HomeMy WebLinkAbout10-10-14 (2) 1505610105
REVi (w-ii)(FI) ��j
-1500 EX( T� OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individuat Taxes DEQ 1-11 County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN rIy ,
Harrisburg,PA 17128-o6o1' RESIDENT DECEDENT `C
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07/14/2014 06/09/1922
Decedent's Last Name Suffix Decedent's First Name MI
Baxter Nicole F
(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
C§D 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
C@D 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(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 TO:
Name Daytime Telephone Number
Thomas P Gleason, Esquire (717) 532-3270
REGISTER OF WILLS USE- LY
C7 s
:71 rl
t t n
First Line of Address
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49 West Orange Street cr-�- t-- r
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Second Line of Address
Suite 3 c�
DATE FILED'
City or Post Office State ZIP Code r— r'rt
N CJ)
Shippensburg PA 17257
;= N
Correspondent's e-mail address:tomgleaSon@tomgleasonlaw.com
Yndy6rjza4tlbs 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 1e,correct and complete.Decl ration of prepareLAtpeAhan the personal representative is based on all information of which preparer has any knowledge.
I E OF P R N ESP BLE FO ILIN ETUR DATE
/C1//0/2.Od
GNATURE OF PREPARE OTHER AN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105
1505610205
REV-1500 EX(Fl) Decedent's Social Security Number
Decedent's Name: Nicole F. Baxter
RECAPITULATION
1. Real Estate(Schedule A). ....... ..... ..... .. ... . .... . .... ....... J.. 0.00
2. Stocks and Bonds(Schedule B) ................... ...... .......... .... 2, 0.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 1 0.00
4. Mortgages and Notes Receivable(Schedule D).......... .......... .. ..... 4. 0.00
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ...... 5. 360,490.78
6. Jointly Owned Property(Schedule F) C=:) Separate Billing Requested .... ... 6. 0.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) C=:) Separate Billing Requested........ 7. 0.00
8. Total Gross Assets(total Lines 1 through 7). .. .. ...... ..... ........ ..... 8. 360,490.78
9. Funeral Expenses and Administrative Costs(Schedule H)... ..... ........... 9. 10,749.55
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). .............. 10. 480.00
11. Total Deductions(total Lines 9 and 10)... ........ ....... 11. 11,229.66
12. Not Value of Estate(Line 8 minus Line 11) .... ..... . .......... .......... 12. 349,261.23
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ......... . .......... .... 13. 0.00
14. Net Value Subject to Tax(Line 12 minus Line 13) ..... ..... ...... ........ 14. 349,261.23
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(11.2)X.0 0 1,000.00 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X.0 45 348,261.23 16. 15,671.76
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. 16,671.76
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=:)
Side 2
1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Nicole F. Baxter
STREETADDRESS
454 Nealy Road
CITY STATE ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 15,671.76
2. Credits/Payments
A.Prior Payments 0.00
B.Discount 783.58
Total Credits(A+B) (2) 783.58
3. Interest
(3) 0.00
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) 14,888.18
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.......................................................................................... ❑ N
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ ■
c. retain a reversionary interest.............................................................................................................................. ❑ 0
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?.............................................................................................................. ❑ 0
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 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 decedent's 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-15o8 EX+(o8-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Nicole F. Baxter 21-14-0690
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. M&T Bank Checking Account No.9857650163 3,866.04
2. M&T Bank Security's Account No.AZD-972164 205,821.42
3. Merrill Lynch/BOA Checking Account No.00431001-6058 29,921.16
4. Merrill Lynch Account No.7PQ-10854 100,882.16
5. Discover Bank CD 10,000.00
6. Discover Bank CD 10,000.00
TOTAL(Also enter on Line 5, Recapitulation) $ 360,490.78
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Nicole F. Baxter 21-14-0690
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Egger Funeral Home 2,525.00
2. Egger Funeral Home for obituary publications 680.75
3. St.Magdalen Catholic Church for Memorial Mass 420.00
4. St.Magdalen Catholic Church to open grave 675.00
5. Harvest Moon for Memorial luncheon 2,110.30
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: 3,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 433.50
5. Accountant Fees: 200.00
6. Tax Return Preparer Fees:
7. Cumberland Law Journal to publish estate 75.00
8. New Chronicle to publish estate 80.00
9. Register of Wills for additional probate fee 50.00
TOTAL(Also enter on Line 9, Recapitulation) $ 10,749.55
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
Nicole F. Baxter 21-14-0690
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
I Friendship Hose Company#1 for transportation to Chambersburg Hospital 480.00
TOTAL(Also enter on Line 10, Recapitulation) $ 480.00
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
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Nicole F. Baxter 21-14-0690
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).)
I. Francine Shea Lineal-Daughter $75,000+ residual
2. Leroy Baxter Lineal-Son $75000.00
3. Malcolm Miller Baxter Lineal-Grandson $25,000.00
4. Jason Baxter Lineal-Grandson $25,000.00
5. Renee Baxter Lineal-Granddaughter $25,000.00
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:
1.
St.Magdalen Catholic Church 1000.00
TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 1000.00
If more space is needed,use additional sheets of paper of the same size.
LAST WILL.AND TESTAMENT
OF
NICOLE F. BAXTER
KNOWALL MENBY THESE PRESENTS,that I,NICOLE F. BAXTER, of 454 Nealy Road,
Newville, Pennsylvania, being of sound and disposing mind, memory and understanding, do
make,publish and declare this to be my Last Will and Testament,hereby revoking all prior wills
and codicils.
ARTICLE I
EXPENSES AND TAXES
I direct the payment of all my legal debts,burial expenses, including my grave marker,my
federal estate and state inheritance taxes together with cost of administration of my estate, as
soon as may be conveniently done following my decease. I further direct that all taxes that may
be assessed as a result of my death, of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as part of the expense of the administration of my estate.
ARTICLE II
APPOINTMENT OF EXECUTRIX
I nominate and appoint my daughter, Francine Shea, as Executrix of my Estate. In the event that
Francine Shea is unable to serve for any reason as Executrix,then I nominate and appoint
Laurence Shea as Executor of my Estate. I request that no Executrix or successor in such
capacity shall be required to file bond or enter security in any jurisdiction.
ARTICLE III
SPECIFIC BEQUESTS
a. I give, devise, and bequeath the sum of Seventy-Five Thousand($75,000.00) Dollars to
LeRoy Baxter and Marie Noelle Baxter, or the survivor thereof,per stirpes.
b. I give, devise, and bequeath the sum of Seventy-Five Thousand ($75,000.00) Dollars to
Francine Shea and Laurence Shea, or the survivor thereof. If Francine and Laurence
Shea should both predecease me; I give, devise and bequeath this $75,000.00 in equal
shares to my grandchildren who are living at the time-of my death.
I
C. I give, devise, and bequeath the sum of Seventy-Five Thousand($75,000.00)Dollars to
be divided in equal shares between Renee Baxter, Malcolm Miller Baxter, and Jason
Baxter,per stirpes.
d. I give, devise, and bequeath the sum of One Thousand($1,000.00) Dollars to the St.
Magdalen Catholic Church in Flemington,New Jersey.
ARTICLE IV
RESIDUARY ESTATE
I direct that the rest, residue and remainder of my Estate be distributed to Francine Shea and
Laurence Shea, or the survivor thereof, who took care of me lovingly and cheerfully and made
my life happy.
ARTICLE V
POWERS OF THE EXECUTRIX
In addition to the powers given by law or by other provisions of my Will,my Executrix shall
have the following powers, which may be exercised as often as considered advisable, and until
final distribution, without having to seek or obtain approval from any court:
a. To retain any property comprising a part of my Estate, and to retain and to invest
all forms of real and personal property.
b. To sell at public or private sale,to grant options on,to exchange, or otherwise to
dispose of any property.
C. To repair, alter, subdivide, or improve any property.
d. To compromise, or submit to arbitration, any claims, including any arising as a
result of my death.
e. To renew, or to extend the time for a debtor to,pay any obligation.
f. To receive, hold, maintain, administer, collect, invest and re-invest Estate assets
and collect and apply the income,profits, and principal of the Estate in
accordance with the terms of this instrument.
g. To compromise, settle, or abandon claims in favor of or against the Estate.
h. To employ or compensate counsel and other persons deemed necessary for proper
administration of the Estate and to delegate authority when such delegation is
advantageous to the Estate.
L To make division or distribution in money or kind, or partly in either, including
disproportionate in-kind distributions, at values to be determined by the
Executrix, and her judgment in such respect shall be binding upon all interested
parties.
j. To bind the Estate by contracts or agreements without assuming individual
liability for such contracts.
2
ARTICLE VI
SURVIVAL & SIMULTANEOUS DEATH
For all purposes of this Will, a person shall not be considered to survive me or another if he or
she shall die within thirty(30) days after my death.
ARTICLE VII
EXCULPATORY PROVISION
My Executrix shall not be liable for any act done or omitted to be done in good faith or for any
loss to or diminution of my Estate unless caused by willful malfeasance or default; nor shall any
Executor hereunder be liable for the act or omission of any other Executor or Administrator
hereunder. No interest shall be payable on any legacy or bequest hereunder,regardless of statute
or court rule, and regardless of when such legacy or bequest is paid, so long as my Executor acts
in good faith in making such payment or distribution.
IN WITNESS WHEREOF, I,Nicole F. Baxter, do hereby declare that I sign and execute this
instrument as my Last Will and Testament,that I sign it in the presence of each of the said
witnesses, and as my free and voluntary act,this day of June, 2013.
Nicole F. Baxter
In our presence,Nicole F. Baxter signed this instrument and declared it to be her Will, and we, at
her request, in her presence, and in the presence of each other,have signed it as witnesses.
Ka eason Thomas P. Gleason
95 Airport Road 95 Airport Road
Shippensburg, PA 17257 Shippensburg, PA 17257
3
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I,Nicole F. Baxter,the Testatrix whose name is signed to the attached or forgoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for
the purposes therein expressed.
We,the undersigned 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
Testatrix sign and execute the instrument as her last Will; that the Testatrix signed willingly and
executed it as her free and voluntary act for the purposes therein expressed;that each subscribing
witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best
of our knowledge the Testatrix was at that time eighteen(18) or more years of age, of sound
mind, and under no constraint or undue influence.
Sworn to or affirmed and acknowledged before me by Nicole F. Baxter,the Testatrix, and sworn
to or affirmed and subscribed to before me by Kay Z. Gleason and Thomas P. Gleason,
witnesses,this 2�S�'''� day of June, 2013.
Nicole F. Baxter
Kay ason
Thomas P. Gleason
Notary Pub c
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