HomeMy WebLinkAbout05-03-06
REV-15oo EX + (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21 -0 60123
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DAY GAYLE
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
O.
DATE OF BIRTH (MM-DD-Year)
2 1 1 - 3 8 - 1 897
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
11/21/2005 12/26/1946
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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[X] 1. Original Return
D 4. Limited Estate
00 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12.12-82)
o 7. Decedent Maintained a Living T rust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (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) (Attach Sch 0)
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NAME COMPLETE MAILING ADDRESS
DOUGLAS G. MILLER ESQUIRE 60 WEST POMFRET STREET
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353 CARLISLE P A 17013
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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)
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)
(1 )
(2)
(3)
(4)
(5)
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OFFICI~USE ONLY
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(6)
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(7)
0.00
(8)
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(9)
(10)
3,606.50
(11 )
(12)
(13)
3,606.50
-3,606.50
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
-3,606.50
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
0.00 X _ (15) 0.00
0.00 X _ (16) 0.00
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 0.00
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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REV-1510 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
DAY
GAYLE
o.
FILE NUMBER
21 06
0123
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
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. V ALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. State Employees Retirement System 114,475.96 1 00.00 0
1000/0 Exclusion - Deceased was 58 years old
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}) b ~ C~v'\
;/ I
TOTAL (Also enter on I" nj f l'1ecapitulation) I $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1511 EX + (12-99)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
DAY
GA YLE
o.
21
06
0123
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home, Inc. 2,037.50
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 Irwin & McKnight 1,125.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 54.00
5. Accountant's Fees
6. Tax Return Preparer's Fees Patricia A. Rosendale, CPA 350.00
7. Register of Wills - Filing Fee 30.00
8. Notary Fees 10.00
TOTAL (Also enter on line 9, Recapitulation) $ 3606.50
(If more space is needed, insert additional sheets of the same size)
REV-15',3 EX + <0.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
DAY GAYLE O. ?1 06 0123
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. Lois D. Counsil Sibling
229 Fox Drive 1/2 Remainder
Mechanicsburg, PA 17055
2. Chester Francis Orsin Sibling
PO Box 10630 1/4 Remainder
State College, PA 16805
3. Edward Orsin Sibling
4669 Long Run Road 1/4 Remainder
Loganton, PA 17747
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
ll. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - 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)
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LAST WILL AND TESTAMENT
OF
GAYLE O. DAY
I, GAYLE O. DAY, of Woodward Township, Clinton County,
Pennsylvania, revoke my prior Wills and declare this to be my
Will.
I. Dispositive Provisions.
A. Household and Personal Bequests. I give my
automobiles, household and personal effects and other tangible
personalty of like nature (net including cash or securities) f
together with any existing insurance thereon, to my husband,
wilford C. Day, Jr., if he survives me. Should my husband,
Wilford C. Day, Jr., not survive me, I give such tangible
personalty to the persons named on the unsigned Memorandum
enclosed with this Will.
B. Residue. I give the residue of my estate to
my husband, Wilford C. Day, Jr., if he survives me by thirty
(30) days. In the event that my husband, Wilford C. Day, Jr.,
does not so survive me, I give the residue of my estate as
follows:
1. One-half (1/2) thereof to my brothers,
Chester Francis Orsin and Edward Orsin, in equal shares7 if they
are then living. In the event that either of my brothers are
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not then living, his share shall be distributed to his issue,
then living, per stirpes.
2. One-half (1/2) thereof to my husband's
sister, Lois D. Counsil, if she is then living, or if she is not
then living, to her issue, then living, per stirpes.
II. Administrative Provisions.
A. Debts and Burial Expenses. My debts and the
expense of my illness and burial shall be paid from my estate.
B. Powers of Executor. In addition to powers
granted by law, my Executor shall have the power, without court
approval, to compromise claims and to sell at public or private
sale, exchange or lease for any period or time, any real or
personal property, and to give options for sales or leases.
c. Death Taxes. All estate, inheritance and
other death taxes payable because of my death, with respect to
the property formi~g my gross estate for tax purposes, whether
or not passing under this Will, including any interest or
penalty imposed thereon, shall be paid from the principal of my
general testamentary estate as if such taxes were my debts.
D. Appointment of Executor. I appoint my
husband, Wilford C. Day, Jr., as Executor of my estate.
If he
is unable or unwilling to serve as such Executor, either at the
time of the creation of my estate or thereafter, then I appoint
my brother-in-law, Eugene Counsil, as Executor.
~
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E. Bond. I direct that my personal representa-
tive, as well as his successors, shall not be required to give
bond for the faithful performance of their duties in any juris-
diction.
Executed on September 5, 1986.
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In our presence, GAYLE O. DAY] the above named
testatrix, signed this Will, and declared it to be her Will; and
now at her request and in the presence of each other, we sign as
witnesses.
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CO~~ONWEALTH OF PENNSYLVANIA )
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COUNTY OF CLINTON )
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We, Gayle O. Day, Alvin L. Snowiss and Ann K. Berger,
the testatrix and witnesses, respectively, whose names are
signed to the attached or foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the
testatrix signed and executed the instrument as her Last Will
and she had signed willingly (or willingly directed another to
sign for her), and that she executed it as her free and
voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the testatrix,
signed the Will as witness and that to the best of their knowl-
edge the testatrix was at that time eighteen years of age or
older, of sound mind and under no constraint or undue influence.
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Wltness
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Subscribed, sworn to and acknowledged before me by
Gayle O. Day, the testatrix, and subscribed and sworn to before
me by Alvin L. Snowiss and Ann K. Berger, witnesses, this 5th
day of September, 1986.
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Notary Public
My Commission Expires:
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3: rH (. PROBSL Notiry Public
Lc,1-. Hjl'~1, CiintJil (CU(1 'r'l, "..
My' l~C ,ml ;i n Lp:r:;,,; J'-!l 26. ! 'n!)
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Carlisle, P A 17013-
(717)243-2421
Novembftf 29, 2005
Wilford C. "Chip" Day /~
103A Partridge Circle
Carlisle, P A 17013
The Funeral Service for Vida Gayle O. Day
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEl'vIENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff. . . . . . . . . . . . . . . . . .. $ I 225.00
3. AUTOl\10TIVE EQUIP~lENT
Vehicle to transfer remains to Funeral Home. . . . . . . . . . . . . . . . $175.00
C. SPECIAL CHARGES
Direct Cremation. . . . . . . . .
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Register Book(s). . . . . . . . . . . . . . . . . . . . . .
Memorial folders. . . . . . . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THA T YOU HAVE SELECTED . . . . . . . . . . . . .
$220.00
$1620.00
$60.00
$75.00
$1755.00
Cash Advances
Certified Copies of the Death Certificate. .
Sentinel Obit
Lock Haven . .
Coroners Fee. .
Cremation Pouch. . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
$48.00
$99.50
$ 7 5.00
$25.00
$35.00
$282.50
Total
Total Cost.
$2037.50
SUB-TOTAL
$2037.50
0.00
$2037.50
INITIAL PAYMENT / DISCOUNT / CREDITS
TOTAL AMOUNT DUE
The unpaid balance over 45 days is subjected to a l.00 % service charge per month - 12.0000 % per annum.
Member of National Funeral Directors Association
COMMONWEALTH OF PENNSYLVANIA
STATE EMPLOYEES' RETIREMENT SYSTEM
30 NORTH THIRD ST STE 150
HARRISBURG, PA 17101-1716
1-800-633-5461
www.sers.state.pa.us
March 02,2006
EUGENE E COUNSIL EXECUTOR
GAYLE 0 DAY ESTATE
60 WEST POMFRET STREET
CARLISLE PA 17013
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RE: GAYLE 0 DAY
8.8. #211-38-1897
We are in receipt of the short certificate you submitted to this office for the Estate of Gayle O. Day,
the named beneficiary in the above referenced account, thank you.
In order that we can voucher a check in the final settlement of this account, the enclosed Release
and Indemriification Affidavit must be completed, notarized, and returned to this System at the
address shown above as soon as possible.
The following information is being provided:
Death benefit payable to you:
Taxable Portion:
Non Taxable Portion:
$114,475.96
$114,475.96
$0.00
If you have any questions or need assistance, please contact the field office nearest you at 1-800-
633-5461 .
Sincerely,
~4" m. )h~
Linda M. Miller, Director
Disability & Death Benefits Section
Benefits Determination Division
Enclosures
BEN63A
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