HomeMy WebLinkAbout09-16-14 � 15�5610143
REV-1500 Ex�o2-ii� ;t��; OFFICIAL USE ONLY
L13
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes �P�TMEMOFREVENUE
Po sox.2soso� INHERITANCE TAX RETURN 21 14 ��S
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03 08 2014 12 10 1940
DecedenYs Last Name Suffix DecedenYs First Name MI
CLINE G�Y L
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
CLINE CAROYLN R
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 � 3. Remainder Return(Date of Death
Prior to 12-13-82)
� 4. Limited Estate � qa.Future Interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� 6 Decedent Died Testate � �� Ae ach Copy�of Trust)a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
� 9. Litigation Proceeds Received � �0�between12�31�J1 andit(Da95�f Death � 11.Election to tax under Sec.9113(A)
T (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GEORGE F DOUGLAS III ESQ 717 249 63,3,3 `�'
� � �
REGIS"�f�F WILLSNISE Qpll$
� � � � � �
First Line of Address i:= �",� � � r�ri �
354 ALEXANDER SPRING RO =' �"' , �
. c� a
. :; .
Second Line of Address ,- ; r 7 `-;; � � 'r�
: � ri
: ►---+ r- r-c�
� • bdTE FILED '�
City or Post Office State ZIP Code , � -rr
CARLISLE PA 17015
CorrespondenYs e-mail address: gdouglasCilsalzmannhuahes.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.
SIGNATU PERSO RESPONSIB FOR FI NG ETURN DATE
��:� � ` Caro In R. Cline 7 '// ' �
ADDRESS
210 Candlelite Drive Carlisle PA 17013
SIGNATU OF PREPARER OTHER T AN REPRESEN IVE �
George F Douglas, III Esq. Q ll %
ADDRES
354 Alexander Spring Road, Suite 1, Carlisle, PA
� Side 1 �
1505610143 1505610143 �
�
� 1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent'sName: CII11@� Gary 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.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous I�nq Probate Property
(Schedule G) �J Separate Billing Requested............ 7. 138 , 788 . 33
g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 13S , 788 . 33
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 1 , �15 . ��
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10.
11. Total Deductions(total Lines 9 and 10)................................................................ ��. 1 , �15 . �0
12. Net Value of Estate(Line 8 minus Line 11).......................................................... �2. 137 , 773 . 33
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. 13 7 , 7 7 3 . 33
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers underSec.9116 137 , 773 . 33 15. O . 00
(a)(1.2)X.00
16. Amount of Line 14 taxable 0 . 0 Q 16. � . 0 0
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 � . �� 17. � • �0
18. Amount of Line 14 taxable
at collateral rate x.15 0 . 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. � . �0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-14
Decedent's Complete Address:
DECEDENT'S NAME
Cline, Gary L.
STREET ADDRESS
210 Candlelite Drive
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�
q. 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) �.��
Make Check Pa able 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:.................................. ❑ ❑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 Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ ❑X
3. 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 ret;rement 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 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 decedenYs 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 adoption.
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPARTMENTOFREVENUE MISC. NON-PROBATE PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Cline, Ga L. 21-14
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 PROPERTY DATE OF DEATH °�OF DECD�s EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFERSATTACFiTA COPY OF THE DEED�OR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
,�age Point Financial -IRA No.66896809
1 Capital World Growth and Income Fund-A(33) 14,797.44 100.000% 14,797.44
2 Fundamental Investors-A 44,232.61 100.000% 44,232.61
3 The Growth Fund of America-A(05) 12,399.04 100.000% 12,399.04
4 The Income Fund of America-A(06) 30,593.82 100.000% 30,593.82
5 The Investment Company of America-A(04) 36,765.42 100.000% 36,765.42
TOTAL(Also enter on Line 7, Recapitulation) 138,788.33
(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 G(Rev.08-09)
REV-1511 EX+(�0-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
RESIDENTDEC D NT URN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Cline, Gary L 21-14 _
DecedenYs debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N M ER
q, FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2, Attorney's Fees Salzmann Hughes, P.C. 1,000.00
3, Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Ziq
Relationship of Claimant to Decedent
4. Probate Fees
5. AccountanYs Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 15.00
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 1,015.00
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Cline, Gary L. 21-14
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Register of Wills-filing fee 15.00
H-67 15.00
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Cline, Ga L. 21-14
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY o DECEDENT �Words) ($$$)
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
1 Carolyn R.Cline Wife Entire Estate 137,773.33
210 Candlelite Drive
Carlisle, PA 17013
Total 137,773.33
Enter dollar amounts for distributions shown above on lines 15 throu h 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
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
LAST WILL AND TESTP,I�IENT
OF
GARY LEE CLINE
I, GARY LEE CLINE, of Cumberland County, Pennsylvania, being
of sound mind and body declare this to be my Last Will and Testament
and revoke any and all Wills and Codicils previouslX made by me,
ITEi�i I; I direct that all my just debts, funeral
expenses, attorney fees, and all administration expenses, including
inheritance tax shall be paid from the assets of my estate as soon
as practicable after my decease,
ITEr� II: I hereby give, devise and bequeath all of my
estate of every name and nature and wheresoever situate to my wife,
Carolyn R. Cline, provided she shall survive me by thirty (30) days.
ITEM TII; If my wife, Carolyn R. Cline, should fail to
survive me by thirty (30) days or we should die in a common disaster,
I hereby give, devise and bequeath all the rest, residue, and remainder
of my estate to Farmers Trust Company or its successors and William H.
Clemens, as Co-Trustees, TN TRUST, however, under the following terms
and conditions:
(a) To pay the inc�me and so much of the principal
and accumulated interest, in such equal or un-
equal amounts as may, in the sole discretion
of Tny Trustee, be necessary for the maintenance,
education, support and medical expenses of mX children,
Bradley Cline and Chxistina Cline,
(b� Payments may be made directly to the person having custody
and care of said persons, or may be made directly to any
institution entitled to such payments by reason of services
rendered or to be rendered;
(c) Any and all payments of any sum or sums whether in cash
or kind and whether for principal or income payable to such
persons shall be made free from anticipation, alienation,
attachment and pledge or control by any creditor of any
of them and shall not be subject to execution or attachment;
(d) The Trustees may expend a portion of the principal, not to
exceed $5000. 00 , when necessary for the maintenance of the
minor beneficiaries of this Trust, for the purpose of partially
reimbursing the said beneficiaries ' guardians for the expense
of an appropriate addition to said guardians ' residence or
the expenses of acquiring a larger residence so as to provide
appropriate housing for my children;
(.e) The provision for support and maintenance of my children
in subparagraph (a) above shall expressly include, but not
be limited to, the continuation of training and lessons in
athletics and the arts for my children to carry on the programs
2 have initiated in ballet, figure skating and gymnastics for
Christina and in basketball summer clinics for Bradley and similar
disciplines as their interest and talents develope;
{f) I direct my Trustees to distribute the entire remaining balance
, . �
of the assets held hereunder to Bradley Cline
and Christina Cline to be equally divided between
them when the youngest surviving child reaches the
age of twenty-two (22) :
(g) I further direct that my Trustees shall have the
power to merge this trust with the trust established
for the same beneficiaries under the will of my wife,
Carolyn R. Cline, and administer the fund created as
one trust;
(h) I direct that in the event william H. Clemens should
resign� die or become unable to serve as Trustee here-
under, my then living children who are sui juris, or
their guardian if all are minors, shall unanimously
name a substitute co-Trustee. Each person becoming
a co-Trustee hereunder shall assume of�ice and serve
in conjunction with my corporate Trustee, with the
same powers and authorities, and without the necessity
o� assignments or transfers of any kind, as if
originally so appointed.
ITEM IV• I hereby nominate, constitute and appo�nt Robert
Clemens and Linda Clemens, jointly, as Guardians o� Bradley Cline and
Christina Cline. In the event that Robert Clemens and Linda Glemens
should become unable to act jointly as Guard�ans � T hereby nominate
constitute and appoint William H. Clemens and Geztrude Clemens as
Alternate Guardians.
ITEM V• I hereby nominate, constitute and appoint my
state. In the event
► •
that my spouse shall predecease me or be unable or unwilling to
serve in this capacity, I then nominate, constitute and appoint William
H. Clemens as Alternate Executor of my estate.
ITEM VI• I direct that my Executrix and Trustees shall
not be required to give bond for the faithful performance of her
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this �L''�.��
day o f �,�c L--1 , 19 7��. ,%��f,..
� � �,
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�,-�i{� r ; �� ,'�
GARY L �-CLI E -
The preceding instrument consisting of this and three (3) other
typewritten pages was on the date hereof signed, published and declared
by Gary Lee Cline, the Testator herein named to be his Last Will and
Testament in the presence of us, who at his request and in the presence
of each other, have hereunto set our names as witnesses hereto:
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American Funds -Historical Account Balance Page 1 of 1
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Sage Point Financial
As of March Q8, 2014
Total value: � ` `
Non-retirement accounts; $0.00
Retirement accounts: �138,788.33Retirement acCOUnts
C68T CUST IRA/ROLLOVER Account: 66$96809
GARY L CLINE/DECD Beneficiary Carolyn R. Cline,wife
! ___
I Fund Name Shares NAV P�tarket Value
March 08, 2014 March 08, 2014 March 08, 2014 !
� .�..>...�_� �:;�., ,,.r..,,.. ,:. . ..
w����CAPITAL WORLD GROWTH AND INCOME FUND-
._.,,;,�,.,�., <�
A (33) 320.638 $46.15 $14,797.44
__. ____
_
_ ___
FUNDAMENTAL INVESTORS - A (10) 838.851 $52.73 $44,232.61 ;
_ _ _ _
THE GROWTH FUND OF AMERICA - A (05) 278.255 $44.56 $12,399.04
____. _ _
_ ____ _ _ _ _
' THE INCOME FUND OF AMERICA - A (06) 1,449.944 $21.10 $30,593.82
. _
__ _ __ ___ _ _ _
_ _ _ _
' THE INVESTMENT COMPANY OF AMERICA - A (04) 981.458 $37.46 $36,765.42
' _ _ _ __ _
Account Total: $138,788.33 '
As of March 08, 2014
Totai value: :� ' 'r=' {
Non-retirement accounts: $0,00
Retirement accounts: $138,788.33
Coavriaht p 2014 American Funds Dfstributors,Inc.
PRIVACY � Portlolio aoreement � Business continuitv �Contact us
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