HomeMy WebLinkAbout01-04-06 (2)
REV-1500 EX (6-00)
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
COUNTY CODE
05
01062
YEAR
NUr.BER
DECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ Theal Sr Charles
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ 11/25/2005 11/8/1911
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
C
Alice Mater Theal
T
SOCIAL SECURITY NUMBER
199-03-7055
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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00 1. Original Retum
[j] 4. Limited Estate
00 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82)
D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credn (data of death balween 12-31-91 ard1-1-95) D 11. Election to tax under Sec. 9113(A)(AllachSch0)
I-
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III
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NAME
John D. Killian, Esquire
FIRM NAME (If Applicable)
Killian & Gephart
TELEPHONE NUMBER
717-232-1851
COMPLETE MAILING ADDRESS
218 Pine Street
Harrisburg, PA 17101
1. Real Estate (Schedule A)
(1)
(2)
OFFICIAL USI:.ONL Y
2. stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposns & Miscellaneous Personal Property
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6. J~ Owned Property (Schedule F)
LJ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
(6)
8. Total Gross Assets (total Lines 1-7)
10,333
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilnies, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
13,240
(2,906)
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12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 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
(2,906)
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
o
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0 x.O ~(15)
0 x.O ~(16)
0 x .12 (17)
0 x .15 (18)
(19)
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
o
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19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
3W4645 1.000
> > BE SURE TO ANSWER AlL QUESTIONS ON REVERSe slOe AND RECHECK MATH < <
Rf.
Decedent's Complete Address:
SlREET ADDRESS
Manor Care
Cwnberland
CITY
Carlisle
STATE
PA
ZIP
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
o
o
o
o
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
o
o
o
Total InteresUPenalty (0 + E) (3)
o
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)
o
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
o
A. Enter the interest on the tax due.
(SA)
o
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Pa able to: REGISTER OF WILLS, AGENT
(5B)
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
D
D
D
D
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 []I
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 retum, 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 intonnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS ){VnL~ iC}. -MA~rflt'P1~el>/
123 cast
SIGNA RE 0 PR ER OlHE
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; . . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . .
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
No
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DATE
/- 3 - 00
Mechanicsburg, PA
17055
DATE
f t.f tJ-b
HarriSburg, PA 17101
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. 99916 (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.!3 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 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. 9 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. 13 9116(1.2) [72 P.S. 139116(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. !3 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.
3W4846 1.000
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Charles T. Theal Sr
FILE NUMBER
21 05 0 1 0 6 2
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
DESCRIPTION
VALUE AT DATE
OF DEATH
1
M&T Bank Checking Account
#9837031062
10,333
3W46AD 1.000
TOTAL (Also enter on line 5 Recaoitulationl $
(If more space is needed, insert additional sheets of the same size)
10,333
ACCOUNT NO. ACCOUNT TYPE
STATEMENT PERIOD
PAGE
9837031062 H&T CLASSIC CHECKING W/INTEREST
NOV.16-DEC.15J2005
1 OF 1
00 0 04350H NH 017
19089
CHARLES T THEAL
123 LANCASTER BLVD
MECHANICSBURG PA 17055-3548
INTEREST PAID YEAR TO DATE
6.30
TRINDLE ROAD OFFICE
DEPOSITS.. I
OTHER ADDItIONS
NO. AMOUNT
4 3,332.14 0.71
ACTIVITY
DEPOsITS, INTEREST .CHECKS&OTHER
&OTHER>ADD:rtIONs SOJrrRAttIOHs
11-16-05 BEGINNING BALANCE
11-30-05 PA TREASURY DEPT ANNUITANT
12-01-05 THE BOARD OF PEN PENSION-CK
12-01-05 THE BOARD OF PEN PENSION-CK
12-02-05 US TREASURY 303 SOC SEC
12-07-05 MISCELLANEOUS DEBIT
12-07-05 MISCELLANEOUS DEBIT
12-09-05 REVERSE DIRECT DEPOSIT
12-15-05 INTEREST PAYMENT
721. 21
1,084.93
675.00
..-'851. 00
$10 J 333.32
llJ054.53
2. ~.jY{;; 000.00
40.00
S5 ........851. 00
12,814.46
13J665.46
0.71
3J625.46
2J774.46
2J775.17
ENDING BALANCE
$2J775.17
ANNUAL PERCENTAGE YIELD EARNED
0.10 %
IMPRESSED BY THE SERVICE YOU RECEIVED AT M&T? IF YOU'D LIKE TO NOMINATE AN MIT
BANK EMPLOYEE FOR EXCEPTIONAL CUSTOMER SERVICE, PLEASE COMPLETE OUR H&T SERVICE
EXCELLENCE FORH AT WWW.HANDTBANK.COH/EXCELLENCE. WE APPRECIATE YOUR FEEDBACK!
REV-1511 EX+(12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Charles T. Theal Sr
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 05 0 1 0 6 2
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Immanuel Church 200
2 Pax tang Cemetary 975
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s) - -
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 750
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 83
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1 Cumberland County Reporter 75
2 Sentinel 152
TOTAL (Also enter on line 9, Recapitulation) $ 2,235
3W46AG 1.000
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Charles T. Theal Sr
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
05 21 0 1 0 6 2
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Chase Mastercard
Act. #5184450251576157 2,957
2 HCR Manor Care 4,689
3 NeighborCare Pharmacy Service 3,359
3W46AH 2.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
11,005
REV-1513 EX+(9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Charles T. Theal Sr
FILE NUMBER
21 05 0 1 0 6 2
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
1
Janette D. Shumberger
123 Lancaster Blvd
Mechanicsburg, PA 17055
Daughter
o
2
Charles T. Theal Jr
Son
o
3
Alice Theal
Surviving Spouse
o
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
" NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46AI 1.000
TOTAL OF PART 1\ - 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)
$
o
REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
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No. 2005-01062 PA No. 21-05- 1062
Estate Of: CHARLES T THEAL SR
(First, Middle, Last)
Late Of:
MECHANICSBURG BOROUGH
CUMBERLAND COUNTY
Deceased
Social Security No: 199-03-7055
WHEREAS, on the
April 14th 1992 was
CHARLES T THEAL SR
6th day of December 2005 an instrument dated
admitted to probate as the last will of
(First, Middle, Last)
late of MECHANICSBURG BOROUGH, CUMBERLAND County,
who died on the 25th day of November 2005 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify tha t I have this day granted Letters TESTAMENTARY to:
JANETTE D SHUMBERGER
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
PARLlSLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 6th day of December 2005.
~~~
, f1iHY\Y~l~.
* *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
.~. .
\t.
OF
CHARLES T. THEAL
I, CHARLES T. THEAL, declare this to be my Last Will and
Testament and hereby revoke all prior wills and cOdicils made by
me.
FIRST: My Executor shall pay from the residue of my estate
all my debts, funeral and administration expenses and all estate,
inheritance, succession and transfer taxes imposed by the United
states or any state, territory or possession which shall become
payable by reason of my death. It shall not be necessary to file
any claims therefor, nor to have them allowed by any court.
SECOND: I give to my wife, ALICE THEAL, all tangible personal
property which I own and insurance thereon, if she survives me by
sixty (60) days. If my wife is not living on the sixty-first
(61st) day after my death, I bequeath such tangible personal
property to my children living at the time of my death, to be
divided among them as they may select in as nearly equal shares as
is practical. If there is any disagreement as to distribution, I
direct my Executor to make such distribution. The decision of my
Executor shall be final and binding. Any items not selected may be
distributed in the sole discretion of my Executor and, if sold, the
net proceeds therefrom shall be added to the residue of my estate.
Any such article allotted to a minor may, as my Executor deems
advisable, either be delivered to the minor or to any person to
safeguard in behalf of the minor. My children now living are
CHARLES T. THEAL, JR and JANETTE D. SHUMBERGER.
-- .
...
LAST WILL AND TESTAMENT
OF
CHARLES T. THEAL
THIRD: To the individuals listed below, I bequeath the
following:
A. To my son, CHARLES T. THEAL, JR., of Hershey,
Pennsylvania, my computer, if owned by me at the time of my
death, and the genealogy file and all related data concerning
the Theal, Attick, Boyer and Meffort families.
B. To my wife, ALICE THEAL, all money in my personal
checking account, located at Dauphin Deposit Bank, and having
the account number 85269441, provided she survives me by sixty
(60) days. However, if said account contains less than Six
Thousand ($6,000) Dollars at the time of my death, I direct
that all money in the aforesaid account be given to my wife,
together with such additional sum of money as is necessary to
equal Six Thousand ($6,000) Dollars.
Should any of the above named bequests lapse, I direct
that the lapsed bequest be added to and distributed as part of
the residue of my estate.
FOURTH: I give and devise the residue of my estate, real,
personal and mixed, of whatever kind and nature, and wherever
situate at the time of my death, including any property over which
I now have or hereafter may acquire a power of appointment, to my
son, CHARLES T. THEAL, JR., and my daughter, JANETTE D. SHUMBERGER,
in equal shares, provided that the share of any child who
predeceases me shall be distributed to his or her then-living
2
- <
LAST WILL AND TESTAMENT
OF
CHARLES T. THEAL
issue, per stirpes, and in default of any such then-living issue,
such share shall be added to the share for my other then-living
child.
FIFTH: I nominate, constitute and appoint my daughter,
JANETTE D. SHUHBERGER, Executrix of this my Last Will and
Testament, to serve without bond or security, and to make
distribution of my estate in cash or in kind, or partly in cash and
partly in kind, and in such manner as she may determine. I
authorize, empower and direct her to sell and convey, by good and
sufficient deed, in fee simple estate, any and all of my real
estate, at public or private sale, for such price or prices, upon
such terms and conditions, as in her judgment is best for my
estate, and to that end to sign, seal, execute, acknowledge and
deliver all deeds or other instruments necessary therefor, as
effectively as I could do if I were personally present.
In the event my daughter, JANETTE D. SHUMBERGER, does not
survive me, or refuses to act as Executrix or does not complete the
duties of Executrix, then I nominate, constitute and appoint my
son, CHARLES T. THEAL, JR., as the alternate Executor, to serve
without bond or security. My alternate Executor shall have all of
the powers, privileges, duties and immunities granted to my
Executor as provided herein.
SIXTH: Whenever the Executor is directed to make a
distribution to a person who is then under twenty-one (21) years of
3
~ .
LAST WILL AND TESTAMENT
OF
CHARLES T. THEAL
age, the Executor shall be authorized to hold such property in
trust for such person until he or she becomes twenty-one (21) years
of age, and in the meantime shall use such part of the income and
the principal of such trust as the Executor may deem necessary to
provide for the proper support and education of such person. If
such person should die before attaining twenty-one (21) years of
age, the property then remaining in the trust shall be distributed
to the personal representative of such person's estate.
Should any distributee of my estate, in the opinion of my
Executor be mentally or physically incapacitated, my Executor may
pay the share to the parent or guardian of the distributee in his
or her behalf.
IN WITNESS WHEREOF, I, CHARLES T. THEAL, the Testator, have to
this my Last Will and Testament, set my hand and seal this 14
day of
AVi'; ,
, 1992.
....-.....,
~~/.
CHARLES T. THEAL
~ ~~(SEAL)
Signed, sealed, published and declared by the above named
Testator, as and for his Last Will and Testament, in the presence
of us, who have hereunto subscribed our names at his request, as
witnesses hereto, in the presence of the said Testator, and of each
other. The preceding document consists of this and three (3) other
consecutively numbered typewritten pages.
~-t(,--n/ t (() 11k~f:esiding at 13"10 I ( 'VA
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ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~lvv:'"
)
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SS. :
The Testator and the witnesses whose names are subscribed to
the foregoing instrument, being first duly sworn and qualified
according to law, do hereby acknowledge and declare to the
undersigned authority that the Testator signed and executed the
instrument as his last will in the presence of the witnesses, that
he signed willingly or willingly directed another to sign for him,
that he executed it as his free and voluntary act for the purposes
therein expressed, that each of the witnesses, in the presence and
hearing of the Testator, signed the Will as witnesses, and that to
the best of their knowledge the Testator was at that time eighteen
years of age or older, of sound mind and under no constraint or
undue influence.
~~--- - /.
Testator
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'ivJ (lJll' c,t .;z1uJ-l/ ~ L
w tness
Sworn to, subscribed and acknow~74ged before m}1by .the above
named Testator and witnesses this 14~ day of Ll'~"~
19lf2., IV V'-{
~~~~fjM~~
Notary Pub ic '
or
Attorney-at-Law
(SEAL)
NotarIal Seal
Ann Marie Bonawitz, No~ Public
Harrisburg, Qauphin CoUnty
My Commission Expir9s Dec. 9, 1995