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Home My WebLink About02-20-15 J � �n�aylaania 1505618403 "`"""Ex�oa�ia� RE V-1500 OFFICIAL USE ONLY BureauoflntlivitlualTaxes �o��b��e �ear FueNumEer PO BOX 280601 INHERITANCE TAX RETURN Narrsb r PA 1�128-0601 RESIDENTDECEDENT 21 14 1188 ENTER�ECEOENT INFORMATION BELOW Social Security Number Date of Dealh nnnnoovvrr Date of BiRh rtnMoom�v 11 24 2014 03 14 1915 DecedenPs Last Name Suffx Decedenfs Firet Name MI LEIB SAMLIEL L (If Applicable)Enter Suniving Spousa's Information Below Spouse's Last Name Suffix Spouse's Fire[Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. OnginalReWrn � 3. Su0Plemen�alReWrn � 3. �Re�m,�odZr3e82'n(tla�eoftlea�h � 6. AgncvlNral Exemp�ion(tlate of � 5. Fu�ure Interest Compmmise(tla�e of � 6. Fetleral Es[a�e Taz ReWm Requiretl Oealb on or afler]-1-20t2) death after 12-02-84) O ]. Decetlen��ietl Tes�ale � 8. Dewtlenl Maintainetl a Livi�g Trus� 0 9. Total Num�er of Sate Deposit Bozes (AV3chcopyafwill) (AftdC11COpY�<«US�.) — � ID. Litiga�ion Proceetls Receivetl � 11. Non-Pro�ate Tranaferee ReWm � 12. DeterraVElection ot Spousal Tmsls (Sahe�ule F an�G Asse�s Only) � 13. Business Nsse�s � 1<. Spouse Is Sole Beneflciary (No Ims�invoNBtl) CORRESPONDENT�THIS SECTION MIIST BE COMPLEiEO.ALL CORRESPON�ENCE AND CONFIOENiIAL iA%INFORMAiION SHOULO BE OIRECTED T0: Name Oaytime Telephone Number GARY L JAMES ESQ 717 533 3280 First Line of Atltlress 134 SIPE AVENLIE Second Line of Address CiryorPostORire SUte ZIPCode Hl1MMELSTOWN PA 17036 � � � ' �i r - � CorrespendenCs email address QliCdisdacom - n -'y ' �> � g w REG STER OE WILFS�ISE bNLY'� U ) ftEGISTEROFWILL505EONLY ' � �ATE FILEO MMDOYYYY . � . . , :_3 � -�I � �l �� `� O 1 OATE FILED Stl�MP Side 1 L I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII 1505618403 1505618403 J � J 1505618411 REV4500EX �ecedenYs Social Security Number oe�ae�r:rvame: Leib, Samuel Loy RECAPITULATION 1. RealEstate(Sc�etluleA) ............._. .____ .._............. 1. 2. SlocksandBontls(SchetluleB) ..._....... __.__ ___......... Z. 3. Closely Heltl Corporetion,Patlnership or Sole-Proprietors�ip(Schetlule C)......... 3. 4. MotlgagesandNotesReceivable(SchetluleD) .._...... ____..... 4. 5. Cash,Bank Deposils antl Miscellaneous Personal Property(Schetlule E)......._. 5. 115 ,859 • 56 6. JoiNly Ownetl Pmperty(Schetlule F) I � Sepa�a�e Billing RequesleG............ fi. ]. In�er-Vivos T�ansfers&Miscellaneous Non-Pmba�e Property (Schedule G) U Separate Billing Requestetl............ ]. 8. Tofal Gross Asse[s Qotal Lines 1 Ihrough]) __...... e. 115 .8 59 • 56 .._._.. ._ . . . _ _. 9. FuneralExpensesantlAdminis�rativeCos�s(SchetluleH)....................__............ 9. 6 .958 • 92 10. Deb[s of Decetlent,Mortgage Liabilities antl Liens(Schetlule Ij................_.......... 10. 197 • 7� 11. TOWIDeduc[ions(b�alLine59and10)__ ........_ __............. 11. 7 .156 . 62 12. NetValueo(Estate(LineeminusLinell) ____. ______. 12. 108 ,702 . 94 13. CharitableantlGovemmen�alBeqces�s/Sec9113Tmstsfo�which anelectiontotaxhasnotbeenmatle(ScheduleJ) .._.._.. .___.__. 13. 2.��0 • 0� 14. NetValueSubjecttoTax(Linel2minusLinel3) ._._._ .______ 14. 106 ,702 • 94 TAX CALCIILATION�SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14�axable al the spousal tax rate,or �rensfers untler Sec.9116 (a)(1 2)X 00 15. 0 • 00 16. Amounl of Line 14[axable at lineal ra[e X .045 0 • Q� i6. 0 • 00 1]. AmountotLinel4taxable atsiminqrarexna 26,675 . 74 n. 3,201 . 09 18. Amount of Gne 16 taxable atcol�ateralrate X .�S 80.027 . 2D 18. 12 .004 . 08 ie. Taxoue ..___. _._.__ . .. .___... . . _ _..........._ 1s. 15 ,Bo5 . 17 20. FILL IN THE OVAL IF VOU ARE REOl1ESTING A REFUND OF AN OVERPAVMENT � Untler penalties of Derjury,I tleclare I M1ave examine0��Is reWm,InclvOing acwmpanying sc�edules anp s�atemenls,an0 to tM1e Desl of my knowletlge antl beliet, itls[m rtectanUcomplete.Declara6onofpreparero�M1erNanlM1epersonrespons0letorflinglnerelvrnls0ase0onalllntormalionofwM1lc�preparerM1as any letlge URE OF PER50 ESP BLE FOR ILING RE IIRN Emily B. Nearhood �AiE i��,.�.�i ; eFx2 wt� ooaess 1243 E. aracas Avenue, Hershey, PA 17093 SIGN F PREP HER THAN REPRESENTATNE Gary L.James Esq. o^TE -�q` 2� Z � •Hl nooaEss 134 Si e v n e, ummelstown, PA I III IIIII IIIII IIIII IIIII III�I IIIII IIIII IIIII IIIII IIII IIII Side 2 L 1505618411 1505618411 J REV-1500 EX Page 3 Fila Number 21-14-1188 DecedenYs Complete Address: OECE�ENT'SNAME Leib, Samuel Loy STREETADDRESS 801 N. Hanover Street CITV � STATE ��.ZIP Carlisle PA ' 17073 7ax Payments antl Credits: 1. Tax Due(Page 2,Llne 18) (1) 15,205.17 2 CretlitslPaymen�s �� A. PriorPayments B. Dlscounl � 76026 Total Cretlits(A +B) I21 760.26 3. Interest (3) q, If Line 2 is greater Ihan Line i +Line 3,en�erthe Gifference. This is[he OVERPAVMENT. (4) Check boz on Page 2,Lina]0 to requesta refuntl 5. If Line 1 +Line 3 is greaterthan Line 2,enterihe tliRerence. This is the TA%DOE. (5) �4�444.9� Make Check Payable to: REGISTER OF WILLS, AGENT. . , . .. yiis .. . .. .. . . . . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X" IN THE APPROPRIATE BLOCKS 1. �itl tlecetlenl make a trans(er antl: Yes No a. retain the use or income of the property�ransferred;......._......_.............................................................. ❑ x I b. retain�herighttodesignatewhoshallusethepropetlytransferretloritsincome',.____._.._____._.___ ❑ � c. retain a reversionary interesk or .____ ____. ____. __.__. ❑ ]n d. receivethepromiseforli(eofeitherpayments.benef�sorcare9... ......_... ......._. ❑ �� 2. If tleath occurretl after �ec. 12, 1982 tl�tl tlecetlen� trans/er pmperty wphin one year ot tlea�h wi�hou� receivingatlequateconsitlerationP.__. ._.__. ..__. ____. ........ �i n 3. �itl tlecetlenl own an"in tmst for' o�payable upon tlea�h bank account o�secutity a�his or her tleath?....... �� 4. �id tlecedent own an indivitlual retirement account,annw�y or o�her non pmbate propehy wh cM1 conlainsaEeneficiarytlesi9nation?_.. .......... ............... .._..... .____ ❑ ❑z IF THE ANSWER TO ANV OF THE ABOVE OUESTION515 YES,VOU MUST COMPLETE SCHEDULE G ANU FILE IT AS PART OF THE RETURN. . ,.,. .,.. :'. .., . . .. . irt:�.:,' For dales of tleath on or afier July 7,1994 and before Jan. 1.7995,Ihe tax rote imposetl on ihe net value of transfers ro or for the use at�he surviving spouse is 3 percent�72 P.S.49116(a)(1.7�(i)�. Por dales of tleaN on or afler January 1,1995,ihe tax ra[e imposed on ihe nel value af iransfers to or tor the use of�he surviving spouse is 0 percent []2 P 5.§9116(a)(1.1)(ii)7. The staWle tloes nat exempt a Irans(er to a surviving spouse from tax,and�he 51aN�ory reQuirements for tlisclosure of assets and filinq a lax reWm are slill applicable even rf Ne surviving spouse is ihe only beneficiary. For dates of tleath on or afier July 1,2000�. . The tax 2�e imposed on�he ne�value of trans�ers(rom a deceased child 21 yea�s of age o�younger at Death�o or for the use o(a na�ural parent,an adoptive paren�,or a s�ep-paren�o(ihe chilC is 0 percenl�]2 P.S.§91 i6(a)(12)�. • The�ax rale impose0 on�he ne�value of Irens(ers lo or for the use ot�he decedenfs lineal benefmiaries is 4.5 percent,except as noled in[12 P.S.§9116(a)(1)]. . The lax rate imposetl on ihe ne[value of iransfers to or far ihe use a(Ihe DeceOenfs siblings i512 percent[�2 P.S.§9116(a)(13)J. A sibling is tle(ned, under Seclian 9102,as an intlivkual who�as at least one parent in common wit�Ne deceden(whelher by blood or atlop�ion. 0.av�160B E%��OB-02) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. oEanarmervrorRevervue PERSONAL PROPERTY INHERITANCE TAX RETIIRN RESIOENi�ECEOENi ESTATE OF FILE NUMBER Leib,Samuel Loy 21-14-1188 m�maa me pro�aa:on�neaoo�a�a me aaia ma p�ooam.werara�waa oy ma e:�m�. nn oronem lannrbwn.awm me nem onunroorsmn m�.�e.ui.cm..n on.on.em.r. ITEM VALUE AT�ATE NUMBER DESCRIPTION OF DEATH 7 F 8 M Money Management Personal Account#0007706017-valuetl per statement dated 96.34179 December 10,2074 Accrued interest on Item 7 through date of death 1732 2 F 8 M Senior Checking Accoun[Number 0003467597-valued per sWtement dated December 6,283.96 10, 2014 Accrued interesl on Item 2 lhrough date o(death 0.07 3 Mass Mutual LiFe Insurance Company Annuity#450191 -November 330.88 4 Mass Mutual Life Insurance Company Annuity#450192-November 88.45 5 Personal Property 500.00 6 Church of God Home-refund 10,Y37.56 7 Jackson National Life Insurance -annuity 65.53 TOTAL�Also enter on Line 5, Recapitulation� 115,859.56 p�more space Is neeJeC,adEitionai pages o(iM1e same size) Copyright(c)2012 lorm software only The Lackner Gmup, Inc. Porm PA.1500 Schedule E(Rev.0842) nev.isn ex.�ae-u� pennsylvania SCNEDULE H oe �wrme�+roFaeveHue FUNERAL EXPENSES AND �""ER"a"°E'A"RE'°a" pDMINISTRATIVE COSTS aEsioeHroeceoeNr ESTATE OF FILE NUMBER Leib,Samuel Loy 27-14-1188 Decedent's tlebts must be reportetl on Schetlule I. ITEM DESCRIPTION AMOUNT M R q, Fl1NERAL EXPENSES: See continuation schetlule�s) attachetl 3,068.a2 B. ADMINISTRATIVE COSTS: 1. PersonalRepresentativesCommissions Name of Personal Representative(s) StreetAddress Ciry State Zip Vear(5)Commission Paid 2. nnomey s Fees James, Smith, Dietterick 8 Connelry, LLP 3,500.00 3 Famity Exemp�b¢ Qf tlecetlenYs atltlress is nol Ihe same as daimanPs,attach explanation) Claimant Sireet AtlOress Clry Sta�e Zio Rela�ionshio o(Claimaniro Decetlent 4. Probate Fees 5. AcwuntanCSFees 6. Tax Retum PreOarers Fees 7. O�herAdminis�rative Cosis 390.50 See continuation schedule�s)attached TOTAL(Alsoenteronline9,Recapitulation) 6,958.92 Copyright(c)2�i3 torm so(iware only The Lackne�Gmup,Inc Fortn PA-0500 Sc�edule H(Rev.OB-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Leib,Samuel Loy 21-14-1188 ITEM NUMBER DESCRIPTION P.MOUNT Funeral Exoenses 1 Ewing Brothers Funeral Home-funeral 1,214.40 2 Kent and Raelene Slrock-meal aker funeral 500.02 3 Osiris Holding of Pennsylvania -headstone 1,354.00 H-A 3.068.42 Other Administrative Costs 4 John R.Zimmertnan-messenger service to ROW 75.00 5 RegisterofWillsCumberlandCounty-probatefee 375.50 H-B7 39a.5U CopY�ight(c)2002(orm soflware onty The Lackner Gmup,Inc Fortn PA-1500 Schetlule H(Rev.6-98) Rer-051E EX��1]1E� SCNEDULE 1 pennsylvania DEBTS OF DECEDENT, oePuerMeNroraeveH�e MORTGAGE LIABILITIES AND LIENS INHEFITANCE TA%PETURN Res�oeHroeceoeHr ESTATE OF FILE NUMBER Leib Samuel Loy 27-14-1788 Repotl tlebb Incumetl Ey�M1e tle[eEen[ptlo��o Eea��I�atnmalne0 un W�0 a�l0e Ga�ealOeaM�indutlinq unnimburtatlmatlicil eRpBnEes. ITEM VALUE AT DATE NUMeER DESCRIPTION pF DEATH 1 BrockiePharmatech-pres<riptions 19770 TOTAL(Also enter on Line 10, Recapitulation) 19770 (I(more space Is neetled atltlitional paAes of tbe same size) Copyright(c)2012 form so%ware only The Lackner Group, Inc Form PA-0500 Schedule I(Rev. 12-12) RE0.151]EF��OF10) pennsylvania SCHEDULE J OEPARTMENTOFREVENUE ir+HeRi*Ar+oe.nxae.ua�+ BENEFICIARIES aesioenr oeceoeHr ESTATE OF FILE NUMBER Leib, Samuel Lo 21-14-7188 NAMEANDADDRESSOF RELATIONSHIPTO SHAREOFESTATE AMOUNTOFESTATE NUMBER PERSONlS1RECEIVINGPROPERTY �ECEDENT �yyords) (55$) I TAXABLE DISTRIBUTIONS [inclutle outrigh�spousal distri0utions,antl irensfers untler5ec.9116a 12 1 H. Romaine Sheaffer(deceased) Sister 1/3 af 1/4 of 8,891.91 c/o Irwin antl MCKnight residue 60 W. Pom(ret Streel Carli5le, PA 770'13 2 Jeanette K.Cepietz Niece 1/31 oF 3/4 of 2,581.53 7533 Farmhouse Lane residue Mitltlletown, PA 77057 3 Roxanne E.Clay Niece 7/S1 of 3/4 of 2,581.53 1136 Boiling Spnngs Road residue Mechanicsburg, PA 77055 4 Joan L.Egolf Niece 1/37 of 3/4 of 2,587.53 101 Spring Road resitlue Dillsburg, PA 77079 5 Nancy A. Faircloth Niece 7/31 of 3/4 of 2,581.52 880 Eppley Roatl resitlue Mechanicshurg, PA 17055 Seecontinuationscheduleattached Continualion 87,484.9P Total �06,702.94 Enter dollar amowts for distribu�ions shown above on lines 15 ihrou h 18 on Rev 1500 cover shee�,as a m ria�e. NON-TAl(ABLE DISTRIBUTIONS: II. p.SPOUSAL�ISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TA%IS NOTTAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Churchtown Church of God 2,000.00 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBl1TIONS ON LINE 13 OF REV-0500 COVER SHEET 2.000.00 Copyrighl(c)2010 form sottware only The Lackner Group,Inc. Fonn PA4500 ScheGule J(Rev. 01-10) SCHEDULE J BENEFICIARIES (PaR I,Taxable Distributions) ESTATE OF: Samuel Loy Leib 11124/2014 182-22-8331 Item Name and Address of Person(s) Share of Estate Amount af Estate Number Receiving Property Relationship (�Nords) ($$S) 6 F.Virginia Hockenberry Niece 1/37 of 3/4 of residue 2.581.52 2313 Lindsay Lat Road Shippensburg, PA 17257 7 Edward L. Hoover Nephew 7/31 of 3/4 of residue 2.581.52 262 Aspen Drive Apollo, PA 75675 8 James E. Hoover Nephew 1/31 of 3/4 of residue 2.581.52 89 Beartl Road Enola,PA t7025 9 Linwootl A. Hoover Nephew 1/31 of 3/4 of resitlue 2,581.52 566 Miller Road Mechanicsburg, PA 17055 �0 Richard S. Hoover Nephew 7/31 of 3/4 of residue 2.581.52 218 Sunset Drive Selinsgrove, PA 77870 '11 A. Dwight Leib Nephew 1/31 of 3/4 of residue 2,581.52 904 Strock Drive Mechanicsburg,PA 77055 12 Blaine L. Leib Nephew 1/31 of 3/4 of resitlue 2.581.52 932 Eppley koad Mechanicsburg,PA 17055 '13 Earl G. Leib Nephew �/31 of 3/4 of resitlue 2,581.52 819 Eppley Raatl Mechanicshurg,PA 17055 14 Harold E. Leib Nephew 1/31 oF 3/4 of residue P,587.52 908 Strotk Orive Mechanicsburg,PA 17055 1 SCHEDULE J BENEFICIARIES (Part I,Taxable Dislributions) ESTATE OF: Samuel Loy Leib 17/24l2014 182-22-8337 Item Name and Address of Person�s) Share of Estate Amoun[of Estate Number Receiving Property Relationship (Words) (S8$) 75 John E. Leib Nephew 7/37 of 3/4 of residue 2,581.52 104 Old Stonehouse Roatl Carlisle, PA 77073 i6 Patricia E. Leib Niece 1/37 of 3/4 of residue 2,587.53 2 Glenfield Drive Mechanicsburg,PA 77050 17 Robert E. Leib Nephew 7131 0(3/6 of residue 2,581.53 11598 5.Carlisle St. Teme Haute,IN 47807 18 Harry P. Line Nephew 7/31 of 3/4 of residue 2.581.52 700 Flintstone Orive Newville, PA 17241 19 Linda L.Marrero Niece 1/31 of 3/4 of residue 2.581.52 704 Laurel St East Beaufort,SC 29906 20 Luther Murphy Nephew �/37 of 3/4 of resitlue 2,581.52 1002 Oriole Drive Mechanicsburg,PA 17050 21 Beverly J. Naylor Niece 1/37 ot 3/4 of residue 2.581.52 24 Wetherhurn Road Enola, PA 17025 22 Cheryl L. Nearhootl Niece 7/37 of 3/4 of resitlue 2,581.52 1243 East Caracas Avenue Hershey, PA 17033 23 Emily B. Nearhood Sister 1/3 of 1/4 of residue 8,897.91 1243 E.Caracas Avenue HeBhey, PA 17033 2 SCNEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Samuel Loy Leib 1712412014 182-2T-8331 Ilem Name and Address of Person�s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($58) 24 Geald Shambaugh Nephew 1/31 of 3/4 of resitlue 2.587.52 1652 Osbourne Avenue WillowGrove, PA 19090 25 Larry E.Sham6augh Nephew t/37 of 3/4 of residue 2,561.52 430 Rolling Roatl Vork Springs,PA 77372 26 Michael L.Shambaugh Nephew 1/37 of 3/4 of residue 2,581.52 724 W.Portland Street Mechanicsburg,PA 77055 27 Ronaltl L.Shambaugh Nephew 1/31 of 3/4 of residue 2.581.52 P.O. Boz 763 Boiling Springs, PA 77007 PB Sally Shambaugh Niece 1/31 of 3/4 of residue 2,587.52 1159 Spring Garden St. Ca�lisle, PA 77�73 29 Emily M.Shute Niece 7/31 013/4 of resitlue 2.587.52 4393 Atlelaitle Avenue North Port, FL 34288 30 Karen L.Simmons Niece 1/31 of 3/4 of residue 2.581.53 503 S. Filbert St. Mechanicsburg,PA 17055 31 Alan W.SVock Nephew 1/31 of 3/4 of resitlue 2,587.53 207 Lauschtown Road Denver, PA 17517 32 Kent L.5[rock Nephew 1/31 of 3/4 of residue 2,587.53 729 Williams Grove Roatl Mechanicsburg, PA 77055 3 SCNEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Samuel Loy Leib 1112412014 182-22-8331 Item Name and Address of Person(s) Share of Estate Amount ot Estate Number Receiving Property Relationship (�Nords) (S8S) 33 Mabel Strock Sister 7/3 of 7/4 of residue 8,697.92 797 Williams Grove Road Mechanicsburg,PA 17055 34 Martina K.Wolfinger Niece 7/31 of 3/4 of residue 2,587.52 2 Hazlewood Path Mechanicshurg, PA 17050 TOtal 87.484.92 4 �� o,��