HomeMy WebLinkAbout12-13-13 1S05610105
REV-1500 EX(o,id(E)T OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes 1 County Code Year File Number
RD BOX 28060l INHERITANCE TAX RETURN
Harrisburg,PA 17128-06o1 RESIDENT DECEDENT i b _J
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0911412008 '0311711948
Decedent's Last Name Suffix Decedent's First Name MI
' Sheeler i Marlene
�A
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Sheeler
Barry
----------- ------ ------
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
162-32-3207
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
CW 1.Original Return C= 2.Supplemental Return C=) 3, Remainder Return(Date of Death
Prior to 12-13-82)
C=D 4.Limited Estate C= 4a,Future Interest Compromise(date of CZD 5. Federal Estate Tax Return Required
death after 12-12-82)
OW S.Decedent Died Testate, C= 7-Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
COD 9.Litigation Proceeds Received C=:> 10.Spousal Poverty Credit(Date of Death CZD 111. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1.1-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO!
Name Daytime Telephone Number
,Adam R. Deluca, Esq. 1(717)249-1177
REG[S R OF WILT USE Lr>
M Cc U) -
First Line of Address Dr,_ r— C7 1`� t Erl
61 West Louther Street Cn
Second Line of Aftd�,es
DATE FI ED
City or Post Office State ZIP Code 4�
Carlisle PA 17013
Correspondent's e-mail address:ardeluca85@aol.com
Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,cannot and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
rNATURE OF PERSON ESP G RETURN DATE
A
ADDRESS
4247 CaXsle Road, Gardners, PA 17324
T E OF PREP MO
MHAN WRESENTATIVE DATE
Zx� aA _3
ADDRESS
61 West Louther Street, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side I
1505610105 1505610105
1505610205
REV-1500 EX(Fl) Decedent's Social Security Number
Decedent's Name: Barry L. Shealer
RECAPITULATION
1. Real Estate(Schedule A). . . ..... ..... ..... ....... ......
2. Stocks and Bonds(Schedule 8) . . ..... ..... ... ..... .. ..... . .... . .... . . 2.
3. Closely Held Corporation, Partnership or Sale-Proprietorship(Schedule C) .. ... 3.
4. Mortgages and Notes Receivable(Schedule D). . ....... . ....... ..... ..... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. 5. 158,000.00
6. Jointly Owned Property(Schedule F) C=) Separate Billing Requested ... .... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) C=) Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7). ....... .. ..... . .......... ... 8. 158,000.00
9. Funeral Expenses and Administrative Costs(Schedule H). ....... ..... . 9. 1 68,878.84
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)... . ..... .... .. 10. i
8,789.45
11. Total Deductions(total Lines 9 and 10). . .... .. . ....... . ... ... 11. 77,668.291
12. Net Value of Estate(Line 8 minus Line 11) ....... . . . ... . .. . .... . .... . .. 12. 80,331.71
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) .... . . . ..... . .. .. .. ..... 13.
14. Not Value Subject to Tax(Line 12 minus Line 13) ... .. ....... . ..... .... 14. 80,331.71
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under See.9116 1
80,331.71
(a)(1.2)X.0 0 15. 0,00
16. Amount of Line 14 taxable
at lineal rate X.0- 1 16.
17. Amount of Line 14 taxable
at sibling rate X.12 j 17.
18. Amount of Line 14 taxable
1
at collateral rate X.15 18.
19. TAX DUE ... .. . .. .. ....... . .... ... . . ... 19 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=)
Side 2
1505610205 1505610205
REV-7500 EX(R) Page 3 File Number C �R— 1U-5-
Decedent's Complete Address:
DECEDENT'S NAME
Marlene A. Shealer
STREET ADDRESS
4247 Carlisle Road
CITY STATE ZIP
Gardners PA 17324
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments _-- ._
8.Discount
Total Credits(A+g) (2)
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)
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS,AGENT.
... ..,.. " d+�dp_.waNw"'..:.daa8 �s'�• ;` idm a ,.F" ,u�. n'.,x RaS,.w;e , !F Ire't A"°. }i;. .... -
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.......................................................................................... ❑ N
b. retain the right to designate who shall use the property transferred or its income..............---..................__.. ❑ N
c. retain a reversionary interest ............................................--.............................................................................. ❑ ■
d. receive the promise for life of either payments,benefits or care?..................................................................... ❑ N
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 172 P.S.§9116(x)(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.
C
REV-1508 EX+(08-12)
. ]pennsylvania SCHEDULE E
DEPARTMENT Of REVENUE CASH, BANK DEPOSITS & MISC.
RESIDENT DECEDENT PERSONAL PERSONAL PROPERTY
RESIOENr DEfFOEM
ESTATE OF: FILE NUMBER:
Marlene A. Shealer 21-08-1051
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
1NUMBER DESCRIPTION OF DEATH
t 1. Settlement on lawsuit filed in Court of Common Pleas Of Cumberland County 1 158,000.00
settlement proceeds received November 7,2013 _ Y
I�
• 4 -
TOTAL(Also enter on Line 5, Recapitulation) $ 158,000.00
If more space is needed,use additional sheets of paper of the same size.
i
REV-1512 EX+(0513)
-jr&v--pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Marlene A. Sheeler 21-08-1051
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES.
rL
B. ADMINISTRATIVE COSTS: -
L Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City state
Year(s)Commission Paid:
56,860.00,
2. . Attorney Fees: '--=--:-- --LL
3. Family Exemption:(if decedent's address is not the same as daimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
• 4. Probate Fees: .. � i
S. Accountant Fees:
6. Tax Return Preparer Fees:
7. . Pat triOt News advertisement ��18102 h
1 "! Cumberl� and Law Journal advertisement 75 00
Attorney fee for Estate work and inheritance tax return*(attorney fee above is from litigation only} _ j: 11,000 00 h',
t� i
t0. Reimbursement of litigation costs �J �L__ 10,460.82]i
TOTAL(Also enter on Line 9, Recapitulation) #� 68,878.841;
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
i pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
rNRERtTANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Marlene A. Shealer 21-08-1051
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
I Pennsylvania Medical Assistance claim(medicaid) ($13,183.65 reduced to—>} 8,789.45
I
I
i
t
TOTAL(Also enter on Line 10,Recapitulation) $ 8,789.45
If more space is needed,Insert additional sheets of the same size.
REV-1513 EX+(01.10)
M7pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Marlene A. Sheeler 21-08-1051
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.9118(a)(1.2).)
I. (Barry L.L.Shealer,4247 Carlisle Road,Gardners,PA 17324 Husband nd- ¢ 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUT10145
A. SPOUSAL DISTRIBUTIONS UNDER SECHON 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART n-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
OF e
MARLENE ADDA SHEALER
I, Marlene Adda Shealer, of 4247 Carlisle Road, Gardners, of Cumberland County
I
l Pennsylvania,being of sound and disposing mind,'memory and understanding;do make, publish
{ and declare this to be my Last Will and Testament,hereby rev'61ingI and making void all previous
k
Wills and Codicils heretofore made by me.'
1 `
The expenses of my last illness and funeral shall be paid from the property of my estate.
2-
I give, devise and bequeath my full estate, together with all mi saran"ce proceeds thereon of
{ whatever nature and wheresoever situate to my beloved spouse Barry Lee Shealer,providing that
i
he survives me by sixty (60) days.
Should my spouse,Barry Lee Shealer,predecease`me or die on or before the sixtieth
(60th) day following my death, then I give, devise and bequeath'the rest,residue and remainder
of my estate together with all insurance proceeds thereon of whatsoever nature and wheresoever
situate in equal shares to my brothers and sisters Marcus C. Crowell,Dolliena Brink,Diane Slisz,
Robert Crowell and Fred Crowell who survive me by sixty(60) days per stirpes. All tangible
personal property is to be sold,either publicly ,or privately,by my personal representative, adding
the proceeds of such sale or sales to my residuary estate and to be disposed of in equal shares
Page 1 of 7
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Last Will& Testament of MARLENE ADDA SHEALER
5
No interest of any beneficiary of my estate, either in income or in principal, shall be
subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any
beneficiary have the power in any manner to charge or encumber his interest either in income or
principal,nor shall the interest of any beneficiary be liable or subject in any manner while in the
possession of my personal representative for the liability of such beneficiary.
6
I nominate,constitute and appoint my spouse,Barry Lee Shealer, as Executor of this my
Last Will and Testament. In the event my spouse is deceased, unable or unwilling to serve or
shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my
brother,Fred Crowell of 3421 Wies Road, Chesapeake,Virginia, as personal representative of
this my Last Will and Testament. I direct that my personal representative shall not be required to
give or post bond for the faithful performance of his,her or its duties in this or any other
jurisdiction.
7
I hereby declare it to be my expressed desire that my personal representative employ the
law firm of Stephanie E. Chertok,Esquire, of Cumberland County,Pennsylvania,for legal advice
and assistance regarding this my Last Will and Testament,they having considerable knowledge
of my affairs, views and wishes respecting any matters that may arise at the probate of this
instrument, the administration of my estate, and the execution of the powers herein mentioned.
Page 4 of 7
Name
l
Last Will & Testament of MARLENE ADDA SHEALER
IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and
Testament thisa>ay of 2005.
WITNES
Marlene Adda Shealer
Page 5 of 7
�1- V [� Qx(41
x y
Last Will & Testament of MMRLENE ADDA SHEALER
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
1, Marlene Adda Shealer,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 the instrument as my Last Will and Testament;that I signed it willingly, and that I
signed it as my free and voluntary act for the purposes therein expressed.
Marlene Adda Shealer
Sworn or affirmed and acknowledged before me by Marlene Adda Shealer the testatrix
this-c R-7 day of�� 2005.
Notary Public
Ry
AprSIEt�I
Casa
Csr � 24,,
Page 6 of 7
Name
J� !
Last Will& Testament of MARLENE ADDA SHEALER
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
WE, andFPt1n��,Llt �,the witnesses
whose names are attached to the foregoing document,being duly qualified according to law, do
depose and say that we were present and saw Marlene Adda Shealer,testatrix, sign and execute
the instrument as her Last Will and Testament; that she signed willingly and that she executed it
as her free and voluntary act for the purposes therein expressed; that each subscribing witness in
the hearing and sight of the testatrix signed the Last Will and Testament as witnesses and that to
the best of our knowledge the testatrix was at the time 18 or more years of age, of sound mind
and under no constraint or undue influence.
Sworn or affirmed and subscribed before me by U
and Akg-L l cv p this 2--j day of_ tom— 2445.
W
Not —Public
NOTAWISM
S7EEE.f
Owl* * y
Page 7 of 7tB�a $e
Name