HomeMy WebLinkAbout12-17-13 (2) J 150561010'5
REV-1500 Ex(o2-ii)(F) g.3
lvania OFFICIAL USE ONLY
PA Department of Revenue pe ennn s y
Bureau of Individual Taxes ° "a T°`"`°`"°` County Code Year File Number
INHERITANCE TAX RETURN
PO BOX 280601 �I 2
Harrisburg,PA 17128-0601 RESIDENT DECEDENT J
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
_.._..._ _....... ._._..,.... _. __E . -.__. _..___-._.
03/1'9/2013 107/11/1922
.. _._... ......... ........
Decedent's Last Name Suffix Decedent's First Name MI
Diller Hazel
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name. MI
Spouses Social Security Number
. THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
OD 1.Original Return C=:) 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
CID 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
C= 9. Litigation Proceeds Received C=) 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
Margaret A Sheaffer (717) 329203
.,.__.::u r�
REGI R$F WILLS t1 ON0)
rt1 C) cD Cd)
First Line of Address r- ;T rrt I F`1 rrI
.728 Laurel Lane
Second Line of Address -
ICity or Post Office ~ µState ZIP Code DATE FILECn CD
Mechanicsburg PA I i 17050
i .......... .................... . .....
Correspondent's e-mail address: pegsheaffer @aol.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.
SIGNATURE OF PERSON RESPONSIBLE FOR FIJLING RETURN DATE
13
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESE TATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
X
1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name:
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. 6,941.72
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . ...... 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested... .... 7 0.00
8. Total Gross Assets(total Lines 1 through 7). .... . ..... .... . ....... . ..... 8. "€ 6,941.72
9. Funeral Expenses and Administrative Costs(Schedule H). .... . .... ... ...... 9. 1,477.40
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). .... . .. ....... 10. 2,412.63
11. Total Deductions(total Lines 9 and 10)... . .... . ....... . ....... ... ..... . 11. 3,890.03
12. Net Value of Estate(Line 8 minus Line 11) . ... . .... ... ..... ... ....... . .. 12. 3,051.69
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. - 3,051.69
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 i
16. Amount of Line 14 taxable
at lineal rate X.0 45 3,051.69 16.1 137.30
17. Amount of Line 14 taxable i
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 € 18.
19. TAX DUE ...... . . ..... . .. ....... . .. . .. .......... ..... . ....... .. . .. 19. 137.30
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Hazel S. Diller
STREET ADDRESS
Lifeways at Messiah Village
199 Mount Allen Drive
CITY STATE ZIP
Mechanicsburg, PA PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 137.30
2. Credits/Payments
A.Prior Payments
B.Discount
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) 137.30
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.......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ N
c. retain a reversionary interest .............................................................................................................................. ❑ E
d. receive the promise for.life of either payments,benefits or care?...................................................................... ❑
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?.............. ❑ 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 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-i5o8 EX+(o8-12)
pennsylvania SCHEDULE E ,
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Hazel S. Diller
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. PSECU Regular Share Account-01#8005814846 2,666.87 jt
2 PSECU Moneyhandler Account-04 #8005814846 4,274.1815
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• i E
1 I Ye
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TOTAL(Also enter on Line 5, Recapitulation) $ a_µ 6,941.72
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hazel S. Diller
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Kathy's Deli-food for funeral 1,163.23
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid: 0.00
2. Attorney Fees:
0.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
0.00
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 143.50
5. Accountant Fees: 0.00
6. Tax Return Preparer Fees: 0.00
7. Cumberland County Law Journal-advertisement of Grant of Letters 75.00
Patriot News-advertisement of Grant of Letters 95.66
TOTAL(Also enter on Line 9, Recapitulation) $ 1,477.39
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pen nsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hazel I. Diller
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
Lifewa s at Messiah Village Nursing home care
2,412.63
3 !
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TOTAL(Also enter on Line 10, Recapitulation) $ 2,412:63
If more space is needed,insert additional sheets of the same size,
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LAST WILL a = n
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of :r> :'U a
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HAZEL S. DILLER
;M
`s--
Z, Hazel S. Diller, now domiciled in Dauphin County,
i
Pennsylvania, declare this to be my Last Will. I revoke all other
wills and codicils that I may have previously made.
L
l
ARTICLE I.
My just debts and expenses of my last illness, funeral, and
administration of my estate shall be paid by my Executor from the
principal of my residuary estate as soon as practicable after my -
death.
t
ARTICLE II
All inheritance, estate, and succession taxes (including
interest and penalizes thereon, but not including any generation
skipping tax) payable by reason of my death shall be paid out of
and be charged generally against the principal of my residuary
estate without reimbursement from any person. This provision is
not a waiver of any right which my Executor has to claim
reimbursement for any such taxes which become payable as the result
of any property over which I have the power of appointment.
f' Page 1 of 5
ARTICLE III
A. I give and bequeath my secretary desk to my daughter,
Nancy A. Altman, provided she survives me by thirty (30) days. If
my daughter fails to so survive me, this gift shall lapse.
B. I give and bequeath my sterling sliver flatware table
service to my daughter, Catherine A. Schmidt, provided she survives
me by thirty (30) days. If my daughter fails to so survive me, t
this _gift shall lapse.
C. I give and bequeath my double maple dresser and matching
mirror to my daughter, Margaret A. Sheaffer, provided she survives
me by thirty (30) .days. If my daughter fails to so survive me,
this gift shall lapse.
D. I give and bequeath my cherry cedar chest to my son, James
R. Sheaffer, provided he survives me by thirty (30) days. If my
son fails to so survive me, this gift shall lapse.
E. All the rest, residue, and remainder of my property,
real, personal, and mixed, I give, devise, and bequeath in equal
shares to my children, Margaret A. Sheaffer, Richard H. Sheaffer,
James R. Sheaffer, Catherine A. Schmidt, and Nancy A. Altman, i
. provided the named-child survives me by thirty (30) days. If a.
named-child fails to survive me by thirty (30) days, - his or her
share of my estate shall be distributed in equal shares to his or
her issue who survive me by thirty (30) days. If any of my named-
children fail to survive me by thirty (3 0) days and he or she
leaves no issue who survive me by thirty (30) days, his or her gift
of a share of my estate shall lapse. !
� � Page 2 of 5
ARTICLE IV
In addition to the powers conferred by law, I authorize my
Executor, in my Executor's absolute discretion:
(a) to retain in the form received and to sell either at
public or private sale, any real estate or personal property except
that which I specifically bequeath herein;
(b) to manage real estate;
(c) to invest and reinvest in all forms of property without
being confined to legal investments, and without regard to
principal of diversification; I
(d) to exercise any option or right arising from the
ownership of investments;
(e) to compromise claims without court approval and without
the consent of any beneficiary; I I
(f) to file any federal income- tax return for any year for
which I have not filed such return prior to my death;
(g) to make distributions in cash or in kind, or in both,
and to determine the value of any such property; I. {
(h) to employ any attorney, accountant, investment advisor, fI
or other agent deemed necessary by my Executor; and to pay from my
estate reasonable compensation for all of their services; and
(i) to conduct along with or with others, any business in
which I am engaged in or have an interest in at the time of my -
death.
1
i Page 3 of 5
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I
ARTICLE V
I nominate, constitute, and appoint Margaret A. Sheaffer to
act as the Executor of my Last Will. In the event of her
renunciation, death, resignation, or inability to act for any
reason whatsoever as my Executor, I nominate, constitute, and
appoint Richard H. Sheaffer to act as my Executor. I hereby
relieve my Executor, whether original, substitute, or. successor,
I
from the necessity of posting security in connection with his or
her duties as such in any jurisdiction in which she may be called
upon to act so far as I an able by law to do so. My Executor shall
receive reasonable compensation for services rendered to my estate.
IN WITNESS WHEREOF, I, Hazel S. Diller, hereby set my hand to
this my Last Will, on this day of 1992 at
Harrisburg, Pennsylvania.
aZ S. Diller, Testatrix
in our presence, the above-named Testatrix signed this and
declared this to be her Last Will and now at her request, in her
present, and in the presence of each other we sign as witnesses.
Name Address
t
/'737Z-
Page 4 of 5
I, Hazel S. Diller, Testatrix, who signed the foregoing
instrument, having been duly qualified according' to law,
acknowledge that I signed and executed this instrument as my Last
Will, and that I signed it willingly as my free and voluntary act
for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
HGuQ S �;llrrc , the Testatrix
this day of pvw� ,
1992.
H el S. Diller, Testatr x �
NOTARRAL SERI �
JFJ�VIFER L.CJi7iSCr Sr 1.J ,y;:;�„y Nbllc
Fiarrisb`-r, Oaupi•r,.i Cou,,:;y
My Commission Expires Oct.29,11)54
We, the undersigned witnesses who signed the foregoing
instrument; being duly qualified according to law, depose and say
that we were present and saw the Testatrix sign and execute this
instrument as her Last Will; that she signed and executed it
willingly as her free and voluntary act for the purposes wherein
expresses; that each of us in her sight and hearing signed the Last
Will as witnesses; and that to the best of our knowledge, that she
was at the time eighteen (18) years or more of age, of sound mind,
and under no constraint or undue influence. 1
Sworn to or affirmed and
subsc *bed to before mkp,
by SGhc� _
and
witness s, this j( day
of , 19.9 Witnes
E
Witn ss
NOTAREAL
JENH1F8t A S L.GPOBERiCH, pub;,-,
Hwisbdro, D?uiphlil Cou?'j
MyCommissim Ex,;ires Oct,29,'1-`;4 {
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