HomeMy WebLinkAbout05-09-06
.
REV-1500 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
! DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
FILE NUMBER
II Ob
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
197-07-8162
NUMBER
0/79
I-
Z
W
C
W
U
w
C
Gardner, Clarence A.
: DATE OF DEATH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
I DATE OF BIRTH (MM-DD-YEAR)
I
j~ 04-23-2004 i 08-01-1918
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
Gardner, Nellie M.
[!J 1. Original Return
,~ 4. Limited Estate
~ 6. Decedent Died Testate (Attach
copy of Will)
[J 9. Litigation Proceeds Received
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
w
....
~:$Ul
oct:~
wo..o
:coo
oct:.J
o..al
0..
c(
LJ 2. Supplemental Return
3. Remainder Retum (date of death prior to 12-13-82)
o
o
o
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
. 12-31-91 and 1-1-95)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
[J 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
....
z
w
C
z
o
0..
Ul
w
II:
II:
o
o
THIS SECTION MUST BE COMPLETED: ALLCORRESPONDENCE'AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME ' COMPLETE MAILING ADDRESS
Jerry A. Weigle, Esquire
FIRM NAME (If applicable)
Weigle & Associates, P.C.
126 East King Street
Shippensburg, PA 17257
TELEPHONE NUMBER
1717/532-7388
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1 )
(2)
OFFICIAb.)USE ONLY
C'_-~
,":'"
-- ) .~-->-"
None
74,571.12
None
None
2,035.64
None
None
(8)
11,365.10
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
z
o
j::
<C
..J
::l
l-
e:::
<C
u
w
0:::
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) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(4)
(5)
(6)
(7)
~
.....
',J~)
",t
")
(::)
76,606.76
(9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
(11)
11,365.10
65,241.66
0.00
65,241.66
12. Net Value of Estate (Line 8 minus Line 11)
(12)
13. Charitable and Governmental Bequests/Sec 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)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
j::
~
::l
a..
:E
o
u
x
~
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
65,241.66
0.00
x .00 (15)
x .045 (16)
0.00
0.00
16.Amount of Line 14 taxable at lineal rate
x .12 (17)
I' 17.Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
I
119. Tax Due
120. D
0.00
0.00
0.00
x .15 (18)
(19)
0.00
0.00
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVER2A'lMENl"_
>:>- Be SURE TO ANSWERAc'LQUEST10NS ON REVERSE SIDE AND RECHECK MATH<<
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00:
;v7-
Decedent's Complete Address:
STREET ADDRESS
22 Maple Avenue, Walnut Bottom,
CITY Walnut Bottom
ZIP 17266
i
: STATE PA
I
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
0.00
Total Credits (A + B + C)
(2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (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
0.00
0.00
(3)
(4)
(5) 0.00
(5A)
(58) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;............................................................................. [J
b. retain the right to designate who shall use the property transferred or its income;................................ [J
c. retain a reversionary interest; or.................................... ........................................................................ [J
d. receive the promise for life of either payments, benefits or care?........................................................... [J
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?........................... ....................................... ....................... __..................... [J
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?....................................... ....................................... ........ ......................... [] ~
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 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.
SIGNATU E OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE
Th as Larry Gardner 10937 Morgan Drive
Shippensburg, PA 17257
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
ADDRESS
ADDRESS
126 East King Street
Shippensburg, PA 17257
No
~
~
~
~
~
~
Jh~G
t / DATE
s-/Lf~~
For dates of death on or after July 1, 19 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 statutedoes 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 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.
99116 1.2) [72 PS. 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.
Rev-1503 EX+ (6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gardner, Clarence A.
FILE NUMBER
21--
ESTATE OF
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 1,209 shares of PPG Industries, Inc. 61.68 74.571.12
TOTAL (Also enter on Line 2, Recapitulation) 74.571.12
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule 8 (Rev. 6-98)
Rev-1508 EX+ (6-9B)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gardner, Clarence A.
FILE NUMBER
21--
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
1 M & T Bank Savings Account #021000001219098
VALUE AT DATE
OF DEATH
935.51
Accrued interest on Item 1 through date of death
0.13
2
1989 Chevrolet G20 Custom Van
1.100.00
TOTAL (Also enter on Line 5, Recapitulation)
2.035.64
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gardner, Clarence A.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21--
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
6,768.10
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State Zip
2.
Attorney's Fees
Weigle & Associates, P.C.
750.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Nellie M. Gardner
Street Address 22 Maple Avenue, Walnut Bottom,
City Walnut Bottom State PA Zip 17266
Relationship of Claimant to Decedent Spouse
3,500.00
4.
Probate Fees
Register of Wills, Cumberland County
257.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule(s) attached
90.00
TOTAL (Also enter on line 9, Recapitulation)
11,365.10
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gardner, Clarence A.
IFILE NUMBER
21--
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Fogelsanger-Bricker Funeral Home
6.768.10
Subtotal
6.768.10
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
contin ued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gardner, Clarence A.
FILE NUMBER
21--
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Register of Wills, Cumberland County - Letters of Administration and Short
Certificates
15.00
2
Register of Wills, Cumberland County - filing Family Settlement Agreement
75.00
Subtotal
90.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleH-B7 (Rev. 6-98)
REV-1513 EX+ (9-00)
.
SCHEDULE ..J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Gardner, Clarence A.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Clistributions, and transfers
under Sec. 9116(a)(1.2)J
FILE NUMBER
21--
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
1
Nellie M. Gardner
Forest Park Nursing Home
700 Walnut Bottom Road
Spouse
100%
65,241.66
Total 65,241.66
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
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleJ (Rev. 6-98)
/ I!M&rBank
499 Mitchell Road, MiIIsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
March 8, 2006
Weigle & Associates PC
Attorneys At Law
126 East King Street
Shippensburg, Pennsylvania 17257-1397
MAR 1~, 20D6
Re: Estate of Clarence A Gardner
Social Security: 197-07-8162
Date of Death: April 23, 2004
Dear Sir or Madam:
Per your inquiry dated March 02, 2006, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
Type of Account
Checking Account
Account Number
97250015
Ownership (Names of)
Clarence A Gardner *
Nellie M Gardner *
Thomas L Gardner, POA *
Opening Date
01/28/80 Closed 07/07/05
Balance on Date of Death
;.69
Accrued Interest
$ 0.29
Total
$5,534.98
2.
Type of Account
Checking Account
Account Number
97250082
Ownership (Names of)
Clarence A Gardner *
Nellie M Gardner *
Thomas L Gardner, POA *
Opening Date
01/28/80
Balance on Date of Death
$ 44.58
Accrued Interest
$ 0.00
Total
44.58
3.
Type of Account
Savings Account
Account Number
015004208520187-01
Ownership (Names oj)
Clarence A Gardner *
Nellie M Gardner *
Opening Date
11/02/90 Closed 05/06/04
Balance on Date of Death
$1,967.87
Accrued Interest
$ 0.33
Total
$1,968.20
.- ------------ ---~----- ------------------- --------------------------- -----------------
4.
Type of Account
Savings Account
Account Number
02100000121815
Ownership (Names oj)
Clarence A Gardner *
Nellie M Gardner *
Thomas L Gardner, POA *
Opening Date
01102/70
Balance on Date of Death
$28,947.13
Accrued Interest
$
4.13
Total
$28,951.26
5.
Type of Account
Savings Account
Account Number
021000001219098
Ownership (Names of)
Clarenc(' A Gardner *
Opening Date
11/02/90
Balance on Date of Death
$935.51
Accrued Interest
$ 0.13
Total
$935.64
~ & ';it Chevrolet,
Pontiac &
Oldsmobile
Cadillac
730 East King Street
Shippensburg, P A 17257
(717) 532-2121
Fax (717) 532-3658
www.hhchev.com
To: Estate of Clarence A. Gardner
22 Maple Ave.
Walnut Bottom, PA 17266
April 7, 2006
The trade-in value for one 1989 Chevrolet G20 Custom Van with a side wheelchair access lift, VIN: IGBEG25KIK7 I 77405, with
79,756 miles, with some surface rust and paint peeling, in fair condition is $ 1,100. The value was determined by using the Kelly Blue
Book Used Car Guide.
If you have any questions concerning this price please call me toll free at 1-888-532-2121.
Sincerely yours,
.~/fL~
Timothy M. Nye
General Sales Manager
H & H Chevrolet, Pontiac, Cadillac Inc.
-
Il\ST WILL AND TESTAMENT
~hi'i1 nr ,...rdlr'lro,..., ;,... ,"""",.,,1 ~t-.~___ _,___
grandchild, then living at the t:i.rre of ~. decease; provided, however, that in
the event:rrw said deceased grandchild leaves no child or children living at
the tine of :rrw decease, then in that event, I give, devise and bequeath the
share of ~ said grandchild to my surviving grandchild or grandchildren, to
wit, either L. CHRISTINE BILGER, C. SUSANNE GARDNER, or, TIrnAS L. GARDNER, JR.
in equal shares, share and share alike, then living at the time of my decease.
FIFrH. Provided further, that in the event any of my aforementioned
Legatees are not at least eighteen (18) ~ars of age at the ti.me of my decease,
then in that event, I hereby naninate, constitute and appoint DAUPHIN DEroSIT
BANK AND TRUST CCMPANY, Harrisburg, Pennsylvania, as the Guardian of the
estate of the said minor child or children, the said Guardian to take and
receive the share of the said minor child or children and invest and re-
invest the same ilin legal or non-legal investments, whichever in its discretion
it deems proper, and the said Guardian to have full power and authority, in
its discretion, to pay such annunts of incone and principal as are necessary
for the support, maintenance and education of the said minor child or children,
and upon the said minor child or children reaching the age of eighteen (18)
years, to pay the said share to the said child.
SIXTH. Provided further, that in the event my said wife, NELLIE M.
GARDNER, slxmld predecease me, or if \\Ie should die in a carmon disaster, then
in either of said events, I herel:o/ naninate, constitute and appoint my said
son, 'rfOv1AS IARRY Gl\RINER, the sole Executor of this ~ Last Will and Testa-
ment; provided further, that in the event my said son, 'I'HCMAS IARRY GARDNER,
shoold predecease me, then in that event, I herel:o/ ncminate, constitute and
appoint my said granddaughter, L. CHRISTINE BILGER, my said granddaughter,
C. SUSANNE GARDNER, and my said grandson, THJMAS L. GARDNER, JR., or the
survivor or survivors of than, to wit, either L. CHRISTINE BILGER, C. SUSANNE
GARI:NER, or, THOMAS L. GARINER, JR., then living at the t:ime of ~ decease,
as Executors of this my Last Will and Testament, ~ said Executor or Executors,
__ .t...1-_ ____ __~_ ,.__
necessary for the C<IIp1ete administration of my estate, iocluding the power
to sell any and all real and f€I'sonal pro};€rty of which I may die seize:l, at
public or private sale, in his, or their, discretion, without any Order of
any Court; and I further direct that my said Executor, or Executors as the
case rnayl::e, not l::e required to file any Bond in connection with the settlanen
of my said Estate.
IN WI'INESS WHEREOF, I, ~ A. GARmER, have hereto set my hand and
seal to this my Last Will and Testament, written on four (4) sheets of paper,
this 4th day of September, 1984.
~VA~Y_ 4.~L~-ICL~~h
,
(SEAL)
Signed, sealed, published and
declared by CIARENCE A. GARDNER,
the Testator, as and for his
last Will and Testament, written
on four (4) sheets of paper, in
the presence of us. who. ,have, at
his request, signed our names as
witnesses hereto in the presence
of the said Testator and of each
other .
('"
(' \ " \, "
, \ ,J,l1J \, tJ M-u-
. ~\ (\ .
- ~, \:J
'- \ Q ..l g .t\.o..... _ l J.....L. 'i"\..O ~ cJ..JL.(
r..
.'
C~TH OF PENNSYLVANIA
SS
COUNI'Y. OF CUMBERIAND
I, CLARENCE A. GARI:NER, Testator, whose name is .signed to the attached
or foregoing instrunent, having reen duly qualified according to lat.;, do
hereby acknowledge that I signed and executed the instrurent as my last Will
and Test.arrent; that I signed it willingly; and tha.t I signed it as my free
and voluntary act for the purposes therein expressed.
~~~ A, /~~A~l!L<J~ //
Clarence. A. Gardner .
Sworn or affinned to an:1acknowledged before me by CIARENCE A. GARDNER,
the Testator, this 4th day of Septernl::>er, 1984,
CCMDNWEALTH OF PENNSYLVANIA
SS
No lie
ELlZA8ETH 8. fElZER. N()TARY P BLle
WESt plHrtSBORO lWP., CUMBE A D COUNTt'
MY COMMISSION EXPIRES SEP . 12, 1987
t.temlaer, P.nlls~lvlnla ASloc!ltictn tlf Hot,Flu
CX>UNTY OF ctMBERIAND
v~e, ROBERr J. YOCUM and TERESA J. BURKHOLDER, the witnesses whose names
are signed to the attached or foregoing inst...-rurnent, being duly qualified
according to law,. d.oaeposeand say that we were present and saw the Testator
sign and execute the. instrurrentas his Last. Will and .Testament; that the
Testator signed willingly; and. that the Testator executed it as his free
and. voluntary act for the purposes therein expressed; that each of us in
the hearing and sight of the Testator, signed the Will as witnesses; and
that to the best of our knCYNledge, the Testator was at that time 18 or more
years of age, of sound mind, and under no ronstraint or undue influence.
PA
~~~~UA-~~
a J. Burkholder
ewburg, PA
S~m or affirmed to and SUbscribed before me this 4th day of. SeptEmter,
1984.
HllABETH B. FETZER. NOTAR BLle
WEST PENN!90RO 1WP ~IlIlRJ'Dt un MUM'"'