HomeMy WebLinkAbout04-03-13 (2) J 1505610143
REV-1500 EX(02-11)
PA Department of Revenue y OFFICIAL USE ONLY
p Penns Ivania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 10 0337
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
162 22 1825 03 10 2010 06 18 1929
Decedent's Last Name Suffix Decedent's First Name MI
CARTER SR. DONALD L
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
CARTER MARIAN E
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1, Original Return F 2. Supplemental Return 3 Prior to 12-13-82)
. Remainder Return(Date of Death
4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
X1 8 Decedent Died Testate Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received 10.Spousal Poverty Credit Date of Death 11.Election to tax under Sec.9113(A)
between 12-31291 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 TeleA�one Number
JENNIFER B HIPP =-g7 7-0 8�6.1
�MCPTER OF WILL14SWSE ONLY
i`rl 6M,
First Line of Address G? ;0 7;
7"; C.
1 WEST MAIN STREET ea c' t
Second Line of Address _ z7 t- m
City or Post Office State ZIP Code 5_0E FILED
SHIREMANSTOWN PA 17011
Correspondent's e-mail address:
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.
SIGNATU OF PERSON RESPONSIBLE F R FILING RETURN DATE
Diane M. Freedman v �3
ADDRESS
700 Drexel Hills Boulevard New Cumberland PA 17070
SIGNATURE 0 PREPARER Off THAN REPRESENTATIVE DATE
Jennifer B. Hipp 2
ADDR
1 West Main Street, Camp Hill, PA 17011
Side 1
L 1505610143 1505610143
N 1505610243
nsv'1*uosx
Decedent's Social Security Number
Decedent's Name: Carter, Donald L. Sr. 162 22 1825
RECAPITULATION
1. Real Estate(Schedule/)....................................................................................... 1
o. Stocks and Bonds(Schedule a)............................................................................. u. 6, 397 ^ 30
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
a. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule s)............... s.
6. Jointly Owned Property(Schedule r) F aenorateominnRenueoteu---- 6.
z Inter-vwv Transfers uMiscellaneous NProbate Property
(Schedule G) t senarateemmomenuouteu---- 7.
u. Total Gross Assets (total Lines 1 through 7)........................................................ a. 6,397 , 30
o. Funeral Expenses and Administrative Costs(Schedule H)------------ o. 450 . 00
10. Debts ofDecedent,Mortgage Liabilities and Liens(Schedule V............................ 10.
11. Total Deductions(total Lines o and 1o)................................................................ 11. 450 ' 00
12. momaluevxsstate(Line o minus Line 11 .......................................................... 12. 5 , 947 ' 3Q
13. Charitable and Governmental Bequests/Sec y11xTrusts for which
unolemionootmheonotbeonmado(SoheduleJ).---------------. 13.
14. Net Value Subject tn Tax(Line 1u minus Line 1o)............................................... 1* 5 , 947 ' 30
TAX COMPUTATION'SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14taxable
au the spousal tax rate,o,
transfers under Sec.e116
� OO
(a)(1.o)x�0 10_ . 000_
1s� xmoummune1��^umo
5f947 . 30 10 ��67 ' 63
ounnou|��X .�5_ �
n Amount of Line 14taxable
� OQ
ouonm/no��X.12 ' �� n Q '
18. Amount of' � OO O�
aumm�a�|m�x.10 ' 10� � `
1eTAX DUE................................................................................................................ 1e 267 ' 63
zo. FILL|m THE OVAL|p YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L_��J
Side
U N
K 1605610243 1505610243 N
REV-1500 EX Page 3 File Number 21-10-0337
Decedent's Complete Address:
DECEDENT'S NAME
Carter, Donald L. Sr.
STREETADDRESS
704 Hilltop Drive
CITY STATE ZIP
New Cumberland PA 17070
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 267.63
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) (2)
3. Interest (3) 18.72
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box 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. (5) 286.355
Make Check Pa able 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;.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ F.
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ ❑x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑x ❑
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?.................................................................................................................. ❑ ❑x
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 January 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.
Rev-1503 EX+(6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Carter, Donald L. Sr. 21-10-0337
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 266 shares of Penn National Gaming, Inc.Stock 24.05 6,397.30
TOTAL(Also enter on Line 2, Recapitulation) 6,397.30
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
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http://finance.yahoo.com/q/hp?s=PENN&a=02&b=10&c=2010&d=02&e=10&f 2010&g=d 3/27/2013
0 0 0 1570 45 UPRR1 Substitute Form W-9: By signing below, I certify under
Penn National Gaming Inc penalties of perjury that:(i)the Tax ID number listed below is
CID UPRR,LLC ' accurate(ii)I am not subject to backup withholding and(iii) i am
P.O. Box 2262 a U.S.citizen or other U.S. person.
New York, NY 10116
Soc. Sec#f or Tax I Cy#:
Date or Birth.-
00315D 000157005 OOODOD1807
DONALD L CARTER SR Signature:
704 HILLTOP DR
NEW CUMBERLAND PA 17070 Transfer Instructions
Your properly will be issued in the name shown unless
otherwise instructed below.
(Complete only when changing the account registration)
a. ❑ Shareholder(s)is deceased. Reissue shares as Name:
indicated in the box to the right Replace any Address:
shares not-enclosed and replace any uncashed
dividend checks Cityistaterzip:
(Less processing lee and surety bond premium if cenfcates are lost).
Medallion Signature Guarantee Necessary(Szz Reverse Q&?#2)
b_ F� Sell all the shares and replace any encashed
dividend checks SHARES HELD BY YOU: 266.0000
I Less processing fees and surety bond premium if certificates are losli. U N CASHED CHECKS: Do
Dear Recipient:
Unclaimed Property Recovery and Reporting LLC ("UFP.R")has been retained by Continental Stock Transfer&Trust Company("Continental)to contact
the Penn National Gaming Inc surviving ieinl tenant, relatives or heirs of shareholders who, based upon Social Security records: are deceased. Any
uncashed dividend checks andior the shares associated with the decedent's accourt should be re-issued into the name of the survivor(s) or heiris).
Possibly,the shares are lost and need to be replaced.
Participation in the services provided by UPRR, is voluntary and you will be charged a fee as described below with a )ortior of that lee being paid to
Continental. To utilize UPRR's services you should complete and sign this authorization form and return it, along with any stock certificates that may be
in your possession along with the appropriate documentation as referenced in the enclosure entitled Insfructions for the Transfer of Ownership. You
should expect to receive the property approximately 45 days after returning this letter;a business reply envelope is provided for your convenience, You
may also contact the Transfer Agent,Continental,at 1-800509-5586, andior work with a broker of your choosing.If you work with Continental
andior a different broker,the fees charged may be different from those charged by UPRR.
If you do not respond to this mailing or contact Continental,the property may be subject to escheatmentto the appropriate state as required
under the applicable unclaimed property laws. Information on escheatment can be obtained at www.unclaimed.org
Options
Choose option 2a above if you vAsh to change the account registration. Enclose the cenificate(s)you have along with this signed authorization form
and applkable documentation (see enclosed: fnstruclions far the Transfer of Qvivership). Be sure to com?leie the information in the "Transfer
lastrLi plete-the..Sutst>Ve VV9.infnrM3tl0n 50.621 Sc.^,ilrff;r.hJumbrh r ;0nah_Ire---3nd date of birihl- LIPPRR ,All --
purchase a surety bond on your behalf for the shares not enclosed and instruct Continental to send you a Direct Registration Statement or certificate for
the n&.v shares and any uncashed dividends will be sent to you.
Choose option 2b above if you wish to sell your shares. Enclose the certificate(s) you have along vrith this signed authorization form and applicable
documentation (see enclosed: Instructions for the Transfer of Qwnership). Be sure to complete the information in the"Transfer Instructions Box"
above, and complete the Substitute"-9 information (Owner's Social Security Numbe-, signature and date of birth). UPRR twill purchase a sureb) bond
on your behalf for the shares not enclosed and sell all the shares. A check for the sale proceeds and any uncashed dividends will be sertto yot:.
please indicate your choice above by checking 2a or 2b.
in order to cover the costs of locating you,processing all required documents,arranging for the reactivation of your account or reissuance of
your shares, and/or selling your shares,a processing fee of 20% of the value of the property will be deducted from your proceeds. If you
have lost some or all of your certificates,UPRR will also purchase the necessary surety bond on your behalf,at a cost of 20% of the current
fair market value of the lost securities.The surety bond premium will be deducted from your proceeds.
If you have any questions, please call UPRR at 1-600-859-7145
You must sign and enter your Tax 10#(Item 1 above),elect one of the two options(Item 2 above), and sign below(Item 3).
AUTHORIZATION
I acknowledge and represent that I am a registered owner of the shares with good'tie to the shares and/or have full po?ver and authority to authorize
this transactian, I irrevocably appoint UPRR as my agent livith respect to this transaction in accordance with my election soecriled above. I agree that a
processing fee of 20% is to be paid to UPRR. If I elect to sell all my shares, I authorize UPRR to arrange through UPRR Securities. LLC, its broker
dealer affiliate,to arrange for the sale of all such shares and to arrange to have the fee(s)due and the premium for any necessarf surety bond deducted
from the proceeds and a check for the balance sent to me. If I elect to receive shares, I authorize UPP.R to arrange through UPRR Securities, LLC for
the sale of only those shares necessary to satisPI the fee due and the premium for any necessary surety bond deducted. I acknowledge that my shares
may be bundled with shares of other shareholders when sold, and that the proceeds I receive may be based on the weighted—average price or daily
price for all shares sold by UPRR on that trade date. I hereby attest That a registered broker dealer does not currently employ me.
3 signature of owner Ignature or -ch+ner e:epIrlone umber -mal address
UPRR Securities,LLC is a registered broker-dealer member FINRA,SIPC.
Z'd 6099tiLLL I L b lJosoloin 136C:L £6 OZ qej
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Carter, Donald L. Sr. 21-10-0337
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State ZiD
Year(s)Commission Paid
2. Attornev's Fees Bogar and Hipp Law Offices 420.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 30.00
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 450.00
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Carter, Donald L. Sr. 21-10-0337
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Register of Wills-filing fee for Supplemental Inheritance Tax Return and Inventory 30.00
H-B7 30.00
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Donald L. Carter, Sr. 03/10/2010 162-22-1825
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
1 Glenn Carter Grandson $10,000.00 specific
307 Mountain Road bequest
Lewisberry, PA 17339
2 Nicholas Carter Grandson $10,000.00 specific
307 Mountain Road bequest
Lewisberry, PA 17339
3 Adrianna Blevens Great-granddaughter $10,000.00 specific
1921 Debbie Drive bequest
York, PA 17403
4 Brandyn Blevens Great-grandson $10,000.00 specific
1921 Debbie Drive bequest
York, PA 17403
5 Danielle Blevens Granddaughter $10,000.00 specific
1921 Debbie Drive bequest
York, PA 17403
6 Donald L.Carter,Jr. Son One-third of rest,
10 Drexel Hills Circle residue and remainder
New Cumberland, PA 17070
7 Erick Carter Grandson $10,000.00 specific
10 Drexel Hills Circle bequest
New Cumberland, PA 17070
8 Gregory D. Carter Son One-third of rest,
1006 Hummel Avenue residue and remainder
Lemoyne, PA 17043
9 Jared Carter Grandson $10,000.00 specific
10 Drexel Hills Circle bequest
New Cumberland, PA 17070
1
SCHEDULE J
BENEFICIARIES
(Part I,Taxable Distributions)
ESTATE OF:
Donald L. Carter, Sr. 03/10/2010 162-22-1825
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
10 Lauren Carter Granddaughter $10,000.00 specific
10 Drexel Hills Circle bequest
New Cumberland, PA 17070
11 Alexander Cheyne Great-grandson $10,000.00 specific
3261 Wendlyn Way bequest
Edgewater, MD 21037
12 Jennifer Cheyne Granddaughter $10,000.00 specific
3261 Wendlyn Way bequest
Edgewater, MD 21037
13 Christopher Freedman Grandson $10,000.00 specific
16 Drexel Place bequest. The Register
New Cumberland, PA 17070 of Wills did not accept
the$50,000.00 specific
bequest as noted in the
Last Will and
Testament due to
failure of Decedent to
initial next to
i nterl i neation.
14 Diane M. Freedman Daughter One-third of rest,
700 Drexel Hills Boulevard residue and remainder
New Cumberland, PA 17070
15 Marian Carter Spouse As per Clause Third of
704 Hilltop Drive Last Will and
New Cumberland, PA 17070 Testament. Marian E.
Carter has disclaimed
her interests in this
bequest. See attached
disclaimer.
2
LAST WILL AND TESTAMENT
OF
DONALD CARTER
I, DONALD CARTER of New Cumberland, Cumberland
County, Pennsylvania, being of sound mind, memory and
understanding, do hereby make, publish and declare this as and
for my Last Will and Testament, hereby revoking all other wills
and codicils heretofore made by me.
FIRST
I direct the payment of my debts and the expenses of my
last illness and funeral from my estate as soon after my death as
conveniently may be done. 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.
SECOND
I give, devise and bequeath the amount of Ten Thousand
($10, 000 . 00) each to each of my grandchildren and great-
grandchildren as survive me. x-570.LDM :TD -to Ch rl S rPt eedw&"-
THIRD
In the event I am survived by my wife, Marian Carter, I
give, devise and bequeath any and all funds owed to me at the
time of my death, of whatever nature, secured or unsecured, to
o4luc M . I--1261ED i4 d as TRUSTEE, under the following
conditions :
A) My Trustee shall hold the principal of the
Residuary Trust in one under the following terns and conditions :
1 . My Trustee shall pay to or for the benefit of my
wife Marian Carter all principal or interest payments received
from the debts owed to me as assigned to the TRUST. In addition,
I give my TRUSTEE the right to use any further sums of money
available in said trust for the health, safety and welfare of my
wife, Marian Carter, taking into consideration such assets as are
otherwise available for this purpose.
2 . Upon the death of my wife, Marian Carter, my
Trustee shall terminate the trust and distribute the remaining
assets of the trust in equal shares to my sons Donald L. Carter,
Jr. and Gregory D. Carter and my daughter, Diane M. Freedman.
3 . in the event any of the designated residual
beneficiaries under this Paragraph THIRD shall predecease the
termination of the Trust identified in this Paragraph THIRD, I
direct that the share of the said decedent sha11 be vested in the
person or persons other than to the child' s creditors, estate, or
the creditors of the beneficiary' s estate, in such proportions
and subject to such trusts and conditions, as such beneficiary
shall appoint by specific reference to this power in his or her
will., or if such power is not exercised in full, the unappointed
residuary assets in the Trust shall be distributed to such
deceased beneficiaries , issue, per stirpes; provided, however,
any portion of such Trust which would be distributed to any
beneficiary for whom a trust is then held hereunder shall be
added to such trust .
B) Should the principal of any trust herein provided
for be or become too small in my Trustee ' s discretion to make
establishment or continuance of the trust advisable, my personal
representative or Trustee may distribute the remaining principal
and any accumulated or undistributed income outright to the
beneficiaries in the proportions to which they are then entitled.
The receipts and releases of the distributees will terminate
absolutely the rights of all persons who might otherwise have
future interest in the trust, whether vested or contingent,
without notice to them and without the necessity of filing an
account with the court .
C) In the event my said Trustee shall, for any reason,
fail to so serve, I appoint
as successor Trustee hereunder.
FOURTH
I give devise and bequest all of the rest, residue and
remainder of my estate of whatever nature and wherever situate in
as nearly equal shares as practicable to my sons Donald L.
Carter, Jr. and Gregory D. Carter and my daughter Diane M.
Freeman of Cumberland County, Pennsylvania. If I am not survived
by any of such children, I direct that his or her share be
divided in as nearly equal shares as practicable among his or her
children.
FIFTH
Any and all payment or payments of any sun or sums,
whether in cash or in kind and whether for principal or income,
payable hereunder 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.
SIXTH
I appoint my children Donald L. Carter, Jr . , Gregory D.
Carter and Diane M Freeman Co-Executors of this my Last Will and
Testament . Further, I direct said Co-Executors utilize my
attorney, Steven J. Fishman, of Carlisle, Pennsylvania for such
services as are legally necessary to settle my estate.
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 three of which bears my initials or
signature in the margin for the purpose of identification, this
day of 9 March, 2010 .
`��.Q N, (seal)
DONALD CARTER
Signed, sealed, published and declared by the above named
testator, DONALD CARTER, 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 witnesses.
DRESS GAO :wC LGet°i (ft
l /7e7 aU
ADDRESS
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
We, DONALD CARTER,
and , 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 day
of 2010 .
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