HomeMy WebLinkAbout11-18-13 1 1505610105
REV-1500 EX(o2-ii)(Fp
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania
Bureau of Individual Taxes County Code Year File Number
PO BOX 28o6oi INHERITANCE TAX RETURN
Harrisburg,PA 17128-0601 RESIDENT DECEDENT IA I 13 `T13
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 03/27/2013 F01/24/1917
Decedent's Last Name Suffix Decedent's First Name MI
HOLTRY U i JOHN H
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name I Suffix Spouse's First Name MI
IF
Spouse's Social Security Number
I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
COD 1.Original Return O 2.Supplemental Return p 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate C=D 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
(AD 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 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 Telephone Number
i
Thomas P. Gleason (717) 532-3270
REGIWR OF WILLS USt ONL4j
C w I'r'1
a
First Line of Address 03 -0 C= Cn
49 West Orange Street n M
00 1rz
Second Line of Address C>
—I � 7
C�
City or Post Office State ZIP Code ME FILED►—+ry
�
Shippensburg PA 17257 O Iv ' CD
W
Correspondent's e-mail address:tomgleason @tomgleasonlaw.com
Under penalties of perjury,1 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.
NATURE PER ON RESPONSIBLE FOR FILING RETURN DATE
Aic (� h
ADDRESS
94 Shippensburg Mobile Estates, Shippensburg, PA 17257
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
t
1505610205
REV-1500 EX(Fl) Decedent's Social Security Number
Decedent's Name: J. Harold Holtry .
RECAPITULATION
..................... ............................. ...............
1. Real Estate(Schedule A). ............................................ 1 0.00
2. Stocks and Bonds(Schedule B) ....................................... 2. 0.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00
4. Mortgages and Notes Receivable(Schedule D)........................... 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 12,253.36
6. Jointly Owned Property(Schedule F) C=) Separate Billing Requested ....... 6. 0.00 i
............ ...... ........
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) C=) Separate Billing Requested........ 7. 0.00
8. Total Gross Assets(total Lines I through 7)............................. 8. 12,263.36
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 3,023.24
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 3,115.71 1
11. Total Deductions(total Lines 9 and 10)................................. 11. 6,138.95 1
12. Net Value of Estate(Line 8 minus Line 11) ...... ........................ 12. 6,114.41
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........................ 13. 0.00
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 6,114.41
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 0.00 15.1 0.00 i
16. Amount of Line 14 taxable
at lineal rate X.0 45 6,114.41 16. 275.15
17. Amount of Line 14 taxable
at sibling rate X.12 0.00 17.1 0.00
18. Amount of Line 14 taxable
at collateral rate X.15 0.00 18 0.00
19. TAX DUE......................................................... 19. 275.15
............ ............ ....................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=:)
Side 2
1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
J. HAROLD HOLTRY
STREETADDRESS
61 Shippensburg Mobile Estates
CITY STATE ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 275.15
2. Credits/Payments
A.Prior Payments 0.00
B.Discount 0.00
Total Credits(A+B) (2) 0.00
3. Interest
(3) 0.00
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
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 275.15
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.......................................................................................... ❑ ]
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑
c. retain a reversionary interest .............................................................................................................................. ❑
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ (gl
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?.............. ❑
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 3 percent[72 P.S.§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 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-15o8 EX+(o8-i2)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
J. HAROLD HOLTRY
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
1983 Holiday Mobile Home VIN#437516991 located at 61 Shippensburg Mobile Estates 11,600.00
2. Orrstown Bank Checking Account No.521906 222.67
3. American Modern Select Insurance-Homeowners Insurance Refund 366.54
4. Hershey Auctions for sale of miscellaneous personal property 56.52
5. Refund from Comcast 7.63
{
TOTAL(Also enter on Line 5, Recapitulation) $ 12,253.36 j
If more space is needed,use additional sheets of paper of the same size.
BILL OF SALE
In consideration of the sum of Eleven Thousand Six Hundred Dollars
($11,600.00),receipt of which is hereby acknowledged,the undersigned, Pamela Maus,
Executrix of the Estate of J. Harold Holtry, (hereinafter referred to as Seller) hereby sells,
assigns and transfers to Delores A. Warren, (hereinafter referred to as Buyer) the
following mobile home presently on rented ground located at 61 Shippensburg Mobile
Estates, Cumberland County, Shippensburg,Pennsylvania, a 1983 Holidays with a VIN
Number of 437516991 and a Title Number of 36217954001HO.
Sellers hereby warrants that title to the property described in this Bill of Sale is
clear and unencumbered and agrees to defend such title as vested, by reason of this sale,
in Buyer and Buyer's successors and assigns against any and all claims whatsoever, and
no other warranties, express or implied, including any implied WARRANTY OF
MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, are given by
Sellers except as set for herein.
IN WITNESS WHEREOF, the undersigned has duly executed this Bill of Sale
this 24th day of April, 2013.
lesis:
Pamela Maus, Executrix of the Estate of
J. Harold Holtry, Seller
Delores A. Warren, Buyer
REV-1511 EX+(08-13) '
92pennsylvania SCHEDULE H
, DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
J. HAROLD HOLTRY
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Fogelsanger Bricker Funeral Home 493.2411;
7
El
❑ -----
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 1,10000.00
Name(s)of Personal Representative(s) Pamela Maus
0
Street Address 94 Shippensburg Mobile Estates
city Shippensburg State PA ZIP 17257
Year(s)Commission Paid: 2013
2. Attorney Fees:
1,100.00
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:
5. Accountant Fees:
• I
6. Tax Return Preparer Fees: T �,
7• Cumberland Law Journal for estate publication 75.00 j
❑s Shippensburg News.Chronicle for estate publication 96 50
i
TOTAL(Also enter on Line 9, Recapitulation) $1 3,023.
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsytvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
J. HAROLD HOLTRY
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 Department of Public Welfare for Medicaid Claim 78_06 .1
2.! Shippensburg Health Care Center 10.15
F�3 West Shore Emergency Medical Services _ 160.73 ',
FAdams Electric 176 42� S.J--� Tax Collector Barry Negley 27.74 l
-6—.--� Donna&Alan McGinty for labor for cleaning 61 SME and for removal of old console tube television N 240 00
�� 7.--� Douglas Maus for labor of cleaning 61 SME prior to sale and for hauling trash to landfill 400.00
{--� ��
�8. Joanne D.Maus for labor of cleaning 61 SME prior to sale of home 400.00
09. FVOHRA Health Services 17.61 .
1 S Real Estate for commission on sale of 61 SME 1,500 00,?
11. ,Breschi&Associates for Settlement Fee on 61 SME 100.00(f
I _
IF 12. Dawn M Shoop for.Notary Fee on Settlement of 61 SME .5.00
L1
M
E-1 L-
El
F-I
El
TOTAL(Also enter on Line 10, Recapitulation) $i 3 115 71
If more.space is needed,insert additional sheets of the same size.
11EV-1513 EX+(01-10)
pennsylvania SCHEDULE J .
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
J. Harold Holtry
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Joanne Maus, 123 Shippensburg Mobile Estates,Shippensburg,PA Daughter 50%
F12 Randy Holtryi12880 Stonewall Road,Shippensburg,PA Grandson 16.666%
F31 Terry Holtry,365 High Mountain Road,Shippensburg,PA Grandson 16.666%
4] Steve Holtry,25 Furnace Hollow Road,Shippensburg,PA Grandson 16.666%
El F--
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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: .
F-7............�
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
F-1 L
F-1 1
Q o�
El
TOTAL OF PART II'-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.
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, J. HAROLD HOLTRY, of
Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this my Last Will and Testament, hereby revoking
all prior wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of all my legal debts, funeral expenses
including my grave marker and all expenses of my last illness, state, federal
estate and inheritance taxes, administration costs, etc., shall be paid as soon as
may be conveniently done following my decease leaving all specific bequests free
of tax to the legatee.
SECOND: I give, devise and bequeath all my property be it real, mixed or
personal, wherever situate as follows:
a. One-Half(1/2) to my daughter, Joann Maus, per stirpes.
b. One-Half(1/2) to Randy Holtry,Terry Holtry and Steve Holtry, in equal
shares share and share alike per stirpes.
THIRD: I direct that my Executors not be required to post bond of any
nature or kind for the performance of any duties in any jurisdiction.
FOURTH: I nominate and appoint, Joann Maus and Pamela Maus, as
Executors of this my Last Will and Testament.
IN WITNESS WHEREOF, I, 1. HAROLD HOLTRY, to this my Last Will and
Testament, set my hand and official seal, this IS-F day of_ c
2001.
a�
(SEAL)
J. Harold Holtry
Sworn to and subscribed, declared and
Published by J. Harold Holtry, as
His Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at his request,
And in his presence, and in the presence
Of each other.
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
I, J. HAROLD HOLTRY, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I
signed it willingly; and that I signed it as my free and voluntary act for the
purpose therein expressed.
J. Harold Holtry
Sworn to and acknowledged, before me,
By J. Harold Holtry, the Testator,
This /S day of 01.
Notary Public
Dawn Mania Shoop. oTary
FI SNPPensbu g Boro. Combeslan C+ ;,:
P P+!Y Commission Expires Feb.
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, H. Anthony Adams and Sharon Coleman Adams, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testator sign and execute the
instrument as his Last Will and Testament; that he willingly and that he executed
it as his free and voluntary act for the purposes therein expressed; that each of
us in the hearing and sight of the Testator signed the Will as witnesses, and that
to the'best of our knowledge and the Testator was at the time at least eighteen
(18) or more years of age and of sound mind and under no constraint or undue
influence.
Sworn to and subscribed before me by,
H. Anthony Adams and Sharon Coleman Adams,
The witnesses, this 3 day of , 2001.
� M
Notary Public
T Natarial Seal
Dawn Mode Shoop,Notanj pub::- .
hiopensburg Born, Cum�E�,?and C
r141 Commission Expires Feb.5,