HomeMy WebLinkAbout04-15-14 REV-1500 EX(01-10) 1505610143
OFFICIAL USE ONLY
Department of Revenue pennsylvania County code year File Number
Bureau of Individual Taxes Do^°^*ME+*or aaveaue
PO BOX.280601 INHERITANCE TAX RETURN 21 14 0065
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
01 10 2014 06 12 1926
Decedent's Last Name Suffix Decedent's First Name MI
ADAMS BETTY L
(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 L1 3. Remainder Return(date of death
prior to 12-13-82)
4. Limited Estate 4a. Future Interest Compromise F-1 5. Federal Estate Tax Return Required
(date of death after 12-12E2)
B Decedent Died Testate ❑ (Decede Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of WWI Copy of Trust) P
9. Litigation Proceeds Received to Spousal Povedvv Credit{tlate of death 11.Election to tax under Sec.9113(A)
between 12-31-91 and -1-95) (Attach$ch.O) ( )
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRADLEY L GRIFFIE 717 243 5551
)
V
REGISTE"F WILLS UWONL'r�
6?
First line of address 1,77 -9 cJt
200 NORTH HANOVER STREE : n r- f~ Firt
Second line of address N p O
CJ n O
n 0 -rt 3
M n
!✓
City or Post Office State ZIP Code Dp41 LED r m_13
CARLISLE PA 17013 N ^
Correspondent's e-mail address: bgriffie( griffielaw.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.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF (L'
PERSON RESPONSIBLE FOR FILING RETURN DATE
R, --t x- LM ' Richard L. Adams,Jr. W—IL{ —/W
ADDRESS
916 Gobin Drive Carlisle PA 17013
SIG PREPA TH N REPRESENTATIVE DATE
Bradley L Griffie y y
DoR
0 North Hanover Street, Carlisle, PA
Side 1
L 1505610143 1505610143
_J 1505610243
REV-1500 EX
Decedent's Social Security Number
Oewded's Nam Adams, Betty L.
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)............... 5. 1 , 771 . 00
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 775 . 28
7. Inter-Vivos Transfers&Miscellaneous tyoq Probate Property
(Schedule G) u Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1-7)..................................................................... 8. 2 , 546 . 28
9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 2 , 771 . 67
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1).............................. 10. 49, 074 . 62
11. Total Deductions(total Lines 9& 10)................................................................... 11. 51 , 846. 29
12. Net Value of Est ate(Line 8 minus Line 11).......................................................... 12. -49, 300 . 01
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. -49 , 300 . 01
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 15 0 . 00
(a)(1.2)X.00
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 00 16. 0 . 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. 0 . 00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L 1505610243 1505610243
REV-1500 EX Page 3 File Number 21-14-0065
Decedent's Complete Address:
DECEDENT'S NAME
Adams, Betty L.
STREETADDRESS
1000 Claremont Road
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 0.00
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
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) 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;..... ...................... .......... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;............. .................... ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ ❑x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ ❑x
1 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 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 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)1. 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.1508
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMOMNFALI OFPENNSYLVWA
INHERITANCE TAX RETURN
RESIDENTDECEMW
ESTATE OF FILE NUMBER
Adams, Betty L. 21-14-0065
Include the proceeds of litig8uon and me data the proceeds were received by the estate.
All property jolntlyo nod vdth the right of survivorship must Da disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 2013 Personal Tax Refund 500.00
2 Claremont Nursing& Rehabilitation Center- 546.24
(Personal Care Account)
3 Highmark Blue Shield - 724.76
Medical Insurance Payment
TOTAL(Also enter on Line 5. Recapitulation) 1,771.00
(If more space is needed,additional pages of the same size)
Copyright(c)2002 form software only The Lackner Group,Inc. Forth PA-1500 Schedule E(Rev.6-98)
Rev-1509 EX-(6.98) �.
SCHEDULEF
COMMGNWEALTHOFPENNSYLVAMA JOINTLY-OWNED PROPERTY
INHERITANCE TA%RETURN
RESIDENTOECEDENT
ESTATE OF FILE NUMBER
Adams, Betty L. 21-14-0065
If an asset was made joint within one year of the decedent's date of death,It must De reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Richard L. Adams, Jr. 916 Gobin Drive Son
Carlisle, PA 17013
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FORTJOIN MADE INCLUDE
NUMBER OR SIMILAR IDENTIFYING I INSTITUTION AND
ATTACH DEED OFOR DATE OF DEATH DEC ES DECE ENTS NTEREST VALUE OF
NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSET
1 A 9/612006 Citizens Bank Checking Account- 1.550.55 50.000% 775.28
Account No. XXXXXX4129
(See attached statement)
TOTAL(Also enter on Line 6, Recapitulation) 775.28
(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 F(Rev.6-98)
REV-1151 EX.(IMG)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
"NEN'DENTTDE DEN�R" ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Adams, Betty L. 21-14-0065
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 883.87
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Yearfs)Commission bald
2. Attorney's Fees Griffie&Associates, P.C. 1,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees 143.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 244.30
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 2,771.67
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
Adams, Betty L. 21-14-0065
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Hoffman-Roth Funeral Home&Crematory, Inc. - 883.87
(Partial prepayment)
H-A 883.87
Other Administrative Costs
2 Cumberland Law Journal (Advertising) 75.00
3 Sentinal (Advertising) 169.30
H-67 244.30
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX.(12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
Adams, Betty L. 21-14-0065
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unrei mbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Commonwealth of Pennsylvania- 48,984.82
Department of Public Welfare
Third Party Liability Claim (Medicaid)
2 Cumberland Goodwill Fire&Rescue EMS 89.80
TOTAL(Also enter on Line 10, Recapitulation) 49,074.62
(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)
REV-1518 EX+t11-0&) +R
E(�TgU SCHEDULE J
COAW WT NTEDEFAPEK
AN � BENEFICIARIES
ESTATE OF R�y FILE NUMBER
Adams, Betty L. 21-14-0065
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT ($5$)
Do Nat List ( Ards)
1. TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Richard L. Adams,Jr. Son One hundred
916 Gobin Drive percent of net
Carlisle, PA 17013 estate
Total
Enter dollar amounts for distributions shown above on lines to throutin 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
S.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 11.08)
Will
I, Betty L.Adams, of 916 Gobin Drive, Carlisle, Cumberland County, Pennsylvania, declare
this to be my last will and revoke any will previously made by me.
Item One: I direct that all my debts and funeral expenses including my gravemarker shall be
paid from my residuary estate as soon as practicable after my decease as a part of the expense of
the administration of my estate.
Item Two: I give, devise, and bequeath my entire estate to my son, Richard L. Adams, Jr. In
the event that he predeceases me, then I give, devise, and bequeath my entire estate to my
grandson Michael R. Adams. In the event that he also predeceases me, then I give, devise, and
bequeath my entire estate to the wife of my son Richard L. Adams, Jr., Marcelina M. Adams.
Item Three: I appoint my son,Richard L. Adams, Jr., Executor of this my last will. Should he
fail to qualify or cease to act as Executor, I appoint his wife, Marcelina M. Adams, to act as
Executrix with the same rights,powers, and duties.
Item Four: I appoint my son's wife, Marcelina M. Adams, Guardian of any property which
passes to any person under the age of 20 years and with respect to which 1 am authorized to
appoint a Guardian and have not otherwise specifically done so. Should she fail or cease to act
as Guardian,I appoint Members First Credit Union to act with the same rights,powers, and
duties. Guardian shall establish separate guardianship accounts and shall have the power to use
income from time to time for the beneficiary's education, including technical and vocational
training and graduate school,travel, support, and welfare without regard to his or her parents'
ability to provide for such education, travel, support, and welfare, or to make payment for these
purposes,without further responsibility, to the beneficiary or to the beneficiary's parents or to
any person taking care of the beneficiary. Guardian shall administer the account until the
beneficiary becomes 18 years of age, at which time the Guardian shall transfer the principal and
income remaining in the separate guardianship account to my trustee, being the same person as
my designated guardian, who shall then administer a trust account, of both principal and income
and any other funds transferred to the accounts designated, for the beneficiary's education,
including technical and vocational training and graduate school, travel, support, health, and
welfare. When the guardianship or trust account is less than'$5,000.00 or the beneficiary
becomes 20 years of age, the share of the beneficiary remaining in the account shall be paid to
the beneficiary in full and the guardianship or trust terminated. In the event of the death of any
beneficiary after my decease and prior to reaching the age of 20 years, his or her share shall be
distributed equally among his or her children; otherwise to my surviving children or child to be
administered in accordance with the guardianship and/or trust provisions. No interest under this
instrument shall be transferable or assignable by any beneficiary, or be subject during its life to
the claims of creditors. Guardian and trustee shall not be required to file accountings with any
court. In the event that any provision of this will shall be interpreted to violate the Rule against
Perpetuities, then the remaining provisions of this will shall not be invalid. Guardian shall
administer the guardianship and dispose of assets so as not to violate the rule, making
distribution as required to a life or lives in being plus 21 years.
Item Five: All estate, inheritance, succession, and other taxes, imposed or payable by reason
of my death, and interest and penalties thereon, with respect to all property comprising my gross
estate for tax purposes, whether or not such property passes under this will, shall be paid out of
the principal of my residuary estate, without apportionment or right of reimbursement.
Item Six: I direct that my personal representative or guardian shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
Item Seven: In addition to the rights and powers given to the fiduciaries by law or elsewhere in
this will, I give to my Executor during the full time necessary and for the administration of my
estate the following rights and powers to be exercised in his or her sole discretion.
A. To retain any real or personal property which may at any time form a part of my estate so
long as he or she deems it advisable.
B. To invest in any real or personal property without restrictions to legal investments.
C. To repair, alter, improve or lease for any period of time any real or personal property and
to give options for leases.
D. To sell at public or private sale, for cash or credit, with or without security, to exchange
or to partition, to mortgage or pledge real or personal property, and to give options for
leases.
E. To make distribution in kind.
F. To compromise claims.
IN WITNESS WHEREOF, I have hereunto set my hand this 25'h day of January,2002.
Signed . Y, Z�
Betty K Adams
The preceding instrument, consisting of this and two 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 subscrib on ames.
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We John H. Broujos and Toy S tf—� witnesses whose names are signed to the
attached or foregoing instrument b ng duly qud according to law; do depose and say that we
were present and saw the Testatrix sign and execute the instrument as her last will; that she signed
willingly and executed it as her free and voluntary act for the purposes therein expressed; that each
of us in the hearing and sight of the Testatrix signed the will as witnesses; d a the best of our
knowledge, the Testatrix was at the time 18 or more years o e,o oupd rMind an nder no
constraint or undue influence.
Swom and subscribed to before
me th s 25`h day of Janua ,2002. /
Gc�Gc�
NO ARY PUBLIC
Notarial Seal
Bridget Ann Corcoran,Note ry Public
Carlisle Boro,Cumberland County
'Ay Commission Expires June 10,2002
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
1,Betty L.Adams, whose name is signed to the attached document, having been duly qualified
according to law, do hereby acknowledge that I signed and executed the instrument as my last will;
that I signed it as my free and voluntary act for the purposes therein expressed.
BettyL. Adams, Testatrix
Sworn and affirmed to and
acknowledged before me
this `h day of January,2002.
TARY PUBLIC �J
Notarial Seal
0rid et Ann Corcoran,Notary Public
Garllsle Boro,Cumberland County
My Gommlesion Expires June 10,2002
Ca .a
,l� z e 6 U s a n One Citizens Drive
ROP 112
Riverside,RI 02915
February 10,2014
Griffie&Associates
Atta Bradley L Griffie
200 North Hanover St
Carlisle PA 17013
Estate of Betty L Adams
Date of Death: Jan 10, 2014
SSN: 498-24-9926
Dear Sir/Madam:
In accordance with your request,the attached information sheet has been provided in the above decedent's
name as of his/her date of death.
As per your request, the decedent's account became jointly titled on September 6, 2006 when Richard L
Adams was added on. Also,there were no large withdrawals made from the account that occurred within
4Decedent ths prior to date of death. For any other inquiries,please call 1-877-579-2667.
r
nt Proce ssing
REF#: 628132
KIM Citizens Bank ,a
Account Number 6100734129
Account Title Betty L Adams/Richard L Adams Jr
Date Opened 5/29/1979
Account Type Checking
Principal Balance as of DOD $1550.55
Interest from Last Posting to DOD $ .00
Account Balance as of DOD $1550.55
YTD Interest to DOD $ .00
I