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Home My WebLink About04-0985REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 COUNTY CODE -- 04 YEAR NUMBER I-- Z UJ UJ z Z DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Heilman Melba DATE OF DEATH (MM-DC-YEAR) I DATE OF BIRTH (MM-OD-YEAR) 7/29/2004 t 11/18/1919 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDOLE INITIAL) I X I 1. Original Return I J 2. Supplemental Retum M SOCIAL SECURITY NUMBER 184-18-4878 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WH ~ R /SOCIAL SECURIT~ NUMBER ~ 3. Remainder Return (date of death pdor to 12-13-82) ~-'J 4. Limited Estate ~ 4a. Future Interest Compromise (date of death a~ter 12-12-82) [] 5. Federal Estate Tax Return Required ~-J6. Decedent Died Testate (Attach copy of V~II) ~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes ~ 9. Litigation Proceeds Received ~'~ 10. Spousal Povedy Credit (date of death between 12-31-91 and 1-%95) ~'~ 1 1. Election to tax under Sec. 9113(A)(~,tmc~ soho) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS James D. Hughes, Esquire FIRM NAME (If Applicable) SALZMANN, HUGHES & FISHMAN PC TELEPHONE NUMBER 717-249-6333 95 Alexander Spring Road, Suite 3 Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) ~'] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1 1. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 0 0 0 0 0 11,950 OFFICIAL USE ONLY (8) 11,950 1,336 8,737 (11) 10,073 1,877 0 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 1,877 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousattax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19 Tax Due 20. 0 x.0 0 (15) 0 x.0 45 (16) 0 x .12 (17) 1,877 x,15 HB~ (19) 0 0 0 282 282 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 Decedent's Complete Address: STREET ADDRESS 402 Pine Dale Road C~TY STATE ~P 17013- Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty o 0 14 0 0 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) (1) 282 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 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. A. Enter the interest on the tax due. 14 0 (4) 0 (5) 268 (5A) 0 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (5B) 268 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; ......... r--] ~ c. retain a reversionary interest; or ................................ ~ [~ d. receive the promise for life of either payments, benefits or care? ................. r--] [~ 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ ~ [] 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? ~] [] 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. UnCler penalties of perjury, ~ cleclare that I nave examlne,~ this retum inclucllng accompanying schedules anQ statements an(~ to the best of my I(nowle~ge and belief, it is tn~e, correc~ ano cornDlete OecJaration of preparer other than the persenal representat*~ is based on all information of which preparer nas any Knowleclge. SIGNATURE OF PC;m'~ON RESPON,~IBLE FOR FILING RETURN [DATE ADDRESS The statute (~oes not exempt a transfer to a surwving spouse from tax, and the statutory requirements fo~' disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only banefic~ry. For dates of death on or after July 1. 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-(me 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% [72 P.S, § 9116('a)(1 The tax rate ~moosed on the net vaiue of transfers to or for tne use of the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P.S, § 9116(1,2) [72 P.S. The tax rate imposed on the net value of transfers to or for the use of the dececlent's siblings is 12% (72 P,S. § 9116(a)(1,3)] A sibting is defined, under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or a(~option 3W4646 1.000 REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY Melba M. Heilman FILENUMBER ~fanassetwasmadej~intwithin~neyear~fthedecedent~sdate~fdeath~itmustbemp~Aed~nSchedu~eG~ SURVIVINGJOINT~NANT(S) NAME ~DRESS RE~ONSHIPTODECEDENT A. Baum, David B 402 Pine Dale Road, Carlisle, PA 17013 None JOINTLY-OWNED PROPERTY: · NUMBER 1 2 DATE MADE JOINT 1/1/2000 2/16/1994 DESCRIPTION OF PROPERTY iNCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NLM~F_.R OR SIM~LAR IDENTIFYING NUMBER ATTACH DEED FOR BP, PLC Waypoint Bank, checking account #1700016927 DATE OF DEATH VALUE OFASSET 22,028 1,871 TOTAL (Also enter on line 6, Recapitulation) I $ %OF DECD'S INTEREST 50.000 50.000 DATE OF DEATH VALUE OF DECEDENTS lN~h~=5 11,014 936 11,950 3W46AE 1 000 (If more space s needed, insert additional sheets of the same size) REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Melba M. Heilman FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. 1. 2 3 FUNERAL EXPENSES: Cremation Society Rev. William Groff St. Patrick's Church AMOUNT 96 100 375 Bo 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State ~ Zip Year(s) Commission Paid: Attorney Fees Salzmann, Hughes & Fishman, PC Family 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 Probate Fees Accountant's Fees Tax Return Preparer's Fees Register of Wills 750 15 TOTAL (Aisc enter on line 9, Recapitulation) $ i ,336 3W46AG I 000 (if more space is needed, insert additional sheets of the same size) REV-1512 EX + COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Me'lba H. He'i.lman FILE NUMBER Include unreimbursed medical expenses. DESCRIPTION VALUE AT DATE OF DEATH ITEM NUMBER 1. 2 3 4 Brockie Pharmatech Church of God Home Metro Med Services West Shore EMS Inc. TOTAL (Also enter on line 10, Recapitulation) 873 7,362 370 132 8,737 3W46AH I 000 (If more space is needed, insert additional sheets of the same size) REV-lS~ 3 E~:+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Melba M. Heilman FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I 2 TAXABLEDISTRIBUTIONS[includeoutrightspousaldistributions, andtrans~rs underSec. 9116(a)(1.2)] David B. Baum 402 Pine Dale Road Carlisle, PA 17013 Laurie Baum 402 Pine Dale Road Carlisle, PA 17013 None None :-NTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 0 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0 3W46AI 1 000 (If more space is needed, insert additional sheets of the same size) 7/.a t ilI e tament OF MELBA M. HEILMAN I, MELBA M. HEILMAN, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, in manner and form following: 1. I hereby expressly revoke all Wills and Codicils heretofore made by me. 2. I hereby direct my Executor to pay all my just debts, funeral and administrative expenses out of my estate, as soon as practicable a~ter my death. 3. I direct that all taxes which may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed shall be paid out of my estate as a part of the administration of' my estate. 4. I give, devise and bequeath the remainder of my estate, of whatever nature and wherever situate, to my friends, DAVID B. BAUM and LAURIE BAUM, or the survivor of'them, in recognition of and with gratitude for all of their kindness to me during my lifetime. S. I nominate and appoint my friend, DAVID B. BAUM, as the Executor of this my Last Will and Testament; and should he for any reason fail to qualify or cease to serve in that capacity, I nominate and appoint, as substitute Executor, my friend, LAURIE BAUM. I further provide that my personal representative shall not be required to file any bond or other security in any jurisdiction to secure the faithful performance of his duties nor be required to obtain any order or approval of any Court for the exercise of any power or discretion set forth in this Will. \\MAINSERVERLPUBLICh'oger\wills\Melba Heilman will.doc 6. All income or principal held for the use and benefit of the beneficiaries of this Estate 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 Executor, 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. 7. If any beneficiary of the Estate shall, in the sole opinion of my Executor, be or become mentally or physically incapacitated, by reason of illness, accident, minority or other circumstance, my Executor may apply either income or principal for the support and welfare of such beneficiary directly or to the person who has the care and control of such beneficiary, without the intervention of any Guardian and without obligation to supervise application of said amounts in any way. IN WITNESS WHEREOF, I have hereunto set my hand and seal this [J ~' day of June, 2000. SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: MELBA M. HEILMAN 2 \WIAINSERVER~PUBLIC\roger\willsWIelba Heilman will.do: COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · ss We, MELBA M. HEILMAN, Roger M. Morgenthal, and Steven J. Fishman, the Testatrix 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 testatrix signed and executed the instrument of her Last Will, and that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses, and that to the best of their knowledge, the testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this ! Jday of June, 2000. #OTARIAL SEAL KATHY L. MUIIMERT, NOTARY PUBLIO cu emA,o co., PA COU~i~:;,ON EXPIRES AUGUST 11, 2003 LOOK FOR US. WI?LL GET YOU THERE 9/2/2004 SALZMANN HUGHES & FISHMAN ALEXANDER SPRING RD STE 3 CARLISLE PA 17013 The information which you requested on the account(s) of MELBA A HEILMANN (Social Security Number 184-18-4898) is/are as follows: Account Number 1700016927 Class of Account CHECKING Date Opened 021694 Principal Balance 1871.24 Accrued Interest .13 Balance at Date of 1871.37 Death Account Ownership JTO Name of Joint DAVID B Owner, if any BAUM Date Ownership 021694 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested SENIOR SERVICES REP. P.O. Box 171 I. HARRISBURG. PENNSYLVANIA 17105-1711 JPMorgan September 30, 2004 JACQUELINE L DRAWBAUGH SALZMAN HUGHES & FISHMAN 95 ALEXANDER SPRING RD STE 3 CARLISLE PA 17013 BP~ PLC MELBA HEILMAN & ..DAVID B BAL~,I JT TEN ACCOUNT NUMBER: BZPEL-8283837 Dear Ms. Drawbaugh: Thank you for your recent inquiry regarding the above referenced account. Our records indicate the above account had a balance of 393 shares on July 29, 2004. Transfer instructions are as described in our previous correspondence, copy enclosed. If you have any questions, please contact a customer service representative at 877-638-5672. Reference Number: 01466543 Enclosure(s): Corro Ref 1456114 Sincerely, Steven J Day Correspondent *** Visit Our Website - www. adr. com- *** Worldwide Market Intelligence One Click Away Send correspondence to: P.O. Box 43013 Providence, RI 02940-3013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD O04563 BAUM DAVID B 402 PINE DALE ROAD CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 184-18-4878 FILE NUMBER: 2104- 0985 DECEDENT NAME: HEILMAN MELBA M DATE OF PAYMENT: 10/29/2004 POSTMARK DATE: 1012912004 COUNTY: CUMBERLAND DATE OF DEATH: 07/29/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $268.00 REMARKS: TOTAL AMOUNT PAID: $268.00 SEAL CHECK//1565 INITIALS: RSK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAiI'C&n:;i INHERITANCE TAK DIVISION nu..J I.) L PO BOX Z8060l HARRISBURG~ PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ED C~FlCE Of NOTICE OF INHERITANCE TAX '. V"iJ&RAISE"ENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS ANO ASSESS"ENT OF TAX 200S JMI I 0 All 9: 41 CLERK OF ORPH~N'S CQV,nT " JAMES D HUGHt,tllJfid'.ij' (';. Pi' SALZMANN ETAL 95 ALEXANDER SPG RD 3 CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-03-2005 HEILMAN 07-29-2004 21 04-0985 CUMBERLAND 101 *' REV~1547 EX AFP (09-041 MELBA Amount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ... REV=isW-EX-AFj'--fiiFo3Y-tliiYicniF-YriHERYfiii.fCE-YAX-jrpPRAYSEi'-itli'~--Ai:rciwiiNCE-ifR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HEILMAN MELBA FILE NO. 21 04-0985 ACN 101 DATE 01-03-2005 TAX RETURN WAS: [X I ACCEPTED AS FILED I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: DRIGINAL RETURN 1. Real Estate (Schedule AJ 2. stocks and Bonds (Schedule 8) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable {Schedule OJ 5. Cash/Bank Deposits/Misc. Personal Property {Schedule EJ 6. Jointly Owned Property (Schedule fJ 7. Transfers (Schedule G) 8. Total Assets III 121 [31 (41 151 161 171 .00 .00 .00 .00 .00 11.950.00 .00 IBI APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses {Schedule HJ 10. Debts/Mortgage Liabilities/Liens {Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 191 1101 1,336.00 8.737.00 1111 1121 1131 1141 NOTE: I~ an assessment was issued previously, lines reflect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rat. (15) 16. Amount of Line 14 taxable at Line.l/Class A rat. (16) 17. Amount of Line 14 at Sibling rat. (17) 18. Amount of line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due NOTE: To insure proper credit to your account} sub.it the upper portion of this form with your tax paYllent. 11,950.00 10.073 DO 1,877.00 .00 1,877.00 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. TAX CREDITS: ;;-""s'E'"~ ,+, A"OUNT PAID DATE INTEREST/PEN PAID I-I 10-29-2004 CD004563 14.10 268.00 TOTAL TAX CREDIT 282.10 BALANCE OF TAX DUE .10CR INTEREST AND PEN. .00 TOTAL DUE .10CR .00 X 00 = .00 X 045 = .00X12= 1,877.00 X 15 = 1191= ~? . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 .00 .00 282.00 282.00 IF TOTAL OUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJJ YOU HAY BE DUE<:{ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I ~/\