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Home My WebLink About12-15-05 (2) ,,-1500 EX + 11-00) *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 05 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 0458 NUMBER COMMONWEALTH OF PENNSYlVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17126-0601 .... z w o w o w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Addison, Betty Mae OFFiCiAL USE ONL',!,' 292-24-7039 05/16/2004 11/05/1928 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) Addison, Jr., William E. ~ 1, Original Return D 4, Limited Estate ~ D D 2, Supplemental Return D D D w .... <Vl 01" 11.0 00 "..J II. III II. < 6. Decedent Died Testate (Altach copy of Will) 9. Litigation Proceeds Received ..... VlZ Ww "0 "z 00 Oil. IRM NAME (If applicable) Knight & Associates, P.e. ELEPHONE NUMBER 717/249-5373 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o ;:: ~ :> .... ii: < o w " 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) 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) REGISTER OF WILLS SOCIAL SECURITY NUMBER 281;20-3834 D" 3. Remainder Retum (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11.Election to tax under Sec. 9113(A) (Altach Sch 0) 11 Roadway Drive, Suite B Carlisle, P A 17013 (1 ) 140,000.00 (2) None (3) None (4) None (5) 39,850.09 (6) None (7) None (9) 12,824.12 (10) 4,944.68 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) 4a, Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31..~1~nd1-1-95)/ ... /< . ./. ... THIS SECTION MUST BE COMPLETEO.ALLc;ORRESPONOENCE ANOCONFIOENTIAI..rAXINFORMATION SHO(,JLO BE DIRECTED TO: AME COMPLETE MAILING ADDRESS Sean M. Shultz, Esquire QfFICIAL USE OMt'Y> ~ :.:;~~ -.0 < ,. ::r~ CJ ['I CJ U'l i-I , C"l ,I \.D (8) 179,850.09 (11 ) 17,768.80 162,081.29 (12) (13) (14) 162,081.29 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, 54,027.10 x .00 (15) or transfers under Sec. 9116(a)(1.2) z 108,054.19 .045 (16) 0 16. Amount of Line 14 taxable at lineal rate x ;:: < .... :> II. 17.Amount of Line 14 taxable at sibling rate x .12 (17) :IE 0 0 ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) .... 19. Tax Due (19) 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 4,862.44 4,862.44 ,,, ';> "'~\;f,: '::>>'BE'SURE:Tb%ANSwERAi.t'QQ~$::n9NS ON'REVERSe'SfQ"E'ANbR.ECHECK MAllf<~'~.~fj~~_ pyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 14 Ashburg Drive CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 4,862.44 r Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 170.09 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. 8. Enter the total of Line 5 + 5A. This is theBALANCE DUE. (3) 170.09 (4) (5) 5,032.53 (5A) (58) 5,032.53 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;............................................................................. ~ ~ ~: ~::::~ ~h~e~~~~i~~:~s:~~;~s~:~. ~~~~I. .~.~~. ~~~. ~~~~~.~. .~~.~.~~~~~~.~. .~~ .i~~ .i.~.~.~:~~..............................~~::::::::::: ~~..... ~ 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 ~ 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 penallies of perjury, I declare lhat I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration preparer other than lhe personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Brian M. A ison. 2769 Chestnut Run Road York, PA 17402 /2 /I CD ATE ADDRESS 11 Roadway Drive" Suite B Carlisle, P A 170 b DATE i z/ )3/liS ADDRESS 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.5. 99116 (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 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 .5. S9116 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. . SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF . AddIson, Betty Mae \ FILE NUMBER 21-05-0458 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be excnanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. I ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 140,000.00 Property situate at 14 Ashburg Drive, Mechanicsburg, Pennsylvania (see appraisal) TOTAL (Also enter on LIne 1, Recapitulation) 140,000.00 ,..' '~_' ,...~, II r I ""'"~ ;, o..j SUMMARY OF SALIENT FEATURES Subject Address 14 ASHBURG DRIVE Legal Description DEED BOOK 00150 PAGE 00864 ./. City "- MECHANICS BURG :. County CUMBERLAND State PA Zip Code 17050 Census Tract 0118.01 Map Reference 38-18-1324-058 Sale Price S N/A Date 01 Sale N/A Borrower I Client N/A Lender PRIVATE Size (Square Feel) 1,488 Price per Square Foot S Location AVERAGE . Age 9 YEARS Condition AVERAGE T olal Rooms 6 Bedrooms 3 Baths 1.5 Appraiser ROBERT K. BANZHOFF Dale of Appraised Value 8-3-05 Final Estimate 01 Value S 140,000 Form SSD - "TOTAL lor Windows' appraisal software by a Ia mode. Inc. -1-800-ALAMODE *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~STATE OF . AddIson, Betty Mae I FILE NUMBER 21 - 05 - 0458 nclude the proceeds of litigation and the date the proceeds were received by the estate. All property JOintly-owned with the right of iurvivorshlp must be disclosed on schedule F. /' ITEM NUMBER I Pre-Paid Funeral DESCRIPTION VALUE AT DATE OF DEATH 8,503.00 2 Waypoint Bank Time Deposit Acocunt 24,964.82 3 Waypoint Bank Checking Account No. 0571130976 6,382.27 TOTAL (Also enter on Line 5, Recapitulation) 39,850.09 . SCHEDULE H RJNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT =STATE OF Addison, Betty Mae I FILE NUMBER 21 - 05 - 0458 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER - A. FUNERAL EXPENSES: /- 1 Food for funeral 340.05 2 Myers-Hamer Funeral Home, Inc. - funeral 8,503.00 3 Rolling Green Cemetery - headstone 2,147.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s}: I Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees to Knight & Associates, P.C. 1,300.00 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 to Register of Wills 293.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Cumberland Law Journal - advertise letters 75.00 2 The Sentinel - advertise letters 166.07 TOTAL (Also enter on line 9, Recapitulation) 12,824.12 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Addison, Betty Mae I FILE NUMBER 21-05-0458 Include unreimbursed medical expenses. /- ITEM NUMBER 1 Jim Holland - accountant DESCRIPTION AMOUNT 135.00 2 Comcast - cable 41.92 3 Silver Spring Township Authority - sewer and water 408.65 4 Verizon 30.91 5 US Treasury - tax 100.00 6 Penn Waste - garbage 183.50 7 PA Water Co. 147.73 8 PP&L - electric 310.03 9 Sowers Realty - management company for townhouse 470.00 10 Debra Basehore Wiest - 2004 school realty taxes 1,166.56 11 Quantum Imaging - medical bill 21.72 12 Allstate - home owners insurance 354.00 13 East Penn Ambulance - medical bill 100.00 14 Debra Bashore Wiest - county/township realty taxes 331.45 15 Debra Bashore Wiest - 2005 school realty taxes 1,143.21 TOTAL (Also enter on Line 10, Recapitulation) 4,944.68 QEV.1513 EX+ (9-00) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Addison, Betty Mae I FILE NUMBER 21 - 05 - 0458 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) " 1 William E. Addison, III son " 2/9 residue of estate 1306 Woodlawn Drive Charleston, Illinois 61920 2 Cheryl Addison Mengle daughter 2/9 of residue of estate 76 Skyline Drive Mechanicsburg, Pennsylvania 17050 3 Brian M. Addison son 2/9 of residue of estate 2769 Chestnut Run Road York, Pennsylvania 17402 4 William E. Addison, Jr. husband 1/3 of residue of estate Forrest Park Health Center 700 Walnut Bottom Road Carlisle, PA 17013 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate. on Rev 1500 cover sheit 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 I TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I " LAST WILL AND TESTAMENT I, BETTY MAE ADDISON, of Hampden Township, Cumberland County, Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Wi~l rand Testament, in the manner and form following, hereby revoking and making void all former Wills and writings in the nature thereof by me heretofore made: FIRST: I direct my Executor, hereinafter named, to pay all my just debts and obligations as soon after my decease as is practicable. SECOND: ve, devise and bequeath unto my b:loved husband, WILLIAM ~. d County, Commonwealth of 5'd.~' 76 ~ IJ. . ~,.t1fl(, U and mixed, of whatsoever nature I~ V' EDWARD ADDISON. Pennsylvania, and kind, and same time of my death, provided he survives me for a period of sixty (60) days. THIRD: In the event my said husband, WILLIAM EDWARD ADDISON. JR., fails to survive me for a period of sixty (60) days, or in the event my said husband and I shall die, either simultan~ously or as the result of a common accident or disaster, or if he and I shall die under such circumstances that it is difficult or impossible to determine whether he survived me, then and in any and every such event, I give, devise and bequeath my said estate to my children, William E. Addison, III, Brian M. Addison, and Cheryl Addison Mengle, who shall survive me by thirty (30) days, to be divided among them in as nearly equal shares as is practicable as they may agree, or in the absence of agreement, then as my Executor shall determine in as nearly equal shares as is practicable. In the event any of my children fail to survive me by thirty.\".: -,!t/ ~ :.;t!~~X:" ~,-}~,,"'!i~', , .~~s\. ,;-,'"'i'o1.:.. '~'~J- .~'i"" .,";;,";'; . , . (30) days, then such child's share shall be divided equally among such child's surviving children. If any of my children have no children surviving at the time of my death, then such share shall be divided equally among my other surviving children, and if none, then to their surviving chi~d~en. ;- ,~ FOURTH: I do hereby nominate, constitute and appoint WILLIAM EDWARD ADDISON. JR., to be the Executor of this my Last Will and Testament, to do any and all things necessary for the complete administration thereof. I further direct that my said Executor shall serve without bond. In the event my husband shall predecease me or shall die simultaneously or as the result of a common accident or disaster, or he is unable to serve as my Executor, for any reason, then I nominate, constitute and appoint my son, Brian Michael Addison, to be Executor of this my Last Will and Testament with all the powers and (3.111< a < authority as granted to the original Executor under this Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of three (3) typewritten pages, each of which bear my initials in the margin for the purpose of identification this Jury day of , 1990, and having been duly qualified according to law, I signed it willingly as my free and voluntary act for the purposes therein expressed. /7 //Jj .. /J-L:tt; h1 tL( U~ Betty ~Addison -2- Commonwealth of Pennsylvania: ~ S5. County of l,uM"r.l.'_Ll\kll) : On this, the \I,l1l day of 1Ui.l.rd,~ ' 1990, before me a Notary Public, the undersigned officer, personally appeared BETTY MAE ADDISON, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the 'same for the purposes therein contained. ~ IN WITNESS WHEREOF, I hereunto set my hand and official seal. CI,;,l. Nota,r~'li' 41(llc;;:~.'~ ,.... ~....:! t... ~ ~.~' .~;..: .~.'.J, I,,'~~-"_~r'j r'Ut.~jC ~:::I: ii I !.ii" ;':'~?(('. '~/'.1r:~t"~~:If'fl,tj CO:Jnty I ,./ ....,... ,.....yr '. ," ',.'.~ Oct ~5. 19(;'> -..'.I.Il~"",,'L~'r--"_') .Go. ~ '-r~l~i';il-;';r:i~~~y;v~S()(..ia!ion of Notaries In our presence, the above named Testatrix, BETTY MAE ADDISON, signed this and declared it to be her Last Will and Testament, and now, at her request, in her presence, and in the presence of each other, we sign as WiO::~ ~nJ {Z--'1 ~~ C:L- ( 0~sP ~ I.;J~ /7tJll Address ~.{r;.a ' //!"n (" ,,) f! ~ >,) 1013.LdA_L&-f.-L ;:J/{. Xo I- /,;J 9 /!@i.L~_t..J.., I' a.. 170/3 Address -3-