HomeMy WebLinkAbout10-31-05
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ASHBURN BETTY
1221 WHIRLAWAY AVENUE
NAPERVILLE, IL 60540
_n_____ fold
ESTATE INFORMATION: SSN: 172-36-1139
FILE NUMBER: 2105-0494
DECEDENT NAME: GLEIM ROBERT L
DATE OF PAYMENT: 10/31/2005
POSTMARK DATE: 10/31/2005
COUNTY: CUMBERLAND
DATE OF DEATH: OS/26/2005
NO. CD 005946
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $61.69
I
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I
TOTAL AMOUNT PAID:
REMARKS: B ASHBURN
CHECK# 1009
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
$61.69
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV-15llO EX (6'()())
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Gleim, Robert L
DATE OF DEATH (MM-DD-YEAR)
OS/26/2005
FILE NUMBER
21 05
^~=~-'~',~=~-~=~--
0494
COUNTY CODE YEAR
NUMBER
SOCIAL SECURITY NUMBER
172-36-1139
DATE OF BIRTH (MM-DD-YEAR)
10/29/1943
NAME
Thomas E. Flower, Esquire
FIRM NAME (II Applicable)
Said is, Shuff, Flower & Lindsay
TELEPHONE NUMBER
(717) 737-3405
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14. Net Value Subject to Tax (Line 12 minus Line 13)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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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
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~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy 01 Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of dealh after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach coPyofTrusl)
o 10. Spousal Poverty Credit (dale of dealh between 12-31-91 and 1-1-95)
o 3. Remainder Return (dale of death prior 10 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)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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. JoinUy 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 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
COMPLETE MAILING ADDRESS
2109 Market Street
Camp Hill, PA 17011
(1)
(2)
(3)
(4)
(5)
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C)
C)
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C)
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c)
C)
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14,111.76
(6)
36,666.66
(7)
67,333.34
(9)
(8)
6,113.04
106.31
(11)
(12)
(13)
6,219.35
111 ,892.41
0.00
(10)
(14)
111,892.41
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
x .0
(15)
(16)
(17)
(18)
(19)
13,427.09
x .0
111,892.41
x .12
13,427.09
x .15
Decedent's Complete Address:
STREET ADDRESS
7 West Butler Street
CITY Mt. Holly Springs I STATEpA I ZIP
17065
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
13,427.09
12,697.15
668.25
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C ) (2)
13,365.40
Total Interest/Penalty ( 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)
0.00
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(SA)
(5B)
0.00
61.69
0.00
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.
Make Check Payable to: REGISTER OF WILLS, AGENT
61.69
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;.......................................................................................... 0 [X]
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [X]
c. retain a reversionary interest; or.......................................................................................................................... 0 [X]
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i]
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [!] 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [X]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 [X]
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 penatties of pe~ury, I declare lIlat 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 olller than the personal representative is based on all information of which preparer has any knowledge.
DATE
-L(}-02~ -tJ.s-
60540
ADDRESS
Saidis, Shuff, Flower & Lindsay, 2109 Market Street, Camp Hill, PA 17011
DATE ~ / ___
-1-, -0 S
For dates of death on or after July 1, 1994 and before January 1, 199$, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (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 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. ~9116(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. ~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 defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (6-98) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Robert L. Gleim
FILE NUMBER
21-05-0494
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.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1 Members 1st Federal Credit Union, savings account #217239-00
25.43
2 Members 1st Federal Credit Union, checking account #217239-11:
principal balance: $4,150.26 plus accrued interest: $1.45
4,151.71
634.62
3 PNC Bank checking acct. no. 5140397428
4 1986 Toyota pick-up truck (sale price)
400.00
5 Household Furnishings (sale price)
8,900.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
14,111.76
REV-1509 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Robert L. Gleim
FILE NUMBER
21-05-0494
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
RELATIONSHIP TO DECEDENT
A. Betty Ashburn
1221 Whir/away Avenue
Naperville, IL 60540
sister
B. Charles Gleim
14812 S.E. 84th Street
Choctaw, OK 73020
brother
C.
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 OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.
1 A 03/16/05 house and lot, 7 Butler Street, Mt. Holly Springs, PA 110,000.00 1/6 18,333.33
2 B 03/16/05 house and lot, 7 Butler Street, Mt. Holly Springs, PA 110,000.00 1/6 18,333.33
i
TOTAL (Also enter on line 6, Recapitulation) $ 36,666.66
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ {6-9S*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Robert L. Gleim
FILE NUMBER
21-05-0494
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY DATE OF DEATH
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. house and lot, 7 Butler Street, Mt. Holly Springs 110,000.00 1/3 3,000.00 33,666.67
2 house and lot, 7 Butler Street, Mt. Holly Springs 110,000.00 1/3 3,000.00 33,666.67
>
TOTAL (Also enter on line 7 Recapitulation) $ 67,333.34
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Robert L. Gleim
FILE NUMBER
21-05-0494
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
1.
DESCRIPTION
AMOUNT
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
5,703.89
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
140.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
8
Publish Estate Notices: Sentinel (166.07); Cumberland Law Journal (75.00)
Estate Checks: printing fee
241.07
28.08
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
6,113.04
REV-1512 EX+ (12-03) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Robert L. Gleim
FILE NUMBER
21-05-0494
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including un reimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Sprint: phone bill
27.16
2
Met-Ed: electric bill
31.33
3
Corncast: tv cable bill
47.82
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
106.31
REV-1513 EX+ (9-00) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Robert L. Gleim
FILE NUMBER
21-05-0494
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a)(1.2)]
1 Betty Ashburn, 1221 Whirlaway Avenue, Naperville, IL 60540 sister 0.50
2 Charles Gleim, 14812 S.E. 84th Street, Choctaw, OK 73020 brother 0.50
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
...
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 1$ 0.00
(If more space is needed, insert additional sheets of the same size)
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.
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LAST WILL AND TESTAMENT
OF
ROBERT L. GLEIM
I, ROBERT L. GLEIM, of 7 West Butler Street, Mt. Holly Springs,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this as and for my Last Vv'iii and Testament,
hereby revoking and making void any and all former Wills, Codicils, or writings in the
nature thereof, by me at any time heretofore made.
FIRST:
I hereby order and direct my Executrix or Executor,
hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses
and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be
conveniently done after my death, out of my residuary estate.
SECOND: I give my entire estate to my brother and sister, BETTY
ASHBURN, of 1221 Whirlaway Avenue, Naperville, Illinois 60540, and CHARLES
GLEIM, of 14812 S. E. 84th Street, Choctaw, Oklahoma 73020, in equal shares, per
capita, and not per stirpes. Should either of them fail to survive me, ! give my e:-:tire
estate to my surviving sibling.
LASTL Y:
I nominate, constitute and appoint my sister, BETTY
ASHBURN, to be the Executrix of this my Last Will and Testament. In the event that my
said sister, BETTY ASHBURN, shall be unable to serve as Executrix for any reason, I
appoint my brother, CHARLES GLEIM, as Executor. In the event that my said brother,
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r
CHARLES GLEIM, shall be unable to serve as Executor for any reason, I appoint my
nephew, JOHN ASHBURN, as Executor. No Executor or Executrix shall be required to
file bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
/ 9'l-h
day of Ifr17
,/i~;t i /:J~
Robert L. Gleim
,2004.
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
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COMMONWEALTH OF pENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, ROBERT L. GLEIM, 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 my Last Will; that I signed it
willingly; and that I signed it ,as my free and voluntary act for the purposes therein
expressed.
Sworn or affi me
Testator, this I
by ROBERT L. GLEIM, the
,2004.
, i
NOTARIAl SEAL j I
RENEE L MURRAY, Notary Public V
Carlisle Bora. Cumberland c."Jrny, PA
My Commission Expires Dac. 13, 2005
3
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COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We James D. Flower, Jr. and Tanya L. Ware
, ,
the witnesses whose names are signed to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we were present and saw
Testator sign and execute the instrument as his Last Will; that he signed willingly and that
he 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 18 or more years of age, of sound
mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by James D. Flower, Jr.
and Tanva L. Ware
this
19th
day of
April
2004.
r~o.~~J~~
Witness
~~dAO
4 Witness
tg!A~*?nl
, Not~ry.,public
~
NOTARIAL SEAl .
RENEE L MURRAY. NoIary PubI~A
Carlisle Bore, Cum~ County, . l:i
: My Commission Exptres Dec. 15, 200...
4
REV-1B3EX (6.96) RECORDER'S USE ONL Y
,. State tax Paid
REAL TY TRANSFER TAX Back Number
COMMONWEALTH OF PENNSYLVANIA STATEMENT OF VALUE
DEPARTMENT OF REVENUE Page Number
BUREAU Of INDIVIDUAL TAXES
DEPT.280603 See Reverse for Instructions mate KecorClOO
HARRISBURG, PA 17128-0603
.
Complete each section and file in duplicate with Recorder of Deeds when (1) the full value/consideration is not set forth in the deed, (2) when the deed
is without consideration, or by gift, or (3) a tax exemption is claimed. A Statement of Value is not required if the transfer is wholly exempt from tax
based on: 1 famil relationshi or 2 ublic utilit easement. If more s ace is needed attach additional sheet s .
A
Name
CORRESPONDENT - All inquiries may be directed to the followina person:
Telephone Number:
Area Code ( 717 \ 737-3405
State Zip Code
17011
Thomas E. Flower, SAIDIS, SHUFF, FLOWER & LINDSAY
Street Address City
2109 Market Street Camp Hill
aeo
1221 Whirlaway Avenue
City
Na erville
ta e
tate
Zip Code
17065
8 TRANSFER DATA
Grantor( s )/Lessor( s)
Betty 1. Ashburn and Charles Gleim
treet ddress
c
IL
PROPERTY LOCATION
60540
PA
Street Address
7 West Butler Street
ounty
Cumberland
o VALUATION DATA
1. Actual Cash onsideration
x
1.00
$110,000
$110,000
A. County Assessed Value
2. Other Consideration
+ 0
6. ommon Level Ratio Factor
$93,190
NONE
2. Check Appropriate Box Below for Exemption Claimed
o
o
o
o
o
Will or intestate succession
(Name of Decedent)
(Estate File Number)
Transfer to Industrial Development Agency.
Transfer to a trust. (Attach complete copy of trust agreement identifying all beneficiaries.)
Transfer between principal and agent. (Attach complete copy of agency/straw party agreement.)
Transfers to the Commonwealth, the United States and Instrumentalities by gift, dedication, condemnation or in lieu of condemnation.
(if condemnation or in lieu of condemnation, attach copy of resolution.)
o Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number , Page Number
o Corrective or confirmatory deed. (Attach complete copy of the prior deed being corrected or confirmed.)
o Statutory corporate consolidation, merger or division. (Attach copy of articles.)
o Other (Please explain exemption claimed, if other than listed above.)
Date
FAILURE TO COMPLETE THIS FORM PROPERLY OR ATTACH APPLICABLE DOCUMENTATION MAY RESUL
TO RECORD THE DEED.
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Estate of: ROBERT L. GLEIM
Date of Death: OS/26/2005
Social Security Number: 172-36-1139
~lm
MEMBERS 1st
FEDERAL CREDIT UNION
217239 -00
05/14/2002
$25.43
$.00
$25.43
None
217239 -11
05/14/2002
$4,150.26
$1.45
$4,151.71
None
;tt;: 1/~RAl CREDIT UNION
Denise A. Wolfe ~
Insurance Services Supervisor
July 21,2005
5000 Louise Drive · P.G. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1st.org
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