HomeMy WebLinkAbout06-25-15 oft Pennsylvania 1505614105
D MRTMEvROFRE ENUE EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
7
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT �'1 ' I l
qj
_ .
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
( 11102014 I 03011931
Decedent's Last Name Suffix Decedent's First Name MI
Barrick Edna _.] M
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
I
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
Qp 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of C=:) 5. Future Interest Compromise(date of O 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
CW 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.)
O 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets C=:) 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
Adam R. Deluca, Esquire [(717) 249-1177
First Line of Address _
61 We�Lout�e:r�treet��
Second Line of Address
E
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1
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City or Post Office State ZIP Code >
Carlisle [ PA 17013
Correspondent's email address: adeluca@allledattorneysllc.com _? r i 7j
REGISTER OF W LLS 4SE b Y ±a
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REGISTER OF
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DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505614105 1505614105
�VJ`
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: EDNA M. BARRICK
RECAPITULATION
1. Real Estate(Schedule A). .. .. .. .. .... ..... .. .. . .. ... .. ..... .. .. .... .. 1.
2. Stocks and Bonds(Schedule B) 2. 45,369.48 i
.. . . .. .. .... .. ... . .. .. .. ..... .... ......
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. 2,725.38
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ... .. .. 6. 53,443.04
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. ... .. . 7.
8. Total Gross Assets(total Lines 1 through 7). . .... .. .. .. .. ... . ... .. .. .. .. 8. ( 101,537.90
9. Funeral Expenses and Administrative Costs(Schedule H). .. .. ... . ... . .... .. 9. 9,742.75
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1).. .. . .... . .. .. . 10. 2,020.67
11. Total Deductions(total Lines 9 and 10). . .. .. .. .. .. .. .. ... .. .. ... .. .. ... 11. 11,763.42 i
12. Net Value of Estate(Line 8 minus Line 11) .. .. .... .. . . .. . .. .. .. . . ..... . . 12. I 89,774.48
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. 89,774.48
{
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_ 15.1
16. Amount of Line 14 taxable
at lineal sate X.0 45 89,774.48 16.. 4,039.85
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.' 4,039.851
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. n j
SI�yCJ�FPE ON�L�FILING RETURN
ADDRESS
105 Susan Lane, Carlisle, PA 17013
SIG UFX O T E HAN PERSON RESPONSIBLE FOR FILING THE RETURN n A
ADDRESS (p
61 West Louther Street, Carlisle, PA 17013
lig11111111I 1111111111111111111111111111 Side 2
1 0 61420 1505614205 J
REV-1500 EX (FI) Page 3 File Number a I I
Decedent's Complete Address:
DECEDENT'S NAME
Edna M. Barrick
STREETADDRESS
105 Susan Lane
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4,039.85
2. Credits/Payments
A.Prior Payments 4,000.00
B.Discount 210.52
(See instructions.) Total Credits(A+B) (2) 4,210.52
3. Interest
(3) 0.00
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) 170.67
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
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 .......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑
c. retain a reversionary interest .............................................................................................................................. ❑
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?.............. ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ N
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.
REV-1503 EX+(02-15)
ispennsylvania SCHEDULE 6
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDNA M. BARRICK 21-14-1141
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' Common Stock:PNC Financial Services Group(PNC)CUSIP#693475105
390 shares(Par Value$5.00)(Market Value on DOD$88.68) 34,585.20
2 Common Stock:Energy Transfer Partners L.P.(ETP) CUSIP#29273R109
121 shares(Par Value$0.01)(Market Value on DOD$65.37) 7,909.77
3 Common Stock:Suncoke Energy Inc.(SXC) CUSIP#86722A103
123 shares(Par Value$0.01)(Market Value on DOD$23.37). 2,874.51
TOTAL(Also enter on Line 2, Recapitulation) $ 45,369.48
If more space is needed,insert additional sheets of the same size
REV-1508 EX+(02-15)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
EDNA M. BARRICK 21-14-1141
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1- Mutual of Omaha-Medical Claim Benefit Disbursement-Certificate Number 6366180 580.00
2. Mutual of Omaha-premium refund 42.25
3. Union Fidelity Life Insurance Company-premium refund 9.50
4. Energy Transfer Partners-dividend payment 120.40
5. Suncoke-dividend payment 7.20
6. Souther Progress Magazine-refund 9.96
7. Food Network/Country Living Magazine-refund 4.10
8. AMA Insurance Agency-refund 8.88
9. PNC Investments:1900 East Ninth St.,Cleveland,OH 44114-Cash Account#005-790818 1,943.09
TOTAL(Also enter on Line 5, Recapitulation) $ 2,725.38
If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+(02-15)
INpennsyLvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
EDNA M. BARRICK 21-14-1141
If an asset became 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.Terri L. Blosser 105 Susan Lane, Carlisle, PA 17013 daughter
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTTRnTON 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 DECEDENT'S INTEREST
1. A. 07/25/13 Metro Bank-Checking Account#537960866 7,432.31 50 3,716.16
2. A. 10/09/12 M&T Bank Savings Account#15004227681275 94,165.35 50 47,082.68
3. A. 02/01/02 M&T Bank Checking Account#950768339 5,288.40 50 2,644.20
TOTAL(Also enter on Line 6, Recapitulation) $ 53,443.04
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(02-15)
Iffpennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDNA M. BARRICK 21-14-1141
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES;
Baughman Memorial Works, Inc.(footstone) 790.0.0
02. [Terri L. Blosser(reimbursement for food purchased from Giant and Wal-Mart for funeral) 60.99:1
IL
B. ADMINISTRATIVE COSTS:
- _
i. Personal Representative Commissions:
Name(s)of Personal Representative(s) - -
Street Address
City State ZIP
Year(s)Commission Paid:
00'190.
2. Attorney Fees; 8,
_._.J'
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: i _ 405.501
5. Accountant Fees: 55.00
. 6. Tax Return Preparer Fees:
�• Estate Advertisement-Cumberland Law Journal IL 75.001
t_.t �E� state Advertisement-Patriot News Co. +^ ; 166.26,
01 EL
TOTAL(Also enter on Line 9, Recapitulation) $� 9,742.75,
If more space is needed,use additional sheets of paper of the same size.
a
REV-1512 EX+(02-15)
pennsylvania SCH EDU LE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDNA M. BARRICK 21-14-1141
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• Bank of America Credit Card-Account#xx-2376 42.41
2. Cumberland Goodwill Fire and Rescue EMS 169.90
3. Family Home Health Care Products 45.95
4. Blair,com(online clothing store) 180.92
5. The Animal Inn(Dog and Cat Boarding and Grooming) 45.00
6. TJ Maxx 10.59
7. Kohl's 30.80
8. United States Department of Treasury(Veteran's Administration)-overpayment of benefits 1,495.10
TOTAL(Also enter on Line 10, Recapitulation) $ 2,020.67
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(02-15)
10 pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
EDNA M. BARRICK 21-14-1141
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. Terri L.Blosser: 105 Susan Lane,Carlisle,PA 17013 daughter 50%
2. Kenneth A.Barrick:PO Box 83289,Fairbanks,AK 99708 son 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II 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.
LAST WILL AND TESTAMENT
OF
EDNA M. BARRICK
I, EDNA M. BARRICK, of Cumberland County, Pennsylvania, declare this to be
my Last Will and Testament and hereby revoke all prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses and administrative
expenses shall be paid from my estate as soon as practicable after my death. It is my
wish that upon my death, my body shall be cremated, and my ashes shall be buried next
to my husband at Mount Zion Cemetery, Boiling Springs, Pennsylvania.
2. I direct that all real property and all personal property that I own at the
Qn-
time of my death shall be given, devised, and bequeathed to my daughter, Terri L.
Blosser, and m son, Kenneth A. Barrick, in equal shares, per sti es.
Y p �
3. I appoint my daughter, Terri L. Blosser, as Executrix of this my Last Will
and Testament. In the event that Terri is deceased, unable or unwilling to serve or shall
cease to serve for any reason whatsoever, then I nominate, constitute and appoint my son,
Kenneth A. Barrick, as alternate Executor of this my Last Will and Testament.
4. The Executor or Executrix of this Will shall have the power to distribute
my estate in cash or in kind, or partly in either.
Page 1 of 5
5. I direct that no Executor or Executrix acting under this Will shall be
required to enter bond in any jurisdiction.
6. I recommend that my Personal Representative retain the law firm of Allied
Attorneys of Central Pennsylvania, L.L.C. to probate my estate.
IN WITNESS WHEREOF, I have hereunto set my hand this -:23 day
of , 2014.
c=� A
EDNA M. BARRICK
Page 2 of 5
The preceding instrument consisting of this and four other pages was on the day and date
hereof signed, published and declared by EDNA M. BARRICK, as and for 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 subscribed our names as witnesses hereto.
Witness Witness
Page 3 of 5
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
I,EDNA M.BARRICK,the TESTATRIX,whose name is signed to the attached
or foregoing 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.
EDNA M. BARRICK
COMMONWEALTH OF PENNSYLVANIA
S.S.
COUNTY OF CUMBERLAND I
On this 0A day of pE l , 2014, before me personally
appeared EDNA M. BARRICK, the TESTATRIX,known to me (or satisfactorily
proven)to be the person whose name is subscribed to the within instrument, and she
acknowledged that she was the declarant who executed the same for the purposes therein
contained.
IN WITNESS WHEREOF I hereto set my hand and official seal.
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Adam Deluca,Notary Public
Carlisle Boro,Cumberland County
My Commission Expires Jan:26,2016
Page 4 of 5
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
WE, lel]c'- L. Zl fn m er k-o,a and
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw testatrix sign and
execute the instrument as her Last Will; that she signed willingly and that she executed it
as her free and voluntary act for the purposes therein expressed; that each subscribing
witness in the hearing and sight of the testatrix signed the Last Will and Testament as
witnesses and that to the best of our knowledge the testatrix was at the time 18 or more
years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed and subscribed before me by
and 5.o r-e- this
�3 day of C`4 2014.
Notary Public/Attorney
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Adam Deluca,Notary Public
Carlisle Boro,Cumberland County
My Commission Expires Jan.26,2016
Page 5 of 5