HomeMy WebLinkAbout03-27-14 REV-1500 Exte1"t0) 1505610143
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year Fue Number
Bureau of-Individual Taxes DEMTHRWOFR EANE
PO BOx.280601 INHERITANCE TAX RETURN 21
Harrisburg,PA 17128-0601 RESIDENT DECEDENT TJ
ENTER DECEDENT INFORMATION BELOW `
Social Security Number Date of Death Date of Birth
11 18 2013 01 10 1911
Decedent's Last Name Suffix Decedent's First Name MI
FOLTZ MILDRED G
(If Applicable)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 OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return 2. Supplemental Return 8, Remainder Return(date of death
prior to 12-13-82)
El 4. Limited Estate El 41.Future Interest Compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-a2)
g Decedent Died Testate T DooedelMaintalned)a Living Trust 8, Total Number of Safe Deposit Boxes
(Atlach Copy of Wilp 1(Attach�Opy of TTrust p
El g. Litigation Proceeds Received 10.bgween 12-31 t and xtice9,of death 11.Election to tax under Sec.9113(A)
(Attach Sch.O)
N
CORRESPONDENT-THIS SECTION MUST 6E COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOP#ATION SHOUk!9E DIfWC TO:
Name - Daytime Tel9hp9e Numt5 rrt c7
JERRY A WEIGLE ESQUIRE 717 5 388==
M = n ( o
REGISTE"IF
��S US'EbNLY�''
_ 7c Gs
Yt
First line of address _ O
126 EAST KING STREET ° N r'
--I r-
Second line of address y}, C ?a
City or Post Office State ZIP Code DATE FILED
SHIPPENSBURG PA 17257
Correspondent's e-mail address:
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.6eclara6on of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN�}TURE OF PEr R,ESSPPPNSIaLE F F'IN-RET RN DATE /�
A t, /F. Larry D. Burkholder �—"' 2S-" I I
AD RE$
66 West Main Street Newville PA 17241
SIGNAT OF PREPARER OTHER THAN REP ESEN ATW€ DATE
Jerry A.Weigle Esquire
DDRES
126 ast King Street, Shi pensb , PA
Side 1
1505610143 1505610143 ,�'
1505610243
REV-1500 EX
Decedent's Social Security Number
Demdenrs Name: FOItz, Mildred G.
RECAPITULATION
1. Real Estate(Schedule A)............._-...................................................._......._....... 1.
2. Stocks and Bonds(Schedule B)...---..................................................................... 2.
3, Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3,
4. Mortgages&Notes Receivable(Schedule D)....................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... S. 5, 664 . 44
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested.....:...... 6.
7. Inter-Yvos Transfers&Miscellaneous W-Probate Property
(Schedule G) U Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1-7)..................._....... ..........._........................... 8. 5, 664 . 44
9. Funeral Expenses&Administrative Costs(Schedule H)...................................... 9. 1 ,236. 80
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1)............................. 10. 1, 124 . 07
11. Total Deductions(total Lines 9&10)..........-..................................... ....... 11. 2, 360 .87
12. Net Value of Estate(Line 8 minus Line 11).....--...............--.............,............... 12. 3 ,303 . 57
13. Charitable and Governmental BequeststSec 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. 3,303 .57
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 i5 0. 00
(a)(1.2)X,00
16. Amount of Line 14 taxable 0 . 00 16. 0 . 00
at lineal rate X .045
IT Amount of Line 14 taxable 0 . 00 17 0 . 00
at sibling rate X.12
18. Amount of Line 14 taxable 3 , 303. 57 t8. 495 . 54
at collateral rate X.15
19. Tax Due.-................ ........ ..... 495. 54
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. El
Side 2
�,� 1505610243 1505610243
REV-1500 EX Page 3 File Number 21
Decedent's Complete Address:
DECEDENT'S NAME
Foltz, Mildred G.
STREETADDRESS
One West Big Spring Avenue
CITY STATE ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 495.54
2. Credits/Payments
A. Prior Payments 350.00
B. Discount 18.42
Total Credits(A +B) (2) 368.42
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 127.12
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 properly,lransferred:.....................................................................
. ......... x
b. retain the right to designate who shall use the property transferred or its income;.................................. B
c. retain a reversionary interest;or............................................................................................................... 8 x
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?....... ❑ ❑x
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which ❑ ❑
contains a beneficiary designation?..!............................................................................................................... x
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 lax 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 January 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 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 common with the decedent,whether by blood or adoption.
Rov-0509 EX.(6.981
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
EoMta HEWTAtiNGr PENFnJFM1 u
iNHERr(ANCE TAX RENaN
FE�+i>�xraEC[aserr
ESTATE OF FILE NUMBER
Foltz, Mildred G. 21
include the doof litigation and the date the proceeds oaro resolved by the estate.
All pmpedy to ntlyawnod with the dent of suMvonhip moat be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 3 -T Investors-refund of security deposit 750.00
2 Allstate insurance Company-refund of premium 152.28
3 Capital Blue Cross-health insurance refund of premium 172.31
4 Comcast Cable-refund 77.23
5 Fogelsanger-Bricker Funeral Home-refund of prepaid funeral 163.92
6 National Retirement Fund-November pension benefit 181.50
7 Amalgamated insurance Fund-November pension benefit 40.50
8 M&T Bank Checking Account 97238104 - 2,078.66
9 M&T Bank Checking Account 97238104 0.02
10 Gross Proceeds of Public Sale of personal property-sold 1-17-14 2,048.00
TOTAL(Also enter on Line 5.Recapitulation) 5,664.44
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.6-98)
REV-1151 EX+(1046) 1A
.pp��PPEN SCHEDULE H
COMINHERITA�NI TAXR TY ANIA FUNERAL EXPENSES &
RE331 ENTTTTTTDECEn N ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Foltz, Mildred G. 21
Debts of decedent must be reported on Schedule 1.
ITEM DESCRIPTION AMOUNT
NUMBS
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Daid
2. Attomev's Fees Weigle&Associates,P.C. 450.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zia
Relationshio of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7, Other Administrative Costs 785.80
See continuation schedule(s) attached
TOTAL(Also enter on line 9,Recapitulation) 1,238.80
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA•1500 Schedule H(Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Foltz, Mildred G. 21
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Expenses of public sale 751.80
2 Register of Wills, Cumberland County-filing PA Inheritance Tax Return 15.00
3 Register of Wills, Cumberland County-filing"Release"to close estate 20.00
H-B7 786.80
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 E%+(12.08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETI
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Foltz, Mildred G. 21
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 Century Link-phone billing 30.77
2 Century Link-final billing 6.21
3 Comcast Cable-final billing 58.97
4 Penelec-final billing 994.95
5 Quantum Imaging-medical billing 11.43
6 Quantum Imaging-final billing 21.74
TOTAL(Also enter on Line 10, Recapitulation) 1,124.07
- (If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08)
x,.
REV-1513 EX-(11-08) y
' SCHEDULE J
COMMONWEALTH OFPENNSYLVANIA BENEFICIARIES
IN RESIDENTEDECEDENTRN
ESTATE OF FILE NUMBER
Foltz, Mildred G. 21
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not Ist Trustee s
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Larry D. Burkholder Nephew 100% 3,303.57
66 West Main Street
Newville, PA 17241
Total 3,303.57
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as a ro riate..
NON-TAXABLE DISTRIBUTIONS: -
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 11-08)
JOEL R. ZULLINGER HAMILTON C. DAVIS
a_....T._., A PROFESSIONAL_CORPORATION
LAST WILL AND TESTAMENT
I, MILDRED G. FOLTZ, of the Borough of Shippensburg, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any
will or codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including
my gravemarker and all expenses of my last illness, shall be paid from my
residuary estate as soon as practicable after my decease as a part .of the
administration of my estate.
ITEM IT: I devise and bequeath all of my estate of every nature and
wherever situate to my husband, HARRY E. FOLTZ, providing he shall survive me
by thirty days.
ITEM III: Should my husband, HARRY E. FOLTZ, predecease me or die on or
before the thirtieth day following my death, I devise and bequeath all of my
estate of every nature and wherever situate in equal shares to my sister,
GERTRUDE G. BURKHOLDER. and my nephew, LARRY D. BURKHOLDER, per capita.
ITEM IV: I direct that all taxes that may be assessed in consequence of
my death, of whatever nature and by whatever jurisdiction imposed, shall be
paid from my residuary estate as part of the expenses of the administration of
y�\�! my estate.
ITEM..V: I appoint my husband, HARRY_E. FOLTZ, executor of this my last
will. Should he fail to qualify or cease to act as executor, I appoint my
sister, GERTRUDE G. BURKHOLDER, and my nephew, LARRY D. BURKHOLDER,
co-executors of this my last will.
ITEM VI: I direct that my executor or guardian or their successors
shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
and /Testament, written on three (3) sheets of paper, dated this 41�k day of
1988. _. &
(SEAL)
Mildred G-.FFol51
.The preceding instrument, consisting of this and two (2) other
typewritten pages, each identified by the signature of the testatrix, was on
the day and date thereof signed, published and declared by the testatrix
therein named, as and for her Last Will, in the presence of us, who at her
request, in her presence, and in the presence of each other have subscribed
our names as witnesses,hereto.
residing at !L I� A0 % 104 ^
residing at
2
COMMONWEALTH OF PENNSYLVANIA :
. as.
COUNTY OF CUMBERLAND
I, MILDRED G. FOLTZ, 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 that I signed it willingly and as my free and voluntary act for the
purposes therein expressed.
Mildred G. FoloV
Sworn to or affirmed and acknowledged
before me by fJ?]jr/re k G. Foltz
the testatrix, this a;-1 day of
r: 1988 VELDA M.SEASE,Notary Public
shippensburg,Cumberland Co., Pa.
AMY Commission Expires April 16,1991
( Notary Public
COMMONWEALTH OF PENNSYLVANIA :
. as.
COUNTY OF CUMBERLAND
We (or I) , ACA i C4a 4 '!L/i/f andTCresa. J. %//}}urle4vlW r the
witness(es) whose name(s) are (is) signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say that we
were (I was) present and saw the testatrix sign and execute the instrument as
her Last Will; that the testatrix signed willingly and 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 Will
as a witness; and that to the best of our (my) knowledge the testatrix was at
that time eighteen (18) or more years of age and of sound mind and under no
constraint or undue influence.
AAA
V
Sworn to or affirmed and subscribed to —
before me by k a :� ,/e!i!f and
threrg ✓• 4"ek .r, witness(es) ,
is 6 j4A day of 44r; / 1488.
VELDA M.Scn.rt, iu..vy rumc
Shippensburg,Cumberland Co., Pa.
C�� 4$
l...on Expires April 16, 19
Notary Public
3
Q M&'TBank
499 Mitchell Road,Millsboro,DE 19966 Adjustment services
Phone 888-502-4349
F ax (302)934-2955
December 10,2013
Weigle& Associates,P.C.
Attorneys at Law
126 East King Street
Shippensburg,PA 17257-1397
Re: Estate of Mildred G. Foltz
Social Security:
Date of Death:November 18 2013
Dear Sir or Madam:
Per your inquiry on December 3, 2013, please be advised that at the time of death, the above-named decedent
had on deposit with this bank the following
I. Type ofAccount Checking Account
Account Number 97238104
Ownership(Names on Larry D. Burkholder(POA)
Mildred G.Folb
Opening Date 0112811980
Balance on Date of Death $2,078.68
Aceruedlnterest S .01
Total $2,078.69
For any additional information on the above accounts,including ownership and any,changes,closures andtor reimbursement of funds,
please tali the 3Gng street at 717.532-4132.
We were unable to lacate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts In which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transrers,
RepresentativePaymor Trustee undera Written Agr ent
Sincerely,
Valarie Mercer
Adjustment Services
*
R.OWE'S AUCTION SERVICE (RH 79L)
2505 Ritner Highway a Carlisle, PA 17015
Bill Rowe (AU 1538L) 249.1978 215-1044 574-1008 Dave Rowe (AU 2295L)
Auction Is Action Call "R/ow/e/" For Satisfaction
SELLERS NAME jz`'ZycVJjJ�,gCt11 a/C�l r✓ DATE
ADDRESS y� (( Aa,h V PHONE
OTHER t(lezyV)d< Yf AUCTIONEER % ._
AUCTION DATE/LOCATION CLERK %
J DESCRIPTION OF MERCHANDISE
r'
T/h�l t 1 41 L
yle" k
/ kf ^n //1 TriK I-lei'Wr
r 4
r.
L�CFS' �.`C..
I Commissio the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise
to be sold/asiis grouped as necessary to obtain bids. I certify that I am the owner or authorized represen-
tative o th er'chandise Frame dr roperty and have good title and the right to sell and that they are free
from a in 6rances. ee to accept)ill responsibility for providing merchantable title and for delivery of
title to a rchas gree to hold armless the Auctioneers against any claims of the nature referred to in
this ent.
AUCTION SIGNATURE-
Total Sales (Clerking Tickets Attached) $ ..-
Less Sale Expense:
�� 0 • �
?.•�% Commission Auctioneer
%Commission Clerks $ ° 0 4 8 ' 00 -
.� 75 i • 80 -
OTHER: l�.N.l ��r' 0 d,3 +� !�
1 4 2 1 .] G
�E
TOTAL SALE EXPENSE DEDUCTED $ _ S --
1y 0 . ..
SELLERS NET $ .. _ N, h