HomeMy WebLinkAbout05-24-13 REV-1500 Ex(02-11) 1505610143
PA Department of I& OFFICIAL USE ONLY
Revenue pennsylvania
Bureau of Individual Taxes 0EPAoNvEK of REVENUE County Code Year File Number
PO BOX.280601 INHERITANCE TAX RETURN 21 12 01237
Harrisburg,PA 17126-Ml RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
11 17 2012 09 07 1917
Decedent's Last Name Suffix Decedent's First Name MI
STAUB THELMA K
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
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 ❑ 2. Supplemental Return ❑ 3.Remainder Return(Date of Death
Prior to 12-13.82)
❑ 4. Limited Estate ❑ 41.Furors v erect C ase 5. Federal Estate Tax Return Required
(date of dam after 12f2e2) ❑ �
6. Decedent Died Testate ❑ 7 Decedent Maintained a Living Trost B. Total Number of Sale Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust) . e to
❑ a. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 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 T"phone Number
DAVID C SMITH 717 88COp'
F.,ttm n'x
REGIS&I F WILLS'E OK"Y u
rrr First Line of Address V) :`j —C ry rri
754 EDGEGROVE ROAD e5 C lI
Second Lino of Address ,i --- FV.) ^`;
GO City or Post Office State ZIP Code DATE FILM
HANOVER HA 17331
Correspondent's e-mail address: dcsmithlaw @comcast.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,correct and complete.Declaration of preparer other than the personal repnesenta6ve is based on all information of which preparer has any knowledge
BIG R OF PERSON RESPONSIBLE FJ)R FILING RETURN DATE
Thomas R. Staub
1RODRESS
202 S.Oxford Avenue,McSherrystown,PA 17344
SIGNATURE OF ` OTHER THAN REPRESENTATIVE DATE
ADDRESS Smith
David C Sm
David C. Smith,Attorney
754 Edgegrove Road, Hanover,PA 17331
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
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&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property 17 , 506 . 6 6
p p rty(Schedule E)................ 5.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7. 238 , 848 . 78
8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 256 , 355 . 44
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 5 , 674 . 79
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10.
11. Total Deductions(total Lines 9 and 10).................................................................. 11. 5 , 674 . 79
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 250 , 680 . 65
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to lax has not been made(Schedule J)................................................. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 250 , 680 . 65
TAX COMPUTATION-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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 250 , 680 . 65 16. 11 , 280 . 63
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. 11 , 280 . 63
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑X
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21 - 12 - 01237
Decedent's Complete Address:
DECEDENT'S A
Staub, Thelma K.
STREET ADDRESS
Maplewood Assisted Living
5525 Wilson Lane
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 11,260.63
2. Credits/Payments
A- Prior Payments 10,750.00
B. Discount 564.03
Total Credits(A +B) (2) 11,314.03
1 Interest
(3) 0.00
4, If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. (4) 33.40
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)
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;.............-.................. .......................... x
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest;or.........__..............-.............._..._......._......................__...__..............._..... x
d. receive the promise for life of either payments,benefits or care?.............................................................. FAI
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?.,....... ❑ 0
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.
u'
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)(1)].
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)(rr)), The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and fling 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 chili 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 p2 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.59116(a)(1.311. 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.
pennsylvania SCHEDULE E
DEPARTMENT OF CASH BANK DEPOSITS AND MISC.
INHERITANCE TAX RETURN RN f
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF Staub, Thelma K. FILE NUMBER 21 - 12 -01237
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 ACNB Bank, Checking Acct.#2050 17,256.66
2 Misc. Personal Property 250.00
TOTAL(Also enter on Line 5, Recapitulation) 17,506.66
IREV-151➢EX+(")
pennsylvania
DEPARTMENTOF REVENUE SCHEDULE Oi
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF
Staub,Thelma K. FNUMBER
21 - 12-01237
This schedule must be completed and filed If the answer to any of questions 1 through 4 on Page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECD'S (IF APPLICABLE) TAXABLE VALUE
py
and Me date of transfer. Attach a co of Me deed for real estate. INTEREST
1 Thrivent Acct#x)=0719(DOD Value) 238.E-78 100% 0.00 238,848.78
Payable to Thomas R.Staub, Raymond F.Staub&
Paul G. Staub,surviving children of decedent, equally
TOTAL(Also enter on line 7,Recapitulation) 238,848.78
i
REV-151i EX*(10-09)
*' Pennsylvania �1��� S♦C�H�ECIL LE1�H�A.�
DEPARTMENT OF REVENUE ��ALEAM
INHERITANCE TAX RETURN
RESIDENT DE A AMSM7WwwM
ESTATE OF Staub, Thelma K. FILE NUMBER 21 -12 -01237
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Murphy Funeral Home- Prepaid 0.00
2 Funeral Reception 1,428.90
3 ( Codori Memorials-Headstone Lettering 180.00
B. ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Name of Personal Representative(s)
Thomas R. Staub 1,000.00
Street Address 202 S. Oxford Avenue
City McSherrystown State PA zip 17344
Year(s)Commission Paid
Z Attorney's Fees David C. Smith, Esq. 2,500.00
3, 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
4, Probate Fees Register of Wills 235.00
Filing Fee- Rev 15001 Inv. 30.00
Filing Fee-Family Settlement Agmt, 20.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7, Other Administrative Costs
1 Estate Advertisement-Cumberland Law Journal 75.00
i
TOTAL(Also enter on line 9,Recapitulation) 5,674.79
COLO
Vic Sch�leH
Funeral E> g&
COMMONWEALTH INHERITANCE TAX RE 5YLVANIA A .n �continued�
INHERITANCE EC RETURN MY1Y
RESIDENT DECEDENT
ESTATE OF Staub. Thelma K. FILE PLUMBER
_ 21 - 12 -01237
2 Estate Advertisement-Carlisle Sentinel 200.00
3 Postage 5.89
Page 2 of Schedule H
REV-151'31!0(01-10)
Iffpennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERTANCE TAX RErURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Staub,Thelma K. 21 -12-01237
NAME AND ADDRESS OF PERSON RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
5
NUMBER RECEIVING PROPERTY ( ) DECEDENT UnTrusTrustee(s)
(Words) ($$$)
DO
i, TAXABLE DISTRIBUTIONS[includeoutrightspousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Thomas R. Staub Son 1/3rd Sch.G; 1/4th
202 S.Oxford Avenue Residue
McSherrystown, PA 17344
2 Raymond F.Staub Son 1/3rd Sch.G; 1/4th
315 N. Middlesex Road Residue
Carlisle, PA 17013
3 Paul G. Staub Son 1/3rd Sch. G; 1/4th
1724 Sheeptown Road Residue
Mechanicsburg, PA 17055
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1560 COVER SHEET 0.00
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
-"
RESIDENT DECEDENT RN BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Staub,Thelma K.
21 - 12-01237
NAME AND ADDRESS OF PERSON RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER RECEIVING PROPERTY (S) DECEDENT (Words) ($$$)
Do Not List Trustea(s)
I, TAXABLE DISTRIBUTIONS[include outright spousal
dlstnbutions and transfers
under Sec.X116(a)(1.2)]
4 Kathryn Roat Granddaughter 1/16th Residue
32 N. Enola Drive
Enola, PA 17025
5 Annette Colgan Granddaughter 1/16th Residue
355 Ridge Avenue
McSherrystown, PA 17344
6 Krista Lookenbill Granddaughter 1/1 6th Residue
429 North Street
McSherrystown, PA 17344
7 Thomas Hufnagle, III Grandson 1/16th Residue
306 W. Hanover Street
Hanover, PA 17331
Page 2 of Schedule J
LAST WILL AND TESTAMENT OF MIKA K. STAUB
I, Thelma K. Staub, of the Borough of McSherrystown, Adams
County, Pennsylvania, do hereby make, publish and declare the follow-
ing as and for my last will and testament, and I do hereby revoke
and declare void any will or wills by me at any time heretofore made.
FIRST: I direct that all my just -debts, funeral expenses I
and administration expenses shall be paid from the assets of my
estate. I direct that all federal, state and other death taxes
payable by reason of my death, with respect to the property forming
my gross estate for tax purposes, whether or not passing under this
will, including any interest or penalty imposed in connection with
such taxes, shall be considered a part of the expense -of the adminis-
tration of my estate, and shall be paid from the residue of my
estate, without apportionment or right of reimbursement. All such
taxes on present or future .interests shall be paid at such time or
times as the personal representative. of ,my estate deems best,
regardless of when such taxes are due.
SECOND: I give, bequeath and devise all of the rest,
residue and remainder of my estate, both real and personal property,
of whatsoever kind and nature and wheresoever situate, to my husband,
Robert F. Staub, if he survives me for a period of at least thirty
(30) days.
THIRD: If my husband, Robert F. Staub, fails to survive m
for a period of at least thirty (30) days, I give, bequeath and
devise all of the rest, residue and remainder of my estate, both
real and personal property, of whatsoever kind and nature and where-
soever situate, in equal shares"to such of my children as may be
living at the time of my death and to the issue then living of such
of my children as may then be deceased, per stirpes.
1"Fielma K. at ub
FOURTH: I appoint Adams County National Bank, with an
office in McSherrystown, Pennsylvania, guardiann of any property
which passes either under this will or otherwise to a minor and
with respect to which I am authorized to appoint a guardian and
have not otherwise specifically done so. Such guardian shall have
the power to use principal as well as income from time to time for
any such minor's education, support and welfare, and to make payment
for these purposes to such minor or to any person or persons pro-
viding education, support or services for such minor without obtain-
ing the approval of any Court whatsoever.
FIFTH: I appoint my husband, Robert F. Staub, executor
of this my last will. Should my said husband fail to qualify or
cease to act as executor, I appoint my son, Thomas R. Staub,
executor of this my last will. I direct that neither my said
husband nor my said son shall be required to give bond in order to
qualify as or perform the duties of the personal representative of
my estate in any jurisdiction. I authorize amd empower my personal
representative to sell any or all of the assets of my estate, both
real and personal property, at public or private sale or sales, and
to make, execute, acknowledge and deliver unto .any purchaser or
purchasers thereof good and sufficient deeds and bills of sale for
the transfer and conveyance thereof.
IN WITNESS WHEREOF, I, Thelma K. Staub, the testatrix,
have to this my last will and testament, subscribed my name and
affixed my seal this.z/ -day o f 1952; this
V/
4(
Thelma Stauo "
I
will being typewritten upon three (3) sheets of paper which are
affixed together and each of which bears my signature at the bottom
thereof.
(SEAL)
_...a. n. .�l.aliD
Signed, sealed, published and declared by the
above
named
inathe as and
Of us; who in her presence and presence
and in the presence oP each othert have hereunto
subscribed our names as witnesses thereto.
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David c Smith
754 Edgegrove Road Attorney at Law
Hanover, PA 17331 - Phone: (717) 630-8880
Fax: (717) 630-8867
Hours by Appointment
May 23, 2013
Glenda Farmer Strasbaugh
Register of Wills
One Courthouse Square, Rm. 102
Carlisle, PA 17013
RE:Thelma K. Staub Estate; File No. 2112-01237
Dear Register,
Enclosed herewith please find the following:
1) an original and one (1) copy of the Inventory for the above referenced estate;
2) an original and one (1)copy of the Rev. 1500 PA Inheritance Tax Return;
3) a check in the amount of$30.00 representing the filing fee for the above documents;
4) a return SASE.
Please file the Inventory and Rev. 1500 in the normal course and return a clocked-in
copy of the Inventory and a receipt for the filing fee in the return SASE provided.
Thank you!
fiery trular yours,
David C.Smith
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