HomeMy WebLinkAbout05-04-15 (3) "`►`J PeAnIins1505618403
TMy" 'IN
(03-14)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 14 01180
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY
11 05 2014 05 23 1922
Decedent's Last Name Suffix Decedent's First Name MI
WILLIAMS PAULINE
(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
❑X 1. Original Return2. Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
4. Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
7. Decedent Died Testate 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 11. Non-Probate Transferee Return 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
13. Business Assets EJ 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 Number
MARK A MATEYA 717 241 6500
First Line of Address
55 W CHURCH AVENUE
Second Line of Address
City or Post Office State ZIP Code f"
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CARLISLE PA 17013 C> rn c7
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CC
Correspondent's email address: mam(cD_mateyalaw.com 7
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REGISTER OF-WILLS UE _NLr '
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REGISTER OF WILLS USE ONLY L." �-'� •� --r}
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DATE FILED MMDDYYW i"a -Tj —�
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DATE FILED STAMP
Side 1
1505618403 1505618403
4
15056]-6411
REVJ500 EX
Decedent's Social Security Number
Decedent's Name: Williams, Pauline
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.
P
,,4. Mortgages and Notes Receivable(Schedule D).................................................... 4.
',5.- Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 32,004 .*76
6. Jointly.Owned Property(Schedule F) Q,Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) Q Separate Billing Requested............ 7. 3 8 011 - 3 7
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 7 0 016 - 13
:9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 11 -s373 - 37
10. Debts of,Decedent,Mortgage.Liabilities and Liens(Schedule 1). ....... ...... 10. 52 . 62
11. Total Deductions(total Lines 9 and 10)..................................... ll-,4251. 99
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 58 -1590 - 14
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. 58-e590 - 14
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES,
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under,Sec.9116
(a)(I.2)X.. 15 000
16. Amount of Line 14 taxable
at findal tittb X .045' 1 . ; : 58 ,590 .14 16. 2,636 - 56
17. Amount of Line 141axible
at sibling rate XA2 0 .0 0 - 17. -a . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. U . 00
19. TAX DUE................................................................................................................. 19. 2 -,636 . 56
20. FILL IN THE,OVAL IF,YOU ARE REQUESTING A-REFUND OFANWERPAYMENT
•
Under penalties of perjury,I declare I have examined this return,including accompanying-schedules and,statements;and to thebestof my knowledge and belief;
complete.Declaration of preparer other than an the,person responsible for filing th6
it is true,correct and return is based on all information of which preparer has
any khowledje.
SIGNAT OF S RPPO G RETURN. DATE -
U David G Williams /5
ADDRESS
764 A East Louther Street, Carlisle,.PA .17013
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Mark A. Mateya DATE
ADDRESS 0
55 W. ChurchAvenue, Carlisle, PA
Side 2
1505618411 .1505,618411
Rev-1508 EX+(08-12)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OFPERSONAL PROPERTY
INHERITANCE TAXAXRETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams, Pauline 21-14-01180
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
NUMBER DESCRIPTION OF DEATH
1 Citizens Bank-Decedent's checking account No.584-9 21,558.40
2 Citizens Bank-Checking Account No. 501-6 1,460.58
3 First Citizens Bank-Account for pre-paid funeral expenses 2,028.97
4 Church of God Home-Refund for assisted living expenses 6,831.81
5 Church of God Home-Refund for overpayment on Account No. 2531 20.00
6 Episcopal Church Medical Trust-Refund 105.00
TOTAL(Also enter on Line 5,Recapitulation) 32,004.76
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12)
Rev-1510 EX+(0&09) SCHEDULE 6
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE MISC. NON-PROBATE PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OFFILE NUMBER
Williams,
Illams, Pauline 21-14-01180
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 OFDEATH %OFDECD'S EXCLUSION TAXABLE
INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND INTEREST (IF APPLICABLE) VALUE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET
I United American Insurance-Non-qualified Annuity- 38,011.37 38,011-37
Contract No. 002087416; Designated Beneficiary is
David Williams
TOTAL(Also enter on Line 7,Recapitulation) 38,011-37
(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+(08-13) SCHEDULE H
pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERRESIDENT
DECEAX DENT
ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams, Pauline 21-14-01180
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 3,606.44
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
David G Williams
Street Address 764 A East Louther Street
City Carlisle State PA ziD 17013
Year(s)Commission Paid 2015 3,500.00
2. Attorney's Fees Mateya Law Firm 3,500.00
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 245.50
5. Accountant's Fees 200.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs 321.43
See continuation schedule(s)attached
TOTAL(Also enter on line 9,Recapitulation) 11,373.37
Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Williams, Pauline 21-14-01180
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 David G.Willams-Reimburse for after funeral meal 89.44
2 Ewing Brothers-Funeral Expenses 2,717.00
3 Monocacy Cemetery-Fee for burial 600.00
4 Sugarloaf Monuments-Inscription on monument 200.00
H-A 3,606.44
Other Administrative Costs
5 Center for Kidney Disease&Hypertension-Outstanding medical bill for decedent 5.10
6 Citizens Bank-Fee for Estate Checks 27.25
7 Cumberland Law Journal-Legal Advertisement of Estate 75.00
8 Kantor and Tkatch Associates PC-Medical bill-Account No. WILPA004 5.44
9 Physicians Mobile X-Ray,Inc.-Medical bill for Account#204870 7.48
10 The Sentinel-Legal Advertisement of Estate 201.16
H-B7 321.43
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-12)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF
RET
INHERITANCE TAXAXRETURRNN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams, Pauline 21-14-01180
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Cumberland Goodwill Fire Rescue EMS-Ambulance Service-Invoice No. 14-233799 23.93
2 Darryl Guistwite, D.O.-Medical services 11.61
3 Darryl Guistwite, D.O.-Medical services 6.23
4 Holy Spirit Medical Group-Outstanding medical bill for last illness 10.85
TOTAL(Also enter on Line 10, Recapitulation) 52.62
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Williams, Pauline 21-14-01180
NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER
PERSON(S)RECEIVING PROPERTY (Words) ($$$)
Do Not ListT t
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions,and transfers
under Sec.9116(a)(1.2)]
1 David G Williams Child One-Third of
764 A East Louther St residual Estate
Carlisle, PA 17013 plus United
American
2 John E Williams Child One third of
7 Ector Street residual estate
Apt S
Asheville, NC 28806
3 Stephen G Williams Child One third of
458 Holiday Park Blvd NE residual estate
Palm Bay, FL 32907
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
COPY
OF
PAULINE GILPIN WILLIAMS
I, PAULINE GILPIN WILLIAMS, of Buncombe County, North Carolina, being of
sound and disposing mind and memory and desiring to make such disposition of my
entire estate as I deem best, do hereby revoke all Wills and Codicils heretofore made
by me,and do hereby make, publish and declare this to be my Last Will and Testament
i.n manner and form as follows:
ARTICLE I
I direct that all of my just debts, funeral expenses and the costs of the
administration of my estate be paid out of the assets of my estate as soon as practicable
after my death.
ARTICLE II
I direct that all estate and inheritance taxes and other taxes in the general nature
thereof, including interest and penalties thereon which shall become payable upon or
by reason of my death with respect to any property passing by or under the terms of
this Will or any Codicil to it hereafter executed by me, with respect to the proceeds of
any policy or policies of insurance on my life, or with respect to any other property
which shall be included in my gross estate for the purpose of such taxes, shall be paid
by my Executor out of my residuary estate and neither charged against nor recovered
from the beneficiaries hereunder or the takers of any such property.
ARTICLE III
will, devise and bequeath in equal shares to my children, DAVID GILPIN
WILLIAMS, STEPHEN GREENLEAF WILLIAMS, JOHN EDWIN WILLIAMS, III, and
CHRISTOPHER NOELL GREENLEAF,per stirpes all the rest, residue and remainder of
my estate and property which I may own or have the right to dispose of at my decease,
of whatever kind,character and description, real, personal, intangible and mixed,and
wherever situated.
ARTICLE IV
I hereby nominate and appoint my son, DAVID GILPIN WILLIAMS,the Executor
of this my Last Will and Testament, to serve without bond, and I grant to my Executor
2 �'
the continuing absolute discretionary power to deal with any property,real or personal,
held in my estate as freely as I might in the handling of my own affairs. Such power
may be exercised independently, without prior or subsequent approval of any Court
or judicial authority, and no persons dealing with the Executor shall be required to
inquire into the propriety of any of his actions. Without in any way limiting the
generality of the foregoing and subject to North Carolina General Statute, Section
32-26, 1 hereby grant to my Executor all the powers set forth in North Carolina General
Statute, Section. 32-27, and these powers are hereby incorporated by reference and
made a part of this instrument, and such powers are intended to be in addition to and
not in substitution of the powers otherwise conferred by law.
In the event my son, DAVID GILPIN WILLIAMS,does not survive me or for any
other reason fails to qualify as Executor of this my Last Will and Testament, or having
qualified thereafter for any reason shall cease to act, then I nominate and appoint my
son, STEPHEN GREENLEAF WILLIAMS as alternate Executor of this my Last Will and
Testament with all the duties, rights, powers, liabilities, privileges and immunities
which are hereinbefore given to DAVID GILPIN WILLIAMS, as Executor,as aforesaid.
1, PAULINE GILPIN WILLIAMS,Testatrix, sign my name to this instrument this
the I I day of 2000, and being first duly sworn, do hereby
declare to the undersigned authority that I sign and execute this instrument as my Last
Will and that I sign it willingly, that I execute it as my free and voluntary act for the
purposes therein expressed,and that I am eighteen (18)years of age or older, of sound
mind, and under no constraint or undue influence.
�a'LJ41 tp-'A (SEAL)
PAULINE GILPIN WILLIAMS, Testatrix
We )e IV ) and (7
Witnesses, sig ri our names to this instrument, being first duly sworn, and do hereby
declare to the undersigned authority that the Testatrix signs and executes this
instrument as her Last Will and that she signs it willingly, and that each of us, in the
presence and hearing of the Testatrix,hereby signs this Will as witness to the Testatrix's
signing, and that to the best of our knowledge the Testatrix is eighteen years of age or
older, of sound mind, and under no constraint or undue influence.
WI ESS
j,
WITNESS U
F15
STATE OF NORTH CAROLINA
COUNTY OF BUNCOMBE
SUBSCRIBED, SWORN TO AND ACKNOWLEDGED before me by PAULINE
GILPIN WILLIAMS, the Testatrix, and subscribed a d sworn before me by
and the Witnesses, t is the
l t day of , 2000.
NOTARY PUBLIC
My Commission Expires:
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