HomeMy WebLinkAbout11-14-13 � 1505610140
REV-1500 EX (02-11)(FI)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po sox 2soso� INHERITANCE TAX RETURN 2 1 1 3 1 0 5 9
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 7 8 3 8 5 2 2 9 0 9 1 4 2 0 1 3 Q 8 0 7 1 9 4 6
DecedenYs Last Name Suffix Decedent's First Name MI
MASEMER WI L L I AM E
(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
� 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 Retum Required
death after 72-12-82)
� 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 SHQULD BE DIRECTED T0:
Name Daytir�Telephone I��ber� �7
m
J OE L R . Z U L L I N GE R 7 � � 2 6r4 �; g2 9
rn � � �
r EIDI6pER OF MdOLLS L{� .�LY
� � � '-� :E7 �
First Line of Address `� c^s � "O � �
c:s � �^� � � —�
1 4 NORTH MAI N STREET � �= '' �.''= c,
_ � �.. �..TM_ �.�
SecondLineofAddress 'v �
�a ....C' Cd� C?
SUI TE 2 00 ° `'
City or Post Office State ZIP COd6 DATE FILED
C H A M B E R S B U R G P A 1 7 2 0 1
CorrespondenYs e-mail address:
Under penalties of perjury,I deGare that I have examined this retum,inGuding accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,�rrect and complete.DeGaration of preparer other than the personal representative is based on all infortnation of which preparer has any knowledge.
SIG �l1RE OF ,ER ON ESPO SIBLE FOR FILING RETURN DATE
�- �_ � �a
�W� � /.
� P.OE BOX 36✓ SHIPPENSBURG PA 17257
SfG TURE Alt�t OT THAN REPRESENTATNE DAT
'� //
RESS
` 4 NORTH N STRE ' , SUITE 200 CHAMBERSBURG PA 17201
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 1505610140 J
� 1505610240
REV-1500 EX(FI) DecedenYs Social Security Number
DecedenYSName: WILLIAM E. MASEMER 1 7 8 3 8 5 2 2 9
RECAPITULATION
1. Real Estate(Schedule A) �• '
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. � 3 3 � 2 Q . 2 7
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. •
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 5 1 9 5 6 � � 6
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7.
S. Total Gross Assets total Lines 1 throu h 7 8. � $ 4 9 7 6 . 3 3
( 9 ) . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Funeral Ex enses and Administrative Costs Schedule H 9. 2 2 6 1 � . � �
P ( ) . . . . . . . . . . . . . . . . . .
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. •
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 2 6 1 � . � �
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12• � 6 2 3 6 5 . 3 3
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(�ine 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. � 6 2 3 6 5 . 3 3
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 15. � . 0 �
76. Amount of Line 14 taxable
at�inea�rate x.o4s 1 1 0 4 0 9 . 2 7 16. 4 9 6 8 . 4 2
17. Amount of Line 14 taxable
at sibling rate X.12 � . 0 � 17. 0 . � �
78. Amount of Line 14 taxable 5 1 9 5 6 . � 6 �g. 7 7 9 3 . 4 1
at collateral rate X.15
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. � 2 7 6 � . $ 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
� 1505610240 1505610240 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 2� 13 1059
DECEDENT'S NAME
WILLIAM E. MASEMER __ __
STREET ADDRESS
700 Newburg Road
CITY STATE ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1• Tax Due(Page 2,Line 19) (1) 12,761.83
2. Credits/Payments
A.Prior Payments
B.Discount 638.09
Totai Credits(A+B) (2) 638.09
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) 12,123.74
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 ...................................................................... ❑ X❑
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? ....................................................... ❑ X❑
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ 0
3. Did decedent own an"in trust for"or payable-upon�ieath bank account or security at his or her death? ......... ❑ 0
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 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in p2 P.s.§s��s(a)(t)�.
• 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
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
WILLIAM E. MASEMER 21 13 1059
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. 2010 Chevrolet Malibu LTZ Sedan, appraised by H&H Chevrolet, with copu 12,000.00
attached
2. Checking Account#6210355823, Citizens Bank, including interest accrued to 10,008.44
date of death
3. Certificate of Deposit#6247369404, Citizens Bank, including interest accrued yo 111,011.83
date of death
TOTAL(Also enter on Line 5,Recapitulation) � 133 020.27
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
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
WILLIAM E. MASEMER 21 13 1059
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 INCLUDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND DATEOFDEATH %OFDECD�S EXCLUSION TAXABLE
NUMBER THEDATEOFTRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE. VALUEOFASSET INTEREST (IFAPPLICABLE) VALUE
1. Roth IRA Account#525-91475-1-9, held with Edward Jones,
with named beneficiary of Kenneth M. Hale, Jr., no
relationship to decedent, consisting of assets as follows:
99.606 shares of American Funds Growth Fund of 4,157.55 100.00 4,157.55
America CI A @41.74
122.78 shares of American Funds American Balanced 2,795.70 100.00 2,795.70
Fund CI A @22.77
2. IRA Account#697-73366, held with Merrill Lynch, with named 45,002.81 100.00 45,002.81
beneficiary of Kenneth M. Hale, Jr., no relationship to
deceddent, consisting of assets shown on attached valuation
TOTAL (Also enter on Line 7,Recapitulation) $ 51 956.06
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENTOF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
WILLIAM E. MASEMER 21 13 1059
DecedenYs debts must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Wetzel Funeral Home, funeral expenses 19,767.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2, Attomey Fees: Joel R. Zullinger 2,500.00
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: L@tt@fS 210.00; renunciation 10.00; short certificates 15.00; JCS fee 23.50; 343.50
automation 5.00; inventory 15.00; inheritance return 15.00; additional probate-50.00
5 Aarountant Fees:
6. Tax Retum Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) S 22 611.00
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
WILLIAM E. MASEMER 21 13 1059
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. Kenneth M. Hale, Jr., P.O. Box 236, Shippensburg, PA 17257- Collateral 51,956.06
Items 1 and 2 on Schedule G -51,956.06
2. Anna L. Masemer, 514 S. Franklin Street, Hanover, PA 17331 Lineal 110,409.27
residue of estate(decedent's father, LaVere G. Masemer
survived decedent but died on 10/17/1913
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
Ij, 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 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.
Oct. 16. 2013 12:38PM HC DAVIS No. 1876 P. 1
� � � Chevrolet Cadillac
730�ast King Street
Shippensburg,PA 17257
(717) 532-2121 Fax (717)532-3658 www.hhchev.com
"I`o: 1'he �,state of'William E. Masemer October l4, 2U13
Kenneth M. 1{ale Jr. C;xecutor
700 Newburg Rd
PO Box 642
Shippensburg, PA 17257
RE: 'Vehicle Appraisals
Dear Mr. Ha1e:
'V�/e have conducted an inspection of the personal vehiele of the late William E. Masemer
Shields on Wednesday October 2nd, 2013 and have assigned a value to the vehicle as
fotlows:
Une(1)2010 Chevrolet Malibu LTZ sedan,ViN 1G1ZE5EB6AF139248 It is
equipped as follo�uvs: 2.4 Liter I-4 engine,automatic transmission,air conditioning,pov��er
windows and locks, stereo with CD, atloy whee[s, leaxher interior irim and has 25,643
miles. The vehicle has a PA Safety Tnspection which wilt expire in I�ecember 2014. The
tires are wearing evenly,the interior seating and carp�ting are in good condition,the paint
finish is in fair eondition however ihere aze several deep seratches on the hood,trunk lid,
on top of the rear bumper and there is a dent and scrape on the rear bumper, several mazks
in the paint on the roof and one of the wheels has damage from hitting a curb. After '
e�valuation of the NADA value guide,the Black Book,Kelle�r Blue Book and local markei
data from Manheim Auto Auctions(using nationwide data)and factoring in the necessary
reconditioning expenses needed to prcpare the vehicte for a retail sale, the vehicle has a
�air Market Va1ae of 512,000.00. �T&H vvould be a buyer of this vehicle in this
condition at that number within the next l5 days.
Please let us know if we can assist you in any way�vith the transportation and disposition
of ihis vehicle.
$inCerely yourS,
, /
c�� �j���� y�i �
W. Mickey Nye � �
Dealer Principal
� �� . <
Account Number 6210355823
Account Title William E. Masemer
Date Opened 10/29/2005
Account Type Checking
Principal Balance as of DOD $10,008.41
Interest from Last Posting to DOD $ .03
Account Balance as of DOD $10,008.44
YTD Interest to DOD $1.61
� �� � � � :
Account Number 6247369404
Account Title William E. Masemer
Date Opened 11/8/2005
Account Type Time Deposits
Principal Balance as of DOD $111,001.95
Interest from Last Posting to DOD $9.88
Account Balance as of DOD $111,011.83
YTD Interest to DOD $241.33
�erican Funds Growth Fund of America;A, AGTHX Historical Quote - (MFD) AGTH... Page 1 of 1
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Fri,Sep 13,2013
Closing Price: 41.66
open: 41.66
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American Funds American Balanced Fund;A, ABALX Historical Quote - (MFD)ABAL... Page 1 of 1
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LAW OFFICES OF
ZULLINGER-DAVIS
PROFESSIONAL CORPORATION
JOEL R.ZULLINGER SUZANNE M. TRINH HAMILTON C.DAVIS
jzullinger(u»zullin�er-davis com strinhna zullinger-davis com hdavis(u�,zullinger-davis com
14 North Main Street,Suite 200 ��'
20 E�4 Burd Street,�:b.Be�j 4�
Chambersburg,PA 17201 Ship �jurg,PA`�''3257 rrt `,.�.�
717-264-6029 717-��I13 G �? p
717-264-1884(FAX) 717-E�0�2�FA� � %�
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November 13, 2013 � c`� � � -`� �i
Register of Wills � �' "�� � �= �
Cumberland County Courthouse `..�, � `J ;-- '''
1 Courthouse Square `' o �'�' °
Caxlisle, PA 17013
Dear Register:
R.E: Estate of William Edward Masemer
File No. 21-13-1059
Enclosed for filing in your office are two copies of the PA Inheritance Tax Return
for the above estate. Also enclosed are the following checks:
• Register of Wills, Agent - $7,403.24 in payment of inheritance t� on
nonprobate assets;
• Register of Wills, Agent - $4,720.00 in payment of inheritance tax on probate
assets;
• Register of Wills - $50.00 in payment of additional probate fee.
If you have any questions,please contact my Chambersburg office. Thank you.
Very tn,ily yours, �"
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.Jo R. Zullirige ' {
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