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HomeMy WebLinkAbout06-14-06 REV.1500 EX + (6-00) ~ . --w OFFICIAL USE ONLY REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER II 0807 05 COUNTY CODE YEAR SOCIAL SECURITY NUMBER NUMBER .. ___ 201-16-0646 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (date of death prior to 12-13-82) [J 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes t- Z W C Z o Q. CI) w It: It: o U NAME George F. Douglas III FIRM NAME (If applicable) Said is, Shuff, Flower & Lindsay TELEPHONE NUMBER (717) 243-6222 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship COMPLETE MAILING ADDRESS 26 West High Street Carlisle, PA 17013 (1 ) None (2) None (3) None (4) None (5) 9,296.48 ----~.~-_._--_.._-_.~ (6) 22,057.93 ~--~-.~--_.- (7) None (9) (10) 2,172.33 358.86 OFFICIA,b.)USE ONLY : -2 ~~ I:J;~: t' .-) .~- ,:-) C) > .i) .' r=~:-, .~ ~~ ::;J , ,_J COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 I DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) .... I Natcher, Viola P ~ DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) ~ ~(1:08_21_2005 01-31-1911 ~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) w [!J 1. Original Return [] 2. Supplemental Return t- .-- ~ ~ ~ I J 4. Limited Estate 4a. Future Interest Compromise (date of death after ~ & g I 12-12-82) n f ~ [!J 6. Decedent Died Testate (Attach 7. Decedent Maintained a Living Trust (Attach Q. ~cl~ ~clfu~ <C 9. Litigation Proceeds Received 10 Spousal Poverty Credit (date of death between . 12-31-91 and 1-1-95) z o ~ S :;:) l- ii: c:( (.) w 0:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) LJ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) [J Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 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) ......-~, .....=r) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) :J~ ro,_..) N CO (8) 31,354.41 (11 ) 2,531.19 28,823.22 (12) (13) 0.00 (14) 28,823.22 z o ~ ~ :) Q. :E o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0.00 x .00 (15) 0 . 00 ! 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 28,823.22 x .045 (16) 1 ,297.04 0.00 0.00 x .12 (17) 0.00 x .15 (18) 0.00 (19) 1,297.04 Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00; . 1 Decedent's Complete Address: STREET ADDRESS C.M.E. Lot 104 I STATE PA IZ'P1~7 2 41 CITY Newville Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 900.00 0.00 Total Credits (A + 8 + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) 4. 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 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. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (58) Make Check Payable to: REGISTER OF WILLS, AGENT 1,297.04 900.00 397.04 397.04 D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................ .................................... ................................................................. D [!] 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 pe~ury, I declare that I have examined this retum, 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 PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Theresa P. Miller PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.................................................................................. b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or................................ ........... ......... ................. ............................................. d. receive the promise for life of either payments, benefits or care?.............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?...................................................................................................................... Yes o [J n I~ LJ 167 Amy Drive Carlisle, PA 17013 SIGNATURE OF PERSON RESPONSIBLE FO Fill ETURN ~^C-,=~€ 'SIGNATURE PREPARER OTHER N REPRESENTATIVE George F. Douglas III ADDRESS ADDRESS 26 West High Street Carlisle, PA 17013 No [!] ~ ~ L!J ~l ~ DATE tj'1?jo? DATE 5/~"3 /0' DATE 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. ~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 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot 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 .5. ~9116 (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. ~9116 1.2) [72 P.S. ~9116 (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 an individual who has at least one parent in common with the decedent, whether by blood or adoption. R~v.1508 EX+ (6-98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONW~THOFPENNSYlVAN~ INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Natcher, Viola P FILE NUMBER 21-05-0807 Include the proceeds of litigation and the date the proceeds were received by the estate. All property JolnUy-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 cash on hand 120.00 2 Comcast, refund 60.31 3 Highmark Insurance refund 578.55 4 insurance premium refund 150.00 5 The Sentinel, refund 87.62 6. 7. Household furnishings and personal property 300.00 mobile home, value based on sale price 8.000.00 TOTAL (Also enter on Line 5, Recapitulation) 9.296.48 (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.1509 EX+ (6-98) . SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. FILE NUMBER 21-05-0807 Natcher, Viola P SURVIVING JOINT TENANT(S) NAME A. Theresa P Miller ADDRESS RELATIONSHIP TO DECEDENT 167 Amy Drive Carlisle, PA 17013 Daughter 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 DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. 1 A 6/12/1997 M&T Bank, certificate of deposit, 20,014.85 50.0000/0 10,007.43 #031003910071362 2 A 10/31/1985 M&T Bank, checking acct. #2674055708 _ 7,563.00 50.000% 3,781.50 joint acct. with Theresa Miller, opened 10/31/85 3 A 7/13/2001 M&T Bank, savings acct. 16,537.99 50.000% 8,269.00 #015004198282219 - joint acct. with Theresa Miller, opened 7/31/2001 TOTAL (Also enter on Line 6, Recapitulation) 22,057.93 (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 F (Rev. 6-98) REV-1151 EX+ (12.99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Natcher, Viola P Debts of decedent must be reported on Schedule I. FILE NUMBER 21-05-0807 ITEM DESCRIPTION AMOUNT NUMBER A FUNERAL EXPENSES: See continuation schedule(s) attached 335.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees 1,500.00 See continuation schedule(s) attached 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 62.00 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 275.33 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 2,172.33 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) R~v-1502 EX+ (6-98) *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Natcher, Viola P FILE NUMBER 21-05-0807 ITEM NUMBER DESCRIPTION AMOUNT 1 clergy 50.00 2 clothing 100.00 3 funeral flowers 150.00 4 hair stylist 35.00 Subtotal 335.00 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-82 ATTORNEY'S FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Natcher, Viola P FILE NUMBER 21-05-0807 ITEM NUMBER DESCRIPTION 1 Saidis, Shuff, Flower & Lindsay AMOUNT 1.500.00 Subtotal 1.500.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B2 (Rev. 6-98) Rev-1502 EX+ (6-98) . SCHEDULE H-B4 PROBATE FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Natcher, Viola P IFILE NUMBER 21-05-0807 ITEM NUMBER DESCRIPTION 1 Register of Wills of Cumberland Co. AMOUNT 62.00 Subtotal 62.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B4 (Rev. 6-98) ~ev-1502 EX+ (6-98) *' SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Natcher, Viola P FILE NUMBER 21-05-0807 ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal, estate notice 75.00 2 Register of Wills - short certificates 12.00 3 Register of Wills, filing fee for tax return 15.00 4 The Sentinel, estate notice 173.33 Subtotal 275.33 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Natcher, Viola P FILE NUMBER 21-05-0807 Include unrelmbursed medical expenses. ITEM NUMBER OESeRI PTION 1 bank fee VALUE AT DATE OF DEATH 18.00 2 electric bill 50.86 3 lot rent for mobile home 245.00 4 phone bill 45.00 TOTAL (Also enter on Line 10, Recapitulation) 358.86 (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 I (Rev. 6-98) ~V.1513 EX+ (9-00) *' SCHEDULE .- BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER Natcher, Viola P NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal C1istributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) I. 1 Logan Chestnut 33 Foreman Mill Rd. Shippensburg, PA 17257 great granddaughter 2 Ashton Grove 5379 Roxbury Rd. Shippensburg, PA 17257 great grandson 3 Ketra Grove 5379 Roxbury Rd. Shippensburg, PA 17257 great granddaughter 4 Mark E. Grove 5379 Roxbury Rd. Shippensburg, PA 17257 grandson 5 Sarah E. Grove 33 Foreman Mill Rd. Shippensburg, PA 17257 granddaughter FILE NUMBER 21-05-0807 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Copyright (c) 2002 form software only The Lackner Group, Inc. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Form PA-1500 Schedule J (Rev. 6-98) 0.00 300.00 300.00 300.00 300.00 300.00 1,800.00 3,300.00 SCHEDULE .J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Viola P Natcher 201-16-0646 08/21/2005 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Stacey L. Grove Granddaughter 300.00 431 Mountain Rd. Newville, PA 17241 7 Tyric Grove great grandson 300.00 5379 Roxbury Rd. Shippensburg, PA 17257 8 Theresa J. Hepler Granddaughter 300.00 4233 English Way York, PA 17402 9 Keith R. Miller grandson 300.00 P.O. Box 116 Upperstrasburg, PA 17265 10 Theresa P. Miller daughter residue 0.00 167 Amy Drive Carlisle, PA 17013 11 Audrey Trussell (Black g randdaug hter 300.00 1519 N. Front St., Apt. 20 Harrisburg, PA 17102 12 Rebecca Grove Varner great granddaughter 300.00 326 Dublin Gap Rd. Newville, P A 17241 Total 1,800.00 1 f! M&fBank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302) 934-2955 October 28, 2005 Law Offices Saidis, Shuff, Flower & Lindsay 2109 Market Street Camp Hill, Pennsylvania 17011 Re: Estate of' Viola P Natcher Social Securitv: 201-16-0646 Date of Death: August 21. 2005 Dear Sir or Madam: Per your inquiry dated October 21, 2005, 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 A ccount Number 2674055708 Ownership (Names of) Theresa P Miller * Viola P N atcher * Opening Date 10/31/85 Balance on Date of Death $7,562.57 Accrued Interest $ 0.43 Total $7,563.00 Interest Paid YTD $ 3.94 (Accrued interest is not included) 2. Type of Account Savings Account Account Number 015004198282219 Ownership (Names oj) Theresa P Miller * Viola P Natcher * Opening Date 07/13/01 Closed 09/15/05 Balance on Date of Death $16,531.91 Accrued Interest $ 6.08 Total $16,537.99 Interest Paid YTD $ 95.64 (Accrued interest is not included) 3. Type of Account Certificate of Deposit A ccount Number 031003910071362 Ownership (Names oj) Theresa P Natcher * Viola P Natcher * Opening Date 06/12/97 Closed 09/15/05 Balance on Date of Death Total $20,000.00 $ 14.85 .....$20:0"J-;{85..............................._-_.._._...................................................................-........................................ Accrued Interest Interest Paid YTD .-.-..- ...--......-.............-.. ,.- ..-.........--...............-.........-.............-..-...-..-...-........-..,....-. .......... ...-.............-.......- .._-......... -- ........- ,--. $ 361.24 (Accrued interest is not included) * For further account information or to locate the existence of a safe deposit box, or regarding ownership and any changes, closures and/or reimbursement of funds, please contact our High Street Carlisle Branch at One West High Street, Carlisle, PA 17013, phone # 717-240-4536. Sincerely, ~(J~ Nancy Clagett Records Management LAST WILL AND TESTAMENT I, Viola P. Natcher, of Newville, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, declare the following to be my last will and testament, hereby revoking any and all wills heretofore made by me. ( Item I. I direct my executrix hereinafter named to pay all my debts and funeral expenses. Item II. I give, devise and bequeath the sum of Three Hundred ($300.00) Dollars each to my grandchildren: -Audrey Black -==-Theresa Hefler ~ Stacey Grove \:.J Sarah Grove Keith Miller Mark Grove. Item IV. I give, devise and bequeath the sum of Three Hundred ($300.00) Dollars to each of my great grandchildren:~ and Rebecca Grove Varner, L~an Chestn~t, Ketra Grove and Pyric Grove. If any of my great grandchildren should be under the age of 18 at the time of my death, I appoint Farmers Trust Company, Carlisle, P A, as trustee. I give my trustee the right to invest as it sees fit and expend principal as it sees fit. The trust will terminate when each of my great grandchildren reaches age 18, at which time the balance of his or her share shall be given to them. Item V. I give, devise and bequeath all the rest, residue and remainder of my estate to my daughter, Theresa P. Miller. (C(O)[Pl[ Item V. I appoint my daughter)' Theresa P. Miller)' of Carlisle)' PA. as my executrix)' and I direct that she should serve without bond. -1Ldayof IN WITNESS WHEREOF)' I have hereunto set my hand and seal this ~. )'2001 \u;4 P ..9?~ Viola P. Natcher Signed)' sealed)' published and declared by the above named testatrix)' as and for her last will and testament)' who at her request)' in her presence)' in our presence)' and in the presence of each other have hereunto subscribed our names as attesting witnesses: ~C.~OA-~ ~Q.~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We ~~ J.A~ -' I and whose names are signed to Ute attached;i&,;;;:g ins~m~nt, being d y qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her last will, and that she signed willingly and that she executed it as her free and voluntary act for the purposes therein contained, that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn te and subscribed before me this 1-, day of ~ ' 2001 ~~ G -"..f-oNotary Notanal Seal Anne M. Cox. Notary Public Carlisle Borough. Cumberland County My commISSIOn expIres July 14, 200S COMMONWEALTH OF PENNSYL VANIA COUNTY OF CUMBERLAND I, Viola P. Natcher, 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, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~f1;~_ Viola P. Natcher Sworn to and subscribed ~ before me this the r L day of ~ Notary , 2001. Notarial Seal \ Anne M. Cox. Notary Public Carlisle Borough, Cumberland count,lY<' . My commiSSIon expIres July 14. 200..,..,