HomeMy WebLinkAbout09-21-12
1505611180
J REV-1500 EX(°2.,,, (F°
PA Depedment or Revenue pennsylvanla OFFICIAL USE ONLY
cev.n.neH,ov vevwue County Code Year File Numbe
Bureau otmdbidual Taxes ~
INHERITANCE TAX RETURN
PO BOX 280801 a `
Harrisbum, PA 17128.0801 RESIDENT DECEDENT UI ~ - ~ ~ ` I
ENTER DECEDENT INFORMATION BELOW
Social Severity Number Date of Death MMDDVYYY Date of Birth MMDDYYYY
12222011 03041929
Decedent's Last Name Suffix Decedent's First Name MI
ANTHONY NANCY T
(I} Applicable) Enter Survlvih® Spouse's In}onnatlon Below
Spouse's Last Name Suffer Spouse's First Namie MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF MALLS
FILL IN APPROPRIATE BO)QES BELOW
® i.Odginal Retum Q 2. Supplemental Return Q 3. Remainder Retum (Date of Death
Pdar to 12-13.82)
Q 4. Limned Estate Q 4a. Future Interest Compremise (date of 0 5. Federal Estate Tax Retum Required
death efler 12-12$2)
® 8. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Capy of VtfiIU (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (Date of Death Q '11. Election to Tax under Sec. 9113(A)
BeNJeen 12J1A1 and 1.1-98) (Attach Schedub O)
CORRESPONDENT-THIS SECTNIN MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL 7AXINFORMATION SXWLD BE DIRECTED U
Name Daytime Telephone
ROBERT G. FREY 7172435838 ,<_?
~
REGISTERO
5: SEO ~C'
7
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First Line of Address ~~ ~~ ~
a -~ ~; C'7
5 S. HANOVER ST. N '
S
d Li
f Add
'! ~
econ
ne o
ress
City or POSt Office State ZIP Code DATE FILED
CARLISLE PA 17013
Correspondent's eartail
under penenies of nerlurv. I r
FlLING
Y.CO
schedules and
OF
L 150561~r180
- / b - / Z
Side 1
1505611180 J
1 1505611280
REV-1500 EX (FI)
Decedent's Social Security Number
Dao,da~rsNam®: NANCY T ANTHONY
RECAPITULATION
1. Real Estate (Schedule A) ........................................ .. 1. N 0 N F_
2. Stocks and Bonds (Schedule B) ................................... .. 2. N 0 N I_
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .. 3. N 0 N E:
4. Mortgages and Notes Receivable (Schedule D) ....................... .. 4. N 0 N E:
5. Cash, Bank Deposits and Miscellaneous Personal Property (SchedWe E) .. .. 5. 38 31.0 D
6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ... 6
N 0 N E
..
7. Inter-Uvos Transfers $ Miscellaneous Non-Probate Property ..
.
.
(Schedule G) ®Separate Billing Requested
..... .. 7 117533 . DD
8. Total Gross Asseps (total Lines 1 throuoh 7) 8 121364 . DD
9. Funeral Expenses alnd Administrstive Costs (Schedule H) ............... .. 9. 210 D . D 0
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... ..10. 5 D 3 . D D
11. Total Deductlons (kotal Lines 9 and 10) ............................ .. 11. 26 D 3 . D 0
12. Net Value of Estatb (Line 8 minus Une 11) .......................... .. 12. 118 761
0 D
13. Charitable and Govgqrnmental BequestslSee 9113 Trusts for which .
an election to tax ha§ not been made (Schedule J) ..................... . 13. 0 . D D
14. Net Value Su eM t Tax Line 12 minus Line 13 ..................... . 14. 118 7 61
D D
TAX CALCULATION - EE INSTRUCTIONS FOR APPLICABLE RATES .
15. Amount of Line 14 taxable at
the spousal tax rate, oA
transfers under Sec. 9~ 16
(a)(1.2)x.0 0
16. AmauM of Line 14 taxable 15. D. DO
at lineal rateX.o 45 118761. DD 1s. 5344
25
17. Amount of Line 14 .
taxable at sibling rate ~ . 12
18. Amount of Line 14 taxable 17. 0 . D D
at collateral rate X .15 18. 0. 0 D
1s. raxouE ........................................................ 1s. 5344.25
20. FILL IN THE BOX IF ;YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L, 150561180 15D5611280
REV•1500 EX (Fl) Page 3
Decedent's Complete Address
.,, ,,,
File Number
17z-2s-seas
DECEDENT'S NAME VVV
NANCYTANTHONY
STREET ADDRESS
1810 LAMBS GAP ROAD
cITY
STATE ZIP
MECHANICSBURG PA 17050
1 ax rayments and CrP'dits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount '~.
3. Interest Total Credits (A+ B )
4. If Line 2 is greater than Line 1 Line 3, enter the difference. This is the OVERPAYMENT.
Fill In box on Page 2, Llne 20~o request a refund.
5. If Line 1 + Line 3 is greater than) Line 2, enter the diRerence. This is the TAX DUE
(1) 5344 25
(2) 0 00
(3)
(4) 0 00
(5) 5344 25
check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER T
E FOLLOWING QUESTIONS BY PLACING AN "X" IN THE ,:.. ..::
AP PROPRIAT E BLOCKS
1. Did decedent make a t osier and:
b
ret
i
th
n me of the property transferred ..................... Yes No
.
a
n
e
M to dry
9 ignate who shall use the property transferred or its income .................................. .........
d
i interest ............................................ .
. rece
ve the romise
P r life of either payments, benefits or care? ........................................................... .........
~
without receivin ade u
9 9
t c. 12, 1932, did decedent transfer property within one year of death
to consideration?
3. D d deceden
own an "in ...................................................................................................
trust for' orpayable-upon-death bank acco
t ......... ^
4. Did decedent own a
n
i un
or security at his or her death? ...
ividual retirement account
annuity or oth ......... ~ ~+
r
y
contains a benefiaa d ,
er non•probate property, which
srgnanon~
..
IF THE ANSWER TO ANY OF 1 GiE ABOVE QUESTIONS IS YES
YOU MUST CO
,, ,., ,
MPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1y94, and before Jan. 1, 1995, the tax rate imposed on the~net value of tr"insfere to or for the use ~of the suvving ~~~
spouse is 3 percent [72 P.S. §9116 (a). (1.1) (i)].
For dates of death on or after Jan. 1, 1;3995, the tax rate imposed on the net value of transfers to or for the use of the survivirg spouse is 0 percent
p2 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a trensfer to a surviving spouse from tax, and the statutory requirements for disclosure of
assets and filing a tax return are still adpliceble even'rf the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 200:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at deathh to or for the use of a natural parent, an
adoptive parent or a stepparem of tF~e child is 0 percent (72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value 0f transfers to or for the use of the decedenCs lineal beneficiaries is 4.5 percent, except as noted in [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 decedem, wheither by blood or adoption.
REV-1508 EX+ (11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, 8r MISC.
DEPARTMEM Of REVENUE
INHERITANCETA%RETURN PERSONAL PROPERTY
RESIDENT DECEDEM
1 elude the proceeds of I@igation and the date the proceeds were received by the estate. J~J
All ropeRy Jointly owned with right of survivorship rrwst be disclosed on Schedule F.
ITC~I
1 Personal property sold at auction
2 Personal property retained by heirs
3 Americhoice Cre~JR Union Account
I
TOTAL (Also enter on line 5, Recapitulation) S
I If more space is needed, use addRional sheets of paper of the same sire.
33
1, 500
2,298
3, 831
REV-1510 EX+ (pa.gg~
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
ITEM
JMBE
1.
2.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
This schedules must bs completed and filed Rthe answerto any of
DE CRIPTION OF PROPERTY
INCLUDE THE NAME OF TIDE TRANSFEREE. TNEIR RELATpN5111F TO OECEDENTAND
T1E MTE OF TRANSFER. ATTACH A CORY OF TIE DEED PoR REAL ESTATE.
Jity Investments B kerage Account. Date of Death valuati
;hed. Account wa~ transferred in equal shares to children.
lily Investments IRA Date of Death valuation attached
'on Wang, sole berheificiary, listed No. 1 on Schedule J
names and addresses of children are shown on Schedule J
questions 1 through 4 on page three of the REV•75g0 is yes.
DATE OF DEATH ~% OF DECD'S EXCLUSION TAXABLE
VALUE OF ASSET INTEREST "`"°°"~"' VALUE
on 97,633 100.00% p 97
19,900 100.00% n ,n
If r}tore space is needed, use additional sheets of paper of the samfusize.
0
nnn
REV-1511 EX + (10-09)
pennsylvania
DEPARTMENT OF REWFNUE
INHERITANCE TAX RETURN
RESIDEM DECEDEM
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Nancy T Anthony
21 11-1385
Decedent's debts must be reported on Schedule I.
A. FUNERAL EXPFENSES:
1. Cremation
2. Gingrich Funera' Home, memorial engraving
B. ADMINISTRATIVE COSTS:
1 ~ Personal Representative Commissions:
Name(s) of bersonal Representative(s)
Sheet Addr4se
Cdy - State
Veer(s) Con mission Paid:
2. Attorney Feas: ~~
3. I Fatuity Exemptioh: (If decedent's address is not the same as claimant's, attach ezplanation.)
Claimant I
ZIP
City
State ZIP
Relationship b(Claimant to Decedent
4. Probate Feed:
5. Accountant F'aes:
6. Taz Return P~eparer Fees:
7. I
1, 545
225
330
I
~~ TOTAL (Also enter on Llne 9 Recapdulatlon) S 2 100
~ If more space Is needed, use addlborlal sheets of paper of the same size.
1
REV-1512IXi (12.08)
pennsylvania SCHEDULE I
OEPARTMEM Of REVENUE
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESIDENT DECEDENT MORTGAGE LIABILITIES 8 LIENS
ESTATE OF
Nancy T Anthony FILE NUMBER
21-11-1386
Repon debts ineum~l by the decedent prkr b death that remained unpaid at the dab of daeth, Includlnp unreimbulsed medkal expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1.
Final medical bills:
2. Quantum Imaging
3. McGlaughlin
4. Blue Mountain Arhastesia
5. Carlisle Medical Group
6. Carlisle HMA Physicians
7. Carlisle Medical F~athologists
8. West Shore Pathology
9. quantum Imaging]
TOTAL (Also enter on Line 10, Recapitulation) S
If more space is needed, inseh additional sheets o(the same s¢e.
137
31
18
19
72
135
77
14
503
REV-1513 EX+ (OU~10)
Pennsylvania
SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDEM DECEDEM
ESTATE OF: FILE NUMBER:
Nanc T Anthon 21-11-1385
NUMBER
NAME AND' DRESS aF PERSON(S) RECEIVING PROPERTY RELATIONShIIPTO DECEDENT
Do Not Llst Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBU ONS ]InGude outfight spousal distributions and transfers under
Sec. 9116 (a) (12).]
1 Sharon Wang
1187 Greenfield Driv9, Mechanicsburg, PA 17055 daughter 0.25
2 Richard H. Anthony, Jr.
707 Range End Roadj, Dillsburg, PA 17019 son 0.25
3 John M. Anthony
373 Rupp Road, Ellio~tsburg, PA 17024 son 0.25
4. Ronald D. Anthony
c/o John Anthony 3731 Rupp Road, Elliottsburg, PA 17024 son 0.25
ENTER DOLLAF
NON-TAXABLE
A. SPOUSAL
FOR DISTRIBUTIONS SHOWN A80VE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
UNDER SECTION 9173 FOR WHICH AN ELECTION 70 TAX IS NOT TAN:EN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1
I
TOTAL OF PART 11- EN~ER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER :iHEET. S
0.00
If nwre space is needed, use additional sheets of paper at the same size.
LAST WILL AND TESTAMENT
NA(VCY T. ANTN~NY
I, NANC1f T. ANTHONY, of Hampden Township, Cumberland
County, Pennsy~rania, being of sound and disposing mind, memory and
understanding, `~' hereby make, publish and declare this to be my Last Will and
Testament, here~y revoking any and all Wills and Codicils previously made by me at
any time heretofore.
F~,,~: I hereby direct that my personal representative(s), hereinafter
named, to pay all of my just debts, not barred by any statute of limitations, as well as
my funeral and testamentary expenses, including Pennsylvania Inheritance Taxes, as
soon after my demise as may be practicable.
I hereby give, devise and bequeath all the rest, residue and
remainder of my estate, equaly and per capita, among my four children:
Rict}ard H. Anthony Jr.,
Sha~on Anthony Wang,
John M. Anthony, and
Ron~ld D. Anthony
THIRD: fie it known that I
r~
_Q _. <?;
;;~ - ;-
,
n ~~
~, m w
~>~:-~ _
~
_, ~ T
~
desire to be cremated and re
h
r ` " `
~
quest t
~
8 -
be no maudim funeral or memorial services conducted following my demise.
,~QURTH: 1 hereby nomk~ete, oor>sti~e and appoirx my daughter
Sharon A Wa
pertorrr~ng su
Anthorry, as e:
ceases to act,
ODre and
as Executrbt of this. my Last Wiq and Testament M the event thai Sharon
fails to qusstfy, s to aet, or for some reason is incapable of
task, 1 then rtominste, corstilule atut appoint my son, John Mlclrael
M ihB event thal John prede~y~g me. fails to qualify,
for some reason ~ bx;apable d performing such task, 1 nominate.
my son. Ronald D., as exeaetor.
The above raened persons shah Trot be required to past bond
or surety in
persorrai
arty other jurisdredon far fakhful cornptiance d Mye duties as
of my estate.
IN WITNESS WFIEREOF,1 Hereby set my hand and seal and
dedare this to my, LAST Wlll AND TESTAMENT, consisting d this and one
dher page. id//erd#ied by ny-. s_,g~i r4ature, dated on this,
~~ ~l~~Yd ___~Lr.-V1.~ __~~.21~J .
Nart~r T.
d tins
BE IT K ,that at the request d the testatrix, Yre have witnessed the signing
. h her presence. and in the presence of each other.
-- (Address). o7p.S~r+i~ 6i7m 0r. !1'lpchcarialou'q P~
y SNarpt _ __ __ l C
(Address) o?U_~i/t, n_~_G r r P h l~r . _[{'ircf!ig~i~ ria,.,-y 1°~
e tk.la~! . l 7oSC
COMMONWEALT~•I OF PENNSYLVANIA )
COUNTY OF CUN'~l3ERLANR )
3ec/Cy SK~rpe
1 w NAN' Y T~ ANTa ONY, G-~' and
the Testatrix, itre wih~esses, respectively,
whose names are IgnBd b The atlaCfled and f(~egoing instrument, being first duly
swum, do hereby are to the iu~dersigned authority that the Testatrix signed and
executed the i as her Last WiN and Testament. Furthermore, she signed and
executed it wiM' . as a tree anti voturuary atx, for the purposes therein expressed.
Each of us, as in the presence and hearing of the Teeffitrbr and each other.
signetl The WNI as and that to the hest of our knowledge and sight. the
Teatatrot, v1Ia.R at tlnt6 elgMeen (1 ~ Or mdre years Of agB, Of SOUnd arld disposing
mind. memory understandug ~p~er no oun~t4aint. duress or undixs infkience.
i
W ITNEySg
(Testatrix)
( ~--t ~-~C~_--`
ESS
swum to and admowtedged before me by:
The
on this, the
NANCY T. ANTHO Y, The T and try
and - -
Clpyr~t (k.Y1a.rF
aft whom personally appeared before me. the utdersigned affioer,
'~ day of J ur ~e Zoos
I~~ ? '~
% ~ f
NOTARY PUBLJC
• YYI~f~'h ~ ,JO ~ .
My Commission
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Elizabeth K. Hull, Notary PutNk
SilverSprirg Twp., Clxnberiantl County
My Commission Expires Mar. 20.2010
Member, Pennsylvania A:saociation of Notaries
~Fidel~iitK
la1 Y'it ral/ rs
July 09, 2012
SHARON A WANGi
PO BOX 74
BOILING SPRGS, ~A 17007-0074
Deaz Shazon A
We are responding to your request for information regazding Nancy T Anthony's Fidelity Investments
account(s). Please no a there is a discrepancy between the social security number listed on the application
versus the one repo in out records.
All information in th enclosed valuation report(s) is (aze) based on assets in the :Fidelity account(s) as of
the date indicated on a report(s). Valuation information is provided through a third party valuation
service provider. Fid ity does not warranty the accuracy of this information for stny particulaz purpose,
nor does Fidelity pro ide legal or tax advice. Consult with an attorney or tax professional regazding any
specific legal or tax s' lion.
We hope this informs 'on is helpful. If you have any questions about account holdings or need
instmctions on how t transfer the ownership of the accounts, please visit us at Fidelity.com and seazch
under "Change Acco t Registration" or call us at 800-544-0003. Fidelity Inheritor Services
Representatives area ailable Monday through Friday from 8:00 a.m. to 6:30 p.m. Eastern time.
Sincerely,
Carla Goins
Cazla Goins
Fidelity Investments f~ccount Re-Registraton Services Representative
Our file; W312471-212
I.GLTR2JDDODCNfM 531 98.1.0
III
B erage Services provided by Fideaty Brokerage Services LLC Member NYSE, SPIC
Clearing custody and settlemrnt services by Natloaal Finsaaal Services LLC Member NYSE, SPIC
P.O. Box 770001, Cincinnati, OH 45277-0034
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