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Home My WebLink About06-09-05 , REY-1WOEX+16.()01 *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER -TDEceDENT's NAME--(LAST, FIRST, AND MIDDLEINITIAL) i Johnston, Glenna M. I ~;~~~;;~~:M.bD'Y_:R)--]~;;~;~~~H21;M'DMEAR) fi~O ."""", '..: - -,"~ST' FIRS: AND MIDDLE INITIAL) Onglnal Return 2. Supplemental Return 4 Limited Estate 4a Future Interest CompromIse (date of death afler12-12-82) ~ 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) I 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 12-31-9Li:1091:1~~1 THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND'CONFIDENTIAL TAX'INFORMATION SHOULD BE DIRECTED TO: AME COMPLETE MAILING ADDRESS Terrence J. Kerwin COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURQ...!.~]!12B.060_~_____~_______ ~ z w " w " w " nH'ICIAl_ US[ ON'_'{ 21 2005 00081 _l_~Q!,Lt'!TY CO.P_L_ _'LE:~H N!,!.MBER__ - ____________________ _______ - ____m_______________ I ,:OCIAl SECURITY NUMBER 201-18-0934 ______ _ _THIS RETUR~~~~;;:~D~~D:IL~C:;E WITH THE SOCIAL SECURITY NUMBER w ~ :.:::$(1) ,,<<" w"" XOO ,,<<~ .... .. < .~ "'z Ww <<" <<z 00 "" lAM NAME (If applicable) l~e"",in 8<. Kerwin TELEPHONE NUMBER 717/238-4765 o D 3. Remainder Return (date of death prior 1012.13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11.Election to tax under Sec. 9113(A) (AltachSch 0) 27 North Front Street Harrisburg, P A 1710 1 (1) None tJlTIClAL \ISE O~JL y (2) None ---------------- (3) None (4) None (5) 58,324.15 (6) None (7) None (8) 58,324.15 (9) 230.00 (10) 1. Real Eslate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 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 ~ :5 7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property CO (Schedule G or L) ~ 8. Total Gross Assets (total Lines 1-7) " ~ 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (11) 230.00 (12) 58,094.15 13. Charitable and Governmental Bequests/See 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) (13) 58,094.15 (14) 0.00 SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >>BESURE'TOANSWERA1.L QUESTIONS ON REVEIlSESipEAND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-(0) Decedent's Complete Address: STREET ADDRESS 801 North Hanover Street CITY ISTATE~A !ZIP 17013 Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penally TotallnterestJPenalty (0 + 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 Une 1 + Line 3 is greater than Line 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) 0.00 (5) (5A) (5B) 0.00 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 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?........................................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................... .......... .......................... ....................... D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.................. .......................................................... ................ D '~ i ~ ~ ~ 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 haye examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeqCl~tion of pre parer other than the personal representatiye J.sJ>~s~ ~~ _Cl" !nformation of which prepa~erhasan}' _knOwledge. SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS TerrenceJ.Ke in, ~ SIGNATURE OF RS N RESPONSIBLEFORFILING RETURN 27 North Front Street l-I<lfTisb_urg, PAl 71 0 1 ADDRESS f:. OTHER THAN REPRESENTATIVE ADDRESS 27 North Front Street Harrisburg, P A 17101 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 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 transfers te [72 P.S. S9116 (a) (1.1) (ii)l. The statute does not exemot a transfer to a surviving spouse from ta> N fl P D of assets and filing a tax return are still applicable even jf the surviving spouse is the only benefici~ 11 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 parent. an adoptive parent. 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 benefi 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 1 ~ i -AJ)51 under Section 9102, as an individual who has at least one parent in common with the decedent, WrltlUIC, "'1 ..........~_ _. _~ ,0% losure I natural .S.99116 ; defined, *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 2005:00081 _ ESTATE OF Johnston, Glenna M. Include the proceeds 01 litigation and the date the proceeds were received by the estate.AII property jointly-owned with the right of survivorshIp must be disclosed on schedule F. VALUE AT DATE OF DEATH 58,198.47 ITEM NUMBER I DESCRIPTION Church of God Home - refunded balance of Trust Account 2 Church of God Home - balance of personal account 125.68 TOTAL (Also enter on Line 5, Recapitulation) 58,324.15 000185 CHURCH OF GOD HOME, INC. 801 N. HANOVER STREET CARLISLE PA 17013 Resident Trust Fund Statement ~esident Name <..esident Number: GLENNA M JOHNSTON 000002170 Account Number: Statement Date: Account Type Lac/Room/Bed FINAL STATEMENT 2170 02/12/2005 RESIDENT TRUST Discharge GLENNA JOHNSTON CHURCH OF GOD HOME 801 N. HANOVER STREET CARLISLE PA 17013 Date Description Withdrawals Deposits Balance Balance Forward 1,323.43 12/05/2003 OTHER BROCKIE PHARMACY CK 1624 800.96 522.47 12/22/2003 DEPOSIT RESIDENT TRUST 60.00 582.47 12/31/2003 INTEREST .05 582.52 01/05/2004 DEPOSIT RESIDENT TRUST 60.00 642.52 01/14/2004 WITHDRAWAL CK 1642 WiD PiC 1/5/04 10.00 632.52 01/14/2004 DEPOSIT CK 976 92.62 725.14 01/31/2004 INTEREST .05 725.19 02/09/2004 DEPOSIT RESIDENT TRUST 60.00 785.19 02/24/2004 OTHER BROCKIE PHARMACY CK 1657 241.59 543.60 02/29/2004 INTEREST .05 543.65 03/03/2004 OTHER CK 1666 DARLENE MOYER 9.90 533.75 03/08/2004 DEPOSIT RESIDENT TRUST 60.00 593.75 03/31/2004 INTEREST .04 593.79 04/0512004 OTHER CK 1682 BROCKIE PHARMACY 528.21 65.58 04/05/2004 DEPOSIT RESIDENT TRUST 60.00 125.58 04/30/2004 INTEREST .01 125.59 06/30/2004 INTEREST .02 125.61 07/31/2004 INTEREST .01 125.62 08/31/2004 INTEREST .01 125.63 09/30/2004 INTEREST .01 125.64 10/31/2004 INTEREST .01 125.65 11/30/2004 INTEREST .01 125.66 12131/2004 INTEREST .01 125,67 01131/2005 INTEREST .01 125.68 Account Balance 125.681 "- t;; ~ z cD '" ~ cD cn Ii ::> 0 0 0 0 <:) ill Z 15 ~ en 0 <L W 0 r- w ~ "' ill 0 cD ~ ill w 0 '" co a: ~ T CJ " cD ~ en w 0 W -_....--'--~-- 0 Z 0 rJ) '< -' ..: w b " '" .... ~ W S (.) z Z 0 ..: z w t: " 0 0 z ~ ~ w w a: W w "' "- a: "'- w w a: "' 0 "' "' w cr z "'- " M W rl 0 to ~ ------------------- -- m ",. '" V w Z 0 - z a: ~ ~ "' ~ '" ,,~ :; '" >0 tii", w ::> :i ~~ "' z "' 0 "'" ~ '-' cD <L cr . 0: r;... -8:l Oz.,,", 0: :2 ~ U ;i."'-. " _ u ;;0 c ~ ::c "' V ow ~ 5t:( ~o .... ~ *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT -~--- ESTATE OF Johnston, Glenna M. SCHEDULEH FUNERAL EXPENSES & ADMINISTRA11VECOSTS . FILE NUMBER 21 - 2005 - 00081 Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT ITEM NUMBER ----..-- A. FUNERAL EXPENSES: B. i ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid 2. Attorney's Fees State Zip 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs Register of Wills - additional probate fee 2 State Zip Register of Wills - filing fee for tax return and Inventory Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 84.00 90.00 30.00 26.00 230.00 '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Johnston, Glenna M. 3 Register of Wills - filing of Release 4 Vital Records - Death Certificates SctledEH FlI1eraI Expel m & Adllli Ibbdi...eCostscorDuld I FILE NUMBER 21 - 2005 - 00081 5 Register of Wills - additional Short Certificate I 4.00 18.00 4.00 Page 2 of Schedule H REV-1513 EX+ (9-00) '* SCHEDULE J BENEFICIARIES I , ---~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Johnston, Glenna M. : FILE NUMBER 21 - 2005 - 00081 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT n... N"t ll.t T....t""'l{.) ___ AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS St. Patrick's Roman Catholic Church, Carlisle 85 Marsh Drive, Carlisle, PA 17013 58,094.15 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 58,094,15 1 K ~ ':t ~ LAST WILL AND TESTAMENT OF GLENNA M. JOHNSTON I, GLENNA M. JOHNSTON, of South Middleton Township (Homar Estates, R. D. 6, Box 104, Carlisle) Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executor to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I direct that my funeral services be conducted by Ewing Brothers Funeral Home, 630 South Hanover Street, Carlisle, Pennsylvania, in accordance with plans and arrangements which I have made with said funeral home. 2. All the rest. residue and remainder of my estate. reaL personal and mixed. and wheresoever the same may be situate. I give. devise and bequeath to Dauphin Deposit Bank and Trust Company. 2 West High Street, Carlisle. Pennsylvania, in tnlst, to receive and to invest the same, and to pay the income arising therefrom together with so much of the principal thereof as in its opinion is necessary or desirable to be expended for the proper maintenance. sUPPO' ~ and medical expenses of my husband, including hospital and nursing home care, to or for the benefit of my husband. Edward H. Johnston, and upon the death of my said husband said trust shall terminate and the then remaining principal. if any. together with any undistributed income, shall be paid to St. Patrick's Roman Catholic Church, Carlisle. Pennsylvania, to be used for such purpose or purposes as the officials of said church shall deem best. Page 1 of 2 Pages 3. I hereby nominate, constitute and appoint Dauphin Deposit Bank and Trust Company, and its successors, as Executor of this my Last Will and Testament and further direct that it shall not be required to post any bond to secure the faithful performance of its duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on two pages this 24th day of April , 1981. M,,'I I?J. ~~ Glenna M. J nston (SEAL) Signed, sealed, published, and declared by GLENNA M. JOHNSTON,- the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~L "( jL/<1? Page 2 of 2 Pages