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COMMONWEAlTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDEI'iT'S NAME (LAST. RRST. AND MIDDlE INITIAL) use a bIa1k block 1D sepaaIe words
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAl USE ONLY
FU HUIlBER
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COUNTY CODE
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~ NUMBER
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M E L L o T T B 0 y D M
SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH
1 6 1 -3 4 -0 7 8 2 1 1 /0 2 /2 0 0 5 0 2 /0 2 /1 9 4 5
(IF APPliCABlE) SURVIVING SPOUSE'S NAME (LAST, RRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
MELLOTT MARTHA 1 6 9 -4 4 -6 8 6 2 REGISTER OF WILLS
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001. Original Retum 0 2. Supplemental Retum 0 3. Remainder Retum (dall!ofdealhprior1D12-13-82)
o 4, Limited Estate 0 4a. Future Interest Compromise (daleofdealh aIIer 12-12-82) 0 5. Federal Estate Tax Retum Required
o 6. Decedent Died Testate (AtlachccpyofWil) 0 7. Decedent Maintained a Living Trust (AtlachccpyofTrusl) _ 8. Total Number of Safe Deposit BOlles
o 9. Litigation Proceeds Received 0 10. SpouSal Poverty Credit (dale ofdealh between 12-31-91 and 1-1-95) 0 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAlUNG ADDRESS
WILLIAM A DUNCAN 1 IRVINE ROW
FIRM NAME (If Applicable)
DUNCAN & HARTMAN P.C.
TELEPHONE NUMBER
717-249-7780 CARLISLE PA 17013
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held COIporation, Partnership or So\e-Proprtetorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1 9 ,0 5 7 . 0 2
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F) (6)
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c( 7 . Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
...I (Schedule G or L)
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... 8. Total Gross Assets (total Lines 1-7) (8)
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c( 9. Funeral Ellpenses & Administrative Costs (Schedule H) (9)
0 8 , 7 7 4 . 0 0
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a:: 10. Debts of Decedent Mortgage Liabilities. & Liens (Schedule I) (10) 1 , 7 6 3 . 9 0
11. Total Deductions (total Lines 9 & 10) (11)
12. Net Value of Estate (Une 8 minus Line 11) (12)
13. Charitable and Govemmental BequestsISec 9113 Trusts for which an eleCtion to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
15. Amount of line 14 taxable 8 ,5 1 9 . 1 2 X 0
Z at lhe spousal tax rate (15)
0 See instructions on reverse side for applicable percentage
i= 16. Amount of line 14 taxable
~~ at 6% rate X .06 (16)
~::) 17. Amount of line 14 taxable
Q., at 15% rate X .15 (17)
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U 18. Tax Due (18)
19.
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1 9 ,0 5 7 .0 2
1 0 5 3 7 9 0
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8 5 1 9 1 2
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8 ,5 1 9 . 1 2
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ADDRESS 1 EMERALD CIRCLE
CARLISLE PA 17013
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Decedents omPlete dress:
STREET ADDRESS
1 EMERALD CIRCLE
CITY I STATE I ZIP
CARLISLE PA 17013
'e Ad
Tax Payments and Credits:
1. Tax Due (Page 1 Une 18)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
T otallnterestlPenalty ( 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 19 to request a refund (4)
5. If line 1 + line 3 is greater than fine 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Une 5 + SA. This is the BALANCE DUE. (56)
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 00
b. retain the right to designate who shall use the property transferred or its income; .................0 00
c. retain a reversionary interest; or ..............................................................................................0 00
d. receive the promise for life of either payments, benefits or care? ........................................... 0 00
2. If death occurred on or before December 12,1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? If death occurred
after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ............................................................................................... 0 00
3. Did decedent own an "in trust for" or payable upon death bank account or security
at his or her death? ....................................................................................................................... 0 00
4. Did decedent own an individual retirement account, annuity, or other non-probate property? ..... 0 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
72 P .5. ~9116 (a) (1.1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995.
72 P .5. ~9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the net value of transfers to or for the use of the surviving
spouse from 3% to 0% for dates of death on or after January 1, 1995. 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 JANUARY 1, 1995 - Please answer the following question by placing an "x" in the
appropriate space.
Did the decedent create a trust or similar arrangement which is soley for the surviving spouse's benefit for his or her entire
lifetime? Yes 0 No 00
If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second
spouse, at which time it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies). Enter the value of the trust on
Schedule J, Part II, in order to remove it from the calculation of the tax due in this estate. You may wish to file Schedule 0 in order to
make the election available under Section 9113. If the election is made, the trust or similar arrangement is taxed in the estate of the
first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate,
and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election, you must
attach Schedule 0 to a timely-filed tax return, along with Schedule(s) K and/or M in order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficiary(ies).
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
MELLOTT
FILE NUMBER
BOYD M
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
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
17,422.65
Citizens Bank Checking Account
2.
Battlefield Motorcycles, Inc. Refund Check # 14695
1,388.00
3.
Battlefield Motorcycles, Inc. Refund Check # 14692
246.37
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
19057.02
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
MELLOTT
FILE NUMBER
BOYD M
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers Funeral Home, Inc. 6,937.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number{s) I EIN Number of Personal Represenlative(s)
Street Address
City State Zip
Year{s) Commission Paid:
2. AIIDmey Fees Duncan & Hartman, P.C. 1,600.00
3. Family Exemption: (If decedents address is not lhe same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills Cumberland County Filing Fees 137.00
5. Accountants Fees
6. Tax Return Prepare(s Fees
7. Held in Reserve 100.00
TOTAL (Also enter on line 9, Recapitulation) $ 8774.00
(If more space is needed, insert additional sheets of the same size)
_..,,~.,'., .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE T P\X RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
MELLOTT
FILE NUMBER
BOYD M
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1,600.00
1.
Steve's Tile Service
2.
Family Home Medical
145.90
3.
Yellow Breeches Family
18.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 763.90
_."~.".,, .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
MI=I lOTI R()Vn M
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)
1. MARTHA I. MELLOTT WIFE 100%
1 EMERALD CIRCLE
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n - 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)
tGast lIi11 au~ IDcstamcut
of
BOYD M. MELLOTT, of 1 Emerald Circle, Carlisle, South Middleton Township,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for my Last Will and
Testament, hereby revoking any and all other wills and codicils heretofore made by me.
FIRST. I direct that all my just debts and funeral expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be interred within my family's burial plot located in
Mt. Zion Cemetery.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a suitable marker for my grave.
FOURTH. If either, Lester Hair or Ruth Hair is residing with me at the time of my
death then they shall be entitled to continue such residence after my death for as long as they
so choose. If either chooses to stay in said property they shall be responsible for any and all
expenses associated with said realty
FIFTH. I give, devise and bequeath any and all tangible personal property owned by me
at the time of my death unto my wife, MARTHA I. MELLOTT, provided she survives me by
thirty (30) days. In the event she fails to survive me by thirty (30) days, I give, devise and
bequeath all said tangible personal property unto my grandchildren, Charity Parthmore, Crystal
Parthmore and Nicole Parthmore, in equal shares, per stirpes.
SIXTH. I give, devise and bequeath any and all real estate owned by me at the time of
my death, unto my wife, MARTHA I. MELLOTT" provided she survives me by thirty days.
In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all said real
estate unto my grandchildren, Charity Parthmore, Crystal Parthmore and Nicole Parthmore, in
equal shares, per stirpes.
SEVENTH. I give, devise and bequeath all the rest, residue and remainder of my estate
unto my wife, MARTHA 1. MELLOTT, provided she survives me by thirty (30) days. In the
event she fails to survive me by thirty (30) days, I give, devise and bequeath all the rest, residue
and remainder of my estate unto my grandchildren, Charity Parthmore, Crystal Parthmore and
Nicole Parthmore, in equal shares, per stirpes.
EIGHTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon
my estate passing under my will or otherwise, shall be paid out of the principal of my residuary
estate.
NINTH. I hereby nominate, constitute and appoint my wife, MARTHA I. MELLOTT,
as Executrix of this my Last Will and Testament. In the event of renunciation, death,
resignation or inability to act for any reason whatsoever of MARTHA I. MELLOTT, I
nominate, constitute and appoint William A. Duncan, Esquire as Executor of this my Last Will
and Testament. I hereby relieve my Executrix from the necessity of posting security in
connection with her duties, as such, in any jurisdiction in which she may be called upon to act
insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize
my Executrix, in his absolute discretion, to retain in the form received, and to sell either at
public or private sale any real or personal property owned by me at the time of my death.
TENTH. If any of my grandchildren, beneficiaries of this, my Last Will and Testament,
shall be under the age of twenty-three (23) years at the time of my death, then any portion of
my estate in which they share shall be held in separate trust for them with William A. Duncan,
Esquire as Trustee. The trusteeship shall end when the child attains the age of twenty-three
(23) years. As Trustee, William A. Duncan shall provide for the care and maintenance and
education of said children and shall from time to time use either principal or income from the
inheritance to provide for these needs.
ELEVENTH. I have made, or may from time to time make, a written memorandum
expressing my desire to give certain items of personal property to specific persons. I urge my
Executrix and beneficiaries to respect these wishes. Such a memorandum, if made, shall be
stored in conjunction with this Will.
IN WITNESS WHEREOF, I have hereunto set my hatt4 ~d seal to this, my Last Will
and Testament, consisting of two typewritten pages this (I ! " d~::f N;V"1'j 199~
4:!;l.Jt.iM
BO M. MELLOTT
Signed, sealed published and declared by the above named Testator Boyd M. Mellott as and
for his Last Will and Testament, in the presence of us, who, at his request, in his sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
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COMMONWEALTH OF PENNSYL VANIA
SS.
COUNTY OF CUMBERLAND
I, Boyd M. Mellott, Testator whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; tha~ I signed it willingly; and tha. ~Ts~9~Q it as my
free and voluntary act for the purposes therem expressed.. /' /{ I() , ____
I~y.,/)t:,. ~ftZ:
Boyd M. Mellott
Sworn or affirmed to and
acknowledged before me, byA'
Boyd M. Mellott this /6t:J.- day
~'kember 999.
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COMMONWEALTH OF PENNSYL VAN/A
:SS.
COUNTY OF CUMBERLAND :
We,(;.)r...., ~~ lA"C~ and fi\~(~, -r. (I1~the
witnesses whose ~a~ are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw Boyd M. Mellott sign and
execute the instrument as his Last Will; that he signed willingly and that he executed 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 knowledge, the Testator
was at that time eighteen (18) or more years of age, of sound mind and under no constraint or
undue influence.
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Sworn or affirmed to and
subscrib~ore me ~ '\
, (;JIt\ , ,1' y!-IlC a./Ij-..J an~
)'l'l (l~* '+ vvt<>eJl1t:h-. ,wItnesses,
this/day of November, 1999.
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Account Number 6140272432
Account Title BOYD M MELLOTT
Date Opened 9/19/2000
Account Type Savings
Principal Balance as of DaD $17435.49
Interest from Last Posting to DaD $ .48
Account Balance as of DaD $17435.97
YTD Interest to DOD $66.99