HomeMy WebLinkAbout10-15-12 1505610140
REV-1500 EX (01-10)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 1 1 0 7 7
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY
1 7 7 2 4 7 2 2 0 1 0 0 1 2 0 1 1 1 1 0 5 1 9 3 0
Decedent's Last Name Suffix Decedent's First Name MI
K E E F E R CA T H E R I N E M
(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
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
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)
0
0 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 Teleph~e Number r°_~
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J O E L R. Z U L L I N G E R 7 1 7~ 4 6'~} 2 -,~ ~~~'
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REGISTE~~ LS USE LY <_ ~ r=
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First line of address ~~ ~:
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1 4 NORTH M A I N STREET ~~ ,.,;, ~-~~ fir;
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Second line of address ~' GIB ~ Q
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S U I T E 2 0 0
City or Post Office State ZIP Code DATE FILED
C H A M B E R S B UR G P A 1 7 2 0 1
Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and cgmplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF P .SON RESPO SIBL R F ING ~tETURN D 'fE, ~~
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ADDRESS 1 - f p
210 WALNUT DA ROAD SHIPPENSBURG PA 17257
SIG E O P R~~ ~ KHAN RfPRESENTATNE DAT
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AD E S
1„ ORTH M~41 STREE~f UITE 200 CHAMBERSBURG PA 17201
PLEASE USE ORIGINAL FORM ONLY
L 1505610140
Side 1
1505610140
J h~u
1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: CATHERINE M. KEEPER 1 7 7 2 4 7 2 2 0
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1
2. Stocks and Bonds (Schedule B) ...................................... 2• •
3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. •
. 4. Mortgages and Notes Receivable (Schedule D) :..................... •.... 4. •
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 7 6 6 7 8. 3 9
6. Jointly Owned Property (Schedule F} ^ Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ....... 7.
8. Total Gross Assets {total Lines 1 through 7) ........................... 8. 7 6 6 7 8 . 3 9
9. Funeral Ex enses and Administrative Costs Schedule H
P ( ) .................. 9. 4 3 1 9. 6 2
10. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I
9 9 { ) ............. 10. 1 3 0 2 8• 2 3
11. Total Deductions (total Lines 9 and 10) ............................... 11. 1 7 3 4 7. 8 5
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12• 5 9 3 3 0. 5 4
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 9 3 3 0. 5 4
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 0 0 0 1 5.
16. Amount of dine 14 taxable
5 9 3 3 0
5
4
at lineal rate X .045 . 16.
17. Amount of Line 14 taxable 0 0 0 17
at sibling rate X .12 .
18. Amount of Line 14 taxable 0 0 0
at collateral rate X .15 18.
19. TAX DUE .................... ........................... ..... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0. 0 0
2 6 6 9. 8 7
0. 0 0
0. 0 0
2 6 6 9. 8 7
0
Side 2
1505610240 1505610240 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 11 1077
DECEDENTS NAME
CATHERINE M. KEEPER
STREET ADDRESS
201 East Burd Street, A t. 3066
CITY STATE ~ ZIP
Shippensburg ~ PA ~j 17257
Tax Payments and Credits:
~ ~ Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Paymenfs 2, 778.75
B. Discount 146.25
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) 2,669.87
Total Credits (A + B) (2) 2,925.00
(3)
(4) 255.13
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
0.00
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; .......................... ..... ^
c. retain a reversionary interest; or ........................................................................................... ..... ^ 0
d. receive the promise for life of either payments, benefits or care? .................................................. ..... ^ 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................................................. ..... ^ ^X
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? .... ..... ^ 0
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 fax return are sti11 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 who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 ~.X+ (11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
CATHERINE M. KEEPER 21 11 1077
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Checking Account #305316, Orrstown Bank, including interest accrued to 4,991.53
date of death
2. Proceeds from sale of decedent's Beistle Company stock, sold prior to death but 71,192.00
received after death
3. Episcopal Square, refunds 162.91
4. Highmark, refund 188.05
5. CenturyLink, refund 7.16
6. Penn National Insurance, refund 8.00
7. Menno-Haven, refund 23.58
8. Health Network Laboratories, refund 68.16
9. PA Department of Revenue, refund 37.00
TOTAL (Also enter on Line 5, Recapitulation) ~ $ 76,678.39
If more space is needed, insert additional sheets of paper of the same size
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
CATHERINE M. KEEPER 21 11 1077
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name{s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
2. Attorney Fees: Joel R. Zullinger 3,500.00
3, Fatuity Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: Letters-30.00; wi1115.00; JCS fee-23.50; automation-5.00; renunciation-5.00; 281.50
short certificates-8.00; filing return-15.00; additional probate fee-180.00
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. Cathy Allen, mileage for estate administration
8. VaporJet, fee to clean carpet in decedent's rental unit
9. Darlene M. Kelly, CPA, fee for preparation of final life tax returns
TOTAL (Also enter on Line 9, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size.
270.20
87.92
180.00
319.62
REV-1512 ,EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
CATHERINE M. KEEPER _21 11 1077
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. Health Network Laboratories, balance due on account 68.16
2. Omnicare, balance due on~account ~ ~ ~ 114.62
3. Menno-Haven, Inc., balance due on account 5,797.17
4. South Mountain Volunteer Fire Company, balance due 105.00
on account for ambulance transport
5. WSEMS, balance due for ambulance transport 503.28
6. U.S. Treasury, balance due on individual income tax return 4,360.00
for 2011
7. PA Department of Revenue, balance due on individual income tax return 2,080.00
for 2011
TOTAL (Also enter on Line 10, Recapitulation) I $ 13,028.23
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CATHERINE M. KEEPER ~1 11 1n77
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 outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Cathy R. Allen Lineal
210 Walnut Dale Road 50% of residue
Shippensburg, PA 17257
2. Wanda K. Koontz Lineal
309 N. Fayette Street 50% of residue
Shippensburg, PA 17257
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 TAXIS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
SCHEDULE J
BENEFICIARIES
If more space is needed, use additional sheets of paper of the same size.
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I Catherine M. Keefer, presently residing at 201 East Burd Street, ~partment
306, Shippensburg, Cumberland County, Pennsylvania 17257, being of sound mind, memory and
disposition, do hereby make, publish and declare this my Last ~ Will and Testament, hereby
revoking and making void all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and
funeral expenses as soon as inay be convenient after my decease.
SECO?*TD. I give, devise and bea~aeath all my estate, real, personal and mixed,
whatsoever and wheresoever situate, to lny beloved daughters, WANDA K. KOONTZ and
CATHY R. ALLEN, in equal shares, on a per stirpes distribution basis, provided that they
survive me by a period of sixty (60) days.
THIRD. I nominate, constitute and appoint my daughters, WANDA K.
KOONTZ, presently residing at 309 North Fayette Street, Shippensburg, Pennsylvania 17257,
and CATHY R. ALLEN, presently residing at 495 Mainsville Road, Shippensburg,
Pennsylvania 17257, or the survivor thereof, to be the Co-Executrices of this my Last Will and
Testament.
FOURTH. I direct that my personal representative(s) shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
FIFTH. I direct my Co-Executrices to retain the services of JERRY A. WEIGLE,
ESQUIRE, with offices located at 126 East King Street, Shippensburg, Pennsylvania 17257, with
respect to the settlement of my estate due to his familiarity with my affairs.
IN WITNESS WHEREOF, I, Catherine M. Keefer, have hereunto set my hand da
seal to this my Last Will and Testament, written on one (1) page, this ~ ~ y
of ~ ~ ~..~'~ , 2003.
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d declared by her to
This instrument was by the Testatrix, on the date hereof, signed, published arl
be her Last Will and Testament, in our presence, who at her request and in the presence of each
other, we believing her to be of sound and disposing mind and memory, have hereunto
subscribed our names as witnesses.
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COMMONWEALTH OF PENNSYLVANIA SS
COUNTY OF CUMBERLAND
I Catherine M. Keefer, the person whose name is signed to the foregoing instrument, ed the
been duly qualified according to law, do hereby acknowledge that I signed and execut
' strument as m Last Will; that I signed it willingly; and that I signed it as my free and
in y
voluntary act for the purposes therein expressed.
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Sworn or affirmed to and acknowledged before
t - Testat '
me by Catherine M. Keefer,
~ day of ~' 003.
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NOTARIAL SEAL
Je~y~i A. Weigle, Notary Public
Shippensburg, ~A Cumberland County
~Itv Commis5ion_Expires October 7, 20Qfi
COMMON `SEAL T ~ OF rE~~T~dSYL ~T~,~~ZiA
SS
COUNTY OF CUMBERLAND
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~rzd ,%~ ~~~%r'~f/~'~~- ~ ~~-~`~~,~;~f~~'~~P ~ ,the witnesses whose names are signed to
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the foregoing instrument, being duly qualified according to law, do depose and say that we were
present and sa~~v Catherine M. Keefer, the Testatrix, sign and execute the instrument as her Last
Will; that she signed willingly and that she executed it as her free and voluntary act for the
purposes therein expressed; that. each of :zs in the heaz-~~~g and sight of the Testatrix. signed the
will as witnesses; and that to the best of our knotiuledge the Testatrix was at the time eighteen
(18) or more years of age and of sound mind and under no constraint or undue influence.
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Sworn or aff need to and subscribed before me
by a t~c~~c4c r~ 1't'~ =~
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and ~~~~~~---
w~ es s, this ~ day of ~~ ~ ~m3.
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NOTAt~`lAl.. SEAL
Jerry A. Weigle, Notary Public
Shippensburg, PP. Cumberland County
My Commission Eacpires October 7, 2x06
October 20, 2011
Law Offices ofZullinger--Davis
Joel R. Zullinger
14 North Main Street, Suite 200
Chambersburg, PA 17201
Fax: 264-1884
Re: Estate of Catherine M. Keefer
Social Security Number 177-24-7220
Date of Death 10/1/l l -
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUI~TT WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account No.-
Account Type-
Date Opened-
Date Closed-
Joint Account (name/date)-
B alance-
Accrued Interest-
305316
50+ Interest Checking
6/1 /73
10/14/11
No
$4,991.50
$0.03
Best Regards,
. f~
R. Worthington
Deposit Processing Clerk
Rer.eived Time Or.t- ~(l. 1~~(I~PM
2695 Philadelphia Avenue
Chambersburg, PA 17201
'i.888.ORRSTOWN
an.r<s~raa~a e~s~o~c~mceora~ r~t-atrvo-ty
_ Vi~lf~~l UW ~l
BANK -
A Ts-adition of Exce~le~xce -
cnwoe~cesoe
ZULLINGER-DAMS
PROFESSIONAL CORPORATfON
JOEL R. ZULLINGER
jzullin ernzullin~er-davis com
14 North Main Street, Suite 200
Chambersburg, PA 17201
717-264-6029
717-264-1884 (FAX)
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P~ 17013
Dear Register:
RE: Estate of Catherine M. Keefer
File No. 21-11-1077
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Enclosed for filing in your office are an original and one copy of the Pennsylvania
Inheritance Tax Return for the above estate, along with check in the amount of $195.00 for
filing fee and additional probate fee. There is no additional inheritance tax due with the
filing as the prepayment exceeded the tax due on the return. Please address any questions
to my Chambersburg office. Thank you.
Very truly yours,
~~ , ~ ~
~'' Jo R. ullin~er ~`
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Encls.
SUZANNE M. TRINH HAMILTON C. DAVIS
strinhna,zullin~er-davis.com hdavis(a~zullin~er-davis.com
20 East Burd Street, P.O. Box 40
Shippensburg, PA 17257
717-532-5713
717-530-5222 (FAX)
October 12, 2012
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