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Home My WebLink About12-23-14 � 15�5611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau oflndividualTaxes INHERITANCE TAX RETURN 21 13 1336 PO BOX 280601 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Dete Of BII'th MMDDYYYY 12142013 �221,1961, Decedent's Last Name Suffix DecedenYs First Name M� PATTERSON CHERYL LYNN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW � 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) � 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 ❑ �� 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 TO: Name Daytime Telephone Number KEITH 0 • BRENNEMAN, ESQ • 717-697-8528 REQI�TER OF WILL�E ONLY � c --� � m � o ;-�, c� cz� � � �? c3 First Line of Address �A� �� r,'� � �� C7 44 WEST MAIN STREET �� '= r'� w ��; � �,-, -:;-, Second Line of Address � ' � °�' � � �-� G 1 —� . � —T� , ,,.� � � � � + r t�,: `°.�: C'� City or Post Office State ZIP Code : r �� DATE FI � f1ECHANICSBURG PA 17�55 �� ~ "' a ct� `n 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. SIGNAlURE OF PERSON SP SIBLE F F G ETURN DA E ADDRESS NATHAN DOUGLAS PATTERSON, EXECUTOR 775 YALE STREET, APT • #304 , �RRISBURG, PA SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ` 17111 I L-�,�. <<�/�,//,� ADDRESS KEITH 0 • BRENNEMAN , ESQUIRE 44 WEST f1AIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY pA 17055 �'�\ Side 1 � � � 1505611185 15�5611185 OM4647 3.000 � 1505611285 REV-1500 EX(FI) Decedent's Social Security Number oe�ede�c�sName PATTERSON CHERYL LYNN RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . � � • 0� 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . Z � • �� 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C), , . . , 3, � • �� 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , q. � • 0� 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , . , , 5. 18,],18 • 4 9 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) . . . . . . . . . . . . . . . . . . g. 18,118 • �I 9 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. ],],,2 2 6 • 5 2 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , , . , . . . 10. 18,2 3 0 • 2� 11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11. 29,4 56 -72 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , 12. (],],,338 - 23) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , �3. Q - �� 14. Net Value Subject to Tax(Line 12 minus Line 13) , , , , , , , , , , , , , , , �4. (],],,3 3 8 • 2 3) TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers un�ler Sec.9116 (a)(1.2)X.0�� • �� 15. � • �� 16. Amount of Line 14 t xable at linea�rate x.0 4� 0 • 0 0 16. O • �D 17. Amount of Line 14 taxable at sibling rate X.12 � , �� • 0� 18. Amount of Line 14 taxable at collateral rate X.15 � • �� 18. � • �� 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. � •�� 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 � 1505611285 1505611285 J OM4648 3.000 File Number REV-1500 EX(FI) Page 3 Decedent's Complete Address: 21 13 1336 DECEDENT'S NAME PATTERSON CHERYL LYNN STREET ADDRESS 4 OUT A TR T CUMBERLAND STATE ziP ciTv MECHANICSBURG PA 1,7055- Tax Payments and Credits: 0 • 00 1. Tax Due(Page 2,Line 19) �� 2. Credits/Payments A. Prior Payments � •�� B. Discount 0 - �� Total Credits(A+B) (2) � • �� 3. Interest �3� � • �� 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. O - �O Fill in box 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) � • �� Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: X a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . : � � b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . ❑ � c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ � d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . 2. If death occurred after Dec. 12, 1982, did decedent 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 death? 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 fiting 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)j. • 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.39116(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. OM4671 2.000 REV-1508 EX+(OB-12) pennsylvania SCHEDULE E DEPARTMENTOF REVENUE CASH, BANK DEPOSITS 8�MISC. INMERITANCE TAX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Chervl Lynn Patterson 21 13 1336 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 �. Department of the Treasury 235.00 refund due the decedent on 2013 income tax return 2 Commonwealth of Pennsylvania 70.00 refund due the decedent on 2013 income tax return 3 2009 Volkswagon Eos 14,159.00 sale value 4 Orrstown Bank 3,059.36 checking account #149000626 5 Orrstown Bank 420.50 checking account #149000858 6 Travelers Insurance 149. 63 premium refund due the decedent 7 Holy Spirit Hospital 25.00 refund due the decedent TOTAL(Also enter on line 5,Recapitulation) $ 18,118.4 9 2wasqD 2 00o If more space is needed,use additional sheets of paper of the same size. REV-1510EX+�oB-o9, SCHEDULE G pennsylvania DEPARIMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Cheryl Lynn Patterson 21 13 1336 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 in��oETreruwneoFrr�rnHNSFEREE,THEiRRE�nnoNSHiaTooECEOENTnNo DATEOFDEATH %OFDECD'S EXCLUSION TAXABLE NUMBE Tr�onrEOFrRavsFeR arrncHncoav oF THe oeeo FOR Ren�esrnTe VALUE OF ASSET INTEREST iF rwPueae�E VALUE � State of New Jersey, Division of Pensions and Benefits 1,800.00 100.0000 1,800.00 0.00 Pension received monnthly ($1,800.00)from a 401A Plan. The decedent's only rights under the plan were to draw a monthly payment and to desiginate a beneficiary. Therefore, the plan is non-taxable and is listed for informational purposes only. The designated beneficiary on the plan was the decedent's sister who will be receiving monthly survivors' death benefit for the remainder of her life. TOTAL(Also enter on line 7,Recapitulation)$ ---- ---- 0.0 0 If more space is needed,use additional sheets of paper of the same size. 9W46AF 2.000 RE�-,5„Ex�"°-°9> SCHEDULE H pennsylvania oEPaaTMENTOF ReveNUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENTDECEDENT ESTATE OF FILE NUMBER Cher 1 L nn Patterson 21 13 1336 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: � Malpezzi Funeral Home, Inc. funeral services 6,556. 62 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 897.00 Name(s)of Personai Representative(s)Nathan Douglas Patterson StreetAddress 775 Yale Street, Apt. #304 City Harrisburq State PA ZIP 17111 Year(s)Commission Paid: 2. Attorney Fees: Snelbaker & Brenneman, P.C. (Estimated) 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 113.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal advertising Executor's Notice 75. 00 2 The Sentinel advertising Executor's Notice 222.40 Total from continuation schedules . . . . . . . . . 1,360. 00 TOTAL(Also enter on Line 9,Recapitulation) $ 11,226.52 swasac 2 00o If more space is needed, use additional sheets of paper of the same size. Estate of: Cheryl Lynn Patterson 21 13 1336 Schedule H Part 7 (Page 2) 3 Snelbaker & Brenneman, P.C. attorney services from 12/20/13 to 12/27/13 860. 00 4 Reserve for filing fees and other miscellaneous costs associated with the administration of the decedent's estate. 500.00 Total (Carry forward to main schedule) 1,360.00 RF�_,S,ZEX�"2.,z, SCHEDULE I pennsylvania o�Pw�TMENTOFRE�EN�E DEBTS OF DECEDENT, INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEOENT ESTATE OF FILE NUMBER Cheryl Lynn Patterson 21 13 1336 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. irEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH � CBE Group, collection agency for Verizon claim against the estate for phone service 325.41 2 DCM Services, collection agency for Chase Bank, USA N.A. claim against the estate for credit card debt, account # ending in 2225 1,525.82 3 Volkswagon Credit payoff on auto loan 6,348.72 4 Wells Fargo Bank, N.A. claim against the estate for cosigned educational loan for Benjamin M. Patterson 10,030.25 TOTAL(Also enter on Line 10, Recapitulation) $ 18 230.20 zwasnH z o0o If more space is needed, insert additional sheets of the same size. REV-1513EX+(01-10) SCHEDULE J pennsylvania DEPARTMENTOF REVENUE BENEFICIARI ES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Che 1 L nn Patterson 21 13 1336 REIATIONSHIP 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).] � Nathan Douglas Patterson 775 Yale Street Apt. #304 Harrisburg, PA 17111 Son 0.00 2 Benjamin M. Patterson 193 Alfred Street Apt. #1 Bidderford, ME 04005 Son 0.00 Ef�fTER DOLLAR AMOUNTS FOR DISTRIBUIIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. �� NON-TAXABLEDISTRIBUTIONS A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 8 CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ O.00 swasai z o0o If more space is needed,use additional sheets of paper of the same size. � � � ��'ill of�l-i��-y; L�'nr Pattersan _._ _ Part l. Personai Information I, Ch�ryl Lynn Patterson, a resident of the State of Pennsylvania, Gumberland Colinty, declare that this is my will. Part 2. Revocation of Previous Wills I revol:e all wills and codicils that I have previously made. Part 3. Marital Status I am inarried to Kiin Dou�las Patterson. Part 4. Children I have the following children now living: Nathan Douglas Patterson and Benjamin Michael Patterson. Part 5. Pets I leave Miniature Schnauzer, Bailey, to Nathan Douglas Patterson and Benjamin Michael Patterson to share equally. If either Nathan Douglas Patterson ar Benjamin Michael Patterson does not survive me, I leave Bailey to the other. If both Nathan Douglas Patterson and Benjamin Michael Patterson do not survive me, I leave Bailey to Laurie J. Owens. Part 6. Disposition of Property A bene�ciary inust survive ine for at least 45 days to receive property under this will. As used in tilus will, the phrase "survive me" ineans to be alive or in existence as an organization on the 45t11 day after my death. If I leave property to be shared Uy two or more beneficiaries, and any of them does not survive me, I leave his or her share to the others equally unless this will provides otherwise. My residuary est�te is all property I own at my death that is subject to this will that does not pass under a general or specific bequest, includinb all failed or lapsed bequests. I leave my residuary estate to Nathan Douglas Patterson and Benjamin Michael Patterson in equal shares. All personal and real property that I leave in this will shall pass subject to any encumbrances or liens placed on the property as security for the repayment of a loan or Page 1 of 4 Initinls: �"� d�� Date: .3 7 � C� Will of Cheryl Lynr� Patter�on debt. Part 7. Executor I name Nathan Douglas Patterson to serve as my executor. If Nathan Douglas Patterson is unwillin�or unable to serve as executor, I name Benjainin 1Vlichael Patterson to serve as executor. If Nathan Douglas Patterson and Benjamin Michael Patterson are both unwilling or unable to serve as executor, I name Laurie J. Owens to serve as executor. No executor shall be required to post bond. Part 8. Executor's Powers I direct iny executor to take all actions legally permissible to have the prabate of my will done as simply and as free of court supervision as possible under the laws of the state having jurisdiction over this will, including filing a petition in the appropriate court for � the independent administration of my estate. I grant to my executor the following powers,to be exercised as he deems to be in the best interests of my estate: � � 1. To retain property without liability for loss or depreciation. 2. To dispose of property by public or private sale,or exchange, or otherwise, and receive and administer the proceeds as a part of my estate. 3. To vote stock; to exercise any option or privilege to convert bonds, notes, stocks or other securities belonging to my estate into other bonds, notes, stocks or other securities; and to exercise all other rights and privileges of a person owning similar property. 4. To lease any real property in my estate. 5. To abandon, adjust, arbitrate, compromise, sue on or defend and otherwise deal with and settle claims in favor of or against my estate. 6. To continue or participate in any business which is a part of my estate, and to incorporate, dissolve or otherwise change the forin of orbanization of the business. These powers, authority and discretion are intended to be in addition to the powers, authority and discretion vested in him by operation of law by virtue of his office, and Page 2 of 4 Initials: �'�� Dat� �� Wil1 of Cher3�1 Lynn Patt�r�on may be exercised as often as is deemed necessary or advisable, without application to or approval by any court. Part 9. Payment of Debts Except for liens and encuinbrances placed on property as security for the repayment of a loan or debt, I direct that all debts and expenses owed by my estate be paid in the manner provided for by the laws of Pennsylvania. Part 10. Payment of Taxes I direct that all estate and inheritance taxes assessed against property in my estate or against my beneficiaries be paid in the manner provided for by the laws of Pennsylvania. Part 11. No-Contest Provision If any beneficiary under this will contests this will or any of its provisions, �ny share or interest in my estate given to the contesting beneficiary under this will is revoked and shall be disposed of as if that contesting bene�ciary had not survived me. ' Part 12. Severa6ility If a court invalidates any provision of this will, that shall not affect other provisions that can Ue given effect without the invalid provision. Signature I, Cheryl Lynn Patterson, the testator, sign my name to this document, this .��°�"� day of_��GG� , a��l , at �9�'QnTr7Gf'� , C.�rn�'l,�iK� �Q�hf�l , f�ili2tyll�ari7�i. (city or county, and state) I declare that I sign and execute this document as my last will,that I sign it willingly and that I execute it as my free and voluntary act. I declare ihat I am of the age of majority or otherwise legally em owered to make a will, and under no constraint or undile influence. Signature: Witnesses We, the witnesses, sign our names to this document, and declare that the testator willingly sib ed and executed this dociunent as the testator's last will. In the presence of�he testator, and in the presence of each other, we si�m this will as witnesses to the testator's si�ning. Page 3 of 4 Initials: w�� Date: 3 I' �'�'ill �f C��r3�1 Lynr� Pattersan To the best of our knowled�e, the testator is of the age of majority or otherwise leg�lly eTnpowered to make a will, is of sound mind and is �mder no constxaint or Lmdue influence. We declare under penalty of perjury that the foregoing is tnle and correct, this �V�,��,�n day of �rG� , �t 1 , at C��'y� na M� Q t; (city or county, and state) Fzrs� l�'itness Sign your naine: Printyour name: I�k�ed r,��r�! �t GiAST'on�(��Ay Address: J�5 W• M�� Do� �i�• City, State: �� NA�r C5 P�u� PA ��5�' Second �tness - �� Sign your name: Print your name: �< < � Address: � �� t/ ' City, State: �� V �-�''t� Date: �� / Page 4 of 4 Initials: � �� Affidavit ACKNOWLEDGMENT State of Pennsylvania County of: �1�L�� I, „�� Y � ��ls� , the testator whose name is signed to the attached or foregoing instrument, having been duly ��aalifiPd according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act far the purposes therein expressed. �'/��/ Testator: Officer: �{,�,��/l� i'�' l 1" ��•(-�'-� � :.�3»��as��,��.::�.a��-��i��v��,�„�� _.�_.._r_.�.�_;ao��ae scai -- ' sias�r��1.P.Deitch,Motary Pubiic �;�pr�r�i!;��:revp.,CumCeriand County � �9y�::c�s��sr,�.�lon E�,pl�a:s Or�.21,2083 �:�F,;�,7r:�rosvlv�ria Associat!on of Nc�rles Affidavit—Page 1 of 2 �ffi�avit AFFIDAVIT State of Pennsylvania County of: ��,1.'�`��C�2 v�G� We, �r�-�� ',.1 M. Ch 5 ont�u A and � I�� ,the witnesses whose naines are signed to the attached o oregoing instrument, having been duly qualified according to ]aw, do �epose and say that we were present and saw the testator sign and execute the instrument as his/her Last Will;that the testator signed willingly and executed it as his/her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by �,1-�\p�21^� �l1, �g-�pV� and �r • �0 U� , witnesses, this S2�en�ln day of �V1ar-�a� ,��— Witness�-1 Witness: . �� Officer: � • �/ CCB�NlC�a�'J'�f��.�;�6�o��'Ei'�PvSYi..`dh��A ? R�Potariai S�al 5usa�a M.�.C�°3tch,P3otary PuGifc � �D�rg�r Allen i vvp�,,Cuim�eiiand Counly h9y C,�mmisslon Fxpl�s Oct.21,2013 Member,Pan�sv�vania As;oclatlon of tdotaries Affidavit—Page 2 of 2