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HomeMy WebLinkAbout09-21-121505610140 REV-1500 EX (°'_'°' OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 7 4 0 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date Of Birth MMDDYYYY 0 6 2 5 2 0 1 2 1 0 2 8 1 9 1 6 Decedent's Last Name Suffix Decedent's First Name MI M I N N I C H N E T T I E A (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 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number J A C Q U E L I N E A K E L L Y 7 1 7 5 4 1 5 5 5 0 REGISTER OF WILLS USE QNbY First lin f ddr e::~ rv ~ ~ e o a ess ~ ~ m ~ _, ' v r- J A N L B R O W N & A S S O C ~~ _:-~ tv Second line of address « ' ~ .. D~, ~"~ ' ~ 8 4 5 S I R T H O M A S C T S T E 1 2 ti 'Z7 n©-`~ ~ pi C ~ _ City or Post Office State ZIP Code D FLED N tV ~`'~ H A R R I S B U R G P A 1 7 1 0 9 ^~' Correspondent's a-mail address: JACKIEJLBCcD_VERIZON.NET Under penalties of perjury, I declare that I have examined this return, including arx:ompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complet D ration of eparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON ES L FILING RETURN DATE 9/20/2012 ADDRESS 240 GRAV L HILL RD NEWMANSTOWN PA 17073 SIGN TURE OF PR ARER OT ER TH N REPRESENTATIVE DATE 9/20/2012 A Ess 8 5 S R THOMAS CT STE 12 HARRISBURG PA 17109 PLEASE USE ORIGINAL FORM ONLY Side 7 1505610140 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number oecedent'sWame: NETTIE A• MINNICH RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 2. Stocks and Bonds (Schedule B) ...................................... 2. 1 2 2 3 8 1. 1 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 5. Cash, Bank De osits and Miscellaneous Personal Pro ) 1 7 9 6 6 6 . 6 1 p party (Schedule E ....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers ~ Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ................ 3 0 2 0 4 7, 7 1 ........... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ..... . 9• 2 6 5 1 1. 1 8 10. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 9 9 ( ) ....... ..... . 10. 2 3 7 3 • 4 2 11. Total Deductions (total Lines 9 and 10) ......................... ..... . 11. 2 8 8 8 4 . 6 0 12. Net Value of Estate (Line 8 minus Line 11) ...................... ..... . 12. 2 7 3 1 6 3 . 1 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................ ..... . 13. 2 7 3 1 6 . 3 1 14. Net Value Subject to Tax (Line 12 minus Line 13) ................ ..... . 14. 2 4 5 8 4 6 . 8 0 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.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .0 _ 0. 0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 2 4 5 8 4 6. 8 0 1 g, 3 6 8 7 7. 0 2 19. TAX DUE ......................................................19. 3 6 8 7 7. 0 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 150561D240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 12 0740 DECEDENTS NAME NETTIE A. MINNICH STREET ADDRESS 4905 E Trindle Road Ham den Townshi _ CITY STATE ZIP Mechanicsbur PA 17055 Tax Payments and Credits: ~• Tax Due (Page 2, Line 19) (1) 36,877.02 2. Credits/Payments A. Prior Payments B, Discount 1,843.85 Total Credits (A + B) (2) 1, 843.85 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 35,033.17 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 : ...................................................................... ^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^X c. retain a reversionary interest; or ................................................................................................ ^ ^X d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? ......... ^ Q 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 3 percent [72 P.S. §9116 (a) (1.1) (i)j. 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, unde Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NETTIE A. MINNICH 21 12 0740 All property jointly~owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. American Funds American Balanced Fund CI F-1 (BALFX); 999.41 shs @ $18.86/sh 18,848.87 2 American Funds American High Income Trust Fund CI F-1 (AHTFX); 19,239.94 1,774.9 shs @ $10.84/sh 3 American Funds Capital World Bond Fund CI F-1 (WBFFX); 1,161.72 shs @ $20.82/sh 24,187.01 4 American Funds Capital World Growth and Income Fund CI F-1 (CWGFX); 4,368.87 134.55 shs @ $32.47/sh 5 American Funds US Government Securities Fund CI F-1 (UGSFX); 19,581.09 1,344.86 shs @ $14.56/sh 6 American Funds Washington Mutual Investors Fund CI F-1 (WSHFX); 10,842.12 374.51 shs @ $28.95/sh 7 Federated GNMA Trust Institutional Shares (FGMAX); 2,201.15 shs @ $11.50/sh ~ 25,313.20 TOTAL (Also enter on line 2, Recapitulation) ~ 3 122 381 10 (If more space is needed, insert additional sheets of the same size) _. _ - REV-1508 EX+ (11-10) Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, 8~ MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: NETTIE A. MINNICH 21 12 0740 Indude the roceeds of litigation and the date the proceeds were received by the estate. All property ~oindy owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Fulton Bank Checking 3619-35548 13,491.96 2 Metro Bank Checking 0536572589 7,754.72 3 Liberty Bankers Life; Non-qualified Annuity A0000044558; Estate beneficiary 156,466.11 4 TransAmerica Financial Advisors Brokerage Account 08H-224225; cash balance 1,241.98 5 Country Meadows at Home; refund 701.25 6 Quantum Diagnostics; refund 10.59 TOTAL (Also enter on Line 5, Recapitulation) I S 179 666 61 If more space is needed, insert additional sheets of paper of the same size REV-1511 EX+ (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER NETTIE A. MINNICH 21 12 0740 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Heffner Funeral Chapel & Crematory 280.00 2 The Patriot-News; obituary 192.82 3 St Johns Cemetery Association 350.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Gerald E Stine 12,136.00 Street Address 240 Gravel Hill Road Cary Newmanstown State PA ZIP 17073 Year(s) Commission Paid: 2012 2, AttomeyFees: Jan L Brown &Associates 12,082.00 3. Family Exemption: (If decedents address is not the same as claimanrs, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: Cumberland County Register of Wills 485.50 5 Accountant Fees: Parks & Company 600.00 6. Tax Retum PreparerFees: 7. Cumberland Law Journal; legal advertising 75.00 8 The Patriot-News; legal advertising 164.96 9 Fulton Bank; service charges 43.75 10 TransAmerica Financial Advisors; advisory fees 101.15 TOTAL (Also enter on Line 9, Recapitulation) I $ 26.511.18 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER NETTIE A. MfNNICH 21 12 0740 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Country Meadows at Home 2,011.50 2 ~ Diamond Pharmacy 251.77 3 I West Shore EMS I 110.15 TOTAL (Also enter on Line 10, Recapitulation) I $ If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NETTIE A. MINNICH ~~ ~~ man 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 outrigh(spous;l distributions and transfers under Sec. 91116 a)) 1.2 .] 1. Gerald T Laubach & Theresa V Brown, friends Collateral (referred to as Ted Laubach & Terry Laubach in Will) 10% residue 907 Oak Hill Rd, Lewisberry, PA 17339 2 Charles B Reynolds and family, friend Collateral 406 Old Stage Rd, Lewisberry, PA 17339 30% residue 3 Gerald E Stine, nephew Collateral 240 Gravel Hill Rd, Newmanstown, PA 17073 50% residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Lisburn Community Fire Company 27,316.31 1800 Main Street Lisburn, Mechanicsburg, PA 17055 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 27 316.31 It more space is needed, use additional sheets of paper of the same size. r ..~ LAST WILL AND TESTAMENT c~ ~~~~ -~, T, ~~, ~ ~-,, ;~ -~- c~ ; ~ _. G,_~i - ~ ~ ~ --_ -__ r. Ste' _~~~: NETTIE A. MINNICH ° ` ' O c- =_~ ~} -o ~?~; c~ ~_ rri D `n,, I, NETTIE A. MINNICH, now domiciled in Cumberland County, Pennsylvania, declare his to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death on any property or interest in property, including taxes assessed on jointly held assets and nonprobate assets, shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. The tax shall be paid and allocated from my residuary estate before my residuary estate is divided into shares for my residuary beneficiaries. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article III I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath according to the following: A. TEN PERCENT (10%) to the LISBURN VOLUNTEER FIRE COMPANY, or its successors, to be used at its discretion. B. TEN PERCENT (10%) to my friends, TED LAUBACH and TERRY LAUBACH, or the survivor, of 907 Oak Hills Road, Lewisbeny, Pennsylvania, per stirpes. C. THIRTY PERCENT (30%) to CHARLES REYNOLDS and his FAMILY, of York County, Pennsylvaniay per stirpes. D. FIFTY PERCENT (50%) to my nephew, GERALD E. STINE, of Lebanon County, Pennsylvania, per stirpes. Article V I understand and direct that my life insurance, annuities, individual retirement accounts (IRAs), in trust for bank accounts and any other assets on which I may designate a beneficiary will pass to the beneficiaries that I have named and will not be controlled by the distribution provisions of -2- this Will. I also understand and direct that any assets I own jointly with another with rights of survivorship or a presumed rights of survivorship (whether the joint ownership was created before or after this Will) will pass to the surviving joint owner and distribution of such assets will not be controlled by the provisions of this Will. Article VI I nominate, constitute, and appoint GERALD E. STINE as Executor of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executor, I nominate, constitute and appoint LINDA R. STINE, of Lebanon County, Pennsylvania as successor Executrix of my Last Will and Testament. I direct that my Executor or successor Executrix be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. My Executor or successor Executrix shall receive reasonable compensation for services rendered to my estate. Article VII In addition to the powers conferred by law, I authorize my Executor and successor Executrix, in his/her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, -3- (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, (j) to file any qualified disclaimer I could have if living, and (k) to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services aze performed. IN WITNESS WHEREOF, I, NETTIE A. MINNICH, hereby set my hand to this my Last Will and Testament, on _ ~- ~~ 2010. ~-~~~ ~ f NETTIE A. MINNI H In our presence, the above-named NETTIE A. MINNICH signed this and declared this to be her Last Will and Testament and now at her request, in her presence, and in the presence of each other, we sign as witnesses. <' Address ` ~ ~ t~" ~' ;~ -4- I, NETTIE A. MINNICH, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by NETTIE A. MINNICH, the Testatrix on _ ~ - ! (} , 2010. .~L.c ~ otary ublic ~~ N TTIE A. M NN H NOTARIAL SEAL JACQUELINE A KELLY CITY OF HARRISBURGPDAUPHIN COUNTY My Commission Expires Doc 17, 2011 We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute this instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to betefore me ~' bYC~ tilC(,C`Y11,r5 and ~~5k~~ ~ ~ ~i.~~--~ witnesses, on ~!- ~~ , 2010. otar 'Public NOTARIAL SEAL JACQUELINE A KELLY Notary Public - $ - CITY OF HARRISBURG, DAUPHIN COUNTY My Commission Expires Dec 17, 201 1 Holdings by Investor Nettie A Minnich THEODORE JAMES BOMGARDNER Combined Account Portfolio 240 Gravel Hill Road Retirewise Financial Servives Inc Date: 06/25/2012 Newmanstown, PA 17073 819 Chestnut St Created: 07/10/2012 Lebanon, PA 17042 717-272-6886 Nettie A Minnich Acct Name:NETTIE A MINNICH GERALD E STINE POA 240 GRAVEL HILL RD NEWMANSTOWN PA 17073-8710 Acct No:08H224225 Acct Type: Power Of Attorney Rep. No:Q40 D ~ICAN FUNp5 AMER BAi;NC~ BALFX l~l}ENb A~~ f11V _ 95;41 't8:~6 ~ 18,$4$.87 AMERICAN FUNDS'CAPVIIORLD WBFFX FIXED INCOME AMERICAN 1,1fi1.72 20:82 24,187:01 BOND'F1 FUNDS AMERICAN HIGFI-INCOME TRUST- AF#TFX ~tXED INGC3ME" AMERICAN 1,774.90 10.84' 19,239'.94 F1 FUN47S BROKERAGE MONEY MARKET CASH OR BROKERAGE 1,241:98 1:00 1,241.98 EQUIVALENTS MONEY MARKET CAPITA! WQRLD ~Rt)WTFF'ANt} CWGFX EQIiITY 4. ~"iAN .„ 134:55 ''32:47 4,368.87. INCOME-F1 ~ . ,. ~`- FEDERATED GNMATRUST ' fGMAX EQUITY ' FEDERATEq 2,201:15 11,50` 25,313.20 SERVICES CORP' U.S. GOVERNMENT SE~UFfIT1ES UGSI=X EQUITY AM~ftIQAN 1,344.86 ' 14.56 19;581:09 FUND-Fi FliNb5 WASHINGTON MUTUAL INVESTORS WSHFX EQUITY AMERICAN 374.51. 28.95 10,842.12 FUND-F1 FUNDS i Account Total: $123,623.08 Investor Total: 5123,823.08 Incomplete H presented without accompanying disdosure pages Page 1 of 2