HomeMy WebLinkAbout07-08-14 J 1505610140
REV-1500 EX (01"10'
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 260601 INHERITANCE TAX RETURN 2 1 1 4 0 3 9 2
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 1 1 2 2 6 6 8 2 0' 4 0 1 2 0 1 4 0 8 2 5 1 9 2 8
Decedent's Last Name ` Suffix Decedent's First Name MI
S 0 U R B E E R M I L D R E D E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
S 0 U R B E E R K E N N E T H L
Spouse's Social Security Number
1 9 7 1 6 U 1 5 6 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
❑X 1.Original Return ❑ 2.Supplemental Return ❑ 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)
OX 6. Decedent Died Testate 7.Decedent Maintained a Living Trust _ 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 Sch. O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
J A C Q U E L I N E A K E L L Y 7 1 7 5 4 1 5 5 5 0
REGIS OF WILLS UWONLY
no
First line of address
8 4 5 S I R T H O M A S C O U R Tom`=f
_a
Second line of address
S U I T E 1 2
'O T—
City or Post Office State ZIP Code GATE FILEDN O
H A R R I S B U R G P A 1 7 1 0 9
CorrespondenCs e-mail address: JACKIE @JANBROWNLAW.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.
I RATURE OF PERSON RESPONSI FOR FILING RETURN DAT
A DRESS
220 SALT ROAD ENOLA PA 17025
ATURE OF PR PARER O H REPRESENTATIVE DATE
JjE ES9S
D e
- y
5 SIR THOMAS COUR , SUITE 12 HARRISBURG PA 17109
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140 J
O'
1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: MILDRED E . SOURBEER 2 1 1 2 2 6 6 8 2
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 and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 3 4 8 , 1 7
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . .. . . . . . . . . . . . . . 8. 3 4 8 • 1 7
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 1 6 1 8 . 5 0
10. Debts of Decedent,Mortgage Liabilities,and Liens Schedule I 10. 0 • 0 0
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 6 1 8 . 5 0
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. - 1 2 7 0 . 3 3
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. - 1 2 7 0 . 3 3
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 _ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X .0_ 0 . 0 0 16, 0 . 0 0
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17, 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 19. 0 . 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑X
Side 2
1505610240 1505610240
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 14 0392
DECEDENT'S NAME
MILDRED E. SOURBEER
STREET ADDRESS
220 Salt Road
CITY STATE ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
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.
Fill in oval 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; ...................................................................... ❑ ❑X
b. retain the dght to designate who shall use the property transferred or its income; ............................... ID ❑X
c. retain a reversionary interest;or ................................................................................................ 1-1 0
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ I]
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................. E] 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ Q
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑ 0
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
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 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,unde
Section 9102, as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1508 EX-(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
MILDRED E. SOURBEER 21 14 0392
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. Members 1st checking account; account#0000476742-0011 343.17
2. Members 1 st savings account; account#0000476742-0000 5.00
TOTAL(Also enter on Line 5,Recapitulation) $ 348.17
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
MILDRED E. SOURBEER 21 14 0392
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
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: Jan L. Brown &Associates 1,000.00
3. Family Exemption:(If decedents address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: Register of Wills 343.50
6 Accountant Fees:
6. Tax Return Preparer Fees:
7. Cumberland Law Journal; legal advertising 75.00
8. The Sentinel; legal advertising 200.00
TOTAL(Also enter on Line 9,Recapitulation) $ 1,618.50
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
MILDRED E. SOURBEER 21 14 0392
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. Department of Public Welfare; Estate Recovery Program 0.00
Restitution of medical assistance; CIS#120313510
Claim of$81,079.48
Amount available for payment to DPW= $0.00
TOTAL(Also enter on Line 10,Recapitulation) $ 0.00
If more space is needed, insert additional sheets of the same size.
t
REV-1513 EX.(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MILDRED E. SOURBEER 21 14 0392
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 ouuthp,ht usal distributions and transfers under
Seo 91 , (a1.2).)
1. Kenneth L. Sourbeer, spouse Spousal 0.00
220 Salt Road
Enola, PA 17025
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
[I. 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 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.
LAST WILL OF MILDRED E. SOURBEER
I, MILDRED E. SOURBEER, of Fast Pensboro Township, Cumberland
County, Pennsylvania, being in good bodily health and of sound and disposing
mind and memory and not acting under duress, menace, fraud, or undue
influence of any person whomsoever, merely calli::p, to mind the frailty of
human life, and being desirous of disposing of my worldly goods while I have
the strength and capacity so to do, I do make, publish and declare this my
last Will and Testament, including codicils thereto, by me at any time made,
and declare this alone to be my last Will and Testament.
As to such estate as it has pleased God to entrust me with, I
dispose of the same as follows, viz:
ITEM 1. I direct that my executors hereinafter named pay and
discharge all of Ply just debts and funeral and testamentary expenses.
ITEM 2. All the rest, residue and remainder of my estate, where-
soever situate and whatsoever it may consist of, I give, devise and bequeath,
absolutely and in fee to my dearly beloved husband, KENNETH L. SOURBEER. In
the event he fails to survive my death by thirty (30) days, or dies with me
in a simultaneous disaster, then I give, devise and bequeath my entire estate,
absolutely and in fee to my children, share and share alike, per stirpes.
ITEM 3. I nominate and appoint KENNETH L. SOURBEER as Executor of
this my Last Will. Should the Executor named fail to qualify or cease to
act as Executor, then I appoint Jan M. Fertenbaugh and Kim A. Sourbeer as
Executricies in his stead.
Imo. I direct that my personal representatives, as well as their
successors, shall not be required to give bond for the faithful performance
of their duties in any jurisdiction.
MILDRED E. SOURBEER
cOUVCEEOOr..v L,w
_u y��EM LpE
COMO WEALTH OF PENNSYLVANIA )
ss
COUNTY OF CUMBERLAND )
I, MILDRED E, SOURBEF.R, Testatrix, whose name is signed to the
attached or foregoing instrument, being duly qualified according to law,
do hereby acknowledge that I„signed and executed the instrument as my Last
Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purpose therein expressed.
Sworn or affirmed to and acknowledged before me, by M1IDRED E.
SOURBEER, the Testatrix, this lot day of November, 1983. /
c� c/
NotfiryPublic
My Commission Expires:
The preceding preceding instrument, consisting of this and identified by the
signature of the Testatrix was on the date thereof signed, published and
declared by MILDRED E. SOURBEER, the Testatrix therein named as and for her
Last Will and Testament, in our presence of each other, have hereunto sub-
scribed our names as witness.
��li:::, �J •�C.-.��:l Chi .�
Residing at 107 St. John's Church Road _
Suite #2
Came Hill, PA 17011
i Residing at 17.St. John's Church Road
te 2
Camp Hill, PA 17011
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C'a IIry EEta n'n:~L.w
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A F F I D A V I T
COMMOMEALTH OF PENNSYLVANIA )
) s
COUNTY OF CUMBERLAND )
WE, James M. Pesch, Esquire and Albert D'Aeostino
the witnesses whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we were present
and saw the Testator sign and execute the instrument as her Last Will; and
that she signed willingly and that she executed it as her free and voluntary
act for the purpose therein expressed; that each of us in the hearing and
sight of the Testatrix signed the will as witnesses; and that to the best of
our knowledge the Testatrix was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscr'bed to before e by
'- and
ne sses, this 1st day of November, 1983.
Au ° IJ
Potary Public
YT Commission Expires: u/Z I
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JAN L. BROWN & ASSOCIATES
ATTORNEYS AND COUNSELORS AT LAW
JAN L. BROWN.ESQUIRE BRENDA F. KEPHART,LEGAL ASSISTANT
JACQUELINE A. KELLY,ESQUIRE JUDITH A. EBERSOLE,ADMINISTRATIVE ASSISTANT
CHRISTA M. APLIN.ESQUIRE MELISSA L. SMITH,LEGAL ASSISTANT
TRICIA J. BELANSEK,LEGAL ASSISTANT
July 7, 2014 �..;
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Register of Wills rr-3
Cumberland County Courthouse a Co I `7
One Courthouse Square
Carlisle, PA 17013 :
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Re: Estate of Mildred E. Sourbeer
Estate No. 2014-00392
Executor: Kenneth L. Sourbeer
Gentlemen or Ladies:
Enclosed please find the following items for filing with the Register of Wills:
1. An original and one copy of the Inventory.
2. An original and two copies of the Inheritance Tax Return.
Please time stamp and return our file copies of the Inventory and Inheritance Tax Return.
Also,please provide us with the appropriate receipts.
If you have any questions, feel free to contact this office.
Sincerely,
J cqueline A. Kelly
JAK/mis
Enclosures
cc: Kenneth L. Sourbeer
Olde English Gap • 845 Sir Thomas Court • Suite 12 • Harrisburg, PA 17109
Telephone(717)541-5550 • Fax(717)541-9223 • Email:JLBassoc @janbrownlaw.com • www.janbrownlaw.com
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