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Home My WebLink About10-24-121505610143 REV-1500 Ex`°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county code Year File Number Bureau of Individual Taxes o~~«r~~weE PO Box.28oso~ INHERITANCE TAX RETURN 21 12 0133 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth O1 23 2012 07 23 1923 Decedent's Last Name FORTNEY Suffix Decedent's First Name SR. LEE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI E MI 1. Original Retum ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Re wired Q a g Decedent Died Testate (Attach Copy of Wilq ^ T Decoder]t Maintained a Living Trust (Attach copy of trust) 8. Total Number of Safe De posit B°xe3 ^ 9. Litigation Proceeds Received ^ 1°, S weal P ve~Credd (date oideath t>~tween 1~-31- and t-1-95) ^ 11.Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDMUND G MYERS (717) 761 4540 First line of address 301 M~R~•T STREET Second line of address PO BOX 109 ' City or Post Office LEMOYNE State ZIP Code PA 17043 REGISTER O~S USE f~.Y ~ ~ ~ 7 -~ ~-- ~ "~ _ N ~ ' ~' ~~` _-, ~`J ~ ~' - - ~ ~. ~ _ L ~- ~ DAT ILE D C Q ~~ C.t..~ ~_~ ~~ ~~ T-1 ~suz I Imder chase Drive Mechanicsbur PA 17050 SIGNAT OF PREPAREgOTHER THAN REPRESENTATIVE DATE /%(I EDMUND G. MYERS /ca/2~~i Z ADDRESS 301 MARKET STREET, Lemoyne, PA Side 1 1505610143 1505610143 J cam" Correspondent's a-mail address: egritltC~JdSW.COn't 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 whim nron~ror ti~~ ~,,,, o-..,,..,i~..e J 15D561D243 REV-1500 EX Decedent's Social Security Number oe~edenrs Name: FORTNEY, Lee E Sr. 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. 15 , 500.00 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous I~nq Probate Property (Schedule G) u Separate Billing Requested............ 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... g, 15 , 500.00 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 4 , 3 68.5 7 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 4 , 3 68.5 7 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12, 11, , 131.43 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 2 O O . O O 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14, 1 O , 931.43 TAX COMPUTATION -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 .00 15. O . OO 16. Amount of Line 14 taxable 10 931.43 at lineal rate X .045 ~ 1s. 491.91 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. O, O O 18. Amount of Line 14 taxable at collateral rate X .15 O. O O 18. O. O O 19. Tax Due .................................................................................................................. 19. 4 91.91 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ 150561D243 Side 2 150561D243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-0133 DECEDENT'S NAME FORTNEY, Lee E Sr. STREET ADDRESS 10 B Richland Lane Apt. 106 CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 0.00 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) (1) 491.91 0.00 491.91 Make Check Pa able 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 :.................................. ^ 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? .................................................................................................................... x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 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. §91 t6 (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)j. . 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-1508 EX+Ig.88J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER FORTNEY, Lee E Sr. 21-12-0133 uweus rn m auon ena me ae[e [ne pfOCeeas wen received by the estate. All property Jo ntlyowned th the right otsurvivonhlp must bs disclosed on schedule F. to rrrore space Is neeaeo, aa0luonal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+(10.06) COMMN,~DECED~ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER FORTNEY, Lee E Sr. 21-12-0133 ....vw v. w~.vvw~...a .na,aa vc ~Q~7V1 LCU VII a7Gr1@pY16 1. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 1,176.97 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s) Commission oaid 2. Attorney's Fees JOHNSON DUFFIE 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationshio of Claimant to Decedent 4. Probate Fees 145.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,046.10 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 4,368.57 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER FORTNEY, Lee E Sr. _ 21-12-0133 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex~erises 1 Hetrick Bitner Funeral Home 1.176.97 H-A 1,176.97 Other Administrative Costs 2 1-800 Junk/Cleaning and Removal of Decedent's Property 3 Long Meadows Apartments -Cleaning/Maintenance of Apartment 4 Reserves; Miscellaneous Administrative Expenses 5 The Cumberland Law Journal 8 The Patriot News -Notice of Estate Administration H-67 600.00 20.00 200.00 75.00 151.10 1,046.10 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE J conn~~~~y~o~~~~vANIA BENEFICIARIES ~F I D D ESTATE OF CART\ICV 1 ~~ r !~ FILE NUMBER 1 VIA 1 LG ~ , LQes G Jf. 21-12-0 133 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distrbutions, and transfers under Sec. 9116 a 1.2 Lee E Fortney, Jr. Son 1/4th of Residue 25 North 3rd Street Harrisburg, PA 17113 Mary Jane Fortney Daughter 314th of Residue 1502 Timber Chase Drive Mechanicsburg, PA 17050 Total Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet, as a r o riate. II NON-TAXABLE DISTRIBUTIONS: • A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Trinity United Church of Christ 200.00 TOTA L OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15oo c~vFR cHFt=T inn nn Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ESTATE OFLEE E. FORTNEY, SR a/k/a LEE E. FORTNEY SCHEDULE OF EXHIBITS EXHIBIT A Last Will and Testament for Lee E. Fortney, Sr. a/k/a Lee E. Fortney signed and dated September 17t°`, 2010 :521685 Last Will and Testament OF LEE E. FORTNEY I, LEE E. FORTNEY, of East Pennsboro Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as mod. for my L~~t ~JVi11 and Testament, hereby revo~ng a..xd making v~:u any a.~.d all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS I direct the payment of all my legal debts and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently maybe done. ARTICLE II TANGIBLE PERSONAL PROPERTY I give and bequeath my household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto those of my chi~drPre; GARY JANE FOI~~TNEY and LEE F,, FORTNI/Y; .TR,, who Sup^~i~~e mie, to be divided between them in as nearly equal shares as is practicable. I direct that should there be disagreement as to the disposition of any item or items in this Article, I direct that the same shall be disposed of under Article N hereof. _ _ I- - --- - -_ __ ~~~+ A ARTICLE III CHARITABLE BEQUEST I give and bequeath the sum of Two Hundred ($200.00) Dollars unto the TRII~TITY UNITED CHURCH OF CHRIST, 117 Verbeke Street, Marysville, Pennsylvania. ARTICLE IV REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, as follows: A. One-quarter (1/4) thereof unto my son, LEE E. FORTNEY, JR., provided that should he predecease me, I give, devise and bequeath his share unto my daughter, MARY JANE FORTNEY; B. Three-quarters (3/4) thereof unto my daughter, MARY JANE FORTNEY, provided that should she predecease me, I give, devise and bequeath her share unto my son, LEE E. FORTNEY, JR.; C. Should both my son, LEE E. FORTNEY, J1L and my daughter, MARY JANE FORTNEY, predecease me, I give, devise and bequeath the residue of my estate in equal shares unto my nieces, MARY ANl~ i~DWELL and FLORA MAE PHILLIPS. 2 ARTICLE V PERSONAL REPRESENTATIVE I name, constitute and appoint my daughter, MARY JANE FORTNEY, Executrix of this my Last Will and Testament. Should my daughter, MARY JANE FORTNEY, fail to qualify or cease to so act, I name, constitute and appoint my nephew, ROBERT P. MATSKO, SR., alternate Executor to complete the administration of my estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNTSS WI~REOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this I?'~~ day of ,~ ~c`.ti~ 2010. ~.~ LE E RT*~NEY (SEAL Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. 4~ "" ,,~ ~Ia,.Ba f- 3 AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA . ss. COUNTY OF CUMBERLAND , We, LEE E. FORTNEY, _, ~~~~~ ~' ~I ~~ ~~ and ~~~~ ~' ~~~~~~~ the Testator and the witnesses, respectively, whose names are signed to the attached or 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 lie had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. EE FORTNEY wi ss a1~o~-1, Witness Subscribed, sworn to and acknowledged before me by LEE E. FORTNEY, Testator, and - J 1~/~ ,L~ fe • I~ l /1~C)~~- y and - •~r~l~'/~/~ L ~'U~~J7I /~"~ , witnesses, this / J~ day of ti 2010. Edmund G. Mye Attorney I.D.#20558 4 COMMONWEALTH OF PENNSYLVA1vIA ss: COUNTY OF CUMBERLAND , On this, the ~ 7 da of G Y C1~ 2010, before me, the undersigned officer, personally appeared EDMi7ND G. MYERS, Attorney I.D. #20558, known to me (or satisfactorily proven) to be a member of the bar of the highest court of Pennsylvania and certified that he was personally present when the foregoing acknowledgement and affidavit were signed by the Testator and the witnesses. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~+`;2L,~ ~ SEAL Notary Publi ( ) TFl OF PENNSYLVANIA N~~ CO1vWio NOrTARIAL Ste' g Ruff, Notary public I,eunoyne Boro, Cumberland County M ~issian Ma 30, 2011 :413470 5