HomeMy WebLinkAbout12-09-14 150561D140
� �` �I �� �00 .EX (02-11)(FI)
OFFICIAL USE ONLY
PA Depaitment of Revenue County Code Year File Number
Bureau of Individual Taxes WHERITANCE TAX RETURN
Po eox 2soso� 2 1 1 4 1 0 3 7
Harrisburg P,4���2s-oso� RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 � 2 2 2 0 1 2 0 3 0 8 1 9 4 1
DecedenYs Last Name Suffix DecedenYs First Name MI
P E I F E R K E � T H E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
P E I F E R S A U N D R A M
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
R�EGiST�R O� 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 � 8.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)
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 T0:
Name Daytime Telephone Number
S A U N D R A M - P E I F E R 7 1 7 4 5 8 8 7 5 3
r REGISTER OF WILLS USE ONLY +
rv
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First Line of Address I � "� m � ,
O n
4 1 2 2 W I L L 0 W B E N D R 0 A D ; c�`� � � � � �,
r� s c� � a �
Second Line of Address � ��� �- � � � � �
State ZIP Code h���DATEQ�LED��1 � _ II�
City or Post Office � ,,,._ �
i� �'� -�l �-�_ ....-._,_.�.
M E C H A N I C S B U R G P A 1 7 0 5 5 �~' ;;� ►—� � rn
-47 � r� C!) �
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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 d complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUR OF ERSON RESP L FOR FILING RETURN DATE
/2 S�1
AD
4122 WILLOW BEND ROAD MECHANICSBURG PA 17055
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 15056101,40 ],505610140 J ;
� 1505610240
REV-1500 EX(FI) Decedent's Social Security Number
DecedenYs Name: K E I T H E • P E I F E 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 3 2 6 3 . 8 �
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) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 4 3 2 6 3 . 8 �
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9� 7 � � . 5 �
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. '
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 7 � � . 5 �
12. Net Value of Estate(Line 8 minus Line 11) . . . . . .. . . . . . . . . . . . . . . . . . . . . . �2� 4 2 5 6 � . 3 �
13. Charitable and Govemmental 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. 4 2 5 6 3 . 3 �
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(�:2)x.000 4 2 5 6 3 . 3 0 15. O . 0 0
16. Amount of Line 14 taxable
at lineal rate X•�_ � • � O 16. O • � �
17. Amount of Line 14 taxable
at§ibling rate X .12 0 • � � 17. � • � �
18. Amount of Line 14 taxable
at collateral rate X.15 0 • 0 0 1 g. 0 . � 0
19. TAXbUE . . . . . . . . :. . . . . . . . . . . . . . . . . . . . . . 19. � • � �
. . . . . . . . . . . . . . . . . . . . . . .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
� 1505610240 1505610240 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 2� �4 �03�
DECEDENT'S NAME
KEITH E. PEIFER
-- -- --
— ._.-- — —_ __—---
STREET ADDRESS
4122 WILLOW BEND ROAD
-- . _ — — - __ - — - -- - -- ----- ----- _ -- ---_ _ ---- ---
CITY I 8TATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
Total Cretlits(A+g) �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 transferretl ...................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ X❑
c. retain a reversionary interest ....................................................................................................: ❑ 0
d. receive the promise for life of either payments,benefits or care? ...................................................... ❑ �
2. If death occurred after December 12, 1982,tlid tlecedent transfer property within one year of death
without receiving adequate consideration? ........................................................................................ ❑ 0
3. Did decetlent own an"in trust for"or payable-upon-tleath bank account or security at his or her tleath? ......... ❑ 0
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 p2 P.s.§s��s(a)(�)�.
• 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-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
REsi�ENroECE�ENr PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
KEITH E. PEIFER 21 14 1037
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 OFDEATH
' 1. Account with Apex Clearing 43,263.80
TOTAL(Also enter on Line 5,Recapitulation) $ 43 263.80
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
. � DEPARTMENTOFREVENUE �� � .- � FUNER/1L EXPENSES AND �
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KEITH E. PEIFER 21 14 1037
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
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: Krug Law Firm 500.00
3, Family Exemption:(If decedeoYs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. probate Fees: Register of Wills 185.50
5 Accountant Fees:
6. Tax Return Preparer Feer.
7. Debts and deductions 10.00
8. Release filing fees 5.00
TOTAL(Also enter on Line 9,Recapitulation) $ 700.50
If more space is needed,use additional sheets of paper of the same size.
REV-1513EX+(01-10)- � � .
pennsylvania SCHEDULE J
DEPARTMENTOFREVENUE . pENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
KEITH E. PEIFER 21 14 1037
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).]
1. Saundra Peifer Spousal 42,563.30
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.
_ . -_. • , . ...,- ✓
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LAST WILL AND TESTAMENT �,�7 -._ ,�> —+ ;.; .:,-
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OF -� _ �.,, �-���
KEITH E.PEIFER ; .:> ; ;.:.�
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, � •.
_..-,
I,Keith E.Peifer, a resident of Mechanicsburg,Pennsylvania declare this to be my�3�as�^_ ��,;
�--, U-� :.7
Will and revoke all former Wills and Codicils. ..� -�,
ARTICLE I
Identification of Familv
In making this Will I have in mind my wife, Saundra.M. Peifer, and my children,Kirsten
M. Shovlin,born 1969,and Eric C.Peifer,born 1971,but does not include any children hereafter
born to or adopted by my wife and me. Any reference to a"child of mine" or"my children"
sha11 include the persons,other than my wife,named or referred to in this Article.
ARTICLE II
� Apnointment of Fiduciaries
A. Appointment of Personal Representa�ive. I appoint my wife as Executor of
my estate.
B. Bond; Court Supervision. My Executor sha11 h�.ve the right to serve without
bond and to administer and settle my estate without the intervention or supervision of any court,
e�ccept to the extent required by law. Nothing herein shall prevent my Executor from seeking
the assistance of the court in any situa.tion where my Executor deems it appropriate.
ARTICLE III
Disposition 4f Residue
A. Provision for Wife. I give all of the rest and residue of my estate,wherever
located(hereafter referred to in this Article as "residue"),to my wife if she survives me.
B. Provision for Descendants. If my wife does not survive me then I give the
entire residue to my descendants.
1. Provision for Others. If I am not survived by my wife,or by any of my
descendants,I give the entire residue to my heirs.
A,RTICLE IV
Alternative Methods of Distribution
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Will of Keith E.Peifer Page 1 of 5 Initials: Date: I t� — t$--t Z---
A. Purpose of Article. Recogni.zing that under certai.n circumstances the terms of
this Will may direct that property be distributed outright to a person who is under age twenty-one
(21)or under a legal disability; I make the following provisions to facilitate the distribution of
property to such persons.
B. Alternative Methods. Whenever the terms of this Will direct my personaI
representative(refeaed to in this Article as the "fiduciary")to distribute property outright to a
person who is then under age twenty-one(21)or under a legal disability,the fiduciary may retain
pursuant to Paragraph C. of this Article or distribute a11 or any portion of that property in any one
or more of the following ways:
1. Delivery directly to the beneficiary;
2. Delivery to the parent or steppazent of the beneficiary;
3. Delivery to the guardian of the beneficiary's person or property;
4. Delivery to any Custodian for the beneficiary under the Uniform Gifts to
Minors Act;
5. Delivery to any then existing trust created for the beneficiary;
6. Deposit in a financial institution in an account established in the name of
the beneficiary alone pursuant to the laws of the State of Pennsylvazua;
7. Storage of any tangible personal properiy in safekeeping with the costs of
storage to be borne by the beneficiary; or
8. Sale of any tangible personal properry and delivery of the proceeds in any
manner pernutted by this Article.
Provided the fidu�iary acts in good faith,upon delivery of any property in accordance
with the provisions of this Article,the fiduciary shall be dischazged from all responsibilities in
connection with the property.
C. Discretionary Trust. Any property not distributed as provided in Para.graph B.
of this Article sha11 be reta.ined by the fiduciary in trust for the beneficiary on the following terms
and conditions: During any period in which the beneficiary is under a legal disability or under
twenty-one(21)years of age,the fiduciary sha11 pay to or apply for the benefit of the beneficiary
so much of the income and principal of the trvst as the fiduciary,in its sole and absolute
discretion,determines is advisable for the beneficiary's health,support,education and general
welfaze. At such time as the beneficiary is neither under a legal disability nor under age
twenty-one(21),the fiduciary sha11 distribute any remaining trust assets to the beneficiary. If
the beneficiary dies before all of the trust assets have been distributed,the fiduciary shall
distribute any remaining trust assets to the beneficiary's estate.
,�
. �
Will of Keith E.Peifer Page 2 of 5 Initials: Date; ��— �`�� ��
a�t��cLE v
Administrative Provisions
A. Powers and Duties of Personal Representative. My personal representative
sha11 have all of the powers and duties granted to or imposed upon personal representatives
serving with non-intervention powers pursuant to the laws of the Sta.te of Pennsylvania.
B. Debts and Ezpenses. All e�enses of administration chargeable to principal,the
expenses of the disposition of my remains,and all my legitimate debts,if and when paid, sh�al�lu e
paid from the principa1 of my residuary estate. No debt need be paid prior to its maturity '
course and except as otherwise provided in this Will no interest in any properry passing under
this Will need be exonerated. ,
C. Tazes. All estate,inheritance or other similar death taxes,together with anY
interest or penalties thereon,arising by reason of my death with respect to any properry
includable in my taxable esta.te,and any adjusted taxable gifts,whether passing under or outside
of this Will,shall be paid from the principal of my residuary estate without reimbursement from
the recipients or beneficiaries of such property,provided,however,that in the event any
proceeds of insurance upon my life or any property over which I held a power of appointment
are included in my estate for purposes of determinin�g the federal esta.te tax liability of my estate,
then the residue of my estate shall be entitled to receive from the recipients of any such proceeds
or properly the portion of such federal estate tax liability attributa.ble to such proceeds or
property deterniined in accordance with IRC §§ 2206 and 2207.
ARTICLE VI
Miscellaneous
" A. Number and h�id ach in ude the otherXand every noun d pronoun ha11 have
and singular forms of words s
a meaning that includes the masculine,ferninine and neuter genders.
B. Survival. To "survive"me,as that term is used in tlus Will, a person must
continue to live for thirty(30)days after my death.
C. Descendants. The "descendants" of an individual include only the following:
1. All such individual`s biological descendants,except any person not born in
lawful wedlo�k and his descendants,unless the biological parent who
would otherwise cause him or her to be a descendant has acknowledged
patemity or maternity in legitimation proceedings,or in an unambiguous
signed writing identifying such person by name,or by raising such person
in the same household; and
2. Persons adopted by such individual or one of his or her descendants, and
_..._--`—�`° ��--
Will of Keith E.Peifer Page 3 of 5 Initials: Date:
t�}� t� —12-
their descendants.
If the parent,who would cause a person to be a descendant as defined above,is replaced in an
adoption proceeding, such person sha11 remain a descendant unless such parent voluntarily
consents to the relinquislunent of his or her status as parent in connection with such adoption
proceedings.
D. Heirs. The term"heirs" shall mean those persons entitled to inherit under the
then-applicable laws of the State of Pennsylvania governing the descent of an intestate's separa.te
estate. They shal;l inherit in their sta.tutory proportions. If the provisions of this VVill call for a
distcibution of property to my heirs or the heirs of any other person and the event giving rise to
the requirement for such distriburion takes place at a time later than my death or the death of
such person,the determination af the identity of such heirs shall be made as if I(or such other
person)had died on the date of the event giving rise to such requirement for distribution.
E. Ezclusion of Pretermitted Heirs. Other than as set forth in this Will,I make no
provision for any child of mine or descendant of a deceased child of mine. I specifically make
no provision for any person(whether now living or hereafter born),other than a child named or
referred to in Article I or a descendant of mine as defined in this Will,who may be entitled to
claim an interest in my estate under the laws of the State of Pennsylvania.
F. Legal Disability. A person is under a legal disability if my personal
representative detetmines, in good faith,that the person is incapable of managing his property or
of caring for himself,or both, or is in need of protection or assistance by reason of physical
injury or illness,mental illness,developmental disability, senility,alcoholism,excessive use of
drugs, or other physical or mental incapacity.
G. Title to Real Property. Upon my death,title to any real property passing under
this Will sha11 vest in my personal representative in his fiduciary capacity and sha11 remain so
vested until my personal representative distributes or sells that property, at which time title sha11
vest in the distributee or purchaser.
H. Disclaimer. Except as may be otherwise specifically provided in this Will,in the
event that any beneficiary disclaims an interest arising out of this Will or any txust created herein
it is my intention that the interest disclaimed sha11 be distributed in the same manner and at the
same rime as if the disclaiming beneficiary had died immediately preceding the event pursuant to
the laws of the State of Pennsylvania
I. Governing Law. The provisions of this Wi11 sha11 be interpreted in accordance
with and in light of the laws of the State of Pennsyivania.
J. Corporate Successors. Whenever a corporation or other business entity is
referred to herein,the reference shall include any successor organization.
K. References to Statutes. In this Will,the abbreviation"IRC" shall refer to the
Internal Revenue Code of 1986 as amended.
.,��
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Will of Keith E.Peifer Page 4 of 5 Initials: Date: l�
I have initialed and dated for identification purposes all pages of this,,}ny Last Will, and
have exe�uted the entire instr�ument by signing this page on the `�day of (� ��3�_, 20 .�7-,
at � ;,ff�s`r�';�i- Pennsylvania.
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Keith E. Peifer
Attestation and Statement of Witnesses
Each of us declares under penalty of perjury under the laws of Pennsylvania that Keith E.
Peifer, the Testator, signed this instrument as his Last Will in our presence, a11 of us being
present at the same time, and we now, at the Testator's request, in the Testator's presence, and in
the presence of each other, sign below as the witnesses, declaring that the Testator appears to be
of sound mind and under no duress,fraud,or undue influence.
; � �...-- -�'" '?���..�..�
(Wiiness Signa e] -'`[Witness Signature]
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[Print Name) [Prnrt Name]
Residing at Residing at
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VJill of Keith E.Peifer Page 5 of 5 Initials: Date: ��` � ��t�