HomeMy WebLinkAbout10-03-05
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REv-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 -05 0 8 0 3
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
STOLTZFUS Daniel K
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
2 1 5 - 5 6 - 5 750
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
08/28/2005 09/04/1936
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
STOLTZFUS Ma S
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
[Xl 4. Limited Estate
[Xl 6. Decedent Died Testate (AttachcoPyolWiIl)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1- 1-95)
o 3. Remainder Retum (date 01 death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
Q... 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under See, 9113(A) (Attach Sch 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Forest N M ers Es uire 137 Park Place West
FIRM NAME (If Applicable)
Law Office Forest N M ers
TELEPHONE NUMBER
717 532-9046 Shi PA 17257
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
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OFFICIAL USE ONLY
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1,397.98
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(8)
703.00
(11)
(12)
(13)
(14)
1,397.98
703.00
694.98
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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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
694.98
0.00 X 0.00 (15) 0.00
0.00 X (16) 0.00
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 0.00
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
499 South Shady Road
CITY I STATE I ZIP
Newburg PA 17240
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
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C)
(2)
0.00
Total Interest/Penalty ( 0 + 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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
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; ........................................................................... D [Z]
b. retain the right to designate who shall use the property transferred or its income; ........................................ D [Z]
c. retain a reversionary interest; or ...................................................................................................... D [Z]
d. receive the promise for life of either payments, benefits or care? ............................................................. D [Z]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. D [Z]
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. D [Z]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D [Z]
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 return, including accompanying schedules and statements, and to 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
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ADDRESS 4lf9 South Shad Road
Newburq
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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ADDRESS 137 Park Place West
DATE
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PA 17240
DATE
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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. 99116 (a) (1.1) (ii)].
The statute does not exempt 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, 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. 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. 99116(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.
Law Office of
FOREST N. MYERS
***
137 Park Place West
Shippensburg, PA 17257
(717) 532-9046
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I, DANIEL K. STOLTZFUS, of Hopewell Township, Franklin CountYd~enhsyhTai1ia, revo,k~
my prior wills and declare this to be my last Will:..., ::~~ . .. : -~. ~
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** LAST WILL AND TESTAMENTi/~
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FIRST: PAYMENT OF EXPENSES - I direct that the expenses of my last illness and funeral be paid
from my estate as soon as may conveniently be done.
SECOND: BEQUEST - I give, devise and bequeath the residue of my estate, real or personal,
tangible or intangible, together with all insurance policies thereon unto my wife, MARY S.
STOl TZFUS, and children, ANNIE STOl TZFUS, AMOS STOl TZFUS, FANNIE FISHER, JOHN
STOl TZFUS, JACOB STOl TlFUS, EMANUEl STOl TZFUS, KA TIE STOl TZFUS, ISAAC STOl TlFUS,
SARAH STOl TZFUS and BEN KING, husband of SADIE KING, my deceased daughter, provided they
shall survive me by thirty (301 days, in as nearly equal shares as possible. In the event any child shall
predecease me, survived by a spouse, his or her share shall be distributed to said spouse.
THIRD: RESIDUE OF ESTATE -I give, devise and bequeath all the rest, residue and remainder of
my estate unto my wife, MARY S. STOl TZFUS, and children, ANNIE STOl TZFUS, AMOS
STOl TZFUS, FANNIE FISHER, JOHN STOl TZFUS, JACOB STOl TZFUS, EMANUEl STOl TZFUS,
KA TIE STOl TZFUS, ISAAC STOl TZFUS, SARAH STOl TZFUS and BEN KING, husband of SADIE
KING, my deceased daughter, provided they shall survive me by thirty (30) days, in as nearly equal
shares as possible. In the event any child shall predecease me, survived by a spouse, his or her share
shall be distributed to said spouse
FOURTH: PROTECTIVE PROVISION - To the greatest extent permitted by law, before actual
payment to a beneficiary, no interest in income or principal shall be (i) assignable to a beneficiary or
(iil available to anyone having a claim against a beneficiary.
FIFTH: DEA TH TAXES - All federal, estate and other death taxes payable on the property forming
my gross estate, whether or not it passes under this will, shall be paid out of the principal of my
probate estate just as if they were my debts, and none of those taxes shall be charged against any
beneficiary. This provision shall not apply to any property over which , have a general power of
appointment for federal estate tax purposes.
SIXTH: MANAGEMENT PROVISIONS - I authorize my Executor, as follows:
A. Retain/lnvest: To retain and to invest in all forms of real estate and personal
property, including common trust funds, mutual funds and money market deposit
accounts and certificates of deposit, regardless of any limitations imposed by law
on investments by executors or any principle of law concerning investment
diversification;
B. Compromise: To compromise claims and to abandon any property which, in my
Executor's opinion, is of little or no value;
C. Borrow: To borrow from and to sell property to my wife or others, and to pledge
property as security for repayment of any funds borrowed;
D. Sell/Lease: To sell at public or private sale, to exchange or to lease for any
period of time, any real or personal property and to give options for sales of leases;
E. Capital Changes: To join in any merger, reorganization, voting-trust plan or other
concerted action of security holders, and to delegate discretionary duties with
respect thereto;
F. Distribute: To distribute in kind and to allocate specific assets among the
beneficiaries (including any custodian hereunder) in such proportions as my Trustee
may think best, so long as the total market value of any beneficiary's share is not
affected by such allocation.
These authorities shall extend to all property at any time held by my Executor or my
Trustee and shall continue in full force until the actual distribution of all such
property. All powers, authorities and discretion granted by this Will shall be in
addition to those granted by law and shall be exercisable without court
authorization.
SEVENTH: EXECUTOR - I appoint my son, AMOS Z STOl TZFUS, Executor of my Will. In the event
of the death, resignation, renunciation or inability of my son, AMOS Z STOl TZFUS to act as
Executor, I appoint my son, JOHN STOl TZFUS, Executor of this, my Will. Neither my Executor, nor
any successor shall be required to give bond
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this Lt day of (f/ f:l-rC~
1999. ~
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DANIEL K. STOLTZFUS,
In our presence, the above.named Testator signed this and declared it to be his will, and now, at his
request and in his presence and in the presence of each other, we sign as witnesses:
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COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF FRANKLIN
I, DANIEL K. STOLTZFUS, having been duly qualified according to law, acknowledge that
I signed the foregoing instrument as my Will, and that I signed it as my free and voluntary act for the
purposes therein expressed.
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DANIel K. STOt TZfUS, T~l~tor
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We, DANIEL K. STOLTZFUS, the Testator in and the undersigned witnesses to the Will, the
attached or foregoing instrument, who have signed the instrument, having been qualified according
to law do depose and say:
fa) that I, the Testator, do hereby acknowledge that I signed the instrument as my
Will, that I signed it willingly and as my free and voluntary act for the purposes
therein expressed; and
(b) that we, the witnesses, were present and saw the Testator sign and execute the
instrument as his Will, that he signed it willingly and executed it as his free and
voluntary act for the purposes therein expressed; that each of us in the hearing and
sight of the Testator signed the Will as witnesses and that to the best of our
knowledge, the Testator was at that time eighteen or more years of age, of sound
mind and under no constraint or undue influence.
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WItness
Subscribed, sworn to or affirmed,
and acknowledged before me by the
above-named Testator and by the
witnesses whose names appear on
this lo+o..day of MA-"2C~ 1999.
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NOTARIAL SEAL
FOREST N MYERS, NOTARY PUBLIC
BC:~:::;::':1 OF SHIPP ENS BURG mANU COUNTY
rw CCiMf.\ISSION EXPIRES OEe 17200.
REV-150B EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
STOLTZFUS. Daniel K
FilE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0803
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,397.98
checking account, Orrstown Bank
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,397.98
REV-1511 EX + (12-{J9)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
STOLTZFUS. Daniel K
FILE NUMBER
21
05
0803
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Law Office Forest N Myers 625.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills Cumberkand County, probate and filing fees 101 .00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 726.00
(If more space is needed, insert additional sheets of the same size)
"'.'''''''''*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STOLTZFUS OaniAI K
SCHEDULE J
BENEFICIARIES
NUMBER
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
?1 n'\
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
nAnq
AMOUNT OR SHARE
OF ESTATE
1.
Mary S Stoltzfus
499 South Shady Road
Newburg PA 17240
694.98
ENTER DOLLAR AMOUNTS 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)