HomeMy WebLinkAbout02-23-15 1505614134
EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO Box 280601 INHERITANCE TAX RETURN 2 1 1 3 0 0 7 8
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 3 5 0 3 0 8 7 0 1 2 3 1 2 0 1 2 0 1 1 9 1 9 1 8
Decedent's Last Name Suffix Decedent's First Name MI
H I C K MA N R E B E K A H E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
❑ 1.Original Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(date of death
Prior to 12-13-82)
❑ 4.Agriculture Exemption El5. Future Interest Compromise(date of El 6.Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
Q 7.Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 0 9.Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
❑ 10.Litigation Proceeds Received ❑ 11.Non-Probate Transferee Return ❑ 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13.Business Assets ❑ 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Nulr
J OE L R . Z U L L I N GE R 7 12o2 6 ' 6r r 9
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First Line of Address r - :
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1 4 N O RT H MA I N
Second Line of Address
SUI TE 200
City or Post Office State ZIP Code + rri
C H A M B E R S B U R G PA 1 72 0 1 w _T1
Correspondent's e-mail address:
REGISTER OF WILLS USE ONLY
REGISTER OF WILLS USE ONLY
DATE FILED MMDDYYYY
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII VIII IIIII IIIII IIII IIII
1505614134 1505614134 _jv_�
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1505614234
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: REBEKAH E. HICKMAN 2 3 5 0 3 0 8 7 0
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) ❑ Separate Billing Requested .. .. . .. 6. 5 3 1 8 4
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . ..... 7.
8. Total Gross Assets(total Lines 1 through 7) ... ......... . . . . ........... 8. 5 3 1 8 4
9. Funeral Expenses and Administrative Costs(Schedule H) . . . .......... . . . .. 9. 0 • 0 0
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . .. . . ....... 10.
11. Total Deductions(total Lines 9 and 10) . .. . .. .......... . . . .. . ......... 11. 0 • 0 0
12. Net Value of Estate(Line 8 minus Line 11) ...... ... . . . . ........... .. . . 12. 5 3 1 8 4
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. 5 3 1 8 4
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.0 _ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.045 5 3 1 . 8 4 16. 2 3 . 9 3
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE ........ . ... . . . ......... . . . ......... . . . . ... ...... . .... 19. 2 3 . 9 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNATURE OF P ON RESPON IBLE R ILI G ETURN DATE
ADDRESS
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Lucinda H. Elliott, 27 North Washington Street, Shippensburg PA 17257
SI ATU E OFP PARE HER N PERSO R PONSIBLE FOR FILING THE RETURN DAT Q
ADDR
14 Worth Main Street, ite 200 Chambersburg PA 17201
1111111111111111111111 Side 2
1505614234 1505614234 J
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REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 13 0078
DECEDENTS NAME
REBEKAH E. HICKMAN
STREET ADDRESS
27 NORTH WASHINGTON STREET
CITY STATE ZIP
SHIPPENSBURG I PA 117257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 23.93
2. Credits/Payments
A.Prior Payments 23.93
B.Discount
(See instructions.) Total Credits(A+B) (2) 23.93
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) 0.00
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 ...................................................................... El
191
b. retain the right to designate who shall use the property transferred or its income ............................... El R
c. retain a reversionary interest ..........................................'......................................................... El 121
El 0
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? ......... ❑ 0
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
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 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 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.
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REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
REBEKAH E. HICKMAN 21 13 0078
If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. Lucinda H. Elliott 27 North Washington Street daughter
Shippensburg, PA 17257
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 812002 Account#103004043, Orrstown Bank 1,063.67 50. 531.84
TOTAL(Also enter on Line 6,Recapitulation) $ 531.84
If more space is needed,use additional sheets of paper of the same size.
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REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
REBEKAH E. HICKMAN 21 13 0078
RELATIONSHIP 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).]
1. Samuel A. Hickman, 228 Hickory Road, Charleston, WV Lineal 0.00
25314
one-third of residue
2. Lucinda H. Elliott, 27 North Washington Street, Shippensburg, Lineal 531.84
PA 17257
Item 1 on Sch. F$531.84 and one-third of residue
3. Roy L. Hickman, 241 Calloway Drive, Evans, GA 30809 Lineal 0.00
one-third of residue
NOTATION -The only asset at the time of the decedent's
death was a jointly held bank account with her daughter,
Lucinda H. Elliott, which is reported on Schedule F.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
�. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
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.
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LAST WILL AND TESTAMENT OF
REBEKAH E. HICKMAN
1, REBEKAH E. HICKMAN, of Kanawha County, West Virginia, do
hereby make, publish and declare this to be my Last Will and
Testament, hereby revoking all former Will's and teztair.entary
dispositions made by me.
ARTICLE 1. DEBTS, ESTATH_ EXPENSES AND SUCCESSION TAXES
I direct that all my just debts, funeral expenses and
expenses of the administration of my estate, and all
inheritance, estate, transfer and other succession taxes or
ry
death duties that may be legally imposed by reason of my death
C:) rn
upon my estate or upon any property which passes to my
M -0
beneficiaries hereunder cr any person, either by this Will., as
beneficiaries of life ineurance policies on my life, or at my
T,
death by survivorship or otherwise, be paid as soon as _73
practicable by my Executor/Exectttrix hereunder named from my
CD
residuary estate, except that any -tax imposed on any property or Cn
money going to any person other than, the primary beneficiary of
my estate named in Article III hereof, or if paid by my
Executor/Executrix, shall be charged to such recipient.
ARTICLE II. DISPOSITION OF ESTATE
A. I give, devise and bequeath unto Lucinda H. Elliott,
all of my A T & T stock in fee simple absolute.
B. I give, devise and bequeath unto Samuel A. Hickman and
Roy L. Hickman, all remaining stock to be divided between them
equally, to share and share alike, in fee simple absolute.
C. I give, devise and bequeath unto my daughter-in-law,
Karen Hickman, the Sculpture of a baby I made.
D. I give, devise and bequeath unto Roy L. Hickman, my
Marjhony Highboy.
REBEKAH E.. HICKMAN Z DATE
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ARTICLE III. JOINT BANK ACCOUNTS
I do hereby declare that all my checking and banking
accounts which are jointly titled in my son, Samuel's, and my
name at the Community Banking and Savings Company in Dunbar,
West Virginia, were created solely for the purpose of allowing
my son to write checks off the same in the event I could not due
to health problems. Therefore, it is my intention that all", sums
of monies in these accounts, be and are hereby declared to be a
part of my estate for distribution in accordance with -the terms
of this Will and that I do hereby by this Will refute any
presumption that said accounts were created for the purpose of
creating righte of survivorship in favor of my son, Samuel A.
Hickman, upon my death.
ARTICLE IV. RESIDUARY CLAUSE
All the rest, residue and remainder of my estate, both real
and personal, and wheresoever situate, which I have not
hereinbefore specifically disposed of, I give, devise and
bequeath to Samuel A. Hickman, Lucinda H. Elliott and Roy L.
Hickman, equally to share and share alike in fee simple absolute.
ARTICLE V. APPOINTMENT OF EXECUTOR OR EXECUTRIX
I appoint my son, Samuel A. Hickman, as Executor of this,
my Last Will and Testament, if he be living; if he should
predecease me, then I appoint Lucinda H. Elliott, as Executrix
of this, my Last Will and Testament, if she be living, if she
should predecease me, then I appoint Roy L. Hickman, as Executor
and direct that no bond be required of either of them.
IDT WITNESS WHEREOF, I have this 2nd day of August, 1989,
signed, sealed, published and declared the foregoing instrument
as and for my Last Will and Testament in the presence of each of
two subscribing witnesses, each of which I have requested in my
presence and in the presence of each other to subscribe his name
r
as attesting witness:
REBEKAH E. HICKMAN WE
The foregoing Will, consisting of two (2)' typewritten
pages, was signed, sealed, published and declared by Rebekah E.
Hickman, the Testatrix, to be her Last Will and Testament in our
presence and we, at her request and in her presence and i'--i the
presence of each other, all present at the time, have hereunto
subscribed our names as attesting witnesses this 2ndday of day
of August, 1989, at Charleston, Kanawha County, West Virginia.
of
A-Z' of
STATE OF WEST VIRGINIA
COUNTY OF KANAWHA, To-wit:
This day personally appeared before me, the undersigned
authority, Q .and
who after being
first duly sworn say that they are the subscribing witnesses to
the Last Will and Testament of Rebekah E. Hickman, of Kanawha
County, West Virginia, which Will is dated the 2nd day of
August, 1989, and that the said Rebekah E. Hickman, Testatrix of
said Will, signed, sealed, published and declared the same as
and for her Last Will and Testament in the presence of both of
these affiants; and, that these affiants, at the request of said
Testatrix, in the presence of said Testatrix, and in the
presence of each other, all present at the same time, signed
their names as attesting witnesses to said Will.
Affiants further say that this affidavit is made at the
request of the said Rebekah E. Hickman, Testatrix, and in her
presence, and that the said Deloris I. Keeling, at the time said
Will was executed, was, in the opinion of affiants, of sound and
disposing mind and memory and over the age of twenty-one (21)
years.
"
Taken, subscribed and sworn t(oo before me by the said
v and
this 2nd day of Augiust, 1989.
o�ytE r�R NOTARY x� PUBLIC �.—� _
f� 2F ssnre OSl{
P a1r<sv alnats
ROBERT A~f416 k _
Charleston,
G9 Cmnraission EYpirn Vcro My W7
OTARY PUBLIC
REBEKAH E. HICKPIA DATE
r
rpennsylvania
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-12)
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
DATE 12-16-2013
ESTATE OF HICKMAN REBEKAH E
DATE OF DEATH 12-31-2012
FILE NUMBER 21 13-0078
COUNTY CUMBERLAND
SSN/DC 235-03-0870
LUCINDA H ELLIOTT ACN 13102556
27 N WASHINGTON ST APPEAL BY DATE:02-14-2014
S H I P P E N S B U R G PA 17257-1420 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS E—
-------------------------------------------------------------------------------------------
REV-1548 EX AFP C12-12)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 12-16-2013
ESTATE OF: HICKMAN REBEKAH E DATE OF DEATH:12-31-2012 COUNTY:CUMBERLAND
FILE NO. : 21 13-0078 S.S/D.C. NO. : 235-03-0870 ACN: 13102556
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO. : 103004043
TYPE OF ACCOUNT: C )SAVINGS ( X) CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 08-12-2002
Account Balance 1 ,063.67 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 531 .84 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 531 .84 REGISTER OF WILLS AT THE
Tax -Rate x .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 23.93 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT. "
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
01-19-2013 CDO17079 1.20 22.73
TOTAL TAX PAYMENT 23.93
BALANCE OF TAX DUE . 00
INTEREST AND PEN. . 00
TOTAL DUE . 00
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND.
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Zuttinger-Davis, PC > ;z'
14 NorthMain Street
Suite 200 ; .1
Chambersburg, PA 17201 r_
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Register ,ofO'Wills
Cumberland County Courthouse "
I Courthouse Square
Carlisle, PA 17013
LAW OFFICES OF
ZULLINGER-DAVIS
PROFESSIONAL CORPORATION
JOEL R.ZULLINGER SUZANNE M.TRINH HAMILTON C.DAVIS
izullineer(a)zullinp,er-davis.com strinh(c g1linger-davis.com hdavis e,zullinQer-davis.com
14 North Main Street,Suite 200 20 East Burd Street,P.O.Box 40
Chambersburg,PA 17201 Shippensburg,PA 17257
717-264-6029 717-532-5713
717-264-1884(FAX) 717-530-5222(FAX)
February 19, 2015
Register of Wills
Cumberland County Courthouse
1 Courthouse Square M
Carlisle, PA 17013 c o
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Dear Register: n w
CD 7?
RE: Estate of Rebekah E. Hickman 3 :C" w C-,
r,-,.
File No. 21-13-0078
Enclosed for filing in your office is an original and one copy of the PA Inheritance
Tax Return for the above estate. Please address any questions to my Chambersburg office.
Thank you.
Very truly yours,
��R. Zullin er
Encls.
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