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Home My WebLink About09-09-05 REV_"OOD..~) *' ~ OFFICJ.A.L USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT RLE NUMBER 21 2005 0578 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER COMMONWEALTH OF PENNSYlVANlA DEPARTMENT OF REVENUE DEPT. 200601 HARRISBURG, PA 17128-0601 ~ z W Q W U W Q DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) CRIBBS, MYRTLE L. 196-22-6951 THIS RETURN MUST BE ALED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ ,. Original Return D 2. Supplemental Return w ~ D D 48. Future Interest Compromise (date of death after :w;::!;cn 4. Limited Estate u.'" 12-12-62) w.u ~ D zOO 6. Decedent Died Testate {Attach copy 7. Decedent Maintained a Living Trust (Attach u~~ .w ofWilJ) copy of Trust) . " D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11:Election to tax under Sec. 9113(A) (Attach Sch 0) 3901 Market Street Camp Hill,PA 17011-4227 (1) None OFFICIAL - ONLY en r-i"l (2) 2,866.05 ~..'") C) . , C) (3) - -~:1 ---CJ ::_J None C7 --, 1 .'-1 (4) .....~) :; ,:-:J None ~, C) -rl +,-, (5) 12,624.96 ;-1 .__-.'1'1 :,-----:> (6) ~.,.) ,~rTl 16,744.47 -, 'j-j :-") --c, (7) None '.D (8) 32,235.48 (9) 12,822.60 (10) 2,551.69 (11) 15,374.29 16,861.19 06/11/2005 01/22/1921 (12) 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) (14) 16,861.19 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Copyright 2000 form software only The Lackner Group, Inc. (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) .;, ::! ~ o u LEPHONE NUMBER 717/737-0464 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o ~ S ~ ~ ~ <l w '" 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 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 B minus Line 11) 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 16,861.19 .045 (16) 0 16.Amount of Line 14 taxable at lineal rate x ~ ~ ~ . 17.Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 u ~ 18. Amount of Line 14 taxable at collateral rate ~ x .15 (18) 19. Tax Due (19) 758.75 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 758.75 20. D . ,~ , , , , .. ,.. . . .. - ... . Form REV-1500 EX (Rev. 6-00) ~ Decedent's Complete Address: STREET ADDRESS 203 April Hill Drive CITY Camp Hill ISTATE PA I ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 758.75 37.94 Total Credits (A + B + C) (2) 37.94 3. Interest/Penalty if applicable D. Interest E. Penalty B. Enter the total of Line 5 + 5A. This is theBALANCE DUE. (3) 0.00 (4) (5) 720.81 (SA) (5B) 720.81 Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is thEOVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. A. Enter the interest on the tax due. 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: Yes No a. retain the use or income of the property transferred;...........................................................__................ ~ ~ ~: ~::~ :~~;~:i~~:~s:~~:s~~.~~~~I..~.~~.~~~.:.~~:.~~..~.~.~~~~~.~..~~.i.~ .~~.~.~~~..............................~~~::~:~:::::~~..... ~ d. receive the promise for life of either payments, benefits or care?.......................................................... [8J 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..... ...... ....................... ... ........ ...... .........--.... ...... ... .....-.. ........-.. ................ ... 0 [8J 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................-... .........--. ........ ............ ....... --....................... .....--_.............-..... D [8J 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 peljury, I declare that I have examined this return, induding accompanying schedules and statements. and to the best of my knowledge and belief, it is true, correct and complete. Declaration preparer other than the personal represenlative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS Karen L. Me in DATE .... 4 Oakwood Circle CampHill,PA 17011 q- 0 DATE ADDRESS ADDRESS DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Lisa Marie Coyne 3901 Market Street CampHiII,PA 17011-4227 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 to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if 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 at death to or for the use of a natural 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 beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2) [72 P.S. 99116 (a) (1)). The tax rate imposed on the net value of transfers to orfor 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. -L , *' SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA ltIHERrT "NCE "TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 2005 - 0578 ESTATE OF CRIBBS, MYRTLE L. All property jointly-owned with right of survivorship must be disclosed on Schedule F. UNIT VALU~VALUE AT DATE OF DEATH ~- 63.69 2,866.05 I ITEM NUMBER I 45 Common Shares of Prudential DESCRIPTION -~ L_____ \ 2,866.05 I TOTAL (Also enter on line 2, Recapitulation) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAl.TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT I FILE NUMBER 21 - 2005 - 0578 ESTATE OF CRIBBS, MYRTLE L. Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshIp must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 500.00 Miscellaneous Personal Property and Furniture 2 Armstrong Co. Emp. FCU Checking Acct. No. 720-00045 12,124.96 TOTAL (Also enter on Line 5, Recapitulation) 12,624.96 *' ESTATE OF _1 SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 2005 - 0578 CRIBBS, MYRTLE L. If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS A Karen L. Melvin RELATIONSHIP TO DECEDENT Daughter B Debbie Flickinger Daughter JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number DATE OF DEATH DECD'S VALUE OF NUMBER or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTERES' TENANT JOINT estate. DECEDENTS INTEREST -- I A 08/05/2002 Commerce Bank 153.26 50% 76.63 Checking Acc!. No. 536170632 2 A 08/05/2002 Commerce Bank 6,534.27 50% 3,267.14 Savings Acc!. No. 626064 133 3 B I 1/02/1 974 Armstrong Co. Emp. FeU 26,801.39 50% 13,400.70 Saviugs Acc!. No. 1-269 I \ I , I ] I I I I TOTAL (Also enter on line 6, Recapitulation) 16,744.47 *' SCHEDULEH FUNERAL. EXPENSES & AIJII"flS'JRA11VE COSTS COMMONWEALTH Of PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FilE NUMBER 21 - 2005 - 0578 ESTATE OF CRIBBS, MYRTLE L. Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Gerald J. Medice Funeral Home, Apollo, PA 6,927.00 2. Headstone Engraving 200.00 3. Reception 230.00 4. Honorarium 100.00 5 191.00 Flowers 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) ( EIN Number of Personal Representative(s): 2. Street Address City Year(s) Commission paid Attomey's Fees Coyne & Coyne, P .C. 3,000.00 Zip Stale 3. Family Exemption: (If decedent's address is not the same as c1aimanfs, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees Cumberland County Register of Wills 120.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs Postage 74.00 2 Certified Mailing to DPW 4.65 -~--- Total of Continuation Schedule(s) 1,975.95 TOTAL (Also enter on line 9, Recapitulation) 12,822.60 *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Sc:I1EKUe H FlI1llI'lIIExpeI ses& M,. Hceve CostsconlirUld ESTATE OF CRIBBS, MYRTLE L. - ~l Advertisement-- Cumberland Law Joumal---- 4 I Legal Advertisement--Patriot News 5 Reserves 6 Mileage Travel for Executrix 7 Filing Fee- Inheritance Tax Return 8 Cleaning Apartment 9 Meals and Lodging for Funeral 10 Kennel II Toll Calls 12 Tolls I FILE NUMBER 21 - 2005 - 0578 I I I Page 2 of Schedule H 75.00 100.95 500.00 100.00 15.00 200.00 825.00 46.50 60.00 53.50 . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSnVANIA INHERITANCE TAX RETURN RESIDENT DeCEDENT I FILE NUMBER 21 - 2005 - 0578 ESTATE OF CRIBBS, MYRTLE L. Include un reimbursed medical expenses. ITEM NUMBER I DESCRIPTION AMOUNT Uncleared Checks from Checking Accounts 400.00 2 Rent 3 Corneast 4 UGI 5 PAWC 6 Verizon 7 Trash 8 PPL 9 R. Wayne Martens-- Grass Cuttings 10 Moffit Peese Lim--Medieal Bills 1,200.00 102.82 141.04 77.35 73.79 81.48 197.56 180.00 97.65 -- - TOTAL (Also enter on Line 10, Recapitulation) 2,551.69 REV-1513 EX+ (9-00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I FILE NUMBER 21 - 2005 - 0578 RELATIONSHIP TO DECEDENT ESTATE OF CRIBBS, MYRTLE L. NUM~ NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Karen L. Melvin 4 Oakwood Circle Camp Hill, PA 17011 AMOUNT OR SHARE OF ESTATE Daughter 1/3 of Residual Est. 2 Gary E. Cribbs 21 Gettle Rd. Newville, PA 17241 Son 1/3 of Residual Est. 3 Debbie L. Flickinger 812 Terrace Avenue Apollo, PA 15613 Daughter 1/3 of Residual Est. Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheE t 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 COMMONWEALTH OF PENNSYlVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES . DEPT. 280601 HARRISBURG~ PA 17128-0601 '*' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 05-0578 05139127 08-23-2005 REV-lS45EX IF'rD9-UUJ EST. OF MYRTLE L CRIBBS 5.5. NO. 196-22-6951 DATE OF DEATH 06-11-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS o CHECKING o TRUST o CERTIF. PA 17011 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 KAREN 4 OAKWOOD CAMP HILL L MELVIN CIR COHHERCE BANK has provided the Department with the infonlation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent~ yoU were a joint owner/beneficiary of this account. If you feel this information is incorrect~ please obtain written correction froll the financial institution~ attach a copy to this fo,... and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Comllonwealth of Pennsylvania. Questions lIay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW Account No. 626064133 .. .. .. SEE Date Established REVERSE SIDE FOR 08-05-2002 FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 6,434.27 50.000 3,217 .14 .045 144.77 TAXPAYER RESPONSE To insure proper credit to your account~ two (2) copies of this notice IIUSt accollpany your pa~ent to the Register of Wills. Make check payable to: nRegister of Wills~ Agentn. x NOTE: If tax payments are .ade within three (3) months of the decedent's date of death~ YOU .ay deduct a 5% discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) months after the date of death. PART [!] A. 0 The above inforllation and tax due is correct. 1. You lIay choose to rellit paYllent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest~ or YOU may check box "An and return this notice to the Register of Wills and an official assessllent will be issued by the PA Department of Revenue. B. ~he above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ~o be filed by the decedent's representative. C. 0 The above infoMlation is incorrect and/or debts and deductions were paid by you. You IIUSt complete PART ~ and/or PART ~ below. [CHECK ] ONE BLOCK ONLY If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4~ Amount Subject to Tax 5. Debts and Deductions 6. AlIOunt Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS OF .1 2 3 4 5 6 7 8 x x PART ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID I TOTAL CEnter on Line 5 of Tax Computation) I $ Under penalties of perjury~ I declare that the facts I co.plete to the best of my knowledge and beliaf. ~~E~A{I~~1{LrhH': , have reported above are true, correct and '7~( -3~:;2 ) HOME WORK ('7(7 ) ( ) TI:"I rDunu~ ................. LAST vilLL and TESTAMENT I, MYRTLE L. CRIBBS, of Borough of Apollo, County of Armstrong and State of Pennsylvania, being of sound mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, in,manner and form following, hereby revok- ing any will or wills heretofore IT~de by me. First. I direct that all my just debts and funeral expenses 'be fully paid and satisfied, as soon as conveniently may be, after my decease. Second. I thereafter give, bequeath and devise all of my property, r~al,'personal or mixed, to my husband, Paul W. Cribbs. Third. If my husband, Paul W. Cribbs, should pre- decease me, or die within thirty (30) days of my death, I then give, bequeath and devise all of my property, real, personal or mixed, to my three '(3)} children, Karen L. Melvin, Gary:e. Cribhs and Debbie L,. Flickinger, equally, share and share alike. Fourth. If at the time of my decease, any of my children, aforenamed in paragraph the Third, have predeceased me, I direct that that deceased person's share shall be distrib- uted to his or her children by representation per stirpes. Page one of two pages. -----~ I do hereby make, constitute and appoint my husband, Paul W. Cribbs, to be my Executor of this my Last Will and Testament, to serve without bond. If Paul W. Cribbs is unable to serve as Executor, I then appoint Karen L,. M.elvin, Gary E. cribbs and Debbie L. Flickinger to serve as my Executors, without bond. In Witness Whereof, I, Myrtle L. ITribbs, the Testa- trix above hamed, have hereunto subscribed my name and affixed my seal, the 15th day of January in the year of our Lord one thousand nine hundred and eighty-one. ~/,JL~ (SEAL) Signed, sealed, published and declared by the above named Myrtle L. Cribbs, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at h~r request as witnesses thereunto, in the presence of said Testatrix, and of each other. jSld~ ~d! ~~ ,~~ ~~~. ,/ Page two of two pages. j J I .1 :1 j COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280801 HA.RRISBURG, PA. '7128-0601 REV-1162 EX(1l-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MELVIN KAREN L 4 OAKWOOD CIRCLE CAMP HILL, PA 17011 nn__n fold ESTATE INFORMATION: SSN: 196-22-6951 FILE NUMBER: 2105-0578 DECEDENT NAME: CRIBBS MYRTLE L DATE OF PAYMENT: 09/09/2005 POSTMARK DATE: 09/09/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/11/2005 NO. CD 005786 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $720.81 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: KAREN MELVIN CHECK# 1033 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS $720.81 GLENDA FARNER STRASBAUGH REGISTER OF WILLS