HomeMy WebLinkAbout09-26-121505610140
REV-1500 EX (01-10)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box 28oso1 INHERITANCE TAX RETURN •~ v~~
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2
ENTER DECEDENT INFORMATION BELOW
Soci I Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
r_ 2 1 0 0 5 1 9 4 2
Decedent's Last Name Suffix Decedent's First Name MI
M A R T I N R A Y M O N D G
(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)
OX 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 TO:
Name Daytime Telephone Number
R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3
First line of address
I R W I N ~
Second line of address
6 0 W E S T
City or Post Office
C A R L I S L E
M c K N I G H T P C-
P O M F R E T S T R E E T
State ZIP Code
REGISTER O
WILLS USE ONLY
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Correspondent's a-mail address:
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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 RSON RESPONSIBLE FOR F ING RETURN D TE
-~ <i L} / i
ADDRES ,r
60 WEST :.PO ~F T BEET CARLISLE PA 17013
SIGNAT~R~E°CSF PRE : RER~i'HE~.~FfiAN REPRESENTATIVE DATEn ,'_ / ,
.I 4 '
60 WEST POMFRET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
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1505610140 1505610140 J
J
1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: R A Y M O N D G• MARTIN 1 9 1 2 8 2 5 8 8
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 and Notes Receivable (Schedule D) ....................... ... 4. •
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 3 1 8 1 6 . 4 6
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. 3 1 8 1 6 . 4 6
9. Funeral Expenses and Administrative Costs (Schedule H) ......... ......... 9• 7 7 8 4 . 5 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ......... 10. 2 0 0 3 5 2 . 3 0
11. Total Deductions (total Lines 9 and 10) .................. .... ......... 11. 2 0 8 1 3 6. 8 0
12. Net Value of Estate (Line 8 minus Line 11) ............... .... ......... 12. - 1 7 6 3 2 D . 3 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for whi ch
an election to tax has not been made (Schedule J) ......... .... ......... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ......... .... ......... 14. - 1 7 6 3 2 0 . 3 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 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .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 0 ~ ~ 18. 0. 0 0
19. TAX DUE ........................................ ..... ........ .19. 0 • 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505610240 1505610240 J
REV-1500' EX Page 3
Decedent's Complete Address:
File Number
21 12 0689
DECEDENT'S NAME
RAYMOND G. MARTIN
STREET ADDRESS
940 WALNUT BOTTOM ROAD
CITY STATE ZIP
CARLISLE PA 17015
Tax Payments and Credits:
~ ~ Tax Due (Page 2, Line 19)
2. CreditslPayments
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
0.00
Total Credits (A + B) (2) 0.00
(3)
(4) 0.00
(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; ............................... ^ Q
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" or payable-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? .................................................................................................. ^ 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 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, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-150a EX+ (11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, ~ MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
RAYMOND G. MARTIN 21 12 0689
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. PRINCIPAL FINANCIAL GROUP -ANNUITY CONTRACT NO. 5-18628 31,816.46
BENEFICIARY: THE ESTATE OF RAYMOND MARTIN
TOTAL (Also enter on Line 5, Recapitulation) I $ 31, 816.46
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
RAYMOND G. MARTIN 21 12 0689
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. RICE MEMORIAL WORKS 4,022.00
B.
1.
2.
3.
4
5
6
7.
8
9
City CARLISLE State PA ZIP 17013
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s) ROGER B. I RWI N
Street Address 60 WEST POMFRET STREET
Year(s) Commission Paid:
Attorney Fees: IRWIN & McKNIGHT, P.C.
Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
ZIP
Probate Fees: REGISTER OF WILLS
Accountant Fees:
Tax Return Preparer Fees:
REGISTER OF WILLS -FILING FEE
REGISTER OF WILLS -ADDITIONAL PROBATE
NOTARY
1,500.00
2,100.00
97.50
15.00
45.00
5.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 7,784.50
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
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ca i H i r yr FILE NUMBER
RAYMOND G. MARTIN 21 12 0689
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. DPW CLAIM -CIS #720147289
200, 352.30
TOTAL (Also enter on Line 10, Recapitulation) I $ 200, 352.30
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
FILE NUMBER:
RAYMON D G. MARTIN 21 12 0689
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. DENISE E. WILSON Collateral
2528 SHERMANS VALLEY ROAD REMAINDER
ELLIOTTSBURG, PA 17024
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
It more space Is needed, use adoltlonal sheets of paper of the same size.
LAST WILL AHD TESTAMENT
I, RAYMOND G. MARTIN, of Carlisle, Cumberland County, Pennsylvania 17013, do hereby
make, publish and declare this to be my last will and testament, hereby revoking all wills
heretofore made by me.
1. I direct my personal representative to pay all of my debts, funeral and administrative
expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed
or payable by reason of my death and interest and penalties thereon with respect to all property,
whether or not such property passes under this Will, shall be paid by my personal
representative out of my estate.
2. I authorize and empower my personal representative to sell any realty and/or personalty
owned by me at my death and not specifically devised or bequeathed herein, at public or private
sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple,
as I could do if living. My representative is authorized and empowered to engage in any
business in which I may be engaged at my death, for such period of time after my death as
seems expedient to said representative.
3. I give, devise and bequeath all of my estate of whatever nature and wherever situate to
DENISE E. WILSON, or if she is deceased, then to her children, Brittany J. Wilson and Tyler C.
Wilson, share and share alike.
4. If any of my beneficiaries is under the age of twenty-one (21) years, then my estate I
give, devise and bequeath to be held in trust by the hereinafter mentioned trustee according to
the following terms and conditions:
The trustee, as well as my representative, is hereby authorized to retain, unconverted, any
property, real or personal, that I may own at my death and shall be under no duty to convert it
into legal investments. The trustee shall have the power and authority to sell, transfer, convey,
invest and reinvest and to pay over the net income of the trust property, to or for the use of such
beneficiaries or to accumulate it in the sole discretion of the trustee. The trustee is also
authorized and empowered to pay over to, or for the use and benefit of such beneficiaries such
portion of or all of the principal of the trust estate, as in the trustee's sole discretion seems
proper for their support, maintenance, education, or medical care. My primary object is to
insure the support, maintenance, education and medical care of such beneficiaries until the
youngest beneficiary reaches the age of twenty-one (21) years. When the youngest beneficiary
reaches the age of twenty-one (21) years, then whatever remains of income or principal of the
trust estate shall be distributed to such beneficiaries, share and share alike, the child or children
of any deceased beneficiary taking the share their parent would have taken if living and subject
to the same-trust provisions as are provided herein.
5. I nominate and appoint Denise Wilson to be the personal representative of my estate, to
serve without bond.
6. I appoint Orrstown Bank, its successors or assigns, to be the trustee of any trust
established pursuant to this will.
7. I suggest that my personal representative retain the services of Harold S. Irwin, III,
Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~1=~' day of March, 2008.
v
-~' (SEAL)
YMON G. MARTIN
Signed, sealed, published and declared by the above-named person as and for a last will and
testament, in our presence, who at said person's request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
~~ h-
ACKNOWLEDGMENT AND AFFIDAVIT
WE, RAYMOND G. MARTIN,-SARAH A. HARDESTY and KATHRYN M. MULLEN, the
testator and witnesses respectively, whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that the testator signed and
executed the instrument as his last will and that he had signed willingly, and that he executed it
as his free and voluntary act for the purpose herein expressed, and that each of the witnesses,
in the presence and hearing of the testator, signed the will as a witness and that to the best of
their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and
under no constraint or undue influence.
~~-a ~. ~n
RAYM ND G. MARTIN
SA .HARDE
Y~t-~~
KA H . MULLEN
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
:ss:
Subscribed, sworn to and acknowledged before me by RAYMOND G. MARTIN, the testator
herein, and subscribed and sworn to before me by SARAH A. HARDESTY and KATHRYN M.
MULLEN, witnesses, this ~ day of March 2008
{'BNfl_NONWEALTH OF PENriSYL.VAIVIA
,'~ ~!OTARIAL sN ~ ~blic Notary Public
~tarold S. l~um lii, Fsq,
O~li~lo, Cumberland County
oot~i~eion ex Tres Februa<y 06, 2011
~.
Financial
Group
September 21, 2012
ESTATE OF R G MARTIN
ATTN: ROGER IRWIN
60 WEST POMFRET STREET
CARLISLE, PA 17013
RE Crescent Plastics, Inc. Employees Retirement Plan
Cresline Plastics Pipe Company
Annuity Contract No: 5-18628
Dear Mr. Irwin:
sl 'Cs4vn u~,.~`
Rl~~tlf4 ~ tVic~(iVl~ H'
~_fi;~'~I r)r ACES
The enclosed check for $31,816.46 represents the full benefit payable to the Estate of Raymond
Martin, from the above named pension plan. This amount represents the death benefit of
$35,351.62, minus $3,535.16 withheld for income taxes.
We'll report this payment to the Internal Revenue Service and send you a 1099-R Form next
January. Please let us know of any address changes or incorrect data before December 31St so we
can mail your 1099-R form on time.
Sincerely,
Daniel Blevins
Client Service Manager II
Retirement and Investor Services
Phone (800) 543-4015
Fax (866) 704-3481
Enclosure
Insurance products and plan administrative services are provided by Principal Life Insurance Company, a member of the
Principal Financial Group®, Des Moines, IA 50392.
DRSO1
DICE MEMQI3IAL WQKKS
a division of
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zngrzc
MEMORIALS Since 1921
421 W. Main Street, New Bloomfield, PA 17068
(717) 582-2512 ~ .Fax (717) 582-3404
www. gingrichmemorials. com
SOLD TO: ~ ~ a
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Phoned ~~ b~~1f~Cell 71~~ ~'~~ '~ ~~1~~
Email
Found. Ordered
Vendor Ack. #
Grave Position Verified ~ Cremation
Date of Order ~~~Y ~~ ~. ~f
Cemetery ~S~` ~
cemetery ~QEatiQn ~~ ~ ~~~~
Center Over 1 Graves Sec. /Lot #
Approx. Date of Completion ~ ~~ • S
Lettering
~nyM~No ~ . n~nRr~N
~'j~t. s,1`74`2
~uN. ac, ao~z
Type ~` ~ ff~~ Material ~ ~nl1 !!/1 i.S~ Additional Lettering:
Size ~~ X ~ X ~'- ~O Finish ~~. ~!~ ~ ~o !' ~ Cts' f'~~` Id ~ ~ ~~ ^ Back ^ Base .
Size ~~ X ~a~ X C> ~ ~ Finish ~d ` ~ ~~ ~
Description
Location on Cemetery
Vase ^ Photo
Agreement: A 50% deposit is required to commencement of work.
^ Other
Agree to pay stated balance upon erection regardless of labor troubles or shipments or any other good reasons. This order or
contract cannot be cancelled by customer unless agreed by both parties. The article herein mentioned shall remain the properly of
James R. Gingrich Memorials until paid in full and they reserve the right to remove the same is not paid as stated.
I agree to carefully proofread all names and dates for accuracy and accept full responsibility for any errors or omissions. THERE
WILL BE AN ADDITIONAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED ON THE
CEMETERY.
I further agree to pay the balance stated for the work performed under this contract within thirty (30) days of receipt of the final
invoice and further agree that interest shall accrue at the rate of one and one-half percent (1'r4%) per month on the unpaid balance
owed to James R. Gingrich Memorials not paid within thirty (30) days of the invoice date. In addition thereto, I agree if it becomes
necessary for James R. Gingrich to institute legal proceeding to collect any funds due from me for my account being past due thirty
(30) days, to pay all court costs and attorneys fees incurred by James R. Gingrich Memorials to collect the same.
. Dealer
Customer
3-01730
Drawing ~ Drawing Sent to Cust.
Approved
Found. By
COSTS:
Memorial $
Foundation $
Cemetery Fees
~f" ~'x~. Q~~.
JYC !! IW
1Trl' d ~ - rb-
TOTAL
DEPOSIT
Balance Due
Upon Completion
S
$ 2-/ ~
s 3~
$ ~.ao
c~2z
(I further agree that the above names, spelling, and dates are correct)
~---~
pennsylvan~a
~, . DEPARTMENT OF PU:B;I:IC W!ELFAR.E
August 6, 2012
IRWIN & MCKNIGHT LAW OFFICES
ROGER B IRWIN ESQUIRE
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE PA 17013-3222
Re: Raymond Martin
CIS # : 720147289
SSN: ###-##-7115
Date of Death : 06/26/2012
Dear Attorney Irwin:
RECEIVED
AUG 10 2012
IRWIN ~ McKNIGNT
LAW OFFICES
Please be advised that the Department of Public Welfare maintains a claim in the
amount of X200.352.30 against the above-mentioned estate. This claim is for restitution
of medical assistance granted on behalf of the decedent for which the Probate Estate is now
responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective
August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the
Department's itemized statement of claim.
A portion of this medical expense, namely $22f610.25, was incurred during the last
six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of
the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the
claim, namely X177.742.05, is to be entered as a priority Class 5.1 claim against the
estate.
Please acknowledge receipt of this letter and advise whether the Commonwealth's
claim is admitted and when payment may be expected. If the estate accounting is
complete, please provide a copy. If the estate contains real estate, please provide
copies of the deed, the latest tax assessment, and a current appraisal, if available.
Sincerely,
r~
Elizabeth D. James
TPL Program Investigator
717-772-6397
717-772-6553 FAX
Enclosure
Bureau of Program Integrity ~ Division of Third Party Liability (Recovery Section
PO Box 8486 ~ Harrisburg, Pennsylvania 17105-8486