HomeMy WebLinkAbout07-15-13 _ �
1 15056101�1
_'� REY-15QQ �to,.,o� �
PA Departmmt of Revenue V�.Y�Mfia qFFiCW.USE ONLY ,,
eureauotIndtviduatTaxes 1NHERITANCETAXRETURN ��� Y�r FaeNumoer
P4 BOX�So6oi ��� � p � � 8
Harrisburg,PA i71z8-o6oi RESIDENT DECEDENT I I
ENTER pECEDENT INFORMATION BELOW �
Social Security Number Date of Daath MMODYVYY Date of Birth A9PAODYYYY ,.
� �'���'°.���.� 8 . p�� o 0 8'� �
DeceQenYs last Name Suffix DecedenYs First Name MI ��
v �i c R k t t c. � ��L� �H !
{If Appilcabla}Enter Survivtng Spouse's information Below :
Spousa's Lest Name Suff� Spouse's First Name MV
t a � � 1� i
Spousa's Social Securiry Number i
TNIS RETURN MU5T BE FiIED tN DUPIiCATE VY17H TME i
����_ � REGISTER OF WILLS ;
FIL�IN APPROPRIATE OVALS�BELOW .
p t.Originai Retum � 2.Suppiementai Reium p 3. ftemainder Retum{date of deakti
priorto 12-13-82) I
, p 4.Limited Estate p 4a.Future loterest Compromise(date of p 5. Federal Estate 7ax Retum Requlred
' . death a@er 12-12-62j
� 6. Decedent Died Teatgte p 7.Decedant Maintainad a�iving Trust Q S. Totsi Number of Safe beposit 6oxes �
{Attach Copy M WAI) (Attach Copy af Trust) �
Q 9.litiga8o�Proct�eds Received O 10.Spousal Poverty Credit(date of death O it Election to tex under Sec.91i3{A) I
between 12-31-91 and t-1-95j (Attach Sch.O)
CORRE$PONDENT- THI$SECTION MU3T BE GOMPLETED.pLL CORRESPONDENCE AND GONFIDENTIAL TA1C INFORMATION 9HOULD BE DfRECTE�TO:
Name � Daytime THepimnB,Number
. . . . . . . ���.� �
CN L S S 1 tD � . .i, � I ! 7 D
� 2 G�t,3TE�IL1�U ONLY
a r �--� rn rn
First line of address � 73 � �y q
' � T
O 0 � fS O � � 'Ti i
,. n C3 -r� «�'' CJ �
Second line of address � C r. p— P-rt
.� y�� .�,� . - —t � 4
� I � ��.�.n �..�wa� � ��} �
� �•��_�.'e � DATE FILED
City or Post ORiae State ZIP Gode
, ��� . ������� � � . ��� � � � � � ��? �'S
, }
CorrospontlenYs e-mall address: CCS��el d s�� Com�ast+n�C
Under penaldes of perjury,I declarN that I have e�mine0 this retum,induding aecompanying schetlulgs and statements,and to the best of my knowleEge entl bellef,
it is We,correq and compieta.Declaraiion W pr5parer other than ihe personal tepresenWtrve is basetl an aii iMomnetion of which preparer hes any knpwfetlge.
SIGNATURE OF PERSQN��t�N�SiBL'E FO ',NG�E7UR�N1 7_/ATE,�
iirYT. // fy/Y}
���r�' �lG4SC 1� u ad
ADDRESS M h�..�� «t- , 3f� 1K �t Jahns ��+�'e� ah4p �+'Jl+tJ !'R" �T���
+�� �,.cR v.
SIQNATURE ��,E�Pf�M1$j�R OTNER TH�j��K���E PR TAJ/��JE�
�5/!ti/flitLF1.. ,S�%R6+f�""` DA7E '
ADDRESS ' �,f��
CNI�2t�ES � sNt��DS Z2', t� Ctauser ��Sad� mec.h�u't�csbury, PA t7oss
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610101 15a56101CJ1
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J 1505610105 •
REV-1500 EX DecedenPs Social Security Number
/ �
pecedent s Neme ��.
RECAPITULATION ��,..�,�.��. .� ����;�.�+. ����D O
1. Real Estate(Schedule A). ... ............�.... . .. .�.. ... ... .. . .. ...... .. �L �
2. Stocks and Bonds(Schedule B) .. ... .. ...... ...... ... ... ...... .. ... ... 2. �
3. Cbsely Held Corporedon,Parinership or Sole-Proprietorship(Schedule C) ..... 3.
D �
0
4. Mortgages and Notes Receivable(Schedule D) ... .. . .. ... ... ..... . .. ... .. 4. �
5. Cash, Bank Deposi[s and Miscellaneous Personal Property(Schedule E).. .. . .. 5. � 7 '..
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. ... . 6. � '.
7. Inter•Vivos Transfers&Miscellaneous Non-Probate Property �� '.
(Schedule G) O Separate Billing Requested.... .. .. 7. � fl � ���.,
8. Total Groas Aasefs(total Lines 1 through 7). .. . .. . .. ... ... . .. .. . .. . .. ... 8. � 6 / 3 ...
9. Funeral Expenses and Administrative Costs(Schedule H). ... . .. . .. .. . ... .. . 9. � 3 �D S �'�,
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . .. . .. . .. . . 10. � il
11. Total Deductions(total Lines 9 and 10). . .. . .. . .. . .. . . . .. . .. . .. . .. .. . ... 1L .� 3 6 5 I
12. Net Value of Estate(Line 8 minus Line 11) . .. . .. . .. . .. . . . .. . .. . .. . .. .. . . 12 � .� � $ i
13. Charitable and Governmenlal Bequesis/Sec 9113 Trusts for which 13 D D .,,
� � an election to tax has not been made(Schedule J)��.. . . . .. . .. . .. . . ::. :.. . ��
14. Net Value SubJect to Tax(Line 12 minus Line 13) . . . . . . . .. . .. . .. . . . .. . .. . 14. � �T 6 8 1 �',
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES '.
15. Amount of Line 14 taxable ���
at the spousal tax rete,or �'�.
transfers under Sec.9116 '� 1e` °" � � '�.
(a)112)X.0- �.. O 15. Q �,
i6. AmountofLinel4laxable O 16 D .� I,
at lineal rate X A_ I
� 17. Amount of Line�4 taxable �� � L� �' '�,
� at sibling rate X.12 ��,.,
18. Amount of Line 14 taxable� c � 18: . � �Q a 7 �'.,
at collateral rate X.15 o p i
19. TAX DUE . .. . . . _ . . . .. . .. . . . .. . .. .�..�. ., ... .. . ... .. . .. :.. . . .... . .. ..�19.. I �0 6 � I
20. FILL IN THE OVAL IF YOU ARE RE�UESTING A REFUND OF AN OVERPAYMENT �
I
. . . � � � � lil
Side 2
� 1505610105 1505610105 � I
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REV.15W EX Page 8 ' p11e Number ��_Jz � ��7 !
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DecedenYs Catnpiete Address:
DECEDENt'S NRME
k/�l1'tt/� f/. fs'e,&ler. Jr.
s�1�zESS�LL 34� �tJ. Sf. Tol�ns Dr ---------------------------
cim"—__— .----- ------------- sTnre----- zia-- --�-
��r � P� �7v�r — �
Tax Payrr►an#s and Credits: �
�. r�nue(r�age 2,u�7e) (�) /?G,f 8 I
z. c��c�eay�,� o
A.Prbr Payrtients ----- ----
B.Diacount Q I
----------- Totai Credits{A+B) {2) O
3, int�esi
�37 3,aa
4. If Lir�2 is greater lhan Line 1 +Line 3,enter Ihe difierence. ThIs ie the BVERPAYMENT:
FIH in ovai on Page 2,Line 20 M requast a rafund. (4) �
5. If line 1 +�i�y 31s greater than Line 2,enter the difference.This is the TAX DUE. (5) �'��.9�
Make check payable to: REGiSTER dF WILLS, AGENT. �
PIEASE ANSWER THE FOLIOWiNG QU�STIONS BY PLACINCs AN "X" IN THE APPRQPRIATE BLQCKS
i. Did decedent make a#ransfer and: Yes No �
a. retain the use or income of#he propeRy trarrsferr�:.......................................................................................... ❑ � �
h. retain the right to designate who shaN use the prop�ty transfened or its incflma:....................................._,.... ❑ (�
c. retain a reversianary interesX or..................................................._..................................._................_..,........... ❑ �
d. receive the promise fa fi(e o(either payments,benefits or care?....._......._.._.................._............,................. ❑ �
2. If death occurred after Dec.12,1982,did decedent transfer prpperly within one year of death
without receiving adequate consideraUon?.............................................................................................................. ❑ � i
3. Did decedent own an"in trust for"or payable•upon-0eath bank account or security at his or her death?.............. ❑ �
4. Did decedent own an individual relirement account,annuity or other non-probate property,which
conteins a beneficiary designaGon? ........................................................................................................................ ❑ �
iF THE ANSNtER TO ANY Qf THE ABQVE QUESTI0�1315 YES,YOU MU37 C4MPLETE SGHEDULE G AND PILE IT AS PART QF THE RETU .
For dates oI death on or after Juiy 1,1994,and before Jan. i, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviwng spo se is
3 parcent[72 P.S.§9116(a)(1.1){i)l.
For dstes of deeih on or aftsr San. 1, 1995, the tax rate imposed an the net vaiue o( transfers to or for the use of the survfving spouse is 0 rcent
(72 P.S.§911fi{a){t.t)(i}]. The statute does not exempt a transfer to a surviving spouse fram t2x,end the statutory requirements for disGosure af asse and
filing a taac relum are still applicable even if the survivmg spouse is the only beneficiary.
For dates af death on or after duly 1,2400:
• The tax rate imposed an the net value of transfers fram a deceased child 21 years of age or younger at death to or for the use of a naturai pa t, an
adoptive parent or a stepparent of the ohild is 0 percent p2 P.S,§9ri6(a)(12}J.
• The �c rate imposed on the net value of transfers to or for the use of the decedenCs Iineai be�eficiaries is 4.5 percent, except as no ed in
72 P,S.§9116(12)(72 P.S.§9f16(a)(1}j.
r The tax rete imposed on the net value of Uansfers to or for the use of the decedenYs siblings is 12 percent p2 P,S.§9i18(a}(1.3}).A sibfing is defined,under
Seciion 91D2,as an ind'mduai who has at least one parent in e4mmon with the decedent,whether by biood or adoption.
Ftvd9mE%:11911 .
sc�Eau« �
CAMMONWFALTH OF PENNSYLVANfA CASN, BANK DEP4StTS� R 1TI�S�. :
�""��T""� �^X�T�R" pERSONAL PROPfRTY '
RE IDE EC ENT
fSTATE pF �`�t�� u � t/�,�� FILE NUMBER �_j�_���,
! /7 / �
Indude ihe proceeds M Iifigation and ihe date tha proceetla were rec'sived by tl�e es��.AN propeM1y JoiMly-ovmad wkh iM ripM of wrvivorship na'at bs dkcbsed on ScheduN .
�T�� VALUE AT OATE
NUMBER DESCRIPTIpN OF DEATH
' 1/este�,{ �'u.nds w� de�e¢d.sac� hw/�'v.r''s erFa�'e , l�elql %n eserocJ
as �ar{� af sale �P redi esi-�fie, d.usi' releasmd. ¢I, 6 9 3,�/�F
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TOTAL(Aisa enter on tine 5,Recapitulation} S r t� 3
(if rtrore s�e is neaded,inseR addiHonal streets of the sart�e site) •
I
REV-1517 EX�(i6�08} �
SGNEDULE M �
COMMONWEAl7H OP PENNSYLVANIA FUNERAL EXPENSES & ,
INHERITANCETAXRETURN ADMINISTRATiVECO5T5 .
RESI4ENT DECEDEH7 � �
ESTATE OF fltE NUMBER �
�v'i1/.'+7/tJ �i�. 1t'o�iler,✓r: a'.I�lZ--dc�j ;
Debts of decsdeot must he reported on Schadule L �
I7EM
NUM6ER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
7.
B. ADMINISTRATlVE C4ST5:
t. Persanal RaprasenlaUve's Commissio�s
Name of Perstmai RepreseMative{s) _�r C __y�_�jQ ����7�
..—_---_—_.—.—.__—.
StreOtA�dre55 �
�!►!_�:._,Tei���r--- ———----- ------
C'ty—i�dl/IL..�i// — -.. State �� Zip ._/�OII _---
Year(s}Commissian Paid: _ .
2. AlYomey Fees C�i�trl�s � oShj Zl�$ d� ���8.S�
3. Famity Exemption:(If decederrt's address is rwt the same as claimant's,attach explanation}
Claimant
Street Address
City_ - 3tele ZQ
Relationship ofClaimentto Decedent -
A. Pmbate Pees
5. AccountanPs Fees
6. Tax Returo Preparer's Fees
' F�'linJ �¢e to lQC�Mi�1"d' /� 1Vi IJs fi1 S.oD
S• ReJn�b. � G�arles �'. Sh:�tds .�`, Pl�f�ocop;rs, �ns�,
i.'er�i� �Ila�i7nqS, eTc• �/!}'.30
Tf1TA�(Aiso enter on Vine 9,Recapitulation} $ d�{.,$$�
(Ii mofe space is needed,insert additional sheeis of ifie same size} � ,
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LAST WILL AND TESTAMENT OF WILLIAM KOHLER I
I,WILi.IAM KOALER,currenUy of 1924 Fisher Rosd,Mechanicsburg,Cumberland County, I
Pennsyivania,being of sound and d'asposing mind,memory ancl understanding,do make,publish and
declare this my Last Wili and Testament,hereby revoking and making void any and all prior Wills and I
Codicils by me at any time heretofore made.
L �
I direct the payment of all my just debts and funeral expenses as sopn after my decease as the
same can conveniently be done. _ I
2.
Ali the m.st,residue and remainder of my Estate,real,persona!and mixed,whatsocver and I
wheresoever situate,I give,devise,and bequeath to be divided and distributed as foliows,to wit: I
A) Fifty(50%)percent to my ex-wife,BEVERLY ZIMMERMAN,currenUy of 5510
Morelend Court,Mechanicsburg,Pennsylvania. I
$) Fifty{50°l0}percent to my sister,MII.LICENT J.STARE,ourrcntly of 34 St lohns
Drive,Camp Hill,Pennsylvania. I
Ia the event my saed e7c-wife predeceases mt,then her share shall go to my said sister. In the
event my said sister predeceases me,tlien her share shall go to rny said ex-wife. I
3. IFOR PURPOSES OF CLARIFICAT[ON:I have several cirildrtu. Theic arnission I
herefmm has been by design snd not by accident or aversight.
AddiHonatly,my children are atssolutoiy not to serve as Executar ar Administrator of my I
Last Will and Testament uader any eirewnstances,by repxesentation or ptherwise.
A.
In the event that any of my said children shall undenake to contest this,my Last Will and
Testament,in any way,form,or menner whatsoevtr,I dixect that any share to which they rnay be I
arguabiy entided shall be forfeited and shali be divided and distributed among the other beneficiaries
in the proportions as set forth above. I further direct that,inspfaz as I am legally authorized to do so, I
my said Exautrix and her cowuet are to seek the paymant of aay attomey's fees and court casts
incuncvi ia a defasse nf this,my Last Will and Testament,from suah contest or similar groceeding.
S. IIt is my intenrion that beneficiazies named before or after the date of tYtis Will on my lifa
insurance,annuities,individual retirement accpunts(IRAs),in Trust for or joint bank accouats and
any other assets for which I may designa.0 beneficiaries wi(1 receivo such invtstments amt that my
Will provisions shall not control such invesunenu.
6.
I nominate,constitutc and appoint my sister,MILLICENT J.STARE,to be the Executrix
af this my Last Will and Testement. In the event that she is unable or unwilling to act as Exeoutrix,
I appoint my ex-wife,BEVERLY ZIMMERMAN,to be Executrix in her plaoe and stead. I
Page t ri'�{—' ��
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further direct that they shail not be required to file bond or other security in the Offisx of the �
Register of Wi!]s far the purpose of administering my Estate.
IN1"W" ITAIESS WSEItEOF,F have hereunto set my hand and seal this 3ly.� day of
�.WC6tyv�--� ,A.D.2010. I
.rYw�__�^ /�t"'G.^'G-�-' (SEAL} I
WILLIAM KOBLEI2
Signed>seated,publis6ed and declazed by tbe above-named WILLfAM KOHf.ER,es m�d I
for his Last Wilt and Teatamcn;'v�the presence of us,who at his request and in his presence,and in
the presence of each other,have hareunto subscribed ovr names as wimesses. I
�����ZL�/` ��%%�7stiE"`..�`�— 'TD
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