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Home My WebLink About03-09-06 /J REV.l500 EX (6-00) REV-1500 '* COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT t- Z W C W o W C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) WILLIS, Elizabeth A. W I-: ::.:::!;(/) 0"::':= wo.o :z:OO oO::..J o.CQ 0. c( ~ 1. Original Retum D 4. Limited Estate D 6. Decedent Died Testate (AIIach copy of Wdl) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrusl) D 10. Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95) FILE NUMBER 21 05 0697 DATE OF DEATH (MM-DD-YEAR) 02-21-2004 DATE OF BIRTH (MM-DD-YEAR) 01-24-1931 COUNTY CODE YEAR NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) NA SOCIAL SECURITY NUMBER 186-24-7771 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (dale of dealh prior 10 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sell 0) COMPLETE MAILING ADDRESS 2215 Forest Hills Drive, Suite 37 Harrisburg, PA 17112-1099 NAME Steve C. Nicholas, Esquire FIRM NAME (If App6cable) NICHOLAS LAW OFFICES, PC TELEPHONE NUMBER (717) 540-7746 (1 ) (2) (3) (4) (5) z o ~ ::l !:: a.. <( o W 0::: 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) 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) -,.., _.;~f~,," N 3,253.29 U1 (8) 4,888.80 3,916.41 (11 ) (12) (13) 3,253.29 (6) (7) (9) (10) 14. Net Value Subject to Tax (line 12 minus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::) a. :E o o g 15. Amount of Une 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 8,805.21 -5,551.92 (14) 0.00 x.O_ (15) x.O_ (16) x .12 (17) x .15 (18) (19) 0.00 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.0 Decedent's Complete Address: STREET ADDRESS 3605 Kohler Place CITY Camp Hill I STATEpA I ZIP 17011 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) 3. InteresUPenalty if applicable D. Interest E. Penalty 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) A. Enter the interest on the tax due. (5) (5A) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. B. Enter the total of Une 5 + SA. This is the BALANCE DUE. (58) 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;.......................................................................................... 0 [KJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [K] c. retain a rever~ionary interest; or....................................................................................... ............. ...................... 0 [KJ 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? .............. 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 penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and. statements, and to the bes~ 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.' 51 ATURE ~ER ADDRESS 2150 S. 2nd Street, Steelton, PA 17113-3084 SI~R~~..,OT~EPRESENTATIVE ADDRESS . 2215 Forest Hilts Drive, Suite 37, Harrisburg, PA 17112-1099 DATE ,3}~J6VO(O I I 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 daes nat exemot 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. ~9116(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. Willis Elizabeth Schedule E FonnlEstates/SCN SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Estate of Elizabeth A. Willis File Number: 21-05-0697 Include the proceeds of Utlzatlon and the date the proceeds were received by the estate. AU property jointly-owned with the right of survivorship must be disclosed on Schedule F. Item # Description Amount 1. Miscellaneous household furniture $1,075.00 2. 1993 Dodge Intrepid Automobile $ 300.00 3. American Funds - #57119883 $ 37.80 4. IRS - income tax refund $ 376.00 5. P A Department of Revenue - income tax refund $ 169.00 6. PSECU Account #0186 $ 243.89 7. Bethany Village - final pay $ 192.60 8. Cremation Society of P A - refund $ 670.00 9. Central PA Teamsters Pension $ 189.00 Total $3,253.29 Pennsylvania State Employees Credit Union /11111111111111111111111 r. u. oox 0 I U I J V II J L J'f-O'fO'f ~ nomsDurgJ Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide) website - http://www.psecu.com USE YOUR PSECU VISA CARD OR DEBIT CARD TO GET CASH DISCOUNTS WHEN YOU SHOP EBATES AT WWW.PSECU.COM. '","'11.'11""""""',,',".111"""'.11,.,..'.1. . ..11.' ELIZABETH A WILLIS APT 3 3605 KOHLER PL CAMP HILL PA 17011-2700 JOINT ONNER PAGE 1 [,!=r!!l:~'l[;':;;!!jii:;;J;lli\=~iwmi;,!i'ii;;j!;:i;;t:i::'i,:!Biil ~=~ li,,~:I~N ".'~::rii'!,D 02/01 ID 01 REGULAR SHARES BEGINNING BALANCE 21 06 02/05 PAYMENT. ATM REBATE 4 00 25 06 ~ ~.~ 02/29 ENDING BALANCE 25 07 DIVIDEND YTD: YEAR TO DATE 0 02 TYPE: ACH CREDIT 10: 1251211909 02/02 PAYMENT: AT ATM 100000747/PN5239 189 00 1007 17 - ~-- -- - ----~._-~-- - ---- - ~ --- --- --- ~ ~~~i~00 02/04 CHECK 000941 59 53- 2085 64 PROCESSED CHECK - CAPITAL ONE 02/07 PAYMENT: AT ATM 100001246/PN5239 90 32 ATH PNC BANK 140 CAHPHIll SHOPP CAHP HIll 02/09 CHECK 000947 300 00- 1254 67 02/09 WITHDRAWAL AT ATM 100001391/PN5239 11 75- 1242 92 . : :,'. ..": ...... :'" ;.:.,,: :,;.::'AT"~fPNC:-':14Nl( 14.0':,C.AMPHILk:::$HOPP. 'CAMP !f.ttLt::: . ... " ':' : ::<; :": ..;:: : PA 02/10 CHECK 000948 25 00- 1217 42 02/10 CHECK 000946 '. . . ..... . ... ... ........ . ... ... '. .. .... .. ... ..' ......... . 8.2..60- . 11 ~4 , 8? !;'.i;'Ii~K~~':':';:';":~~~HpR~~.t;;}~11,:~i!'.~i:""D.~.~.~~~~~*~~~P\\l:;;::.)):?::}HiF;!!:;j"..'Xi;!.}}'t;':i"'\')~~;~~#;WI.~~';!1Z. . .. 02010000 .. ~-~{;UN i INUJ:IJ ON I'D I !!",TNr. PAGE - 4099614 :," 'J a~~6.ii~:6: :'; :': ::. : i 7:Z:PJ;~ Z: ~ ::: i ::ji6.4:..b!.8:1Ur... ... .. "': 1733 19 Pennsylvania State Employees Credit Union I " 1111 "' r.u. IjOX O/U I J V II) LJ'f-O'fO'f \nurfl~uury) Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide) . 'I website - http://www.psecu.com t USE YOUR PSECU VISA CARD OR DEBIT CARD TO GET CASH DISCOUNTS WHEN YOU SHOP EBATES AT WWW.PSECU.COM. ELIZABETH A WILLIS JOINT ONNEA PAGE 2 li~~::i~':;;;;;I:',i"";'.,..:,,".:~I~tE[!t~~~ii:t""."::.'.;,;.';/ ~= I'~:l,~'. .... ,.,..,.... ~,.,."...,t.iy'.' ATH PNC BANK 325 HESLEY DRIVE MECHANICSBURG PA ,~~(ll., "IoHT~P~~IoI~L~T!:,f~L ...,...,.."..... ,....".,...... ...... ..... .... 0 5Q- 1122 57 !1.J;~~.~.Jij:.i,I!:;.jU~iilil~~i!:~:il~r:~:~~~~ri~;.::;I::;,;H.ii?H' ..../,.. .. ...... .. ". .. ATH PNC BANK 140 CAHPHILL SHOPP CAHP HILL PA 02/16 WITHDRAWAL AT ATM #00002729/DBOOO~. 21.00- 1079 82 02/15 2444500DZN36KP6HG 5541 TURKEY-HILL *0236 HECHANICSBURG PA 02/18 CHECK 000942 684 00- 379 72 ~.: 02/19 WITHDRAWAL POS #56014238 .. .~5 08- 324 64 02/18 2461043E12322JLP3 5411 GIANT FOOD STORES *110 CAHP HILL PA 02/23 02/22 WITHDRAWAL CHECK CARD 127 14- - - - -.- o-2/-19---2427-53()E3FPV3EffFO-M-l1-t-INENS-'N -THTNGS- Z07 YORK PA ;s~~~~{~~J~~w~~~rHI~ BASED ON AVERAGE DAILY BALANCE OF 838 09 ENDING BALANCE .. ....... .... '. . .. .:..II.............!.......;.. /!::::(:~..:</?:!:::-:2:1>lS8i:: :'lfO:tL:&Z:::.' . . . ..:' '" 116 75 02/29 !. .~~~ TOTAL DIVIDEND YTD: IN 2003 13 96 , 116 92 .............. : .,. . 02020000 4099615 PSECIlP Pennsylvania State Employees Credit Union 1111111 11/11I111111 P.O. Box 67013 (717) 234-8484 (Harrisburg) Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide) website - http://www.psecu.com DID YOU KNOW THAT YOUR IMMEDIATE FAMILY IS ELIGIBLE FOR PSECU MEMBERSHIP? THEY CAN APPLY AT WWW.PSECU.COM. 1...111...111......11...11..1.11... J 1 J ...1 J ...1.1..1.1....11.' ELIZABETH A WILLIS APT 3 3605 KOHLER PL CAMP HILL PA 17011-2700 JOINT O'NNER .~~/~8'<; ::~~~,~I~c.. . . 03/01 ID 01 03/05 4.00 25.07 29.07 03/01 ID 04 03/26 116.92 0.02 116.94 03/25(9.4 -- - ==--=-===-=-=-===-==============-=-====-==:-==-==------- . ""'" ....... .. . ..... ... .., ... "... ."... .. n,n,nnn, .. . . 4007778 Willis Elizabeth Schedule H scn/est SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Estate of Elizabeth A. Willis File Number: 21-05-0697 Debts of decedent must be reported on Schedule I. A. FUNERAL EXPENSES: 1. 2. Wiedeman Funeral Home - Services $4,544.80 $ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions: Name of Personal Representative(s): Social Security Number(s) of Personal Representative(s): Address: Year(s) Commission Paid: $ 2. Attorney Fees: NICHOLAS LA W OFFICES, PC $ 275.00 3. Family Exemption: (If decedent's address is not the same, as claimants, attach explanation) Claimant: Address: Relationship of Claimant to Decedent: 4. Probate Fee - Register of Wills ofCumb~rland County $ 54.00 5. Advertising - $ 6. Advertising - $ 7. Postage, Copies, Notary - NICHOLAS LAW OFFICES, PC $ 8. Filing Fee - Inheritance Tax Returns - Register of Wills of $ 15.00 Cumberland County TOTAL $4,888.80 Willis Elizabeth Schedule I Form sen/est SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Estate of Elizabeth A. Willis File Number: 21-05-0697 Item # Description Amount 1. Jackson Hewitt - income tax preparation $ 84.00 2. West Shore EMS ALS #22048 - medical $ 650.97 3. Verizon #7177612889-149-56Y - open account $ 72.50 4. R. Lynn Magargle, MD - #3153 - medical $ 107.97 5. PP&L #42500-77022 - open account $ 209.92 6. Kathryn W. Fetrow, Treasurer - personal tax $ 11.00 7. NeD Financial Services #513678 $2,780.05 Total $3,916.41 Willis Elizabeth Schedule J scn/est SCHEDULE J BENEFICIARIES Estate of Elizabeth A. Willis File Number: 21-05-0697 A. Taxable Distributions No. Name / Address of Beneficiarv Relationship Amount or Share of Estate 1. Norma Jean Graul 731 Hogestown Road Mechanicsburg, P A 17050 Daughter 250/0 2. Gary L. Willis 2150 S. 2nd Street Steelton, P A 17113 Son 25% 3. Jay D. Willis 25041 Ballycastle Ct., #101 Bonita Springs, FL 34134 Son 25% 4. James R. Willis, Jr. PO Box 177 Tom Bean, TX 75489 Son 25% B. Nontaxable Distributions No. Name / Address of Beneficiarv Amount or Share of Estate