HomeMy WebLinkAbout11-13-14 (2) -J REV-1500 EX(02-11) 1505610143
PA Department of Revenue OFFICIAL USE ONLY
P Pennsylvania County Code Year Fede Number
Bureau of Individual Taxes DEPARTF"TOFREVE?"
PO BOX.280601 INHERITANCE TAX RETURN 21 14 019
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
04 11 2014 04 08 1913
Decedent's Last Name Suffix Decedent's First Name MI
PIERCE MARY C
(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
® 1. Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(Date of Death
1�2
❑ 4. Limited Estate ❑ 4a,Future Interest Compromise [35. Federal Estate Tax Return Required
(date of death after 12-12-02)
® 8. Decadent Did Testate ❑ 7, Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
yyust)
❑ B. Litigation Proceeds Received ❑ 10.beotween
Poverty
and 1-1-96)f Death ❑ 11.Attach Sch dule 0) 8113(A)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GERALD J BRINSER 717 838 6348
REGISTER,QF&ILLS USE 6NLYr h
C 7D C3
First Line of Address
6 E MAIN STREET I _= ' c c-.r
Second Line of Address `
PO BOX 323 `' '
City or Post Office State ZIP Code DATE fiLED = r'j
PALMYRA PA 17078 CD `n
Correspondent's e-mail address: gjbrin@aol.com
Under penalties of pedury,I declare tha ave examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
It is true,co nd complete.DeciaggionNf preparer other than the personal representative is based on all Information of which preparer has any knowledge.
SIGNAT 0 RSON RE IBLE FOR F ING RETURN DATE
Glen A.Pierce
ADDRESS
5 Conway Drive,Mechanicsburg,PA 17055-6194
SIGNATOR F PREPARER OTHER THAN REPRESENTATIVE DATE
Gerald J Brinser l
ADD SS
Brinser,Wagner&Zimmerman
6 E. Main Street,Palmyra,PA 17078
Side 1
L 1505610143 1505610143 J
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: PIERCE, MARY C.
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. 1 , 990 . 9 7
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 12 , 813 . 23
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7.
8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 14 , 804 . 20
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 6 , 115 . 13
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 1 , 225 . 14
11. Total Deductions(total Lines 9 and 10).................................................................. 11. 7 , 340 . 27
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 7 , 463 . 93
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. 7 , 463 . 9 3
TAX COMPUTATION-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.00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 7 , 463 . 93 16. 335 . 88
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE................................................................................................................... 19. 335 . 88
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 - 14
Decedent's Complete Address:
DECEDENT'SNAME
Pierce, Mary C.
STREET ADDRESS
Messiah Lifeways @ Messiah Village, 100 Mt. Allen Dr.
CITY- STATE 1Z. 17055
IP
Mechanicsburg PA
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 335.88
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) (2) 0.00
3. Interest (3) 0.00
4. 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) 336.88
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;.................................................................................. ix b. retain the right to designate who shall use the property transferred or its income:....................................
c. retain a reversionary interest;or..................................................................................................................
d. receive the promise for life of either payments,benefits or care?.............................................................. H
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑ R
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... F-1 ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?...................................................................................................................... ❑ 0
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.§9196(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 retturn 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,w ether bloo or adoption.
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN CASH, BANK DEPOSITS AND MISC.
RESIDENT DECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Pierce, Mary C. 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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Celtic Insurance-Refund; Medicare Supplement Ins. 1,727.23
2 (PERS-Pension 263.74
TOTAL(Also enter on Line 5, Recapitulation) 1,990.97
REV-1608 EX+(01-10)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULE F
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Pierce,Mary C. 21 -14
If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
Glen A. Pierce 5 Conway Drive Son
A Mechanicsburg, PA 17055-6194
Linda M.Pierce 5 Conway Drive Daughter-in-Law
B Mechanicsburg, PA 17055-6194
JOINTLY OWNED PROPERTY:
ITEM LETTER DATE DESCRIPTION O R DATE OF DEATH %OF DATE
OF OF
DEATH
NUMBER FOR JOINT MADE Include name of financial institution and bank account number'VALUE OF ASSET DECD'S DECEDENrs INTEREST
TENANT JOINT similar Identifying number.Attach deed for join*held real estat . INTEREST
1 AB 09/26/2008 PNC Bank-Checking Account#5005832984 2.177.96 33.3% 725.99
2 AB 09/29/2008 PNC Bank-Money Market Account 36,261.72 33.3% 12,087.24
#5005150908
TOTAL(Also enter on line 6,Recapitulation) 12,813.23
REV-1611 EX+(10.09)
1-7 pennsylvania SCHEDUIFH
DEPARTMENT OF REVENUE FLIWM iL� "!V�fLJ
INHERITANCE TAX
RESIDENT DECEDENT RETURN AMINSMTM COM
ESTATE OF Pierce, Ma C. FILE NUMBER
Mary 21 -14
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Iles Funeral Home-Brandt Funeral Home Expenses 2,463.19
2 Cocklin Funeral Home-Preparation and Transport to Iowa 2,473.06
3 Additional Miscellaneous Funeral Expenses 323.77
4 Funeral Luncheon,etc. 390.11
B. ADMINISTRATIVE COSTS:
�. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Years)Commission Paid
2. Attorneys Fees Brinser,Wagner&Zimmerman—Gerald J. Brinser 450.00
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
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Register of Wills-Filing Fee 15.00
TOTAL(Also enter on line 9,Recapitulation) 6,115.13
C ScheduleH
COMMONWEALTH OF PENNSYLVANIA /� ru ^,, ,t
INHERITANCE TAX RETURN AdrmW ntf11 ftfi @WD corftUed
RESIDENT DECEDENT
ESTATE OF Pierce, Mary C. FILE NUMBER
121 -14
NOTE: All expenses in excess of probate assets were paid by the joint owners of
accounts on Schedule F.
Page 2 of Schedule H
pennsylvania SCHEDULE 1
102 DEPARTMENT OF
AXRET DEBTS OF DECEDENT
INHERITANCE TAX RETURNRN , MORTGAGE
RESIDENT DECEDENT LIABILITIES & LIENS
LEUMBER
N
ESTATE OF Pierce, Mary C. FILE
E N
-14
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 West Shore EMS 1,025.14
2 Glen Pierce-Personal expenses incurred in March 200.00
NOTE: All expenses in excess of probate assets were paid by the joint owners of accounts on
Schedule F.
TOTAL(Also enter on Line 10,Recapitulation) 1,225.14
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENTOF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Pierce,Mary C.
21 -14
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS(inciude outright spousal
distributions and transfers
under Sec.4116(a)(1.2))
1 Glen A.Pierce Son 1/2 Schedule F; 1/2 3,731.97
5 Conway Drive Residue
Mechanicsburg,PA 17055-6194
2 Linda Pierce Daughter-in-Law 1/2 Schedule F 3,731.97
5 Conway Drive
Mechanicsburg,PA 17055-6194
3 Carol Craig Daughter 1/2 Residue 0.00
1335 45th Street
Des Moines,IA 50311
Enter dollar amounts for distributions shown above on lines 15 through 18 on 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
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
�;aof Pill ung Zvotament
MARY C. PIERCE
I , MARY C. PIERCE, of the County of Dallas, State of Iowa,
ie ng.-4 mind_and_ .,,tr�emo.ry_,do_.,__her, by_make,__.publ
declare this instrument to be my Last Will and Testament, hereby
revoking any and all Wills, Testaments or Codicils by me
heretofore made, in manner and form as follows :
ARTICLE ONE SS
It is my will that all of my legal debts, expenses of my
last sickness and burial, and expenses of administration of my
estate be paid as soon as possible by the representative of my
estate at and after my death.
ARTICLE TWO
My husband, RALPH E. PIERCE, has predeceased me. We have
,two children, namely: GLEN A. PIERCE, now of Nappanee, Indiana;
and CAROL BETH STILL, now of Des Moines, Iowa.
LAST WILL AND TESTAMENT OF
MARY C. PIERCE
Page 2
ARTICLE THREE
I direct my executors to distribute my tangible personal
property as I have described in a dated list, letter, or written
statement, handwritten or signed by me, that I may leave at my
death. If my executors are unable to locate such writing within
a reasonable time following my death, or if such writing does not
effectively dispose of all my tangible personal property, I r
bequeath the balance of all of my clothing, jewelry, automobiles,
household furniture and furnishings, recreational equipment, and
all other personal effects used by me about my person or home to
my children, GLEN A. PIERCE and CAROL BETH STILL, in equal
shares, in fee simple .
ARTICLE FOUR
I hereby give, will, devise and bequeath all of the rest,
residue, and remainder of my property, real, personal or mixed,
to my children, GLEN A. PIERCE and CAROL BETH STILL, to be theirs
in equal shares, in fee simple.
ARTICLE FIVE
In the event any child of mine shall not survive me, it is
my will that the share of my estate to which such child would
have been entitled shall be distributed to his or her children
LAST WILL AND TESTAMENT OF
MARY C. PIERCE
Page 3
living at my death, in equal shares . If such child shall leave
no children surviving, then his or her share shall be distributed
to my surviving child.
ARTICLE SIX
I hereby empower my Executors with the right and authority
to. -Bell-any-property,. whether._ real.-or-per_sonal,.___which__I__.may - own.
at the time of my death or which may be acquired thereafter by my
executor, providing such executors shall deem such sale to be
provident and advantageous to my estate, without the approval of
Court being required and no bond shall be required of my
executors upon any such sale of property. My executors shall be
granted authority to distribute any or all of my personal
property as is deemed appropriate by my executors, subject to the
provisions of Article Three.
ARTICLE SEVEN
I hereby nominate and appoint my children, GLEN A. PIERCE
and CAROL BETH STILL, to serve as Co-Executors of this, my Last
Will and Testament, and request that they not be required to post
or furnish bond for the faithful performance of their duties .
LAST WILL AND TESTAMENT OF
MARY C. PIERCE
Page 4
ARTICLE EIGHT
Throughout this Will the masculine gender shall be deemed to
include the feminine, and the singular, the plural, and vice
versa.
IN WITNESS WHEREOF, I, the said MARY C. PIERCE, have
subscribed my name to this, my Last Will and Testament,
consisting of six (6) typewritten sheets of paper, including the
attestation and verification clauses,. upon the margin of each of
which I have also written my name at Dallas Center, Iowa, on this
7 th day of June, A.D. 2001 .
MARY C. 'PIVRCE
Subscribed, published, acknowledged and declared by the
testator, MARY C. PIERCE, as, for and to be her Last Will and
Testament, in our sight and presence, whereupon, at her request
and in her sight and presence, and in the sight and presence of
each other, we and each of us do sign our names as attesting
witnesses this 7th day of June, 2001 .
7 �
Lisa M. Howell
WITNESSES :
Karen M. Marean
LAST WILL AND TESTAMENT OF
MARY C. PIERCE
Page 5
AFFIDAVIT
STATE OF IOWA
ss.
COUNTY OF DALLAS
We, the undersigned, MARY C. PIERCE, Lisa M. Howell and
Karen M. Marean, the testator and the witnesses, respectively,
- _-_ whose .-names.---are,- signed - to -the - foregoing--instrument,--.being _ fi-rst
duly sworn, declare to the undersigned authority that said
instrument is the testator' s Will and that the testator willingly
g Y
signed and executed such instrument as a free and voluntary act
for the purposes therein expressed; that said witnesses, and each
of them, declare to the undersigned authority that such Will was
executed and acknowledged by the testator as the testator' s Will
in their presence and that they, in the testator' s presence, at
the testator' s request, and in the presence of each other, did
subscribe their names thereto as attesting witnesses on the date
of the date of such Will; and that the testator, at the time of
the execution of such instrument, was of full age and of sound
LAST WILL AND TESTAMENT OF
MARY C. PIERCE
Page 6
mind and that the witnesses were sixteen years of age or older
and otherwise competent to be witnesses .
MARY C. IERCE
- — ----_ - - - -- _--- -------` i .a_N!:
Dallas Center, Iowa
Karen M. Marean
Grimes, Iowa
Subscribed, sworn and acknowledged before me by MARY C.
v
PIERCE, the .testator; and subscribed and sworn before me by Lisa y
M. Howell and Karen M. Marean, witnesses, this 7th day of June,
A.D. 2001 .
Ralph R. Brown, Notary Public
in and for the State of Iowa
� RALPH R.BROWN
• n E* 242000
Performance Checking Statement � PNCBANK
PNC Bank
Primary account number: 50-0583-2984
Page 1 of 2
For the period 03/14/2014 to 04/11/2014 Number of enclosures: 0
MARY C PIERCE 2 For 24-hour banking,and transaction or
GLEN A PIERCE interest rate information,sign-on to
LINDA M PIERCE PNC Bank Online Banking at pnc.com
5 CONWAY DR For customer service call 1-888-PNC-BANK
MECHANICSBURG PA 17055-6194 Monday-Friday:7 AM-10 PM ET
Saturday&Sunday:8 AM-5 PM ET
Para servicio en espanol,1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANK
Write to: Customer Service
PO Box 609 S
Pittsburgh,PA 15230-9738
R Visit us at pnc.com
cl TDD terminal:1-800-531-1648
For hearing impaired clients only
Performance Checking Mary C Pierce
Glen A Pierce
Interest Checking Account Summary Linda M Pierce
Account number. 50-0583-2984
Overdraft Protection has not been established for this account.
Please contact us if you would like to set up this service.
Overdraft Coverage -Your account is currently Opted-Out
You or your joint owner may revoke your opt-in or opt-out choice at any time.
To learn more about PNC Overdraft Solutions visit us online at pnc.com/overdraftsolutions.
Call 1-877-588-3605,visit any branch,or Sign on to PNC Online Banking,and select the"Overdraft
Solutions"link under the Account Services section to manage both your Overdraft Coverage and Overdraft
Protection settings.
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
3,361.95 1,002.76 2,186.75 2,177.96
Average monthly Charges
balance and fees
2,545.19 .00
Transaction Summary
Checks Check Card POS Check Card/Bankcard
paid/withdrawals signed transactions POS PIN transactions
3 0 0
Total ATM PNC Bank ATM Other Bank ATM
transactions transactions transactions
0 0 0
Interest Summary As of 04/11,a total of$.10 in interest
was paid this year.
Annual Percentage Number of days in Average collected Interest Paid
Yield Earned(APYE) interest period balance for APYE this period
0.01% 29 2,545.19 .02
Activity Detail
Deposits and Other Additions There were 3 Deposits and Other
Date Amount Description Additions totaling$1,002.76.
03/31 263.74 Direct Deposit-Ipers Mthl
ST OF IA- IPERS 68872120
Deposits and Other Additions continued on next page
Premium Money Market Statement PNCBANK
PNC Bank
Primary account number: 50-0515-0908
Page 1 of 2
For the period 01/15/2014 to 04/11/2014 Number of enclosures: 0
MARY C PIERCE For 24-hour banking,and transaction or
GLEN A PIERCE interest rate information,sign-on to
LINDA M PIERCE PNC Bank Online Banking at pnc.com
5 CONWAY DR For customer service call 1-888-PNC-BANK
MECHANICSBURG PA 17055-6194 Monday-Friday:7 AM-10 PM ET
Saturday&Sunday:8 AM-5 PM ET
Para servicio en espanol,1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANK
® Write to: Customer Service
PO Box 609
Pittsburgh,PA 15230-9738
Visit us at pnc.com
TDD terminal:1-800-531-1648
For hearing impaired clients only
Premium Money Market Account Summary Mary C Pierce
Glen A Pierce
�Abcount number: 50-0515-0908 '
""` Linda M Pierce
Overdraft Coverage -Your account is currently Opted-Out.
You or your joint owner may revoke your opt-in or opt-out choice at any time.
To learn more about PNC Overdraft Solutions visit us online at pnc.com/overdraftsolutions.
Call 1-877-588-3605,visit any branch,or Sign on to PNC Online Banking,and select the"Overdraft
Sotutions"link under the Account Services section to manage both your Overdraft Coverage and Overdraft
Protection settings.
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
36,254.80 6.92 .00 36,261.72
Average monthly Charges
balance and fees
36,259.48 .00
Interest Summary As of 04/11,a total of$9.54 in
interest was paid this year.
Annual Percentage Number of days in Average collected Interest Paid
Yield Earned(APYE) interest period balance for APYE this period
0.08% 87 36,257.18 6.92
Activity Detail
Deposits and Other Additions There were 3 Deposits and Other
Date Amount Description Additions totaling$6.92.
02/13 2.39 Interest Payment
03/13 2.22 Interest Payment
04/11 2.31 Interest Payment
Daily Balance Detail
Date Balance Date Balance Date Balance Date Balance
01/15 36,254.80 02/13 36,257.19 03/13 36,259.41 04/11 36,261.72
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