HomeMy WebLinkAbout01-21-14 � 150561�101
REV-1 soo EX�o�_�o, �Y� �:
OFFICIAL USE ONLY
PA Depa�tment of Revenue Pennsylvania ^�
Bureau of Individual Taxes �FO�M:MEkfOi NC:VGNUE COU�I�CIJU� Year File Number
PO BfJX�8o6os INHERITANCE TAX RETURN Z 1 /3 ���?
Harrisburg,PA�.��28-0601 RESIDENT DECEDENT _;_ ;
��
ENTER DECEDENT lNF�RMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMODYYYY
' 05/06/2013 ' 03/05/1931
...... . _ _ ___ .
__ _ _ _ _ ___ ____ ___ ____ _
Decedent's�ast Name Suffix DecedenYs First Name M�
_ ................. . ... ... ..__... __.. _ __ __ _ _ , _ _ _ _ ___ _ ;_ ,
SI-�EAFFER GAYLE ' K '
(If Applicabie)Enter Surviving Spouse's Information Below
Spouse's Last Name _ _ Suffix Spouse's First Name _ M�_
_.. _ _ .. __ _ _......
Spouse's Social Security Number
-- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
_ ____ __ _ _ __ _ .
REGISTER OF WILLS
FILL IN APPROPRIATE OWALS BELOW
(� 1.Original Retum O 2.Supplemental Return Q 3. Remainder Return(date of death
prior to 12-13-82)
p 4.limited Estate O 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Mumber of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election ta tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Sch.O) ,�,,
CORRESPOMDENT- THIS SECTION MUST BE COMPlETEO.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA SHOULD BE D�TED ` : �
. ' �. .:.
Name Daytime'�e{�ne Num er � � �
_ ___
;THOMAS E. FLOWER (717)7�,,�-`�'I� � � �' '
....� �
_ _ _ �a �,,, r..,. � .
RE LL�SE O�Y�
� � � #"�r G.�'
� �„j � —�y "'r� "�'1
First line of address ___ __ __ � � '�"� "'� �
. .. . ....... . ...._ _ __ _ _ ___. ___ __ "'r'!
_ _ «.�-i ~' f"�'"' f�f
FLOWER LAW, LLC '
_.. . _ _... __ _ ___ _ __ _ _ _ ,� _ � � �
Second line of address �
10 W. H1GH STREET
City or Post Office State ZIP Code DATE FILED
CARLISLE ' PA !17013-2922
Correspondent's e-mail address:TOf�A�FLOWER-LAW.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.Decla 'tion of than the personal representative is based on atl information of which preparer has any knowledge.
SIGNATURE OF RESPO E F FIU TURN DATE
ADORESS
SANDRA K. SHEAFFER; 1 HOLLOW ROCK; LINCOLN UNIVERSITY, PA 19352
SI A OF P T R THAN REPRESENTATIVE DATE
41/13/14
ADOR
FLOWER LAW, LLC; 10 W. HIGH ST; CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 15056101�1 ],505610101 J
� 15�561�105
REV-1500 EX Decedent's Social Secu�ity Number
oecedenrs►vame: GAYLE K. SHEAFFER ' 200-24-2356 '
RECAPlTULATION _
_ _
1. Real Estate(Schedule A). ................... .............. ..... ...... 1. 240,657.00;
2. S#ocks and Bonds(Schedule B) .............. ............ .. ........... 2. _ ;
3. Closely Heid Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. ;
4. Mo�tgages and Notes Receivable(Schedule D}............... ........ .... 4. ;
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. '; 43,259.16
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. '
7. Inter-Vvos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. ;
8. Tatal Gross Assets(total Lines 1 through 7}....................... ..... . 8. ' 283,916.16 '
9. Funeral Expenses and Administrative Costs(Schedule H)............. ...... 9. ', 28,427.81
10. Debts of Decedent,Mortgage�iabilities,and Liens(Schedule I)............. . 10. ' 14,710.45 '
Y1. Total Deductions{total Lines 9 and 10)................................. 11. ; 43,138.26 '
12. Net Value of Estate(Line 8 minus Line 11) ....................... ....... 12. ; 240,777.90 ;
: : _, .
_.
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ..... ............ ....... 13. 0.00 ;
14. Net Value Subject to Tax{Line 12 minus Line 13) ....................... . 14. ; 240,777.90
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
__
__ __ __ __
__ __ _
transfers under Sec.9116 '
(a)t1.2)X.0- , 15.
: : _ _ . _..
16. Amount of Line 14 taxable
at Iineal rate x.0 45 240,777.90 : �g. 10,835.00 ;
_ .
17. Amount of Line 14 taxable
at sibling rate X.12 ! ' 17.'
__ _.
18. Amount of Line 14 taxable
at collateral rate X.15 ' �8•!
19. TAX DUE ........ ....... ....... ................. .............. .... 19 ' __�
10 835 00
� _ _
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 150567,0105 1505610105 J
REV-1500 EX Page 3 File Number �t � � I _D���
Dec�dent's Complete Address: S
DECEDENTS NAME
GAYLE K. SHEAFFER
........ . ...._........... ... ........ . _ . _....._ ___ __
STREET ADDRESS
7 COUNTRY CLUB DRIVE
MIDDLESEX TOWNSHIP
__.. _____. .. __ ____ _._ __ _ _ _ _ ...._._. __._ _... _..
_ ssATEPA _ z�P17015
C CARLISLE
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 10,835.00
2. Credits/Payments
A.Prior Payments 0.00
B.Discount 0.00
_._. _ _ _ 0.00
Totai Credits(A+B) (2)
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 Fage 2,Line 20 to request a refund. (4) 0.00
5. If Line 1+Line 3 is g�eater than Line 2,enter the difference.This is the TAX DUE. (5) 10,835.00
� �
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. �etain the right to designate who shall use the prope�ty transfeRed or its income:............................................ ❑ 0
c. retain a�eversionary interest;or.......................................................................................................................... ❑ 0
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If death occurred after Dec.12,1982,did decedent transfer prope�ty within one year of death
withaut 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 ar other non-probate property,which
containsa 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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....:.:: r> .<,:>...Jr.,,:�'� ? >...:.,> :.:: .. <: .. . ,, : . . � . . . . . . . .
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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)(ijJ.
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or far 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 statutary requirements for disclosure of assets and
filing a tax retum are stil!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 trans�ers 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(aj(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(1.2)[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 comman with the decedent,whether by bload or adaption.
REV-1502 EX+(11-0$)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIQENT DECEDENT
ESTATE OF FILE NUMBER
GAYLE K.SHEAFFER 21-13-0587
Ail r�l property owned solely or as a tenant in common must be reported at fair marlcet value.Fair market value is defined as the price at which property
wouid be exchanged between a wiiling buyer and a wiliing seller,neither being compelled to buy or sell,both having reasonabie knowledge of the relevant facts.
Real property tha#is jointly-owned with right of sunrivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
�M Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1� DWELLING HOUSE AND LOT,7 COUNTRY CLUB DR.,MIDDLESEX TWP,CUMBERIAND
:COUNTY TAX PARCEL#21-17-2694-017;ASSESSED$201,900 X 0.97 C.L.R. 195,843.00
2. 0.76 ACRE UNDEVELOPED LOT,CIRCLE DR.,MIDDLESEX TWP.,CUMBERLAND
COUNTY TAX PARCEL#21-17-2694-017A;ASSESSED$46,200 X 0.97 C.L.R. 44,814.00
TOTAL,(Also enter on Line 1, Recapituiation.) $ 240,657.00
If more space is needed,insert additional sheets of the same size.
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REV-i5o8 EX+(il-lo)
ennsylvania SCNEDULE E
p CASH, BANK DEPOSITS &MISC.
OEPARTMENT OFREVENUE
INMERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GAYLE K. SHEAFFER 21-13-0587
Inciude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointiy owned with right of survivorship must be disclosed on Schedule F.
�M VALUE AT DATE
NUMBER DESCRIPTION _ _ OF DEATH
�,' COMMONWEALTH BANK CHECKING ACCT#1691018368 28,425.29
2, CITIZENS BANK CHECKIGN ACCT#892-7 9,966.55
3.
'HIGHMARK,SENTINEL&COMCAST REFUNDS 494.34
4_ PROCEEDS,YARD SALE OF HOUSEHOLD GOODS AND AUTOMOBILE 4,373.00 '
TOTAL(Also enter on Line 5� Recapitulation) $ 43,259.16
If more space is needed,use additional sheets of paper of the same size.
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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
GAYLE K. SHEAFFER 21-13-0587
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' HOFFMAN-ROTH FUNERAL HOME,TRADITIONAL FUNERAL SERVICE 4,850.00
2. CASKET 3,060.00
3. OUTER BURIAL CONTAINER 1,620.00 `
4. LETORT CEMETERY,INTERMENT 900.00
5.' DEATH CERTIFICATES($30)AND OBITUARIES($600.22) 630.22
s. CLERGY HONORARIA($100)AND FLOWERS($159) 259.00 `.
7.' PILLOW 2fi.50
6. ADMINISTRATIVE COSTS:
i. Personal Representative Commissions:
Name(s)of Pe�sonal Representative(s)
Street Address
__... _ ..___ _ _ _ ___ __ _ __ _ __ __. _ _..___..
City State ZIP
Year(s)Commissian Paid:
2. Attorney Fees:
10,000.00
3. Family Exemption:(If dec2dent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City _____._State _ _ ZIP ___ . .
Relationship of Claimant to Decedent
___ --- __ _.__ _ _ ____ _. ____... ___.__ .__....
4• Probate Fees: 413.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
�• PUBLISH ESTATE NOTICE,THE SENTINEL 227.45
_ __ _ _ _ _ _ .
s. PUBLISH ESTATE NOTICE,CUMBERLAND LAW JOURNAL 75.00 '
_
s. SCOTT LAMPETER,PROPERTY MAINTENANCE/LANDSCAPING 1,610.00 :
'�o.` 2013-2014 SCHOOL DISTRICT REAL ESTATE TAX 2,396.35 .
��. ENCOMPASS INSURANCE,FIRE&HAZARD POLICY 1,630.00
'�2. :CONTINUATION SHEET TOTAL _ __ _ 724.79 `
TOTAL(Also enter on Line 9, Recapitulation) $`' 28,427.81
If more space is needed,use additionai sheets of paper of the same size.
SCHEDULE H
CONTINUATION SHEET
ESTATE OF FILE NUMBER
GAYLE K.SHEAFFER 21-13-0587
1. PPL,electric service 238.54
2. Middlesex Twp.Water/sewer 157.50
3. ADM Electric, repairs 85.00
4. York Waste Disposal 243.75
Continuation sheet total: 724•79
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�'�d�t�a�Fungr�t S�et��
`TR�ifi1�3[�!.F�lNERAL SE�t/iCE Pr0.�1�A�E $ �,��tl.�lt}
�u�Tt��: $ 4,8�.4t?
M�R�A��:
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' S►�t�T+�t�i: � �,+�.�t3
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REV-1512 EX+(iZ-Q8)
� pennsylvania SCHEDULE I
�EPARTMENT OP REYENUE DEBTS OF DECEDENT�
INHERITANCE TAX RE7URN MORTGAGE LIABILITIES &LIENS
RESIOEM DECEDENi
ESTATE OF FILE NUMBER
GAYLE K. SHEAFFER 21-13-0587
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medicai expenses.
ITEM , VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1� 'AT&T CREDIT CARD 2,263.36
2. DISCOVER CARDS 2,395.67 '
3.`' BANK OF AMERICA CREDIT CARDS 5,339.26
4. 'CITI CREDIT CARDS 1,566.13
5. 'COMCAST 91.68
6. CHASE CREDIT CARD 813.00
7. 'PPL 33.32
8. LEFFLER ENERGY,HEATING OIL 264.84 '
9.; 'CUMBERLAND GOODWILL FIRE&RESCUE EMS,AMBULANCE SERVICE 1,943.19
TOTAL(Also enter on Line 10,Recapitulation) $ 14,710.45
If more space is needed,insert additionai sheets of the same size.
REV-1513 EX+(O1-10)
� pennsylvan�a SCHEDULE �
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT OECEDEIYT
ESTATE OF: FILE NUMBER:
GAYLE K. SHEAFFER 21-13-0587
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(Indude outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1• RANDY L.SHEAFFER,477 MT.HARMON RD,EARLEVILLE,MD 21919 SON ��2
2.! :SANDRA K.SHEAFFER,1 HOLLOW ROCK,LINCOLN UNIV.,PA 19352 DAUGHTER '1�2
__ __ _ _ :
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 SECfION 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.
a i
r�sr c�.rr.���v.v rESr���1vr
OF
GA��E K. SHEAFFER
I, GAYLE K. S�IEA►FFER of? �ountry Club Road, Ca.rlislc, Cumberland
County, Pennsylvania, 17013,being of sound and disposing mind,memory and
understa.nding, do make,publish and declaxe this as and for my��,ast Will and
Testament, hereby revoking and making void any and all former�XTills, Codicils, or
writings in the nature thereof, by me at any time heretofore made.
FIRST: I hereby order and d.irect my Executor, hereinafter named, to pay
all my just debts, funeral expenses, testamentary expenses and all Inherita.nce, Estate,
1'ransfer and 5uccession Taxes, as soon as may be conveniently done after my death,
out ot my residuary estate.
SECOND: I give all the rest, residue and remainder of my esta.te be it rea1,
personal or mixed, or whatsoever kind, of wheresoever situate, to my children,
S.ANDRA K. SHEAFFER and RANDY L. SHEAFFER, in equal shares. Should
either of my children predecease me, I give that child's share to my surviving child.
LASTLY: I hereby nominate, constitute and appoint my children, SAND1tA
K. SI�E AFFER an.d RAND�C' .L. SHEAFFER, to be Executors nf this,my Last
`Ylill and "I"estament, they to serve without Bond in the Commonwealth of
I'ennsylvania, or any other jurisdicrion. In the zvent that either of my sa.id children
shal] predecease me or be unable to act as Executor of my Esta.te or comp�ete the
administration thereof for any reason whatsoever, my other child shall act in his or
her place as Executor hereof.
IN WITNESS WHEREOF, I, Gayle K. Sheaffer, have hereunto set my hand and
seal to this my Last Will and Testament, this�day of���'_� -� , 2012.
Gayle . Sheaffer, Testa.trix
Signed, sealed, published and declared �j= the above-named Gayle I�.
Sheaffer, Testa.trix, as and for her Last Will and Testament in the presence of us, who
have hereunto subscribed our names at her request as witnesses thereto, in the
presence of sa.id Testatrix and of each other.
�� �
ADDRESS 10 W. Hi�h Street
Carlisle. PA 17013
.
ADDRESS 10 W. High Street
Carlisle, PA 17013
COMM�rJWEALTH OF PENNSYLVANIA :
.
COUNTY OF CUMBERLAND •
We, Gayle K. Sheaffer, James D. Flower, Jr, and ��JrG L , l�irr��the
Testa.trix and witnesses, respectively whose names are signed to the foregoing or
attached instrtunent, being first duly sworn, do hereby declare to the undersigned
authority that the Testa.trix signed and executed the instrument as her Last Will and
Testament and that she signed willingly and that executed as her free and volunta.ry
act for the purp�ses therein expressed, and that ea.ch of the witnesses, in the presence
and hearing of the Testatr� signed the Will as �vitnesses and t�at to the best of their
knowledge the Testa.trix was at the time eighteen (18) or more years of age, of sound
mind and under no constraint or undue influence.
,
G e K. Sheaffer
James D. Flower,Jr.
Witness
� • r
On this, the /a-� da. of ���• 2012 before me the undersi ed
Y > > , gn
officer personally appeared James D. Flower,Jr., Esquire, known to me (or
satisfactorily proven) to be a member of the bar of the highest court of sa.id state, and
a subscribing witness to the foregoing instrument, and certified that he was perspnally
present when the testator and witnesses,whose names are subscribed to the foregoing
instrument, executed the same, and that they acknowledged that they executed the
same for the purposes therein contained.
IN�ITNESS WHEREOF, I hereunta.set my hand a.r�d official seal.
(SEAL)
Nota.ry Public
���atwoNw�A�TM oF r�:�����v�.vwwun,
�� PtOTARiAL SE��
TNQMAS E.FLOWER,No:�,�PUbi'�c
���iis{e Baro.,Cumberl��� � �'ounty
��:���',�mmission Expires Oc: .. ..�5,2014