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Home My WebLink About11-09-06 (2) .. ....J 1505b051047 REV.1500 EX (0lH)5) PA 0epaIlIIIlri aI Rewnue *' &nlII a11ncliYiWB1 T.. PO BOX 280601 HlI'ri8blI'g, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date fA Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY ColIIly Code Yw File tunber ;~7<; 'O;G,~ ii<Q~7'71 '. _!:"L'''':'_', i:',-,.f')"-':"", '''' ;:.,C::-:.; '.:","f;f"""":_,,,:_, ,c,' ~ ::".<j.,'-""O~__' _,"_",~\.,.,.\.~,;, .ii:I,.,..,m;,e,;/'''~'';_/ ,"", Date fA Birth MI i'\.~"":',:,:i:" '< ~','.i, -i':";;;; -,' l:7~ 0').",3 ~~j' :~'.y, 3.:~~ ~(J;~, ''4 Decedent's Last Name Suffix (If AppIIC8bIe) Enter Surviving Spouse's InfonnlItIon Below Spouse's Last Name Suffix Spouse's FIrSt Name MI THIS RETURN MUST BE filED IN DUPlICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return c:::> 2. Supplemental Retum c:::> 3. Remainder Retum (daIIe of death prior to 12-13-82) 5. Federal Estate Tax Retum Required _ 6. Decedent Died Testate (Attach Copy of Will) c:::> 9. Litigation Proceeds Reoeived c:::> 48. Future Interest ColnpromiSe (daIIe of c:::> death after 12-12-82) c:::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::> 10. Spousal Poverty Credit (daIIe of death c:::> 11. Elecllon to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SEC110N MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTlAL TAX INFORMATION SHOULD BE DIRECTED TO: Name DaytIme Telephone Number i~"~:..~."~~i.. .'. ....~.......:,t~tl,~~,Fi.i3~ 8. Total Number of Safe Deposit Boxes c:::> 4. Limited Estate C"".' " ..,......:.......>.;.. . :.,.. . ::.., i;;p iI/:'AA-A-P . .... e ,:f3,.A VIt4~ Ann Name (If Applicable) CJ1 \.0 Arst line of address ~~/M~A.r:6~ Vf/+. ?-,Rc<< .~t/e~~'" ~q i Second line of address CIty or Post Oftice SWA'R'TAA1P~ E.. PA Correspondenfs e-mail address: ;:::. AA-uN / G" r L:).;1.(C4S 7: AI lifT" Under penalties of plIIjury, I declar8lhat I have examined this telum. including acc:ompanylng schedules and 1Il8t8ments, and to lha beet of my knowledge and belief. it Is !rue, conect and complet8. Dec:laratlon of preperer other than lha p8I1OIl8l repreMntatIve Is baed on an Information of which preperer has any knowledge. SIG~RI_~F PERSON1E~SIBLE~ FILING RETURN DATE ~~~~~ ~~9~~ ",OORESS &~) S"7/PA-rX /-IA-v'€N Ac/~J./(7~ 5t.vA~~A/(P,e€ /?A /?~tf"/ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE) / DATE I\OORESS PLI!A8I! USE ORIGINAL PORM ONLY Side 1 L 1S05bOS1047 1S0SbOSJ.Olf7 ....J 0b ....J 1505b052048 REV-1500 EX Oecedent's Name: RECAPITULATION 1. Real estate (Schedule A). ............................ . . . . . . ., .. . .. .,. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or SoIe-ProprietorshIp (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & MisceUaneous Personal Property (Schedule E) . . . . . . .. 5. 6. JoinUy Owned Property (Schedule F) c:::> Separate Billing Requested . . . . . .. 6. 7. Infer-VIVOS Transfers & MIscellaneouS Non-Probafe Property (Schedule G) c:::> Separate BIlling Requested.. . . . . .. 7. 8. Total Gr'oM Aueta (total Unes 1-7). . . .. . .. .. . .. .. . .. .. .. .. .. .. . .. .. ... 8. 9. Funeral Expenses & Administrative Cosl& (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent. Mortgage UablIitIes, & Uens (Schedule I). . .. ........... . 10. 11. Total Deduc:ttons (total Unes9& 10)................................... 11. 12. Net V.... of EstBIa (Une 8 moos Une 11) ... . . . . . ... . .. . .. . . . . . . ... .. . . 12. 13. Charitable and Governmental BequeslsISec 9113 Trusls for which an eIecliontotax has not been made (Schedule J) ..................... ...13. 14. Net YlIIue Subject to To (Une 12 mioos Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTAnON . SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Une 14 taxable at lineal rate X.O _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESnNG A REFUND OF AN OVERPAYMENT Side 2 L 1505b052048 Decedent's SocIal Security Number ."-,' "--"';itIC,'l."'--."""'" ,..-,,,;..-.;'ti,,\'X"'~V':'-,,H.:,,-"':'..1.'Ij;,i\:!""-''''''"..;2.... c:::> 1505b0520lf8 ...J File Number CITY Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) 2. CreditslPayments A. Spousal PCMlfty Credit B. Prior Payments .C.Discourit (1) o Total Credits ( A + B + C ) (2) 3. InteleStIPenatl if applicable D. Interest E. Penalty TotaIlnterestn=lena1ty ( 0 + E ) 4. If Une 2 is greater than Une 1 + Une 3, enter the dilferenc:e. This is the OVERPAYMENT. Fill In OVII on 'age 2, Une 20 to request. ntfund. (3) (4) (5) (SA) (58) 5. If Une 1. + Une 3 is greater than Une 2, enter the dilferenc:e. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Una 5 + SA. This is the BAlANCE DUE. (J o Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent I1'I8ke a transfer and: Yes No a. retain the use 0( income oflhe properly transferred;.......................................................................................... 0 3 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 8 c. retain a nwersionary interest; 0(.......................................................................................................................... 0 g( d. receive the promise for life of either payments, benefits 0( care? ...................................................................... 0 1(1 2. If death occurred .. December 12, 1982, did decedent transfer property within one year of death without receMng adequate consideration? .............................................................................................................. 0 .&:I 3. Did decedent own an "in trust for" 0( payable upon death bank account or security at his 0( her death? .............. 0 );a 4. Did decedent own an Indivldual Retirement Aooount, annuity, 0( other I1ClI1-pIObete property which contains a beneficiary designation? .............................................................................................................,.......... 0 j;g IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [72 P.S. fi9116 (a) (1.1) (i)). FO/' dates of death on 0/' after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. fi9116 (a) (1.1) (ji)). 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 July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age 0/' younger at death to or fO/' the use of a natural parent, an adoptive parent, 0/' a stepparent of the child is zero (0) percent [72 P.S. S9116(a)(1.2)]. The tax rate imposed on the net value of transfers to 0/' for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent. except as noted in 72 P.S. fi9116(1.2) [72 P.S. fi9116(a)(1)). The tax rate imposed on the net value of transfers to 0/' for the use of the decedent's siblings is twelve (12) percent [72 P.S. i9116(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 0/' adoption. REV-I508 EX. (1.&7) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~MONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Uto (E.T J3A-UMf :JOO~ - OO~~7 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1.CA.sA - WAt::.AI:JVI4 I3A:Nk 3rr'73~ ~e1 ~. ;:'" ~. rA.I.o r~~ ....1P;q...L .()CC.en~N T C o~{s ... fiE.e.€.e ,c',hV'~/f,4 L. #I1.MAE. i LTJ). J ~ 5"'" IV t:' It~ c;... M r" ~ S" TIeE.~ T N "p.ou /'"D.vl\/' / PA t ?oo? / t:1', 3...5""1 ' ?" TOTAL (Also enteron lineS, Recapitulation) $ 10// ~:16: rcP (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) , " *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF 1/1 cJ Le. T ~A../'/J1<f Debts of decedent must be reported on Schedule I. FILE NUMBER ;) CJe7~ - OO~ "7 '/ ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. /Jt.e.. ;01'410 Ft::''''€~A-'e. A C(.oc.nV T CO~(.IE - ~e8l!tr 'r&lN"~If4.L ,JI,M'~ /' ~t:)~ N"'~~ c/NuJW .s:-r;f.~T M,t:>PC€ ~""N / ~A /705"? ~TO $' /0/ 361.. 'to 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 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 68',. Ot!J 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ /0 1 ~ /'?, ~, (If more space is needed, insert additional sheets of the same size) r-"'--- -- \ I . (I ., I ! COBLE-REBER FUNERAL HOME, LTD. A .2;//. Yf::,t'/'m!,('.n'. Home Mrs. Rita German 1131 Country Club Road Camp Hill, PA 17011 FOR THE FUNERAL SERVICE OF: VIOLET S. BAUM, April 21,2006 PROFESSIONAL SERVICE CHARGE: OTHER STAFF & RELATED FACILITIES CHARGE: TRANSPORTATION CHARGE: MERCHANDISE: Batesville, 4NP Hartfield, Solid Hardwood Casket Eagle, Sentinel, Concrete Burial Vault with Nameplate Memorial Folders I Prayer Cards Register Book Stone Engraving 208 North Union Street Middletown, PA 17057 Phone: (717) 944-7413 Fax: (717) 944-3939 Brendan J. McGlone, Supervisor .. 2,255.00 900.00 795.00 3,695.00 1,325.00 45.00 40.00 190.00 9,245.00 Total Funeral Charges CASH DISBURSEMENTS: Cemetery Cemetery Equipment Certified Copies Harrisburg Patriot News Middletown Press & Journal 600.00 125.00 60.00 134.10 58.28 Total Cash Disbursements Balance Prepaid Funds Balance Due ....... PAID IN FULL ...... THANK YOU ..... 977.38 -------f(f,222:38 10,351.90 $ -129.52 Coble-Reber Funeral Home is a Proud member of the Life Ce.lebration'. Provider Services Network www.lifecelebration.com , i I I I I i , i I . I I Ii I i i i I I i I ! I I i I I I I I I ' II REV-151~ EX+ (12-03) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABIUTIES, & UENS ESTATE OF ITEM NUMBER 1. FILE NUMBER ~~~- aoc;. z> Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. VALUE AT DATE OF DEATH ". :3 t?'06; ~CJ DESCRIPTION CO<<M~WE~~ aP ~t~~ /JEpr 0 P /:;)v/3(..Jt:.. U/1ZC-rAlrtE 15 s "T'l9- r:e: ~ E C-OI./ ~If. Y ? Ifp () If ,4.tYf r'~ ~"J( ~'(~~ /-i~IP~/S/j&/te~ /.pA- /?/tJ.s- 1/ / tt:' LE r 84v M 'TOTAL (Also enter on line 10, Recapitulation) $ 38" CJ 6':. 6 t!> (If more space is needed, insert additional sheets of the same size) '* COMMONWEALTH OF PENNSYlVANIA OEPIIRTMENT OF PUBLIC WElFARE BUREAU OF FINANCIAl OPERATIONS TPl SECTION - CASUAl TV UNIT PO BOX 8486 HARRISBURG PA 17105-8486 October 5, 2006 STATEMENT OF CLAIM SUMMARY . Estate of BAUM, VIOLET. 820 176072 INPATIENT OUTPATIENT LONG TERM CARE DRUG .00 .16 22,677.39 31.54 .00 .00 25,724.06 1,357.57 .00 .16 48,401.45 1,389.11 22,709.09 27,081.63 49,790.72 . . ", LAST WILL AND TESTAMENT OF VIOLET S. BAUM I, VIOLET S. BAUM, having my legal residence at 621 Vine Street, Middletown, Dauphin County, Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other wills and codicils heretofore made by me. 1. I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. 2. I devise and bequeath all of the remainder of my estate and property, of whatsoever nature and wheresoever situate, to my husband, TRUMAN M. BAUM, if he survives thirty calendar days after my death. I intentionally make no devise to my children should my husband, TRUMAN M. BAUM, survive me by thirty cal- endar days for the reason that I am confident that he will provide adequately for l any children now living or hereafter born to us. 3. If my husband, TRUMAN M. BAUM, does not survive thirty calendar \....., days after my death, then I devise and bequeath all of the remaifl~er of ~ est~t~ .....: ~:~~ .~'"" ;"71 (2 and property, of whatsoever nature and wheresoever situate, to rli~?~su~ pe~;~ a : ,-~.\~~. T1 , t-; J f}1 ....:::.:J I'" ....JO '-"j) ;>~ \~~~~~ \f~ ,.'~-; z;-.-~ ~~ - '~".~J - I '_. , :: (:-:> 4. All estate, inheritance, succession and other death Jtiiixes, Impd~~~~~ :.'. w-n or payable, by reason of my death, and interest and penalties the~eon, wi~ respect stirpes, who so survive, in equal shares. to all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the principal of my gen- eral estate, as if such taxes were administration expenses, without apportionment or right of reimbursement. I authorize my Personal Representative to pay all such taxes at such time or times as may be deemed advisable. 5. I appoint my husband, TRUMAN M. BAUM, Executor of this Will and direct that he be permitted to serve without bond and without any intervention of any court, except as required by law. I authorize my Executor to sell, encumber, /f, . J:" /'\/::11:/ 2?:.-~;d~T.~~<7.' V~'%-~L~"t-.<- V/7/t;?C .. ~ .~ mortgage, invest, distribute in kind, or retain any items of property of my es- tate in such manner as he shall deem proper, limited only by his own discretion. If for any reason my Executor appointed under this Will should fail to serve in that capacity, I appoint my son, EDWARD E. BAUM, my Executor, with the same powers and privileges set forth above. IN WITNESS WHEREOF, I have at Middletown, Pennsylvania, this /7--5day of June, 1966, set my hand and seal to this my Last Will and Testa- ment consisting of two pages. 0'/ r/ ~) .;' Y -- - .... t"/' ~t-ftt~.' BA'/ Mat~4'~"L,. (SEAL) Signed, sealed, published and declared by the above named VIOLET S. BAUM, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. .~. -----'. ~J ',/,/ ,I' / < ,r1-- .,., ~ ,/ , ,,' . > . ; '"~~ _~C/L7 residence: "I5~~.L~,il ~I . / " _' ':f l;~) /: - - f l _ . ;:::. -'.,,' / ...\.~ '~~'-'''l I kif,!, ,-",/th, 1I/~ /[/ ' / .,h... {/ ~/ ~ /.' ~U.; 2'-~ residence:, 5.., ",,'10M. xii :Ii" 'I }; .. . . .~ZM~~--~ jQ': , C] :---.',8 1 "-i-1 ,"::.. I::) r--- r-n ':.0 ?" 3~ "0_"- -' :0 '-"1 r-.:> = = Cr" :U" C:: G"J , I""':; ~ -o.t~ - - .. iJt!~ ~3 , " _.) t~c3 r""; rTl -::uc::i (..) c:::> "" --11 -,.. o JTl :: :~) (-) l.- W ..0 ---...~ ~ .>.! _1- ~ <:C <.Oo~ r- 0-;. ;' thM '8Cl\jJ- .01 I o.......f;J:.r:tl'2,l{).::. <:cOa ("la J,o..~~7gr;; . ~ ~O ? <:C ~ \..Q r- ~ 5~ ~~ '^~ ~\~ !::~ H ~ - -; -= -: -= - -; ::; ~ 1 ... ~ g-; a=::' -; - ~ ~ ~ ~ ~ t<\ ~ \ \'C\ , ~ I' .~ ~ ~ '" ~ ~ _ ,...l c;:l '=--- ~ ~-~ I=.=