HomeMy WebLinkAbout10-17-05
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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 1 -05 7 7 2
COUNTYCci5E --YEA~ - - NUMsER- -
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Pa ton, John D.
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURIT'Y NUMBER
DATE OF BIRTH (MM-DD-Year)
2 1 5 - 3 4 - 4 7 6
THIS RETURN MUST BE FILED IN O~PLlCATE WITH THE
REGISTER OF WILLS
08/15/2005 04/07/1938
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
o 4. Lirnited Estate
[Xl 6. Decedent Died Testate (AllachcopyolWiIl)
o 9. Litigation Proceeds Received
D 2. Supplernental Return
o 4a. Future Interest Compromise (date 01 death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AllachcopyofTrusl)
o 10. Spousal Poverty Credit (dale 01 death between 12-31-91 and 1-1-95)
D 3. Remainder Return (daul 01 death pliorto 12-13-82)
o 5. Federal Estate Tax Ret~rn Required
8. Total Number of Safe Dbposit Boxes
-- I
o 11. Election to tax under ~ec. 9113(A) (Attach S<:h 0)
THIS SECTION MUST BEiCOMPLETED.ALLCORRESPONDENCEANDCONFIDENTIALTAXINFORMATIONSHOULD' BEDI ECTED TO:
NAME COMPLETE MAILING ADDRESS
David R. Getz Es uire 508 North Second Street
FIRM NAME (If Applicable)
WIX, WENGER & WEIDNER P.O. Box 845
TELEPHONE NUMBER
717 234-4182 Harrisbur PA 17108-0845
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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)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D 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)
H,i
c,
I
22,184.14
(6)
(7)
(8)
22,184.14
(9)
6,045.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
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)
(11)
(12)
(13)
6,045.00
16,139.14
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
16,139.14
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
16,139.14 X ~(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 < < ..
II
De~edent's Com lete Address:
STREET ADDRESS
906 Bonn Lane
CITY
Mechanicsburg
STATE
PA
ZIP
17055
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
Total Credits (A + B +C)
(2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 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)
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 Nd
a. retain the use or income of the property transferred; ........................................................................... 0 ~
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 ~x
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
3. ~:~h~~~:~~~~~;:~~~~:~;u~~~::~~~a~~;:~;~. ~;~~ .~~~~~ .~~~.~. ~~~~~~;. ~.; ~~~~.r;;~. ~~ ~;~.~; .~~; ~~~;~~.::::::::::::::::: B ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate 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 l1HE RETURN.
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net vall "0 ,-- 'h" "~F! of the surviving spouse is 3%
[72P.S.~9116(a)(1.1)(i)]. I : \0
U'- loo .0D
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for t 'P \ R
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for I C 010. OD
the surviving spouse is the only beneficiary. ? A P '~.
For dates of death on or after July 1, 2000: If\. ~ ~ c~
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or you t"\ -r D r::-
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. :.:::> . C')\)
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiarie~._ .::::r k.t...\ST 1.2) [12 P.S. ~9116(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. ~9116(a)(1.3)]. A sibling IS oelll''''', _.Ider Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
i. ~9116 (a) (1.1) (ii)l.
3 still applicable even if
lrent, an adoptive parent,
Rey-1508 EX: ".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Pavton. John D.
FILE NUMBER
21 05
Include the proceeds of Ittigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
772
ITEM
NUMBER
1.
DESCRIPTION
Net payroll/accrued sick pay rec'd from PA Department of Labor & Industry
VALUE AT DATE
OF DEATH
22,184.14
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert addttional sheets of the same size)
22,184.14
REV:1511 EX",: (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Pavton. John D.
"
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
05
772
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Conklin Funeral Home 5,358.00
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 Wix, Wenger & Weidner (estimated) 600.00
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 Cumberland County Register of Wills 87.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
,
I
,
,
I
.
TOTAL (Also enter on line 9, Recapitulation) $ I
I 6,045.00
(If more space is needed, Insert additional sheets of the same size)
,,,,.,,,,,, ".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EST ATE OF
P~vton John D.
NUMBER
I.
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
Nancy J. Payton
906 Bonny Lane
Mechanicsburg, PA 17055
FILE NUMBER
21 011
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Spousal
772
AMOUNT OR SHARE
OF ESTATE
16,139.14
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-150~ 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)
CODICIL TO THE
LAST WILL AND TESTAMENT OF
JOHN D. PAYTON
I, John D. Payton, of Mechanicsburg, Cumberland County, Pennsylvania, being df
sound and disposing mind and memory, do make, publish and declare this Codicil to my
Last Will and Testament dated November 27,2000 (hereinafter my "Will").
ARTICLE III of my Will is hereby amended and restated in its entirety as
follows:
ARTICLE III
REST, RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue, and remainder of my
Estate, of whatsoever nature and wheresoever situate unto my wife, NANCY J.
PAYTON. Should my wife, NANCY J. PAYTON, predecease me, I give, devise
and bGqueath all the rest, residue and remainder of my estate as follows:
A. FIVE (5%) PERCENT thereof unto my daughter, CAROL D.
NEUMANN, of Jacksonville, Florida, or her then-living issue per stirpes should she
predecease me. In the event she predeceases me and is survived by no issue, I
direct that her share shall be distributed equally among the beneficiaries described
in ParagraphG;
B. FIFTEEN (15%) PERCENT to my wife's cousin, ELIZABETH WYLIE
RADAKOVICH of Colorado Springs, Colorado, or her then-living issue per stirpes
should she predecease me. In the event she predeceases me and is survived by
no issue, I direct that her share shall be distributed equally among the beneficiaries
described in Paragraph C; and
C. EIGHTY (80%) PERCENT thereof in equal shares unto the following:
1. SAMARITAN'S PURSE, Boone, North Carolina;
2. HIS MANSION MINISTRIES, Hillsboro, New Hampshire; and
3. MONAGHAN PRESBYTERIAN CHURCH, Dillsburg, Pennsylvania,
for the specific use in the building fund.
Page 1 of 5
It is my intention that the bequests set forth in Article III.C shall qualify for
charitable deductions under the Internal Revenue Code of 1986, as the same may
be amended or modified from time to time.
ARTICLE VI of my Will is hereby amended and restated in its entirety as
follows:
I name, constitute and appoint my wife, NANCY J. PAYTON, Executrix of this my
Last Will and Testament. Should my wife, NANCY J. PAYTON, fail to qualify or cease
to so act, I name, constitute and appoint my friend, ROY ANDREWS of Mechanicsbu~g,
Pennsylvania, alternate Executor to complete the administration of my estate. Shoulq
ROY ANDREWS also fail to qualify or cease to so act, I name, constitute and appointi
PNC BANK, N.A., alternate Executor to complete the administration of my estate. I
direct that no fiduciary appointed herein shall be required to post bond for the faithful
administration of the duties required in any jurisdiction.
In all other respects, my Will shall continue and remain in full force and
effect.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this
Codicil to my Will, consisting of four pages, this 25th day of July, 2005.
~/1 -'. .'
(X' 'c#A'
; John D. Payton!
Page 2 of 5
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-
named Testator, John D. Payton, as and for a Codicil to his Will, in the presence of us,
who, at his request, in his presence, and in the presence of each other, have hereunto
subscribed our names as witnesses in attestation thereof.
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ame
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Name
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Address
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Address
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Address
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Page 3 of 5
II
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF DAUPHIN
I, John D. Payton, the Testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as a Codicil to my Last Will and
Testament; and that I signed it willingly and as my free and voluntary act for the purpos~s
therein expressed.
Sworn to or affirmed and acknowledged before me by John D. Payton, this
25th day of July, 2005.
~L--
~ n~: Payton, T stator
("'.
\ ' ~\ 'L
\I~ C~ ("I~\. 0 CTl.ll
N Public
My Commission Expires:
NOTARIAL SEAL .
Lisa M Sites. NotarY ~bhc
City of H1Irrisburg,. Daup~ County
My commission expires Apn128, 20~
Page 4 of 5
"
COMMONWEALTH OF PENNSYLVANIA :
SS.
COUNTY OF DAUPHIN
fl, W.e,n~,-\j\c\ f2 . 6-e+z- , Der\\~ \:) lA)..\~o.~t9n ,and
-t/1rfq tIJA)(nt2I:aM~(J1ftv1 ,the witnesses whose names are signed to the
attached or for~going nstrument, being duly qualified according to law, do depose and
say that we were present and saw the Testator sign and execute the instrument as a
Codicil to his Last Will; that the Testator signed willingly and executed it as his free and
voluntary act for the purposes therein expressed; that each subscribing witness, in the
hearing and sight of the Testator, signed the Codicil as a witness; and that to the best df
our knowledge, the Testator was at that time 18 or more years of age, of sound mind arnd
under no constraint or undue influence.
, "Sworn to or affj~ed and subscribed to before $ by ~~.h1 .
\<. b cf2-- ,\:)e'(\(l.R ~ LAJ,thn ~1iY1 ,and fYa 1//1 "Y", thIS i
25th day of July, 2005.
~ t2~1
I ... 1 ,"
i)~- ,.7-
Witness I e::-
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#!/L!ptdL
W ess
Y-kwr:r [b(~/f!tI#J
Witness
Q-=1-
\;{) c"'-- \~-, . .._)~LLi
Not Public
',--.
My Commission Expires:
NOTARIAL SEAL
Lisa M Sites, Notary Public :
City of Harrisburg, Dauphin Coun~
My commission expires Apri128, 20~9
F:\dbw\WiIIs\Payton\John D. - Codicil.doc
Page 5 of 5
mant Bill aUll wrntamrut
OF
JOHND. PAYTON
I, JOHN D. PAYTON, of Upper Allen Township, Cumberland COlmty, Pennsylvania,
being of sOlmd 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 or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS
I direct the payment of all my legal debts, and the expenses of my last illness and funera~
from my Estate as soon after my death as conveniently may be done.
ARTICLE II
TANGIBLE PERSONAL PROPERTY
I give and bequeath my motor vehicle(s), household and personal effects and other tangible
personalty of like nature (not including cash or securities), together with any existing insurance
thereon, unto my wife, NANCY J. PAYTON, provided she survives me.
ARTICLE III
REST, RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever
nature and wheresoever situate unto my wife, NANCY J. PAYTON. Should my wife, NANCY J.
PAYTON, predecease me, I give, devise and bequeath all the rest, residue and remainder of my
estate as follows:
A. FIVE (5%) PERCENT thereof unto my daughter, CAROL D. NEUMANN,
Virginia Beach, Virginia, or her then-living issue per stirpes should she predecease me. Irl the
event she predeceases me and is survived by no issue, I direct that her share shall be distril)uted
equally among the beneficiaries described in Paragraph B; and
B. NINETY FIVE (95%) PERCENT thereof in equal shares unto the following:
1. SAMARITAN'S PURSE, Boone, North Carolina;
2. IDS MANSION MINISTRIES, Hillsboro, New Hampshire; and
3. COUNTRY AND TOWN BAPTIST CHURCH, 1822 South Market
Street, Mechanicsburg, Pennsylvania.
ARTICLE IV
UNIFORM TRANSFERS TO MINORS ACT
In the event that any beneficiary of my Will shall not have reached the age of twenty-one
(21) years at the time for distribution of his or her share, distribution of said share may be mane in
the discretion of my Personal Representative after considering the age and needs of the benefidiary,
either directly to the beneficiary or to a Custodian under the Pennsylvania Uniform Transfers to
Minors Act, 20 Pa. C.S.A 95301 et seq., or the applicable Uniform Gifts to Minors Act or Uniform
Transfers to Minors Act in the state of residence of such beneficiary as the case may be. My
Personal Representative may designate as such Custodian any institution or person, including my
Personal Representative, qualified to act as a Custodian for such beneficiary lmder such Aict in
effect at the time such distribution is made. A receipt for any payment or distribution so made ishall
be a full discharge therefor to my Personal Representative, who shall not be responsible to see to, or
be liable for, the application of such proceeds thereafter.
II
ARTICLE V
TAX PAYMENT CLAUSE
I direct that all estate, inheritance, transfer and other taxes of similar nature payable by
reason of my death, together with any interest or penalties thereon, and imposed with respect to any
property, whether or not disposed by this Will, shall be paid out of the residue of my Estate. I
:further direct that any and all such taxes shall be paid from and be deducted from my residuary
estate prior to the calculation of the shares of the residuary beneficiaries, so that each residl.i1ary
beneficiary, charitable or not, shall bear a portion ofthe burden of such taxes.
ARTICLE VI
APPOINTMENT OF PERSONAL REPRESENTATIVE
I name, constitute and appoint my wife, NANCY J. PAYTON, Executrix of this my Last
Will and Testament. Should my wife, NANCY J. PAYTON, fail to qualify or cease to so act, I
name, constitute and appoint my friend, JOHN DiGIUSEPPE, Harrisburg, Pennsylvania, alternate
Executor to complete the administration of my Estate. Should JOHN DiGIUSEPPE also falil to
qualify or cease to so act, I name, constitute and appoint PNC BANK, N.A., alternate Executor to
complete the administration of my estate. I direct that no fiduciary appointed herein shall be
required to post bond for the faithful administration ofthe duties required in any jurisdiction.
IN WITNESS WH~REOF, I have heretmto set my hand and seal to this, my Last Will
and Testament, this 276day of tJ ~~(/ , 2000. .
/~X
JolIN D. PAYTON
(SE~)
II
Signed, sealed, published and declared by the above-named Testator, as and for his Last
Will and Testament, in the presence of us, who at his request, in his presence and in the presence of
each other, have hereunto subscribed our names as witnesses.
~
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AFFIDAVIT AND ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
We, JOHN D. PAYTON, E o,"\''-H\n C" . }.. h ~~~ and
';\..A\C' \lClf"\ S ~a~~\ ct\..~ ' the Testator and the witnesses, respectively, :whose
names are signed to the attached or'f6regomg instrument, being first duly sworn, do hereby ~ec1are
to the lmdersigned authority that the Testator signed and executed the instrument as his La~t Will
and that he had signed willingly and that he executed it as his free and voluntary act ~or the
purposes therein expressed, and that each of the witnesses, in the presence and hearing! of the
Testator, signed the Will as witness and that to the best of his/her knowledge the Testator! was at
that time eighteen years of age or older, of soun;.w~ :0 or undue infl~ence.
~O~~. PA~~LJ
~Mt~
Witness
~~ e.. ~~
Witness U .
II
,
Subscribed, sworn to and acknowledged before me by JOHN D. PAYTON, Testator,
and subscribed and swam to before me by 't n m 1,,0 CC), U "-Sr,::-> and
M\c..r-ae.1 ~. C(~'\'::""'::,,\c\l ~' witnesses, this 2.11::~dayof ~ \(>r:\~",,~)r, 2000.
~'- Cl-:n.1L L~ ~ - ~'"\..O~
Notary Public
C'.,:..,: 'iI\RtAL SEAL
; ;\,'i,. "lir.LU: M. BROSS. Notary Public
I Lemoyne Borough Cumberland Co.
My Commission Exnirp,S ~ept. 23, 2002
.-.---". . ',". .....-...-.--
NOTARIAL SEAL
MICHEllE M. BROSS. Notary Public
Lemoyne Borough Cumberland Co
My Commission Expires Sept. 23, 2002