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Home My WebLink About03-10-06 . r " --.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAl USE ONLY County Code Year File Number 21 05 0519 Date of Birth 209-05-0519 02/18/2005 07/10/1908 Decedent's Last Name Suffix Decedent's First Name MI SHIVEL Y CARRIE A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Ml Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate 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 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number . 6. Decedent Died Testate (Attach Copy of Will) g. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes JOHN MCCREA (717) 776-~~ ; J REGISTER O;:iWrCD.S US~gNLY ""--."1,.0", '~_. "r"-: ,'"1 0 Firm Name (If Applicable) First line of address PO BOX 341 Second line of address N City or Post Office State ZIP Code DATE FILED NEWVILLE PA 17241 Correspondent's e-mail address: Under penalties of perjury, I declare that 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 other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P SO"WESPONSI~L~ FO/}'fflLlNG RETURN DATE .' ,/I /1./ /Vi l L.h~ .:; 1'-' (:'6 ADDRESS PO BOX 3 SIGNATURE OF DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 ---1 - pt - - -.-J 15056052059 REV-1500 EX Decedent's Name: CARRIE A SHIVELY RECAPITULATION 1. Real estate (Schedule A). ........... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested. . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10)....... .... . .................. ..... 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subjectto Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14laxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 75,715.99 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 - 209-05-0519 Decedent's Social Security Number 15056052059 63, '160.00 22,767.06 85,927.06 6,991.25 3,219.82 10,211.07 75,715.99 75,715.99 11,357.40 11,357.40 --' . REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER CARRIE A SHIVEL Y 209-05-0519 - STREET ADDRESS 112 FAIRFIELD STREET -- CITY I STATE I ZIP NEWVILLE PA 17241 21 05 0519 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 11,357.40 10,400.00 3. InteresVPenalty if applicable D. Interest E. Penalty 195.43 Th~Crnd~(A+B+C) ~ 10,400.00 TotallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 195.43 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make Check Payable to: REGISTER OF WILLS, AGENT 957.40 195.43 1,152.83 A. Enter the interest on the tax due. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (58) 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 Ii] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 Ii] c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 Ii] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 Ii] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 Ii] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of dealh on or after Ju~ 1, 1994 and before January 1, 1995, ~e lax rate imposed on !he net value of transfen; to or for ~e use 01 !he surviving spouse is three (3) percent [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 zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)J. 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 tlX rate In,JOSed on ~e net value of transfen; - a deceased chi~ Iwenty-one years 01 age or younger at de6~ to or for !he use of a natural ""'"' an adoptive parent, or a stepparent of the child is zero (0) percent (72 P.S. ~9116(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 PS. ~9116(1.2) [72 P.S. 99116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)J. 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-1502 EX+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF CARRIE A_ SHIVELY FILE NUMBER 21-05-0519 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 exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant fdcts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION House and lot situate at 112 Fairfield St., Newville, PA 17241 (Newville Boro, Cumberland County). Tax parcel no. 28-20-1754-081A. (copy of 2004 tax reassessment showing 2004 market value as $63,160.00 attached to this schedule.) VALUE AT DATE OF DEATH 63,160.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 63,160.00 - .-. --+ -----~---'--~----_._--_.~-_.._-----~-- .. ------------," ----._- - ._-+.~----~ -----.. -~-~_._----- - -_._~--_.._--~---_._.- .~,---_._..- THIS IS NOT A TAX Bill MAILING DATE: March 1, 2004 Parcel Identifier: 28-20-1754-081A District: 28 - NEWVILLE BORO SOUTH School..: BIG SPRING SO Location: 112 FAIRFIELD STREET LAND Old Assessed Value 2004 New Assessed Value (2000 Market x 100%) Market Value (2004 Market x 100%) Land 12,100 15,000 15,000 Buildings 33,240 48,160 48,160 TOTAL 45,340 63,160 63,160 2004 Clean and Green Values Land NOT NOT NOT Buildings APPLICABLE APPLICABLE APPLICABLE TOTAL . .. Clean and Green values apply to some farm and forest land. Such values become effective only upon application and approval. All applications must be received by the Assessment Office by 4:30 p.m. on October 15, 2004. Those previously approved for Clean and Green do not need to re-apply. TAXABLE Land Size. ...: .14 acres Property Type: R Residential Building Pennsylvania law requires that all real estate be valued as of the most recent county-wide reassessment. The last reassessment, or tax base year, was 2000. Since the last reassessment in 2000, properties have been assessed at 100% of Year 2000 value (the .Pre-Determined Ratio'). The new tax base year will be the Year 2004, with the new assessed values becoming effective for the 2005 tax year. The Pre-Determined Ratio remains at 100%. Your new assessed value equals your Year 2004 market value. When the new 2004 tax base is determined after this reassessment, all taxing districts are required by law to lower the millage rate by the same proportion that the tax base went up. The law provides that in the first year after reassessment (2005), the county and all townships and boroughs may not increase overall revenue on their existing taxbase by more than five percent (5%) and school districts may not increase overall revenue on their existing taxbase by more than ten percent (10%). The county and the other taxing bodies will make these decisions next year, and may choose not to increase overall revenue. Of course, some individual's taxes will go up or down by more than those percentages. The essential point is that an increase in market values does not necessarily mean a corresponding increase in taxes. Individual changes in taxes will depend upon a specific property's change as compared to the overall change for the taxing district. The ESTIMATED impact statement printed below is our best estimate of change, based on 2004 COUNTY tax figures. THIS ESTIMATE DOES NOT INCLUDE ANY BOROUGH, TOWNSHIP, OR SCHOOL DISTRICT IMPACT. ESTIMATED COUNTY TAX IMPACT: Current 2004 County mills = Adjusted 2004 County mills = 2.352 2.138 $ $ 107 135 2004 County Tax BEFORE Reassessment. 2004 County Tax AFTER Reassessment. - REV-1508 EX+ (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF CARRIE A. SHIVELY FilE NUMBER 21-05-0519 ITEM NUMBER 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. DESCRIPTION Farmers National Bank DDA checking acet. #129755 plus accrued interest. VALUE AT DATE OF DEATH 1.405.54 2 Farmers National Bank irrevocable burial acet. #9652965 plus accrued interest. 8,025.24 3 Farmers National Bank savings accl. #9645403 plus accrued interest. 12,656.28 (for 1,2, & 3, see attached statement from Farmers National Bank) 4 Household goods & furnishings 680.00 (per attached appraisal of auctioneer Riock Foreman) TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 22,767.06 . ~ FARMERs NATIONAL BANK OF NEWVILLE I \:/""/,,,! fI,n;! June 10,2005 Re: Carrie A. Shively Estate To whom it may concern, Carrie A. Shively had accounts with Farmers National Bank of Newville, a division of Adams County National Bank. The following is a list of accounts she maintained with this bank and balance as of this date: DDA Checking account129755: balance $1,405.48 and 0.06 accrued interest Irrevocable burial account #9652965: balance $8,015.88 and $9.36 accrued interest Personal passbook savings account #9645403: balance $12,641.52 and $14.76 accrued interest. ~e~relY' ~j~~l,-f Dougl R Li ~sl""( Sales ager, Asst. Farmers National Bank of Newville A division of Adams County National Bank PO. Box I')(,. ;\Jnvvillc. PA 1-2il . (""'17) --6-')512 - Rick Foreman Auctioneer 776-4602 Appraisal for Estate @ 13 Fairfield S1. Newville PA Marble top buffet with mirror China closet Drop leaf table (small) Wooden desk Dresser Trunk Chest of drawers Wooden rocker Cedar chest T.V All other old furniture & knick-knacks, appliances, ec1. total Rick Foreman Au1163L 386 Springfield Rd. Shippensburg Pa. 17257 ~~j~/cL f} ~(rti/Yk-O'l<-I /l ill / IP3L 200.00 100.00 35.00 10.00 25.00 5.00 25.00 20.00 50.00 10.00 200.00 $680.00 . REV-1511 EX+ (12-99* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF CARRIE A. SHIVELY ALE NUMBER 21-05-0519 Debts of decedent must be I'eIlOI1ed on Schedule L ITEM NUMBER A. DESCRIPTION AMOUNT B. 1. 1. FUNERAL EXPENSES: Egger Funeral Home, Newville, PAQ 17241 5,424.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) John McCrea Social Security Number(s)/EIN Number of Personal Representative(s) 188-32-2759 Street Address PO Box 341 1,100.00 City Newville Year(s) Commission Paid: 2005, 2006 . State PA Zip 17241 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 4. Claimant Street Address City State .Zip Relationship of Claimant to Decedent Probate Fees 5. Accountant's Fees 169.00 7. 6. Tax Return Preparer's Fees 8 9 10 Appraisal fee for appraisal of personal property (Rick Foreman, auctioneer) Advertisement of letters (Valley Times-Star & Cumbo Law Journal) File inheritance tax return 75.00 134.25 14.00 75.00 Reserved for filing account TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,991.25 REV-1512 EX+ (12-03) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CARRIE A. SHIVELY FILE NUMBER 21-05-0519 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 12. 13 14. 15 16 17 18 1. electric bill (PPL Electric Utilities) 2 275.36 medical bill (Belvedere Medical Corp) 3 169.11 sewer & water bill (NW&SA) 4 209.22 medical bill (Appalachian Orthopedic) 5 225.09 hospital bill (Carlisle Regional Med. Center). 6 912.00 anesthesia bill (Blue Mtn. Anesthesia) 7 23.20 home patient care (American Homepatient) 8 140.95 x-ray bill (RPC Associates Walnut Bottom Road) 6.34 9 trash bill (Waste Management of Central PAl 10 51.26 lab services (Carlisle Pathology) 11 10.73 cardiologist services (Moffitt Heart & Vascular Grp.) 14.37 medical bill (Masland Assoc.) 1.77 x-ray bills (2) (Andorra Radiology Assoc.) 22.34 anesthesia bill (Central Penn Mgmt. Group) fuel oil bill (Suburban Energy Services) 26.75 274.35 propane bill (Penn Fuel Propane) 118.28 real estate taxes (2005 county & boro plus 1/2 of 2005-06 school) at face value 634.09 sewer & water bill (NW&SA) 104.61 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,.219.82 REV-1513 EX. (9-00) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CARRIE A. SHIVELY FILE NUMBER 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)J 50_00;?: 1 Albert Stouffer nephew 2 Betty Stouffer spouse of nephew 50.00 address of both beneficiares (husband and wife) 118 Big Spring Avenue Newville, PA 17241 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 $ 0.00 21-05-0519 Ic? (If more space is needed, insert additional sheets of the same size)