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Home My WebLink About03-11-13 W 1505610105 EX (m-u) (FI) REVf,-1 500 I, OFFICIAL USE ONLY PA Department of Revenue pennsylvania Bureau of Individual Taxes ---l `"°E County Code Year File Number PO BOX28o6o1 INHERITANCE TAX RETURN Harrisburg, PA 17128-o6o1 RESIDENT DECEDENT ? ~'T ' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 209-60-7715 11/03/2012 08/11/1960 Decedent's Last Name Suffix Decedent's First Name MI Dieffenbach Petra E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Dieffenbach Lewis Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW COD 1. Original Return 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) COD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 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 D1time Telephone3,4 umber Ronald E. Johnson, Esq (t17043-012T m C'> )ca ~ ,F,.GWER OF9NILL. - S - NLY M First Line of Address - 78 West Pomfret Street {.n' -T7 C', -~s N-~ Second Line of Address ry C~p (n 0. DATE FILED City or Post Office State ZIP Code Carlisle PA 17013 Correspondent's e-mail address: rejohnson@pa.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, c rect and comp! Pte. Decl ration of preparer other than the personal representative is based on all information of which preparer has any kn wledge. SI A OF P SIB R ILING RETURN DA DD ESS A -1w o 78 ,West mfret Street, Carlisle, PA 17013 O ER REPRESENTATIVE DATE SS ~OL West Po ~fjrStreet, Carlisle, PA 17103 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 7 i 1 1505610205 REV-1500 EX (Fl) Decedent's Social Security Number Decedent's Name: Petra E. Dieffenbach 209-60-7715 RECAPITULATION 1. Real Estate (Schedule A) 1. ! 0.00 2. Stocks and Bonds (Schedule B) 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. ! 0.00 4. Mortgages and Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 15,646.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6. ! 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... 7. 0.00 8. Total Gross Assets total Lines 1 through 7 8. 15,646.00 9. Funeral Expenses and Administrative Costs (Schedule H) 9. 9,550.58 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) 10. 6,109.23 11. Total Deductions (total Lines 9 and 10) 11. 15,659.81 12. Net Value of Estate (Line 8 minus Line 11) 12. ! -13.81 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 13. 0.00 14. Net Value Subject to Tax Line 12 minus Line 13 14. -13.81 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 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE .........................................................19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Petra E. Dieffenbach STREETADDRESS 133 B Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments 0.00 B. Discount 0.00 Total Credits ( A+ B) (2) 0.00 3. Interest (3) 0.00 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. (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 ❑ E b. retain the right to designate who shall use the property transferred or its income ❑ E c. retain a reversionary interest ❑ E d. receive the promise for life of either payments, benefits or care? ❑ N 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ❑ E 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ❑ 0 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ❑ 0 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)]. 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(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)]. 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. t REV-15o8 EX+ (08-12) T pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Petra E. Dieffenbach 21-12-1246 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. 2012 Kia Rio Sx Hatchback automobile (see attached) 14,891.00 2. HMA - Physician Management - refund 35.00 3. HMA - Physician Management - refund 720.00 TOTAL (Also enter on Line 5, Recapitulation) $ 15,646.00 If more space is needed, use additional sheets of paper of the same size. 2012 Kia Rio SX Hatchback 4D Trade In Values - Kelley Blue Book Page 1 of 3 ZIP CODE: 17013 1 Sign in (or Sign up) home car values I cars for sale I car reviews kbb top picks ( research tools - We'll fired the coverage Popular at KBB.com 3r: ~'AVS 71,7 IT C YC J. The 40 mpg Cars of 2013 ::xsrn, advertisement why ads. Kla Rio 2012 k go Home > Car Values > Kia > Rio > 2012 > Category > Style > Options > SX Hatchback 4D - _ - 8 Your Blue Book Value Show Used Car Prices I Price Your Next Car 2012 Kia Rio Style. SX Hatchback 4D i out You Credit - ` What Influences Credit ScUres, k ~ r:m M s. . 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Hoffman-Roth Funeral Home 5,024.08 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 500.00 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00 Claimant Lewis Dieffenbach Street Address 133 B Street city Carlisle State PA ZIP 17013 Relationship of Claimant to Decedent husband 4. Probate Fees: 111.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Register of Wills - filing fee 15.00 8. Reserve for closing and accounting 400.00 TOTAL (Also enter on Line 9, Recapitulation) $ 9,550.58 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Petra E. Dieffenbach 21-12-1246 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Huntingdon National Bank - automobile loan 6,109.23 TOTAL (Also enter on Line 10, Recapitulation) $ 6,109.23 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Petra E. Dieffenba 21-12-1246 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. Lewis Dieffenbach, 133 B Street, Carlisle, PA 17013 hsuband 100% 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. $ If more space is needed, use additional sheets of paper of the same size. LAST WILL AND TESTAMENT OF PETRA E. DIEFFENBA CH I, Petra E. Dieffenbach, of Carlisle, Pennsylvania, revoke my former Wills and Codicils and declare this to be my Last Will and Testament. ARTICLE I IDENTIFICATION OF FAMILY I am married to Lewis M. Dieffenbach and all references in this Will to "my spouse" are references to Lewis M.. Dieffenbach. The name of my child is Denise M. Braun. All references in this Will to "my children" are references to the above-named child. ARTICLE II PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, funeral expenses and expenses of last illness be first paid from my estate. ARTICLE III DISPOSITION OF PROPERTY A. Specific Bequests. I direct that the following specific bequests be made from my estate. However, such bequests (other than bequests, if any, to my spouse or my children) shall be made only if my spouse, Lewis M.. Dieffenbach, and my children do not survive me. My remaining tangible personal property shall be distributed to Lewis M.. Dieffenbach. If this beneficiary does not survive me, this bequest shall be distributed to Denise M. Braun. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. B. Residuary Estate. I direct that my residuary estate be distributed to my spouse, Lewis M. Dieffenbach. If my spouse does not survive me, my residuary estate shall be distributed to my children in equal shares. If a child of mine does not survive me, such deceased child's share shall be distributed in equal shares to the children of such deceased child who survive me, by right of representation. If a child of mine does not survive me and has no children who survive me, such deceased child's share shall be distributed in equal shares to my other children, if any, or to their respective children by right of representation. If no child of mine survives me, and if none of my deceased children are survived by children, my residuary estate shall be distributed to my spouse's heirs-at-law, their identities and respective shares to be determined under the laws of the State of Pennsylvania, then in effect, as if my spouse had died intestate at the time fixed for distribution under this provision. ARTICLE IV NOMINATION OF EXECUTOR I nominate Lewis M.. Dieffenbach, of Carlisle,Pa., as the Executor, without bond or security. ARTICLE V EXECUTOR POWERS My Executor, in addition to other powers and authority granted by law or necessary or appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or otherwise encumber any real or personal property that may be included in my estate, without order of court and without notice to anyone. My Executor shall have the right to administer my estate using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate coml. ARTICLE VI MISCELLANEOUS PROVISIONS A. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this Will in any gender shall extend to and include all genders, and any singular words shall include the plural expression, and vice versa, specifically including "child" and "children", when the context or facts so require, and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number. B. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, no person shall be deemed to have survived me unless such person is also surviving on the thirtieth day after the date of my death. C. Common Disaster. If my spouse and I die under circumstances such that there is no clear or convincing evidence as to the order of our deaths, or if it is difficult or impractical to determine which person survived the death of the other person, it shall, for the purpose of distribution of my life insurance, property passing under any Trust or other contracts, if any, and property passing under this Will, be conclusively presumed that I predeceased my spouse, and notwithstanding any other provision of this Will, my spouse (or my spouse's estate as the case may be) shall receive the distribution to which my spouse would otherwise be entitled to receive without regard to a survivorship requirement, if any. D. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or nonactions of the fiduciary, except for such actions or nonactions which constitute fraudulent conduct or bad faith. No successor trustee shall be obliged to inquire into or be in any way accountable for the previous administration of the trust property. IN WITNESS WHEREOF, I have subscribed my name below, this day of Testator Signature: All Petra E.Dieffenbach We, the undersigned, hereby certify that the above instrument, which consists of pages, including the page(s) which contain the witness signatures, was signed in our sight and presence by Petra E. Dieffenbach (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in the Testator's sight and presence, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. Witness Signature: Name: Kim Smith City: Landisburg State: Pennsylvania Witness Signature: Name: Phil Smith City: Landisburg State: Pennsylvania Witness Signature: Name: Diane Gray City: Carlisle State: Pennsylvania PENNSYLVANIA Self-Proving Clause COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, Petra E. Dieffenbach, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly and as my free and voluntary act for the purposes expressed in the instrument. Sworn to or affirmed and acknowledged before me by Petra E. Dieffenbach, the Testator, this ,31 day of 00-4 J~C 2ehL Testator Signature Petra E.Dieffenbach u Signa of officer v2~yka1 ~j ~~SL~ c, Official capacity of officer . (Seal) COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL ROLAND L. DOYLE JR., Notary Public Mechanicsburg Boro., Cumberland County My Commission Expires December 31, 2012 s AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, Kim Smith and Phil Smith and Diane Gray the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as the Testator's Last Will; that the Testator signed willingly and executed it as the Testator's free and voluntary act for the purposes expressed in it; that each of us in the hearing and sight of the Testator signed the Will as a witness; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by Kim Smith and Phil Smith and Diane Gray the witnesses, this Ji day of U C't S-~ c-~ i Z Witness Signature: Name: Kim Smith City: Landisburg State: Pennsylvania Witness Signature: l Gf~ 1~' Name: Phil Smith City: Landisburg State: Pennsylvania Witness Signature: Name: Diane Gray City: Carlisle State: Pennsylvania Signature PQ L Seal and official capacity of officer COMMONWEALTH OF PENNSYLVANIA. NOTARIAL SEAL ROLAND L. DOYL- JR., f- ary Public Mechanicsburg Eoro., Cumberland County My Commission Expires Decamber 31, 2012