HomeMy WebLinkAbout01-08-15 (2) 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 DEPARTWNTOFREMUE
PO BOx.280601 INHERITANCE TAX RETURN 21 15 '�O
Harrisburg,PA 17128-0601 RESIDENT DECEDENT `J 0111D
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
03 20 2014 03 04 1920
Decedent's Last Name Suffix Decedent's First Name MI
SELGRATH MIRIAM R
(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
X❑ 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
(dale of death after 12-12.82) ❑
RX
S. Decedent Died Testate ❑ T petach❑ Main��jned a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of will) (Attach&M o crust)
❑ 9. Litigation Proceeds Received ❑ 10.b9iweenP�1 31i a dit{Da�S�f Death ❑ 11.Election to tax under Sec.9113(A)
(Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MICHAEL J CASSIDY (717) 761 4540
REGISTER OF WILJ,,§USE ONLY
n o
First Line of Address 'o `_rl --Z;`m
301 MARKET STREET rn, C>
Second Line of Address " r-
.�z .r71 GC? CT't rn
PO BOX 109 QD "-' o C>
City or Post Office State ZIP Code EFATE F D "n
LEMOYNE PA 17043fesrn
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tri -n
Correspondent's e-mail address: mjc@?jdsw.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.
SIGNATURE OF PERSON R ONS
IBL FO FLING RETURN DATE
�,- -C Miriam Eichelber er
ADD —
511 Sharon Avenue, Mechanicsburg, PA 17055
SIGNATURE OF PREPARER THER THANBEPRESENTATIVE DATE
[ Michael J Cassidy
ADDRESS
301 MARKET STREET, Lemoyne, PA 17043
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Selgrath, Miriam 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&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 270 . 71
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) u Separate Billing Requested............ 7. 2, 000 . 00
8, Total Gross Assets(total Lines 1 through 7)........................................................ 8. 2,270 . 71
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 17,584 . 92
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10.
11. Total Deductions(total Lines 9 and 10)................................................................ 11, 17, 584 . 92
12. Net Value of Estate(Line 8 minus Line 11).................................................:........ 12. -15, 314 . 21
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. -15, 314 .21
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 "0 . 00
(a)(1.2)X.00 0 . 00 15.
16. Amount of Line 14 taxable 0 . 00
at lineal rate X .045 0 . 00 16.
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
15�56�,0243 1505610243
REV-1500 EX Page 3 File Number 21
Decedent's Complete Address:
DECEDENT'S NAME
Selgrath, Miriam R
STREET ADDRESS
511 Sharon Avenue
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;.................................. H x
c. retain a reversionary interest;or............................................................................................................... x
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?.................................................................................................................... ❑ 0
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 172 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+(111.10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Selgrath, Miriam R
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right ofsurvivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Fulton Bank Checking Account 153.56
2 Fulton Bank Variable Rate CD 117.15
TOTAL(Also enter on Line 5, Recapitulation) 270.71
(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)
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE /�
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Selgrath, Miriam R
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.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSER.SFEREE ATTACHTHEIR A COPY OF THE DEIP TO ED FFOREREAL ESTATE. VALUE OF ASSET EDENT AND INTEREST (IF APPLICABLE) VALUE
1 Office of Personel Management(OPM) -Death 2,000.00 2,000.00
Benefits Payable to Miriam Eichelberger, Daughter
TOTAL(Also enter on Line 7, Recapitulation) 2,000.00
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDENTRETURN
SIDENTDECEDENTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Selgrath, Miriam R
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 17,284.92
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid
2. Attorney's Fees JOHNSON DUFFIE 300.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees
C
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL(Also enter on line 9, Recapitulation) 17,584.92
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
ESTATE OF MIRIAM R. SELGRATH
SCHEDULE OF EXHIBITS
EAWIBITA bast Will and Testament of.Miriam R. Selgrath signed and dated
April 29, 2010.
EXHIBIT B Death Certificate.
EXHIBIT C Fulton Bank Statement for Checking and Certificate of Deposit
Account
1
i
:673261
ESTATE OF MIRIAM R. SELGRATH
SCHEDULE OF EXHIBITS
EXHIBITA Last Will and Testament of Miriam R. Selgrath signed and dated
April 29, 2010.
EXHIBIT B Death Certificate.
EXHIBIT C Fulton Bank Statement for Checking and Certificate of Deposit
Account
:673261
Last Will and Testament
of
MIRIAM R. SELGRATH
I, MIMM R. SELGRATH, of Hampden Township, 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 and making void any and all
Wills or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS
I direct the payment of my legally enforceable debts and the expenses of my last illness
and funeral from my estate as soon after my death as conveniently may be done.
ARTICLE II
TANGIBLE PERSONAL PROPERTY
I give and bequeath my motor vehicles, household and personal effects and other tangible
personalty of like nature (not including cash or securities), together with any existing insurance
thereon, unto my daughters, MIRIAM C. EICHELBERGER and JUDITH S. STARE, to be
divided between them with due regard for their personal preferences in as nearly equal shares as
possible. If there are any remaining items or any disagreement as to the disposition of any item
or items described in this Article, I direct that such item or items shall be sold and disposed of in
accordance with the terms set forth in Article III.
EXHIBIT A
ARTICLE III
REST, RESIDUE AND REMAINDER
I give and bequeath the rest, residue and the remainder of my estate, of whatsoever nature
and wheresoever situate, to my daughters, MIRIAM C. EICHELBERGER and JUDITH S.
STARE,to be divided between them in equal percentages.
ARTICLE IV
UNIFORM TRANSFERS TO MINORS
In the event that any beneficiary of my Will shall not have reached the age of eighteen
(18) years at the time for distribution of his or her share, distribution of said share may be made
in the discretion of my Personal Representative after considering the age and needs of the
beneficiary, either directly to the beneficiary or to a Custodian under the Pennsylvania Uniform
Transfers to Minors Act, 20 Pa. C.S.A. § 5301 et seq., or the applicable Uniform Gifts to Minors
Act or Uniform Transfers to Minors Act in the state of residence of such beneficiary as the case
may be. My Personal Representative may designate as such Custodian any institution or person,
including my Personal Representative, qualified to act as a Custodian for such beneficiary under
such Act in effect at the time such distribution is made. A receipt for any payment or
distribution so made shall be a full discharge therefore to my Personal Representative, who shall
not be responsible to see to, or be liable for, the application of such proceeds thereafter.
ARTICLE V
POWERS OF PERSONAL REPRESENTATIVE
My Personal Representative (Executrix or Successor) shall have the following powers in
addition to those vested in her by law and by other provisions of my Will applicable to all
property, whether principal or income, including property held for minors, exercisable without
court approval and effective until actual distribution of all property:
2
n
A. To make distribution in cash or in kind, or partly in cash and partly in kind, and in
such manner as they may determine.
B. To retain any or all of the assets of my estate, real or personal, without restriction to
investments authorized for Pennsylvania fiduciaries, as they deem proper, without
regard to any principle of diversification or risk.
C. To invest in all forms of property without restriction to investments authorized for
Pennsylvania fiduciaries, as they deem proper, without regard to any principle of
diversification or risk.
D. To sell at public or private sale, to exchange, or to lease for any period of time any
real or personal property and to give options for sales, exchanges or leases, for such
prices and upon such terms or conditions as they deem proper.
E. To allocate receipts and expenses to principal or income or partly to each as they
from time to time think proper.
F. To compromise any claim or controversy.
G. To make such elections, decisions, concessions and settlements in connection with
all income, estate, inheritance, gift, generation skipping or other tax refunds and the
payment of such taxes as my Personal Representative shall deem appropriate,
without obligation to adjust the distributive share of any person thereby affected.
H. To combine, without prior court approval, any Trust contained in my Will with any
other Trust with substantially similar provisions, although such Trust may have
been created by separate instrument.
3
y
ARTICLE VI
PERSONAL REPRESENTATIVE
I appoint my daughter, MIRIAM C. EICHELBERGER,Executrix of this, my Last Will
and Testament. Should my daughter, MIRIAM C. EICHELBERGER, fail to qualify or cease
to so act, I name, constitute and appoint my grandson, JAMES E. EICHELBERGER, as
Alternate Executor to complete the administration of my estate. No fiduciary appointed herein
shall be required to post bond for the faithful administration of the duties required in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this a9 day of
d/ 2010.
(SEAL)
MIRIAMR. SELGR,4Af
Signed, sealed, published and declared by the above-named Testatrix as and for her Last
Will and Testament in the presence of us, who, at her request, in her presence and in the presence
of each other,have hereunto subscribed our names as witnesses.
:399338
4
AFFIDAVIT AND ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
We,MIRIAMR. SELGRATH, /G/��� ,T. ( /Q�G/ , and
cS(•l-i'Gt/� �- �-�d�GH't the Testatrix and the witnesses,
respectively, whose names are signed to the attached or foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the
instrument as her Last Will and that she had signed willingly and that she executed it as her free
and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence
and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge
the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint
or undue influence.
MIRIAMR. SELGRATH
Witness / 1
Witness
Subscribed, sworn to and acknowledged before me by MIRIAM R. SELGRATH,
Testatrix, and subscribed and sworn to before me by M I CAd_e/ J,
and &6tr" Afi1CQ7a,,--i , witnesses, this 99'J5 day of Aq,j
2010.
U11 Maqa- f
Notary Public
5
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