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HomeMy WebLinkAbout07-22-15 (3) 1505618627 3M464710OD0 J pennsylvania DEPARTMENtOF REVENUf EX(03-�4��TP) REV-1500 OFFICIAL USE ONLY Co�nty Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2� ]�4 11,5 4 Po eox zsoso, RESIDENT DECEDENT Harrisbur , PA 1 7 1 28-060 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 174- 1�302�1,4 ],0091925 DecedenYs Last Name Suffix Decedent's First Name MI BOYER RACHAEL 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(date of � 5. Future Interest Compromise(date of �_l 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 a._ 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) � 10. Litigation Proceeds Received � 11. Non-Probate Transferee Return �� �2. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) � 13. Business Assets � 14. Spouse is Soie Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RICHARD C • SNELBAKER 717-697-8528 First Line of Address 44 WEST MAIN STREET Second Line of Address City or Post Office State ZIP Code MECHANICSBURG PA 17055 CorrespondenYs email address: ----- — REGISTER OF WILLS USE OI� C'� �,`�j-� � REGISTER OF WILLS USE ONLY � O ��� DATE FILED MMDDYYYY � � � -4�— i Tl � G`� � � � �J ;-a. f'" fV ;_r� � � ,..._ __ �'' N . _ ,., ._... _ {.., , ;_} DATE'�-iLF,#7;�,ST�AMP � "�_1 � ----- .-- ,� � ,, C_7 T _._ C� 1� �'i __ + � , � � � PLEASE USE ORIGINAL FORM ONLY " f""� Side 1 I I'II'I IIIII IIIII I'III IIIII III�I II'�I I'II"III'IIIII II'I II'I � 1505618627 ],505618627 J �, \- � 15D5618635 REV-1500 EX(TP) f)ecedent's Soaal Securiry Number oe�ede�t�SNameBOYER RACHAEL E : RECAPITULATION 1 Real Estate(Schedule A) - • • - • • • • � • • • • � • � • � • • • • • • • • • • � 0 •�0 2 Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . 2. � •�� 3 Closely Held Corporation,Parmership or Sole-Proprietorship(Schedule C)_ . _ , . 3. Q •Q 0 4 Mortgages and Notes Receivabie(Schedule D), , , , , , , , , , , , , , , , , , a. Q •Q Q 5 Cash. Bank Deposils and Miscellaneous Personal Properry(Schedule E), , , , , , 5. 119,3 4� • 5 4 6 Joinlly Owned Property(Schedule F) j Separate Billing Requested. . . . . 6 � • �0 7 Inter-Vivos Transfers 8 Miscellaneous Non-f'robate Property (Schedule G) ' � Separate Billing Requested. . . . . 7. � •0� 8. Total Gross Assets(total lines 1 througn 7) . . . . . . . . . . . . . . . . . . g. li 19,3 4 0 • 5 4 9 Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9 16,14 7 • �2 10 t)ebis oi Decedent, Mortgage Liabilities and Liens(Schedute 1). . . . . . . . . . 10. 8,2 0 7 •81 �� Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 1 1 2 4 ,3 5 5 • ],3 12. Net Value of Estate(l.ine 8 minus Line 11) . . . . . . . . . . . . . . . . . . . 12. 9 4 ,9 8 5 - 41 13 Chantable and Govemmental Bequests/Sec.9113 Trusts for which an election to tax has not bc:en made(Schedule J). . . . . . . . . . . . . . . . �3. �L,2 3 9 -0 6 14. Net Value Subject to Tax(Line 12 minus Lme 13). . . . . . . . . . . . . . . . �4. �3,?4 6 - 3 5 TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15 Amount of Line 14 taxable at ihe spousal tax rate,or transfers ur�er Sec.9116 (a)(12)X OU o • oo �5. o -oa 16 Amount of I_ine t.4�xable atlinealrate XA4— 23,746 • 35 �s 1,�68 • 59 17 Amount o(Line 14 taxable at sibfing rale X.12 � - 0� 17. � • �� 18. Amount of Line 14 taxable at collateral rate X.15 0 • �� 18. � . �� 19 TAXDUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1�068 . 59 20 FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Under penalties of per�ury,I declare ihal I have examinetl this return.mcludmg accompanying schedules antl statemerts,and to the best of my knowledge antl betief. �t is true correct and complete Oeclaration of preparer other than the person responsible for filling the retum is based on afl information of which preparer has any knowledge TURF.OF,.PERSON RESPONSIBL FOf��ILING RFTURN pATF �. C' .� ', � ,r ,C=w,-, .�.—z��'— '-�'�/.�-a —�/��� .�' SI NA A DRES h1 'T— ORRSTOWN BANK P • 0 • BOX 25v, ?7 EAST KING STREET, SI t�REPARFR OTHf_R THMI PERSON f2FSPONSIL3L.F.FOR f'ILING THE RETURN �arEShippensburg, PA -- �1�� � 1 7257 ADDRFSS Keith 0. Brenneman, Esquire 44 WEST MAIN STREET, MECHANICSBURG I IIIII IIIII IIIII I IILI I IIII II IJ I IV IIIII IIIII III IIII PA 1 � �5��6��6�� Side 2 � :L5Q5618635 �nnasas�o 000 REV-1500 EX(TP) Page 3 File Number Decedent's Complete Address: 21 14 11,5 4 DECEDENTS NAME BOYER RACHAEL ---E- STREET ADDRESS ��t L�ANCE DRIVE, APT #308 ---- CARLISLE BORO , CUf1BERLAND s-r�T�--- ziP ciTv CARLISLE PA 1701,3 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,,0 6 8 • 5 9 2. Credits/Payments A. Prior Payments 1 ,��� ' �� B.Discount 5� • �0 (See instructions J Total Credits(A+B) (2) 1,�5� • 0� 3. Interest �;;� � • �� 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. ��� O � 0� 5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 18 • 5 9 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TNE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . . . . . : O � b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . . . . ❑ � c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O � 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? . . . . X 4. Did decedent own an individual retirement account,annuity,or other non-probate property,which ❑ ❑ contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 Jufy t, 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. f-�or dates of death on or after July 1,2000: • 1he 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)j. • 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 witM the decedent,whether by blood or adoption. 3M4671 4.000 R E V-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOF REVENUE CASH, BANK DEPOSITS 8 MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Rachael E Bover 21 14 1154 Include the proceeds of litigation and the date the proceeds were recerved 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. Apria 106. 95 refund due the decedent for medical expenses 2 Century Link 80.03 refund due the decedent 3 Commonwealth of Pennsylvania 1,302.00 income tax refund due the decedent on 2014 taxes 4 Orrstown Bank 89,175.34 investment account #50000559007 consisting of: a. 184 shares o£ PNC Financial Services Group stock, valued at $85.075 per share for for a total of $15,653.80. b. Federated Money Market Fund valued at $73,521.54 Dividend accrued on 10/30/2014 88•32 5 Orrstown Bank 24,714. 91 checking account #106004702 Dividend accrued on 10/30/2014 0.34 6 Persoanl property and household goods 1,872. 65 net proceeds from sale at public auction 7 Proceeds due the decedent in criminal case #1476-2014 against Bobby Joe Rickrode, Jr. 2,000.00 for restitution for items that were stolen TOTAL(Also enter on line 5,Recapitulation) $ 119,340.54 2wasnD 2 000 If more space is needed,use additional sheets of paper of the same size. RE�-,5„EX'`°e-,3, SCHEDULE H pennsylvania DEPARTMENTOFREVENUE FUNERAL EXPENSES AND iNHERiTANCETwcRET�RN ADMINISTRATIVE COSTS RESIDENT DECEDENT - Estate of: Rachael E. Boyer 21 14 1154 Schedule H Part 7 (Page 2) 3 Orrstown Bank date of death valuation fee $2.00 & service charge fees on checking account $6.00 8.00 4 Register of Wills additional probate fee due 50.00 5 The Sentinel advertising Executor's Notice 266. 00 6 Reserve for filing fees, accountant fees and other miscellaneous costs associated with the administration of the decedent's estate 1,000.00 Total (Carry forward to main schedule) 1,324 .00 RE�_,S,zEX'"z-,2, SCHEDULE I pennsylvania DEPAFtTMENTOF REVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT _-_.__ ESTATE OF FILE NUMBER Rachael E Boyer ____?_1 14 1154 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. VALUE AT DATE ITEM NUMBER DESCRIPTION _ _ OF DEATH � Apria Healthcare balance due for medical expenses 178.25 2 Century Link balance due for phone service 211.73 3 Chapel Pointe at Carlisle payment of apartment fees from 11/1/14 - 12/31/14 1,601. 61 4 Cumberland Goodwill Fire Rescue EMS ambulance service 810.30 5 Home Instead Senior Care in-home nursing care from 10/16/14 - 10/30/14 4,792.36 6 Hope Oxygen Company balance due for medical services 9.58 7 PA Department of Revenue 2014 Form PA-40 estimated tax payment due 529.00 8 Verizon Wireless balance due for cell phone services 74•98 TOTAL(Also enter on Line 10,Recapitulation) $ 8 207.81 zwasaH 2 00o If more space is needed, insert additional sheets of the same size. i REV-1513EX+(01-10) SCHEDULE J pennsylvania oEP,��E�oF RE�EN�E BENEFICIARI ES INHERITANCE TAX RETURN RESIDENT DECEDENT ___ ESTATE OF: FILE NUMBER: Rachael E. Bo er ----- 21 14 1154 _ RELATIONSIiIP 10 DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING F'ROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec. 9116(a)(1.2).J � Pamela K. Wallace 343 Caraway Drive Mountville, PA 17554 25� of Residue: 23,746.35 Daughter 23,746.35 EPfTER DOLLAR AMOUNTS FOR DISTRIBUfIONS SHOWN ABOVE ON LINES 15 TFiROUGH 18 OF REV-1500 COVf:R SHEET,AS APPROPRIATE. II NO�TAXABLE DISTRIBUTIONS A.SPOUSAL DISTRIBU1lONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: � See Attached 1 TOTAL OF PART il-EN1ER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 71,23 9.06 if more space is needed, use additional sheets of paper of the same sire. 9W46AI 2A00 Estate of: Rachael E. Boyer 21 14 1154 Schedule J Part 2B (Page 1) Item No. Description .Amount 1 Samaritan's Purse P.O. Box 3000 801 Bamboo Road Boone, NC 28607 25$ of Residue: 23,746.35 23,746.35 2 Immanuel Church of The Christian and Missionary Alliance of Mechanicsburg 800 South Market Street Mechanicsburg, PA 17055 50$ of Residue: 47,492.71 47,492.71 LAST WILL AND TESTAMENT �'----a '� ..� - I, R.ACHAEL E. BOYER, of the Borough of Carlisle, County of Cumberland, and i Commonwealth of Pennsylvania, being of sound and disposing mind, memory and �I understanding, do make, publish and declare this as and for my Last Will and Testament,hereby revoking and making void all former wills and codicils by me at anytime heretofore made. , FIRST. I order and direct that all my just debts and funeral expenses be paid by my �� Exec hereinafter named, as soon as conveniently may be done after my decease. � � SECOND. I order and direct that all my tangible property be converted into cash, and the � net proceeds thereof be added to my cash assets and distributed pursuant to Item Third c.�� hereinbelow. THIRD. I give, devise and bequeath all the rest, residue and remainder of my Estate, ' real, personal and mixed,whatsoever and wheresoever situated,unto the following named beneficiaries in the amounts and proportions as follows: � A. Twenty-Five per centum (25%) of said residue unto my daughter,namely, PAMELA K. WALLACE, absolutely, if she survives me. B. Twenty-Five per centum (25%) of said residue unto THE SAMARITAN PURSE of Boone,North Carolina, absolutely. C. Fifty per centum (50%) of said residue unto IMMANUEL CHURCH OF THE CHRISTIAN AND MISSIONARY ALLIANCE of Mechanicsburg,Pennsylvania, absolutely. LASTLY. I nominate, constitute and appoint ORRSTOWN BANK(of Shippensburg, �p,W OFFICES SNELBAKER SC BRENNEMAN, P.c. PA)to be the Executor of this,my Last Will and Testan�.ent, to serve without bond or ot er .��___ _. . _ __. _... _ - - security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, RACHAEL E. BOYLR, have hereunto set my hand and seal to this my Last Will and Testament, which consists of two (2)typewritten pages to each of which I have affixed my signature this 26th day of Jlule, 2013. .4. - � � ` ti. (SE� L) RACHAEL E. BOYrR ( � � �.� , � The preceding instrument, consisting of this and one (1) other typ itt�n page, each identified by the signature of the Testatrix,was on the date thereof signed, sealed, published and declared by RACHAEL E. BOYER, the Testatrix therein named, 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. . ,� ' r ���.�-�-�-'' -r -����`� �c��cQ�--X�f LAW OFFICES � COMMONWEALTH OF PENNSYLVANIA) : SS. COUNTY OF CUMBERLAND ) We, RACHAEL E. BOYER, RICHARD C. SNELBAKER and SANDRA K. SHOWERS, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his or her knowledge,the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. �`� � � � Te'statri � !, . i � Witness '`�`` � Z�`���L�' ;�r�.�"' ��� W1tlleSS Subscribed, sworn to and acknowledged before me by RACHAEL E. BOYER,the Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and SANDR.A K. SHOWERS, the witnesses,this ��'��'�, day of �'�/ �t��- , 2013. �% . ,. , / Notary Public COMMONWEALTH OF PENNSYLVANIA LAW OFFICES Notarial Seal SNELBAKER BC Susan L.Matrazi,Notary Public Mcrl+ani�-r1.�....o..... r.....4._��_�.�"'_�.