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HomeMy WebLinkAbout08-12-14 � 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 21 14 0 57 2 PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 05172014 03161930 DecedenYs Last Name Suffix DecedenYs First Name M� STAVER AMY JEAN (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 � 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) � 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 Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MICHAEL J • CONNOR, ESQ • 717-262-2185 n � REGISTE 0�'ILLS USE�LY �;- � =�7�C .-- C r�;: ti� r'r1`�c G"� :_. :,� �—� '3:7�f_ �, �� �.� First Line of Address N ! r--% �U'- _ 247 LINCOLN WAY EAST ���' �' ��-, � . ;-; _. - ,=_; C��..__ �- i-�.= Second Line of Address : �� Z,,J ' -p _' � C� A --- '-r,� City or Post Office State ZIP Code DATE FILED t`f` CHAMBERSBURG PA 17201 CorrespondenYs e-mail address: M J C a�W C S L A W O F F I C E •C 0 M 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 infortnation of which preparer has any knowledge. SIGNATURE F ERSON RESPO IBLE F FILING RETURN DAT ` 02�� ADDRES C/ LKER, CONNOR & SPANG, LLC 247 LWE, CHAMBERSBURG, PA 17201 SIGNATUR O �PFjRER O TH EPRESENTATIVE � ��T � � � �D�� ADDRESS 247 LINCOLN WAY EAST CHAMBERSBURG, PA 17201 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505611185 1505611185 OM4647 3.000 � ls,��,.�K. >.,.. � ,.. � ._,� . . .�.: ,��� _ _ _ �����_���_.�. _ � 1505611285 REV-1500 EX(FI) DecedenYs Social Security Number DecedentsName STAVER AMY JEAN 182- RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . � Q • �� 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . Z. � • �� 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , . . 3. � • 0 0 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4. � • �� 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , . 5. 2 4 ,0�5• �� 6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , , , g, � • �� 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested . . . . 7. 18,8 7 4 • �� 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . g. 4 2,8 7 9 • �� 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. 3,2 0 5 • �0 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , , , . . , , �p, 3,7 4 3 • �0 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. 6,9 4 8 • �� 12. Net Value of Estate(Line S minus Line 11) , , , , , , , , , , , , , , , , , , , 12. 3 5,9 31 • 0� 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. 3 5,9 31 • �� 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 at�inea�ratex.o 45 35,931 • 00 16. 1,617 • 00 17. Amount of Line 14 taxable at sibling rate X.12 Q . Q� �7 � • �0 18. Amount of Line 14 ta�ble at collateral rate X.15 � • �� 18. � • �� 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1,617 • �� 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � $Id@ 2 � 1505611285 1505611285 � OM4648 3.000 y._���.�,..�.�., a,,� „n,.. s,.� 4- � ,�..�. . ��� s�_ _ REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 14 0 5 7 2 DECEDENT'S NAME STAVER AMY JEAN STREET ADDRESS C MBER AND CIN STATE Z�P SHIPPENSBURG PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,�ine 19) (1) 1,617 • 0 0 2. Credits/Payments A. Prior Payments 1�5 3 6 • 0 0 B. Discount 81 • 0 0 Total Credits(A+B) �2� 1,617 •0 0 3. Interest �3� � • �� 4. If Line 2 is greater than Line 1 +Lin�3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2,Line 20 to request a refund. (4) � • �� 5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0 • �0 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 . . . . . . . . . ❑ � 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 X without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : a � 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 or a stepparent of the chiid 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 individuai 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 DEPARTMENTOF REVENUE CASH, BANK DEPOSITS 8 MISC. INHERITANCETAXRETURN pERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Am Jean Staver 21 14 0572 Include the proceeds of litigation and the date the proceeds were received by the estate. All ropert 'ointl owned with ri ht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Investment Deposit - post mortem 15 2 Investment Deposit - post mortem 108 3 M&T Bank Checking Account #97536091 7,891 4 M&T Bank Checking Account #9853127547 1,366 5 Members lst Federal Credit Union Savings Account #405457-05 12,092 Interest accrued to 5/17/2014 1 6 Members lst Federal Credit Union Checking Account #405457-00 1,719 Interest accrued to 5/17/2014 � 7 Senior Care Operations Holding LLC - nursing home refund 813 TOTAL(Also enter on line 5, Recapitulation) $ 24,005 zwasAD 2.00o If more space is needed,use additional sheets of paper of the same size. Q M�z�a.� 499 Mitchell Road,Milisboro,DE 19966 Records Management Phone 888-502-4349 F ax (302)934-295� June 30.2014 Walker, Connor& Spang LLC 247 Lincoln Way East Chambersburg, PA 17201 Re: Estate of Amy Jean Staver Social Security: 182-22-7027 Date of Death: Mav 17, 2014 Dear Sir or Madam: Per your inquiry on June 23,2414,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type of Accac�nt Checking Account Account Number 97536091 Ownership(Names o� Amy Jean Staver Glenn A.Staver James C.Staver(POA) Thomas A.Staver(POA) Opening Date Ol/28/1980 Ba[ance on Date of Death $ 7,891.28 Accrued Interest � .03 __._.__ _ __._____ Total $ 7,891.31 2. TypeofAccount CheckingAccount Account Number 9853127547 Ownership(Names o� Jean Staver(Principal) James C.Staver(Guardian) Opening Date 10/22/2010 Balance on Date ofDeath $ 1,365.88 Accruedlnterest $ •�� Total $1,365.89_ _ __ _ _ _ For anv additional information on the abo�e accounts,including ownership and am changes,closures and/or reimbursement of funds, please call the I�ing Street at 717-532j1132. ��"e were unable to locate any safe deposit box for the abo��e-mentioned decedent. This letter dces not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of tiniform Transfers, Representative Payee,or'I�rustee under a V1'ritten Agreement Sincerely, Valarie Mercer Records Management St � MEMBERS lst FEDERAL CREDIT UI�IION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 405457-00 Date Account Established 12/23/2010 Principal Balance at Date of Death $1,718.85 Accrued Interest to Date of Death $0.08 Total Principal and Accrued Interest $1,718.93 Name of Joint Owner None INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix 405457-05 Date Account Established 09l24/2012 Principai Balance at Date of Death $12,092.39 Accrued Interest to Date of Death $0.56 Total Principal and Accrued Interest $12,092.95 Name of Joint Owner None MEMBERS 1ST FEDERAL CREDIT UNION G nderson Lending insurance Support Specialist July 3, 2014 Estate of: Amy J. Staver Date of Death: 05/17/2014 Social Security Number: 182-22-7027 , 5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 • (800) 283-2328 • wwwmemberslst.org �_,. ��,��,���-�.,�-��-K> }... � .� _ _ REV-1511EX+�o&,3, SCHEDULE H pennsylvania DEPPJ2TMENTOF REVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Am Jean taver 21 14 0572 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: � Auer Cremation Services of Pennsylvania, Inc. obituary notices 326 Total from continuation schedules . . . . . . . . . 1,070 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) James C Staver Street Address 29 Mont ome Avenue City Shippensburg State PA ZIP 17257 Year(s)Commission Paid:none T�aid 2, Attorney Fees: 1,500 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach e�lanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 221 4. Probate Fees: 5. AccountantFees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal 75 legal advertising 2 US Postal Service 13 postage expenses TOTAL(Also enter on Line 9,Recapitulation) $ 3 205 swasa,�z.000 If more space is needed, use additional sheets of paper of the same size. Estate of: Amy Jean Staver 21 14 0572 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Auer Cremation Services of Pennsylvania, Inc. 35 3 Bill Miller organist 25 4 Our Lady of Visitation Church reception 150 5 Pastor Jim Bulich funeral service 50 6 Springhill Cemetery opening/closing grave 360 7 Tim Wyrick cemetery attendant 50 8 Wagoner's Memorials gravestone inscription 400 Total (Carry forward to main schedule) 1,070 REV-1512EX+(�z_�2) SCHEDULE I pennsylvania DEPAR'fMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCETAXRETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Amtr Jean Staver 21 14 0572 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 � Care First Pharmacy services rendered prior to death 48 2 Elmcroft Nursing nursing services rendered prior to death 2,445 3 Veteran's Administration reclaimation of deposit not due to decedent 1,250 TOTAL(Also enter on Line 10,Recapitulation) $ 3 743 zwasa,H z.000 if more space is needed, insert additional sheets of the same size. REV-1513EX+(01-10) SCHEDULE J pennsylvania DEPARTMENTOF REVENUE BENEFICIARI ES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Am Jean Staver 21 14 0572 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).] �. Robert G. Staver son one-fifth of residue 805 Hillmeade Drive Nashville, TN 37221 2 Amy K. Whitcomb daughter one-fifth of residue 876 Clouser Hollow Road Shippensburg, PA 17068 3 Thomas A. Staver son one-fifth of residue 473 South Second Street Chambersburg, PA 17201 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 SEC110N 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. $ 0 If more space is needed, use additional sheets of paper of the same size. 9W46AI 2.000 Estate of: Amy Jean Staver 21 14 0572 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 4 James C. Staver son one-fifth of residue 29 Montgomery Avenue Shippensburg, PA 17257 5 Jeffrey Staver son one-fifth of residue 4042 Linden Street Allentown, PA 18104 \\Forrestmyers�SharedDocs\Word Processing\esta[e planning\cl�ent's work\staver,amy j.LW&T.05-40-0196.Mar05.doc n.-,� . . i�.— � , , , , , _ J. '��`� ��'�`'� !� ��►L�,4�1'' L�7ILL AND TES TAMENT� I,.;Ah�l'�;)"STAVER, of Shippensburg Borough, Franklin County, Pennsylvania, revoke my prior wi(C� �nd declare this'to be my Last Will: C _ , , _ , , .'� FIRST: PAYMENT OF EXPENSES - i direct that the expense of my last illness and funeral be paid from my estate as soon as may conveniently be done. SECOND: In the event i am the owner of real estate situate at 731 Fireside Drive, Borough of Shippensburg, Franklin County, Pennsylvania, at my death, I direct that the proceeds of the sale of said property be distributed as follows: (a) Fifty-five Thousand Dollars ($55,000.00) shall be distributed to my children who shall survive me by sixty (60) days, in as nearly equal shares as practical per stirpes. The said amount of Fifty-five Thousand Dollars ($55,000.00) shall be increased by the amount of three percent (03%) per annum to reflect the increased value based on inflation. The amount given hereunder represents my and my husband's investment in this rea� estate from the sale of our former residence at 121 North Penn Street, Shippensburg, Pennsylvania. (b) The balance after distribution under Paragraph Second (a) above, I give and bequeath to my son, ROBERT STAVER and daughter-in-law, DEBORAH STAVER, per stirpes, in recognition of the cash sums they have contributed to the purchase price of this residence by my husband and I. THIRD: RESIDUE OF ESTATE- I give, devise and bequeath all the rest, residue and remainder of my estate unto my husband, GLENN A STAVER, provided he shall survive me by thirty (30) days. In the event my husband fails to survive me by thirty (30) days, I then give, devise and bequeath all the rest, residue and remainder of my estate to my children provided they shall survive me by thirty (30) days, in as nearly equal shares as possible, per stirpes. FOURTH: PROTECTIVE PROVISION - To the greatest extent permitted by law, before actual payment to a beneficiary, no interest in income or principal shall be (i) assignable to a beneficiary or (ii) available to anyone having a claim against a beneficiary. FIFTH: DEATH TAXES -All federal, estate and other death taxes payable on the property forming my gross estate, whether or not it passes under this will, shall be paid out of the principal of my probate estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. This provision shall not apply to any property over which I have a general power of appointment of federal estate tax purposes. SIXTH: MANAGEMENT PROVISIONS - I authorize my Executor, as follows: A. Retain/Invest: To retain and to invest in all forms of real estate and personal property, including common trust funds, mutual funds and money market deposit 1 _ _ _ . _ \\Forrestmyers\SharedDocs\YVord Processing\estate planning\client's worklstaver,amy j.LW&T.OS-40-0196.�titar05.doc accounts and certificates of deposit, regardless of any limitations imposed by law on investments by executors or any principie of law concerning investment diversification; B. Compromise: To compromise ciaims and to abandon any property which, in my Executor's opinion, is of little or no value; C. Borrow: To borrow from and to sell property to my husband or others, and to pledge property as security for repayment of any funds borrowed; D. Sell/Lease: To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property and to give options for sales of leases; E. Capital Changes: To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; F. Distribute: To distribute in kind and to allocate specific assets among the beneficiaries (including any custodian hereunder) in such proportions as my Trustee may think best, so long as the tota) market value of any beneficiary's share is not affected by such allocation. These authorities shall extend to all property at any time held by my Executor or my Trustee and shall continue in full force until the actual distribution of all such property. All powers, authorities and discretion granted by this Will shall be in addition to those granted by law and shall be exercisable without court authorization. SEVENTH: EXECUTOR- I appoint my husband, GLENN A STAVER, Executor of my Will. In the event of the death, resignation, renunciation or inability of my husband to act as Executor, I appoint my chiidren,JAMES STAVER, ROBERT STAVER, and AMY STAVER DETWEILER, Co-Executors of this, my Will. Neither my Executor, nor any successor shall be required to give bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal this Olst day of April, 2005. �. .—� �-_-.�- .i..w �;; �t::�...�.��� (SEAL) � At�i'f J;STAVER, Testatrix In our presence, the above-named Testatrix signed this and declared it to be her wiil, and now, at her request and in her presence and in the presence of each other, we sign as witnesses: ,__.� - � i i _.?... '' �� � �. � t' �,.,.i,:�.; .� � ! `\� C z _ _ \\Forrestmyers�SharedDocs\bVord Processing\estate planning\client's 4vork\�taver,amy j.LW&T.05-40-0196.��tar05.doc ' STATE OF PENNSYLVANIA . : SS COUNTY OF FRANKLIN . I, AMY J STAVER, having been duly qualified according to law, acknowledge that I signed the foregoing instrument as my Will, and that i signed it as my free and voluntary act for the purposes therein expressed. - ; _... ���1��.:�, �... ; ':�'- �r. AMY J STA 'E�R„>`Testatrix ; ..� We, AMY J STAVER, the Testatrix in and the undersigned witnesses to the Will, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: (a) that I, the Testatrix, do hereby acknowledge that I signed the instrument as my Will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the Testatrix sign and execute the instrument as her Will, that she signed it 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 and that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. �� � , .�-- __.. -�•--"-�. 3� �tC: .�4 4'[.w.� AMY J ST V�.R, Testatrix ��1:�,��'-�,� ��z'�;__ �,,;. � .� __ Wit ss ' ' i ness Subscribed, sworn to or affirmed, and acknowledged before me by the above-named Testatrix and by the witnesses whose names appear on this O15t day of April, 2005. ...���_.. Notary Public NOTARIAL SEAL FORGST P�..MYERS,NOTA�iY PU[iLIC SHIPPENS6UAG BOROUGH,COUNTY GF FRANKLfN �MY COMMISSION EXPIRES DECEMBER 17,2005 3