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Home My WebLink About01-23-14 (2) 1505610105 REV-1500 Ex(02.11)(R) PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes 1—T—TOFae�"u` County Code Year File Number INHERITANCE TAX RETURN r" __. .._..� PO BOX 280601 l Harrisburg,PA 17128-0601 RESIDENT DECEDENT ,_ I ); 1 ins ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY - __.--- .____.__..._ —1 ..__... . _. . _.--..__ . _. .. 10124/2013 02/29/1948 Decedent's Last Name Suffix Decedent's First Name MI F_ .. . -- --- ---- -- --- —— -_.-.1 �_.. , Kelley .. J �_. _ _. _ (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name _ MI = r Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CiD 1.Original Return O 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) CW 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.) O 9.Litigation Proceeds Received O 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 0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name __ _ Daytime Telephone Number Patrick T. Beaty ._ .. _ .---.,.__,._._.._._�_.___�� (717743-0648 � IM L_..._. CAVI ROF fisU M 'O n (n rC3 r-- fV rn m First Line of Address t" rn CO ;,o C.) 205 West Main Street ° Second Line of Address _ M _ _ O City or Post Office State ZIP Code DATE fteD -T1 Shiremanstown ` �PA_j 17011 Correspondent's e-mail address: Under penalties of perjury,I declare that 1 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 FILING RETURN 5� 01/21/2014 ADDRESS 205 West Main Street, Shiremanstown, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedents Name: Nancy Elizabeth Kelley RECAPITULATION 1. Real Estate(Schedule A). ............. ............................... 1. 183,300.00 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. 408,935.10 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. 179,665.41 _J 8. Total Gross Assets(total Lines 1 through 7)............................. 8. 771,900.51 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. E 18,442.41 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 63,864.53 , 11. Total Deductions(total Lines 9 and 10)................ ................. 11. .82,306.94 12. Net Value of Estate(Line 8 minus Line 11) ................... ........... 12. 689,593.57 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. 689,593.67 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 16. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0- 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 16. 689,593.57 17. Amount of Line 14 taxable - at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. 19. TAX DUE ........... .................... .......................... 19.1 31,031.71 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Nancy Elizabeth Kelley STREETADDRESS 1109 Baldwin Street CITY STATE zIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 31,031.71 2. Credits/Payments A.Prior Payments B.Discount 1,551.59 Total Credits(A+B) (2) 1,551.59 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) 29,480.12 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.............................................................................................................................. ❑ N 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)(1)]. 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-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Nancy Elizabeth Kelley All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 1109 Baldwin St.,Mechanicsburg,PA 17055 183,300.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 183,300.00 If more space is needed,use additional sheets of paper of the same size. Property Mapper Cumberland County, PA '-23-0561 171 PIN7 1, - HAS} \ T r,•:rz• `rw _--vim Mlddiesex Si( r,S 'ng s, s�sr''X d ding Alsessed Value 1:13/400 „ { S •rL � > S3 �„ _ a i _Q �,,... `�• 1, ~' r .i Copyright 2011 Esri. All rights reserved. Sat Jan 18 2014 05:10:39 PM. 1109 BALDWIN STREET PIN: 17-23-0561-171 Deedbook:00195-00963 Owner: KELLEY, NANCY E Land Use Code: 101 Property Type: R Acreage: 0.24 Square Feet: 1716 Taxable Status:T Clean&Green Status: Land Assessed Value$:45900 Building Assessed Value$: 137400 Total Assessed Value$: 183300 Sale Price$: 1 Sale Date:Tue Mar 16 1999 08:00:00 PM Year Built: 1964 Municipality: MECHANICSBURG 2ND WRD Height In Stories: Type of Dwelling: DETACH Primary Exterior: Vinyl Basement Percentage: 50 Air Conditioning: NO Total Rooms: 8 Bedrooms:4 Full Bath: 2 Half Bath: 1 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 Nancy Elizabeth Kelley Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Funeral service 300.00 2. Funeral luncheon 918.46 3. Chadwick&McKinney Funeral Home services(incl.transportation,cremation,fees) 1,640.77 4. Estate account checks 8.25 5. Estate notices 184.52 6. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 10,000.00 Name(s)of Personal Representative(s) Patrick T. Beaty Street Address 205 West Main Street City Shiremanstown state PA ZIP 17011 Year(s)Commission Paid: 2013 2. Attorney Fees: 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) 3,500.00 Claimant Brian Kelley Street Address 1109 Baldwin Street City Mechanicsburg State PA ZIP 17055 Relationship of Claimant to Decedent Son 4. Probate Fees: 633.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. PPL electric utility 392.46 8. United Water Co. 71.95 9. Service Oil Co. 644.00 10. Mechanicsburg Sewer 126.00 11. PA DOT--duplicate car title 22.50 TOTAL(Also enter on Line 9, Recapitulation) $ 18,442.41 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 N_ancy Elizabeth Kelley 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. Mortgage on 1109 Baldwin St.,Mechanicsburg,PA 36,218.97 2. Chase credit account 947.62 3. Chase home equity line of credit 26,324.82 4. Gustafson's lawn service 373.12 TOTAL(Also enter on Line 10,Recapitulation) $ 63,864.53 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE 3 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Nancy Elizabeth Kelley 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. Brian Kelley,1109 Baldwin St.,Mechanicsburg,PA 17055 Son 100% 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 SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. I I �I TOTAL OF PART 11—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. REV-*o8 EX+(o8-]2) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Nancy Elizabeth Kelley 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. Millers Mutual Insurance Company employee pension—Ameritrade Trust 380,284.80 2. PA Central Credit Union account#37392-017 9,915.28 3, Miscellaneous personal property(inol.furniture,clothing,household items) 4,500.00 4. 2010 Nissan Rogue S 14,002.00 5. U.S.Savings Bonds Series EE 233.02 TOTAL(Also enter on Line 5, Recapitulation) $ 408,935.10 If more space is needed,use additional sheets of paper of the same size. Kelley Blue Book Page 1 of 2 Kelley Blue Book The Trusted Resource f inc!the lowest rate. 1 c� fii�.rt�c t E s s 1-V-E- EVEN IF IT'S NOT WITH US. NAf-1"tlhy4101 ndvatisement wM ads? 2010 Nissan Rogue Sell To Private Party Pricing Report Good Fair Condition Ve Good Style:S Sport Utility 4D Condition $14,tiD2 Condition $12,852 Mileage:io,000 ��, $14,402 Exmtlent Condition $14,852 i Vehicle Highlights V Fuel Economy: Max Seating:5 City 21/Hwy 26/Comb 23 MPG Private Party Values valid for your area through 1/1612014 Doors:4 Engine:4-CyL 2.5 titer Drivetrain:AWD Transmission:Automatic,CVT EPA Class:Sport Utility Vehicles Body Style:Sport Utility Country of Origin:Japan Country of Assembly:Japan �{ Your Configured Options Our preselected options,based on typkal equipment for this car. ✓Options that you added while configuring this car. Engine Comfort and Convenience i Seats 4-Cyl,2.5 Uter Keyless Entry Rear Seat i Transmission Alr Conditioning Wheels and Tires Automatic,CVT Power Windows Steel Wheels Drivetrain Power Door Locks AWD Cruise Control Braiding and Traction Steering Traction Control Power Steering Vehicle Dynamic Control Tllt Wheel i ABS(4-Wheel) Entertainment and Instrumentation i AM/FM Stereo CD(Single Disc) Safety and Security Dual Air Bags Side Air Bags F&R Head Curtain Air Bags Glossary of Terms T Kelley Blue Book®Trade-in value-This Is the amount you can expect to receive when you trade In ip: your car to a dealer.This value is determined based on the style,condition,mileage and options It's crucial to know your car's indicated• true condition when you sell it, Trade-In Range-The Trade-In Range Is Kelley Blue BoWs estimate of what you can reasonably expect so that you can price it to receive this week based on the style,condition,mileage and options of your vehicle when you trade It appropriately.Consider having In to a dealer.However,every dealer is different and values are not guaranteed. your mechanic give you an objective report. http://www.kbb.com/nissan/rogue/2010-nissan-rogue/s-sport-utility-4d/?condition=good&... 1/13/2014 Calculated Value of Your Paper Savings Bond(s) Page 1 of 1 Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 10/2013 Total Price Total Value Total Interest YTD Interest 200.00 $233.02 $33.02 $3.66 Bonds: 1-4 of 4 Issue Next Final Issue Interest Serial # Series Denom Date Accrual Maturity Price Interest Rate Value Note 1616964993ee; EE __$S9:10/2001,*11/2013 _10/2031T__$25.00] -$10.0-j _-- ---- $35.08Y 1636757141ee __ -- T-___$50:10/2006:11/2013:-- --- _10/2036x__ ---- _ $7.30: 3:70%x_ $32.30x c830982363eery_ EE ; $100x10/2006:11/2013; 10/2036: $50.00; $14.60; 3.70%x_ $64.60: r204461325ee: EE ; $200_12/201.1_11/2013: 12/2041x $100.00; $1.04, 0.60%x$101.04; P5 --------------------------- - - - _ _-. � - ..�.. - -�- --------------- . Totals for 4 Bonds; 200.00 33.02 233.02 Notes NI ;Not Issued _!Ilk:Not eligible for payment_____------------------ P5 :Includes 3 month interest penalty........ f -: - ---- ------------ MA ;Matured and not earning-interest http://www.treasurydirect.govBC/SBCPrice 1/20/2014 REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND - INHEMANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Nancy Elizabeth Kelley 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. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE INCLUDE THE NAHE OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPKICABtE) VALUE I. +Vanguard IRA account#9939486152—Brian Kelley,son 24,285.44 j 10001 24,28544 f )Amedpdse Financial IRA account#174865865133--Brian Kelley,son »--. _ 2.� 46,110.54; } 100 46,110.54 eriprise Financial IRA account#340093160133—Brian Kelley,son -i 3. 10,092.751 1001 } 10,092.75 4 I American Funds IRA account#81858861—Brian Kelley,son 587.21 h V1001 587.21 5 MetLrfe annuity account#7700179371 —Brian Kelley,son 22,981-001 1 �- A 100j _ 22,981.00 Millers Mutual Insurance Company—Brian Kelley,son 1 i 75,608.47 ; .6 4 6 75 i � r _j ( I I TOTAL(Also enter on Line 7, Recapitulation) $ w 179,665:rl If more space is needed,use additional sheets of paper of the same size. LAST WILL AND TESTAMENT OF NANCY ELIZABETH KELLEY I, NANCY ELIZABETH KELLEY,currently resident at 1109 Baldwin Street, Mechanicsburg, Pennsylvania, being over the age of eighteen(18)years and of sound mind and disposing memory,do hereby make and publish this, my Last Will and Testament,to-wit: ITEM ONE I do hereby revoke all Wills and Codicils and testamentary instruments heretofore made by me. ITEM TWO I hereby direct that no other action shall be had in the County Court or any other court in relation to the settlement of or administration upon my estate than the probating and recording of this Will and the return of an inventory, appraisement and list of claims. ITEM THREE I hereby appoint PATRICK T. BEATY, sole Independent Executor under this Will and of my estate and direct that no bond shall be required of him. In the event of the death or inability of PATRICK T. BEATY,then I appoint, LINDA C. BEATY, Independent Executrix, under this Will and of my estate and direct that no bond shall be required of her. ITEM FOUR I direct that all my just debts and funeral expenses and any taxes that have been or may be assessed in consequence of my death, of whatsoever nature and by whatsoever jurisdiction imposed, shall be paid from my residuary estate at the time of my death. ITEM FIVE I will, give,bequeath and devise to my son, BRIAN KELLEY, in absolute fee simple, all my property of every nature and description,real,personal or mixed, wherever situated. ITEM SIX In addition to the authority conferred on fiduciaries by law, I authorize my Executor: (1) to retain any real or personal property pending distribution hereunder without liability for loss or depreciation resulting from such retention; (2)to distribute any real or personal property in kind; (3)to dispose of real or personal property by public or private sale, or exchange,or otherwise, and receive or administer the proceeds as a part of my estate; (4)to sell, lease or exchange property and to receive or administer the proceeds as a part of my estate; (5)to pay, as he or she deems best(unless state law requires a specific method for payment), all my debts and taxes,that may by reason of my death, be assessed against my estate or any portion of it; (6)to vote stock, to exercise any option or privilege to convert bonds, notes, stocks or other securities belonging to my estate into other bonds,notes, stocks or other securities, and to exercise all other rights and privileges of a person owning similar property in his/her own right; (7)to abandon, adjust, arbitrate, compromise, sue or defend and otherwise deal with and settle claims in favor of or against my estate; (8)to do all other acts in his or her judgment that may be necessary or appropriate for the proper and advantageous management, investment and distribution of my estate. The foregoing powers may be exercised as often as is deemed necessary or advisable without a placation to or approval by any court in any jurisdiction. -2- ITEM SEVEN I direct my Executor to apply as much of the proceeds of my estate as may be necessary to the payment and full satisfaction of the mortgage on my property at 1109 Baldwin Street, Mechanicsburg, Pennsylvania. IN TESTIMONY WHEREOF, I have hereunto subscribed and signed these presents at Mechanicsburg, Pennsylvania, in the presence of the witnesses whose names are affixed hereto and whom I have requested to sign their names hereto as witnesses, and in the presence of said witnesses I have declared and published the foregoing as my Last Will and Testament on the day of_ AeCA 2012. NANCY E E KELLEY Testator The foregoing Will was on the day and date above set out signed by the Testator, NANCY ELIZABETH KELLEY, in our presence and in the presence of each of us, and at the time she signed this Will,he declared that it was her Last Will and Testament,and at her request and in her presence and in the presence of each other, we hereunto sign our names as attesting witnesses. NAME ADDRESS �i �2ys "esjyl 1 Y�Yh 5fdwh ,T - -3-