HomeMy WebLinkAbout11-25-13 (2) J 1505610140
REV-1500 � �02-"'�F°
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PA Department of Revenue
Bureau of Individuai Taxes County Code Year File Number
PO BOx 28oso� INHERITANCE TAX RETURN 2 1 1 3 0 3 5 3
Hanisbur41 PA 17�28-OSO� RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 2 2 6 2 0 1 3 0 2 2 9 1 9 2 4
Decedent's Last Name Suffix Decedent's First Name MI
A R C H E R C A T H E R I N E M
(If Appiicable)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 �F WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1.Original Return � 2.Supplemental Return � 3.Remainde�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)
� 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) ( ach Schedul�
CORRESPONDENT-THIS SECTION MUST BE COMPIETED.ALL CORRESPONDENCE AND CONFIDENTIAI TAX I R�TION SH . B �ED T0:
Name Daytim� one Nu�� � p
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D A V I D H S T 4 N E , E S Q U I R E 7 1���,,�-'? � ?�t ' 5
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First Line of Address :� � �,,,, � �
4 1 4 B R I D G E S T R E E T � cn � �
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Second�ine of Address
City or Post Office State ZIP Code DATE FILED
N E W C U M B E R L A N D P A 1 7 0 ? 0
Conespondent's e-ma�t address: D S T 0 N E a�S T 0 N E L A W•N E T
Under penalties of pe�jury,I declare that I have examined this retum,inGuding accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,conect and complete.Declaration of preparer other than the personal representative is based on all information of which prepare�has any knowledge.
�GNATU F SO SP �E FOR FILING RETURN DATE
.
505SALIS V MECHANICSBURG PA 17055
SIG UR PA 0 H N REPRESENTATIVE DATE
.
ADDRESS
414 BRIDGE ST ET NEW CUMBERLA�ND PA 17070
PLEASE USE ORIGINAL FORM ONLY
Side 1
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1505610140 1,505610140 J
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� 1505610240
REV-1500 EX(FI) DecedenYs Social Security Number
oecedent'sName: CATHERINE M• ARCHER
RECAPITULATION
1. Real Estate(Schedule A) . . ... .. . . . .. . . .. . ... ... . . .. . . . . . . . . . . .. .... �• '
2. Stocks and Bonds(Schedule B) . .... . .. . .. .. .. . ..... . ... . .. . ... ... . . . 2• '
3. Closely Held Corporation,Partnership o�Sole-P�oprietorship(Schedule C) . .. .. 3. •
4. Mortgages and Notes Receivable(Schedule D) . . . . . ... . . .. . . . . . . • . . • • • • • 4. '
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .. .. 5. 3 9 0 8 . � 5
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . .. . 6. •
7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property
(Schedule G) � Separate Billing Requested . . . . . . . 7. •
8. Total Grass Assets(total Lines 1 through 7) . . .. . . ... . . .. . . . . ... ... ... . 8. 3 9 � 8 . � 5
9. Funeral Ex enses and Administrative Costs(Schedule H 9. 8 5 2 3 . 5 8
p ) ... ... . . . . . . . . . . . .
10. Debts of Decedent,Mo�t a e Liabilities,and Liens Schedule I 10. 1 0 8 8 . 1 8
9 9 ( ) . .. . . . . . . .. . .
��. Total Deductions(total Lines 9 and 10) .. . . .. . ... . .... . .. . .. . .. . . . . . . . 11. 9 6 1 l, . 7 6
12. Net Value of Estate(Line 8 minus Line 11) .. . . . .. ... . . . .. .. . .. . . .. .. .. �2. - 5 7 0 3 . ? 1
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . ... . . . . ... . ... ... .. . �3• •
14. Net Value Subject to Tax(Line 12 minus Line 13) .. . ... . ... . .. . .. . ... .. 14. - 5 7 � 3 . 7 1
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfe�s under Sec.9116
(a)(1.2)X •� � . 0 0 15. � . � 0
16. Amount of Line 14 taxable
at Iineal rate X 0 4 5 0 . 0 0 �6, O . 0 0
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. � • 0 �
18. Amount of Line 14 taxable 0 . � �
at collateral rate X.15 0 • 0 0 18.
19. TAX DUE . . . .. . . . . .. . . . . . .. .. .. . . .. . . .. . .. . . .. . . ... . . . . . . . . . . . . 19. � • 0 �
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
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1505610240 1505610240 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 ],3 0 3 5 3
DECEDENTS NAME
CATHERINE M• ARCHER
STREET ADDRESS
31 SOUTHPOINT DRIVE
��n STATE ZIP
MECHANICSBURG PA 17055-
Tax Payments and Credits:
1• Tax Due(Page 2,Line 19) (1) 0 •0 0
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0 •0 0
3. Interest
(3) 0 •0 0
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) 0-0 0
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0•0 D
Make check payable to: REGISTER OF WILLS, AGENT
�� ,����� �� �: ����.;���� �._ .����a���£ ���.�. � � . a a..
'-, w°{sa 4 ��'cxx� 4 Y � +i,i�'t,� ..A'%..L9: „ ,aY...�. .�`,�... s"::sx ,<f.:En.rw x... a ._, ,a . , .�..., a,s,n e.,�n„>.. .,., , . ...,., .
......... . .. , ,.a,.o, r.m ,. .... . %`� .3';�y.,
PLEASE ANSWER THE F4LLOWING 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 transfeRed ...................................................................... � �
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? ....................................................... ❑ �
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-death 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.
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s,. �'.' a�n�r� �;>r,���-�"°�.-'�� �� ��,� z� ,i°'��x `z� ��'�°� '�`�s�:���" ',y� :,g'.� �q:a. . ....
� ..':.a.�,� �Y� �x�. ����
' � -'"� � �b � '� � �'. ,a�.,.:< �iE�, �`' . ��Y,c..,..�"�`_...,.z�, ,��,�����.���.� ��?�a--' �R�..�:.,,��.`?.�.��� ;:a��� �'•'�cz:,�`....,� ,v< �.�s�� . . .. .
'�;r , ,�.0 a,2��� �A `�'�.a,7�'.�4,��� �._.. ..:�.a ,.'� - . ....�. ,� . ..�.. .. ..,,:� . . '.;
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 retum 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�t2 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 Secbon 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
RESIDENT DEC D NTTURN PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
CATHERINE M. ARCHER 21 13 0353
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with�ight of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• Nerd Chiropractic-refund on payment ?9•82
2 PNC Bank-Checking Acct #5140001593 3,423•21
Princ �3,423• 21, Int $•02
3 PNC Bank-Checking Acct #5140001593 - Accrued Int 0 •02
4 Vault refund received 405•00
TOTAL(Also enter on Line 5,Recapitulation) � 3,9 0 8•0 5
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
CATHERINE M• ARCHER 21 13 0353
Decedent's debts must be�eported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
George Archer Jr-Reimb on funeral luncheon 550•00
Dioceses of Harrisburg-grave marker 250 �00
Malpezzi Funeral Home-funeral expenses 6,38?•52
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Persanai Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. AttomeyFees: David H Stone, Esquire 750•00
3, Family Exemp6on:(If decedeni's address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4 • Probate Fees: S e e #1 b e 1 o w
5. Acxountant Fees:
6 • Tax Retum P�eparer Fees:
7• George Archer Jr-Reimb for probate costs 93•50
2 George Archer Jr-Reimb for filing ITR and Inv 30•00
3 PNC Bank-Miscellaneous expense 4 •00
4 Dennis Zerbe-personal taxes 4 •90
5 Vital Check-death certs for George Archer Sr 3?•00
6 Notary fees 5•00
? United Water-water service 16•91
8 Verizon-services rendered 3?•01
9 PPL-electric service 157•74
10 Reserve for closing expenses 200•00
TOTAL(Also enter on Line 9,Recapitulation) 3 8,5 2 3•5 8
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�
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CATHERINE M• ARCHER 21 13 0353
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 • Sarah Lynch DDS-dental services prior to death 1?7•16
2 Express Scrips-medical services prior to death 44 •00
3 Hershey Cardiology-medical services prior to death ?.13
4 West Shore Anesthesia-medical serv prior to death 100 • 47
5 �amp Hill Fire Co-ambulance service 200 •00
6 Holy Spirit Hospital-debt of decedent 306 •78
? Quantum Imaging-services prior to death 1•93
8 James R Hartz MD-debt of decedent 4 • 47
9 Capital Cardiovascular Assoc-debt of decedent 173•02
10 Pinnacle Health Med Svcs-debt of decedent 16 .99
11 Lower Allen EMS-trip to hospital 8•23
12 Commercial Acceptance Co-East Penn ambl serv 48 •0�
TOTAL(Also enter on Line 10,Recapitulation) S 1,0 8 8•18
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEpENT
ESTATE OF: FILE NUMBER:
CATHERINE M • ARCHER 21 13 0353
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 out n'ght spousal distribu�ons and transfers under
Sec.91'�6(a)(1.2).]
1 GEORGE S ARCHER JR Lineal 0•00
505 ALISON AVENUE
MECHANICSBURG PA 17055-
2 CAROL A ARCHER Lineal 0 • 00
2100 CEDAR RUN DRIVE
CAMP HILL PA 17011-
3 BONITA PARK Lineal 0•00
1763 KINGS ARMS COURT
NEW CUM6ERLAND PA 17070-
4 MARK A ARCHER Lineal 0•00
1246 REBERT DRIVE
MECHANICSBURG PA 17055-
ENTER DOUAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAI 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. s
if more space is needed,use additional sheets of paper of the same size.
i
LAST WILL AND TESTAMENT
OF
CATHERINE M. ARCHER
I, CATHERINE M. ARCHER, of Upper Allen Township, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any �
will previously made by me. '
ITEM I : I direct that my Executor hereinafter named shall pay �
�
ebts and funeral expenses as soon as conveniently may be I
all my �ust d .
I
done after my decease from the residue of my estate . !
;
ITEM II : I devise and bequeath a11 the rest, residue and '
I
remainder of my estate of every nature and wherever situate to my
children, GEORGE S . ARCHER, JR. , CAROL A. ARCHER, BONITA PARK, and
�
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MARK A. ARCHER. Should any of my children predecease me, I devise and '
I
be queath the share of such child to his or her issue, per stirpes; and ,
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mine leave no such issue living following my I
should any such child of �
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death, I devise and bequeath the share of such child to my issue, per �
i
I
i
5t,irpes . �
I a oint my son, GEORGE S . ARCHER, JR. , Executor of "
ITEM III . Pp
this my last will . Should my son, GEORGE S . ARCHER, JR. , fail to �
i
ualify or cease to act as Executor, I appoint my dauqhter, CAROL A. �
q i
I
ARCHER, Executrix of this my last will . I
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Page 1 of 4
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ITEM IV: No fiduciary acting hereunder shall be required to post ;
bond or enter security for the faithful performance of his or her
�
duties in any jurisdiction. ;
IN WITNESS WHEREOF, I, CATHERINE M. ARCHER, have hereunto set my �
� �
hand and seal this 13 day of , 2006. ;
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� _�;'GG��-�— �X ��.�.�tt/
( CATHERINE M. ARCHER �
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Page 2 of 4
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SIGNED, SEALED, PUBLISHED ��:� DECLARED �_ ��r y:-;�R.I^;E ::. :,�,��::�n.,
the Testatrix above named, as and for .ncr Last ���ai�i and Testa�ent, �n:�
�i in the presence of us, who at �er request, in her presence ar.d in the
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" presence of each other, have subscribed our names as witnesses .
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'' �r� 414 Bri�ae St . , New Cumi�er i and, p�
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Witness " ""'�`" AddYess
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Witness ` Address
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COMMONWEALTH OF PENNSYLVANIA:
! : SS :
il COUNTY OF CUMBERLAND .
I, CATHERINE M. ARCHER, the Testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according
,
;) to law do hereby acknowledge that I signed and executed this instru-
,
I ment as my last will; that I signed it willingly arid that I signed it
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� as my free and voluntary act for the purposes therein contained.
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� C�THER.INE ��l. t�RCHER
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Sworn to or affirmed to and acknowledged before me by CATHERINE
I
j M. ARCHER, the Testatrix, *�his � � day of \ • ,. � , 2006 .
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� NOrary PUbi�C '
� COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
i CAROL L.TROXEU.� Notary Pubiic �;��p 3 �i 4
� Naw Cumberland Boro.Cumberland Ca. �
� My Cr�;,u��issi�n�xpiras C'-�... �7,tOG9
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COMMONWEALTH OF PENNSYLVANIA : '
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COUNTY OF CUMBERLAND • ;
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We, ►�. ti :
' nesses whose names are signed to the atitached or foregoing ,
the wlt
ument being duly qualified according to law, depose and say that i
instr , �
we were present and saw Testatrix sign and execute the instrument as !
;
! will; that Testatrix signed willingly and that she executed i
her last
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her free and voluntary act for the purposes therein expressed; ,
i t a s '�
the hearing and sight of the Testatrix signed the �
that ea
ch of us in I
he best of our knowledge, the Testatrix �
will as witnesses; that to t �
was
at that time eighteen or more years of age, of sound mind anci
under no constraint or undue influence . � 1 A
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Witnes '
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Witness ;
Sworn to or affirmed to and acknowledged before me by
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, 2006. 'I
witnesses, this ��� day of i
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Notar P blic I
� 'M oF�►vNSnvaNU► y �
NOTARIAL SEAL I
CAROL i..TROXELL Notary Public
New Cumberland Bcro.Cumborisnd Co P a g e 4 o f 4
My Commiasion Expkes Dec,27,2ppg
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Apr. 17. 2013 12:33PM PNC Bank No, 2611 P. 1/1
���.
h •
Apri117,20I3
I�aVid H Stone Es4.
Stonc Laf��►er &Sheklet�i
41�]gridgc St .
p 01�3a�E
I�e�v�rxmberYand,PA 1707a �
RE: �atherine M Archcr
SSN: �6C>-Z2�4750 .
�OD: 02-26-2013 �
Dear NSr. Stonc:
I�a response to�our reqncst for]�ate of 17ca.th(�OD)ba�nces �'or tbe cusiozner noted abo�ve, our
rccords s�o�v the follavvi.n�: �
Checki�g Account �
Account# �140001593 �sta,blished.:03-01�1957
CATHERL►�TE M,A,�.CHER -
IaOD balanc�: S 3;423.21 +0.02 accrucd interest
Sntores*.p�id Q 1-01-2013 thr�u Q2-26�2013 � O.Oa 'YTD �
l�lease no�te t�hat this ofbce pro�vides dau of d�ath balancss for deposit accounts(�t.As.Cl�s,Ch�ecking a,nd
Sa�vin�s), We do not�rocess any$nancial transac�ions or pro�i�e statemeniKS. Yf vau neod a�ssistantcc�uvith
an�of�es�itcrns,please ca11 1-$88-FNC�BAN�(1-888-76�-2265)or stop by your loca�P]�C�an�c bran�h
ofFice.
S incerely,
� National Fin�uacial Services Cerater
� PNC Ba�k.,N.A.
Ivlembar FDI�
This message zs inrended far the use o f the xndividual ar er�tity to which it is acaidressed and may
coruain information t�ar is prirvYle�er� c�n,fidential and exempr.fr�arn disclQSUre u»der appltcable Ia►��.
1'f the reader o.►`thzs messags is not the irjtended recipiena or the em�rovee or agent resporzrible for
delivering thrs messacge to the intended recipient, yvu r�re h�rebv notif E�'that ar��dlssem�riatcon,
distribution or copying of rhis comrrrunications is strictly prohibited, I,f you have re�eived t�is�
Cplri�fitlniCQtTOn i�2 Brrpr, ptease nati�y me imrr�ediaiely by reply ar by�elephane�at 800�7bZ�17�S and
rrrimediately destroy this faxed dacumenr.
1°a,�e � of 1
_
STONE LAFAVEI3 & SHEKLETSKI
ATTORNEYS AT LAW
414 BRIDGE STREET
DAVID H.STONE POST OFFICE BOX E OF COUNSEL
GERALD J.SHEKLETSKI NEW CUMBEBLAND.PA 17070 CHARLES H.STONE
JON F.LAFAVER
www stonelaw net
TELEPHONE(717)7747435
November 2 2, 2 013 FACSIMILE (717)774-3869
Register of Wills Office
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3887
RE: Estate of Catherine M. Archer
No. 21-13-0353
Greetings :
Enclosed please f ind an original and one copy of the Inheritance
Tax Return and Inventory for the above mentioned estate. Please
clock in the copy of the Inventory and send it back to my office
along with any receipts in the enclosed stamp addressed envelope.
Should you have any questions, please do not hesitate to contact
my of f ice.
Very truly yours,
ST AVER & SHEKLETSKI
D ' d H. one
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