HomeMy WebLinkAbout09-29-15 �y pennrylvania 1505614105
J lG7 �••n•,m�Y��� ex(a�aal(eI
REV-1500 OFFICIAL USE ONLY
Bureau of Indivitlual Taxes Counry/Caae Vear FJeNumber
PO Box z806ot INHERITANCE TAX RETURN ,Z'I I � /,,
H � b g PA lllze-o6oi RESIDENT DECEDENT 0� �U/
ENTER DECEDENT INFORMATION BELOW
Social Secunty Number �a�e of Death MM��VYVY oate of einh MMODYVYV
07022015 12151920
Decetlenfs Last Nama Sufix Decedenfs First Name MI
SHEIBLEY fRANCES
(It Appliwble)Enter Survlving Spouse's Information Below
Spouse's Last Name Sufix Spouse's Firsl Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original ReNm O �� Supplemental ReWm O 3. Remaintler ReWm(dale ol death
pnorto 12-13-B2)
p 0.AgnculWre Exemption(tlate of p 5. FUWre Interesl Compromise(date of p fi. Federal Es�ate Tax ReWm ReqWretl
tlealh on or afler]-L2012) tleath afler 12-12-B2)
�p ]. Oecedenl Died Testate O B.Decetlent Meintainetl a Living Tmst _ 4 Total Number of Safe Deposit Boxes
(AtlacM1 wpy of wiIIJ (AvacM1 copy of tmsiJ
p 10. Lttigation Proceeds Receivea O »-Non-0ro�a[e Transferee RaWm O 12. �eferrellElection of Spousal Tmsls
(Schetlule F and G Assets Only)
O 13. Business Assets O 14.Spouse Is Sole Benefciary
(No Vusi 1nvoNetl)
CORRESPONOENT- TMIS SECTION MIIST BE COMPLETE�.RLL LORfiE5PON0ENCE RND CONFIDENTIRL TA%INfORMATION SNOULU BE OIRECTEO T0:
Name Daytime Telephone Number
KENNETH H SHEIBLEY (717)691-1202
First Line of Atltlress
511 NURSERY DRIVE SOUTH
Secontl Line olAtldress
City or Pos�Otfice S�a�e ZIP Code
MECHANICSBURG PA 17055
CorrespondenPs¢mall atltlresa:
REGISTER Of WILLS l�ONLY
n �
RE�ISTEROFWILL6U6EONd � � �1 I�1 n
DAIE FILED MMDDYVYY - �'�� ��
_I - I ,
ro I
c�
OATE FILED STANd
� i�
�Ca ?
PLEASE USE ORIGINAL FORM ONLV - N -�
Side 7
L IIIIIIIIIIIIIIIIIIII��I��II�II�II�I��IIIIIIIIIIIIIIIIII y5�5614105 J �
I,)
J 1505614205
REV45�0 EX(FI) DecetlenPs Social Secunry Number
oe�eae�r:Nama: FRANCESSHEIBLEY
RECAPITULATION
1. Real ESWte(Schetlule A). . ... . . . .. . ... ... . ... ... . ... . .. . .... ... ... . .. 1.
2. Stocks and Bonds(Schedule B) .. . . .... ... . ... ... .... . .. . .... ... ... ... 2.
3. Closely Heltl Corpora[ion,Partnership or Sole-Propnelorship(Schetlule C) ... .. 3.
4. Motlgages and Nates Receivable(Schetlule D) .. .... . ... . .. .... .... ... . .. 4.
5. Cash,Bank Deposits and Miscellanaous Personal Property(Schetlule E). ... ... 5. 29•4��.Z9
6. Jointty Owned Pmperty(Sc�etlule F) O Separate Billing Reques�ed . ... ... 6.
]. Inter-Uvos Transfers&Miscellaneous Non-Probate Propetly
(Schetlule G) O Separa�e Billing Requestetl.. ... ... 7.
B. Total Gross Asseb(rotal Lines 1 ihrou9h]).. .... .... . .. . ... .... ... . ... . 8. 29�477.$9
9. Funeral Expenses and Adminishative Cosffi(Schedule H)... . .... ... . .. .... . 9. �,sas.$0
10. Oebis of Decedent,Mortgage Liabili[ies and Liens(Schedule I)... .... . .. .... . 10. 669.47
tt To�al Deductions patal Lines 9 and iol.. . .. . .... .... .. . .... ..- . .. . .. - ��. 2,155.97
12. Net Value of Estate(Line 8 minus Line 11) .. . .... ... . ... .... .... ... . ... . 12. 27,121.32
13. Chanlable antl GovemmenGl 8equests/Sec.9113 Tmsis for which
an election ro tax has not been matle(Schedule J) . ... . ... . .. . ... . ... .... . 13.
14. Net Value SubJect to Tac(Line 12 minus Line 13) .... . ... . ... ... . ... .... . 14. Z�r�2�.3Z
TAX CALGULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 16 taxable
at the spousal tax rete,or
transfers under Sec.9116
(a)(1 Z)X 0- 15.
16. Amount of Line 14 taxable
atiinealrate X.o45 27.121.32 16. 1,220.46
1]. Amount of Line 14 taxable
at sibling rata X .12 ��-
18. Amount of Line 14 taxable
atwllateralra�e %.75 �8�
19. TAX DUE . ... . ... . ... ... . . . ... .. . .. . ... . ... . ... ... .... . .. . .... .. . . 19. ��$24.d6
20. FILL IN THE OVAL IF VOII ARE RE�UESTING A REFUND OF AN OVERPAYMENT O
❑ntler penal�ies ol perjury.I detlaR I M1aae examinetl�bis reWm,indutling ec[ompanying scM1Mules anJ sW�emenLs,antl lo IM1e Cest o�my knowletlge antl bPlie[
i�Is�me,m�rec�and complOE.Oecla�allon ot prepare�oNe�I�an�M1e person res�nsi�le lo�filing�be reW m IS baseE on ell 'mfo�mation o�w�icM1 pRpare�M1as
any knowlMge.
51 NATURE 0 P R O SI9L FlLING RETURN DNTE
� i
AD�RESS
511 NURSERY DRIVE OUTH, ECHANICSBURG, PA 17055
SIGNATURE OF PREPARER OTHER AN PE SON RESPONSIBLE FOR FlLING THE RETURN �ATE
ADORESS
L iiiiiiuiiiiiiiii������li�i4ii�i�i�iiiiiiiiiiiiiiiiii S,de2
1505614205 J
REV-1500 EX (FI) Page 3 File Number
DecedenYs Complete Address:
DECEDENTSNAME
SHEIBLEY, FRANCES
sTaeernooRess � �
770S. HANOVER STREET
QTY -. .. . . . STATE ZIP . ...-
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax�ue(Pa9e 2,Llne 19) (1) 1,220.46
2. CretlitslPaymen�s
A.Pnor Paymenls .. .
B.Discount fi�.�Z
(See insimctions) To�al Cre0lls(A*B) (2) 81 A2
3. Interest
(3)
4. If Line 2 is greater than Line 1 t Line 3,enler the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 2010 requeat a refund. (4)
5. Ii Line 1 +Line 3 is greater Ihan Line 2,enter�he diHerence.This is the TA1(DUE (5) 1,159.44
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. �id deceden�make a Uansfer and'. �es No
a. retain the use or income of the P��rtY Iransferree......... ........... ............. ........_._.... ❑ �
b. retain lhe righ��o designate wha shall use�he property iransferred or i�s income ......_._...._........................... ❑ �
c. retain a reversionary interest ............... ,_.,..,....... ._,..,, ........ ..,.... ❑ ■
d. receive�he promise for life of ei�her paymenis,henefits or care� ........ ,........ _..
2, If Oeath ocmned aNer Oec. 12, 1982,did dece0ent transfer properly wi�hin one year of death
withom receiving adeQuate considera�ion? ............... _ .............. .,............ .................. ❑ �
3. Did dece0ent own an"in Ws�for"or payable-upomdeath bank acmun�or securiry at his or her dea�h2............. ❑ �
4. Did decedent own an intlividual re�irement aaounl,annuity or o�her non-pmbate pmperty,which
containsabeneficiarydesignation? ......... ................ ................. .....__._.... .................. ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE ITAS PART OF THE RETURN.
For tlates of death on or afler July 1, 1994,and betore Jan. 1,1995,ihe tax rate imposed on the net value of transfers to or for ihe use of ihe surviving spouse
�s a Pemem R2 es.§sns�a��i.i��p�.
Por dates of deam on or afler Jan. 1, 1995, the +zx rate imposed on the net value of trensfers to or for the use of ihe surviving spouse is 0 percent
[/2 P5.§9116(a)(1.1)(ii)].The staNte tloes not exemp�a lrensferto a suniving spouse hom tax,and ihe statutory requirements fordisdosure of assets and
filing a tax retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of dea�h on or afler July 1,2000:
. The tax rate imposed on ihe net value of iransfers from a deceased child 21 years of age or younger at tleath to or for the use of a natural parenL an
adoptive parent or a step-parent of ihe child is 0 percent[72 P.S. §9116�a)(12)J.
. The tax rate imposed on the net value of t2nsfers to or tor the use of the decedenYs lineal beneficianes is 4.5 percent,except as noted in�72 P.S.§9116�a��1)�.
. The tax rate imposed on the net value of Uansfers to or for the use of the decedenfs siblinqs is 12 percent�72 P.S.§9116(a)(1.3�].A sibling is defined,
under Secfion 9102,as an individual who has at least one parent in common with the decedent,whether by bloo0 or adopfion.
arv-ison rx+ �oa-�s�
� pennsylvania SCIIEDULE E
�i1 oeaanrnervrovAevervue CASH� BANK DEPOSITS & MISC.
�n�eanANce*A.xeruxx PERSONALPROPERTY
aEs�oervr oEceoervr
ESTATE OF: FILE NUMBER:
FRANCES SHEIBLEY 21-15
Indude[he pmcee0s of litigation and the date the proceeds were receive0 by the estate.
All property IointlY owne0 with righ[of survivorship must be AlscloseE on 5[hMule F.
ITEM VALUE AT DATE
NOMBER DESCRIPTION OF�EATH
�� METRO BANK 3801 Paxton St.,Harrisburg Pa 17111-Checking aarount k0536935919 1,966.06
2 METRO BANK,3801 Pazton St.,Hartisburg, PA 17111-Savings account#7760517451 2fi,987.52
3 CASH 66.04
4 HIGHMARK-HEALTHINSURANCEPREMIUMREFUND 207.67
5 Personal Properry 250.00
TOTAL(Also enter on Line 5, Recapitulation) ; 29,4��29
I!more space is needed, use ad�itional sheeh of paper af Ihe same size.
aev-�sn ex+ (ovis)
�'i� pennsylvania SCHEDULE H
ry� oecnArnervroFaEvervuE FUNERALEXPENSESAND
�r�HEvrnrvcEravacruarv pDMINISTRATIVE CO5T5
aes�oerv.oeceoen.
ESTATE OF FILE NUMBER
FRANCES SHEIBLEY 21-15
Decedent's debts must be reported on Schedule 1.
ITEM
NUM6ER DESCRIGTION AMOUNT
A. FUNERALEXPENSES:
�� Boyer Funeral Home-Honoreriums 500.00
Chapel Pointe-Van to services 93.50
Boyer Tombstone Engraving-Headstone engravng 175.00
B. ADMINISTRATNECOSTS�.
1. Personal Representative Commissions'.
Name(s)of Gersonal Aepresen2tYe(s)
Street ACGress
City State ZIG
�Pdf(5)�OI�OIi5510�Pdl�l
Z. Attomey kes: 437.50
3. Family EKemption (If GeceOenCs adEress is not Me same as tlaimant's,attach explanation J
Claimant
Sheet AGGress
CiW—_. ____.._-- _ _—_-- ____ —. SWte— —ZIP— ..__..
Relationship of Llaimant[o DeceEent _ .. _ . . _ __ . _ . .
4. Probace Fees: 150.50
5. Acmw[antFees�,
6. Tax Return Preparer Fees:
�� Registerof Wills, Cumberlantl County-Atltlitional probate 30.00
TOTAL(Also enter on Line 9, Recapi[ulation) f 1,686.50
If more space is needed, use aCCitional sheet5 of paper of the same size.
aev-isiz ex+ �oais7
�'�jpennsylvania SCHEDULE I
"� oevaxrmeerovaevervue DEBTS OF DECEDENT�
�NnEa�r�,rvcEr�acruax MORTGAGE LIABILITIES & LIENS
aEsmExr oEceoexr
ESTATE OF FILE NUMBER
FRANCES SHEIBLEY 21-15
Neport Eebts incurrcA by the EeceEent priar to tleath that remaineE unpaiE a[[he tla[e af Eea[h,including unreimburuE meAial ex0enses.
REM VALOE AT DATE
NIIMBER DESCRIPRON OF DEATH
�' Chapel Pointe-Final bill br assisted living 211.68
2 AledPharmacy-JuneBJulystatements 53.37
3. Holy Spint Hospital-fi/25/15 ER Co-pay 58.50
4. CarlilseRegionalMedicalCenter-Labservices 42.11
5. DrBranscum-visit629 43.53
6. ChapelPointe-Juty/Aug2015 biling 162.60
7. W L Schneider Associates,Inc-Medical supplies 97.68
TOTAL(Alsa enter an Line 10, RecapiNlation) S 669.47
1!more space is neeDeQ insert atldi[ional shee[s ol[he same size.
aEv-isi3 ex+{ox-�s7
�i,f pennsylvania SCHEDULE ]
V� oeanarnervraFaevervue BENEFICIARIES
INHERITPNCE TP%PFfURN
RESI�EM OECEOEMi
ESTATE OF: FILE NUMBER:
FRANCES SHEIBLEY 21-15
REUIIONSHIPTODECE�ENT AMOUNTORSHARE
NUMBER NAME AN�AD�RE55 OF PERSON(5)RECEIWNG PROPERTV Oo Not list Tmstee(s) OF ESTATE
I TAkABLE�ISTRI9UTIONS�IntluCe ou[righ[spousal Gi#nbutions antl[ransfers under
Sec 911fi(a)Q.l).)
i. JEANSNVDER DAUGHTER 20%
2 kENNETHH.SHEIBLEY SON 20%
3 DORISMYERS DAUGHTER 20%
4 JANETSWIFT DAUGHTER 20%
5 RONALD E.SHEIBLEV SON 20%
EfYTER�OLN0.AMOUNTS FOR DISrRIBIR10fJ5 SHOWN A80VE ON LINES 15 THROUGH 10 OF REV�1500 COVER SHEEj 0.5 AGPROPRIATE.
�� NON-TA%NBIE�ISTRIBUTIONS
A. SPOUSAL�ISTRIBl1T10N5 UNDER SEQI�N 9113 FOR WHICH NN ELEQION TO TA%IS NOT iAKEN:
1.
B. CHARITABLE AN�GOVERNMENTNL�ISTRIBOTIONS:
1.
TOTAL OF PART Il- ENTEft TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15�0 COVE0.SHEEf. S
If more space is neetleQ use additional sheets ol paper of Me same siie.
�asr �:�ii_� auo TEsrnraeNr
I , FRnNGES 54EIBLEY, of Sorinn Township� °erry County � Pennsylvania�
heing of sound and tlisnosln0 mind an0 memory� tlo �ereby Catlare hhis
to bx my Itsf w� li and 1est�menl; revoking all former wills by me at
any lime he�etofore mada:
fIRST : I �irect my nereinafte� named exacufor, or alfernate
eaecuto�. as thp c�se may be, to oay a� l af my Just Oebts, fune�al
exoenses� In�e�Ilance taxes and costs o4 administrati�n nf my estate as
soon after my decease as it is oractical to do so,
SECOND: In fhe evant that my husband, Marlln 4. Sheibley, survives
my decease, ih¢n antl in thef event 1 give, aev�se anA beQueafh all of
my rrooerfy. real � personal and mixed and w�eresoever sifuafe unto my
sald nusbantl �o be his absolutely.
TNIRD: In the event ihat my husband� Marlin H. S�eibley does not
;orvive my tlecease� then and in that evenf I 9ive. aevise and be�ueafh
all of my nronerty, real � oersonal antl mixed and wheresnever situate
unto my five chilAren, in eoual shares. In the evenh any of my said
�hil ��an sti�uld ,r=decease me , ihan and In lheh event ttie =hare wM1ich
sald child wnul^ �nve t=ken shali qo ho Nis or her chilAren �y reoresenta-
fion.
FiU9Tuv I nxme , conslitufe and a000int my hus5antl, ++arlin 4. .
Snei�ley� as the executar o' this my lasf will and lestament, In the
event my saitl husband shoultl pretlecease ne� o� should nnf live to
comolefe fhe sattlement of my esiate, then an0 in thzh event I naTe �
constilufe antl aonolnt my son, Kenneth N. Sheibley as fhe subslltute
executor of tM1is my I�st will and festament.
IN 'NITNE55 MUFRF.OF� I �ave �araunio sef my nantl and seal fo tM1is
� t/
my lasf will and fes�ament. inis f � day of June� 1900.
j (SEAL)
Slnnad, se=_ led, nublished an� declareA by fhe above named fA tatri. as
and for her last will and testament in ou� oresence, who, In her presenca,
a1 ner re�vest an� �n t�e oresenre of each nlher have 4ereun!o se1 our
na��s alfa�tinn ifnesses.
� W /
�_/� L�- J
/.__ ��(/L(�N �r.��� /_Oil
`. __
Y�_c�.i}2��.- '�4,,.�w�