HomeMy WebLinkAbout11-14-14 REV-1500 EX(02-11) 1505610143
PA Department of Revenue y OFFICIAL USE ONLY
p penns Ivania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOx.280601 INHERITANCE TAX RETURN 21 14 0915
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
08 22 2014 06 18 1932
Decedent's Last Name Suffix Decedent's First Name MI
RICK CARROLL E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
EMERICK JOYCE E
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 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 TestateDecedepp,Maint 'ned a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Gopy of rust)
9. Litigation Proceeds Received 10,S ousal PovertCrelit(Date of Death 11.Election to tax under Sec.9113(A)
b�tween 12-31J1 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX Iff.,ORMATION Sht('LD BE DIRECTED TO:
Name Daytimelephone"Ilber:�p rn
JAMES D BOGAR (7:k 737 76 ' o
C �C. ;) x
REGISTER OFiWILL�USL:ON°`
First Line of Address c� "n
ONE WEST MAIN STREET
Second Line of Address �, O
City or Post Office State ZIP Code DATE FILED
SHIREMANSTOWN PA 17011
Correspondent's e-mail address: jbogarAbogarlaw.com
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.
SIG URE OF PERSON RESPONSIBLE FOR FILINGIRETURN DATE
C .t/" CA, Joyce E. Emerick vt 12 04
A ESScc_,
915 Nixon Drive, Mechanicsburg, PA 17055
SIGNAT F PREPARE THER THAN REPRESENTATIVE DATE
James D. Bogar it i t Z4 14
ADDRE S
One West Main S et, Shiremanstown, PA 17011 \
1505610143 Side 1 1505610143 J yl
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: EmeriCk, Carroll E.
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. 34,381 . 65
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous inn;Probate Property
(Schedule G) u Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 34 ,381 . 65
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9.
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10.
11. Total Deductions(total Lines 9 and 10)................................................................ 11.
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 34 ,381 . 65
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. 34 ,381 . 65
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 34 381 . 65 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 00 16. 0 . 00
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 0 . 00
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 21-14-0915
Decedent's Complete Address:
DECEDENT'S NAME
Emerick, Carroll E.
STREETADDRESS
915 Nixon Drive
CITY STATE 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 0.00
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. (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) 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;.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
2. If death occurred after Dec. 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?.................................................................................................................. ❑
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 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 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[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+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emerick, Carroll E. 21-14-0915
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
1 Citizens Bank-Checking Account No.6300104889. Principal balance as of date of death 30,131.65
$30,129.90;accrued interest$1.75.
2 2005 Chevrolet Malibu-VIN No. 1G1ZT52895F304024. Value per attached appraisal. 4,250.00
TOTAL(Also enter on Line 5, Recapitulation) 34,381.65
(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)
One Citizens Drive
ROP 112
Riverside, RI 02915
October 10, 2014
James D Bogar,Attorney At Law
One West Main Street
Shiremanstown PA 17011
Estate of Carroll E Emerick
Date of Death:Aug 22, 2014
S SN:
Dear Sir/Madam:
In accordance with your request, the attached information sheets have been provided in the above
decedent's name as of his/her date of death.
If you require anything further,please do not hesitate to contact me at(8770 579-2667 option 2.
Sincerely,
6
Kristen B. Correia
Decedent Account Processing
REF#: 664092
co &,a,
Ban'
Account Number 6300104889
Account Title Carroll E Emerick
Date Opened 9/16/2013
Account Type Checking
Principal Balance as of DOD $30129.90
Interest from Last Posting to DOD $1.75
Account Balance as of DOD $30131.65
YTD Interest to DOD $68.21
w
CRiSWELL 1 1 1 Frederick Road
Thurmont, MD 21788 , $4
CHEVROLET 888.881.3052
OF THURMONT
OWNER OF VEHICLE: Carroll E.E.merick
VEHICLE IU NO: I G I ZT52895F X05024
YEAR/MAKE/MODEL: 2005 Chevrolet Malibu
FAIR MARKET VALUE AS OF 8/22/201.4: $4,250
ABOVE INFORMATION PROVIDED BY:
SIGNATU E
TITLE
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CARROLL EUGENE EMERICK
915 NIXON DR
MECHANICSBURG PA 17055
• pennsylvania
DEPARTMENT OF TRANSPORTATION
• 1 CW*7as�oi✓the date of Issue,me omaelrr000raa a ens Penreytvenb Llep t • ., ALLEN`D KEHLER
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TO BE COMPLETED ABY�;P(JfICHASER WHEN VEHICLE IS SOLD AND THE
"APPLICAT16N 1' TITLE AND �140'RMATION APPROPRIATE SEC!!ONS tTME,REVE RISE SIDE OF THIS DOCUMENT ARE
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REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emerick,Carroll E. 21-14-0915
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trusteeis)
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
Joyce E. Emerick Wife Rest, Residue
915 Nixon Drive and Remainder
Mechanicsburg, PA 17055
Total
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as appopriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
A
LAST WILL AND TEST*M OF CARROLL E. EMERICK
I, CARRDLL E. EMERICK, of the Township of Monroe, County of
Cumberland and State of Pennsylvania, being of sound and disposing mind,
memory and understanding, do make, publish and declare this my Last Will
and Testament, hereby revoking and making void all former Wills by me at
any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses
as soon after my decease as the same can be conveniently donne.
2.
I give, devise and bequeath all the rest, residue and remainder
of my estate, real, personal and mixed, of whatsoever nature and wheresoever
the same may be situate, to my wife, JOYCE E. EMERICK, absolutely and un-
conditionally.
nconditionally.
3.
In the event that my said wife, JOYCE E. EMERICK, should prede-
cease me, or should she die at about the same time as I do, such as in an
accident common to both of us, or should she die within thirty (30) days
of my death, then upon the occurrence of any of such events, I direct the
settlement and distribution of my estate to be made in the following mariner,
to wit:
(a) I give and bequeath my entire coin collection to my
-1-
f'
grandson, SHAWN MICHAEL WILLIAMS.
(b) I give and bequeath all the rest, residue and remainder
of my estate, real, personal and mixed, of whatsoever nature and
wheresoever the sage may be situate, to my two daughters, to wit,
ELAINE MARTHA EVERICK GREEN and MELODY ANN EMERICK YOUNG, share
and share alike, per stirpes.
(b) Should my wife so predecease me, then in such event,
for the purpose of facilitating the settlement and distribution
of my estate, I authorize and empower my Executrices hereinafter
named to sell any and all real estate which I may own at the tine
of my decease,. as well as my personal property, at either public
or private sale or sales.
LASTLY, I nominate, constitute and appoint my wife, JOYCE E.
EMERICK, Executrix of this, my Last Will and Testament., and in the event
she should predecease me, or should she be unable or unwilling to serve in
such capacity for any reason, then in such event, I nominate, constitute
and appoint my daughters, ELAINE MARTHA EMERICK GREEN and MELODY ANN
EMERICK YOUNG, Co-Executrices of this, my.Last Will and Testament, in her
place and stead.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
144a day of December, A. D. 1987.
r
( � (SEAL)
Carroll E. Emerick
-2-
Signed, sealed, published and declared by the above-named
CARROLL.E. EHMCK, 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 subscribed our names as witnesses.
-j"�Ky_xZ_Z\'_
-3-
OCr2`MWEALZi OF PENNSYLVANIA)
)SS:
COUNTY OF CUMBERLAND )
it CARROLL E. EMERICK the tes tat or , 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 uV free and voluntary
act and deed for the purposes therein expressed.
Sworn and affirmed to and acknowledged,before me, the 11th day of
Pr A. D. , 19_d7
(SEAL)
otary
My Ca:mission Expires: September 21, 1991
M4VIMALTH OF PENNSYLVANIA)
)SS:
OD= OF CUMBERLAND )
We, the undersigned, T_ ROBERT STATTFWR and
JOHN M. EAKIN 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 the testator , CARROLL E. EMERICK ,
sign and execute the instrument as his/i= Last Will and Testament; that the said
tes tat or , CARROLL E. EMERICK signed the same willingly and
that the said CARROLL E. EMERICK , - executed it as his/hw free and
voluntary act for the purposes therein expressed; that each of us, in the hearing and
sight of the testator signed the Will as witnesses; and that to the best of our
knowledge the testator was, at the time, 18 or more years of age; of sound mind;
and under no constraint, duress or 1 ence.
Sworn and subscribed to before me this
14th day of December l87Z�L _71-Aa •
sem'
tary Public
Nfy Ccnrnission Fxpires: September 21, 1991