HomeMy WebLinkAbout11-13-12 (2)I 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 2 0 9 2 9
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
4 4 1 1, 8 5 2 0 9 0 1, 2 9 2 0 L 2 0 L 0 8 L 9 2 0
Decedent's Last Name Suffix Decedent's First Name MI
B E R K H E I M E R E S T H E R M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
B E R K H E I ~1 E R W I L L I A f1 L
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
1, 7 4 3 6 7 2 8 5 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Return
4. Limited Estate
Q 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust 0
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULU tat ulRt(:I to I U:
Name Daytime Telephone Number:~_..~ -.~--~
C7 `~ ~-7 ~~`.~
~1 i c h a e l H S m a l l E s g 7 1, 7 ~'~-~ 8 ~ ~. 0 ~`~,[3
First line of address
2 L 0 S R a i l r o a d S t•
Second line of address
P 0 B o x 7 6
City or Post Office
P a l m y r a
State ZIP Code
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
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DATE FILED
P A 1 7 0 7 8
Correspondent's a-mail address: mhSlaW Imf.net
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 teas any knowledge.
S SIB R~FILING R RN / QAT ~
~• / cyC
ADDRESS /
291,0 Sunset Drive Cam Hill PA 1,701,1,
S1 E PREPA R T REPR TIVE DATE
ADDRESS
210 S• Railroad St•, P-0• Box 76 Palmyra _PA 17078
PLEASE USE ORIGINAL FORM ONLY
Side 1
150561,01,4D ],50561,01,40
J
1,50561,0240
REV-1500 EX
Decedent's Name: ESTHER M • BERKHEII'1ER
Decedent's Social Security Number
4 4 1 1 8 5 2 0 9
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1. 2 1, L 9 0 0 0 0
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. 1, 7 2 1 . 5 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) ........................... g. 2 L 3 6 2 1 . 5 9
9. Funeral Expenses and Administrative Costs (Schedule H) ............ ...... 9. 1 1 6 8 3 . 5 2
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ...... 10. •
11. Total Deductions (total Lines 9 and 10) ......................... ...... 11. 1r 1r 6 8 3 . 5 2
12. Net Value of Estate (Line 8 minus Line 11) ...................... ...... 12. 2 0 1 9 3 8 . 0 7
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. 2 0 1 9 3 8 . 0 7
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 .o0 2 D 1, 9 3 8 0 7 15.
16. Amount of Line 14 taxable
at lineal rate X .0 D 0 0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18.
19. TAX DUE .................. ........................... .. ..... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
0. 0 0
0. 0 0
0. 0 0
0. 0 0
0. 0 0
0
L 150561024 1505610240 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
ESTHER M. BERKHEIMER
STREET ADDRESS
2910 Sunset Drive
East Pennsboro Townshi
CITY STATE ZIP
Camp Hill PA 17011
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.
File Number
21 12 0929
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;
................................................................ ^
...... ^X
b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ X^
c. retain a reversionary interest; or .......................................................................................... ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^
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? ............................................................................................ ...... ^
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)].
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.
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LAST WILL AND TESTAMENT _
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ESTHER M. BERKHEIMER ~ `~-~'
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I, ESTHER M. BERKHEIMER, having my legal residence at 2910 Sunset Drive, Camp
Hill, East Pennsboro Township, Cumberland County, Commonwealth of Pennsylvania, do hereby
declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore
made by me.
FIRST: I direct that the expenses of my last illness and
funeral be paid from my estate as soon as practicable after my death.
SECOND: I direct that all furniture, furnishings, household
goods, books, jewelry, clothing and other articles of personal property owned by me at the time of
my death shall be distributed in accordance with the provisions of a certain memorandum which 1
may choose to prepare and keep with my Will. If for any reason said memorandum is not found
and properly identified as such by my Executor within thirty (30) days after the filing of my Will
for probate, then it shall be presumed that such memorandum was destroyed by me with intent to
cancel the same, and all of the aforesaid property shall fall into and become part of my residuary
estate hereinafter disposed of, according to the sole and exclusive discretion of my Executor.
THIRD: I devise and bequeath all of the remainder of my~
estate and property, of whatsoever nature and wheresoever situate, subject only to the piovisiol~s
1
of Paragraph SECOND herein, to my husband, WILLIAM L. BERKHEIMER, if he survives thirty
(30) calendar days after my death.
FOURTH: If my husband, William L. Berkheimer, does not
survive thirty (30) calendar days after my death, I give, devise and bequeath the sum of One
Hundred Fifty Thousand ($150,000.00) Dollars to my granddaughter, ELIZABETH A. PASSO, as
Trustee, intrust, for my son, DAVID S. STAFFORD. My said Trustee shall hold, manage, invest
and reinvest said share for so long as said beneficiary shall live; and, as in the absolute judgment
and discretion of the said Trustee may be necessary or advisable, said share shall be used, paid or
applied, by said Trustee, for his welfare, support, maintenance and general benefit. So much
thereof as shall not be so paid, used or applied, shall be held and accumulated by said Trustee f'or
said beneficiary. Payments applicable to the use of beneficiary as aforesaid may be made by the
Trustee to the beneficiary, guardian or any other person having the care and custody of such
beneficiary, or to such persons or in such other manner as the Trustee in her sole and absolute
discretion believes will benefit such beneficiary. The Trustee may also make such payments
directly to such beneficiary as the Trustee may deem advisable as an allowance to him.
If my Trustee, in her sole and absolute discretion, determines that the size of the Trust Fund
at any time as provided for herein does not warrant continuing the same in Trust, or that its
administration would be impractical for any reason, the Trustee may, without further ~
responsibility, pay such remaining fund or share to the beneficiary.
z
Should Elizabeth' A. Passo predecease me or fail for any reason to serve as Trustee, I appoint
MICHAEL H. SMALL, ESQUIRE, or his designee, as Trustee, with the same powers and
privileges set forth above.
Upon the death of David S. Stafford, my Trustee shall immediately distribute the
remaining Trust funds equally to his children, ELIZABETH A. PASSO and DAVID H.
STAFFORD, or their respective issue, per stirpes, in a manner consistent with the provisions set
forth herein.
FIFTH: If my husband, William L. Berkheimer, does not
survive thirty (30) calendar days after my death, then I give, devise and bequeath all of the rest,
residue and remainder of my estate and property, of whatsoever nature and wheresoever situate,
subject only to the provisions of Paragraphs FIRST through FOURTH set forth above, in six (6)
equal shares, as follows:
A. One (1) equal share to my granddaughter, ELIZABETH A. PASSO,
per stirpes;
B. One (1) equal share to my grandson, DAVID H. STAFFORD, per
stirpes;
C. One (1 } equal share to my granddaughter, SARAH A. PARKER,
per stirpes;
D. One (1) equal share to my granddaughter, JESSICA R.
SPAULDING, per stirpes;
3
E. One (1) equal share to my granddaughter, ERICHA R.
HORNAMAN, per stirpes; and
F. One (1) equal share to my grandson, ISAAC M. HAGENBUCH,
per stirpes.
SIXTH: All estate, inheritance, succession and other death
taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to
all property comprising my gross estate for death tax purposes, whether or not such property
passes under this Will, shall be paid out of the principal of my general estate, as if such taxes were
administration expenses, without apportionment or right of reimbursement. I authorize my legal
representative to pay all such taxes at such time or times as may be deemed advisable.
SEVENTH: I appoint my husband, WILLIAM L.
BERKHEIMER, Executor of this Will and direct that he be permitted to serve without bond and
without any intervention of any court except as required by law. I authorize my Executor to sell,
encumber, mortgage, invest, distribute in kind, or retain any items of property of my estate in such
manner as he shall deem proper, limited only by his own discretion. If for any reason my
Executor appointed under this Will should fail to serve in that capacity, I appoint my
granddaughter, ELIZABETH A. PASSO of Camp Hill, Pennsylvania, my Executrix, with the
same powers and privileges set forth above.
4
IN WITNESS WHEREOF, I have at Palmyra, Pennsylvania, this 11th day of
November , 2010, set my hand and seal to this, my Last Will and Testament,
consisting of five (5) pages.
`~ .~? ' `~~ > ' (SEAL)
Esther M. Berkheimer
SIGNED, sealed, published and declared by ESTHER M. BERKHEIMER, the above-
named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request.
in her presence acid in the presence of each other, have hereunto subscribed our names as
witnesses.
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~ ~ .'~~~ 12 N. Clearview Drive
y ~~, ~ 7~Zesidence.
E `'~c~~~.;.~,.~t~-;~~e~ Residence:
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Palmyra, PA 17078
826 Cornwall Road
Lebanon, PA 17042
s
REV-1502 EX+ (01-10)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ESTHER M. BERKHEIMER 21 12 0929
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. Real estate situate at and known as 2910 Sunset Drive, Camp Hill, East Pennsboro 211,900.00
Township, Cumberland County, PA, as in Cumb. Co. Deed Book I, Vol. 33, Page 88
$211,900 X 1.00 (Assessed Value X Common Level Ratio Factor)
See copies of Deed, Cumberland County Property Record Card, and Common
Level Ratio Factor Schedule.
TOTAL (Also enter on Line 1, Recapitulation.) I $ 211,900.00
If more space is needed, use additional sheets of paper of the same size.
i0t~r Warranlr Deed--Short Form-Act 190-Double Sheet
Henry Hsil, Ina, Indiana, Pa. ~ ~ '- ~.~.i - ' -
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~S ~a~'~ ~ tl~ ~ ~!
t r ~~ .---____._ in the year
MADE THE ----- ~ _-_-------- day o f ---- ., t.
of our Lord one thousand nine hundred EIGHTY-EIGHT (1988) .
BETWEEN ALAN BARNEY and DONNA L. BARNEY, his wife, of Camp Hill, Pennsylvania
Grantor s
and ESTHER M. STAFFORD, a single woman, of Camp Hill, Pennsylvania
Grantee
WITNESSETH, that in consideration of NINETY-FOUR THOUSAND FIVE HUNDRED DOLLARS AND
NO/100---------------------------------------------($94,500.00)-----------Dollars,
in hand paid, the receipt whereof is hereby acknowledged, the said grantors do hereby grant
and convey to the said grantee ,
ALL THAT CERTAIN Iot or tract of land situate in East Pennsboro Township, Cumberland
County, Pennsylvania, more particularly bounded and described as follows, to
wit:
BEGINNING at a point in the centerline of Sunset Drive having a 33 feet right
of way at line of lands now or formerly of Lucy C. Garno, also located 113 feet
West of the Western right of way line of Clifton Road extended; thence by centerline
of Sunset Drive South 63 degrees 00 minutes 00 seconds West 90.00 feet to a
point, also being located 100.00 feet East of the line of lands of the West
Shore Country Club; thence crossing Sunset Drive and along line of lands now
or formerly of William F. Wolfe through an iron pin on line located 162 feet
North of the center line of Sunset Drive North 25 degrees 43 minutes 35 seconds
West, 147.03 feet to a point on the Southern line of lands now or formerly of
Murray T. Bretz; thence by aforementioned line of lands North 65 degrees OS
minutes 00 seconds East 87.00 feet to a point on the Western tine of lands now
or formerly of Lucy C. Garno; thence by aforementioned line of lands and crossing
Sunset Drive through an iron pin located 162 feet North of the centerline of
Sunset Drive South 26 degrees 54 minutes 58 seconds East, 143.83 feet to the
point being the place of BEGINNING.
BEING 2910 Sunset Drive and having thereon erected a brick and frame ranch dwelling.
UNDER AND SUBJECT, NEVERTHELESS, to restrictions, easements and conditions of
prior record pertaining to said premises.
BEING THE SAME PREMISES WHICH Alan Barney and Donna L. Barney, his wife (formerly
Donna L. Pearson) by the Deed dated September 3, 1986 and recorded in the Office
of the Recorder of Deeds in and for Cumberland County in Deed Book 32-D, Page
971, granted and conveyed unto Alan Barney and Donna L. Barney, his wife, Grantors
herein.
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School Qist. Cumb. Co., Pa
-- "' t% Aeal Estate Trertsfer sex
`ate,_:...,1.... Anat. ~ _.
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C:um~. Co. D7s'.. Cot. NfR. , `~
tofn~p of • • Pt.
Cumb. Co.,
lx gee{ Estate Treashr Tax ('
. ,rib. ~ Ca. OILt. Col. Agt. '~'-~
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And the said grantors hereby covenant and agree that they
will warrant specially the property hereby conveyed.
_ . --
IN WITNESS WHEREOF, said grantors have hereunto set their hand and seal
the day and year first above written.
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~ig~Te~, ~eaieb attb ~eCibere3 --------- ---------------------;=----k~'-=--- ----- ---- ~aL
had Barney _'
in tide e~ente of _ • ~__
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- ------------------ --------------~-----------------•-------. 9HS~Sa
• ~ ,,r 1` ~ Donna L . Barney `~
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State of "'-a~~ ~ r.-_--
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County o f ~ ~ Lv~it~ -••
On this, the ` ~-;:~ day of G/~~~" ~'G---•-~ , 1988 ,before me,
G A Notary "['ublic
the undersigned o.~icer, personally appeared Alan Barney and Donna L. Barney, his wife
known to me (or satisfactorily proven) to be the persons whose name s are subscribed to the
within instrument, and acknowledged that they executed same for the purposes therein
contained.
IN WITNESS WHEREOF, I hereunto set my, hated arul offeeial seal. ry
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-----------li~l[!i A_ GAUBIER. N0t11R11 PU9llC ,.... ~.
pERRT TOINNSNt~, le o O cer,. _ ;~ ' •.:
MY COMMISSiI~i? cXPiRES OCT. 17.1 ~ ~ f,, ~
WiaMt, peansyivaaia Ass~tietion of Nobri~ i,
State of ` ..
ss.
County of
C1;n this, tfze day of , 1~ ,before 7ne,
the undersigned officer, personally appeared
known to me (or satisfactorily proven} to be the person whose name subscribed to the
urithin instrument, and acknowledged that executed same for the purposes therein
contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seat.
Title of O,~cer.
~`- do hereby certify that the precise residence and complete post o,~ce address
o f the within named grantee is Z g 1 ~ S v ~s ~-~- -t1 E ~~,• ~ C`~'``'P ~~ ~~ ~ ~~c~ , i 1 C» ~ 1
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Attorney for -------- -~ -~~~•c.~St.~ --------------------------
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COMMONWEAL ~H OF PENNSYLVANIA
County of ------------`-~=~~I-`~~.~..~._~.~C~~~`~ ~~:.~_..____ ss.
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RECORDED on this f __.____---- day of ---.-------- L'~iv-~-
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A. D. 19 ~.'a, in the Recorder's o,~ce of the said County, in Deed Book -,t _.
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Vol. ~.-- ~ -= ~-------•- Page ~ ---------------
-----
Given under my ha~ the seal oft aid ~~er.~•he date above written.
1 h~
-------_..~--------------------------~____., Recorder.
No.
Deed
Mortgage
Power of Attorney
RECORDED
Assignment of Mtg.
Release
Miscellaneous
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Carlisle, Pa., 19
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Patricia H. Vance
Recorder of Deeds
CUMBERLAND COUNTY
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REALTY TP;ANSFER TAX July 2011
~`~ ~~~v~t~ 20.0 cOrs~ON LERVEL RATIO
DEPARTIMENT QF REVENUE ~ FAC'TORS
g,F.ATs ESTATE VAZ,UATIO
The following real estate valuation factors are based on sales
data compiled by the Mate Tax Equalization 3oard in 2010. ~`hese
factors are the mathematical reciprocals of the actual common
level. ~.:ati.o (CLR} . For Pennsylvania Realty 'Transfer Tax purposes,
these factors are applicable for documents accepted from July 1,
2011 to June 30, 2012, except as indicated be3ca~. The date of
acceptance of a document is rebuttably presumed to be its date of
exc-cutron, that is, the date specified in the body of the document
as the date of the rostrum<e~.t ~ 61 Pa . Code § 31..102 } .
CLR CLR CLR
COUNTY FACTOR COUNTY FACTOR COUNTY FACTOR
Adams ;1} 1.G0 .Elk 2.36 Montour 1.23
A1leghenLL>>~ 1.27 Erie 1..18 Northampton 2.98
Armstrong 2.65 Fayette i.21 Northumberland 3.62
Deaver 3.Q6 Forest, 3."73 Perry j1} 1.00
Bedford 1.28 Franklin ;.63 Philadelphia 5.53
BeV~s 1.37 Fulton 2.85 Pike ~'_ . 6 7
B=air 6.67 Greene 1.20 Potter 3.21
Bradford 2.99 Huntingdon 7.19 Schuylkill 2,11
~u;:ks 8.85 Indiana 5.21 Snyder 5.56
Butler 5.24 Jefferson 1.8'5 Somerset 2.51
~~.ambria 2.59 Juniata 4.74 Sullivan 1.44
Cameron 2.44 Lackawanna 5.45 Susquehanna 2.82
C=.?bon 2.33 Lancaster 1.31 Tioga 1.36
Ce??tre. 3.56 ~awr_ence 1.05 Union 1.29
Chester 1 . '? 5 I:ebai.on 6.33 Venango 1.11
Clarion 3.38 Lehig~~ 2.80 warren 2.89
Clearfield 4.95 Luzerne 1 . CO t~~ashi_r~gton 4.69
Clinton 1.01 ~ Lycoming 1.21 ~z'ayr~e 1.'25
Columbia 3.79 McKean 1.16 GJestmoreland 4.20
C~~aTsaford 2.68 Mercer 2 . 8 ~~ ~^~yoming 5 . Uri
Cumberland ~;1) 1.00 Tv~-f f1i n, 1.91 `pork 2.19
Bauphin 1.36 Monroe 5.95
Delawar`: 1.48 Montgo~lery 2.72
elf Adjusted by the Department of Revenue to reflect an
assessment base change effective January 1, 2011
• ,
say, ~o.- ..:~t . ~~`~~~
REV-1508 EX+ (11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ESTHER M. BERKHEIMER 21 12 0929
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. Stillwater National Bank And Trust Company 1,721.59
Checking Account #819075 -See Verification attached
TOTAL (Also enter on Line 5, Recapitulation) I $ 1 721.59
If more space is needed, insert additional sheets of paper of the same size
10/29/2012 11:24:21 AM Faxs~rver PAGE 2 OF 2
' ~ ~ ' Dated: ~d - ~~ " ~ r ~-
' e ~
,~
TO: Michael H. Small, Esquire ~; Estate of Esther M. Berkheimer,
230 South Railroad Street a a st er Mae Berkheimer,
P.O. Box 76 a/lC/a Esther M. Stafford
Palmyza, PA 17078-Q07b
'lie information which you requested on the account(s) of ~' M• ~-"~"~ ~k/a Fst~r'
Nye ~~, a/k/a ~~ M• St~affc~ (Social Security rTo. 441-18-5209 )
rs as follows:
Account Number {s} 819075
Type of Account ~~-'-~
Date Opened ~^ j ' ~~
Principal Balance ~f~ _
Accrued Interest t ~ 3
Balance at Date , ~~ ~ C ~~
of Death: 01/29/2012 !/
Acct. Ownership
Name of Joint /il /~
Owner, ~f any !~
Date Ownership ~ _ /` _. ~ ~
Was Establislxed
Additional Information ~ ~
Requested
STILLWATER NATIONAL BANK AND TRUST COMPANY
'l___--
By:
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
ESTHER M. BERKHEIMER 21 12 0929
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1. FUNERAL EXPENSES:
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: Michael H. Small, Esquire 7,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3, 500.00
Claimant William L. Berkheimer
Street Address 2910 Sunset Drive
City Camp Hill State PA ZIP 17011
Relationship of Claimant to Decedent SpOUSe
4. Probate Fees: (Initial Probate Costs - $311.50; Add'I Probate Costs - $50.00; 376.50
Filing Fee - $15.00)
5 Accountant Fees:
6, Tax Return Preparer Fees:
7. Cumberland Law Journal -Estate Notice 75.00
8. The Sentinel -Estate Notice 232.02
TOTAL (Also enter on Line 9, Recapitulation) I $ 11,683.52
If more space is needed, use additional sheets of paper 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:
ESTHER M. BERKHEIMER 21 12 0929
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. William L. Berkheimer Spousal
2910 Sunset Drive Entire Residuary Estate
Camp Hill, PA 17011
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, $
If more space is needed, use additional sheets of paper of the same size.
~HS MICHAEL H. SNLALL
November 9, 2012
FEDERAL EXPRESS
Cumberland County Court House
Register of Wills & Clerk of the Orphans' Court
Attn: Danielle Beaverson
1 Courthouse Square
Carlisle, PA 17013
In re: Estate of Esther M. Berkheimer
File No. 2012-00929
PA File No. 21-12-0929
Date of Death: January 29, 2012
Dear Ms. Beaverson:
C7 ` ~`'
-- C =~ -~~ ~~
;~ , -,-,
i1~ -~ -'~ ~-~f'~ ~
.i
_
,~ _
; ~_ _ ~a
:. ; - .-
~---t ~ ~_ 7'i
~ --
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In regard to the above-captioned matter, you will find enclosed herewith for filing in this order:
1. An original and two copies of the executed Inheritance Tax Return.
Please time-stamp and file the original and one (1) copy and
time-stamp and return the second copy in the enclosed self-addressed
and stamped envelope.
2. My Escrow Check #1 1 1 1 dated November 5, 2012 payable to Register of
Wills in the amount of $65.00 submitted as payment of additional Probate
costs - $50.00 and Filing fee - $15.00; please apply the check as required
and time-stamp and return the copy along with an Official Receipt.
3. An original and one (1) copy of the Status Report indicating that the
administration of the Estate is complete. Please time-stamp and file the
original and time-stamp and return the copy in the enclosed self-addressed
and stamped envelope.
Of course, if you have any questions or comments, or if I have overlooked anything to accomplish these
filings, please feel free to contact me. Thank you for your assistance in this matter!
Very truly yours, ~ '~
r~ ,' ~ ~ ~~
~~`
ichael H. Small, Esquire
'?10 South Railroad Street, P.O. Boy: 76
Palmyra, Pennsylvania 17078-0076
Telephone: (717) 838-3030 Fas: (717) 838-8867
Email: mhslaw@lmf.i-et
M H S/pab
Enclosures
cc: William L. Berkheimer, Exec.