The URL can be used to link to this page

Home My WebLink About05-13-05 r REV.1500 EX ,(,-oOj I OFFICIAL USE ONLY COMMONWEALTH OF REV-1500 .~ PENNSYLVANIA , :FILENUMBER ~ ::;:E~r~;6;::;~:'J IN~~~~ENN;EDT~XE~~~~RNLN~COOE y~ _ ~U:~E~ I DECEDENrs NAME (LAST, FIRST, ANDMIODlE INITIAL) YSOCIAl SECURITY NUMBER - .... Jackson, Martha H. 239-52-8765 I O~T~ ~~ ~~;H~~:OD:YEAR~6:;;~~ (;~;-YEARj _ THIS RETU~~~:~~E:~E~; o;~~~; V.TH THE ~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) I SOCiAl SECURITY NUMBER Jackson, Leonard L. -----.._-- [!J 1. Original Return D 2. Supplemental Return 0 3. Remainder Return (dale of death prior 1012-13-82) D'. 4. Limited Estate D. 4a. Future Interest Compromise (date of death after D 5. Federal Estate Tax Return Required . 12-12-82) [!] 6. Decedent Died Testate (Attach [!] 7. Decedent Maintained a living Trust (Attach 0 8. Total Number of Safe Deposit Boxes copy of Will) copy of Trust) D 9. litigation Proceeds Received D 10 Spousal Poverty: Credit (date of daath between .12.31.91 and 1-1-95) miiiilFiall~FK4U~'1i!!I!!illi 'il.. .;~~i'!i!ll '1IJ!i'jlll!ii!i~ill!!.... NAME Donna M. Mu_llin, Esq. FIRM NAME (If applicable) JAMES, SMITH, DIETTERICK & CONNELLY, w ,.. ~o('" u"~ w~g :r::~.... u~.. ~ ,.. z w Q Z l/ '" w ~ ~ Q U I TELEPHONE NUMBER 717/533-3280 1. Real Estate (Schedule A) 2, Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o ;:: :5 :::J .... ii: <( u w a: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) D Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 134 Sipe Avenue Hummelstown, PA 17036 ---=----=-------::-:-:-::::~-----::-:-:------'-'-'----------:-:-::---.._-------,--,-----.,~_.------::----- .:-:;:~FICIAli5lISE ONLt " ::CJ ;; -'I,] -, (1) None (2) 29,138.08 --...._.._~---"._- (3) None ..------ (4) None _m._ (5) None -- '-,.- (6) None - (7) 468,224.46 (9) 17 ,645.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) ~. 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) ---- SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ;:: ~ :::J "- ::E o U x ~ 15.Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16.Amount of line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 0.00 X .00 (15) 0.00 X .045 (16) 0.00 0.00 x .12 (17) X .15 (18) (19) iiiiliiij\ill !mn!!) !1hmi!i!i1gmnjjm!!m!!!j!i!j!!jj!!!1j!!jjjN)!~!~gl 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT mli!ll!!!l!il~~'lll!~, Copyright 2002 form software only The Lackner Group, Inc. .:r- w -cJ N 0"' (8) 497,362.54 (11) 17 ,645.00 (12) 479,717.54 (13) 479,717.54 (14) 0.00 0.00 0.00 0.00 0.00 0.00 Form REV-1500 EX (Rev. 6-00: Decedent's Complete Address: STREET ADDRESS 506 Kentwood Drive CITY Mechanicsburg 1STATE PA IZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 0.00 Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) (4) (5) 0.00 (5A) (58) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT THE "X" IN THE 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;. ....................................................................... ~ b. retain the right to designate who shall use the property transferred or its income;... ................................ ~ c. retain a reversionary interest; or..................................... ................................................................ ~ d. receive the promise for life of either payments, benefits or care?............... .............................................. 0 2. If death occurred after December 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?........ ....................... ...... ................... .... .......................................................... ~ D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of pe~ury, I declare that I have examined this retum, Including accompanying schedules and statements, and to the best of my k.nowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which prepar9f has any k.nowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS Leonard L. J son Ves No D D D D o D o o DATE L 506 Kentwood Drive Mechanlcsburg, PA 17055 S=/1)~ f) S- OATE I NATURE F A A llr ~ /0_ 0 r:r- I NATU F PREPARER OTH R HA Donna M. Mullin Esq. AD OATE 134 Slpe Avenue Hummelstown, p, n~PD For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on surviving spouse is 3% (72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfer' [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from of assets and filing a tax retum are still applicable even if the surviving spouse is the only benef For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of a natural parent, an adoptive parent, or a stepparent of the child is 0% [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%, except as noted in TL P.S, 99116 1.2)[72 P.S. 99116 <a) (1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [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. of the is 0% sclosure ::T >fa Rev-1563 EX+ (8-98) '* SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETIJRN RESIDENT DECEDENT Jackson, Martha H. FILE NUMBER 21-05-0210 ESTATE OF All property JOlnUy-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 708 shares of M&F Bancorp Inc. - valued per public 21.50 15,222.00 listing 2 10 Series EE U.S. Savings Bonds - titled Jointly with 13,784.00 deceased daughter - valued per Savings Bond Wizard 3 2 Series EE U.S. Savings Bonds - titled in the name of 132.08 pre-deceased daughter, payable to Decedent - valued per Savings Bond Wizard TOTAL (Also enter on Line 2, Recepltulatlon) 29,138.08 (If more space Is needed, addItional pages of the same sIze) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule B (Rev. 6-98) Rev.1510 EX+ (6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jackson, Martha H. FILE NUMBER 21-05-0210 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes ITEM DESCRIPTION OF PROPERTY DATE OF DEATH .'" OF DECO'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1 Edward Jones Brokerage Account No. 60.038.11 1 00.000 0.00 60,038.11 270-03848-1-7 - titled in the name of the Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any amendments thereto- valued per letter dated 5/17/04 (1/2 of value reported) 2 Personal property - titled in the names of 10,000.00 100.000 0.00 10,000.00 Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any . amendments thereto (1/2 of value reported) 3 Real estate located at 506 Kentwood Drive, 97.009.50 100.000 0.00 97.009.50 Hampden Township, Cumberland County, PA - titled in the name of the Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any amendments thereto - valued per county assessment times common level ratio (184,780. 1.05 = 194,019) -1/2 of value reported 4 Smith Barney Brokerage Account No. 211.751.06 100.000 0.00 211.751.06 724-25381-19 - titled in the names of Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any amendments thereto - valued per spreadsheet (1/2 of value reported) 5 USAA Brokerage Account No. 43901002853 - 5.332.74 100.000 0.00 5.332.74 titled in the name of the Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any amendments thereto - valued per letter dated 4/12/04 11/2 of value reoortedl Total of Continuation Schedule(s) ee attached page TOTAL (Also enter on Line 7, Recapitulation) 468,224.46 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 ScheduleG (Rev. 6-98) Rev-1510 EX+ (6-98) *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jackson, Martha H. FILE NUMBER 21-05-0210 ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE 6 USAA Brokerage Account No. 44900877632 - 10.380.74 100.000 0.00 10.380.74 titled in the name of the Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any amendments thereto - valued per letter dated 4/12/04 (1/2 of value reported) 7 Waypoint Bank Checking Account No. 52.900.39 100.000 0.00 52.900.39 300300111 - titled in the name of the Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any amendments thereto- valued per letter dated 4/16/04 (1/2 of value 8 Waypoint Bank Checking Account No. 6.63 100.000 0.00 6.63 300300111, accrued interest - titled in the name ofthe Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any amendments thereto - valued per letter dated 4/16/04 (1/2 of value reported) 9 Waypoint Bank Savings Account No. 3114366309 20.804.50 100.000 0.00 20.804.50 - titled in the name of the Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any amendments thereto - valued nAP IAHAP l'f~tAI'f AliA;/nA Iii? nf \I~I..A PAnn....AI'f\ 10 Waypoint Bank Savings Account No. 0.79 100.000 0.00 0.79 3114366309, accrued interest - titled in the name of the Leonard L. Jackson and Martha H. Jackson Living Trust dated 1/12/1995, and any amendments thereto - valued per letter dated 4/16/04 (1/2 ofvalue reported) TOTAL (Also enter on Line 7, Recapitulation) 468.224.46 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV.1151 EX+ (12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESlOENT DECEDENT ESTATE OF Jackson, Martha H. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-05-0210 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 3,750.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Stale Zip - Year(s) Commission paid 2. Attorney's Fees JAMES, SMITH, DIETTERICK & CONNELLY, LLP 10,000.00 3. Family Exemption: (If decedenfs address is not the same as cJaimanfs. attach explanation) 3,500.00 Claimant Leonard L. Jackson Street Address 506 Kentwood Drive City Mechamcsburg State PA Zip 17055 Relationship of Claimant to Decedent Spouse 4. Probate Fees 130.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 265.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 17,645.00 Copyright (c) 2002 fonn software only The Lackner GrouP. Ino. Fonn PA-1S00 Schedule H (Rev. 6-98) R8'I-1502 EX+ (6-98) '* SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jackson, Martha H. FILE NUMBER 21-05-0210 ITEM NUMBER DESCRIPTION AMOUNT 1 Cremation Society of Pennsylvania - cremation and funeral services 3,750.00 Subtotal 3,750.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-96) Rev-1502 EX+ (6-98) '* SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jackson, Martha H. FILE NUMBER 21-05-0210 ITEM NUMBER 1 DESCRIPTION James, Smith, Dletterlck & Connelly, LLP - reservation for administration costs AMOUNT 200.00 2 North Carolina Vital Records. death certificates 20.00 3 Vital Records. death certificates 45.00 Subtotal 265.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) REV 1513 EX+ (9-00) *' SCHEDULE J COMMONVv'EAL TH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jackson, Martha H. 21-05-0210 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not list Trust~els\ I. TAXABLE DISTRIBUTIONS [include outright sgous'l distributionSg and ransfers under Sec. 116(.)(1.2)] See attached schedule Total Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE See continuation schedule(s) attached 479,717.54 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 479,717.54 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ScheduleJ (Rev. 6-98) . SCHEDULE oJ BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Martha H. Jackson 239-52-8765 02/10/2004 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Leonard L. Jackson Spouse 506 Kentwood Drive Mechanlcsburg, PA 17055 0.00 2 Leonard L. Jackson and Martha H. Trust Jackson Family Trust 506 Kentwood Drive Mechanlcsburg, PA 17055 0.00 Total 1 R8y-1502 EX+ (S-98) *' SCHEDULE .J-IIA SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE continued COMMONWEALTH OF PENN$YL VANIA INHERITANCE. TAX RETURN RESIDENT DECEDENT Jackson, Martha H. IFILE NUMBER 21-05-0210 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Family Trust created under the Leonard L. Jackson and Martha H. Jackson Living Trust dated 9/13/1999 479.717.54 Subtotal 479.717.54 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J-IIA (Rev. 6-98) Register of Wills of Cumberland County, Pennsylvania INVENTORY . ueceasea No. 2005-00210 Date of Death 02/10/2004 Social Security No. 239-52-8765 Estate of Martha H. Jackson also known as Leonard L. Jackson The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each Item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears In a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Personal Representativ Attorney: Donna M. Mullin, Esq. Signature: tB>+-t eonard L. Jac I.D. No.: 30392 Signature: JAMES, SMITH, DIETTERICK & CONNELLY, LLP Signature: Firm: Address: 134 Sipe Avenue Hummelstown, PA 17036 Telephone: 717/533-3280 Address: 506 Kentwood Drive Mechanicsburg, PA 17055 Telephone: 717/840-2656 Dated: ~~ / D - D--!J Personal ProDertv Cash............................................................................................... Miscellaneous Property................................................................ Stocks/Listed... ............. ......... .................... .................... ................ Stocks/Closely Held...................................................................... Bonds............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable............................................... ~) 15,22~,~~ :rn ~ .I 13,91~~98. -~"H.. ,".,) .'-"j "0=--1 ""..- N Total Personal Property......................................... 29,138.08 0.'\ Total Real Property................................................ Total Personal and Real Property......................... 29,138.081 Total Out-of-State Real Property.......................... J-- Register of Wills of Cumberland County, Pennsylvania INVENTORY , ueceased No. 2005-00210 Date of Death 2/10/2004 Social Security No. 239-52-8765 Estate of Martha H. Jackson also known as Stock I Listed 708.0000 shares M&F Bancorp Inc. - valued per public listing 15,222.00 Total Stock / Listed 15,222.00 Bond 10 Series EE U.S. Savings Bonds - titled jointly with deceased daughter- valued per Savings Bond Wizard 13,784.00 2 Series EE U.S. Savings Bonds - titled in the name of pre-deceased daughter, payable to Decedent - valued per Savings Bond Wizard 132.08 Total Bond 13,916.08 (Attach additional sheets if necessary) Total Personal Property and Real Estate 29,138.08