HomeMy WebLinkAbout11-21-14 (3) J 15056111�1
REV-1500 EX t°z_'1, �
PA Department of Revenue pennsylvania oFFiCsa�USE oN�Y ��
Bureau of Individuat Taxes �"ppTME`r� `°`"L` County Code Year File Number
Po Box Z8osoi INHERITANCE TAX RETURN � J I � o � �
Harrisburg,PA i�izs-osoi � RESIDENT DECEDENT �
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
� � R 06 � o � y o8� 7 / ��. l
DecedenYs Last Name Suffix Decedent's First Name MI
�FA � J2nMA- t �� 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
� 1. Original Return � 2. Supplemental Return (� 3. Remainder Return(Date of Death
Prior to 12-13-82)
(� 4. Limited Estate t� 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6. Decedent Died Testate p 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 DIRECTEQ T0:��
Name Daytime Telephone Number
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Second Line of Address q � �""'' f+
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City or Post Office State ZIP Code - — �.�--- �-a-j
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CorrespondenYs 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.
SI NATURE OF PERSON R SP SIB OR FI NG RETURN �W���v� DATE��yvM��H���,
�• _.....�....m._.�.._.�,...... _..�..._. _....._.�._._.�,....._.._..
AD�o � M,�Q I����Q � 6 r Y i 1 . 5�.;?r�n�S�I�7�'6.� �_�_m______�...._.w
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
..ADDRESS �_�. �� _ _ �.�...�___.�..�.....,�.._.._..,
��4��m,� pLEASE USE ORIGINAL FORM ONLY���������� �
Side 1
� 1505611101 1505611101 �
�
�
� 1505611201
REV-1500 EX
DecedenYs Social Security Number
DecedenYs Name: ���Q (�e �, IJC a � ( �� � / � ` `�' �
r.�._.____._�____��.._._ M.___.____. ,..r.___�._..��_s.,...�_._.__�_.__
RECAPITULATION
1. Real Estate(Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. •
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. •
3. Closely Heid 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. �� q y3 •
6. Jointly Owned Property(Schedule F) :""�:� Separate Billing Requested . . . . . . . 6. •
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property r � � D �
(Schedule G) �:":" Separate Billing Requested.. . . . . . . 7. (O •
8. Total Gross Assets(total Lines 1 through 7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. C y '� �j�� •
.._._._.--- .. _ ..._...__.___._.�__.___.. _. . .___.. .._.... __.. . _. ._._.___,. ..,.__.. �..___�._�._.._.___,.._._,___�._..,.,._...,_
9. Funerai Expenses and Administrative Costs(Schedule H). . .. . . . . . . . . . . . . . . . 9. � �p q� .
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). . . . . . . . . . . . . . . 10. � �� .
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. � 6 ,6 � .
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. � � � � g�p .
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 / 3� ��� •
_�-_._....�..a._..�. ,.,._�._._.�r___ _�._...._.� ....._. ._�.�._M .. ,.__.... �.n.__uk.._�_ ...� ._ ..._.., _..� mu_..._�.�� .�.. ._ .�m._�..��
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers und ec. 9116 !� / / / Q
�a)�1.2)X.0� � �� `�1 �C/ • 15. (V l ! / •
16. Amount of Line 14 taxable �
at lineal rate X.0_ . 16. .
17. Amount of Line 14 taxable
at sibling rate X.12 • 17. •
18. Amount of Line 14 taxable
at collateral rate X .15 • �$• •
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. � � ` � •
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 1505611201 1505611207, J
REV-1500 EX Page 3 File Number � �� y Do Q��
t�
Decedent's Complete Address:
DECEDENT'S NAME
-- -__- ____ _ — _ __ _
���_�t1�-- F. ` ��►�- -- --- _ _
STREET ADDRESS
____ ___����-5���-�a� -__--- -- ---- ------ -- ------
----_._
_ -__- _ _
cirv
���1��� STATE� ZI j��'�
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) �c � � �q
2. Cretlits/Payments
A.Prior Payments
B.Discount �('?�
__ ----- 3a�
Total Credits(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the tlifference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 5, g �3
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 .......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferretl or its income ............................................ ❑
c. retain a reversionary interest .............................................................................................................................. ❑
tl. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If tleath occurred after Dec.12, 1982,did decetlent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her tleath?.............. ❑ �
4. Did decetlent 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 tlates 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 decedenYs 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-i508 EX+(11-10)
�:�������pennsylvania SCHEDULE E
:' DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
R � �q �Yl � �. ��a�►�► �c7 /�/� oo i�L�9'
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
I � a n�q�e� e�' P.��nK - C� e c K i ,� «v��1-t ��� 2 3�
��gqt (��S7Q�.
� ��'t �����Cr �U ��:' � D � Z �q5�"55o�tq � �a 7�/�
,
TOTAL(Also enter on Line 5, Recapitulation) $ �73, G�3
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
� pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
��'M Q 11n� �. ('�f q !°V) O!�1- �D 8�i�'
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE Of DEATH %OF DECD�S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. Al"fACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
�. Sar���n��r �av1� - r �f� ��
� 2�$�4 �q6� - C�h�Tdre� � r� 7�1�3 /��� 7, I �3
{� 9�� � �x�n ����ia r�es
,�. ��r1 tc� nd ��- ��a,�k /� �nr�u�-t/ !.���5� 1 od� � �. ��`�
-� o�� 3,� � i ��- Ch,�d r�n �,�e
� �C� I ��' � ������aYt�-S
TOTAL(Also enter on Line 7, Recapitulation) $ �j�� '7 Q 7
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
I���rv� q � ne �Fo I�e�r n� �v��- od��9
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
i. �= t,c,, ►r�1� �Bros. �i�E�c� I �E'�pPn S G 1� ,S`��'0•Q9
� , � �S7'�rY1�S'TP�' ��mf��v� �� 4 N3. �
3 S r, P��rr� ckS Ch v��h- Y'�c�����n f��n�rn I ��DO. �o
�
e. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) _
Street Address_ __ —__
City_ _ _ State ZIP
Year(s)Commission Paid: _ _
Z• Attorney Fees:
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: RQ('j�ST e� �
LUiI�S `3 ��. S�U
J
5. Accountant Fees: �p��r Ct� �r'tZeY' ��.�
6. Tax Return Preparer Fees:
�. BG n K Gh �c�t �� � I��7q
g , S��•��r e ) - a c� �'�r ��s�� �s T�rte �oT-�c� 4�•G�
TOTAL(Also enter on Line 9, Recapitulation) $ (�7� �'7�• a y
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(O1-10)
�'�pennsylvania SCHEDULE ]
UEPARTMENT OF REVENUE
INMEiIRANCE TAX REiURN BENEFICIARIES
RESIDEM�ECEDENT
ESTATE OF: FILE NUMBER:
� �►MA�`N� F. ��flm ot� -- oo C,
RELATI�NSHIP TO DKEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OE PERSON(S�RECEIVING PROPERTY Do Not List Trustee(s) Of ESTATE
I TAXABLE�ISfRIB1JTI0N5[]nclude outright spousal distributfons and transfers under
5ec.9115(a)(1.2).) ��� ?J3� ��'
i. �r�'�;,�� P , ��yv���'
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( l '�3 MG��I� 5t���
Ca r 1�S 1� {�!� I 7�'�
�3� �fnrti ��v�h �•��1ZZ �Q�,S �n'�e� 33 '13�I�
�y �� � [.� �d R�� =
M�-• t�,►�,� s P,,,,m�s . �r4 i-y�
ENTER DOLLAR AMOUNTS FOR DISTRIfiUTI0N5 SHOWN ABOVE ON LiNES 15 THkOUGH 18 QF REV-1500 COVER SHEET,AS APPROPRIATE.
ZI NON-TAXABLE�ISTR[BUTIONS
A, 5POUSAL DISTRIBUTfONS UNDER SECTION 9113 FOR WHICH AN EIECRON TO TAX IS NOT 1'AKEN:
1.
B. CHARI7ABLE AND G04ERNMEN7AL DISTRi8UTI0N5:
1.
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Nov. 12. 2014 9: 06AM Sa�ta�der Bank No. 8$Q8 P, 2
.: � Tradit�onal ❑ SEP
,.
App��car�oN To �aaTic�Par� .'�, �Sovere�gn Banl�
IItA Owner Information Check here if Amendment ►
Romaine F Beam 205-09-9989 8/27/1921
Namo . �
208 Walnut Bottom RD Social Sccuriry Number Date of Birth
Add�.Ss . 7��-24�-3456
C�TIISIE PA 17Q13 ' , Home Phone Numbcr
City/Stste2ip - - ext
Daytimo Pho,re Number
E-mail Address
Beneficig InFormation �'�
�'�imary Bene�ciary �timary$en�ciary Cantinge�t Bene�ciary
Edwin A Beam 11/15/1942 Maril nn K Kuntr 7/77I1944
M�e Dasc of Birth Name . Date ofBirth
�°�' dau hter
Sociei Sccurity Nam6erlTsx LD.Number Relatienship � �� Soeial 5ecurity NumberlTax LD.Numba- Relat;on9hip
241 W Middlesex Dr 4QZ McLand �td
Address
Carlisle Pq 17013 . '�aaz�s
c:ry�scaruz�P � . ML Holl S rin s PA 17065
Ciry/5rate/Zip
� Primary Benefciary � Conhngent Benefic;sry ❑ primary�enefcciary �]�Contingent Benefciary
S lvia L provenzano 12/2/1949
x�e patc oFBitth Name Due af Bitth
dau hter
Social SecuritylVumberll'�I_B,N�unber Rclation5hip $ocial SecurityNumber/I'ax I.D.Number Relazionship
'!143 IUIa le St
Address �d�
Garlisle PA 17013
CitylSteterLip Ciry/Srate/2ip.
I,d,e undersigned IRA pwner,hereyy d�si�ate the above as my bonefiti�y(ies). If prinwy or cQratingtnt is noc indicated,primary will be assumed Un�css otherwise
rcquestcd haein,esch paymeut mada pursuant to this drsi�►ation:($)shall 6e paid in equa�shares to th�primary bencficiary(ies) who are living at the timc of my
dcath;or(b)if no prim�ry bmefrciary{ica)she11 bc living at she time of my death,such payenent shsll be made in cqual shares w the cantingcnt beneficiary(ics)who are
then Iiving. I havo the right to change this dcsignarion at any timo.
Spoosa)cansm�(for use in connmunity pr marital proper4Y srates) I agree to�y spouse's naming a pri�ary'beneficiary other than nqysclf.I traresfer{transmute)any
community properry interest I have in this IR.4 into the separatc property af my spousa I agee tn seel;the advice of a legal or s�c professienal,as needed.
Si ature of S c � Date
Revocation
This IItA may bc rcvoked within seven days of the dato of its establishment Sec the Distlosw�S�[emerat far more i�formation. Such rcvocation may bc madt only
by w�itton notite mailed or deliv�d to�
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Ihis Applir,�ion to paRicipata is mado part of tf►e Individaal Ftetilrment Aceounk I acknowlcdgc receipt of nc�IItA Agreemcnt a�ablishing roy 1RA,rhe p}sclosure
Statanent,end a copy of ehis p,pplir�arion to Participere. I oertify that,to chE best of my}sowlcdge,thc inforn�ation providcd on�his farm is tn,e and rorrect and it may
be ralied on by thc TrusterlCustodian. I agrec,to seek thc advice of a logal or tax profcssional,as ncoded. The Tnistee has not provided me,vith any legal or tar
advice,and 1 assume full respOnsibility for this uansactian, I will not hold the Truseee/Cus�odian liable For any advcrso coitscqurnccs that may r�sult from[his
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LAST WILL AND TESTAMENT
�� � OF
ROD�IAINE F. BEAM
I,ROMAINE F.BEAM,of The Borough of Cazlisle, Cumberland County,Pennsylvania,
being�of sound and disposing mind,memory and understanding,do hereby make,publish and declare
this as and for my Last Will and Testament,hereby revoking a11 other wills and codicils heretofore
made by me.
FIRST: I direct that all my just debts and fimeral expenses,including my grave
mazker, shall be paid from the assets of my esta.te as soon as practica.ble after my decease.
SECOND: I give and beqnea.th my grandfather clock,small desk and chair and dry
sink to my soi�, �Dtii�`I�i"1�:'B��VI,JR.
THII2D: I give and bequeath my blanket chest to my daughter,MARILYNN K.
KUNTZ.
FOURTH: I give and bequea.th my walnut drop-leaf table to my daughter,
SYLVIA PROVENZANO.
FIFTH: I give,devise and bequea.th the residue of my estate,of every nature
O and wherever situate,to mythree children equally,namely,EDWIN A.BEAM,JR.,MARILYNN
�� K.KUNTZ and SYLVIA PR4VENZANO,provided that should any of my children predecease
me their share sha11 be distributed to his or her issue, per stirpes, living on the thirty-first day
' following my death,and in default of such then living issue,such shaze shall be added to the share or
shares for my other children or their issue.
SIXTH: 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 esta.te as a
part of the expense of the administration of my estate.
SEVENTH: I nominate, constitute and appoint my daughter, MARILYNN K.
K[JNTZ, Executor of this my Last Will and Testament. Should my daughter, MARILYNN K.
KUNTZ, fail to qualify or cease to act as Exccutrix, I appoint my san,.EDWIN A. BEAM, JR,
Executor of this my Last Will and Testament.
EIGHTH: I direct my Executrix and her successors shall not be required to give
bond for the faithful performance of their duties in this or any other jurisdiction.
IN WITNESS WHEREOF,I have hereunto set my hand and seal to thi.s,my Last Will and
Testament,consi�ng,o��wo��)�pe.w�tten=pages,.each.ide�ti•fied by my signature,this �S'�-
day of January 2011.
� (SEAL)
Romaine F.Beam
Signed,sealed,published and declared by the above-named Testatrix,Romaine F.Beam,as
and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and
presence, and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
� �� ' ar►.a..e,�;��.�'. �.J.
COMMONWEALTH OF PENNSYLVANIA )
. SS.
COL7N'TY OE:GUMBERLA�IIU . .) _
I, Romaine F. Beam, Testatrix, 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 and Testament;that I signed it willingly;and that I signed it
as my free and voluntary act for the purposes therein expressed.
„�a Sworn or affirmedto and acknowledged before me by Romaine F.Beam,the Testatrix,this
-� �' day of January 2011.
� (SEAL)
COMMONUUEALTH OF PENNSYLt�Atv�� Ro ' e F.B�m,,, es
� � � ` �,
NOTARIAL SEAL �-�� , �..
SHELLY SEXTON, Notary Public
Carlisle Boro, Cumberland County N Public
MY.Commission Expires Aprii 26,2011
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
. SS.
COUNTY OF CUMBERLAND )
We, RONALD E. JOHNSON and ��?��.tc��. �+-^' Z- , the witnesses
whose names are sign.ed to the attached or foregoing instrument,being duly qualified according to
law,do depose and sa.y that we were present and saw Testatrix sign and execute the instnzment as her
Last Will and Testam.ent; that Romaine F.Beam, signed willingly and that she executed it as her
free and voluntary act:for the purpose therein expressed;that each of us in the hearing and sight of
the Testatrix sigued trie Will as witnesses;and that to the best of our knowledge the Testatrix was at
that time 18 or more�years of age, of sound mind and under no constra3nt or undue irifluence.
����vorn or a� z�j to and subscribed to before me by RONALD E. JOHNSON
and ,�G v�c�� G� � F---��F�i Z. witnesses,this ��`` day o anuary 201 l.
� (SEAL)
nald E. Johnso itness
COMMONWEALTH OF PEI�NSYLVANIA a�-Le�C[ ' (SEAL)
NOTARIAL SEAIL ; � , `ess
SHELLY SEXTON, Notary Public , / ,,�
Cariisle Boro, Cumberland County �,,� � '
My Commission Expires AK►ril 26, 2011
Notary li
�