HomeMy WebLinkAbout04-02-14 r REV-1500 EX(02-11)(FI) 1505611185
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN 21 14 209
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth Iv1MDDYYYY
01132014 07081922
Decedent's Last Name Suffix Decedent's First Name M I
FULTON RUTH E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name - Suffix Spouse's First Name M I
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
a1. Original Return ❑ 2. Supplemental Return E] 3. Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate - ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 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 SHOT"BE DIREWD TO:
Name Daytime Telephone Numb M rn
c m C->
VICKY ANN TRIMMER, ESQ . 717-92A24407wv " °
CO N A
RE.W WWILLS USE ON4Ym
r y m N 7:0 O
m v p o
First Line of Address C7 n ° -10 -+t T
[7 T 3 :,� n
PERSUN & HEIM, PC r m
r
Second Line of Address
D W
PO BOX 659
City or Post Office State ZIP Code DATE FILED
MECHANICSBURG PA 170550659
Correspondent's e-mail address: VATRIMMER@PERSUNHEIM - COM
Under penalties of perjury, 1 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 reparer has any knowledge.
=IF RS RE PONSIBLE FOR FILING RETURN DATE
•ADDRESS
ROBE T C . FULTON, JR . SANDRA L . LONG
SIG R OF PRE RER THAN REPRESENTATIVE DATE
ADDRESS `
VICKY ANN TRIMMER, ESQ -
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611185 OM46473.000 1505611185
_1 1505611285
REV-1500 EX(Fl)
Decedent's Social Security Number
Decedents Name FULTON R LIT H E
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 . 00
2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2 11 - 110
3. Closely Held Corporation, Partnership or Sole•Proprielorship(Schedule C), . , , , 3, 0 .00
4. Mortgages and Notes Receivable(Schedule D) . . . . , q 0 .00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) . , , , , 5. 65,433. 00
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested , , . . 6. 0 - 00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) F-1 Separate Billing Requested . . . . T 0 - 00
8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 65,433 - 00
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. 111689 .00
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , , , , , , . . 10. 18,29? - 00
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11 291986 •00
12. Net Value of Estate(Line 8 minus Line 11) . . , 12 35144? .00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to lax has not been made(Schedule J). . . . . . . . . . . . . . . . 13 0 .00
14. Net Value Subject to Tax(Line 12 minus Line 13) , 14. 35144? • 00
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 a- 0 . 00 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X.0 -5 351448 .00 16. 11595. 00
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17, 0 .00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 .00
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 11595 . 00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505611285 1505611285
OM4648 1000
REV-1500EX(FI) Page File Number
Decedent's Complete Address: 21 14 209
DECEDENTS NAME
FULTON RUTH E
STREET ADDRESS
1910 RITNER HIGHWAY
CUMBERLAND
CITY STATE ZIP
SHIPPENSBURG PA ?25?
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 11595 . 00
2. Credits/Payments
A. Prior Payments 11515 - 00
B. Discount a 0 . o 0
Total Credits(A+B) (2)' 1,595 . 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 box 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) 0 . 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 . . . . . . . . . . . . . . . . . . . . . . . . ❑
b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . El ❑
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . El 2. If death occurred after Dec. 12, 1982,did decedent transfer propertywithin one year of death lil
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? . ❑
4. Did decedent own an individual retirement account, annuity, or other non-probate property,which
.contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ly
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 ore 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.
OM4671 2.000
REV-1508 EX-(0-12)
pennsylvania SCHEDULE E
DEPARThENROF REVENUE CASH, BANK DEPOSITS Sr MISC.
IRESIDENrIJECEDEN'T PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Ruth E. Fulton 21 14 209
Include the proceeds of litigation and the date the proceeds were recen,ed by the estate.
All ro ert jointly owned with right of sumivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. Members First Savings 91509
2 Diakon Lutheran Social Ministries - refund 5,453
3 Adams County National Bank 50,469
Interest accrued to 1/13/2014 2
TOTAL(Also enter on line 5,Recapitulation) $ 65,433
2W 46AD 2.000 If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX-(0&13)
Pennsylvania SCHEDULE H
DEPARTWNTOF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Ruth E. Fulton 21 14 209
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
1, Harpist 100
2 Vernon Gauther, Pastor 100
Total from continuation schedules . . . . . . . . . 10,300
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) -
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: 11000
3. Family Exemption:(If decedent'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: 189
5. Accountant Fees:
6. Tax Return Preparer Fees. _
7.
None
TOTAL(Also enter on Line 9,Recapitulation) $ 11,689
3W46AG 2.000 If more space is needed, use additional sheets of paper of the same size.
Estate of: Ruth E. Fulton 21 14 209
Schedule H Part 1 (Page 2)
Item
No. Description Amount
3 Funeral Meal 75
4 Edgar Funeral Home 9,175
5 First United Fresh Church 11000
6 Organist 50
Total (Carry forward to main schedule) 10,300
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPABrA WOF REVENUE DEBTS OF DECEDENT,
INHERTANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Ruth E. Fulton 21 14 209
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. Omnicare King of Prussia 185
2 Cumberland Goodwill EMS 333
3 Hope Medical Services 23
4 West Asset Management 20
5 Members First - 4,529
6 Shippensburg Hospital 3,746
7 Darryl Gustwite Do 229
8 Diakon Lutheran 8,982
9 Carlsile Regional Medical 250
TOTAL(Also enter on Line 10, Recapitulation) $ 18,297
2w46AH 2.000 If more space is needed, insert additional sheets of the same size.
REV-1513 EX+( SCHEDULE J
Pennnsns ylvania
DEPARTfvENTOF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Ruth E. Fulton 21 14 209
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
[ TAXABLE DISTRIBUTIONS[Include outright spousal distributions and tmnsfers under
Sec.9116(a)(1.2).]
1. Sandra L. Long
One Third of Residue: 11,816 Daughter 11,816
2 Janet L. Ralston
One Third of Residue: 11,816 Daughter 11,816
3 Robert C. Fulton, Jr.
One Third of Residue: 11,816 Son 11,816
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
p 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.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E 0
9W46AI 2.000 If more space is needed,use additional sheets of paper of the same size.
Last Will and Testament .
Of
RUTH E. FULTON .
I, RUTH E. FULTON, of Shippensburg, Cumberland County, and Commonwealth of
Pennsylvania, make this my Last Will and revoke any and all of my prior Wills.
ARTICLE I. PAYMENT OF DEBTS AND FUNERAL EXPENSES. I direct my Executor to pay
all my just debts and funeral expenses from my estate.
ARTICLE II. TRANSFER OF PERSONAL AND HOUSEHOLD ITEMS. My automobiles,
clothing, jewelry, books, pictures, furniture, furnishings, and other personal or household items .
shall be transferred according to a list which I intend to attach to this Will. If there is no list, or
to the extent that any such items are not included on the list, then such personal and household
items.shall be paid over and transferred to my children according to their own arrangements. If
they cannot agree or arrange for a division in a friendly way, then my Executor may distribute or
dispose of those items in any way he deems to be fair, including private sales or a public sale.
If any minor becomes entitled to any items under this Article, those items may be delivered to
the minor whenever my Executor decides, provided that the transfer shall take place not later
than the date when the minor reaches the age of twenty-one (21) years.
ARTICLE III. RESIDUE AND REMAINDER.
Fulton, Ruth.will 5/11/02#294950 .
A. All the remainder.of.the property that) may own or that I may be entitled to
dispose of or to appoint at the time.of my death shall be divided into three (3) equal shares. I
give, devise, bequeath, and appoint one (1) equal share,to each of my children.
Any reference to my "child" or "children" shall refer to SANDRA L. LONG,.JANET
L. HALSTON, and ROBERT C. FULTON, JR.. Any reference to the masculine in my Will as it
relates to my child or children shall also include the feminine wherever necessary:
In the event that any child fails to survive me and leaves issue, then I give,
devise, and bequeath that deceased child's share in equal parts to the issue of that deceased
child, per stirpes. The share of any such issue under the age of twenty-one (21) years shall be
paid over and transferred to a Trustee, IN TRUST, NEVERTHELESS, for such issue and that
trust shall be administered as a,separate trust for that issue according to the terms of Article
III-B below.
In the event that any child fails to survive me and leaves no issue, then I give,
devise, and bequeath that deceased child's share in.equal shares to my other children, per
stirpes. .
B. The share of any issue of a deceased child shall be paid over and transferred to
a Trustee, IN TRUST, NEVERTHELESS, for such issue if such issue is under the age of
twenty-one (21) years at the time a distribution.is to be made to such issue. The share of each
such issue under the age of twenty-one (21) years shall be administered as a separate trust for
such issue according to the following terms and provisions. The Trustee shall pay over or use,
apply, and expend income or principal or both for such issue in such amounts as the Trustee, in
his sole discretion, shall deem advisable in order to provide health, support, maintenance, and
education for such issue. At the time when such issue attains the age of twenty-one (21)
2
ARTICLE V. WAIVER OF BOND. To the extent that such requirements can legally be waived,
I direct that no Executor named in my Will or any persons succeeding in that office, whether in
the Commonwealth of Pennsylvania or elsewhere, shall ever be required to post any bond or
give any security in connection with his duties.
ARTICLE VI. EXECUTOR'S POWERS. In addition to powers given him by law and by other
provisions of my Will, my Executor shall have the following powers, applicable to all property
held by him, and these powers shall be effective without court order and until actual distribution:
A. To sell at public or private sale, mortgage, exchange, transfer, or lease for any
period of time any real or personal property and to give options for.sales, exchanges, or leases
for such prices and upon such terms or conditions as he deems proper. No purchaser shall be
held liable to see to the application of any purchase money;
B. To retain any and all of the assets of my estate, real or personal, in the sole
discretion of my Executor, without being restricted to investments authorized for Pennsylvania
fiduciaries and without regard to any principle of diversification or risk;
C. To delegate discretionary powers to agents, remunerate them, and pay their
expenses;
D. To collect rents and other proceeds from real estate, paying all carrying charges
and making such repairs as he may deem proper, all without the necessity of obtaining leave of
any court;
E. To carry on any business owned or controlled by me at the time of my death for
whatever period of time he shall think proper, with full powers in the property, including the
power to borrow and to pledge assets contained in my estate as security for said borrowings;
4
F. To exercise any rights or elections to pay death taxes in installments and to
make interest payments on such installments as a charge against the principal of my estate;
G. To disclaim on my behalf any interest as my Executor deems advisable.
All the foregoing powers, together with those granted by law to executors, may
be exercised by the Executor named in my Will and by all persons succeeding in said office,
including administrators with Will annexed.
IN WITNESS WHEREOF, I, RUTH E. FULTON, the Testatrix, have to this my Last Will,
typewritten on six (6) sheets of paper (including the witnesses' signatures), of which this is
Sheet No. 5 set my hand and seal this )-�A day of 20 a 2
(SEAL)
u h E. Fulton
5
SIGNED, SEALED, PUBLISHED, AND DECLARED, by RUTH E. FULTON as and for
her Last Will, in the presence of us, who at her request and in his presence and in the presence
of each other, have hereunto subscribed our names as witnesses this 28 day of
, 200Z
1 r
ADDRESS C L15 F Inc
Witness Town and State
1
4� Al ADDRESS _PA
Witness Town and State
ADDRESS
Witness Town and State
6
ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
/ // : SS.
COUNTYOF GU!, 5i;v191'-k
The Testatrix, Ruth E. Fulton, whose name is signed to the foregoing instrument and the
witnesses whose names are signed to the foregoing instrument, being duly qualified according
to law, do hereby declare to the undersigned authority.that the Testatrix signed and executed
the instrument as her Last Will; that she signed willingly and that she executed it as her free "
and voluntary act for the purposes therein expressed; that each of the witnesses, in the hearing
and presence of the Testatrix, signed the Will as a witness; and that to the best of their
knowledge and belief the Testatrix was at that time eighteen (18) years of age or older, of
sound mind and under no constraint or undue influence.
(SEAL)
Ruth E. Fulton
(SEAL)
Witness
(SEAL)
Witness
(SEAL)
Witness
Subscribed, sworn to and acknowledged before me by Ruth E. Fulton, the Testatrix, and
subscribed and sworn to before me by _2n —
,4mrsasi 14FIA)P and
the witnesses, this day of / "! 20 n i_
c« (Notary Public)
Notarial Seal
Vicky Ann Trimmer,Notary Public
:294950_I Susquehanna Twp.,Dauphin county
y Commission Expires Mar.11,2006
LMIV
6
Member,Pennsylvania Association of Notaries
St
MEMBERS
PEDERALMMM UMON
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix 284019-00*
Date Account Established 04/24/2006
Principal Balance at Date of Death $9,508.77
Accrued Interest to Date of Death $.47
Total Principal and Accrued Interest $9,509.24
Name of Joint Owner None
*PLEDGE OF SHARES FOR VARIABLE RATE SHARE SECURED LOAN.
LOAN ACCOUNT:
Account Number/Suffix 83323-04
Date Opened 02/28/2011
Principal Balance at Date of Death $4,529.26
Loan Type Variable Rate Share Secured
Interest Rate 2.60%
Name of Co-Borrower None
Primary Owner JANET HOLSTON
M F^FD�LREDIy t.{NTQN
Danielle A. Kline ����L)/'\ �
Lending Insurance Support Specialist
March 14, 2014
Estate of: RUTH E. FULTON
Date of Death: 01/13/2014
Social Security Number: 178-16-6687
5000 Louise Drive • P.O. Box 40 • Mechanicsburg,Pennsylvania 17055 (800) 283-2328 www.memberslst.org
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Account# 117196
Statement Date 01/20/14
Page 1 of 3
ACNB
BANK
"****'**'**"*AUTO'*3-DIGIT 172 See insert for important
842 0.8920 AB 0.384 51 76 information about managing
rItIIIIIII�IIrII�iIrll�il�ItllIIIIIIIIIIII IIr�IIIiIIIIi���II your account.
RUTH FULTON
1910 RITNER HWY
SHIPPENSBURG PA 17257-9760
For a number of years, the Community Calendar has been included in checking statements.
Going forward, the Community Calendar will no longer be printed and inserted in statements.
However, the event information is available online at acnb.com
by clicking on the Community Events button in the left menu.
This change not only helps the Bank reduce expenses and its paper usage, but also
is due to the continuing trend of more and more people going online to obtain information.
If you have questions, please contact us at 1.888.334.ACNB.
Esteem Checking Account Summary # 117196
Beginning Balance on 12/16/13 $19,263.34
+ Deposits&Other Credits $42,584.37
-Withdrawals & Other Debits $19,379.00
-Service Charges $0.00
+ Interest Paid $2.33
Ending Balance on 01/20/14 $50,471.04
Days in Statement Period 35
Account Activity
Date Description Deposits/Credits Checks/Debits Balance
12116/13 BEGINNING BALANCE $19,263.34
12/20/13 CUSTOMER DEPOSIT $41,518.37 $60,781.71
12/23/13 CHECK#5298 $10,617.00 $50,164.71
01/03/14 SSA TREAS 310 XXSOC SEC $1,066.00 $51,230.71
RUTH E FULTON
01/06/14 CHECK#5299 $713.00 $5051771
01110114 HEALTHASS PA HLTH PREM $49.00 $50,468.71
FULTON,RUTH E
01/17/14 INTEREST PAYMENT $2.33 $50,471.04
Checks Paid
Check# Date Amount Check# Date Amount Check# Date Amount
5298 12123 10,617.00 5299 01/06 713.00
Total Checks 2 Total Checks Amount $11,330.00 Check number out of sequence
acnb.com•acnbbusiness.com"P.O.Box 3129,Gettysburg,PA 17325 •Phone 717.334.3161 •Toll Free 1.888.334.ACNB(2262)