HomeMy WebLinkAbout06-09-05
REV-!500EX{6-OO)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Bolan, Thea B.
DATE OF DEATH (MM.DD.YEAR)
03/19/2005
DATE OF BIRTH (MM-DD- YEAR)
12/03/1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
NA
[!] 1. Original Return
o 4. limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a living Trust (Attach copy 01 Trust)
o 10. Spousal Poverty Credit (dateotdealhbelween 12-31-91 and 1-1-95)
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THISSECTIOi'jiMUST ll!::iCQ!\IIPI')!':TEQ.I,A!lIli'cQRRE$PQi'jDE
NAME
William C. Dissinger
FIRM NAME (II Applicable)
Dissinger and Dissinger
TELEPHONE NUMBER
(717) 957-3474
FILE NUMBER
21 05
0315
COUtH" CODE 'fEAR
NUMBER
SOCIAL SECURITY NUMBER
204-03-6591
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (dale 01 deall1 prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
JL 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AUachSchO)
CE. NO;.Cqi'jfIDENT Al,; AX.INFQI'tMATION SHOUl,;D ae.'DIREQTED.'rO:
COMPLETE MAILING ADDRESS
400 South State Road
Marysville, PA 17053
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
0.00
2,254.16
0.00
0.00
136,919.39
3, Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable {Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G orL)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Deceden~ Mortgage Liabilities, & Liens (Schedule I)
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 (ScheduleJ)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 ta:>.able at the spousal tax 0.00 ,.0L
rale, or transfers under Sec. 9116 (a)(1.2) (15)
16. Amount of Line 14 taxable at lineal rate 121,761.89 ,o~ (16)
17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
1 B. Amount of Une 14 taxable at collateral rate 0.00 x .15 (18)
19, Tax Due (19)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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0.00
0.00
(B)
17,24672
164.94
(11)
(12)
(13)
139,173.55
17,411.66
121,761.89
0.00
(14)
121,761.89
0.00
5,479.29
0.00
0.00
5,479.29
Decedent's Complete Address:
STREET ADDRESS
The Woods at Cedar Run
824 Lisburn Road
CITY Camp Hill I STATEpA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page Hine 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
5,479.29
0.00
5,162.58
271.71
Total Credits ( A + 8 + C ) (2)
5,479.29
3. InteresVPenally if appiicable
D.lnter.st
E. Penalty
0.00
0.00
TotallnteresVPenalty ( D + E ) (3)
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 (4)
A. Enter the interest on the tax due.
(SA)
0.00
0.00
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
8. Enter the total of Line 5 + SA This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Ves No
a. retain me use or income of the property transferred;.."................... ""'.."""'.."'''.....'' 0 ~
b. retain the right to designate who shall use the property transferred or its income;..... ...............'" ......... 0 ~
c. retain a reversionary interest; or... .......................... .......................................... ............ 0 ~
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? ...... ..................." ................... .................... 0 (i]
3. Did decedent own an "in trust fo( or payable upon death bank account or securily at his or her death? 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-proba1.e 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,
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and slalemenl$, and 10 the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG~ OF PERSON RESPONSIBLE FOR FILING RETURN
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AD RESS
1A Schoolhouse Road, Duncannon, PA 17020
SIGNATURE F PREPARER OTH AN R PRESENTATIVE
DATE
G.-3-os
DATE ___
- 3~().::::>
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS. 99116 (al (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 thl
The statute does no! exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of a:
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 twenty-one years of age or younger a1 death 10
or a stepparent of the child is 0% [72 P.S. 99116(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 n
The tax rale imposed on lhe nel value of transfers to or tor the use of the decedent's siblings is 12% [72 P.S. 99116(a)1
individual who has at least one parent in common with the decedent, whether by blood or adoption.
f\HPD
1.1) (ii)].
9' even if
e parent,
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REV-1SD3 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESI DENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Thea B. Bolan
FILE NUMBER
All property jointly-owned with right of survivorship must be disc.losed on Schedule F.
ITEM
NUMBER
,.
DESCRIPTION
38 Shares of Prudential Financial Inc., common stock (Ace!. #001245079) at $59.32/share
VALUE AT DATE
OF DEATH
2,254.16
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,254.16
REV~1508 EX+ 16~98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Thea B. Bolan
FILE NUMBER
Include the proceeds of litigation and the dale the proceeds were received by the estate,
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Account #31000230912 with PNC Bank 10,191.42
2. Account #31600238805 with PNC Bank 38,685.12
3. Account #31800241906 with PNC Bank 10,167.99
4. Bankers Life & Casualty (unused premium) 340.06
5. Account #0571119565 with Sovereign Bank 22,245.92
6. Account#0575135520 with Sovereign Bank 25,035.52
7. Account #1055447187 with Sovereign Bank 30,040.21
8. Erie Insurance (refund) 99.00
9. Woods at Cedar Run (refund) 114.15
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
136,919.39
REV-1511 EX. 112-99*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Thea B_ Bolan
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A_
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Parthemore Funeral Home (amount not prepaid)
3350
B_ ADMINISTRATIVE COSTS:
1_
Personal Representative's Commissions
Name of Persona! Representati'le{s) Lee C. Bolan
Social Security Number(s)/EIN Number of Personal Representative(s] 184-38-0590
StreelAddress 1A Schoolhouse Road
8,350.41
20-6496276
Cily Duncannon
Year(s) Commission Paid: 2005
Slale P A
Zip 17020
2_
Attorney Fees
8,350.41
3_
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
0_00
Claimant
Street Address
Cily State _Zip
Relationship of Claimant to Decedent
4_ Probate Fees
5_ Accountant's Fees
6_ Tax Return Preparer's Fees
7_ Cumberland Law Journal
B_ Patriol-News
310_00
0_00
0_00
75_00
127.40
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
17,246.72
REV-1512 EX+(12-03)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thea B. Bolan
FILE NUMBER
Report debts incurred by the decedent prior to death which remained llnpaid as of the date of death, inclllding unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Verizon
I\I.A-
.o:tbert Phar. Serv. Inc. (amount paid by Estate)
37.75
2,
103,52
3,
The State Employees Retirement System (refund)
23.67
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
164.94
REV-1513 EX+ (9-00)
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SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Thea B. Bolan
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
[ TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec. 9118 (a) \1.2)J
1. Lisa Bolan, 919 Grand St., Harrisburg, PA 17102 Granddaugter 2,000.00
2. Slacl Bolan, 435 S. 3rd St., 2nd floor, Lemoyne, PA 17043 Granddaughter 2,000.00
3. Amy Gustafson, 211 Middlebury Lane, Aiken, SC 29803 Granddaughter 2,000.00
4. Alexis Snyder, 211 Middlebury Lane, Aiken, SC 29803 Great Granddaughter 2,000.00
5. Vance C. Bolan, 200 Bel Dr., Hollidaysburg, PA 16648 Son 5" 68S'O.~
6. Lee C. Bolan, 1A Schoolhouse Road, Duncannon, PA 17020 Son b6?,~D,Cj
ENTER DDLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
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(If more space is needed. insert additional sheets of the same size)
Sovereign Bank
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Thea B. Bolan
204-03-6591
March 19,2005
Account #: 0571119565 Type:
In the name of: Thea B. Bolan
Date of Death Balance:
Int.(YTD) from 1/1/2005 to
Accrued interest to date of death:
Other Info: Closed 4/12/05
Checking
Open date: 3/23/1981
$22,244.90
3/6/2005
$1.02
$2.96
Account #: 0574115887 Type:
In the name of: Thea B. Bolan
Date of Death Balance: Closed prior
Int.(YTD) from 1/1/2005 to
Accrued interest to date of death:
Other Info: Closed 3/18/05 $17,379.38
Savings
Open date: 2/9/1993
3/1812005
$0.00
$7.25
Account #: 0575135520 Type:
In the name of: Thea B. Bolan
Date of Death Balance:
Int.(YTD) from 1/1/2005 to
Accrued interest to date of death:
Other Info: Closed 4/12/05
CD
Open date: 10/31/1996
$25,000.00
2/28/2005
$35.52
$99.80
Account #: 1055447187 Type:
In the name of: Theo B. Bolan
Date of Death Balance:
Int.(YTD) from 1/1/2005 to
Accrued interest to date of death:
Other Info: Closed 4/12/05
CD
Open date:
8/6/2003
$30,000.00
2/28/2005
$40.21
$112.98
Page 1 of 1
V;): .Lt:f!~VV;) Vtl;l.1 rt1..\. ..:.'lltlfi)")d':'~
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~PNCBAN<
May 16,2005
William C. Dissinger
28 North Thlrty.Seeoncl Street
Camp Hill, PA 17011
RE: Estat= of Thee B. Bol&ll, deeeased
SSN: 204-03-659\
DOD: J/19fJOOS
Dear Mr. Dissmaer.
In _pense to your requeat for Date of DeaIh b.lances for the CUSlOlller no~ above, cur
records ahow the followin;:
c.rtlJlc.tet or Depotit
Account~31000230912
EmbUahod t OI2tI2.OQ:l
nmo B BOLAN
DODb~: $10,IIJjl"'SI0.11~inleres1
Rate: 1.34%
AecQunt#3160023880S
E.tabli.sllad 0310912002
THEa B BOLAN
DOD balance: 538,664.90'" $20.22
Rate: 1.73%
Account 1131800241906
Eatablis11ed 0712\ 1200 I
THEO B BOT.AN
DOD 1lal1lllOC: 510.162,60 + $5.39 awtJe<l interest
Rata: 2.42%
Pl_ nOle that this offi<>e only prOVide. d.ote of death balance. for d.eposil: ICCOWIli
(IRA., Co.. Checking and Savings l(:C(Iunts). W. do Il4t ProetM P)' tlllallcllll
tr."",.e&.. or PI"O"id. nat.....DIlI. lfyou need usl,laIIce wttlllllY of thete 11enSs,
pi..... call 1.88&.PNC-BA.~K ( 1-888-762.2265) or slOp by YOllr local PNC Bank brmch
office.
Sincerely,
~ LtJJ-lh
R.a.chene Well.
1-800-762-1775
P7-PFSC.Q4.F
SOO !\rat Avo.
PiltibutJh PA 11219
Mombtr FDIC
TOiAL P. 01
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LAST WILL AND TESTAMENT
OF
THEa B. BOLAN
I, Theo B. Bolan, of 824 Lisburn Road, Apt. 612, Camp Hill,
Cumberland County, Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this
to be my Last Will and Testament, hereby revoking all Wills and
codicils heretofore made by me.
ITEM I.
I direct that all my debts and funeral expenses, including my
cemetery lot and gravemarker and all expenses of my last illness,
shall be paid from my residuary estate as soon as practicable
after my death as part of the expense of the administration of my
estate.
ITEM II.
I make the following specific bequest:
A. To Lisa Bolan, Staci Bolan and Amy Gustafson,
$2,000.00 each.
B. To Amy Gustafson, IN TRUST for, Alexis Snyder,
I give the sum of $2,000.00 payable to Alexis at
majority.
ITEM III. I devise and bequeath all rest, residue and
remainder of my estate of every nature and wherever situate to my
sons, Vance C. Bolan and Lee C. Bolan, or the survivor of them.
ITEM IV.
I direct that
any and all Inheritance,
my estate passing under
Estate and
my .'lill or
Transfer taxes imposed upon
1
otherwise, shall be paid out of the principal of my residual
estate.
ITEM V. I appoint my son, Lee C. Bolan, Executor of this my
Last will and Testament. In the event of his renunciation, death,
resignation or inability to act for any reason whatsoever, I
appoint my son, Vance C. Bolan, Executor of this my Last Will and
Testament. I relieve my Executor from the necessity of posting
security in connection with his duties as such in any jurisdiction
in which he may be called upon to act.
IN WITNESS WHEREOF, I have hereunto set my hand to this my
Last Will and Testament, which consists of two pages, to each of
which I have affixed my signature this ~~ay of April, two
thousand and three (2003).
!to U .~JCU-L
Theo B. Bolan
2
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, Theo B. Bolan,
ty\((,y ,A, H~-[r 0/5'),,,,,,,.
(J
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the testatrix signed and executed the
instrument as her Last Will and that she had signed willingly, and
that she executed it as her free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the testatrix, signed the Will as witness
and that to the best of their knowledge the testatrix was at that
time eighteen years of age or older, of sound mind and under no
constraint or undue influence.
and
Ko.r.:,1
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and the witnesses
and
the
testatrix
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Testatrix .-
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Subscribed and sworn to and acknowledged
before me by Theo B. Bolan, Testatrix
and subscribed and sworn to and acknowledged
before me by KC,c;-(" L. Ko\',),c"b,.-,-,. , and
!f]cz('{ A. t:tt<f' I) >';,,(.( I , wi tn~ssesJ this
30~day of April, 2003.
tJL:!I, /l.~' U '-;kL'(cJ,...~"Q. k__
Nota y Public ,)
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