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Home My WebLink About05-20-05 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, FA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BLACK JOSEPH W 714 PETERSBURG ROAD CARLISLE, PA 17013 -------~ fold ESTATE INFORMATION: SSN: 194-26-6854 FILE NUMBER: 2105-0094 DECEDENT NAME: BLACK PEARL S DATE OF PAYMENT: OS/20/2005 POSTMARK DATE: OS/20/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/16/2005 NO. CD 005349 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $64.70 I I I I I I I I TOTAL AMOUNT PAID: $64.70 REMARKS: ESTATE CHECK CHECK# 157 INITIALS: RSK RECEIVED BY: SEAL REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS REV-1500 EX + (6-00) . OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENU DEPT. 280601 HARRISBURG, PA 17128-06 1 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT filE NUMBER .... z w Q w U w Q DECEDENrs NAME (LAST, FIRST, AND IDDlE INITIAL) Black, Pearl S. DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DO-YEAR) 21 05 00094 01-16-2005 01-21-1917 (IF APPUCABlE) SURVIVING SPOUSE'S ME (LAST, FIRST AND MIDDLE INITIAL) COUNTY CODE YEAR SOCIAL SECURITY NUMBER NUMBER 194-26-6854 THtS RETURN MUST BE filED IN DUPLICATE WITH T1tE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ "ill!:! ~l';~ uf. ill Original Return limited Estate 2. Supplemental Return 4a. Future Interest Compromise (date of death aftar 12-12-82) 7. Decedent Maintained a Living Trust (Attadl copy of Trust) 10 Soousal PovertY Credit (date of death between . 1:1:-31-91 and 1-1-95) D 3. RemainderRatum (data ofdealh prior to 12-13-82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe DeJX>Sit Boxes ffi Q Z ~ ! __ L. Webber, Jr. Esquire FIRM NAME (If applicable) Weigle & Associate. P.C. TELEPHONE NUMBER 717-532-7388 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedul B) 3_ Closely Held Corporation, P rtnership or Sole-Proprietorship z o ~ i:! ii: '" ~ 4. Mortgages & Notes Receiv ble (Schedule 0) 5. Cash, Bank Deposits & Mis lIaneous Personal Property (Schedule E) 6. Jointly Owned Property (S edule F) [J Separate Billing Requ sted 7 . Inter-Vivos Transfers & Mis lIaneous Non-Probate Property (Schedule G or L) 0 Sep rate Billing Requested 8. Total Gross Assets (total ines 1-7) 9. Funeral Expenses & Admini trative Costs (Schedule H) 126 East King Street Shippensburg, PA 17257 (1) (2) (3) (4) (5) (6) (7) OFFICIAk-.l:lSE ONLY ......l , L.' 10. Debts of Decedent, Mortga e Liabilities, & Liens (Schedule I) 11. Total Deductions (total Un s 9 & 10) 12. Net Value of Estate (Line minus Line 11) None None None None r,.) C'~) 23,728.05 :':-1. None None (>J o (8) 23,728.05 (9) (10) 1,777.29 2,969.25 (11) 4,746.54 18,981.51 0.00 18,981.51 (12) 13. Charitable and Governmen 81 Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule 14.Net Value Subject to Tax ( ine 12 minus Line 13) (13) (14) SEE INST CTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0.00 854.17 0.00 0.00 854.17 15. Amount of Line 14 taxable t the spousal tax rate, 0.00 x .00 (15) or transfers under Sec. 911 (a)(1.2) z 0 18,981.51 x .045 (16) i= 16.Amount of Line 14 taxable t lineal rate ~ ::> .12 (17) Q. 17. Amount of Line 14 taxable t sibling rate 0.00 x :IE 0 u 18. Amount of Line 14 taxable t collateral rate 0.00 x .15 (18) ~ 19. Tax Due (19) Copyright 2002 form software only The Form REV-1500 EX (Rev. 6-00: Decedent's Complete Ad ress: STREET AOORESS 50 Bonnybrook Road, Lot 49A CITY Carlisle STATE PA Tax Payments and Credi s: 1. Tax Due (Page 1 Line 19) 2. CredilslPayments A. Spousal Poverty Cr dit B. Prior Payments C. Discount 750.00 - 39.47 Total Credits (A + B + C) 3. InterestlPenalty if applicable D. Interest E. Penally TotallnteresVPenally (D + E) 4. If Line 2 is greater than Line + Line 3, enter the difference. This is the OVERPAYMENT. heck box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater t an Line 2, enter the difference. This is the TAX DUE. A. Enter the interest 0 the tax due. B. Enter the total of Li e 5 + 5A. This is the BALANCE DUE. ake Check Payable 10: REGISTER OF WILLS, AGENT ZIP 17013 (1) 854.17 (2) 789.47 (3) (4) (5) 64.70 (5A) (5B) 64.70 ER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 3. Did decedent own an ain rust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Ind vidual Retirement Account, annuity, or other non-probate properly which contains a beneficiary d ignation?.................... ......................... .................................. D [!] IF THE ANSWER TO ANY OF THE QVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penaIlies of perjury, I declare that I haVa exam this retlDl, including accompanying schedules and statements, end to the best of mv knowledge and baliaf, it is true, correcI and ~~. Declarelio~ ~ preparer other ~the pe aI ~n1ative is based~n alllnformalioo of wI1~chJ)reparer has any knowl~~. SIGNATURE OF PERSON RESPONSIBLE FOR FliNG RETURN ADDRESS Joseph W. Black 1. Did decedent make a tra sfer and: a. retain the use or in me of the property transferred; ........................ ........................................................ b. retain the right to d ignate who shall use the property transferred or its income;............ c. retain a reversiona interest; or .............................. ........................... ...................................................... d. receive the promis for life of either payments, benefits or care?............................ ....................... 2. If death occurred after camber 12, 1982, did decedent transfer property within one year of death without receiving adequate consi eration? ...nn................. ............................ ................. .................................... 714 Petersburg Road Carlisle, PA 17013 Sl AODRESS RE 0 ERSON RESPONS muel E. Black ~~ l:~ SIGNATURE OF PREPARER OTHER THAN REPR SENTAT1VE Richard L. Webber, Jr. Esquire ~ /C.<.-/ 261 Allen Road Carlisle, PA 17013 ADDRESS- 126 East King Street Shippensburg, PA 17257 Yes D n n D U No [!] ~ [Xl [!] liJ Ix] DATE > ~/ 17/os' DATE \.. !;7[lLf?J ~A'rE $f f). oS- For dates of death on or after July 1, 1 94 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survivin9 spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. . For dates of death on or after January ,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (U)]. The statu e does not exemDt 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. For dates of death on or after July 1, 2 00: The tax rate imposed on the net value f transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or stepparent oflhe child is 0% [72 P.S. ~9116 (a) (1.2)]. The tax rate imposed on the net value f transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2) [72 P.S. ~9116 (a)(1)]. The tax rate imposed on the net value f 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 ind idual who has at least one parent in common with the dececlent, whether by blood or adoption. Rev-15GB EX+ (6-9ll) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY cow.AONWEAL TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Black, Pearl S. FILE NUMBER 21-05-00094 ESTATE OF ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 1980 Benchcraft Mob Ie Home - VIN #BP80197 2.000.00 2 Cash on hand 67.00 3 Contents of Mobile H bme 2.500.00 4 Cumberland County ehabilitation Center - Balance in account 38.27 5 MetLife Stock distrib tion 3.553.80 6 Personal Tax Refund 9.80 7 Sprint Refund 25.70 8 State Farm Insurance Refund 237.54 9 Waypoint Bank Certi cate of Deposit #8000035519 8.000.00 Accrued income on I em 9 through date of death 3.42 10 Waypoint Bank Chec in9 Account #90865885 7.292.46 Accrued income on I em 10 through date of death 0.06 TOTAL (Also enter on Line 5, Recapitulation) 23.728.05 If more space is needed, additional pages of the same size} Copyright (c) 2002 form software only The ackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolnUy-owned with the rtght of survtvorshlp must be dlsclosecl on schedlhle F Rev-1602 EX+ (6-9ll) *' SCHEDULE H-A FUNERAL EXPENSES .. continued cot.NON\I\IEAL TH OF PENNSYLVANIA. INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Black, Pearl S. 21-05-00094 ITEM NUMBER DESCRIPTION AMOUNT 1 Carlisle Memorial Ser 'ice - Engraving of Tombstone 160.00 2 Ewing Brothers Fune '81 Hose - Balance of Funeral Bill 410.00 Subtotal 570.00 Copyright (c) 2002 form software only The ackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) REV-1151 EX+ (12-6' *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Black, Pearl S. FILE NUMBER 21-05-00094 ESTATE OF Debts of decedent must be re~orted on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: See continuation s hedule(s) attached 570.00 1. ADMINISTRATIVE COSTS: Personal Representative's ommissions B. Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission pai State Zip 2. Attorney's Fees Wtigle & Associates, P.C. 825.00 3. Family Exemption: (If dece ent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claim nt to Decedent State Zip 4. Probate Fees 110.00 See continuation sl;hedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fee 7. Other Administrative Costs See continuation schedule(s) attached 272.29 TOTAL (Also enter on line 9, Recapitulation) 1,777.29 Copyright (c) 2002 form software only The fackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (8-H' *' SCHEDULE H-B4 PROBATE FEES continued COY.tONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Black, Pearl S. 21-05-00094 ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland County ~egister of Wills - Probate Fee 110.00 Subtotal 110.00 Copyright (c) 2002 form software only The L ckner Group, Inc. Form PA-1500 Schedule H-B4 (Rev. 6-98) Rev-1502 EX+ (8-H) *' SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS COMMONINEAL TH OF PENNSYLVANIA continued N-lERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Black, Pearl S. 21-05-00094 ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland County ~egister of Wills - Filing fee for inventory and inheritance tax 25.00 return 2 Cumberland County ~egister of Wills - Short Cerlificate 3.00 3 Cumberland County ~egister of Wills - Short certificates and certified copies of 20.00 letters testamentary 4 Cumberland Law JOI rnal - Legal Advertisement 75.00 5 Judy Campbell, Tax ollector - Pennit fee for removal of Mobile Home 2.00 6 The Sentinel - Legal dvertisement 144.29 7 Waypolnt Bank - Che ~kbook Fee 3.00 Subtotal 272.29 Copyright (c) 2002 fonn software only The L ckner Group, Inc. Fonn PA-1500 Schedule H-B7 (Rev. 6-98) R~-1612 EX+ (6-98) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS cot.'UONWEAl TH Of PENNSYlVANIA INHERITANCE""" RETURN RESIDENT OECEDENT ESTATE OF FILE NUMBER Black, Pearl S. 21-05-00094 Include unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cumberland County ~ehabilitation Center - Balance owed 2.025.00 2 Met Ed - Electric Bill 29.98 3 Met Ed - Electric Bill 65.32 4 Sigman's Mobile Ho~ es - Lot Rent 255.00 5 Sigman's Mobile Ho~ es - Lot Rent 255.00 6 Sprint - Telephone Bi I 29.26 7 Suburban Energy Se vices - Fuel Oil 287.47 8 Taxes for 2005 - Mot ile Home 22.22 TOTAL (Also enter on Line 10, Recapitulation) 2,969.25 (If more space is needed, additional pages of the same size) Copyright (c) 2002 !onn software only The L ckner Group, Inc. Fonn PA-1500 Schedule I (Rev. 6-9S) REV.1513 EX" {I-GO) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYlVANI INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Black, Pearl S. NAME A D ADDRESS OF PERSON(S)'F ECEIVING PROPERTY TAXABLE DISTRIBUTIO S [include outright spousal ctistributions, and transfers under See. 9116(a)(1.2)] FILE NUMBER 21-05-00094 ESTATE OF RELATIONSHIP TO DECEDENT Do Not Oat Trusteel.1 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. Joseph W. Black 714 Petersburg Rc ad Carlisle, PA 1701 Samuel E. Black 261 Allen Road Carlisle, PA 1701 Son One-half 9,490.76 Son One-half 9,490.75 II. Total 18,981.51 Enter dollar amounts for d~tributions shown above on lines 15 through 18, as appropnate, on Rev 1500 cover sheet NON-TAXABLE DISTRIB TIONS: A. SPOUSAL DISTRIBUT :JNS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GO~ERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER T TAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 CoPyri9ht (e) 2002 form software only The acl<ner Group, Ine. Form PA-1500 Schedule J (Rev. 6-98) LAST WILL AND TESTAMENT I, S. BLACK, of the Borough of Carlisle, Cumberland County, ennsylvania, being of sound and disposing mind and memory, 0 hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils y me made. 1. I di ect that all my just debts, funeral expenses, testament all inheritance taxes shall be paid I e, devise and bequeath all of my estate, both real and personal roperty, unto my husband NELSON S. BLACK, absDlutely. tate as soon as practicable after my decease and as inistration of my estate. 2. PT of the a 3. In t e event my said husband shall predecease or fail to then I give, devise and bequeath all of my estate, both real and personal property, as follows: (a) (b) thereof to my son, JOSEPH W. BLACK; thereof to my son, SAMUEL E. BLACK. 4. I no inate, constitute and appoint NELSON S. BLACK as Executor f my estate. In the event he shall be unable or unwilling to serve in such capacity, then I appoint JOSEPH W. BLACK and SAMUEL E. BLACK to act in such capacity. that my E ecutors shall not be required to file I direct ' i I a bond to secu;re ~. the fait ul performance of their duties in any jurisdiction. sole and absolute discretion, to purchase or otherwise acquire and reta n any investments for which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgag , transfer, exchange, dispose of or grant option in regard to any or all p operty of any kind forming a part of my estate for such terms an such prices as they may deem advisable; to borrow money fo any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal roperty forming a part of my estate or to join in or to secure partition of same; to compromise any claims or demands of my est te against my estate; to make distribution in kind and I to cause ny share to be composed of cash, property or undivided fractiona shares in property different in kind from any other shares; a d to execute and deliver such instruments as may be necessary to carry out any of these powers. IN W TNESS WHEREOF I have hereunto set my hand and seal this 1&1/1 day of ~ , 1979. G~~. 13fl~/ Pearl S. Black (SEAL) SIGN D, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix PEARL S. BLACK, as and for her Last Will and Testament, in the pr sence of us, who, at her request, have hereunto subscribe our names as witnesses thereto, in the presence of said Test trix and of each other. __~\l.~~.. -rLgw~ COMMO LTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND . . . . ) SS. I is si been d that I that I and va PEARL S. BLACK , Testatrix, whose name ed to the attached or foregoing instrument, having ly qualified according to law, do hereby acknowledge signed and executed the instrument as my Last Will; signed it willingly; and that I signed it as my free untary act for the purposes therein expressed. a-e.AdJ~ ~ / S orn or affirmed to and acknowledged before me by the ab ve Testatrix, this Ilj~ day of ~ ,l979. ~~~ Notary MCSHENJIC. Nolary PubIIlI .~!V .. COMMO TH OF PENNSYLVANIA ) ea.llole, ~Iand Co..PA : S S . Me QoomIssj"" li:q;>ireo Fob. 21, Iii'" COUNTY OF CUMBERLAND . . . . ) . W ,~U. ~!E,~./~fl. {u~ the wi nesses whose names are signed to the attached or forego'ng instrument, being duly qualified according to law, d depose and say that we were present and saw PEA S. BLACK , Testatrix, sign and execute the in trument as his Last Will; that PEARL S. BLACK signed willingly and that PEARL S. BLACK execut d it as her free and voluntary act for the purposes therei expressed; that each of us in the hearing and sight of P RL S. BLACK , Testatrix, signed the Will as wit esses; and that to the best of our knowledge, the Testat ix was at that time l8 or more years of age, of sound mind a d under no constraint or undue influence. ~\J, ~~, Address ~ '3.0" ~:);>. 0,\- \ C~... \>A. \"10\'>] I 1 I , r~. J'f.1 . I , c.... ! I Sw rn or affirmed to and subscribed before me this I~~ day of ~ ' 1979. "'WayRqi!lt LOOK FOR US. WE'LL GET YOU THERE. 2/9/2005 WEIGLE & ASSOCIATES 126 EKING ST SHIPPENSBURGPA 17257-13 FEB 1 0 2005 The information which you reque ed on the account(s) of PEARL S BLACK (Social Security Number 194-26- 854) is/are as follows: 9 65885 C CKING 07 197 72 2,46 .0 72 2.52 Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership SOLE Name of Joint Owner, ifany 8??oo35519 CERTIFICATE 073197 8000.00 3.42 8003.42 S LE Date Ownership 073197 Was Established 07 197 Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, ifany Date Ownership Was Established Additional Information Requested ~I;~\~ ~TIS SENIOR SERVICES REP. .0. BOX 1711. HARRISBURG. PENNSYLVANIA 17105-1711 Toll FrEE I-B 6-WAYPOINT (I-B66-929.7F;.4F;1 . ............~"ftft,ft+...__,,___ _".', ','C- ,_,".; Description: Sale Proceeds Check No. 00750523 &m 213 Check Date 04/11/05 Investor ID 8065 4196 3460 Pay ****51,397.56 Pay 10 The Order of: Pearl Black 50 Bonnybrook Rd, Lo 49A Carlisle, PA 17013-42 3 Payable at Chase Manhattau Bauk, Syracuse, NY or The Chase Manhattan Bank, New York /fIJIfl ~~ Authorized Officer Signature ~OO?5052~~ I:02~~Oq~?~~ ~O~5q200~~ m>....-n-M~..,TIJ.::;"I--r::n~nul..-- ,.- -i-jF Description: Sale Check No. 00750522 50-937 213 Check Date 04/11/05 Investor ID 8066 3081 3515 Pay ****$1,038.19 Pay to The Order of: Pearl S. Black 50 Bonnybrook Rd. Lot 9A Carlisle, PA 17013-421 Pa)'able at Chase Manhattan Bank, Syracuse, NY or The Chase Mauhattan Bauk, New York /fIJIfl ~~ Authorized Officer Signature ~OO?50522~ ~02~~O~~?~~ ~O~5~200~~ c_.~:....... __ _~.. .~.. n=-.::n...-..:;T-rTn;;-.--~~'U...-..;... 'C: 'hi3 ~)()C Ai'! hi'-: , Description: Sale Check No. 00750521 ~ 213 Check Date 04/11/05 Investor ID 8063 8956 3529 Pay ****$1,118.05 Pay to The Order of: Pearl E. Black 50 Bonnybrook Rd. Lot A Carlisle, PA 17013-42] Payable at Chase MauhattaD Bauk, Syracuse, NYor The Chase Mauhattau Bank, New York /fIJIfl ~~ Authorized Officer Signature ~OO?S052~~ :02~~Oq~?~~ ~O~5q200q~