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Home My WebLink About09-07-12 1505610143 -~ REV-1500 Ex (01-10) ~ OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.28osot INHERITANCE TAX RETURN 21 11 1157 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 178 58 5431 06 20 2010 04 10 1968 Decedent's Last Name KEESEMAN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Suffix Decedent's First Name MI SCOTT A Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ^ 2. Supplemental Return 4. Limited Estate ~ 4a, ~ uture Interest Compromise ) date of death after 12-12-82 ^ 6 Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 9. Liti ation Proceeds Received g ^ 10. Spousal Povert Credit ((date of death between 12-31 X31 and T-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. 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 JERRY A WEIGLE ESQUIRE 717 532 7388 First line of address 126 EAST KING STREET Second line of address City or Post Office State SHIPPENSBURG PA ZIP Code WILLS USE ONLY REGISTER OF /' (..J 7 ~ 4~ ~~., ,--- ~_,.. ~t ~.s U ir- --ca DAT ~ `- -~ < ~ ^, _~ I . ;~ ;"Ti p G~ Correspondent's a-mail address: 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN .+.. ./`'~„~,. _~o~_ ~ ~>»~,~..,,.~_._/ Madella M. Keeseman ~ J ""~~ L 129 ak Flat Road Newvule r ~ i~4-i SIGN UR OF EP ROT THAN R PR SE ATIV DATE Jerry A. Weigle Esquire r' ~,~ Z---- ADDRESS 126 East Kin Street, Ship ensbur A Side 1 1505610143 1505610143 J J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name. KeeSeman ~ Scott A. 17 8 5 8 5 4 31 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. 3 , 696.30 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7 Inter-Vivos Transfers & Miscellaneous ion; Probate Property . (Schedule G) u Separate Billing Requested............ 7. g. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 3 , 696.30 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 5 , 92 9.03 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 5 , 92 9. 0 3 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. -2 , 232.73 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. -2 , 232.73 TA X COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 O . O O (a)(1.2) X .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 O , 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 1s 0.00 19. Tax Due ............................................................................................................... ... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-11-1157 Ut'SGCL7CItL A vv1~~F/~~.a~i rya. a+. v..... DECEDENT'S NAME Keeseman, Scott A. STREET ADDRESS 90 Potato Road CITY Carlisle STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund (1) Total Credits (A + B) (2) (3) (4) 0.00 0.00 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 :............................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income :.................................. ^^ 0 c. retain a reversionary interest; or ............................................................................................................... d. receive the promise for life of either payments, benefits or care? ............................................................ ^ ~-~ 2. If death occurred after December 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?....... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^ contains a beneficiary designation? .................................................................................................................. x 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 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)]. 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. Rev-1,508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Keeseman. Scott A. 21-11-1157 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1 David W. Jardine Painting -replacement check for labor performed prior to date of passing 1,600.00 received 8-13-12 2 U. S. Treasury -replacement check for labor performed prior to date of passing received 7-16I 2,096.30 -12 TOTAL (Also enter on Line 5, Recapitulation) I 3,696.30 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-3151 EX+ (10-06) COMMNHERITANCEOT~ERETURN ANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Keeseman. Scott A. 21-11-1157 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address Citv Year(sl Commission paid State 5,101.53 Zio 2. Attorney's Fees See continuation schedule(s) attached 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ( laimant 750.00 Street Address City State Zio Relationship of Claimant to Decedent a. ~ Probate Fees Register of Wills, Cumberland County 62.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 15.00 7. Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 5,929.03 Form PA-1500 Schedule H (Rev. 10-06) Copyright (c) 2009 form software only The Lackner Group, Inc. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued GCTATr r,~ .... ~ v~ Keeseman, Scott A. ITEM NUMBER DESCRIPTION Fungal XD ncrac 1 Ewing Brothers Funeral Home H-A Attorn v F 2 Weigle & Associates, P.C. -collection fees and estate administration fee 9ther Adm~nic+....:.._ ,. H-B2 3 Register of Wills, Cumberland County -filing Insolvent PA Inheritance Tax Return H-B7 Copyright (c) 2002 form software only The Lackner Group, Inc. FILE NUMBER 21-11-1157 AMOUNT 5,101.53 5,1 750.00 750.00 15.00 15.00 Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (11-08) SCH ~~ p E EDULE J COM INHERITANCE T~ R~T~1RN ANIA RESIDEN DECED N BENEFICIARIES ESTATE OF Keeseman, Scott A. FILE NUMBER 21-11-1157 NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S) RECEIVING PROPERTY DECEDENT o t Trustee (Words) ($$$) I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 NOT RELEVANT AS ESTATE IS INSOLVE~T. Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 covOeasheet, as a I i 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 SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) 1066 60-994/313 {{-- !f ~~d. BRANCH 81 4~ ~`~ / Q ADDS COUNTY NATIONAL BANK ~ ` c~rnrse rEnnvsrcvernn FOR ~ ~~u' '~- ,E~° J'~'1Et~,/c./ ~~' " "v<.-~ NP u^00 LO-66i~' ~:0 3 ~ 30994 5~: 2 3 5.~~gg 2...1,n^ ~ttui~ Jttrdin~ ~htt Jttr~inr',~ ~ttinfin~ 47D3 ~ttnla ~~ ~emuil[e, ~~ 17241 _ ~ .. t a 'a~y~ - . ~ ~ _ ~ ~ J .~t V L('1 ~ ~ ~LL S J ? ~L:.1 j ~ ~~ ' i. ~.. 4 . ~ J .. O ~~ .p C # , ~ ~ g ' ~ ,,~~frt ~' lJl .£ d ~ ;Dx ~ I ~ ~ ~ ~ ~~3 ~ ~~ ti3; r ~ 9 ,~ ~~ ~ S ti. ' ,;w ~: k~ . .,~ _ Ca a ~7 ..i ,~ ,; ~ d' ~~ "~Y~e" . ~f s """ "' ~ ~ Lll ~ ~ i m.~ ~ ~' , Fu~~ .-t . O ` s ~ ~~ ~~ ~ l ~ Hr. M ~~ b v ^ ~ ~ ~ ,t~ if ~ ~' ~~ ?~ ~ Q.Zq~I~` ~ ~~ ~~' ~~ a 't ,° ~ k L!1 :" ! dBt ~ ~ i. ~, ~ ^ ~ F IC.O n ~ ~ ~~t ~ ~ ~~~~~ ~ ~ n Z<N A, :. ~ ,,fi~tt y~ l~ ~.A ~ y y LL a ~Oa 1 ~ r ,~ ` ~ ~ i ~ p W Q rY1 d R~ _ L as~ O a' ..{{ } ~.. Q~ ~ ~. Q Z {Y ~ ~ / .. ~ t I tWd.l} [fea f ~ooo K 844, 048, 962 ,~• ~~~ ~ a~ Check No. ~ /.~ 07 16 12 16010002 KANSAS CITY, MO 4030 10718800 0120044801 4030 10718800 M p^y~ 00003221396WFS theoraerof ESTATE OF SCOTT KEESEMAN BENIFICIARY MARK E KEESEMAN WEIGLE & ASSOCIATES P C SHIPPENSBURGGPA1725 $***209b*30 'ATSALIS BROTHERS PAINTING DOL-ESA-WH neoiaia.neeu~meoomcen VOID AFTER ONE YEAR "~ II-= li_~i_I= I,j 'i I-~ OD7-i _'i'il,~{-_r_ i-- _~ ~, T i!= - r ~Lli~r~ ir;_il_~ ; ~- -i ~-iu'~~i 1 ~Ijli_r-~~ 1i~=11~i i=1'~TIII~?- ti'• Ji_y=J-~-:~_T-I_ ii.-=1ii_i-~ I_~i_~ ~ i,-~ ~ ..,~Lir,,~-I~~~riTiL~l ~~~:,L~_,-II-i,iiiei- ~~r-'- i ~F..~i.--Ali'-ilTt~~~-iTl~ll ?~~~~=`!~_.~~r... ~~ Ire ,~;w'~II~, ~ ~I~F?~~~;~lii ~:ODDD00 5 L$~: ~0 4 LggOD411' DLO 7 L 2 .vrraaa~ yaVaaaplJ 1' ~u~i a- r1uIIIe, iuc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 August 6, 2010 Mark E. Keeseman 129 Oak Flat Rd. Newville, PA 17241 The Funeral Service for Scott Allen Keeseman We sincerely appreciate the confidence you have placed in us feel free to contact us if d an will continue you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMI to a ' sstst you in every way we can, please ZED STATEMENT OF AND MERCHANDISE THAT YOU SELECTED WH~t 1~CI VG VICES, FACILITIES, AUTOMOTNE EQUIPMENT, i. PROFESSIONAL SERVICES ~ FUNERAL ARR ANG Services of Funeral DirectorlStaff EMENTS. Embalming, , Dressin ~ ~ 8. Casketing, ~osmo $1665.00 , 2. FACILITIES A . ND SERVICES $875.00 $290 00 ` Viewing (Visitation/Wake) , . Funeral Ceremony, ~ , 3. AUTOMOTIVE EQUIPMENT . $495.00 $495 00 Utility Vehicle for DC retrieval/Filing . , C. SPECIAL CHARGES Direct Cremation , $125.00 FUNERAL HOME SERVICE CHARGES ~ $320.00 SELECTED MERCHANDISE: ~ 54265 00 Solid Oak Rental Casket, . _ Acknowledgement ~ ~ ~ , . Register Book(s) ~ ~ ~ ~ $575.00 , _ Memorial folders ~ ~ $10.00 , THE COST OF OUR SERVICES E ~ ~ ~ THAT YOU HAVE SELECTED ~ , Qi7IPMENT' AND MERCHANDISE ~ $40.00 $75.00 Cash Advances ~ ~ ~ $4965.00 Certified Copies of the Death Certificate , Coroner Authorization fee , The Sentinel with Photo ~ ~ ~ ~ ~ TOTAL CASH ADVANCES AND SPECIAL•CHARGES • ~ ~ $12.00 $25.00 $99.53 • . Total $136.53 Total Cost , • • ~ $5]01.53 U a ro .,.{ U W N ro O b~ n N n ti a b~ N _a