HomeMy WebLinkAbout08-14-15 pennsybama 1505614105
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REV-1500 OFFICIAL USE ONLY
Bureau of Intlividual Taxes Caunry Code Vear FJe Number
co eox zeo6oi INHERITANCE TAX RETURN ) �
n � b g vn vi28-oboi RESIDENT DECEDENT Z I I S �J ��-� �L'
ENTER DECEDENT INFORMFTION BELOW
Social Securiy Number �a[e of Death MMD�YYrv Date oi Birih MM��YYrv
06112015 01291925
DecetlenPs Las�Name SuKx DecedenPs Firs�Name MI
Mathna Helen M
(It Applicable)Enter Surviving Spouse's In(ormation Below
Spouse s Last Name Sufix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.O�iginal ReWm O �-Supplemen�al ReWm p 3. Remaintle�ReWm(tlale of tlealh
pno��o 12-13-B2)
p 4.AgriculWre Exemption(tlate o! p 6 FUWre Interest Compromire(tlate o( p 6. Fetleral Esta[e Tax ReWm Requiretl
dea1M1 on or afler 1-1-2012) aeat�atler 12-12-82)
� ]. Decedent�ietl Testate O 8. �eceaent Maintainetl a Living Tmst 0 & Tolal Num�er of Safe�eposit Boxes
(AXaoh copy of wlll) (Atlac�copY o��NSL)
p 10. Li[igation Pmcee05 Receivetl O 11. Non-Probate Transferee ReWm p 12. OeferraVElection ol Spousal Trus6
(ScheOule F antl G Asse6 Onty)
O 13. BusinessAssets � 14. Spouse is Sole 9eneficiary
(No Vust involvetl)
CORRESPoNDENT- THIS SECTION MlIST BE COMVLETEO.ALL LORHESPON�ENCE RND CONFI�ENTIAL tAX INFORMATION SHOULD BE DIRECTE�TO�.
Name Daytime Telephone Number
Thomas P Gleason Esquire (717) 532-3270
Pirst Line of Adtlress
49 West Orange Street
Secontl Line of Adtlress
Ciry or Pwt ORice Sta[e ZIP Code
Shippensburg PA 'I7257
co..e�ao�ae�rsemanada.ess: tomgleason@tomgleasonlaw.com
REGI R OF WILL 'S�E ONJ.�' m
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J 1505614205
ftEV-1500 EX(F1) Decedenfs Social Security Number
oe�eae�rs rvame� Helen M. Mathna
RECAPITULATION
1. RealEsla[e(ScheduleA). . .. . .. .. . . .. . ... . .. . . .. ... . 1. 0.��
. .. . . . . . ... . . .. . .
2. Slocks and Bontls(Schetlule 8) . . . .. .. . ... .. 2. �.00
. .. .. . .. . .. . ... . . . ... . ... .
3. Closety Held Gorporatfon,Partnerehlp or SolaPmpnetorshlp(Schetlule C) .. . _ 3- 0.0�
4. Mortgages and Notes Receivable(Schedule D) .. . . . . ... . 4. 0.00
... . . . ... . . . . ... .
5. Cash,Bank Deposi[s and Miscellaneous Personal Pmperty(Schetlule E). ... . .. S 9,243.63
6. Jointly Owned Property(Schetlule F) O Separa�e Billing ReQuesletl .. . .. . . 6. 0.0�
]. InlerVlvos Trarefers 8 Miscellaneous NonProbate Property Q00
(Scnetlule G� O Separate Billing Requested.. . .. ... ].
8. Total Gmss Assets (blal�ines 1 ihrough 1).. ... ... . . .. . .. . .. . ... .. 8. 9�24$.6$
9_ PonerolExpensesandAtlminlshetiveCosls(ScheduleH�. .___. . _ . .--.. . . . . 8- 23,302.17
10. DebS oi Oeceden[,Morlgage Liabililies and Gens(Schedule Ij... . . . . . .. . ... . 10. 0.0�
11. To[ai Detluc[ions Qotal Lines 9 and 10). . ... .. . . .. . . . . . .. . . ... . .. .. 11. 23,302.�7
�2. Net Value of Es�ate(Line 8 minus Gne 11) . ... . .. . . ... . . . . . . . . ... . .. . . . . 12 -14,058.54
13. CharitaGle antl Governmental Beques�s/Sec.9113 TmsS for which
an election�o�ax has not been matle(Schedule J) . ... .. . ... . .. . . .. . . 13. 0.00
14. Net Value Subject to Taz(Line 12 minw Line 13) .. . ... . . .. . . . . ... . .. . . .. 14. -�4�058.54
TAX CALCULATION�SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount oi Line 14[axable
e�the spouseltaxra�e,or
Iransfers unaer Sen 9116 0.00
(a)(1 2)X.0_. 15- 090
16. Amount ot Line 14 taxable �.�0
atlinealrale % .045 0.00 16.
V. Amount o(Line 14 Yaxable �.�p
at sibling rate X .t2 0.00 1�.
18. nmount oi Line ia taxable 0.00 0.00
at collateral rate X 15 �8�
19. TAX DUE ... .. . . . .. . . . . ... . .. ... . . .. . .. . . 19. O.00
20. FILL IN THE OVAL IF VOU ARE REOUESTING A REFUND OF AN OVERPAYMENT O
Untler penal�ies o(pe�jury, I tlecF.rte I �ave axnmined��is reWm.inclutling eccompanying scM1edules antl slalemenig.end�o Ne best ol my knowletlge and belie(
II is tme, c rretl antl oomplele. �etlara6on o!preparer otM1er IM1an iM1a person responsiblo lor filing Ne retum is basetl on all Informatlon o�wM1icb praparar M1es
any knowletlge.
SIGN RE OF PERSON RESPONSIBLE FOR FlLING RETURN �AT€-
�RM ✓V1N7Z�n CI�� �� �5
nooaEss
c?")0 Mprn��u (y��vti c�.v��t�� �3unyt Pi} r�zs7
SIGNATUFE OF PFEPARER OTIIEF THAN PERSON RESPONSIBLE FOR Fl�ING THE eETl1RN OATE
AO�RESS
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L �5056 1505614205 J
REV-1500 EX �Fp Page 3 F�le Number
Decedent's Complete Address:
DECEDENT5 NAME
Helen M. Mathna
_ .. . _. _ . _. . . ._—__.
STftEETADDRE55
210 Big Spring Road
._. .. _ .._. ..__—_ .
CITY �STATE � ZIP
Newville PA ��Z4�
Tax Payments and Credits:
1. Tex Due(PaAe�.Line 18) (1) 0.00
2. Credits/Paymen�s
A.Pnor Paymen�s 0.00
B.Discount 0.00
(SeelnsVuctlonsJ TotalCredlk(A�B) (2) 0.00
3. Interest
(3) Q 00
4. If Line 2 is greater ihan Line 1 +Line 3,enter ihe diBerence. This is Ihe OVERPAYMENT.
Fill in oval on Page],Line 7010 request a rePond. (4) 0.00
5. If Line 1 +Line 3 is grealer ihan Line 2.en�er�he OiRerence.This is Ihe TAX DUE (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING �UESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a iransfer and: Yes No
a. re�ain Ihe use or income of Ihe propetly VansFerred ......... ..._._. .........._.._ ._..... ❑ �
b. reWin Ihe nght to designate who shall use the property Iransferred or its income ..._._.._................................ ❑ �
c. re�ainareversionarym�erest ,_.._.. ........_.._ ........... ............ ............ ❑ �
d. receive Ne promise far li�e o�ei�her paymenls,benefils or care� .......... ......._.._. ._...... ❑ �
2. If tlea�h wcurzed after�ec. 12, 1982,did deceden112nsfer pmperty within one year of death
wilhoulreceivingadequa�econsideration? ...._....._ ............ ._.._.. ............. ❑ �
3. Did decedent own an"in�mst fof or payable-upon-0eath bank accoun�or security at his or her dea�h?............. ❑ �
4. Did deceden�own an indivitlual re�iremen�account,annuiry or other nan-pmba�e propehy,which
contains a beneficia7 designation? ........_ . ......... .................. ......... .............. ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEUULE G AND FILE IT AS PART OP THE RETURN.
For dates of tleath on or after July 1, 1994,and before Jan. 1,1995,ihe tax rate imposed on�he net value of iransfers to or for the use of ihe surviving spouse
ls a percent[/2 Ps.§s11s�a��1.1��i��.
For dates of death on or after Jan. 1, 1995, the tax ra�e imposed on �he net value of transfers �o or for the use of �he surviving spouse is 0 percent
[72 P5.§9116(a)(1.1)(ii��.The staWte does not exemp�a transfer to a surviving spouse 6om�ax,and ihe staWtory requiremenls for disGosure of assets and
filing a�az return are s�ill applicable even if the surviving spouse is the only beneficiary.
For Oates of death on or aker July 1,2000:
• The tax ra�e imposed on the net value of Vansfers from a deceased chiltl 21 years of age or younger at death�o or for�he use of a naNral parenL an
atlopfrve paren�or a s�ep-pareo�of�he child is 0 percent[12 P.S, §9116(a)(12)].
• The taz rale imposed on ihe net value of trdnsfers to or�or Ihe use of ihe tlecedents lineal benef cianes is 4 5 percent ezcept as noted in�72 P.S.§9116(a)(1)�.
. The tax rate imposed on ihe net value of iransfers�o or for ihe use of ihe decedenCs siblings is 12 percent[72 PS. §9116(a)(1.3)].A sibling is defned,
under Seclion 9102,as an individual who has at least one paren�in common wi�h�he decedenC whe�her by blood or adoption.
aev-isoe ex. �oz-�s;
r,�J pennsylvania SCMEDULE E
"� oecanrmE�vroraevExuc CASH� BANK DEPOSITS & MISC.
�r�neurnrvce.a.aeruae PERSONALPROPERTY
aEsmervr oeceoErn
ESTATE OF: FILE NUMBER:
Helen M. Mathna
IneWee[he pmcee�s of li[igation and[he date the pmceetls were receive0 by[he es[ate.
All properry lointly ownetl with right a(survivorohip mus[be tlisclouE on ScheEule F.
REM VA W E AT DATE
NUMBER DESCRIPTION OF DEATH
1. M8T Bank checking account no.fi7347096 8,803.13
Z. Commonwealth of PA for 2014 Tax Retum 250.00
3. Highmark,retund of unused supplemental insurance premium 175.50
4. The Sentinel for refund of newspaper subscnption 15.00
TOTAL(Plso enter on Line 5, Rewpitulation) S 9,z43.63
If more space is neeaed,use atlditional shee[s of paper of Me same size.
i pennsylvania SCHEDULE H
� oEvnnTwErvroFnEVENUE FUNERAL EXPENSES AND
�NnE«�.a�crr�+aEr�a� ADMINISTRATIVE COSTS
aEsmErcr�erFOErvr
ESTATE OF FILE NUMBER
Helen M. Mathna .
�ecedenCs Eebts must be re0artetl on ScheAule I.
ITEM � . . —� �
NUMBER DESCRIPTION__ _ AMOUNT ._
A. � FUNERALEXPENSES'.
�� OsinsHoldingsofPA-gravemarkerinscription 499.00
B. A�MINISTRATNE CO5T5:
1. Personal Representa[ive Commissions', 450.00
Name(s)ofPersonal FeOresentative(s) Dana Alan Mathna_ _ _ _ _
Srecc A�aress 270 Matthew Drive ___. _...
Ciry Chambersburg 5cace PA ZIP 17201 ..
1'eaqs)[ommissio�PatE� 2015 ........ . .._.
1,OWA0
L pttorney Fees.
3. FamllyExemp[ion'. (IfaewdeaPsaOaresslsnotthesameastlaimanPs,at[a[M1eeplana0oa)
❑aimant . _ . . --. .. . _.
StreeCAdtlmss . .
[iry ___. ..... .___._. .. State . . Ziv ...
Re'atlorship of Gal'nant ro Decedent ______ . ..—____ ._
4. Proba's Fees�. 145.50
5. Acmuntant Fees'.
6. Tax Return Pre�amr Fees:
�� News Chronicle lo publish esta[e 12125
a. Money withdrawn by Social Secunry for overpayment 1,006.00
9. Cumberland Law Journal�o publish estate 75.00
i0. Es�a�e Recovery Claim 6om PA Depahment of Human Services 19,885.31
�� GreenRidgeVillageforfinal6illforcare. 92.�Z
iz. GreenRidgeVillageforfinaltelephonebill 28�09
� � TOTAL(Also enter on Gne 9, Recapitula[ion) ; 23,302.17
I�more space is neetled,use aaGltional sheets of paper oFthe same size.
� �� pennsylvania SCHEDULE ]
oEanarwEN�orn_vErvuE gENEFICIARIES
�rvne:*nrvc�lnxaeror.�
aesme.uroeceowt
ESTATE OF: FILE NUMBER:
Helen M. Mathna
RELATiONSHI4T00ECEDENT AMOUN?00.5HARE
Nl1MBER NANE AND N�9RE55 OF GERSON(5)RECEiVING PROGERP' Do No[List Trurtee(s) OF ESTATE
I TA%NBLE�14RI0UTIONS;1nduCe outnght SDousal tlislnbu6ons and hansfers untler
Sea 9116(a)�12).)
i. Janel Louise Walls Lineal-Daughfer 1/4 of residual
2 DanaAlanMathna Lineal-Son 1/4ofresidual
3. Ronald L Mathna Lineal-Son 1/4 of residual
4. RichaN L.Mathna Lineal-Son 1/4 of residual
5 BrookeMathna Lineal-Grandchiltl
6. BarbaraMathna Lineal-Grandchiltl
7. Justin Davidson Lineal-Grandchild
ENTEF�OLtAR AMOUVTS FOR�ISTRIBUTI�NS SMON'N ABOVE ON GNES IS iHROUGN lA OF 0.EV-1500 COVER SNEET,NS APPROPAIATE.
t] NOfi4A%ABLE�ISiRIBUiI0N5
A. SPOUSAL D6TALBUTi0N5 I1N�ER SECTIO�Y 9113 FOR WHICN AN E�ECION'0 TA%IS NOT rqKEN:
i.
0. C4ARITABtE FN�GOVcRNP1ENTAL�ISTRIBUTIONS:
1.
TOTAL OF PART II-EMER TOTAL NON-TA%ABLE DISTRIeUT10N5 ON LINE 13 OF REV-1500 COVER SHEET. $
� If rt�re spacc is neeAed,use aGGiNonal sheeh of Daper of[he samesize
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, HELEN M. MATHNA, of
Pennsylvania being of sound and disposing mind, memory and understanding, do
make, publish and declare this my Last Will and Testament, hereby revoking all
prior wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of all my legal debts, funeral expenses
including my grave marker and all expenses of my last illness, state, federal
estate and inheritance taxes, administration costs, etc., shall be paid as soon as
may be conveniently done following my decease leaving all specific bequests free
of tax to the legatee.
SECOND: I give, devise and bequeath ali my property be it real, mixed or
personal, to my husband, Dana C. Mathna.
THIRD: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give and bequeath the
mauve recliner, tiger eye ring, 5 pieces of pink depression glass and the white
bible to Ronald L. Mathna.
FOURTH: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give and bequeath the
spindle side-table made by Oliver Burkhart and all my books (excepting the said
bible) to Dana Alan Mathna.
FIFTH: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give and bequeath the
drop leaf table to Richard L. Mathna.
SIXTH: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give and bequeath the
bedside table (master bedroom) long side table and a set of pearls to Barbara A.
Mathna.
SEVENTH: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give and bequeath the
ruby birthstone necklace to Janet Louise Walls.
EIGTH: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events; I give and bequeath
$ 1,000.00, the porcelain music box with birds and the Christmas village to
Brooke Mathna.
NINTH: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give and bequeath
$1,000.00, the child's rocking chair and the Hess trucks in boxes to Tyler
Mathna.
TENTH: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give and bequeath
$500.00 to Justin Davidson.
ELEVENTH: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give and bequeath the
rest and residue of my estate be it real, mixed or personal to my children Janet
Louise Walls, Dana Alan Mathna, Ronald L. Mathna, Richard L. Mathna and
Barbara A. Mathna in equal shares, share and share alike, per stripes.
TWELTH: I nominate and appoint my husband, Dana C. Mathna as
Executor of this my Last Will and Testament. Should he fail to serve or be
unable to serve then in that event I nominate and appoint Dana Alan Mathna as
Executor. No executor appointed herein shall be required to post bond in this or
any other jurisdiction.
IN WITNESS WHEREOF, I, HELEN M. MATHNA, to this my Last Will and
Testament set my hand and official seal, this �'�°C� day of September 2002.
7�� �Y�fL�:9t�Y�-r'k � (SEAL)
Helen M. Mathna
Sworn to and subscribed, declared and
Published by Helen M. Mathna, as
Her Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at her request,
And in her presence, and in the presence
Of each other.
� �
/C 9�
i
�� i GAG2L I ����¢� V /� � '
COMMONWEALTH OF PENNSYLVANIA:
:55
COUNTY OFCUMBERLAND .
I, HELEN M. MATHNA, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I
signed it willingly; and that I signed it as my free and voluntary act for the
purpose therein expressed.
�M� ��vt�.C�i
Helen M. Mathna
Sworn to and acknowledged, before me,
By Helen M. Mathna, the Testatrix, �
This �''L day of September 2002.
��
Notary Public
COMMONWEALTH OF PENNSYLVANIA: rvauia� s�
H.AnJwny Adarm, Nduy Publi<
:SS Shippensburg Bom, Cumbedand Caunry
COUN7Y OF CUMBERLAND , My c°mm���°" E`P„" "°'y is, zoo�
Mem�er.Pen�n�.4is.^.cisU�naNda�s
WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testatrix sign and execute the
instrument as her Last Will and Testament; that she willingly and 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 and belief the Testatrix was at
the time at least eighteen (18) or m e years of age and of sound mind and
under no constraint or undue influ nce�. �/
/2�� '���� .��.r�i�l
��])�j^ /. /� //- /
/C '/ /IQ.(.['I�Li ( �'IlG�A✓-� l�-�t KlGfen_�_
Swom to and subscribed before me by,
Darlene M. Bigler and Sh ron Coleman Adams,
The witnesses, this 32� day of September 2002.
�
Notary Public
No�aria15w1 �blic
H. AniiwnY Adams.Naary
Shippcnsburg Bom. CumbcdavE County
My Commissian Expirrs May I5. 2006
Mem�E�.PennryNarvx Assaciatpn ol Nd2�le5