
State ZIP Code
T
~ r1 (^~
REGISTE fIL1$ USE 9LY `~~ ~ ~
ccr =in
~~i~, w ~.. _;
~,
~-y
A -
..- fir?r--'rn
C~f7 tww~
.['- i f
DATE FILED '~
- -
H A R R I S B U R G P A 1 7 1 1 1
Correspondent's a-mail address: PetrieLaW(C~AOL.CDm
Under penalties of perjury, I declare that I have examined this return, inclutling accompanying schetlules and statements, and to the best of my knowledge antl belief
it is true, correct antl complete. Declaration cyljpreparer other than the personal representative Is basetl on all Information of which preparer has any knowledge.
SIGN/4~1fJE~ EgSON I~SPOy$I I,•EB /KOR FILING RETURN DATE
l///~1/ ~ Y/vg 1/SiA/cD\C 8131/2012
DATE
3528 BRISBAN STREET HARRISBURG PA 17111
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 J
J
1505610240
REV-1500 EX Decedent's Social Security Number
Decedent's Name: PATRICIA J. RUSSELLBUCKWAS
RECAPITULATION
1 5 1 4 1 4 3 8
1. ......................................
Real Estate (Schedule A) .... .
.
2. Stocks and Bonds (Schedule B) ................................. .... . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3.
4. Mortgages and Notes Receivable (Schedule D) .................... ..... . 4. '
2 0 5 4 2 , 2 5
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .... .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6.
7. Inler-Vivos Transfers & Miscellaneous N -Probate Property
(Schedule G) ~ Separate Billing Requested . .... .. 7.
8. 7oWl Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 7 1 9 5 6 6 3
9. Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9. 1 5 1 0 3 . 5 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 3 6 0 . 0 0
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 1 5 4 6 3 . 5 0
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. 5 6 4 9 3 . 1 3
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. 5 6 4 9 3 . 1 3
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
al the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X~0_ 0 0
0
15.
0.
0
0
i6. Amount of Line 14 taxable
at lineal rate x .045 5 6 4 9 3. 1
3
16.
2 5 4
2.
1
9
17. Amount of Line 14 taxable
0 0
0
17
0.
0
0
at sibling rate X .12 .
18. Amount of Line 14 taxable
0 0
0
18
0.
0
0
at collateral rate X .15 .
19.
................................................
TAX DUE
....
.. 19. 2 5 4 2 1 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
L 1505610240 :L505610240 J
REV-1500 EX Page 3
Flle Number
21 11 1379
VGYGMGI I~ J Vvu~r"~ v ~~~. ~--•
DECEDENT'S NAME
P_ATRICIA J. RUSSELLBUCKW_ASH _ - __ -_ --
STREET ADDRESS
59 WOODMYRE .. - ----- - --
CITY _ __.. ._ _~ .. _ _ __- ~ STATE ZIP
ENOLA PA 117025
Tax Payments and Credits:
~. 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.
(1) 2,542.19
Total Credits (A+g) (2) 0.00
(3)
(4) 0.00
5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2,542.19
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN T'HE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
^ No
a. retain the use or income of the properly transferred : .................................................................
i .....
^ ^
ncome : ..........................
b. retain the right to designate who shall use the property transferred or its .....
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 properly within one year of death
^
without receiving adequate consideration? .................................................................................
d
h7
" ......
^ 0
...
e~al
orpayable-upon-death bank account or security at his or her
3. Did decedent own an "intrust for ......
Did decedent own an individual retirement account, annuity or other non-probate property, which
4
.
contains a beneficiary designation? ............................................................................................ ...... ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE O 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
fling a tax return are still applicable even if the surviving spouse is the only benefciary.
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 who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+(Ot.t O)
pennsylvania ~ SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~~ i Ai t ter: FIILE NUMBER:
PATRICIA J. RUSSELLBUCKWASH 2'I 11 1379
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is joindy-owned wkh right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. REAL ESTATE AT 3746 BRISBAN STREET 51,414.38
SWATARA TOWNSHIP
DAUPHIN COUNTY, PA
TOTAL (Also enter on Line 1, Recapitulation.) ~ S
If more space is needed, use additional sheeLS of paper of the same size.
REV-1808 EX a (e-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
PATRICIA J. RUSSELLBUCKWASH 21 11 1379
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-ovmed whh right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
ITEM OF DEATH
NUMBER DESCRIPTION
1 ACCOUNTS AT PSECU 9,281.19
2. ACCOUNTS AT FULTON BANK
TOTAL (Also enter on line 5,
11,261.06
(If more space is needed, insert additional sheets of the same
REV-1511 EX+(10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
PATRICIA J. RUSSELLBUCKWASH 21 11 1379
Decedenfs debts must be reported on Schedule I.
ITEM AMOUNT
NUMBER DESCRIPTION
A. FUNERAL EXPENSES: 4,750.00
1.
2. HEADSTONE 2,950.00
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State ZIP
2, AtrorneyFees: INCLUDED ON REAL ESTATE SETTLEMENT SHEET
3, Family Exemption: (If decedents address is not the same as claimants, attach explanalion.) 3,500.00
Ciaimant MARK CALEY
Street Address 59 WOODMYRE
Cay ENOLA state PA zIP 17025
Relationship of Claimant to Decedent
4. Probate Fees: 223.50
5 Acauntant Fees:
6. Tax Return Preparer Fees:
7. REPAIRS TO REAL ESTATE NECESSARY FOR SALE 2,950.00
8. OIL FOR TANK 645.00
9. TRASH REMOVAL 85.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 15,103.50
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX« (12-OB)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
PATRICIAJ.RUSSELLBUCKWASH 21 11 1379
Report debts incurred by the decedent prior to death that remained unpaid al the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~ IWATER BILL 110.00
2. IPA POWER & LIGHT I 250.00
TOTAL (Also enter on Line 10, Recapitulation) I $
If more space is needed, insen additional sheets of the same size.
REV-1513 E%4(01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FILE NUMBER:
PATRICIA J. RUSSELLBUCKWASH 21 11 1379
RELATIONSHIP TO DECEDENT
AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outnght spousal distdbutions and Vansfers under
Sec. 9116 (a)(1.2).1
1. MICHAEL CALEY Lineal 28,246.56
1032 S. 102ND STREET
EDWARDSVILLE, KS
2. MARK CALEY Lineal 28,246.57
59 WOODMYRE LANE
ENOLA, PA 17025
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1;
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TP,KEN:
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1
SHEET. AS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
If more space is needed, use additional sheets of paper of the sarrle size.
eo\wiils\nssellbuc kwash
G~`
LAST WILL AND TESTAMENT
19 ~ ~®~$~ OP ~mU~ iYVPtI, OF
original is in ?he sale deposit boz pATRICIA J. RUSSELL-BUCKWASH
one, Lafaver & Shekletski, attorneµs.
I, PATRICIA J. RUSSELL-BUCKWASH, of the Borough of Paxtang,
Dauphin County, Pennsylvania, declare this to be my last will and
revoke any will previously made by me.
ITEM I:I direct that my Executrix hereinafter named shall pay all
my just debts and funeral expenses as soon as conveniently may be done
after my decease from the residue of my estate.
ITEM II: I bequeath my automobiles, household and personal
effects and other tangible personalty of like nature (not including
cash or securities) together with any existing insurance thereon to
such of my children, MICHAEL A. CALEY and MARK A. CALEY, as are then
living, to be divided among them by my Executrix with due regard for
their personal preferences in as nearly equal shares as practical.
ITEM III: I devise and bequeath all the rust, residue and
remainder of my estate, of every nature and wherever situate, in equal ~
shares to such of my children, MICHAEL A. CALEY and MARK A. CALEY, as
survive me. Should MICHAEL A. CALEY predecease me, I devise and
bequeath his share to his wife, PEGGY CALEY, if she survives me. Ii
Should my son, MARK A. CALEY, predecease me, I devise and bequeath his
share to his issue, per stirpes. ii
i
rage i of 4
ITEM IV: I appoint my Executrix and her successors guardian of
any property which passes, either under this will or otherwise, to a
minor and with respect to which I am authorized to appoint a guardian
and have not otherwise specifically done so, provided that this ap-
pointment of a guardian shall not supersede the right of any fiduciary
in its discretion to distribute a share where possible to the minor or
to another for the minor's benefit. Such guardian shall have the
power to use principal as well as income from time to time for the
minor's support and education (including college education, both
graduate and undergraduate) without regard to his or her parent's
ability to provide for such support and edudation, or to make payment
for these purposes, without further responsibility, to the minor or to
the minor's parent or to any person taking care. of the minor.
ITEM V: I appoint my sister, DIAN GRADY, Executrix of this my
last will. Should my sister, DIAN GRADY, fail to qualify or cease to
act as Executrix, I appoint my son, MARK A. CAI,EY, Executor of this my
last will.
ITEM VI: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his or her
duties in any jurisdiction.
IN WITNESS WHEREOF, I, PATRICIA J. RUSSELL-BUCKWASH, have here-
/ ;'7
unto set my hand and seal this %~ day of~=
~T. RUSSELL-BUCKWASH
Page 2 of 4
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
we, ~-~;i/,//r~i~-~~l`Y/ and ,.i~ ~ r'r'//~~-'i~ ,
the witnesses whose names are signed o the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
her last will; that Testatrix signed willingly and that she executed
it as her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed the
will as witnesses; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, cf sound mind and
under no constraint or undue influence.
Sworn
/
Cs'-Cu lam/ to
/. or affirmed to and
~/ // ~/
~1~r`'!r-~l~"f~F / ack dged before me by
and ) ^r ~. Q ~~ ~
i
witnesses, this~_ day o
007.
~ ~~' ~L~
COMMONWEALTH OF PENNSY~VA~\La Not:ary PU~.'`11C
NOTAfiIAL Si:AL
CAROL L. TROXELL, Nctary Piabl~c ;
New Cumberland Boro. Cumberland Cc. !.
My Commission Expires Dec. 27, 2009
Page 9 cf 4
SIGNED, SEALED, PUBLISHED and DECLARED by PATRICIA J. RUSSELL-
BUCKWASH, the Testatrix above named,. as and for her Last Will and
Testament, and in the presence of us, who at her request, in her
presence and in the presence of each other, have subscribed our names
Witness
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS:
914 Bridae St. New Cumberland, PA
Address
414 Bridae St. New Cumberland, PA
Address
I, PATRICIA J. RUSSELL-BUCKWASH, the Testatrix whose name is
signed to the attached or foregoing instrument, Yiaving been duly
qualified according to law do hereby acknowledge that I signed and
executed this instrument as my last will; that I signed it willingly
and that I signed it as my free and voluntary act: for the purposes
therein contained.
PATRIC J. RUSSELL-BUCKWASH
Sworn to or affirmed to and acknowledged before me by PATRICIA J. I
~-
RUSSELL-BUCKWASH, the Testatrix, this ~ day c ~ I
2007. (~~ I
COMMONWEALTH OE PENNSriVAN1A `` i
NOTARIAL S[AL ~
'C
CAROLLTRCIXELL, Notary Public Notary Public ~'
My Comm ss on E ptras Dece27 2009
Page 3 of 4