HomeMy WebLinkAbout03-26-15 (4) REV-1500 EX(02-11) 1505610143
OFFICIAL USE ONLY.
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
Po BOx.280601 INHERITANCE TAX RETURN 21 14 00643
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
06 26 2014 12 16 1928
Decedent's Last Name Suffix Decedent's First Name MI
WITMAN EVELYN L
(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
® 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
(date of death after 12-12-82)
® 6 Decedent Died Testate ❑ 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.between Poverty 1Cre ditl(Datte f Death ❑ 11.Election
ach Schedule under Sec.9113(A)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
DEBRA K WALLET 717 737 13010!�
c rte-,
REGISTEkPFVILLS US'g;ONL1y:_' <�
wT y:r I" r
First Line of Address
24 NORTH 32ND STREET
! `f7 C .I I
Second Line of Address - -
t
DATE FILED c u-) C>
City or Post Office State ZIP Code 1.
CAMP HILL PA 17011
Correspondent's e-mail address: walletdeb@aol.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 RESPONSIBLE FOR FILING RETURN DATE
Thomas R.Witman
ADDRESS
959 South Mountain Road, Dillsburg, PA 17019
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
WtA►.to Oma*' Debra K Wallet 312Y rirJ—
ADDRESS
Law Offices of Debra K.Wallet
24 North 32nd Street, Camp Hill, PA 17011
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: W I T M A N, E V E L Y N L
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. 59 , 099 . 19
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7. 298 , 691 . 23
8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 357 , 790 . 42
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 7 , 317 . 50
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 2 , 052 . 85
11. Total Deductions(total Lines 9 and 10).................................................................. 11. 9 , 370 . 35
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 348 , 420 . 07
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. 348 , 420 . 07
TAX COMPUTATION-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.00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 348 , 420 . 07 16. 15 , 678 . 90
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE................................................................................................................... 19. 15 , 678 . 90
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. EJ
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 - 14 - 00643
Decedent's Complete Address: -
DECEDENT'S NAME
Witman, Evelyn L
STREET ADDRESS
402 Wren Court
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 15,678.90
2. Credits/Payments
A. Prior Payments 10,000.00
B. Discount 526.32
Total Credits(A +B) (2) 10,526.32
3. Interest
(3) 0.00
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) 5,152.58
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;.................................... ❑ ❑x
c. retain a reversionary interest;or.................................................................................................................. ❑
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?....................................................................................................................... ❑
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?...................................................................................................................... ❑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)l.
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 reffurn 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)l.
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)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,w ether y blood or adoption.
pennsylvania SCHEDULE E
DEPARTMENT OFCASH BANK DEPOSITS AND MISC.
INHERITANCE TAXAXRETURN
f
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF Witman, Evelyn L FILE NUMBER21 - 14-00643
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 Double wide trailer and contents (based on proceeds from actual sale) 32,000.00
2 M&T Checking Account#12726915 23,307.67
3 1995 Jeep (based on proceeds from actual sale) 1,000.00
4 Cash in possession of Decedent 37.64
5 PA Property Tax Rebate 250.00
6 Penn Treaty reimbursement 394.47
7 United Healthcare refund 41.70
8 Penn Treaty reimbursement 960.00
9 United Healthcare Insurance Company refund 260.60
10 Verizon Wireless refund 16.45
11 Aegis Security Insurance Company refund 217.00
12 Erie Insurance refund 557.00
13 PP&L refund 56.66
TOTAL(Also enter on Line 5, Recapitulation) 59,099.19
REV-1510 EX+(08-09)
pennsylvania
DEPARTMENT OF REVENUE SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Witman, Evelyn L FILE NUMBER
4-00643
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION
NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECO'S TAXABLE VALUE
and the date of transfer. Attach a copy of the deed for real estate. INTEREST (IF APPLICABLE)
1 Ameriprise Financial mutual fund 3,526.51 100% 3,526.51
Acct. #01132873254 002
2 Ameriprise Fiancial deferred annuity 218,990.14 100% 218,990.14
Acct. #93002547003 004
3 Ameriprise Fiancial deferred annuity 12,426.57 100% 12,426.57
Acct. #93102670243 004
4 Ameriprise Fiancial deferred annuity 26,808.50 100% 26,808.50
Acct. #93103304532 004
5 Ameriprise Fiancial payout annuity 35,453.51 100% 35,453.51
Acct. #93108312443 004
6 Prudential deferred annuity Acct. #DMS428945 1,486.00 100% 1,486.00
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TOTAL(Also enter on line 7, Recapitulation) 298,691.23
REV4511 EX+(10-09)
pennsylvania SCHEDILEH
DEPARTMENT OF REVENUE FIMML 693EWSES MD
INHERITANCE TAX RETURN
RESIDENT DECEDENT wy NSIRWTW
ESTATE OF Witman, Evelyn L FILE NUMBER
21 - 14-00643
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER FUNERAL EXPENSES:
A. 1 Musselman's Funeral Home 867.00
2 Gingrich Memorials 175.00
3 Camp Hill Church of God 200.00
4 Pastor Richard Drover 150.00
5 Rachel Hess (funeral singer/guitar player) 100.00
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 Debra K. Wallet, Esq. 5,000.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 473.50
5. Accountant's Fees James H. Hess, CPA(prep of lifetime return) 146.00
I
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Postage, copies, mileage, etc. 40.00
See attached 166.00
TOTAL(Also enter on line 9, Recapitulation) 7,317.50
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COMMONWEALTH OF PENNSYLVANIA Ay R e�.4M «
INHERITANCE TAX RETURN A I �Ym Costs continued
RESIDENT DECEDENT
ESTATE OF Witman, Evelyn L FILE NUMBER
21 - 14-00643
2 PA License Broker(trailer title transfer) 102.00
3 Luther Murphy, Jr. (lawn mowing) 64.00
Page 2 of Schedule H
Em pennsylvania SCHEDULE 1
DEPARTMENT
INHERITANCE TAXRETURN DEBTS OF DECEDENT, MORTGAGE
RESIDENT DECEDENT LIABILITIES & LIENS
FILE NUMBER
ESTATE OF Witman, Evelyn L 21 - 14 -00643
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Home Instead Senior Care 544.32
2 Wood Wire Metal Lathing pension refund 65.39
3 Angels on Call 607.32
4 Verizon Wireless 110.79
5 Village Associates (water bill) 31.02
6 Frannie Kramer(school tax installment payment) 128.34
7 Luther Murphy(lawncare) 32.00
8 PP&L Electric Utilities 125.22
9 Verizon 26.30
10 Village Associates 360.00
11 RVG Management 22.15
TOTAL(Also enter on Line 10, Recapitulation) 2,052.85
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Witman, Evelyn L
21 - 14-00643
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
ITAXABLE DISTRIBUTIONS[include outright spousal
distributions and transfers
under Sec.6116(a)(1.2)]
1 Thomas R. Witman Son 1/2 of residuary
959 South Mountain Road Estate
Dillsburg, PA 17019
2 Terry Lee Mellick Son 1/2 of residuary
115 Clearview Place Estate
Carlisle, PA 17013
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
IIS NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
LAST WILL AND TESTAMENT
OF
EVEL N Lo WITMAN
i, EVELYN L. WITMAN, of Mechanicsburg, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory, and understanding, do hereby make, publish, and
i
declare this to be my Last Will and Testament and hereby revoke all other Wills and Codicils
that I have made, including the Will dated September 5, 2012. I acknowledge here the
r s existence of a separate trust agreement entitled "The Evelyn L. Witman Revocable Trust"
which is in no way revoked by this, my Last Will and Testament, but which may be hereafter
S
.� revoked or amended.
FIRST: All of my Estate, of whatever nature and wherever situate, I give,
devise, and bequeath, in two equal shares, to those of my sons who shall survive me by thirty
(30) days: THOMAS R. WITMAN, of Dillsburg, Pennsylvania; and TERRY LEE MELLICK,
3 of Carlisle, Pennsylvania. Should either of my sons fail to survive me by thirty (30) days, but
be represented by children then living, these children shall take,per stirpes, the share to which
my son would have been entitled if then living. In the event that either of my sons fail to
survive me by thirty (30) days and fail to have living children, then I give, devise, and
bequeath that son's share to his lawfully wedded wife, so long as my son and his wife were
living together as husband and wife at the time of my son's death.
SECOND: All interests of any beneficiary in the income or principal of this Estate,
while undistributed and in the possession of my Executor, even though vested and
distributable, shall not be subject to attachment, execution or sequestration for any debt,
contract, obligation or liability of any beneficiary and, furthermore, shall not be subject to
pledge, assignment, conveyance, or anticipation.
THIRD: All inheritance, estate, and succession taxes (including interest and any
penalties thereon) payable by reason of my death shall be paid out of and be charged generally
against the principal of my residuary estate, without apportionment or right of reimbursement
from any person. In the event that a substantial portion, as determined in the sole and absolute
judgment and discretion of my Executor, of the non-probate assets such as an annuity or
mutual funds are directed to be paid to a beneficiary or beneficiaries, so that the taxes referred
to herein would be paid out of the probate residue passing to the beneficiary or beneficiaries of
1
this will (whether or not the same as the beneficiary or beneficiaries under the non-probate
assets), my Executor, in the Executor's sole and absolute judgment and discretion, shall have
the right to allocate the full or partial payment of the taxes to the beneficiary or beneficiaries of
the non-probate assets.
FOURTH: In addition to all rights and powers conferred by law, I authorize and
empower my Executor and his successors, in his absolute discretion and without necessity of
obtaining court approval:
A. To buy investments at a premium or discount.
B. To hold property unregistered or in the name of a nominee.
C. To give proxies, both ministerial and discretionary.
D. To compromise claims.
E. To join any merger, consolidation, reorganization, voting trust
plan, or any other concerted action of security holders and to delegate discretionary duties with
respect thereto.
F. To lend to, and buy from, my estate.
G. To borrow and to pledge real and personal property as security therefore.
H. To sell at public or private sale for cash or credit or partly for each, to
exchange, or to lease for any period of time, any real or personal property, and to give options.
for sales, exchanges, or leases.
I. To exercise any option permitted by law which he believes to be
advantageous from the viewpoint of overall tax reductions, including, without limitation of the
foregoing, power and authority to claim administration or other expenses either as income tax
deductions or inheritance or estate tax deductions, without regard to whether they were paid
1 from principal or income and without requiring adjustments between principal and income for
any resulting effect on income or estate taxes, and a deduction of such expenses for income tax
purposes shall be given effect in computing the respective shares of all persons interested in
p g P D my estate set forth herein, even though the effect is to increase the share of one beneficiary or
class of beneficiaries hereunder at the expense of another; and to make such adjustments, if
,t
ty\b
-? any, between beneficiaries with respect thereto as he shall deem appropriate in view of the
nature of the transaction and the amounts involved.
J. To distribute in cash or in kind or partly in each.
K. To employ agents, legal counsel, brokers, and assistants, and to pay their
fees and expenses as he may deem necessary or advisable to carry out the provisions of this
Will or any Trust.
The powers granted hereunder shall be exercisable with respect to all real and personal
property, including, but not limited to, income and principal held for minors or disabled
beneficiaries at any time, until the actual distribution of all property. All powers, authorities
and discretion granted here shall be in addition to those granted by law and shall be exercisable
without leave of court. However, nothing herein shall be interpreted or construed to
encourage, authorize, empower, or permit the Executor to act or cause anyone to act in a
manner contrary to or inconsistent with accepted standards of portfolio diversification and risk
management.
FIFTH: I nominate, constitute, and appoint my son, THOMAS R. WITMAN, as
Executor of this, my Last Will and Testament. In the event of the renunciation, death,
resignation, or inability of my son to act for whatever reason in this capacity, then I nominate,
constitute, and appoint my other son, TERRY LEE MELLICK, as Executor of this, my Last
Will and Testament.
I direct that no representative named above shall be required to post security for the
faithful performance of his duties in any jurisdiction insofar as I am able by law to relieve him
of such obligation. Any of my representatives shall be entitled to reasonable compensation for
the performance of the duties set forth here.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ltd.L day of
2013, on this, the fourth of four typewritten pages. I have also signed the
left-hand margin of the first three of these pages for purposes of identification only.
EVELYN L.IWITMAN
SIGNED, PUBLISHED, and DECLARED by the Testatrix, EVELYN L. WITMAN,
as 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.
PA
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ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of Cumberland
I, EVELYN L. WITMAN, Testatrix, whose name is signed to the attached instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as
my free and voluntary act for the purposes therein expressed.
fil
EVELYN L. WITMAN
Sworn or affirmed to and subscribed before me by EVELYN L. WITMAN, the
Testatrix, this ;j'` day of 'J}�� , g�- , 2013.
Notary Publffc
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Mary McGill,Notary Public
Camp hili 6oro,Cumberland County
Wry Commislon Expires Nov.15,2015
MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES
AFFIDAVIT
Commonwealth of Pennsylvania
County of Cumberland
We, Debra K. Wallet and un-k) Z , the witnesses whose names
are signed to the attached instrument, being duly qualified according to law, depose and say
that we were present and saw the Testatrix, EVELYN L. WITMAN, sign and execute the
instrument as her Last Will and Testament; that she executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix
signed the Will as witnesses; and that, to the best of our knowledge, the Testatrix was at that
time 18 years of age or older, of sound mind, and under no constraint or undue influence.
0,411, �.W,44.a--
Sworn or affirmed to and subscribed before me by bszk�-- and
, witnesses, this day of � �, , 2013.
Notary Publi4
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Mazy McGill,Notary Public
Camp Hill®oro,Cumberland County
My Commiszion Expires Nov.15,3015
MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES