HomeMy WebLinkAbout06-17-13 1 1505610105
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REV-1500 �' o�,�a���o„�Y
PA Department of Revenue �^n'��a ��ry� Year Fli e Numbe�
eureauoflndiv�dua�7a�ces INHERiTANCE TAX RETURN
�aoXZ�o� i--2i—� f %3� � /9�
Harrisburg,PA iyv806oi RESIDENT DECEDENT
ENTER DECEDEhT INFORMATION BELOW
Social Secudty Number - Date of Death MMDDYriY Date of Birth MMODYYYY
f'"�_
+ �01262013 � 08051922
' DecedenPs tast Name Suffix DecedenCs First Name �Mt
jWIISON MR RII CH D 'i F {
— l�_J
(H Appliwble)Enter Surviving Spouse's IMOrmation Below
Spouse's Last Name Suffix Spause s First Name � M� -
{� � � � � ❑
Spouse's Socia�Security Number T►11S RETURN MUST BE FILED IN DUPLICATE WITH THE
C_�.� � REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW `
,_� 1.Original Retum �;� 2.SupplemeMaf Retum �� 3.RemairMer Retum(Date of Death
Prior to 12-1382)
�� 4. Limited Estate , �� 4a.FuNra lotaras{Compmmise(date of i�� 5. Federal Estate Taz Retum ReQUireC
death afler 12•12-82)-
� 6. Decedent DieA Testate �� 7.Decedent Malntained e Livi�Trust o 8. Totaf Number af Safe Deposit Boxes
(Attach Copy of Will) (Attach CopY of Trust.j .
�� 9. LitigaAon Proceeds Received !� 14 Spousal Poverty Gedit(Date of Death • ��� 17. Eledion fo Tax under Sec.9N3iA)
Between 12-31-91 and 1-b95) � � (Attach Schedule O)
CORRESPON�ENT- THIS SECTtON MUST BE COMVLEiED.ALL CORRESVON�ENCE AND CONFIDENTIAL TA7(INFORMATION SHOULD BE DIRECTED T0:
Name �Da'ytime Telephone Number
DONALD L. SUTHERLEN �717-7663585
REGISTER OF MiILLS USE ONIV
First Line olAddress a � ;
1409 FROST RD. � `" m .� '
� ° �- � o
Second Une of Address �a � Z N �U
i m c� ..1 v
� . � n r � m m
r�� r z re Flt�n � o.
City or Post Office � State LP Code ,
r--'� �z--'_�` i
�MECHfWICSBURG _—_—� LPA � 17055 . , � c o] � � -� ,
o �� �
� � r= m .
co.resPondenrs e-mau address:sutherlen(a�msn.com -t, � F� � o ;
UrMer peneWes o(paQury,l GeGere Ihat I heve e�mined thls retum,Intluding eaompanying schedules end statements, A to Ne best at ad9e and bellef�, �
it k Wa,corted end cmnpleta.Dedarellon ol preparer oiher than t�e personal representafive is based o�ell inlortnatlon M whlch preparer has eny knowledge.
SIGN RE OF P S RES SI O REN � /DATF���/�'
!O �
/ � d, / O,J -S/��
SIGNATURE OF PREPARER OTHER THAN REPRESEMATIVE DATE
AODRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 �
�
,
J 1505610205 �
REV-1500 EX(FI)� '
DecedenPS Social Securiry Number -
oecedenesName: RICHARD F.WILSON �
� RECAPITULATION - � � ,
� . . �_.-�__-__ �-� ..
. 1. Real Eslate(Schedule A). .......:
.................................... 1.j j
' 2. Stocks and Bonds(Schedule B) ....................................... 2.j � �
r-
- 3. Closefy Heid Corporation,Partriership or Sole-Pmprietorship(Schedule C) ..._. 3. ( ( ,
�
4. Mortgages and Notes Receivable(Schedule D)........................... 4 � I
tf- i
5. Cash,Bank Deposiis and Miscellaneous Personal Property(SChedule E).-..-.. 5. i � �
6. Jointfy Owned Pmperty iSchedule F) m Separate Billing Requested ....... 6. � 17907.30 (
7. lnter-Vvos Trans/ers 8 Misceilaneous Non-Probale Property � � �
(Schedule G)- �^ Separate Billing Requested........ 7.
8. Sotal Gross Assets(total Lines 1 thmugb 7)................�:............ 8. �7��f 7„�
9. Funeral Expenses and Adminisirative CosLs(Schedule H)................... 9. � 15489.61 , .
� i
10. Debts oi Decedenk Mortgage Lia6ilNes and 4iens(Schedule I)............... 10. { 2823.43'
� � t
11. 7otal Deduetions(tofal Lines 9 and 101................................. it.1 18313.04
72. Net Value of Es[ate(Line 8 minus Line 71) .............................. 12.�_ -405.74
13. CharifaWe and Govemmerrtal Bequests/Sec 9113 Trusis for which �
an election to fax has not been made(Schedule J) ........................ 13.� I
j �
14. Net Value Sub ect to Taz(Line 72 minus Line 13) ........................ 14. ' � ��
� 1
TAX CAICULATION-SEE INS'[RUCiIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable -
at ttie spnusat ts�c rate,or � � - . -
6ansfers under Sec.9116 ry �_.�-"-..-�--��-`--} ; - � '
� (a)(12)X.0_ � I 15.�._^�
16. �Amount of Line 14 taw�6le
at lineal rete X.0_ �' 76. _ �
77. Amount M Line 14 taxaWe
at siMing rate X.12 l 17.
18. Amount nf Line 14 ta�cable � �
at wllateral rate X.15 18- �
_�._.______--...-.-�_.__- �
� 19. 7AX DUE ......._................................................ '19. � J
20. FfLL iN THE OVAL IF YOU ARE REQUES7ING A REFUND OF AN OVERPAYMENT i�� �
Side 2
� 15056102i15 1505610205 J
REV-1500 EX(Fl) Pagfl 3 Ffio Numhcr
Decedent's Complete Address:
�EGEOEM'S NAME
RICHARD F.WII.SON
sTREETAD�RESS
1409 FROST RD.
cro sTnh Da
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Taz Due(Page 2,Line 19) {tl 0
2. CreditslF'aymeMs 0
A Prior Paymenis
s.o�m �
Total Credils(A*B) (2) 0
3. Interesl
(3) 0
4. fl Line 2 is greffier ihan Line 1 +Line 3,enter the diNerence. This is the OVERPAYMENT.
Ffll fn oval on Page 2,line 2�to request a refund. (4) 0
5. If Line 1+line 3 is greater ihan Line 2,enier the diiference,This is the TAJi DUE. (5) 0
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 Vansfer and: Yes No
a. retain the use or income oi Ne property transferted.......................................................................................... ❑ �
b. retain the right to designate who shall use the property tr2nsfeRed or iGS income ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. rece'rve the promise for IHe ot either payments,benefrts rn care?...................................................................... ❑ �
2. if death occurted after Dec. 12.1982,did decedent transfer property within one year of death
without receihng adequate considerationl.............................................................................................................. ❑ �
3. Oid decedent own an"in Wsi(o�or payable-upon-0eath bank acwunt or secunty at hfs or her death?.............. ❑ �
d. Did decedent mm an indrriduat retiremenl acwunt,annuity or atfi�v riarpTObate property,which
ooMains a benefidary designalion? ...._.................................................................................................................. ❑ �
1F Tt1E ANSYIIER TO ANY OF THE ABOVE QUESTlUNS IS YES,YOU MUST COMPLETE SCHEDULE G AND FlLE R AS PART OF THE RETURN.
�-- --_ ___�, - - -- -� -- - - ------- - - -,- - - - '�}
For dates of death on m after Juiy 1,1994,and be}rne Jan.1,1995,fhe tax rate imposed on the net value of transfen to or im fhe use of the surviving spouse
is 3 percent[72 P.S.Q9116(a)(t.t)()].
For dates of deaih on or aRer Jan. 1, 7995, the tax rate imposed on the net value af transfers ta or for the use of fhe survihng spouse is 0 percent
(72 P.S.§9116(a)(1.1)(i)).The statute dces rrot ezempt a transfer to a surviving s�ouse irom tax,and the slaMay requirements fnr disdosure of assets and
filing a tax retum are stilf appGp6le even if ihe surviving spouse is the only benefidary.
For dates of death on a after Juy 1,Z000:
. The Wx rate imposed an the nei value oF transfers from a deceased chld 21 years af age or younger at death to or for the use of a natural parent,an
adop8ve parent or a stepparent of the child is 0 percent(72 P.S.§9f 76(aH1.2�].
• The tax rate imposed on the net value ot transiers to or for fhe use of tl�decedenYs lineal benefidaries is 4.5 percent,except as noted in(72 P.S.§9116(a)(t)].
. The tax iate imposed on the�t value of ba�sfers to or for the use oi fhe decedem's sblings is 12 percent(72 P.S.§9116(a)(1.3)].A si6ting is defined,
under Section 9102,as an ind'rvidual who has at teast one parent in common with tha decedent,whether by bfood or adoption.
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REV-I�J fX+(01-10) .
` �:pennsylvania _ SCNEDULE F�
OEPAPTMEnTOFREVEMUE � � �� ' � �
MMERITAN�TAXRETURH ]OINTLY-OWNED PROPERTY:
� rt�or*ruECmerrt .., . . . . � - �
ESTATE OF: FILE NUMBER: '
. � If an asset became joiiMlY bwned witldn one year of the QecedenYs date oi death,k must be reported on Schedule G.
_ SURVMNG JOIM T6VAM(S)NAME(5) ADDRESS � REUTIONSHiP TCI DECEDB�ff
q,-_' -_.�� ,._.-- --=- �. � �` _
f ;
iDonald L Sutherlen , � � �1409 Rnst Rd.Mechanicsburg,Pa,17055-5136 I iSon-in Law �
' � ( f
�---- �� f � } �
s.�___-_ __�—_, i � _�__� — -----� +=____--____.__�.
' ` I ` '
1 .�
J � ! �
- -- - - - ? �-.-_.___'
�.�---�-�_ --�_ - ---- -- - -
, _ _
, , I �_____________.__ -- .� �^
� ;
�_ � �_ � � .
' __ ' ' _�.__J L _____' 1
JOINTLY.OWNED PROPERTY:
tE77et w7E . ��OFSO!lPRON Oi PROPERT`I � M aP OAIE oP OFatt� �
REN faR10lM Mf�DE 1NUli0EN�lQEOFFlNPitOKlM5i11MON11NDBIJIX/i0C0UNfM1�9lOR5Il10M. DAEOFOFATI DEQUBlfS . VAlJ1E0f�
MIMBFR THIANr 707M • . IDBl16YfNG N1AM�t AfTAQ10�FOq 10IMlY 1�D NFAL BTRIE ' . .; VRWE OF A:4T . (f1I9fESf �S IMf91ESf
���7 ' y _� .—'__—_ __—_ .__; ___ _— __—_. _— - _ _ �`_�..,._ �.�...�_.�..
1• 1 p• . . I ` � �.eo.�s�re � �..Veww.r�e�i •
�Americhoice FCU Aomunl Mo.41999
`! 1 35.614.59 50 17,907.30� .
n ❑ C-� C_--�_�-._ , � �� � �
c� �-� � �--_��—--_�___� �:.7 �� �.:�
[�� C� C�� C� ._ � _ ! �� C� �...
� � i_ _� C_ _^�=-,-�_T�� ��`i �1 ��
C���_ � �� �� ��
� C� !�J C��- -_-.--. �� �°",� C� �
❑ UC� _� � �� ��
t� ❑ �; C���-�_����-�-�_�' �� L�_; �
C Cf C_._� C�_ _ __ _ _ _ � -� � C.�� � �
� ❑ C�C---�-�____�^�_-�____-� �:� C! ��
� [�__ C-�-==_-- __:� �.� C ,. �
r-� j�-_ ; !-� �- ------- --- �_— --- � �.� C� �
r- --- -- --
�.�.�' 1_� �_.�.� �-- --- -�-- _l �.n.:.� C:-1 ��.
❑ C_i [�_-.: � i=_._---._�_�- ^--_--� �� r--� �
---, r--� --� r—
!.J I-! ��`� i�_:_-----------------� � �! �� �
�TOTAL(Also eirt�on Line 6,Recapitulation) $� 17,90 37 0
� ' If more space 151needed,us¢add�b"onal shee�M
paper of the same stze.
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.REV-1511EX+(]0-09) . . � < � ,
� �pennsylvania
SCHEDULE H '
oerr�ameHrora�hue FUNERAL EXPENSES AND
INHBtRAqCETA%pEfi/IW ADMINISTRATIVE COSTS � �
. aESroerr oc�oart �
ESTATE QF FILE NUMBER
R �
' � � OxedenYs debts must be reported on ScBedule I. .
� REM �� . ., � .
NUM66t � •�pESCRIP'fION AMOUNT �
a. FlINERAIEXPENSES: '=':;^�'i,
1. Hopki�Redor Funerdl Home � -----------� � 13871.89;
� {Edel's� . ^ ����396.92
--� --—.� 40.....�..�..�....w .
�3 �Holfda y E�ress (out af state I�ging� �---- V---�----� � �,"�, ���
J �.�_ _
�, - --_-�-_ -----�---_._ - -- ----=_ �► ���
i=- ------___�_.----------------- _ __ _ _
�� �------ __--__-`-- -- ;_---=---__- ---� �.o.�...�...,.�
I_� r_____--------__-_____-------- __-------J, ���
�____-----_�.-=-�
[_� i��,._ -_�----------------- - ---��i �..',�.�
s. aoMmisrnamrt cosrs: p
1. Pamnal Representative Cammis�mrs: ���
Name(s)of Personai Represer�tive(s) . '
Stree[Addtess � �
, Gty State_IIP ' �
Yeahs)Commis5ion Paid:
2. Attomey Fees: L.�..�...�
3. Family Exemption:(It deoedenYs address B no[Me same as datmaM's,attad�ecplanatlon.) �.���
`C]almant �
� . Street Address "
. Gty State_ZIP .
. � Rtlatlorrship oF tlaimard to DeaderK ' � .
a. Robate re�: 1 .......-.�
i..��
5. AorouriOM Feet: ��� .
. 6. Tax Re[um Preparw Fees: - �� �
7.. L `_'__'_'__---------"_----____.��____-------_� ��
�--� r-----�--«- _ --- __-^� ��.�„�
�--_.__._...___--------------.._._^________
_, j---�------------------_-_____----------__._._---
--� -._� ��
�._.�___^____._.__-�___.________�__----_
�--, -- �� ���
L . � ,
;� ,_.-_-.._-----------_�_--_----__ _---_____.�,_—� ��„�
_.__------ -------_f___
,--, r—. ___ _�`_T_ �_ �_
, �
� � �
_ ., �- ------ __ _-- ----- --- --- -- ---- -- -��__—
^ TOTAL(Also enter on Une 9, RecapiNladon) #�I _�.^r�_ 15,489.61 `
If more space_is needeA,":use.add'Rtonal sheeLs of paper of Me same size.
. . . � . . —. � . r �.�.. . . - - e°• ", - .f... ' • Y5'. _ . . , .._ .
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, .. ' ' REV-1512 E%+(]2-12j ' � .
��� penrisylvania SCHEDULE I ,.
°�AHfpO�'iOF"E"F''°E , DEBTS OF DECEDENT, '
m�urnncernxa�uan , , MORTGdGE LIABILITlES& LIENS '
a�s,�r oECEO�rrr -
ESTATE OF ` FILE NUMBER
r
.Report debfs inwrred hry the deoedeM p'ios M deaN ffiat remained unpai0 at tRe date at deaM,f�rclu�m�unreimbursed medial expenses.
�M � �� � � � VALUE AT 60.'!E
NUMBER DFSCRIPiiON " �
OF DEA7H
1._ ��.._. , . .�. ._ ^_`7
Intemists of Central Pa_ (Medipt Service � �p q_ ��g
2� �Gaodwill Fire Resae EMS (Medicai Service) _`� -__.___..__ _� ���
��—�^� ,
; 3' � PRISM ! (Medical Service) _�__..�� - ------- �� ��
�_ 4l' I.i B.M. , (Last Mo.Insurance) �±^`' _ =~�`��������� �� .
—����_--�-�---�--.______—"__--_—�-�_._.-_-_._��._.--�, �"�"�"`°'"�°�
�s Holy Spirit Hospital �ed�cai semce) � _A� sa2.so.
-, ----- - --- -�- —
6 �Intemist of Central Pa. (Mediql Service) ,� 2�'
�_J ��__, �^-�
�� �Cha�fes Inners MD (Medipl Service)+-- ___�_.._ __.._.__._� - —_YJ L.��'
- ----_— --.--�.__—�—�-.��:_-�—_.__�---
r_� � � -�,
� 8 i?RISM (Medicai Service) 155.50
ri � _._..��.. __�_..._=---_�._.._.._._..----------_-=`; � ;
4 9 Otfice of Aging (Home Service)� .� � ^ �� �� . 5.50
,._�---�. � ��...�. .__________..�__�--�--_�_...�� .�+.-.� �
�^1��p 'WestS�S (TranspmfServicel_,________�_-.__ - � �� , .
�..� � _ � 1
�� ;�_.��__;_ ___________---=------ l �..��...�,....,� .
� - - - =- __ - - - - -
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"—�—�i � -- . .�.�.._.�__..----��._..--_---�� ���� ' .
---. - �� ___.
�t�_� �_____._ -----1__��=-_:�:-___-----.-._-�:__---:__=�-':�
'----------------_---�--____-_._---__� ______.�7 ��'�
,�l ___ ____ ��
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�i._.� �. _..._ ,�.�—_-�_.___---z--_. _._�. ��-___�_�
---� i-------------
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- _______�...�_..��.- -- --
i-- --� .�:__.:_—�:�:z_=�-._._�___�_..'". _ �,,,��
' ,' '— ___._._i_-- -_-_______—.__�.�_---------------__� k�...�+..........�,
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F
t--� '-------------- ---------
TOTAL(Nso enter on Line 10, Recapitulatlon) $ �2823.43� , ,
' � [f mare ipace is needed,i�ert additional sheets of the same s)ze. �
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l76C�bx�iq�N d6135 6¢.M.
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SOWfB.t'lenw�c ED2p5Q'pob
' Hisi�mlJaeseMwbaFN111(�Wi1
Statement of Funeral Goods aad Services Selected/pnrc6ase A�reement � �f�«�
nm�arn�n��narzms
� Dereof erviee 42�12�(z
n,mea[u�x,ua 2ichnn{FWilson
�b'� 08105/1922
Dar��s�A�T 1409FmstRd
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Co-PacEneritlomeAA4c� �
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6dmv.YouaubaisusaprepreaMaeefaf6e6adyafthedcedavomdinthis �^�"R'��'���Y�^+S�mboPJegoo6lmdsenicadmaihed
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SEC NI-SERVIC AMDMERCNAtlDISE YERCHAMOISE
FUNERA�OIRECTOR AND 8TAFF SERNCES
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CARE AMD PREPARA7pY OF RE/A�NS �B"��^d+�
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USE OF FAqL1T1E5 ApD RELA7ED SERVICE$ t ""
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��� �i�� �� �.����SIn�
I, RICHARD F. WILSON, a citizen of the United States of
America and a resident of 6reencastle, County of Putnam, in the
State of Indiana, being over the age of twenty-one (21) years,
of sound mind and disposing memory and in no way acting under
duress or undue influence do hereby make, publish, and declare
this instrvmant to be my Last S4i11 and Testament, hereby re-
voking and annulling all vther former Wills, Testae�ents, and
Codicils thereto made by me heretofore at any time.
ITEM I
Personal Representative
T hereby nominate and appoint Donald L. Suthetlen as exe-
cntor of this my Last Will and Testament. If Donald L. Sutherle
shall predecease me or £or any reason shall fail to qualify as
executor hereunder, than in such event, I nominate and appoint
Martha D. Sutherlen as executor of this my Last Wili and Tes-
tament.
ITEM II
Settlement Costs
A. I direct my executor to pay all of my just debts and
funeral expenses, as well as the cost and expense of the ad-
ministration o£ my estate, as soon after my death as shall be �
practicable and heraby give to my executor full poNer and
authority to settle and pay all such claims.
B. I direct my executor to pay all inheritance, transfer,
succession, estate and other such tazes or assessments levied
or assessed againsL my estate, against the beneficiaries under
this Will or against any beneficiaries or surviving joint ten-
ants oP any property or interest which passes because� my
death out of my residuary estate. Said taxes s�li no e�e m ,
charged against any particular beneficiary, incYU�ng iabu��ge
beneficiaries, surviving co-owners and owners o��g p�E�7rs
included in my estate for tas purposes. a z� r�n � Q .
�
ITEM III = �` ° ° .
ProQerty cs o-q,� 3 � T' �
o � �._. cs . -
A. If my wife survives me, I give, bequeA�h� and`13evds@� ' :"� �
to her all the rest, residue and remainder of att prope£�y �
whatsoever kind or character, whensoever acquired and iv7iere-
soever located, in fee simple, outright and without condiLion.
B, If my said mife does noi survive me, I hereby give,
bequeath and devise all my property, real, personal and mixed
hoxsoever acquired and whetesoever situated, of which I may
die seized or possessed, or to which I may be eatitled, to
Martha D. Sutherlen and Donald L. Sutherlen in equal shares.
thenaItdiredsthatrall of mynproperLyupasslto thensurvivorvofine,
the two. If Martha D. Sutherlen and Donald L. Sutherlen, both,
do not survive me, but are survived by living issue, I give.
devise and bequeath alI my property to their Iiving issue,
per stirpes.
ITEM IV
Simuitaneovs Death
I£ my wife and I die simultaneously or in such circumstance
as to render it difficult or impossible to determine i+hich of
us predeceased the other, ur in the event, my wife does not
survive me by at least ninety (90) days, I direct that she shall
effectmas though sheehadrnotesurvived meat this Will shall take
�
�
� :.�- - � - _ ; _
ITEM V
Definitions
A. I am married to Lema Wilson, any references to my
"wife"� are to har and her alone.
8. I have one daughter by my marriage to my wife;
Martha D. (Wilson) Sutherlen
date,dtheythave52mvingeissueD�as1fo11ow5theLesley Lee�Sutherlen,
daughter; Nathan Ray Sutherlen, son; Aaron D. Sutherlen, son.
Last WN11IandSTestament, consistingcafbtwom(2)atypewritienmY
pages, including this page, afFixing my initials to each page
for better identificatiun, and do hereunto set my hand and
seal this �t day of July, 1978.
l��3..� � ,r��,� ��,zB�,,.__. �
ic ax , i sow 1 n —
This instrument, consisting of two (2) typewritten pages,
was signed, published, and declared by the above-named-Richard
F, Wilson to be his Last Will and Testament, in our presence,
who at his request and in our presence, and in the presence
of each other have hereunto suscribed our names as witnesses
on the date above written.
IP I T N E S S E S
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_ll1L��E/- C/STcc�-Tk.O�YtfkS OF�E�,./����� i.vf�tAn[il
� UNDER P ALTIES OF yp��-RJURY, We, ��k�^ � ��/6J�J -
� A�FY.YaS (� and �P/Or ` Zs - �.fn�n �
cne estator an tie nesses, respective7y, whuse namas are �
signed to the attached or foregoing instrument declare:
(1) That the Testator executed ihe 3nstrument as his
Last Wi21 and Testament;
C2) That, in the presence of witnesses, he signed his
signature; .
(3) That he executed the Will as his free and vol�tary
act for the purpose expressed in it;
(4) That each of the witnesses, in the presence of the
Testator and af each other, signed the Will as Witnesses;
(S) That the Testator was of sound mind; and
at thebtime eighteene(18)torfmore yearseofeagee orswas�a member
of the Armed Forces or of the Merchant Marines of the United
States, or iLs Allies.
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