HomeMy WebLinkAbout02-01-131505610140
REV-1500 ~` (°'-'°'
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO Box 28oso1 INHERITANCE TAX- RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 1 0 6 8
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYW
1 0 0 9 2 0 1 1 1 0 2 7 1 9 1 8
Decedent's Last Name Suffix Decedent's First Name MI
B U S H E Y R I C H A R D W
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
B U S H E Y E S T H E R M
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Return
4. Limited Estate
^X 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
L A W O F F I C E S
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust ~
(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 SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
I V O V O T T O I I I 7 1? 2 4 3 3 3 4 1
r .;
~-- ~
First line of address
M A R T S O N
Second line of address
1 0 E A S T
City or Post Office
C A R L I S L E
H I G H S T R E E T
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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Correspondent's a-mail address: IOTTO(cr~,MARTSONLAW.COM
Under penalties of perjury, 1 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 PERS N ESPONSIB FO FILI ETURN
1~ ,~ DA E ~ ~~ 3
ADDRESS ~I
4 CONWAY STREET CARLISLE PA 17013
THAN REPRESENTATIVE
ADDRESS
10 EAST HIGH STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
J
1505610240
REV-1500 EX Decedent's Social Security Number
~ecedent'slVame: RICHARD W• BUSHEY 1 6 0 1 6 3 9 3 0
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.
3 4 8 4 2 . 1 4
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 0 • 0 0
7. Inter-Vivos Transfers & Miscellaneous N -Probate Property
uested
Billin
Re
t
~ S
7
0 •
0
0
.......
g
q
epara
e
(Schedule G) .
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 3 4 8 4 2 . 1 4
9.
...............
Funeral Expenses and Administrative Costs (Schedule H) 9.
... 0 ' 0 0
10. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I
9 9 ( ) ....
...... 10.
... 0 • 0 0
11. Total Deductions (total Lines 9 and 10) ...................... ...... ... 11. 0 0 0
12. Net Value of Estate (Line 8 minus Line 11) ................... ...... ... 12• 3 4 8 4 2 . 1 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. 3 4 8 4 2 . 1 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.oo 3 4 8 4 2 1 4 15. 0. 0 0
16. Amount of Line 14 taxable
0
0 0
0
0
0
.
at lineal rate X .0 _ 1g, .
17. Amount of Line 14 taxable
0
0 0
17
0.
0
0
at sibling rate X .12 .
18. Amount of Line 14 taxable
0
0 0
0
0
0
at collateral rate X .15 18, .
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 1068
DECEDENT'S NAME
RICHARD W. BUSHEY
STREET ADDRESS
4 CONWAY STREET
CITY STATE Zlp
CARLISLE PA 17013
Tax Payments and Credits:
1 ~ Tax Due (Page 2, Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits (A + B) (2) 0.00
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) 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 : ...................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^ 0
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? ..................................................................
3. Did decedent awn 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 fS 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 i;
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-1508 EX+ (11-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
RICHARD W. BUSHEY 21 12 1068
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. 1 Year Certificate, Patriot Federal Credit Union, Acct. No. ******6990 (40) 16 662.33
($16,659.05 plus $3.28 accrued interest). See attached.
2. 1 Year Certificate, Patriot Federal Credit Union, Acct. No. ******6990 (41) 14 383.72
($14,381.05 plus $2.67 accrued interest). See attached.
3. 1 Year Certificate, Patriot Federal Credit Union, Acct. No. ******6990 (42) 3 796.09
($3,795.43 plus $0.66 accrued interest). See attached.
TOTAL (Also enter on Line 5, Recapitulation) I $ 34 842 14
If more space is needed, insert additional sheets of paper of the same size
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
orcinr~rr nrnr..r..:
SCHEDULE J
BENEFICIARIES
~~ ~ M i ~ vr: FILE NUMBER:
RICHARD W. BUSHEY 21 12 1068
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. Esther M. Bushey Spousal 34,842.14
4 Conway Street
Carlisle, PA 170 l3
I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV 1500 COVER SHEET, AS APPROPRIATE
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
If more space Is needed, use additional sheets of paper of the same size.
F \FILESI~ATAFILEIIVILLS\ I I/i32-h.wdl
LAST WILL AND TESTAMENT
I, RICHARD W. BUSHEY, ofthe Borough of Carlisle, Cumberland County, Pennsylvania,
being of sound and disposing mind and memory, do hereby make, publish and declare this to be my
Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made.
ITEM ONE
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all
inheritance taxes shall be paid to the extent possible from the assets held or passing under ITEM
FIVE hereof as soon as practicable after my decease and as part of the administration of my estate.
ITEM TWO
In the event my spouse shall predecease or fail to survive me by thirty (30) days, then I give
such items of personalty as are itemized in a certain list attached hereto to the persons named thereon,
which list is signed and dated by me at the end thereof.
ITEM THREE
If my spouse, ESTHER M. BUSHEY, is living thirty (30) days after my death, then I give,
devise and bequeath all of my estate, both real and personal property, unto my said spouse,
absolutely. If my said spouse does not so survive me, then I give, devise and bequeath all the rest,
residue and :remainder of my estate, both real and personal property, unto my Trustee to be held or
distributed by such Trustee under ITEM FIVE hereof.
ITEM FOUR
In the event my said spouse shall disclaim all or any portion of any devise or bequest made
to my spouse under the foregoing ITEM THREE, then the amount otherwise payable shall be held
by my Trustee under ITEM FIVE hereof. For purposes of the Trust established under ITEM FIVE
hereof, my said spouse shall not be deemed to have predeceased me by virtue of my said spouse's
exercise of the right to disclaim set forth herein.
ITEM FIVE
RESIDUARY AND DISCLAIMER TRUST
My Trustee shall hold the assets received under ITEMS THREE and FOUR hereof, if any,
for the following purposes:
R ~~r-,
R.W.B.
Page 1 of 7 Pages
A. My Trustee shall pay the net income, at least quarter-annually, to my spouse,
ESTHER M. BUSHEY, for life. In addition, my Trustee in my Trustee's sole discretion, may invade
the principal of the Trust for the proper and adequate support of my said spouse.
B. My Trustee shall further pay to my said spouse, annually, such sum from the principal
of the Trust as my said spouse may request in writing, provided, however, that said sum may not
exceed the greater of Five Thousand Dollars ($5,000.00) or five percent (5%) of the aggregate value,
at the time of said request, of the principal of the Trust hereunder.
C. Upon the death of my said spouse my Trustee shall distribute the principal of the Trust
to my children, CAROL M. FUCHS and RICHARD D. BUSHEY, in equal shares, absolutely.
D. In the event that any of my said children shall fail to survive my spouse and me, but
shall leave issue surviving, then such deceased child's share shall be held by my Trustee and the net
income therefrom shall be used for the support, maintenance and education of the issue of such
deceased child. My Trustee shall use as much of the principal as it shall deem desirable for said
purposes. IVIy Trustee shall distribute absolutely the principal of such share of such deceased child
to the issue of such deceased child per stirpes as each shall attain the age of thirty-five (35) years.
In the event that any of my children shall fail to survive my spouse and me and not leave issue
surviving, then such deceased child's share shall be added to the share of my other child as if originally
a part thereof.
ITEM SIX
POWERS OF EXECUTRIX AND TRUSTEE
In addition to the powers conferred by case law, `by statute, and by other provisions hereof,
my Executrix and Trustee and their successors, shall have the following discretionary powers
applicable to all property held by them which powers shall be effective without order of any court and
shall exist until final distribution.
A. To retain any property of any nature received by them for whatever period they shall
deem advisable;
B. To invest and reinvest all or any part of said property in such stocks, bonds, common
trust funds, securities, accounts, certificates of deposit (including, but not limited to, stocks, bonds,
R.W.B.
Page 2 of 7 Pages
common trust funds, securities, accounts or certificates of deposit of the Trustee) or other property,
real or personal, as in their discretion they shall deem proper, without regard to statutes limiting the
property which a fiduciary may purchase;
C. To sell, transfer, exchange or otherwise dispose of, any part of said property, for cash
or on terms, publicly or privately, or to lease, even for a term exceeding five (5) years or the duration
of any trust herein, without liability on the purchasers or lessees to see to the application of the
proceeds, and to give options for these purchases without the obligation to repudiate them in favor
of a higher offer;
D. To execute and deliver any deeds, leases, assignments or other instruments as may be
necessary to carry out the provisions of any trust hereunder;
E. To borrow money, including the right to borrow money from any bank and to
mortgage or pledge any asset of the estate as security;
F. To assume continuance of the status of any beneficiary with regard to death, marriage,
divorce, illness, incapacity and the like in the absence of information deemed reliable without liability
for disbursements made on such assumption;
G. To pay from the trust, or the income therefrom, all debts or claims against my estate,
or any taxes or similar chazges on my estate;
H. To make any distribution hereunder either in kind or in money, or partially in kind and
partially in money. Distribution in kind shall be made at the market value of the property distributed,
and my Trustee, in my Trustee's absolute discretion, may cause the share distributed to any
distributee to be composed of property similaz to or different from that distributed to any other
distributee;
I. To exercise any subscription right in connection with any security held hereunder, to
consent to or participate in any recapitalization, reorganization, consolidation or merger of any
corporation, company or association, the securities of which may be held hereunder, to delegate
authority with respect thereto, to deposit investments under agreements, to pay assessments, and
generally to exercise all rights of investors;
RW~'~
Page 3 of 7 Pages
J. To invest in endowment, insurance or annuity policies on the lives of beneficiaries of
any trust hereunder;
K. To continue in any partnership, joint venture, joint ownership or other business
enterprise of which I am a part at the time of my death;
L. To compromise claims;
M. To continue for whatever period of time as they shall deem necessary any ownership
as a tenant in common or as a partner, in real estate or other property and to act as I could have done
had I been living;
N. To lend money to my estate or to any trust created hereunder or to purchase from the
estate or from any trust created hereunder, at the market value thereof at the time of purchase, any
securities or other property tendered to them by my estate or any trust created hereunder at any time
and from time to time within a period of nine (9) months after my death;
O. In the event that any amounts are payable hereunder or under any trust created
hereunder to a minor, or to a person otherwise under legal disability, or to a person not adjudicated
to be an incapacitated person, but who, by reason of illness or mental or physical disability is, in the
opinion of the fiduciary(ies) hereunder, unable to properly administer such amounts, such amounts
may be paid by the fiduciary(ies) hereunder in his, her or their sole discretion in any of the following
ways as he, she or they may deem best:
1. Directly to such beneficiary;
2. To a legally appointed guardian of such beneficiary for the benefit of such
beneficiary;
3. To a person having custody of such beneficiary for the benefit of such
benef=iciary;
4. By the fiduciary(ies) hereunder using such amounts directly to the benefit of
such beneficiary.
Evidence of the application of payment of an amount in such a manner shall be a full and complete
discharge of the fiduciary(ies) hereunder to the extent of such payment or application. This paragraph
shall be applicable to payments of income as well as principal.
~~~
R.W.B.
Page 4 of 7 Pages
P. To employ agents, attorneys and proxies and to delegate to them such power as my
personal representatives and Trustees consider desirable and to pay reasonable compensation for such
services as may be rendered by such agents, attorneys and proxies;
Q. To conduct an inventory of any safe deposit box necessary to the administration of
my estate.
R. To do all other acts in their judgment necessary or desirable for the proper
management, investment and distribution of my Estate.
ITEM SEVEN
PROTECTIVE PROVISIONS
All income or principal held for the use and benefit of the beneficiaries of any trust hereunder
shall not be in any way or manner subject to anticipation, assignment, pledge, sale or transfer, nor
shall any such interest, while in the possession of my Trustee, be liable for or subject to the debts,
contracts, obligations, liabilities or torts of any beneficiary, or to attachments, executions or
sequestrations under process of law.
ITEM EIGHT
APPOINTMENT OF EXECUTRIX AND TRUSTEE
I nominate, constitute and appoint my spouse, ESTHER M. BUSHEY, as Executrix of my
estate. In the event that my said spouse shall predecease me or fail to act as Executrix, then I appoint
my children, CAROL M. FUCHS and RICHARD D. BUSHEY, or the survivor of them, as Executor
of my estate.
I nominate, constitute and appoint my spouse, ESTHER M. BUSHEY, as Trustee of any trust
created hereunder. In the event that my said spouse shall fail or be unwilling to continue to act as
Trustee, then I appoint my children, CAROL M. FUCHS and RICHARD D. BUSHEY, or the
survivor of them, as Trustees of any trust created hereunder.
ITEM NINE
WAIVER OF BOND
I direct that neither my Executrix nor my Trustee, or her successors, shall be required to file
any bond in any jurisdiction to secure the faithful performance of their duties, nor shall they be
~~
Page 5 of 7 Pages
required to obtain any order or approval of any court for the exercise of any power or discretion set
forth in this Will.
IN WITNESS WHEREOF I have hereunto set my hand and seal this ~~~ day of
,c~00 ~ .
`,
EAL)
Richard W. Bushey
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator, as and for his
Last Will anal Testament, in the presence of us, who at his request, have hereunto subscribed our
names as witnesses thereto, in the presence of the said Testator and of each other.
Page 6 of 7 Pages
COMMONWEALTH OF PENNSYLVANIA )
. SS.
COUNTY OF CUMBERLAND )
-{ We, Richard W. Bushey, /VCS ~ s~~y ~ ,and
J ~ .02 2iS n ) ,the Testator and the 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 the Testator
has signed willingly, and that the Testator 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 a witness and that to the best ofhis/her knowledge the Testator was at that time eighteen
years of age or older, of sound mind and under no constraint or undue influence.
W
T tato
Witness
~~,
Witness
Subscribed, sworn to and acknowledged before me by Richard W. Bushey, the Testator, and
subscribed and sworn to before me by ~VU ~. (} ~ ~ and
..~
~~/q ~u U,E'~..is ~ ,l? ,the witnesses, this 1s ~ day of ,, 2001.
Notary Public
NOTARIAL SEAL
CORRINF L. MYERS, ~~~~
Carlisle Boro. Cumberl
.._~omm~s~±'?n Expires Ma 27, 2 3
Page 7 of 7 Pages
~~
atrlot
FEDERAL CREDIT UNION
Catch the Sprit ojFtrmruia( Freedom
January 15, 2013
Martson Law Offices
Attn: Melissa A Scholly
10 East High Street
Carlisle, Pa 17013
RE: Richard W. Bushey Estate
To Whom It May Concern:
I am writing in response to your request for date of death values on the above referenced
member.
Account Date of Interest R;
XXXXXX6990 Death
Princi al
Prime Share (00) $4,640.03 0.050%
06/03/1977 - o ened
1 Year Certificate (40) $16,659.05 0.897%
02/13/1998 - o ened
1 Year Certificate (41) $14,381.05 0.847%
05/20/1998 - o ened
1 Year Certificate (42) $3,795.43 0.798%
01/23/1998 - o ened
1 year Certificate (43) $17,154.90 0.897%
11/02/1998 -opened
ate Accrued Joint Owners
Interest to
DOD
$0.05 Esther M Bushey
06/14/77
$3.28 N/A
$2.67 N/A
$0.66 N/A
$3.37 Esther M Bushey
11/02/1998
If you have any questions with regard to the above balances, or need additional
information, please feel free to contact a Membership Officer at 717-263-4444.
Sincerely,
Patriot Federal Credit Union
S Lh . ~ , Z~ m ~ 1 , ~ n~c-I
~~