HomeMy WebLinkAbout10-28-14 1505610143
EX(02-11)
REV-1500 OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 14
Harrisburg,PA 17128-0601 RESIDENT DECEDENT vas
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
09 19 2014 07 12 1923
Decedent's Last Name Suffix Decedent's First Name MI
MARTIN SR GALEN S
(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
O 1. Original Return 2. Supplemental Return D 3. Remainder Return(Date of Death
Prior to 12-13-82)
4. Limited Estate 4a,Future interest Compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
6. Decedent Died Testate Decedent Maintained a Living Trust 7.
1XI (Attach Copy of Will) (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes
10.Spousal Povertgredit(Date of Death 11.Election to tax under Sec.9113(A)
El 9. Litigation Proceeds Received betweerI12-31- and1-1-95) El (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JERRY A WEIGLE ESQUIRE 717 532 7388
REGISTER OF WILLS USE ONLY
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First Line of Address _r_- ;�13 M
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3-- T.) C)
126 EAST KING STREET C> —
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ICU -0 (n :�O
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Second Line of Address r— r-\)
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City or Post Office State ZIP Code PAYE,FILEDD -1
SHIPPENSBURG PA 17257C'>M
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Correspondent's e-mail address:
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,
SIGNATURE OF PERSON RESPONSIBFOR FILING RETURN DATE
Betty L. Pisle
ADDRESSJ
602 Westover Road, Shippensburg,ILA 17257
SIG n1,OF PREPARER OTHER THAN rPRE DATE Jerry A.Weigle Esquire
ADORES '
T&L QZ
V
126 East King Street, Shippensbil, PA 17257
V
Sidel
1505610143 1505610143
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Martin, Galen S. Sr. 21-14
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.
Signature#2
Name Galen S.Martin,Jr.
Addressl 77 SME
Address2
,City, State,Zip Shippensburg,PA 17257
Date
` .
N ' 1505610243
�
REV'15VDEX
Decedent's Social Security Number
Decedent's Name: Martin, Galen S' Sr.
RECAPITULATION
1, Real Estate(Schedule A)...................................................................................... 1
z. Stocks and Bonds(Schedule B)............................................................................. 2.
u. Closely Held Corporation,Partnership orSole-Proprietorship(Schedule C)......... a.
4, Mortgages&Notes Receivable(Schedule[V—...----.................................... *.
S. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)........—... 5� 4 , 073 . 80
s. Jointly Owned Property(Schedule F) LJ Separate Billing Repuested—........ O.
7. ImepvivusTransfers&Miscellaneous Property
(Schedule G) P GeparateBiUinuRepueoted---- 7.
o. Total Gross Assets(total Lines 1through 7l------------------. o. 4 , 073 . 80
9. Funeral Expenses and Administrative Costs(Schedule H)....---- ........—...— 9� 290. 00
10. Debts ofDecedent,Mortgage Liabilities and Liens(Schedule/)...............—.......' 10,
n. Total Deductions(total Lines 9and 1O)............................................................... 11. 290 . 00
12. Net Value ofEstate(Line Dminus Line 11 .......................................................... 12 3 / 783 . 8D
13. Charitable and Governmental Bequests/Sec 8113Trusts for which
anelection totax has not been made(Schedule ................................ ......... 13.
14. Net Value Subject toTax(Line 12minus Line 13)...—...... ........................ � 14, 3,783. 80
TAX COMPUTATION'SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount ufLine 14taxable
atthe spousal tax rate,ur
transfers under Sec.9116(a)(/.2)X=00 1� 0Q0
^
_
16 ��numovUna14�xau�
� 3, 783 . 80 1� ��� ���
at lineal�mx �45_ ^
17 Amount ofLine 14taxable
at sibling Q �O �7 noxatox12 ^ . 0 . 00
18. Amount ofLine 14taxable
atcollateral rate x1n 0 ' 00 18. 0 ^ 00
19. TAX DUE.... ........ ---- ..................... .......................................................... 19. 170 .27
on. FILL|wTHE OVAL|FYOU ARE REQUESTING xREFUND oFmuOVERPAYMENT. L_]��
Side
0 Q
0 1505610243 1505610243 0
` .
REV-1 500EXPage o File Number 2144
Decedent's Complete Address:
DECEDENT'S NAME
Martin, Galen S. Sr.
STREET ADDRESS
121 Walnut Bottom Road
CITY STATE ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2.Line 1S) 170'27
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +8) (u) 8'51
3. Interest (3)
4. IfLine oisgreater than Line I +Line o.enter the difference. This isthe OVERPAYMENT, (u)
Check box vnPage a.Line oomorequest anefunu
5, |fLine I +Line aisgreater than Line u.enter the difference. This iathe TAX DUE. (5) 161.76
Make Check Pa able toREGISTER OF WILLSAGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS 8Y PLACING AN "X" INTHE APPROPRIATE BLOCKS
1. Did decedent make atransfer and: Yes No
a. retain the use or income of the property tnansfe/ned;..................................--.......----................
u. retain the right to designate who shall use the property transferred or its income;......................._.........
o. retain areversionary interest;or---------------------------- ........................
d. receive the promise for life n[either payments,benefits mcare?............. ............................ ........... R
o. If death occurred after Dec. 12, 1982. did decedent transfer property within one year of death without
receiving adequate consideration?...................................................— .......................................................... [l F-xl
3. Did decedent own an'in trust for" orpayableupvndemhbankaccnumornacvritymthismhovdoath?--. Fl rX_1
4. Did decedent own onindividual retirement account,annuity,orother non-probate property which
contains obeneficiary 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.
rmuotaocxdeath onvraftorJu|y1.18o4and before Jan.1,1995,the tax rate imposed on the net value of transfers to orforthe use ofthe surviving spouse
im3percent[72p.3.US116<a>(1.n(i)}.
For dates m[death momafter January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouseisOpercent
[72P.G.§9116(a}(1.1)(ii)). The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure nfassets and
filing atax return are still applicable even xthe surviving spouse iathe only beoefiuiam
For dates ofdeath mnorafter July 1.2OOo:
° The tax rate imposed on the net value of transfers from a deceased mild 21 years of age myounger at death morfor the use of anatural parent,an
adoptive parent,mastepparent o,the child mVpercent(72P.S.09116V$(1.2)].
° The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1
^ The tax rate imposed on the net value oftransfers horfor the use of the decedent's siblings is percent .S.0911V($(1.3)]. Asibling iodefined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1508 EX+(11-10t
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Martin, Galen S. Sr. 21-14
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I Shippensburg Health Care Center-refund of patient account 4,073.80
TOTAL(Also enter on Line 5, Recapitulation) 4,073.80
(if more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
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
Martin, Galen S. Sr. 21-14
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid
.2. Attorney's Fees Weigle&Associates, P.C. 275.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zia
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's 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) 290.00
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
Martin, Galen S. Sr. 21-14
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Register ofWills, Cumberland County'filing RA Inheritance Tax Return 15.00
M-B7 15.00
Copyright(c)2002 form software only The Lackner Group,Inc. Form Px4500Schedule H(Rex6-g8)
11EV-1513 EX+(0140)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Martin, Galen S. Sr. 21-14
NAME AND ADDRESS OF RELATIONSHIP 70SHAREOF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT
Do Not List Trustee s (Words) ($$$)
TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2))
I Galen S. Martin,Jr. Son Fifty Percent 1,891.90
77 SME
Shippensburg, PA 17257
2 Betty Lou Pisle Daughter Fifty Percent 1,891.90
602 Westover Road
Shippensburg,PA 17257
Total 3,783.80
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
P
LAST WILL AND TEST AP'IL 4T
I, GALEN S. MARTIN,_ SR., of R. D. 5, Shippensburg,, Southampton Township, `
Cumberland County, Pennsylvania,t being of sound,mind,,..mcnnory and understanding,
do make and publish this my Last Will and Testament, hereby revoking and making
void any and
,all'former)wills and c' icils'by me at,.any t�me'hdtetofo're`'made.
P'IRS'P. I direct my hereinafter, amed;Executrix,, oxiLxecutors as,;the;case
may be, to pay all'my just debts and funeral expenses as soon as conveniently
may be after my decease; I further..di.rect3 that,I I taxes.,that,may=be assessed
in consequence of my death, of,whatever.nature, and by ihatev*6r?jurisdiction
imposed, shall be paid' frcxn my residuarv.`estatei as a:-part'of the e*pense of
the administration of my estate. ;
SECOND. I dive, devise and l queatli all:my pral�erty, zeal,,}?ersonal and
mixed, whatsoever and wheresoever situate, to in'y 17eloved w.ifc,'H=N C. MARTIN,
absolutely.
THIRD. I hereby nd-ninata, constitute and appoint my said wife,,I-Mmrm C.
M71R`.C1•N, 'the sole Executrix of this my Last Will and Testament.,
FOURTII. Provided, however, that in the•event mv. sai,d.wi-fe, HELEN C.
MARTIN, should predecease me, or if we should die in.a carmon disastpr' , ;then
in either of said. events, I hereby, give, devise and bequeath all my property
as follows:
A. I,give and deviser to my..son, G�STEN S. MAPTTN, .J"R., my two tracts of
land situate in South,�!n;ton Township, Cumberland County, Pennsylvania,
lx>_i.ng canposed of to.a.ct: of land which Lewis,E. Willis,and,Ema T. .Lillis,
his wife, by Deed dated Septeanber 30, 1962, snit recorded in the`Office
OF the Recorder of Dracds of Cumberland.Cou_n:ty, PA, in Decd Boot: "C.";,•
Volwne 22, Page 204, conveyed to Galen Martin and Helen Martin, his wife;
and being composed of that tract of land which Aaron.N. .Hoover, and Esther
N. Hoover, his wife, by Deed dated September' 26, 1.977, and recorded•in the
Officeof the.Recorder of Deeds of Cumberland County,-PA, in Deed Book "L
Volume 27, Page--. 125, conveyed to Galen S. Martin and tie.ch C. ME r`.tin-,
each being one and the same person as Galen Martin and Helen Martin, his
wife. Provided further, that in tie event my saic son, `GALEN S. MARTIN,
JR.,, should I7.r(-Aagease.me, Hien,,in -that event l•dive and devise the
aforesa-id*real castzite to*my:grand'son, GALLV S. MNtTRJ, IIi, son' of'niy
said son; GALEN.S. P AMT-IN,•JR. .,
/ .
| '
which is erected on the above descrilxwl tract of land which was C(,)1-1\7CYCI
to Cal.(-.11 MRI-1:in �Jnd Helen Martin, his Wife, by I)C(-Vl of Tcwis B�. lzi
anJ Bnma T. Willis, his wiFe, datec-1 SeptcnA_�.r 30, 1962, and recorded in
Book "C", Volume 22, Page 204.
C. T gwc and bc(,.�ieath to my daughter, BETTY LOU RUSIE, my automobile
which I may (x�ni at tbe'time of my decease.. Provided further, that ji-i
-Hie event my said daughter, 13F.TTY 1011 PISLE, should predecease me,
then in that event, I give and bequeath the said.au Uno.bile.'.to,my son,
_-_N S. MARTIN, _.. -_--__-.
�
D. I give, devise and 1x-,queaLh all. the re.�t, residue and remainder
of my estate, real, personal. and mixa-], whatsower and ,t�ffieresoever
situate, in two (2) c,-.cjual shares, share and share alike, on4 U.)
equal share -to my son, GALEN S.'MAR'.VIN,. JR. and one U) equal. share
-to my daughter, DETTY LOU PISM, absolutely. Provided further, that
in 'the event my said daughter, BETTY WTJ TIME., should predecease me,
then in that event I give, devise and bequeath her share to my said
Son, GALEN S., MARTTN 'JR.; and providod further, that in the event
Py.'s,'aid son": GAMN S; MARTIN, JR., should predecease me, then in
'that event, I give', devise and 1yemp.1cath his share to my said grandson,
GATEN S. MARTIN,' ITI, son of my said son, GATIN S. MARTiN, JR.
E. Provided further-,-that in -the evPnt any of my aforenamed 1,e-gatees
are not at ledst eighteen (18) years of age at the time of my decease,
then in'tbat-event, Ihdrcby nominate, constitute and appoint DAUPHM
the Guardian of the said minor-child Is estate, the said Cuardian to
take and receive the share of -the said minor child and invest and rein-
vest tbe same in leccd. or non-legal investments, whichever in its dis-
cretion it deems proper, and the said Guardian to Nave full-power and
authority in its discretion to pay such amounts of- income and principal
as are necessary for the sup -1
,I,K.)rt, maintcwnce and education of the said
mi,nor child, and upon the said minor. child reachinq the age of cighte.en
(18) years, -to pay -the said share to the said child.
FIF".111. Provided fan.-thox, that in the event my said wife, I-MUN C. MA.M.11NI
shc
Aild predecease me,, or if we should die in a cowon disaster, then in either
of said events, I hereby nominate-, constitute and appo.b-it my --,aid son, (-w,a4 S.
MARTIN, JR., and my said daughter, BE9. 11Y TOU PISTE, or -the survi.vol-. of t1wall
then at Me tjinc of my decense, as the Executors c.,f this my la!�t will
and TesLamcint, nty saj.(,i li�KCCUtOrS to have full Ix-)w=- and authority to do any
rwid all tjiings necessary for the compleL.e. ad ministration of my estate-., includin,
the power to sell
' and all real. and- ^__-- property_~ of -__. - may `i~
se�ocm' except as specifically
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tf nn
I :t r�jj- ;(.1 'T 1(", 1 1 1
'P 'VIC
private sales, in their discretion, and wittliout, any order of any Court; and
1: further direct that iiky s-Ad Executors not be to file any Bond in
connecti.on with the settlement of my said Estate,.
N munto. set:M.y hand
IN WITNESS VMBIMOF, 1, GALE, S.� MARTIN, �SR., have,he i.
and seal to this my Last Will and Testament, written on four (4) sheets of
papa-r, this, 22nd day of Fehruary 1985.
MAL)
Signed, scaled, published and
declared by Ghav S. PHARM-N, Sn.,
the Testator, as and for his T.)s t
Will and Testament, written on
four (4) sheets of paper, i,n the
presence of us who have, at his
request, signed our names as
witnesses hereto in the presence
of the said Testator and of each
o-Uxx.
m--j I
-3-
'r; I Y 1 P
CDAMOMEAT."JI) OF PE:fqN5YIVAN1A
CK)UNrUY OF CUMBERI.,NID
T, GAIEN S. MARTIN, SIR. 'It'stator, whose nzmie is signed to -the attached
or fore.-Ljoing instrLvient, having bc.,(..,n duly qualified according to law, do
hereby acknowledge that I siqiiM- and executed the instrument as illy Last 4-7ill
and Testament; that I signed it willingly; and that I signed it as my free
and voluntary act for the therein expressed.
Galen S. Martin, Sr.
Sworn or affinTKA to and acknowledged Lyafore Pra by GALEN S. PIATZTIN, SIR.,
the Testator, this 221-td day of February 1985-
Notary n)I-')'I.iC
COMMONWEALU1 OF PENNSYIWANIA
Ss Shippenstnug,PA Cumbeftmd C
COUNTY Of., CUM131-1112I.AND MY COMMISSIbn Expires Pwgust is.i
We, IRC)BE'ItP J. YOCOM and J.'11'RESA J. BUR11110MUR, the vi.itncsses whose IWImas
aro sj.gn(-,J to the attached or forff-joing instrument, ly.J.nq dul"qozilified
y
according to law, do dcq:rjsc and say that u-_ were I'esent and saw the ry-'.stator
sign and execate the instruitent as his Tzist 10ill and that the
12cstator signed willingly; and that the Testator executed it as his f37(-:c
aityi voluntary act for the purposes therein axpres":�I; that: each of us, in
tho hearing and sight. of the. Testator, signed the w. ].l. as Witne.ssc.s; and
that to the best. of ciur was at that time 18 017 more
years c.')f &.)gc-,,, of soi-ind m.ind and under no const-raint or influence.
13.6 n wi/street, ShippenSbUra, I?A
o
I3w7)-holdor
NeIVU117g, PA
Sworn or a f f j rved to and subscrilxxl befurc- nx� I:hj s- 2211d day of
February 1985.
Notary Public
Lisa N. Dut?bs, NOTARY PUBLIC
ShIppensbur-j,PA cumboritind County
My commission ExPimt Au;iucl 15.1108
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C.4 .+:.flo.eesX psi-:•5v.v.�s2Y'�• -.�_ "�_'_
PERINI SVCS/SOUTHAMPTON_MANOR 004298
LP T/A SHIPPENSBURG HLTH CC'- �G•�I�e
RFMS PETTY CASH ACCOUNT 2560
121 WALNUT BOTTOM RD DATE
SHIPPENSBURG,PA.17257
PAY s
Oa DEO OT
CAPITAL ONE BANK
11100004 G2981Im ii 2 S 50 2 198 0:09 3 4 2 743111 .