HomeMy WebLinkAbout04-03-14 � 1505610105
REV-1500 EX(oz-11)(FI) .
enns Lvania OFFICIAL USE ONLY
PA Department of Revenue PEp pr�E Y County Code Year File Number
Bureau of Individua�Taxes Fp`�E�uF
PO BOX 28o6oi
INHERITANCE TAX RETURN / _
Harrisburg,PA i�i28-o601 RESIDENT DECEDENT � / l ; ; V �7;
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
204-01-5251 06/10/2013 '. 11/09/1918
__. _ _...... .. .._. .. _„ :.. ....... .. .
DecedenYs Last Name Suffix DecedenYs First Name MI
_. __ __ __
Timothy ' ' Jane ' E `
. . ......
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
_... ......... . . _ ___ _ ,.,� ,
n/a __ � �' �a
Spouse's Social Security Number � �y�
THIS RETURN MUST BE FILED IN DUPLICATE WIT � .� � �' '�
�, �; �
_ REGISTER OF WILLS ��'` G, ��
FILL IN APPROPRIATE OVALS BELOW �.� N J
rJ'C:�, t:'.. ,';
� 1.Original Return O 2.Supplemental Return p 3. Remainder�(Date of C�ath T_ �i-:
Prior to 12- � �;.-=�"°
O 4.Limited Estate p 4a.Future Interest Compromise(date of p 5. Federal Estatpl�"�Return Re�quired ���..n,,
death after 12-12-82) _' W �'
� 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust _ 8. Total Number of Safe Depos t�oxes
(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 O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
__. __ __ _ ____ __ ____...
,Adam R. Deluca, Esq. ;(717)249-1177
_ . __. J'�"
REGISTER ILLS USE OPt
r
� ;-� ,.�..
First Line of Address C'' x" � %"`�
. ........ ..... ....... ..... ....... ......... ......... ......... ......... .. � �.Y e' .ti/
_..__.
r..� �
'61 West Louther Street ��`-�T � r � ��
.... ____.... __.__...v �. . ... . '
_._...... _.___..: ._�� --
Second Line of Address � % � �
. � r -,
.. ..... .._.. ......_. ____. .___. ...
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_.. p _._._.. ILED � c.7 f J
City or Post Office ��� State ZIP Code
.....--_. _........ . _ _ __
�Carlisie PA 17013 �'
CorrespondenYs e-mail address:8�deluC885@aOl.COm
Under penaities of perjury,I declare that I have examined this return,inciuding 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.
SIG���P�ON RESPONSIBLE FOR FILI RETURN TE�/ �
�..�-- i L�� l
ADDRESS
160 Hunky Hollow Road, Duncannon, PA 17020
SIGN U OF PREP ER AN REPRESENTATIVE � D�lfE� /�
c..
.�l��G-� ��! i
ADDRESS
61 West Louther Street, Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 �
�
� 15056102�5
REV-1500 EX(FI)
DecedenYs Social Security Number
DecedenYs rvame: Jane E. Timothy '204-01-5251
RECAPITULATION
1. Real Estate(Schedule A). .... . ....... ............... . .......... ...... 1. ', '
2. Stocks and Bonds(Schedule B) .. .......... ................ ....... ... . 2. ! 10,558.99 '
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. '. 13,753.71 ',
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ...... . 6. : ;
__.., ,. _
7. Inter-Vivos Transfers&Misceilaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... . .. 7. 41,047.00
8. Total Gross Assets(total Lines 1 through 7). ............... ....... . ..... 8. 65,359.70 ',
9. Funeral Expenses and Administrative Costs(Schedule H)........ ........... 9. I 8,571.33 '
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)..... .......... 10. 1,323.46 j
11. Total Deductions(total Lines 9 and 10).... ....... ..... . ......... . ...... 11. ; 9,894.79 '
12. Net Value of Estate(Line 8 minus Line 11) . . ............ . ... .. ..... ..... 12. 55,419.91
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. ' 55,464.91
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_ 15. '.
16. Amount of Line 14 taxable
� _ ...,. . ..�.�.. ... �. ,. � v..... _, - _ ...,,,;
at linea�rate x.0 45 55,464.91 ' �s.; 2,495.92 '
.�....,. _ �. ...., ......... ..,...,,, .�... ...,....._. .
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. '' 2,495.92 '.
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 � � — � 3 ` / �/„ � �
V l{�
Decedent's Complete Address:
DECEDENT'S NAME
Jane E. Timothy
STREETADDRESS
16 South Enola Drive, Apt. 312
��TY STATE ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 2,495.92
2. CreditslPayments
A.Prior Payments 3,100.00
B.Discount 124.79
Total Credits(A+B) (2) 3,224.79
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) �2$87
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
Make check payable to: REGISTER OF WILLS,AGENT.
: , .
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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 ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. ❑ �
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?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or 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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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 imposetl 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 decedenYs 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 atloption.
REV-i5o3 EX+(8-iz)
� pennsylvania SCI�IEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jane E. Timothy 21-13-0677
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' Stock-PNC Financial Services Group(PNC)130 shares,common stock,value$74.15/share
'CUSIP 693475105 9,639.50 '
2 Stock-Banco Santander,S.A.(ADR)143 shares,common stock,value$6.43/share
CUSIP 05964H105 919.49
TOTAL(Also enter on Line 2, Recapitulation) $ 10,558.99 '
If more space is needed,insert additional sheets of the same size
REV-i5o8 EX+(o8-i2)
� pennsylvania
SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCETAXREfURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Jane E. Timothy 21-13-0677
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
' �.' M&T Bank 423 N.Enola Rd.,Enola,PA 17025-savings acct#15004211274713 4,937.53
2.' 'M&T Bank-checking acct#86035886 7,737.47 '
3. Pennsylvania Employees B.T.F.payment refund 266.41
4.' ,Enola Commons securiry deposit balance refund 523.40
' 5., PNC Bank-Stock dividend check 57.20 '
g.' 'Refund from Trust Ambulance,Inc. 94.00
7.' 'Santander Bank-stock dividend check 5.20 '
g. Personal property sold at auction-Cordier Auctions and Appraisals #AU005321 132.50 '
TOTAL(Also enter on Line 5, Recapitulation) $ 13,753.71
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
� pennsylvania SCHEDULE G
DEPARTMENTOFftEVENUE INTER-VIVOS TRANSFERS AND
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jane E. Timothy 21-13-0677
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 PROPERIY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
INCLUDE THE NAME OF THE TRANSFEREE,TFIEIR RElATIONSHIP TO DKEDENi AND
NUMBER THEDAlEOFTRANSFHLA7TACHACOPY0FIHEDEEDFORRE4LESfATE. VALUEOFASSET INTEREST (IFAPPLICABLE) VALUE
1. ING Annuity Acct#2A02381700: Transferee-David C.Timothy(son)160 41,047.00' ' 100 41,047.00
'Hunkey Hollow Road,Duncannon,PA 17020. Transfer Date-07/02/2013
TOTAL(Also enter on Line 7, Recapitulation) $ 41,047.00 '
If more space is needed,use additional sheets of paper of the same size.
� REV-1511 EX+ (08-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXREfURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jane E. Timothy 21-13-0677
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Richardson Funeral Home 3,907.77
2. Enola Emmanuel United Methodist Church(refreshments, reverend) 250.00
3. Pamela's Flowers(flowers for service) 225.40
B. ADMINISTRATIVE COSTS;
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
3,800.00
2. Attorney Fees
3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 213.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
�• Cumberland Law Journal Estate Advertisement 75.00
s. Patriot News Company Estate Advertisement 99.66
TOTAL(Also enter on Line 9, Recapitulation) $ 8,571.33
If more space is needed,use additional sheets of paper of the same size.
RfV-1512 EX+(12-12)
� pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jane E. Timothy 21-13-0677
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. Holy Spint Hospital _ 55.25 '
2.' Discover Card balance-account ending in 4784 825.03
3. Azizkhan Intemal Medicine 10.00 '
4.' Trust Ambulance,Inc. 94.00 '
5. Computershare Inc.,account closing fee 339.18
TOTAL(Also enter on Line 10, Recapitulation) $ ' 1,323.46
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
� pennsylvania SCHEDULE ]
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDEIVT DECEDENT
ESTATE OF: FILE NUMBER:
Jane E. Timothy 21-13-0677
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. 'David Timothy, 160 Hunky Hollow Rd.,Duncacnnon,PA 17020 son 1/5
' 2. 'Virginia Walter,301 Water Street,New Cumberland,PA 17070 daughter 1/5 '
' 3.' 'Judith Brauchy,5446 Oakvilla Manor,St.Louis,MO 63129 daughter 1/5 '
' 4.' Ruth Timothy, 16 Nottingham Rd.,Camp Hill,PA 17011 daughter 1/5 '
' S. 'Debra Lehman,342 Fox Run Circle,Etters,PA 17319 : daughter 1/5
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:
L
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.
�ECO�;G��'� C'r r I�'=: F � p
W _ _ t �AST WILL AND TESTAMENT OF �
�EC�S:���:� 0�� '.°;';�.�.� �
JANE E. TIMOTHY �
;��i3 ��N 13 Fli"1 i� CQ
�LE�� G�
��, E��C-�THY, of Cumberland County, Pennsylvania, declare tlus to be
lny��B'�I���E.����t and hereby revoke all prior Wills and Codicils.
1. I direct that all my just debts, fiineral eYpenses and administrative
expenses shall be paid from my estate as soon as practicable after my death. It is my
wish tliat upon my death my body shall be buried next to my husband in our family burial
plot.
� �`�� 2• I direct that m real ro e and all ersonal ro ert th
Y P P rtY p p p y at I own at the
time of my death shall be divided equally between my son David C. Timothy, my
daughter Deborah J. Lehman, my daughter Judy Brauchy,my daughter Virginia Walter,
� and my daughter Ruth Ann Timothy,per capita.
�
ti 3. I appoint my son, David C. Timothy, as Executor of tlus my Last Will and
- Testament. In the event that my son is deceased,unable or unwillin�to serve or shall
cease to serve for any reason whatsoever, then I nominate, constit�rte and appoint my
\ dau�hter Deborah J. Lehman, as alteinate Executrix of this my Last Will and Testament.
\ 5. The Executor or Executri� of this Will shall have the power to distribute
; ` � my estate in cash or in kind, or partly in either.
v��
6. I direct that no Executor acting under this Will shall be required to enter
\ bond in any jurisdiction.
��
� 7. I recorrunend that my Personal Representative retain the law firm of Allied
Attonleys of Central Pennsylvania, L.L.C.,to probate my estate.
_�'.
- �
1N WITNESS WI�REOF, I have hereunto set my hand this � 3�"day
of ,/�/�����,� , 2012.
�� � � ':���� � _
; NE E. TIMOTHY
Page 1 of 4
The preceding instilmient consisting of this and tluee other pages was on the day and date
hereof sigiled,published and declared by JANE E. TIMOTHY, as and for her Last Will
and Testament in the preseiice of us, who at her request, in her presence and in the
presence of each other have subscribed our names as witnesses hereto.
, �� �,
Witness �itness `
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Page 2 of 4
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND •
I, JANE E. TIMOTHY,the TESTATRIX,whose name is si�ed to the attached or
foregoulg instniment, having been duly qualified accord'uig to law, do hereby acknowledge
that I signed and executed the inst�-uinent as my Last Will and Testament;that I signed it
��� \ �villingly, and that I si�7ed it as my free and voluntary act for the puiposes therein
� expressed.
�
l� �� �-r� - �����
� ,� ; /JANE E. TIMOTHY r�
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Sworn or affirnled and acl:nowledged before me by JANE E. TIMOTHY,the
"� TESTATRIX,this �.��day of /�'�GJ`� ,2012.
`J �
�� otary ublic ttorne
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Page 3 of 4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA .
: SS
COTJNTY OF CUMBERLAND •
n 7
wE,���a„ 1� c��ld �.�s�. S-#� e � ,
��,� the�vitnesses �vhose na�lles are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw testatriY sign and
� � execute the instrument as her Last Will; that she signed willingly and that she eYecuted it
� �
� as her free and voluntary act for the purposes therein expressed; that each subscribing
\� witness in the hearing and si�ht of the testatrix signed the Last Will and Testament as
witnesses and that to the best of our knowled;e the testatriY was at the time 18 or more
v� years of age, of sound mind and under no constraint or undue influence.
�� � � �
_ � , _ � _
�� �;-� Swoni or affirmed and subscribed before nle by
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� r� u.m � ���1
�� �/c� and ,r,,,, .�this
i�� �
i � day of � � , 2012.
otary P�b� c A iney
S�e4;dE F ��
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Page 4 of 4