HomeMy WebLinkAbout10-23-13 (2) 4 ,
15056101L10 REV-1500 EX (02-11)(Fl)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN i rZ r�t7}r
Hamstrung, PA 17128-0601 RESIDENT DECEDENT ! J 45
ENTER DECEDENT INFORMATION BELOW
0 1 3 1 2 0 1 3 1 2 0 5 1 9 7 0
Decedent's Last Name Suffix Decedent's First Name MI
S h a t z e r K a t h y D
(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
0 1. Original Return E] 2. Supplemental Return 3. Remainder Return(Date of Death
Prior to 12-13-82)
4, Limited Estate 4a. Future Interest Compromise(date of 5. Federal Estate Tax Return Required
death after 12-12-82)
Q 6. Decedent Died Testate 7, Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
E] 9. 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 SHOyLD BE DIRECTED TO:
Name Daytime TaiePhor, umber
CD
D a v i d W R a h a u s e r ;7 1 7c_i 2 .N ' 3 2 3 9
---
' - rREGIl OF WILTS USE ONLY
?t CJ Q
O CD
First Line of Address cr r.> C U —,I
1 5 7 E W a s h i n g t o n S t r e e t
rV r r
Second t-ine of Address -p L{ (A O
i> r
City or Post Office State ZIP Code l__.. DATE FILED
C h a rn b e r s b u r g P A 1 7 2 0 1
Correspondent's e-mail address: dwruldwrlaw•us
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 troe,correct and compVete.Declaration or preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI�yATUk O PERS N RE OnNISIBLE FOR RUNG RETURN DATE
ADDRE-ESSS��
r7zzs
51 T F P R R OTH HA RE^PR.ESENTATIVE DATE
A117RESS
157 E Washington Street Chambersburg PA 17201
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
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1505610240
REV-1500 EX(Fl)
RECAPITULATION
1, Real Estate(Schedule A) ... ... . ... ... . . .. . . .. . .. ... .
2. Stocks and Bonds(Schedule B) . _ . r . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Closely Held Corporation.Partnership or Sole-Proprietorship(Schedule C) .. ... 1
4 Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E), 5. 1 2 1 L 4 5 1 3
6, Jointly Owned Property(Schedule F) ❑ Separate Billing Requested 6.
7. Inter-Vivos Transfers&Miscellaneous N Probate Property
(Schedule G) Separate Billing Requested . 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . 8. 1 2 1 6 4 5 1 3
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . .. . . . . .. . .. 9 1 6 8 5 3 1 5
10. Debts of Decedent, Mortgage Liabilities, and Liens(Schedule 1) . . . . 10, 2 6 6 0 8 6
11. Total Deductions(total Lines 9 and 10) . .. .. . . ... .. . . .. . .. 11. 1 9 5 1 4 0 1
12, Net Value of Estate(Line 8 minus Line 11) . . . . . . .. . .. . . . . . . . .. . . . . . . . . 12. 1 0 2 1 3 1 1 2
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . .. . .. . .. . 13.
14, Net Value Subject to Tax(Line 12 minus Line 13) .. . .. . . .. ... . 14. 1 0 2 1 3 1 • 1 2
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 _ 0 0 a 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X 04 1 0 2 1 3 1 1 2 16, 4 0 8 5 . 2 4
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral fate X.15 0 , 0 0 18. 0 . 0 0
19 TAX DUE . . .. . ... . . . . . ... ... . .. . .. . .. . .. . .. .. . .. . .. . .. . .. . .. . 19. 4 0 8 5 . 2 4
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240
REV-1500111-X(171) Page 3 File Number
Decedent's Complete Address: D o
,DECEDENT'S NAME
Kathy D. Shatzer
STREET ADDRESS
303 N . Faye_ e Street; Apt_7
---- ----
CITY STATE ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4,085.24
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3)
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
S. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 4,085- 24
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
ar retain the use or income of the property transferred ...................................................................... ❑ ❑
b, retain the right to designate who shall use the property transferred or its income ........................... 171 El
retain a reversionary interest ........... ....__................................................................................. ❑ ❑
d. receive the promise for life of either payments,benefits or care? ...... ........ ❑ ❑
2. If death occurred after December 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? ......... ❑ ❑
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.
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
is 3 percent[72 RS.§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 PS.§911e(a)(1)f.
• 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-1806TXI(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT OECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Kathy D. Shatzer 0 0
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. Orrstown Bank Acct No . 103007750 104 ,162. 41
2. Car Insurance Premium Refund 549.66
3• Tax Refund 11029.00
4 . 2008 Honda Accent Blue Book Value 81000.00
5• Mitsubishi Lancer Blue Book Value 2,500.00
6. Fidelity Investment 401k Account No- 5,404 .06
TOTAL(Also enter on Line 5,Recapitulation) $ 121,645 - 13
If more space is needed,use additional sheets of paper of the same size.
REV-1511,EX*(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kathy D . Shatzer 0 0
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Geisel Funeral Home 7 ,141. 40
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representatives) Kimberly Trace 5,812 -00
Street Address 10855 Burkett Road
City Greencastle State PA Zip 17257
Years)Commission Paid:
z. AhomeyFees: David W . Rahauser 3,500.00
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 Fee Register of Wills 215. 00
5 Accountant Fees:
6. Tax Return Preparer Fees:
7, Legal Ads - News Chronicle ($104 . 75 Legal Journal $75 . 00 179. 75
8 • Short Certificate 5 . 00
TOTAL(Also enter on Line 9,Recapitulation) $ 16,853- 15
If more space is needed,use additional sheets of paper of the same size.
REV-1'512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kathy D . Shatzer 0 0
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. Penelec 481 . 11
2 • State Farm Insurance 130 .04
3 Comcast Cable — Final bill 190 .66
4 AT & T Mobility 175 . 24
5 Dr . Baxter Wellmon 69 .28
6 Chambersburg Hospital— co—pays 300 .00
7 H & R Block— 2012 Tax Preparation 184 . 00
8 Professional Corp . of Pennsylvania 517 . 53
9 APIRA Health Care 461 . 85
10 Young ' s Mechanical Equipment 151. 15
TOTAL(Also enter on Line 10, Recapitulation) $ 2,660 - 816
If more space is needed, insert additional sheets of the same size.
REb-1513 tx�,(o1-1o)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF:
Kathy FILE NUMBER:D . Shatzer 0 0
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSONS)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2),)
1, Yvette Eileen Starr Lineal
243 Mealey Pkwy
Hagerstown, MD 21742
2 • Dillon Scott Starr Lineal
637 Pine Mountain Drive
Fayetteville, PA 17222
3 • Preston William Facion, II Lineal
417 Stock Street
Hanover, PA 17331
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE,
11. 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 11 - 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.
I
KATHY D. sHATZEx
1, Kathy D. Shatzer, of the Borough of Shippensburg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby
make, publish and declare this instrument as and for my last will and testament, hereby
revoking any and all wills and testaments by me at any time heretofore made.
ITEM I: 1 direct that all expenses of my last illness, including hospital expenses,
expenses for medical care, funeral expenses and the cost of the grave marker, as well as
all debts or obligations owed by me at the time of my death, which in the opinion of my
Executrix is not subject to either a legal or equitable defense, shall be paid from my
residuary estate, unless otherwise provided herein as soon as practicable after my
decease, as part of the expense of the administration of my estate.
ITEM I1: 1 give, devise and bequeath all of my estate real, personal and mixed of
every nature and wherever situate to my three children in equal shares:
A. Yvette Eileen Starr
B, Dillon Scott Starr
C. Preston William Facino, II
ITEM III. If any one of my children is not living at the time of my death, but
leave children to survive him/her, then the surviving children shall share equally that
portion belonging to my deceased child, per stirpes. If any of my said children shall die
leaving no lawful issue, then his or her share shall lapse and shall pass to the surviving
siblings.
ITEM IV: I direct that the legacy or share of real or personal property falling to
any child not having attained the age of 21 years under the provisions of this my last will
and testament shall be retained IN TRUST, to invest and reinvest the same, to collect the
income, and after paying all expenses incident to the management of the trust, to use and
apply as much of the net income and principal as may be necessary in the sole discretion
of my Trustee for the child's support, well being and education. I direct that such
payments shall be made without the intervention of a guardian, and the receipt of such
person as may be selected by my trustee to disburse such payments shall be sufficient
acquittance. Should any such child not use any part of the remaining principal and any
accumulated income for the aforementioned purposes, the Trustee shall pay the balance
of principal and any accumulated income upon the child's reachiS his 215 'larth.Qyp
terminating the trust. Ca m rn o
-2
v
While in the hands of my Trustee and until actually paid ovP ors-'"-q[e4ivMd twP9
person entitled thereto, the interest of the beneficiary in the incom `qy MnciR in-�rfy�
h c7 c>
C7 c� =3 -n -Yl
ti r-, to 0
c,s m
ITEM V: I appoint Orrstown Bank of Shippensburg, Pennsylvania, Trustee of the
trust created by this my last will and testament.
ITEM VI: I appoint Kimberly Trace, Executrix of this my Last Will and
Testament.
ITEM VII: I direct that my Executrix as well as her successors, shall not be
required to give bond for the faithful performance of their duties in any jurisdiction and
that my Executrix and Trustee shall receive compensation in accordance with their
schedule of fees in effect from time to time during the period over which their services
are performed.
ITEM VIII: All estate, inheritance, succession and other death taxes, imposed or
payable by reason of my death, and interest and penalties thereon, with respect to all
property shall be paid out of the principal of my general estate, as if such taxes were
administration expenses and shall be paid without apportionment or right of
reimbursement.
IN WITNESS WHEREOF,.I have hereunto set my hand and seal
this �t.�,�l.� day of 12013.
,')KATHY D. SHA ZER
},�pNWEALTH F N 3YLVA
Nofadal Seal
Barbara J.Lange,Notary Publk
Chemberaburp Boron FrenlUin CounH
. .Nry_Commleabn 6r a 6,2013
The preceding instrument consisting of this and other typewritten pages, identified by the
signature of the Testatrix was the day and date thereof signed, sealed, published and
declared in the sight and presence of us, who, at her request, in her sight and presence and
in the sight and presence of Kathy D. Shatzer, the Testatrix, herein named, as and for her
last will and testament in the presence of each other, have hereunto subscribed our names
as witnesses.
David W. Rahauser
Betty H. Iles
u
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
We, Kathy D. Shatzer, David W. Rahauser, Betty H. Ile, the Testatrix and the
witnesses, respectively, whose names are signed to the foregoing instrument, being first
duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and
executed the instrument as her last will and testament and that she signed willingly, and
that she executed it as her free and voluntary act for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as
witness and that to the best of their knowledge, the Testatrix was at that time eighteen
years of age or older of sound and disposing mind and under no constraint or undue
influence.
Kathy D. Shatzer
David W. Rahauser
v
Betty H. Ile
Subscribed, sworn to and acknowledged before me by Kathy D. Shatzer, Testatrix, David
W. Rahauser and Betty H. Ile, witnesses, this day of �r
2013.
Lan-
Notary
P i�1bi c 0
CO M NWFALTH F P NNSYIVANIA
Notarial Seal
Barbara J.loops,Notary Public
Chambemburg Born,Franklin County
My Commiaalon Expires May u`,2013
ember, ennsw ams As" n of Nolartes
Pennsylvania
DEPARTMENT OF REVENUE
BUREAU OF INOJVFDUAL TAXES
October 17, 2013
DAVID W RAHAUSER
157 E WASHINGTON ST
CHAMBERSBURG, PA 17201
Re: Estate of: KATHY D SHATZER
Social Security Number: 169-56-4461
File Number: 2113-0245
Dear Sirs:
The Department issues this waiver for the following security held in beneficiary format by the
decedent. The security will be subject to Pennsylvania inheritance tax. The Department will
issue an information notice to the transferee of the potential Pennsylvania inheritance tax
due for this asset. A copy of this waiver is to be used by you to notify the transfer agent
that the reporting requirements of Section 6411 of the Probate Estates and Fiduciaries Code
(Title 20, Chapter 64, Pennsylvania Consolidated Statutes), have been satisfied.
Name of Company: FIDELITY INVESTMENTS
Type of Account(s): Other
ID Number(s) 12409
Account Balance(s): $5,404.06
Sincerely,
Deneen Gethouas--
Inheritance Tax Division
Department of Revenue I PO Box 2806011 Harrisburg, PA 11.77..28 1 71.7.787.1794 1 www.revenue.state.pa.us