HomeMy WebLinkAbout12-30-14 � 1505610140
REV-1500 EX �°,_,°>
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes �NHERITANCE TAX RETURN County Code Year File Number
Po Box 2soso� 2 1 1 4 1 0 2 7
Harrisbur9,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 8 2 1 2 0 1 4 1 2 2 6 1 9 2 2
DecedenYs Last Name Suffix DecedenYs First Name MI
S H 0 E M A K E R C • A D R I A N
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
S H 0 E M A K E R A N N A C
Spouse's Social Security Number
1 9 3 1 2 8 3 3 0 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL I�d APPROPRIATE OVaLS BELOW
O 1.Original Return � 2.Supplemental Return � 3.Remainder Return(date of death
priorto 12-13-82)
� 4.Limited Estate � 4a. Future Interest Compromise(date of � 5.Federal Estate Tax Return Required
death after 12-;2-82)
❑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. Li;igat6on F�oceeds Re�eived � 10.�pousal�ovarty Crea�t(date of deatF � 11.Ele�tion tc tax und�r Sec.91 i3(A)
between 1231-91 and 1-1-95) (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
NamE Daytirra Telephone Numt� � rn
M A R C U S A - M c K N I G H T , I I I 7 1 7c �, 4 9 � 3��5�
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6 � W E S T P 0 M F R E T S T R E E T ^µ' ~'� -_ � �
City or Post Office State ZIP Code DATE FILED
C A R L I S L E P A 1 7 0 1 3
CorrespondenYs e-mail address:
U enalties of perjury,I declare that " return,incfuding accompanying schedules and statements,and to the best of my knowledge and belief,
it is true, rcect and compleke.D a' n of prepa�er other th the�+ersenal representati��e is tased on all�r.formation of which preparer haa any knowledge
P SON R PON FOR FILING RETU I � � 9 A E
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1,4 BIDDLE DRIV CARLISLE PA 17013
SIGN URE OF PREPA ER THAN REPRESENTATIVE ATE
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0 WEST POMFRET EET CARLISLE PA 17013
�- PLEASE USE ORIGINAL FORM ONLY
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REV-1500 EX Page 3 File Number
�ecedent's Complete Address: 2� 14 �027
DECEDENT'S NAME
C.ADRIAN SHOEMAKER
STREET ADDRESS
1 LONGSDORF WAY
��n' srArE ziP
CARLISLE PA 17015
Tax Payments and Credits:
�� Tax��e;Page 2,Line'9) (1) O.00
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+g) �2� 0.00
3. Interest
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. (3)
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. !f Line 1 +�ine 3 is greater inan I.ine 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: ...................................................................... [�J �
b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ X❑
c. retain a reversionary interest;or ................................................................................................ ❑ 0
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ X�
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? ......... ❑ QX
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
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
ilir.g a tax retum a�e still applicable even if the surv�ving spo�se is±he c�nly 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(1.2)[72 P.S.§9116(a)(1)].
• 7he tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.�.§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+(OS-12)
p�nnsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC.
INHERITANCE TAX:'2ETURN
RESIDENTDECEDENT PERSONAL PROPEI�TY
ESTATE OF: FILE NUMBER:
C.ADRIAN SHOEMAKER 21 14 1027
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. NATIONWIDE INSURANCE 43,381.56
LIFE INSURANCE POLICY#0003104410
BEP.IEFICIARY: THE �STATE OF C. ADRIAI�! SHOEIl4AKER
i
TOTAL(Also enter on Line 5,Recapitulation) $ 43 381.56
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
� pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
C.ADRIAN SHOEMAKER 21 14 1027
DecedenYs debts must be reported on Schedule I.
ITEM
NUN!BER DESCRlPTION AMOUNT
A. FUNERA�EXFENSES:
1.
B. ADMINISTRATIVF COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
��Y State ZIP
Year(s)Commission Paid:
2, AttomeyFees: IRWIN & McKNIGHT, P.C. 3,000.00
3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.)
Claimant
Sfreet Address
��Y State ZIP
Relationship of Claimant to Decedent
4� ProbateFees: REGISTER OF WILLS 140.50
5 Accountant Fees:
6. Tax Retum PreparerFees: PATRICIA A. ROSENDALE, CPA 375.00
FINAL FIDUCIARY TAX RETURiV
7.
70TAL(Also erter on Lins 9,4ecapitulation) I $ 3 515 50
if more space is needed,use addifional sheets of paper of the same size.
REV-1513 EX+(01-10)
pennsylvania S�,yEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERI?ANCE TAX F.ETLR�J
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
C.ADRIAN SHOEMAKER 21 14 1027
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee�s) OF ESTATE
I 7AXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. ANNA C. SHOEMAKER Spousal 39,866.06
1 LONGSDORF WAY REMAINDER
CARLiSLE, FA 17015
ENTGR DOL�R AMOUNTS F�R D!STR!SU?IONS SHOWN ABO�lE ON LlNES 15 TNROUGH 18 OF REV-1500 CO�fEP,S!1EET,AS APPROPRI.4TE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBU?IONS UNDER SFCTION 91?3 FOR WHICH AN ELECTION TO TAX IS NOT TAK.FN:
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.
� � ' `
��� G�!'�G�'i.�V�G�l�B�L�
�
� C���'Q/�'GQ/!L ��1��Zld�
I, C• ADRIAN SHOEMAKER, of the Borough of Cazlisle, Cumberland County,
Pennsylvania, declaze this instrument to be my Last Will and Testament, hereby expressly
revoking a11 Wills and Codicils heretofore made by me.
ONE: I direct my Executrix to pay all of my debts, funeral and administrative expenses
as soon as may be done conveniently after my decease. Furthermore, I direct that all state,
inheritance, succession and other death taxes imposed or payable by reason of my death and
interesri and penalties thereon with respect to ail property composing of my gross estate for death
tax purposes, whether or not such properry passes under this Will, sha11 be paid by the Executrix
from my estate, and that none of the aforesaid taxes sha11 be prorated among those persons or
entities named herein or otherwise beneficiaries hereunder.
TWO: I give, devise, and bequeath a11 of my esta.te of every nature and wherever situate
to my wife, ANNA C. SHOEMAKER, provided she survives me by thirty(30)days or more.
THREE: If my estate exceeds $310,000.00 net after payment of all expenses and
inheritance taxes, then I specifically give, devise, and bequeath the sum of$1,000.00 to each of
my grandchildren,the sum of$500.00 to each great-grandchild and any step-grandchildren.
If any of my grandchildren or step-grar.dchildren should predecease me, the shaze of said child
will be distributed prior to my residuary estate. If any of my grandchildren have predeceased me
without living issue, the share of said grandchild will be equally distributed to my living
grandchildren.
�' r �, �,
FOUR: All the rest, remainder, and residue and of my estate, I give, devise; and
bequeath to the following:
a. To ANN C. SNYDER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33'/s%;
b. To NATALIE E. PARENTEAU . . . . . . . . . . . . . . . . . . . . . . . . . 33%%;
c. To JEANNE L. QiJINTILE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33%3%;
If one of my children named above should predecease me, the share of said deceased
child would be distributed equally to the living issue or adopted children of said deceased child.
FIVE: I appoint ANNA C. SHOEMAKER to serve as Executrix of this my Last Will.
If she has predeceased me or failed to qualify or ceased to serve as Executrix, I appoint
STANLEY W. ALBRIGHT, to serve as Substitute Executor of this my Last Will. If he has
predeceased me or failed to qualify or ceased to serve as Substitute Executor, I name, MARCUS
A.McKNIGHT,III, to be the Substitute Executor of this my Last Will.
SIX: My Executrix may, at her discretion, compromise claims, borrow money, retain
properry for such length of time as she may deem proper; lease and sell property for such prices,
on such terms, at public or private sales, as she may deem proper; and invest estate property and �
income without restriction to legal investments.
SEE'EN: No Exes�ttrix, or Substit�te Executor acting rereunder srall be required to
post bond or enter security in this or any jurisdiction.
EIGHT: I direct my Executrix or Substitute Executor to retair� the servi�es of
MARCUS A. McKNIGHT, III, Esquire with regazd to the settlement of my estate. I further
suggest that upon m f death that my wife retain thP servic�s of MARCUS A. McKNIGHT,III,
ESQUIRE,at a reasonable monthly fee,to assist her with her finances.
2
S' t . .
YN WITNESS WHEREOF, I have hereunto sei my hand a.�id seal �his 21 st day of
August 2012.
C. �
EAL)
C. ADRIAN SHO MAKER
Signed, sealed, published and declared by C. ADR�AN SHOEIVIAK�R, the above
named Testator, 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 subscribed our names as witnesses
hereto.
C(iC-U'� �^ SK/'�s.d.rd� .�
. Q-� �,
3
f � . ,
ACKNOWLEDGMENT AND AFFIIaAVIT
WE, C ADRIAN SHOEMAKER, SHARON L. SCHWALM, and TRACI D.
SMITH, the testator and witnesses respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declaze to the undersigned authority that the
testator signed and executed the instrument as his last will and that he had signed willingly, and
that he executed it as his free and voluntary act for the purpose herein expressed, and that each of
the witnesses, in the presence and hearing of the testater, sign�d ±he witl as a�i�itness and that to
the best of their kn�,wledge the testator was, at trat time, eighteen years of age or older, of sound
mind and under no constraint or undue influence.
C. �
C ADRIAN SHOEMAKER
�l>—�t/1� �. �C/�i�-E�w
SH ON L. SCHW ,.�,
CI D. SMITH
COMMONWEALTH OF PENNSYLVANIA .
. SS:
COUNTY OF CUMBERLAND .
Subscribed, sworn to and acknowledged before me by C. ADRIAN SHOEMAKEI�, the
testator herein, and subscribed and sworn to before me by S ON L. SCHWALM, and
TRACI D. S1dII 1 H,v�itresses,this 21 st rlay of August �l. � '% _.�
� -
, � i�
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COMMONW�►L`PM Of�I��NN�YLVANXA � '
Notarial Seal 1�To ty P blic �—_
Martha L.Ncel,Notary Public �
Cariisle Boro,Cumberlana�:;ounry �-
My Commissio�=�-� �. .8,2015
�.,�W��-- -� � %�n oF Nora�s COMMpNWFALTH OF PENNSYLVANIA
COMMONW��-TM aF�NNSYLVANIp► Notarial Seal
�������� Martha L.Ncel;NoWry Public
N���p���� Carlisie Boro,Cumberland County
MBRha L.Niie�� My Commisslon Expires Sep4 18,2015
Cadisle earo,E�m���ntl�� MEFISER,PJ4hSYLVANtA lSSOCIATSO4 OF NOTARIES
missian i�s 9e �8 1315
MY�m, ..... ._
MEM6ER� EN AN
Fax Server 9/17/2014 8:16; 52 AM PAGE 2/005 Fax Server
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' �^��� '�RnAa!!S'�,4'+8�' Karen
A A�F9f raR P�ge 1 oi 1
�7JNJl)�� Y � r ���
""u{{`#- ' E���4�r"`. Daie prepared Se�lember 17,2014
Policy niunber �003104410
(luestions? Ca11800-882-2822
Visit us online Go io n�timwide.com to learn
about our producls,services and
more.
Karen
Fax:717-249-6354
Important claim Dear Karen,
information Please accept our sincere sympathy for the loss of C Adrian Shoemaker. Please
see belaw far a list of everything we need to process the insurance claim.
Policy details
Insured: C Adrian Shoemaker
Policy number: 0003104410
Beneficiary(ies): Estate oF C Adrian Shoemaker
Contingent beneficiary(ies):
What you need to do
� ����� Please send us the following item(s)in the envelope provided,or by fax to 888-
� 677-7393,or by email to Powert3@nationwide.com:
. A completed Claimant Statement: each primary beneficiary named above
must complete each part of the form
�� � �/���� • A certified copy of the Letters of Administration or Letters of Testamentary for
i � the Estate of C Adrian Shoemaker
For help when you need it
If you have any questions or need additional information about this claim, please
contact me by calling 800-882-2822 ext. 56539.For all other contract
information,simply dial 800-848-6331 and our customer service specialists are
happy to help.
Sincerely,
�;,'.'4;; , . ;_� ;'.% � ;.' r
:i�.'.•' ;I•',.+�%::,.. ;.' �!}fY;.,`:",f' i
Theresa Power
Nationwide Life Insurance Cornpany and/or Nationwide Life and Annuily Insurance Company;PO Box 182928 Coltvnh►�s OH 43218
Life Insuranc�and Annuities are issued by Nationwid�Gfe Insurance Company and/a Nationwitle Life and Annuibj Insurance Compan�,Columhus.�hio.The
�enaral dlstribulor for variabls insuranca protlucls is fJa[ionwitle Invesimen[Seriices Corpora[ion,rnernber FINRA.In MI only:NaGonwiCe Invaslmen[Svcs.
Cnrpnratinn.Natimm��ir's Finandal anrl tlie Natinnuvirle framamark ara sarvir.e rnarks nf Na[innwirle Mutual Insuranr.a Cnmpany. SLN-OA19An