HomeMy WebLinkAbout02-12-131505610105
REV-1500 Ex X02-11' ~~' ~
OFFICIAL USE ONLY
PA Department of Revenue pennsytvania
OEVARTNENT O(REVENUE County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 nn
Harrisburg, PA 1~i2E-o6oi RESIDENT DECEDENT of ~ ~~ Il b~ _ ,
ENTER DECEDENT INFORMATION BELOW
ial Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
~ 10/25/2012 ~ 06/26/1917 _------T-_...---- ^` -_-
i
Decedent's Last Name Suffix Decedent's First Name MI
~__._ ~.._.____~.__._.__..~~~.~..___~..___.______.___..__._.____._....____k_ P_..__._._
Mentzer ~ i Dale ~~
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name _ MI
f ~
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Retum O 2. Supplemental Return O 3. Remainder Return (Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
Cif 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
David A. Baric, Esquire i (717)49-6873 ::;~
~
~ r.+..A
f~ R OF WILi~ USE L47
m z n m ~
First Line of Address
r--- ~ 3~ r"' f--+ ~
~
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Baric Scherer LLC ~ ~ N ~ C~
A~
~
Second Line of Address ~ ~ ~ ~ ~
i 19 West South Street ~ ~' ~~
City or Post Office State ZIP Code
""'~ DATE FILED I""'
Carlisle ~ r--------, -
PA I 17013 ___..._------ ----..-_...___-- ,
w ~
Correspondent's a-mail address: dbaric@baricscherer.com
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.
SIGN/~2E OF PERSO I~RESPONSI$4E F~~Ii~lr.! TURN
/L~/ 'DATfl a~ "~
a[
ADDRESS
On raharq ad Newville, P sylvania 17241
SIG F EPAR ROT TH ESENTATIVE DATE ~ ^
dC
~
AD ESS
19 West South Street, Carlisle, Pennsylvania 17013
PLEASE USE ORIGINAL FORM ONLY
1505610105
Side 1
Lsos61o1os J
~~
J
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name:
RECAPITULATION
1. Real Estate (Schedule A) ............................................. 1. ~ ~.. I
2.
Stocks and Bonds (Schedule B) .......................................
2. I
3.
Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .....
3. I
4. Mortgages and Notes Receivable (Schedule D) ........................... 4. ~
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ 14 372.00
--;
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. i 94,481.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8.
Total Gross Assets (total Lines 1 through 7) .............................
8. ; 108 853.00
~
9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ~ 10,906.68 ~
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 0.00
I
11. Total Deductions (total Lines 9 and 10) ................................. 11. 10,906.68
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 97,946.32 f
13.
Charitable and Governmental Bequests/Sec 9113 Trusts for which i
an election to tax has not been made (Schedule J) ........................ 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 97,946.32
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_ ~ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 45 97,946.32 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 I 18.
19. TAX DUE .........................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~
Side 2
L 1505610205 1505610205 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
DECEDENTS NAME
Dale. W. Mentzer
STREET ADDRESS
One Graham Road
CITY
Newville STATE
PA ZIP
17241
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount
3. Interest
6,268.00
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.
(1) 4,407.58
Total Credits (A+ B) (2) 6,268.00
(3)
(4) 1,860.42
(5)
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 .......................................................................................... ^
b. retain the right to designate who shall use the property transferred or its income ............................................ ^
c. retain a reversionary interest .............................................................................................................................. ^ ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^
2. If death occurred after Dec. 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 security 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.
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)J.
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)J. 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(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-iso8 EX+ (o8-iz)
~ Pennsylvania SCHEDVLE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Dale W. Mentzer 21-12-1166
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.
If more space is needed, use additional sheets of paper of the same size.
REV-i5og EX+ (01-10)
~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
-------
ESTATE OF: FILE NUMBER:
Dale W. Mentzer 21-12-1166
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A• Bonie R. V~It One Graham Roa daughter
Newville, Pennsylvania 17241
B.
c.
70INTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET °h OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
i A %
. . Orrstown Bank; Acct. No. xxxxxx00575 188,962.00 50 94,481.00
TOTAL (Also enter on Line 6, Recapitulation) $ 94,481.00
If more space is needed, use 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
Dale W. Mentzer 21-12-1166
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
L
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Names} of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
7,511.00
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,000.00
Claimant Bonnie R. Wilt
Street Address One Graham Road
city Newville state PA ZIp 17241
Relationship of Claimant to Decedent daughter
4. Probate Fees: 115.00
5. Accountant Fees:
6. Tax Return Preparer Fees:
~~ Sentinel obituary 48.00
s. The Sentinel (legal advertising) 157.68
9. Cumberland law Journal (legal advertising) 75.00
TOTAL (Also enter on Line 9, Recapitulation) ~ 10,906.68
If more space is needed, use additional sheets of paper of the same size.
OF
DALE W. MENTZER
I, Dale W. Mentzer of Cumberland County, Pennsylvania, do hereby declare this to be my
Last Will and Testament and hereby revoke all Wills and Codicils previously made by me.
ITEM ONE: I direct the payment of my debts and the expenses of my last illness and
a
funeral from my estate as soon after my death as conveniently may be done. If there be no
cemetery lot available for my interment, owned by me at the time of my death, I authorize my
personal representative to purchase such cemetery lot with a contract for perpetual care, using
therefor funds from my estate, and I authorize my personal representative to cause title to or
ownership of such lot so purchased to be vested in such person as my personal representative
shall designate.
Further, in this connection, I authorize my personal representative to expend funds
from my estate, in such amount as my personal representative shall consider necessary and
desirable, for the purchase, erection and inscription of a suitable marker for my grave.
ITEM TWO: I give, devise and bequeath such of my personal property as may be listed
on a signed and dated memorandum kept with my Will to the persons named thereon, provided
they survive my death. Should such a memorandum not be found with my Will, it shall be
conclusively presumed that none was prepared, and all of my personal property shall pass
according to the remaining provisions of this Will.
ITEM THREE: I give, devise and bequeath rest, residue and remainder of my estate of
whatever nature and wherever situate to my daughter, Bonnie R. Wilt, per stirpes. I am
specifically not providing anything through my estate for Curtis J. Shearer, Jr.
ITEM FOUR: I direct that no trustee, executrix or other fiduciary named, nominated, or
appointed by this my Last Will and Testament shall be required to post any bond or give any
security of any type for any purpose whatsoever, any law or rule of the court of the
Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. I
direct that the law of the Commonwealth of Pennsylvania shall apply to any interpretation or
application of the validity of this instrument.
ITEM FIVE: My executrix and trustee shall have the following powers in addition to
those vested in them by law and by other provisions of this Will, applicable to all property, real,
personal or mixed and wheresoever situate, including property held for minors, whether principal
or income, exercisable without court approval, and effective, with respect to each item of said
property until actual distribution thereof.
A) To retain, as investments of my estate or trust, any or all assets of my
estate, real, personal, or mixed, without regard to any principal of diversification, and to purchase
and acquire real or personal property and to hold any or all of such real and personal property
retained or acquired without making the same productive of income.
B) To permit the child, or any of them, to occupy any real estate retained or
acquired upon such terms and conditions as my executrix or trustee shall deem proper.
C) To pay all taxes, charges and expenses of maintenance, upkeep,
improvements, development, protection, preservation and investment of any retained or acquired
real or personal property, such payments to be made from either principal or income as my
executor or trustee shall determine.
D) To retain or invest any and all funds, whether principal or income, in any
real or personal property without restriction to legal investments; to purchase investments at
premiums; to exercise all rights of a security holder or share holder in any corporation; and to
lease, mortgage, pledge, give options upon or sell at public or private sale and without approval
of any court, any real or personal property, or portion or portions thereof, irrespective of the
manner or the means by which the same was acquired by my said executrix or trustee.
E) To make payment or distribution herein provided for in cash, kind or
partly in cash and partly in kind, at valuations fixed by my executrix or trustee at the time of
distribution.
ITEM SIX: Any and all payment or payments of any sum or sums, whether in cash or in
kind and whether for principal or income, payable to an heir, or any of them, shall be made upon
the sole receipt of the respective individual to whom the payment is made, and free from
anticipation, alienation, assignment, attachment, and pledge, and free from control by the
creditors of-any such beneficiary.
ITEM SEVEN: I appoint my daughter, Bonnie R. Wilt, Executrix of this my Last Will
and Testament. Should my said Executrix fail to survive me or for any reason fail to qualify as
Executrix, I then appoint my granddaughter, Crystal L. Seiders, Executrix of this my Last Will
and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, consisting of four (4) typewritten pages, the first two (2) of which bear my
signature in the margin for the purpose of identification, this the ~~ day of ~0 5 ~ s~ , 2011.
D ~ (SEAL)
Dale W. Men er
Signed, sealed, published and declared by the above named testator, Dale W. Mentzer, as
and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and
presence, and in the sight and presence of each other, have hereunto subscribed our names as
~~WV~/l/•~"iVV~ ADDRESS /l ///i U~"~„~l ~ G""_ ""~ ~//~./
,~,'-w^'-` ~.~'r ~ ~~~ ADDRESS ti;~ ~~~ ti, - -t ~ ~ ~'\ c.d ,~~' ~~'-~ ~U C~~' r
4
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
We, Dale W. Mentzer, i~ l ~ ~ . ~ Q Y ~ ~ and ~..-~ ~' ~ ~ ~ n C' e~-~-- ,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 of his Last Will and Testament, and that he signed willingly
and that he executed 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 witnesses,
and that to the best of their knowledge, the testator 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 the ~ ~~ day of ~- ^ 5 .~` , 2011.
~~
COMMONWEALTt10F PENNSYLVANIA
Notarial Seal
Triaa D. Naybr, Notary Public
CarNsle 8oro, Cumberland County
My Commission Expires Oct. 2, 2014