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1505618403
OEPARTN.ENT TOFOF REREVENUEX(03-14)
REV-1500 OFFICIAL USE ONLY
County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
-� POBox.2aosol
Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 14 01146
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
10 24 2014 11 30 1928
Decedent's Last Name Suffix Decedent's First Name MI
BASSLER DOROTHY M
(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. Agricultural Exemption(date of ❑ 5. Future Interest Compromise(date of ❑ g, 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 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-THISSECTION MUSTBE COMPLETED.ALLCORRESPONDENCEANDCONFIDENTIALTAXINFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
DEBRA K WALLET 717 737 1300
First Line of Address
24 NORTH 32ND STREET
Second Line of Address
City or Post Office State ZIP Code
CAMP HILL PA 17011
Correspondent's email address: walletdeb@aol.com
REG CtER OF WILLS E OMt-jf C")
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REGISTER OF WILLS USE ONLY ::0 C"_
DATE FILED MMDDYYYY r—I = C) O
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Side 1 '
1505618411
REV-1500 EX
1 Decedent's Social Security Number
Decedent's Name: BASSLER, DOROTHY M
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. 105,515.80
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7. 18,607.03
8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 124,122.83
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 16,177.32
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 4,549.53
11. Total Deductions(.total Lines 9 and 10).................................................................. 11. 20,726.85
12. Net Value of Estate(Line.8 minus Line 11)............................................................. 12. 103,395.98
13: Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)................................................. 13. 94,91 7.08
14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 8,478.90
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.00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 16.
17. Amount of Line 14 taxable
at sibling rate X,12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 8,478.90 18. 1 ,271.84
19. TAX DUE...................................................................................................:............... 19. 1 ,271.84
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.
SIGNATU E OF PERSON RESPONSIBLE FOR FILING RETURN Lorraine Murdocca DATE
ADDRESS
204 Somerset Drive, Camp Hill, PA 17011
SIGNATURE OFAPREPA ER QTHER`HAN REPRESENTATIVE Debra K Wallet TES 1
a. WHEr
ADDRESS Law Offices of Debra K.Wallet
24 North 32nd Street, Camp Hill, PA 17011
Side 2
REV-1500 EX Page 3 File Number 21 - 14 - 01146
Decedent's Complete Address:
DECEDENT'S NAME
Bassler, Dorothy M
STREET ADDRESS
335 Wesley Drive, Apt. 404
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,271.84
2. Credits/Payments
A. Prior Payments 1,000.00
B. Discount 52.63
Total Credits(A +B) (2) 1,052.63
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) 219.21
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;.................................... ❑ ❑x
c. retain a reversionary interest;or.................................................................................................................. ❑ ❑x
d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ 0
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receivingadequate consideration?....................................................................................................................... ❑ 0
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?.....................................................................:................................................ 0 ❑
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 spo
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
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
f72 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
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 21ears 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)('
•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.
pennsylvania SCHEDULE E
DEPARTMENT OFCASH BANK DEPOSITS AND MISC.
INHERITANCE TAXAXRETURN
7
RESIDENT DECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Bassler, Dorothy M 21 - 14-01146
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 Members 1st checking account#408866-11 54,314.49
2 Members 1st savings account#408866-00 7.20
3 Members 1st investment savings account#408866-05 50,134.10
4 Cash in possession of Decedent 126.32
5 Bethany security deposit refund 346.70
6 Highmark refund 494.51
7 Westfield Insurance auto insurance refund 64.00
8 Holy Spirit Hospital Provider Services refund 22.02
9 19 $0.34 postage stamps 6.46
10 Personal property located in apartment at Bethany Towers(living room furniture, bedroom 0.00
furniture, wooden table and chairs, microwave, television -older condition, all donated)
TOTAL(Also enter on Line 5, Recapitulation) 105,515.80
REV-1510 EX+(08-09)
pennsyivania
DEPARTMENT OF REVENUE SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Bassler, Dorothy M FILE NUMBER
21 - 14-01146
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 DECD'S (IF APPLICABLE) TAXABLE VALUE
and the date of transfer. Attach a copy of the deed for real estate. INTEREST
1 Riversource Annuity Contract#9920-3400663 18,607.03 100% 18,607.03
Beneficiary: St. Joseph's Church, Mechanicsburg, PA
TOTAL(Also enter on line 7, Recapitulation) 18,607.03
REV-1511 EX+(08-13)
pennsylvania SCHEDULEH
LF DEPARTMENT OF REVENUE
FUNERAL B93MMS AND
INHERITANCE TAX RETURN AMNSTMWE
RESIDENT DECEDENT liLJ111����1h7�IV1
COM
ESTATE OF Bassler, Dorothy M FILE NUMBER
21 - 14-01146
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Malpezzi Funeral Home 7,110.00
2 Gate of Heaven Cemetery 1,500.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Lorraine Murdocca 3,500.00
Street Address 204 Somerset Drive
City Camp Hill State PA zip 17011
Year(s)Commission Paid 2015
2. Attorney's Fees Debra K.Wallet, Esq. 3,500.00
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 325.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Photocopies, postage, mileage, etc. 40.00
See attached 201.82
TOTAL(Also enter on line 9, Recapitulation) 16,177.32
REV-1511 EX+(08-13)
pennsylvania cm,�,.
DEPARTMENT OF REVENUE Sc ule H
INHERITANCE TAX RETURN FUnerd E7Q3el ws&
RESIDENT DECEDENT
AlfninMafm Casts continued
ESTATE OF Bassler, Dorothy M FILE NUMBER
21 - 14-01146
2 Cumberland Law Journal (advertisement of Grant of Letters) 75.00
3 The Sentinel (advertisement of Grant of Letters) 126.82
Page 2 of Schedule H
pennsylvania SCHEDULE
DEPARTMENT
INHERITANCE TAX RETURN DEBTS OF DECEDENT, MORTGAGE
RESIDENT DECEDENT LIABILITIES BIL ITIES O LIENS
FILE NUMBER
ESTATE OF Bassler, Dorothy M 21 - 14-01146
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 Hospice 3,375.00
2 Bethany Towers 310.00
3 Jenny Leah (apartment cleaning) 22.00
4 Verizon 36.97
5 Highmark 664.26
6 Holy Spirit EMS 141.30
TOTAL(Also enter on Line 10, Recapitulation) 4,549.53
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Bassler, Dorothy M
21 - 14-01146
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I� TAXABLE DISTRIBUTIONS(include outright spousal
distributions and transfers
under Sec.6116(a)(1.2)]
1 Lorraine Murdocca Friend 10% of residuary
204 Somerset Drive Estate
Camp Hill, PA 17011
Enter dollar amounts for distributions shown above on lines 15 through 18 on 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
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 St. Jude Children's Research Hospital 76,310.05
501 St. Jude Place, Memphis, TN 38105
2 St. Joseph's Church (beneficiary of Riversource Annuity) 18,607.03
400 E. Simpson St., P.O. Box 2012, Mechanicsburg, PA 17055
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 94,917.08
LAST WILL AND TESTAMENT
OF
DOROTHY M. BASSLER
I, DOROTHY M. BASSLER, of Mechanicsburg, Cumberland
County, Pennsylvania, make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me .
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, as follows :
e (A) Ninety percent (90a) thereof to ST. JUDE
CHIL-DREN' S RESEARCH HOSPITAL, of 501 St . Jude Place, Memphis, Tennes-
see 38105, to be used for general purposes, as the governing body
_3
�. of that organization deems appropriate .
i
(B) Ten percent (100) thereof to my friend, LORRAINE
MURDOCCA, of 204 Somerset Drive, Shiremanstown, Pennsylvania
17011, provided that should she predecease me, then to her
husband, ANTHONY MURDOCCA.
SECOND: No provision is made in this, my Last Will and
Testament, for my children, HARRY J. BASSLER, III and DEANDRA
WINTERS, not necessarily because of an lack of affection for
Y Y
-`� them, but because they are already well provided for.
THIRD : In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it .
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate .
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value .
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
I\��
(E) To exercise any option, right or privilege granted.
in insurance policies or in other investments .
(F) To exercise any election or privilege given by the
"`. Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws .
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
!Ns (H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes .
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
2
any other rights which they may have under the plan, in whatever
manner they consider advisable .
FOURTH: I direct that all inheritance, estate,. trans-
fer, succession and death taxes, of any kind whatsoever, which
may be payable by reason of my death, whether or not with respect
to property passing under this Will, shall be paid out of the
principal of my residuary estate .
FIFTH: I nominate and appoint LORRAINE MURDOCCA,
Executrix of this, my Last Will and Testament . In the event of
the death, resignation or inability to serve for any reason
whatsoever of the said LORRAINE MURDOCCA, I nominate and appoint
ANTHONY MURDOCCA, Executor of this, my Last Will and Testament .
I direct that my Executrix or Executor, as the case may be, and
their successors, shall not be required to post security or a
bond for the performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this day of
2013
(SEAL)
DOROTHY M. ,b ASSLER
3
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last will and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses .
Address
a
Address kJ
e�
4
ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA:
SS .
COUNTY OF CUMBERLAND
We Aw r t
I , Je B - I
and Dorothy M. Bassler, the TV-,t--at-rix in and the undersigned
witnesses to the Last Will and Testament, the attached forgoing
instrument, who have signed the instrument, having been qualified
according to law do depose and say:
(a) that I, Testatrix, do hereby acknowledge that I signed
the instrument as my Last Will and Testament, that I signed it
willingly and as my free and voluntary act for the purposes
therein expressed; and
(b) that we, the witnesses, were present and saw the
Testatrix sign the instrument as her Last Will and Testament,
that she signed it willingly and executed it as her free and
voluntary act for the purposes therein expressed, that each of us
in the hearing and sight of Testatrix signed the Will as a
witness and that to the best of our knowledge, the Testatrix was
at the time at least eighteen (18) years of age, of sound mind
and under no constraint or undue influence .
Dorothy M.%�Bassler, Testatrix
r
Witne
Witness '
Subscribed, sworn to and acknowledged before me by Dorothy M.
Bassler, the Testatrix, and sub ried and sworn to before me by
.PS N�C.` , and /3 Le.P, !�'-
the
witnesses, this �d of ,, . T013 .
Notary Public
My Commission Expires :
5 RM6
RY PUBLICGUSTI3,20I13�