HomeMy WebLinkAbout02-05-14 �
J �. pennsytvania 15 0 5 61410 5
��"�0i�� EX(03-14}(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN � �� �q,(� /f
Harrisburg, PA 17128-0601 RESIDENT DECEDENT /�7 �'��
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
� VZ-1 Z-2�� ��-�' I�Zg
DecedenYs Last Name Suffix Decedent's First Name MI
/�'���c�r� ��-�-�� �
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
� /'�
I'1'O � ��� ��, i� 1 �
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE�
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death
priorto 12-13-82)
p 4.Agriculture 6cemption(date of � 5.Future interest Compromise(date of 0 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
p 7.Decedent Died Testate p 8.Decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
� 10.Litigation Proceeds Received p 11.Non-Probate Transferee Retum p 12. Deferrai/Election of Spousal Trusts
(Schedule F and G Assets Only)
Q 13.Business Assets O 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
r �
�1G�1 Le�c ��l�� �`�i//�.5 �1�8� �'qf�"" l�q�
First Line of Address
oZ�?� E ���i5e �v�e-
Second Line of Address
City or Post Office State ZIP Code
��t<S�- ._1_.I� ��7o Co
Correspondent's email address:
REGISTER OF WILLS USE ONLY
REGISTER OF WILLS USE ONLY ��->>
DATE FILED MMDDYYW `-' �J
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DATE FFLF�SY, P , : '`�
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PLEASE USE ORIGINAL FORM ONLY "
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Side 1 f�� `:- ��
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(\) V� �
i iiiiii iiiii iiiii����u������!�����iiiii iiiii iiii iiii . � J�'
� 15�5614105
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� 15�5614205
REV-1500 EX(FI)
Decedent's Social Security Number
DecedenYs Name: I )�j�� �� ��� ���`� ����
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 and Notes Receivable(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5.
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. i y� � ���
7. Inter-Vivos Transfers 8�Miscellaneous Non-Probate Property �
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7).................:........... 8. � � q �
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. r/I ���]
l /
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10.
11. Total Deductions(total Lines 9 and 10)................................. 11. �` � � �
12. Net Value of Estate(Line 8 minus Line 11).............................. 12. ! ��� ���
13. Charitable and Govemmental Bequests/Sec.9113 Trusts for which
an election to tax has not been made(Schedule J) ........................ 13.
14. Net Value Subject to Ta�c(Line 12 minus Line 13) ........................ 14. '�S� ��
TAX CALCULATION-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.o- � C-,�/'� � �� 15.
`,! V
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 1 g,
19. TAX DUE......................................................... 19. --�
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Under penalties of perjury,I declare 1 have examined this retum,inGuding accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,cortect and complete.Declaration of preparer other than the person responsible for filing the retum is based on all infortnation of which preparer has
any knowledge.
SIGNQT RE OF P RSON R PONSI�,I�Cj FOR ILING RETURN DATE -
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AD �S � �. � � �
L}
SI AT E OF PA E R T N R PONSIBLE F F T ETURN DAT
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A �
L i i�ii iiNi iiiii iiiii�ii iiiii i�ii i�i�iiiii iiiii iiii iiii Side 2
7,� 561 2 1505614205 J
REV-1500 EX (FI) Page 3 Fiie Number !
Decedent's Complete Address: �L "� �-" ��l�
DEC D T'S NA �
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STREETADDRESS
� ��
CITY STATE � ZIP�����
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Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) �
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions.) 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.
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) Pe''�
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 N,c-o,�/
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.............................................................................................................................. ❑ t,��G,/
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ f►d"
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................................. ❑ �j
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 ftom tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the suroiving 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 step-parent 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 decedenPs sibiings 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-igo9 EX+(oi-io)
��f.����pennsylvania SCNEpULE F
DEPARTMENTOFREVENUE ]OINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: . FILE NUMBER:
Vr'L�-�� J - ��n -� � - � � � ��I��f
If an asset became jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
��irl {�- ��i�n 31�� �' r�.n i��
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e. �e,�,r �i� �� 1�70�
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JOINTLY OWNED PROPERTY:
�rrEa oa� DESCRIPTION OF PROPERTY %oF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OP FINANCIAL INSiITIff[ON AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFVING NUMBER.ATTACH DEED FOR lOINTLY HELD REAL ESTATE. VALUE OP ASSEf 1NTEREST DKEDENT'S 1NTERESi
�. A. j�a� ���s ��r�'� `�- �t�� gt�� 6a � ��; 9�'
�' l�s��. �f� ► 7� � �
ar l
`��~c�. �G���-
TOTAL(Also enter on Line 6, Recapitulation) $ ��� (��
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
� µ.' �pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX REfURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF � � FILE NUMBER
V t�-�r' �� ll`�'� sc�ra Zl -1�- �L��9`�
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. — o` a_
�Q ��n�-`f�-t�G, ��c�er�..L i-��r�� �'7 3!�`7
�
e. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City _ _State ZIP
Year(s)Commission Paid:
2. Attorney Fees:
3. Family Exemption:(If decedent's address is not the same as ciaimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
��
TOTAL(Also enter on Line 9, Recapitulation) � � ,3��
If more space is needed,use additional sheets of paper of the same size.
COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE
COUNTY OF CUMBERLAND
y �F C�M ' - `
�,� �~ � e�`� I, LISA M. GRAYSON, ESQ.
O Z R e g i s t e r f o r t h e P r o b a t e o f W i l l s a n d G r a n t i n g
V D � Letters of Administration in and for
� CUMBERLAND County, do hereby certify that on
the 21st day of October, Two Thousand and
Fourteen,
y750 Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
estate of V/CTOR J MAD/SON , late of M/DDLESEX TOWNSH/P
(First,Midd/e,LasU
in said county, deceased, to SHIRLEYA MADISON
(First,Midd/e,Last)
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 21st day of October
Two Thousand and Fourteen.
File No. 2014- 00994
PA Fi 1 e No. 21- 14- 0994
Da te vf Dea th 2/12/2013
S. S. #,
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Register f ills �.
i ( �
_ `-__�-�
eputy
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NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 5.6(a)
i REG STER OF�VILLS
�=�=-'ei�'` COUNTY,PENNSYLVAI+TIA
Name ofDecedent• � � � � �� �
<
Date of Death: � File Number. -' � — i-�-
Date Letters Granted: � �' � c� ��' �
To the Register:
I certify that Notice of Estate Administration required by pa,O.C.Rnle 5.6(a)of ttte Qrphans'Court
Rules w s sei ed on or mailed to the following beneficiaries of the above-captioned estate on
� � � ��
ame: _ �: '
. _
� � �s �. �`�� c�v�
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(If m�e space is needed attcrch sepm-arte sheet)
Notice has now been given to alI persons entit2ed thereto under Pa.O.C.Rule 5.6(a)elccept
j�--� �� "� 2�}�� _ �
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Signa�ure ofPerson Fil6ig this Farm
Capaciry: �ersonal Representative C]Counsel
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Nmhe ofPerson F'dmg rh'v Form
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Telepho,rs� �
Form RiP-QS reu 10.13 06
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� 1IaDETH� � � `s� :..- -' Jsa�a:- �
i � �-� 7 �n tne yenr � .
� o)our Lord one tAousa„d,�int Au„d,id and sixty-five (1965), _
if �
BETWEEN CLYDE E. BRENVER and PEARL T, BREN"lER, his wife, of North j
�fi3dleton• Tak-nsh:p, Cumberlaz� CaunYy� Pennsylvania� heseinafter
called •
Grantor5 , �
and VICTOR J. �fAD2S0Y and SNIRLEY A: �(ADI504� his xife� of the �
BorouEh of Cariisle, Cumberland County, Pennsylvania, hereinafter
called
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I . Cranlees : �
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I RITVESSETN, u,at ia eonsiderns;o„ v/ EiYhty Five Hundred (f8500.00)
Dollara,
i in hand paid,the reuipt wheseo/u here6y aeknowledDed.the aaid pmntor 5 do hereby prnnt � �
Irz:.d c�n:;r��u:t aa;d y„aA�e s, their heirs and assigns� •
i ALL those certain two tracts of land situate in Diiddiesex Tok7tsFiti, �
: Cumberland Counxy, Psnns/lvania� hounded and described as folloNs: � • +
! TRdCT !;0, 1. - LOT A. BECIYYI`JC at a point on the center line of h `
['ennsylvania lii�hh•ay :�o. 34, 6ein� the road leading �
fror.. Carlisle to Sterrett's Gap.at. line of lands a6out to be conveyed �
to Clarence E. Lauer et al;'xAich point is located 495.58 feet South of
lands now or fornerly of I�'illiam �filler; tlience by the center of the said �
niEhway Vorth 24 degrees 45 ninutes East-60 feet to a point on line of
other lands about to be conveyed eo .ClyJe E. Brenner and being Lot B '
hercin; thence by said lands South 65 degrees 15 minutes East 160 £eet �
to a point in lir.c of other lands about to be conveyed to Clyde E, erenner �
and being Tract Vo. 2 herein; rhence .by said lands South 24 de£rees 45 � �
minutes Icest 60 feet to line o. lands about to be conveyed to Clarence E. � �
�auer et al; thence by said lands ,\orth 65 degrees 15 minutes liest 160 I
eet to the place of Beginnin�.
i
I
LOT d. BEGI�`:IVC at a point on the center line of I'ennsylvania Hi�h�•aY �
:�o. 34� being the zoad leadinE fro�r Carlisle to Sterrezt's Ca�, ;
at line oi lanJs about to be conveyed to Clyde E. Brenner and beinr Lot j
,1. herein, uhich point is located 435,53 feet South of lands now or � �
iorr.,erly of l;illian ;•filler; thence by the center of said hi�hwav tiorth 24
de�rees 45 ninuLes East 60 �eet to a roint on the South side of�a ❑ro-
?ose�� SO feot sr�A�:; t:;e,-.ca b�-i.�-�„-.�, ;�-ce-vr=sai� srreec Soutn 65
desrces 15 minutes East :.FO feet tD a point in line of other lands about
t� be cor.veve�i to C1yZe E, Brenner� which lands are 7zact \o. 2 herein;
:henCe b� said lands Soutli 24 de�rces 45 ninutes 1�;cst 60 feet to line of
lanJs about to be conveyed to Clyde E, erenner, which lands are Lot A.
herein; thence by said lands Vorth 65 deprees 1S miautes ��est 160 feet
to the place of BeFinning. '
i .
LQT C: 3EGIVYI\G at ;� point on the center line af Penn.svlvania lfighwa;r '
\o. 34, bein� the road �eaditt� from Carlisle La Sterrett°s Ga,j i
at the YorChern l.inc� af �. proposed 50 foot street ��hich
cated 325.53 feet SouY}i af line of lands now or forcierly of1lVilliai���iller;
thence by the center of said road North 24 degrees 45 minutes East 71
feet to a point in lina of lands now or fornerly of Betty E. Span�ler;
thence by said lands South 65 degrees 15 minutes East 160 feet to a point
in line of other lands about to be conveyed to Clyde E. Brenner; thence
by said lands SouYh 28 degrees 45 minutes West �4 fcet to Yorthern side
9���rn;�1 FALE �i3 C6NTIyUED ON SECOND PAGE �
I
A VD, thc aaid prantor 5, do htre ` : �
6Y eovrnant and apree to and with ihe aaid grantee � that
t h e y ,t h e�r a n t o r 5�t h ii�*s,es�tutori arid cdminiatratora,ahall and wil!u,armnt �
general�y a;zd f�rever deJeful the Tfss°eia o.hove desr.ri6ed �
prcr,cisc�. u.;� the. l:cruf.sEasr r�Cr_. 4�ct ur7,�:r f,rruc@,ra�to tFa F :rt rvr./,ec ,
f� r Lf1P.tY teir�s
arid csszp;ef,ap�a�ist ti�c t�t a�r•a:.i:tc; 5,ana ept:r:�t evrs��ptlKr�:trao;a laru�aJl�tdtti�nin�r os•snho ��
ahaf!lie�•�rijGtr c�aivc fha s�r,:e Gr¢vay p�rti lhe;�e=af. �I
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IN WITNESS I9HEREOF,.aaid pnastor s ha ve kcreunto�d t �T : . hand sand Bca! s
. Lha day a�ut year fint abv„e,ortiite,�; .: ,. . ' �,,
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a+�.a. s�a.�n otim�,�a. . ." , � , � ;-���t�1i : � I
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tn s�r �lrraeare ot : .� �Iyde E.:. Brepner) �
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_ . . (Pearl T. � renner) .
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On thia,the o-�,�.."" ,'.ay oJ J12aua:7 .. , 19 6$ _ z
, bejore me,
the w+dersipned o[fee--veraanallyappeared CLYDE E. BREN:IER and PEARL T. BREV�ER� •
his wife, • __=
•�_ •
knman to me(orsahalactonlY P*ovm)to be theP�S�S.toiw�e�mC S are suBscribed to the �
u�ithia instrument,and¢�,(ytpt�(edptd ihut t 1ta.V ,.�P�ecu.!ed tt1C NOnte)or the purpeaea therein '�
cor�lairud, •/ � �, .
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