HomeMy WebLinkAbout06-12-06
REY.ISOO EX (6.;1(J)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
FRAIN, MARIE T.
DATE OF DEATH (MM.DD-YEAR)
03/25/2006
INHERITANCE TAX RETURN
RESIDENT DECEDENT
REV-1500
OFFICIAL USE ONLY
FILE NUMBER
1-~--.iL~
i -.? 2.. 0_
NUMBER
COUNTY CODE
YEAR
SOCIAL SECURITY NUMBER
201
03
5433
DATE OF BIRTH (MM-DQ-YEAR)
07/01/1919
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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IX] 1. Original Return
o 4. Limited Estate
liJ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12.12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death be~veen 12.31-91 and 1-1-95)
D 3. Remainder Retum (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Anacn Sch 01
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COMPLETE MAILING ADDRESS
11 9 Locust street
P. O. Box 11847
Harrisburg, PA 17108-1847
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TELEPHONE NUMBER
717-238-1731
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
4. Mortgages & Notes Receivable (Schedule 0)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(1 )
(2)
(3)
(4)
(5)
0.00
OFF ICtAL USE ONLY
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0.00
0.00
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7fl1 c;1
(6) _145 ~ 969 ~g
(7) 0 . 00
(8)
146,733.21
~) 9,827.25
(10) 52.54
(11 )
(12)
(13)
9,879.79
136,853.42
0.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
136,853.42
Z 15. Amount of Line 14 taxable at the spousal tax
0 0.00
~ rate, or transfers under Sec. 9116 (a)(1.2) x .0_ (15)
136,853.42 45
~ 16. Amount of Line 14 taxable at lineal rate x .0_ (16)
::3
a.. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
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>< 19. Tax Due (19)
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0.00
6,158.40
0.00
0.00
6,158.40
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Decedent's Complete Address:
STREET ADDRESS
20 Beaver Rood
CITY
1 STATE
PA
I ZIP 17011
CamP Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
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1?4 11
Total Credits ( A + B + C ) (2)
324.18
3.
InteresUPenalty if applicable
D. Interest
E. Penalty
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(3)
(4)
(5)
(SA)
4.
TotallnteresUPenalty ( 0 + E )
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
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(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1.
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or........... ................ ......................................................... .................................. .... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
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? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..... ........... .... ........................................ ..... ........................ ...... ............. ...... ...... 0
6,158 40
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5,834.22
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
BLE FOR FILING RETURN
EI:MUND J. GRIBLEY (Son)
DATE
\S/2<f/~~
ADD ESS
20 Beaver Road, Camp Hill, PA 17011
~113NATURE OF P~PA~THER THAN REPRESENTATIVE
~ d:-, )~.~ ANN E. RHOADS, Esquire
ADDRESS
119 Locust street, P.o. Box 11847, Harrisburg, PA 17108-1847
J DATE
S ~01(}k
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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 does Get exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still appiicable even j,
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 P.S. 39116(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. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as ar
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX. (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
FRAIN, MARTE ~ 21-06-
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
Heal th Insurance Premium Refund
VALUE AT DATE
OF DEATH
618.00
2.
Country Meadows Refund
145.51
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
763.51
REV-1509 EX + (1-97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FRAIN, MARIE T.
FILE NUMBER
21-06-
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Edmund J. Gribley
20 Beaver Road
Camp Hill, PA 17011
Son
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number, Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 7/1997 Wachovia C/O #247042060200086 10,065.80 50% 5,032.90
2 A. 1/1998 Wachovia C/O #247042090319691 10,031.18 50% 5,015.59
3 A 5/1999 Wachovia C/D #247042090682739 10,034.93 50% 5,017.47
4 A. 2/2005 Wachovia Checking #1010110807975 185,177.72 50% 92,588.86
5 A. 5/1994 Wachovia Checking #1030159071289 1 ,601 . 71 50% 800.86
6 A. 9/1976 Ten (10) $500 Series H Savings Bonds 5,000.00 50% 2,500.00
7. A. 2001 Citizens Bank Savings Acct #6141-932606 10,603.75 50% 5,301.88
8. A. 8/2002 Citizens Bank C/O #6146-276944 10,039.90 50% 5,019.95
9. A. 8/2002 Citizens Bank C/O #6146-276936 10,042.35 50% 5,021.18
10. A. 2/2000 Citizens Bank C/O #6146-308838 10,058.10 50% 5,029.05
11 . A. 1/1981 Wachovia Savings Acct. #3005280136916 29,283.92 50% 14,641.96
TOTAL (Also enter on line 6, Recapitulation) $ 145,969.70
(If more space is needed, insert additional sheets of the same size)
F\E\I-L~11 [X~ (12-99)
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Ii Ji~"R,TA: iCE T;,X RETlJ,HJ
Fir:SiDE, iT DECEDEiJT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
_FRAIN, MARIE T.
FILE NUMBER
21-06-
Debts of decedent must be reported on Schedule l.
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Molden Funeral Chapel
Fishers Tudor House 1 (funeral luncheon)
Bensalem, PA
7,652.05
2.
675.20
:=:.::: j!~~h,c,T:'jE COSTS:
PI?'SJilsi ~~'3:)resen\Jti'-je's COiTilll'SSICr:S
;,!a::':e cr PC;SOrlci! ficpresGntatiIJ8iS,'
Secu!:\\' f'iu,,-,:)u(s\.El,1
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State
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';:tc:l~e/ Fees Cleckner and Fearen 1
1,500.00
Film;!)' Excrrption: (If cJecedent's address IS not the sa11e ilS cIJirnJnt's. attJch explanJtlon)
(-:'2:!:I::1nt
S~~0Gt Acidre~s
City
State
_ Zip
Relationship of Claimant to Decedent
J P~cb(lte Fees
~CCCUI~:Jr:t'S Fees
;', -_~y Return Preparer's Fi~es
1
Estate expenses paid by joint tenant from jointly-owned assets
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9,827.25
TOTAL (Also enter on line 9,
Ilf mere srDce :s l1eej('cL insert z,c!rj:\;cn31 sl1eeb of \1'.8 S3m2 Size)
O[I '512 E,( .. (1.;71 f*.
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CCMMer :'NE,AL TH OF PENr'jSYL ';;r,I,\
l~lHERITANCE TAX RETURn
W SiDENT CECcDE'JT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FRAIN, MARIE T.
FILE NUMBER
21-0n-
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
}lMOUrJT
1.
West Shore EMS
52.54
TOTAL (Also enter on line 10, Recapitulation) S
(If more space is needed. insert additional sheets of the same size)
52.54
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
Edmund J. Gribley
20 Beaver Road
Camp Hill, PA 17011
FILE NUMBER
?1-0fi
I RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF EST,AJE
ESTATE OF
FRAIN, MARIE T.
NUMBER
I
Son
Entire
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
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)
LAST WILL AND TESTAMENT
OF
MARIE T. FRAIN
I, MARIE T. FRAIN, of Cumberland County, Pennsylvania, being
of sound mind, memory and understanding, do hereby make, publish
and declare this to be my Last Will and Testament, hereby revoking
any and all former Wills and Codicils by me at any time heretofore
made.
ITEM I: I direct that all my funeral expenses and estate or
inheritance taxes be paid by my hereinafter named Executor as soon
after my death as may be found convenient.
ITEM II:
I give, devise and bequeath all the rest, residue
and remainder of my estate, both real and personal, wherever
situate, to my son, EDMUND J. -GRIBLEY, JR., if he survives me by
sixty (60) days. If my son does not survive me by sixty (60) days,
I give, devise and bequeath all the rest, residue and remainder of
my estate, both real and personal, wherever situate, to my
daughter-in-law, DOROTHY P. GRIBLEY.
ITEM III: I appoint my son, EDMUND J. GRIBLEY, JR., Executor
of this, my Last Will and Testament. If he is unable or unwilling
to qualify as Executor, or, having qualified, is unable or
unwilling to continue to act, I then appoint my daughter-in-law,
DOROTHY P. GRIBLEY, as Executrix of my Will.
ITEM IV: I direct that no personal representative hereunder
shall be required to provide security, surety or bond in any
jurisdiction for the faithful performance of any duty under this
will.
This clause is applicable only to such personal
representatives as are specifically named in this will.
IN WITNESS tiHEREOF, I, MARIE T. FRAIN, have set my hand and
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seal to this, my Last Will and Testament,
this
day of
34
, 2004.
7714" ~ <),rJ! ;!0',,u~~
MARIE T. FRAI
(SEAL)
Signed, sealed, published and declared by MARIE T. FRAIN, the
Testatrix, as and for her Will, in the presence of us, who, at her
request, in her presence, and in the presence of each other, we
believing her to be of sound mind, memory and understanding, have
hereunto subscribed our names as witnesses.
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COMMONWEALTH OF PENNSYLVANIA
S8
COUNTY OF DAUPHIN
We, MARIE T. FRAIN,
LI/7d~ /lJ~/(),,"1e-
A/7r'7
E. KAoac/~
and
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 Testament and that she had signed
willingly, 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
witnesses and that to the best of their knowledge, the Testatrix
was at that time eighteen (18) years of age or older, of sound mind
and under no constraint or undue influence.
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MARIE T. FRAIN, Testatrix
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Subscribed, sworn to
FRAIN, the Testatrix, and
/}/1'" F Rhoad's
witnesses, this ;ZJr~t
and acknowledged before me by
subscribed and sworn to before
and L~ ;., d~ //? e:;- /0....-, <-
day of c/(,.//-./ , 2004.
/
MARIE T.
me by
~./7/7 /" &.~ ~7;T6t6~
Notary Pbblic
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Jenny A. Tobias, Notary Public
City of Harrisburg, Dauphin County
My Commission Expires Feb. 15, 2005
Member. Pennsylvania Association of Notaries
CLECKNER AND FEAREN
ATTORNEYS AT LAW
119 LOCUST STREET
P.O. BOX 11847
HARRISBURG, PENNSYLVANIA 17108-1847
TELEPHONE: (717) 238-1731
FAX: (717) 238-8481
RICHARD W. CLECKNER
(1926 - 2004)
RETIRED:
WilLIAM FEAREN
ROBERT D. HANSON
DENNIS J. SHATTO
ANN E. RHOADS
June 8, 2006
Office of the Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
Re: Estate of Marie T. Frain
Dear Ladies and Gentlemen:
I enclose the following for filing:
(1) Original death certificate
(2) Original and one (1) copy of Estate Information Sheet
(3) Original and two (2) copies of PA Inheritance Tax Return
(4) Check in the amount of $15.00 as filling fee
(5) Check payable to "Register of Wills, Agent" in the amount
of $5,834.22 for inheritance tax.
There is no probate estate.
Please date-stamp the extra copies and return them to me in
the self-addressed, stamped envelope enclosed. If anything further
is needed to accomplish this filing, please contact me.
Thank you.
Very truly yours,
CLECKNER AND FEAREN
. S~)ljr-,,_
Ann E. Rhoads
AER: lnm
Enclosures
cc: Edmund J. Gribley (wjencls.)
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