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Home My WebLink About10-31-14 J1505610140 REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 7 5 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 7 0 4 2 0 1 4 0 9 2 0 1 9 2 6 Decedent's Last Name Suffix Decedent's First Name MI M A S 0 N J R J A M E S W (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 Q 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) ❑X 6. Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust _ B.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)1. Between 12-31-91 and 1-1-95) (Attach Schedule O) a CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX IORMATION St kD BOiIRECTED TO: Name Daytimeffeghone Nue rq q M U R R E L W A L T E R S I I I E S Q 7 1 ;y 1629 W 4`= � 0' R•tGISTER_l)F WILLS USE ONL4Y� , .. a:71 r m1 First Line of Address , 4.= -- c'7 ►—' t— M W A L T E R S & G A L L O W A Y P L L C U) cn Second Line of Address 5 4 E M A I N S T R E E T City or Post Office State ZIP Code DATE FILED M E C H A N I C S B U R G P A 1 7 0 5 5 Correspondent's e-mail address: murrelAwaltet'SCIaIIOWaV.COCTI Under penalties of perjury,I declare thats have examined this return,Including accompanying schedules and statements,and to the bestof 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 0 PRSlr PO $IBLE FOR FILING RETURN DATE ADDRESS MURR - WALT R�-, II, 54 E . MAIN ST MECHANICSBURG PA 17055 SIGNATURE OF P E ARE O R AN REPRESENTATIVE / DAA - ADDRESS ( �-U MURREL W LTERS, III, 54 E . MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 . \ 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: JAMES W- MASON-i J R 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. 4 6 8 1 . 8 2 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) 4 6 8 1 . 8 2 9. Funeral Expenses and Administrative Costs(Schedule H) . . ..... . ........ .. 9. 1 6 2 5 . 5 0 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . .. . ... ..... . 10. 1 2 6 3 1 . 8 2 11. Total Deductions(total Lines 9 and 10) . . ... . ........ . ... . . . . ... . ... .. 11. 1 4 2 5 7 . 3 2 12. Net Value of Estate(Line 8 minus Line 11) . . . ...... . . . . . . .. . ... . ... . . . 12. - 9 5 7 5 . 5 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. - 9 5 7 5 . 5 0 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 ❑ Side 2 1505610240 1505610240 REV-1500 EX(FI) Page 3 File!Number Decedent's Complete Address: 21 14 0759 DECEDENT'S NAME JAMES W. MASON,JR STREET ADDRESS 100 MT. ALLEN DRIVE CITY STATE ZIP MECHANICSBURG PA 117055 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 right to designate who shall use the property transferred or its income ....I.......................... ❑ ❑X c. retain a reversionary Interest ..................................................................................................... ❑ IXI d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑ 2. If death occurred after December 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 retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ❑ X❑ 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 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 fordisclosure 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 172 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-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: JAMES W. MASON,JR 21 14 0759 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 2,151.56 CHECKING 2. BEATTY RICH FUNERAL HOME, INC. 1,530.26 REFUND 3. WESTERN PENNSYLVANIA TEAMSTERS& EMPLOYEES PENSION FUND 11000.00 BURIAL BENEFIT TOTAL(Also enter on Line 5,Recapitulation) $ 4,681.82 If more space is needed, use additional sheets of paper of the same size. REW 511 EX+(08-13) pennsylvania SCHEDUL�+E�+H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JAMES W. MASON,JR 21 14 0759 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. BEATTY-RICH FUNERAL HOME, INC. MADISON, PA-PREPAID B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) MURREL R.WALTERS, 111 750.00 Street Address 54 E. MAIN STREET City MECHANICSBURG State PA ZIP 17055 Years)Commission Paid: 2014 2. AttomeyFees: MURREL R. WALTERS, 111 750.00 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: CUMBERLAND COUNTY REGISTER OF WILLS 125.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9,Recapitulation) $ 1,625.50 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 JAMES W. MASON,JR 21 14 0759 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 1. PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE 12,631.82 MEDICAL ASSISTANCE TOTAL(Also enter on Line 10,Recapitulation) $ 12 631.82 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JAMES W. MASON JR 21 14 0759 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 out, hts ousal distributions and transfers under Sec.9116(af(1.2).] 1. CHESTER J.MCFARLAND Collateral 4239 RIDGE ROAD DALLAS,TX 75229 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. TOTAL OF PART II-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 AND TESTAMENT BE IT REMEMBERED THAT I, JAMES W. MASON, JR. , a resident of Cumberland County, 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 any and all wills and Codicils previously made by me. I I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. II I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. III I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to CHESTER J. McFARLAND, per stirpes. IV If CHESTER J. -McFARLAND shall predecease or fail to survive me by thirty (30) days, I give, devise and bequeath all of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to MESSIAH VILLAGE ENDOWMENT FUND. IV I nominate, constitute and appoint MURREL R. WALTERS, III, ESQUIRE as Executor of this LAST WILL, to serve without bond. if MURREL R. WALTERS, III, ESQUIRE is unable or unwilling to act in that capacity, then I nominate, constitute and appoint CHESTER J. McFARLAND as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, JAMES W. MASON, JR. , have set my hand to this LAST WILL this day of 2006. ES W. MASON, JR. Signed, sealed, published and declared by the above-named JAMES W. MASON, JR. , as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscr.bed our names as witnesses. 77 2 ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND I, JAMES W. MASON, JR. , Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. JAMES W. MASON, JR. Sworn or affirmed to and acknowledged before me by JAMES W. MASON, JR. , Testator, this /5/_ day of 2006. Notary Public it 'IfUrARIAL SEAL DEBORAH L RYAI`d,NOTARY Pt)PLIC iC,!Ty Or MEGH.PNICUBURGCWAHRLAND 0OUNTY My 0101AN113SiON EXPIRES JUNE 111.2006 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND and 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 Testator sign and execute the instrument as his LAST WILL; that JAMES W. MASON, JR. signed willingly and, that he executed it as his free and voluntary act' for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will a witnesses; and,-that to the best of our knowledge, the Testatc, was- a the time 18 years of age or more, of sound mind a d nde no c nst int or undue influence. A, Sworn or affirmed to and acknowledged before me this /--' day of 2006. Notary Public NOTARIAL SEAL 1DEEI0!;m,'-1':-RYAN,NOYARY PUBLIC CUNIBERLAND COUNTY1 OMMISISION EXPIRESIME 11.2006 1 3