HomeMy WebLinkAbout11-21-13 (2) � 1505610140
REV-1500 EX (02-11)(FI)
PA DepaRment of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po sox 2soso� INHERITANCE TAX RETURN
Harrisbur9,PA 17128-0601 RESIDENT DECEDENT 2 1 1 3 1 0 1 2
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 3 1 2 2 7 7 7 0 9 0 3 2 0 1 3 1 0 2 8 1 9 2 0
DecedenYs Last Name Suffix DecedenYs First Name MI
P A X T 0 N W A L T E R N
(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
O 1. Original Return � 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.)
� 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 SHOULD BE DIRECTED T0:
Name Daytime Telephone Wutnber
._ ;:�
I V 0 V . 0 T T 0 I I I 7 �' 70 2 4� � �.; 4 1
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First Line of Address t� e , s �� � , ,
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Second Line of Address �:a `�
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Clty or PoSt OffiCe State ZIP COde y� _DATE F�IC�D
C A R L I S L E P A 17 0 1 3
CorrespondenYs e-mail address: lOTTO(c�,MARTSONLAW.COM
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 representative is based on all information of which preparer has any knowledge.
SIGN R�OF PER ON RESPONSIBLE FOR FILING RETURN DATE
�d4 '�.l.Lc.� 1�/.�o��3
ADDRESS
23 BARE ROAD MECHANICSBURG PA 17�50
SIGNATU OF R P OTHER THAN REPRESENTATIVE D TEl `
�sr'� Y��.. Y C `�
ADDRESS
10 EAST HIGH STREET CARLISLE PA 17�13
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 1505610140 � �
� 1505610240
REV-1500 EX(FI)
DecedenYs Social Security Number
�ecedent's Name: W A L T E R N • P A X T 0 N 1 8 3 1 2 2 7 7 7
RECAPITULATION
1. Real Estate(Schedule A) �•
� . � 0
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Stocks and Bonds(Schedule B) 2, � • � �
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. •
4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. •
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 2 7 1 7 2 . � 5
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 1 � � • 5 7
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . . . . 7. 1 2 2 5 . 5 1
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 2 8 4 9 8 . 1 3
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9� 2 3 4 4 . 5 0
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 6 2 4 . 4 8
��, Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 9 6 8 . 9 8
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . �2• 2 5 5 2 9 . 1 5
13. Charitable and Governmental Bequests/Sec 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. 2 5 5 2 9 . 1 5
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 _ � . � � 15. 0 . � �
16. Amount of Line 14 taxable
at�inea�rate X.045 2 5 5 2 9 . 1 5 �s. 1 1 4 8 . 8 1
17. Amount of Line 14 taxable
at sibling rate X.12 � . 0 � 17. � . � �
18. Amount of Line 14 taxable
at collateral rate X .15 0 . 0 0 1g. 0 . 0 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 1 4 8 • 8 1
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
� 1505610240 1505610240 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Compiete Address: 2� i 3 i o�2
DECEDENT'S NAME
WALTER N. PAXTON
- ___ ._. . __ _ _ _ __ ___
STREET ADDRESS _ __ _ _._ _ __ _
442 WALNUT BOTTOM ROAD
_ ___- - __ __ __ _ _ _-- __ _ _
- — __ _ ___ - _ __ -_ _
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. TaxDue(Page2,Line19) (�) ���`�g•g�
2. CreditslPayments
A.Prior Payments
B.Discount 57.44
Total Credits(A+B) (2) 57.44
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
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,091.37
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 ............................... X
c. 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? .................................................................................. . ..
. . X
3. Did decedent own an"in trust for"or payabie-upon-death bank account or security at his or her death? ......... ❑ 0
4. Did decedent own an individuai retirement account,annuity or other non-probate propeRy,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)(iij].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 p2 P.s.§s�is(a)(���.
• 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-1508 EX+(OB-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERiTANCE TAX RETURN pERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
WALTER N. PAXTON 21 13 1012
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. M&T Bank Checking Account No.432172 20,146.80
See attached.
2. Sovereign Bank Checking Account No.2891028201 1,085.89
See attached.
3. United Church of Christ Homes-refund 5,751.81
4. West Virginia Teachers Retirement System-final payment 187.55
TOTAL(Also enter on Line 5,Recapitulation) 3 27,172.05
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE �OINTLY•OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
WALTER N. PAXTON 21 13 1012
If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
q. Linda K. Miller 23 Bare Road
Mechanicsburg,PA 17050
B.
C.
JOINTLY-OWNED PROPERTY:
LETfER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 5/1998 Sovereign Bank Savings Account No.2894019716 20 L 14 50. 100.57
See attached.
TOTAL(Also enter on Line 6,Recapitulation) 3 100.57
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON•PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
WALTER N. PAXTON 21 13 1012
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABIE) VALUE
1. Morgan Stanley, IRA AccountNo. 410-038125-003 1,225.51 ]00.00 1,225.S1
Beneficiary: Linda K. Miller, daughter
See attached.
* Annuity death benefit of$29,250.00 payable to Linda K.
Miller,daughter
TOTAL (Also enter on Line 7,Recapitulation) $ 1,225.5 I
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
WALTER N. PAXTON 21 13 1012
DecedenYs debts must be reported on Schedule l.
ITEM
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1. Baughman Memorial Works, Inc. 219.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
SUeet Address
City State ZIP
Year(s)Commission Paid:
2. AttomeyFees: Martson Law Offices 1,927.00
3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: Register of Wills, Cumberland County 133.50
5 Accountant Fees:
6. Tax Retum Preparer Fees:
7. Sovereign Bank-bank fee to obtain date of death value 20.00
8. Register of Wills,Cumberland County-additional probate 45.00
TOTAL(Aiso enter on Line 9,Recapitulation) $ ?,344.50
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES 8� LIENS
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
WALTER N. PAXTON 21 13 1012
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. Millennium Pharmacy Systems, Inc.-account payable 123.72
2. Thornwald Home-account payable 76.97
3. ADS(portable ultrasound)-account payable 35.07
4. West Shore EMS-account payable 1 12.57
5. George Branscum,M.D. -account payable 24.99
6. Carlisle Regional Medical Center-account payable 251.16
TOTAL(Also enter on Line 10,Recapitulation) 3 624.48
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(p1_10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
WALTER N. PAXTON 21 t 3 1012
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
� TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Linda K. Miller Lineal 25,529.15
23 Bare Road Residue
Mechanicsburg, PA 17050
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:
1.
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
1.
TOTAL OF PART ll-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.
F:�FILE5IDATAFILE�WILLS�bJ02-will
w , .
LAST WILL AND TESTAMENT
I, W. NELSON PAXTON,of the Borough of Carlisle, Cumberland County,Pennsylvania,
being of sound and disposing mind and memory,do hereby make,publish and declare this to be my
Last Will and Testament,hereby revoking any and all former Wills or Codicils by me made.
1.
I direct that all my legally enforceable debts,funeral expenses,testamentary expenses and all
inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any
property)shall be paid from my residuary estate as soon as practicable after my decease and as part
of the administration of my estate. My Executrix shall have no duty or obligation to obtain
reimbursement for any such tax so paid,even though on proceeds of insurance or other property not
passing under this Will.
2.
I give, devise and bequeath all of my estate, both real and personal property, unto my
daughter, LINDA KAY ROTZ, absolutely.
3.
I nominate, constitute and appoint my daughter, LINDA KAY ROTZ, as Executrix of my
estate.
4.
I direct that my Executrix shall not be required to file a bond to secure the faithful
performance of her duties in any jurisdiction.
5.
1 authorize and empower my Executrix, in her sole and absolute discretion, to purchase or
otherwise acquire and retain any investments of which I die seized or any real or personal property
of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in
regard to any or all property of any kind forming a part of my estate for such terms and such prices
as they may deem advisable; to borrow money for any purposes connected with the protection and
preservation of my estate;to mortgage or pledge any real or personal property forming a part of my
estate or to join in or secure the partition of same;to compromise any claims or demands of my estate
��,�Y�
W.N.P.
Page 1 of 3 Pages
. . .
against others or of others against my estate; to make distribution in kind and to cause any share to
be composed of cash,property or undivided fractional shazes in property different in kind from any
other share; to employ agents, attorneys and proxies and to delegate to them such power as my
Executrix considers desirable and to pay reasonable compensation for such services as may be
rendered by such agents, attorneys and proxies;and to execute and deliver such instruments as may
be necessary to carry out any of these powers. In addition,I direct that my Executrix shall have the
power to conduct an inventory of any safe deposit box necessary to the administration of my estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this ��t�� day of
C1,a,tr?xk;� , -.�C'OI •
U
` �� / (SEAL)
W. N son Paxton
SIGNED,SEALED,PUBLISHED AND DECLARED by the above-named Testator,as and
for his Last Will and Testament,in the presence of us,who at his request,have hereunto subscribed
our names as witnesses thereto, in the presence of the said Testator and of each other.
C��� � � �� e ' ,
.«tG' ,.1�'!��'� ��►•,..
Page 2 of 3 Pages
COMMONWEALTH OF PENNSYLVANIA )
. SS.
COUNTY OF CUMBERLAND )
We, W. Nelson Paxton, �nG �D���S��'1 , and
Q/'C�G� �. / "Dr�h�, ,the Testator and the witnesses,respectively,whose names aze
signed to the foregoing instrument, being first duly sworn, do hereby declaze to the undersigned
authority that the Testator signed and executed the instrument as his last Will and that the Testator
has signed willingly, and that the Testator executed it as his free and voluntary act for the purposes
therein expressed,and that each of the witnesses,in the presence and hearing of the Testator,signed
the Will as a witness and that to the best of his/her knowledge the Testator was at that time eighteen
years of age or older, of sound mind and under no constraint or undue influence.
!� L�
Testat / �� ,
�!���G�i�.���4'h
Witness
�� ��
wim ss
Subscribed, sworn to and acknowledged before me by W.Nelson Paxton, the Testator,and
subscribed and sworn to before me by f/���' /�0�/i�J`�� and
GV'C(�Q y. �n►M� , the witnesses,this �day of C2�y� ,-�u0/•
� - �J
y .
� �'�.c ��
Public �
�VOTARSAL SEAL
rr;r�c�in�E L. MYERS,Notary Public
�=�^���sie 8oro.CumberiandCounty
�I l,ommission Ex ires Ma 27,2003
Page 3 of 3 Pages
p ��s��
499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 888-502-4349
F au (302)934-2955
October 17,2013
Martson Deardorff Williams Otto Gilroy & Faller
Law Offices
10 East High Street
Carlisle,PA 17013
Re: Estate of W.Nelson Paxton
Social Security: 183-12-2777
Date of Death: September 03.2013
Dear Sir or Madam:
Per your inquiry on October 1 l, 2013, please be advised that at the time of death, the above-named decedent
had on deposit with this bank the following:
l. TypeofAccount CheckingAccount
Account Number 432/72
Ownership(Names o.f} Linda Miller(POA)
W. Nelson Paxton
Opening Date 09/Ol/1967
Balance on Date of Death ,�20,146.80
Accrued Interest $ .00
____ ____ _
_ __ _ _ ___.
Total �20,146.80
For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of fund�,
plesse call the High Street Carlisle at 717-24(1-3536.
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts in which the deceased may have been 6sted as Power of Attorney,Custodian of L'niform Transfers,
Represeniative Payee,or Trustee under a Written Agreement
Sincerely,
Valarie Mercer
Adjustment Services
G,���_ iG � ;=1- �-�t:�i1���1 �
Santander Bank
ESTATE OF W. Nelson Paxton
SOCIAL SECURITY#: 183-12-2777
DATE OF DEATH: September 3, 2013
Account#: 2891028201 Type: Checking Open date: 6/21/1984
In the name of: W.Nelson P�ton(Linda K Miller POA added 1/2/2013)
Date of Death Balance: $1,085.89 '��.F� E� "I- �r�,� �
Int.(YTD) from 1/1/2013 to 9/3/2013 $0.04
Accrued interest to date of death: $0.00
Other Info:
Account#: 2894019716 Type: Savings Open date: 5/13/1998
In the name of: Linda K Miller or W. Nelson Paxton
Date of Death Balance: $201.14 �-,�, . �= .i-�'m (
�
Int.(YTD) from 1/1/2013 to 9/3/2013 $0.42
Accrued interest to date of death: $0.00
Other Info:
Account#: 4539904221 Type: Line of Credit O�en date: 3/31/2011
In the name of: W.Nelson Paacton
Date of Death Balance: $0.00
Int.(YTD) from to n/a
Accrued interest to date of death: n/a
Other Info:
%;,L �1. ��.4 �_�t ���1 ��
Page 1 of 1 '
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