HomeMy WebLinkAbout11-22-06
--.J
15056041147
REV.1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes ~
PO BOX.280601 ~
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN 21 06
RESIDENT DECEDENT
Fila Number
00855
168016846
08292006
Date of Birth
04011916
Decedent's last Name
Suffix
Decedent's First Name
VIVIAN
MI
L
BERG
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WillS
FILL IN APPROPRIATE OVALS BELOW
D 1. Original Return
D 4. Limited Estate
[K]
D
6. Decedent Died Testate
(Attach Copy of Win)
D 2. Supplemental Return D 3. Remainder Return (date of death
prior to 12-13-82)
D 4a. Future Interest Compromise D 5. Federal Estate Tax Return Required
(dete of death after 12-12-82)
D 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
'-
D 10 Spousal Poverty Credit ~date of death D 11. Election to tax under Sec. 9113(A)
. between 12-31-91 and -1-95) (Attach Sch. 0)
9. litigation Proceeds Received
~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
IVO V. OTTO III 7172433341
Firm Name (If Applicable)
MARTSON DEARDORFF WILLIAMS
City or Post Office
CARLISLE
State
PA
ZIP Code
17013
REGISTERAF WillS US~NL Y
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DAT~LED ~
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First line of address
10 EAST HIGH STREET
Second line of address
s:-
Correspondent's 8-mall address:
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 DATE
R. David Berg
ADDRESS
/::/2 ~/oG
232 Pine Road, Mount HolI Sprin s, PA 17065
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Ivo V. Otto III
10 East High Street, Carlisle, PA 17013
ADDRESS
L
Side 1
15056041147
15056041147
--.J
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],5056042L48
REV-1500 EX
Decedent's Name:
VIVIAN L. BERG
Decedent's Social Security Number
168016846
RECAPITULATION
1. Real Estate (Schedule A).......................................................................................... 1.
2. Stocks and Bonds (Schedule B)............................................................................... 2.
234,834.20
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D).......................................................... 4.
5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5.
290,570.76
6. Jointly OWned Property (Schedule F) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested............. 7.
9. Funeral Expenses & Administrative Costs (Schedule H)......................................... 9.
525,404.96
45,442.36
18,147.60
63,589.96
461,815.00
8. Total Gross Assets (total Lines 1-7)....................................................................... 8.
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)................................ 10.
11. Total Deductions (total Lines 9 & 10)...................................................................... 11.
12. Net Value of Estate (Line 8 minus Line 11)............................................................. 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 1"'4"taX8ble
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
461,815.00
o . 00
15. o . 00
16. 20,781.68
17. o . 00
18. 0.00
19. 20,781.68
461,815.00
o . 00
0.00
19. Tax Due.... .......... .............................................................,....... ....... ...........................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
D
Side 2
L
L5056042148
L5056042148
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-06-00855
DECEDENT'S NAME
VIVIAN L. BERG
STREET ADDRESS
232 Pine Road
CITY I STATE /ZIP
Mount Holly Springs PA 17065
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditsJPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
20,781.68
1,039.08
3. InterestJPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
1,039.08
TotallnterestlPenalty (0 + 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)
(SA)
(58)
19,742.60
19,742.60
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:
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? ............ ...... ......................... ............................ ..... ................. ........... .............. 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 [!]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Yes No
~ ~
[!]
[!]
~~'" ~~ ~ &~~ t~I~:'~,~? ;,;~:" ;; ....~.:;' I} ~~i'~ ~~;;~ !;~*~~~~~if.:~~~~~~~ ~ h~~~~~~~~:~~\.~ ~ ! tt~~:t,~1t?~~~.~~f$~~,r ~ tJrrt&}~;~ ~~?m~~ ~ l$!(:~:<< ~ ~~~~:~~ -~.; . ~"~~,;;
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. ~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 zero
(0) percent (72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemDt 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 zero (0) percent [72 P.S. ~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 four and one-half (4.5) percent,
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 twelve (12) percent [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.
Rev-1503 EX+ (8-98)
'*
SCHEDULE B
STOCKS & BONDS
COMMONYIIEAI.. TH OF PENNSYLVANIA
~HERITANCETAXRETURN
RESiDeNT DECEDENT
BERG, VIVIAN L.
FILE NUMBER
21-06-00855
ESTATE OF
All property Jolntly-owned with right of survlvol'lhlp must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 783859101 7686 shares S & T Bancorp Inc - Com 30.5535 234.834.20
TOTAL (Also enter on Line 2, Recapitulation) 234.834.20
(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 B (Rev. 6-98)
Rev-11GB EX+ (6-8Bl
*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESlOENT DECEDENT
BERG, VIVIAN L.
FILE NUMBER
21-06-00855
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jolntly-owned with the right of survivorship mUlt be dlscloeed on schedule F.
ITEM
NUMBER DESCRIPTION
1 PNC Bank, - Checking #5003249197
VALUE AT DATE
OF DEATH
221.883.15
2 Countrywide Bank - Money Market #9200134588
16.256.89
3 Countrywide Bank - C.D. #9602008679
48.230.72
4 2001 Hyuandai Sonata GLS
4.200.00
TOTAL (Also enter on Line 5, Recapitulation)
290.570.76
(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'" (12-89)
*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
BERG, VIVIAN l.
FILE NUMBER
21-06-00855
ESTATE OF
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
See continuation schedule(s) attached
6,407.81
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
R. David Berg
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address 232 Pine Road
City Mount Holly Springs
Year(s) Commission paid 2006-2007
State P A
Zip 17065
18,762.00
2.
Attorney's Fees
Martson Deardorff Williams & Otto
19,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
456.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
See continuation schedule(s) attached
316.55
TOTAL (Also enter on line 9, Recapitulation)
45,442.36
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
R8Y.1502 EX+ (6-B8)
'*
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BERG, VIVIAN L.
FILE NUMBER
21-06-00855
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Joseph J. Chiusano, Pittsburgh, PA - Monument lettering
160.00
2
Saxman Funeral Homes, Ltd, - Funeral and burial expenses
6.247.81
Subtotal
6.407.81
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1102 EX+ (6-98)
'*
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COt.HONWEAL. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BERG, VIVIAN L.
FILE NUMBER
21-06-00855
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Register of Wills - Filing fee, inheritance tax return
15.00
2
Register of Wills - Additional probate fee
50.00
3
EVP - Stock valuation
1.55
4
Reserved for filing fees, postage and miscellaneous expenses
250.00
Subtotal
316.55
Copyright (c) 2002 form software only The Lackner Group, Inc.
FormPA-1500 Schedule H-B7 (Rev. 6-98)
R.v-U12 EX+ (1"8'
*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RET\JRN
RESIDENT DECEDENT
BERG, VIVIAN L.
FILE NUMBER
21-06-00855
ESTATE OF
Includ. unrelmburs.d medical .xpen....
ITEM
NUMBER DESCRIPTION
1 Sandy Ridge Homes, account payable, assisted living
VALUE AT DATE
OF DEATH
486.39
2 U.S. Steel, supplemental health insurance, account payable
302.00
3 U.S. Treasury - 2006 individual income tax, balance due
12.917.00
4 PA Dept. of Revenue - 2006 individual income tax, balance due
3.341.00
5 Outstanding medical expenses, decedent's co-pay
1.101.21
TOTAL (Also enter on Line 10, Recapitulation)
18,147.60
(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)
REV-1I13 EX+ (8-00)
*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
BERG, VIVIAN L.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions,.: and transfers
under Sec. ~116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not Ust Truatee(a)
I.
1
R. David Berg
232 Pine Road
Mount Holly Springs, PA 17065
Son
2
Thomas W. Berg
2605 West Bobwhite Lane
Chino Valley, AZ 86323
Son
FILE NUMBER
21-06-00855
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
230;907.50
230,907.50
Total 461,815.00
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, 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
For the year Jan 1 - Dec 31, 2005, or other tax year beginning ,2005, endine ,20 OMS No. 1545-0074
label Your first name MI Last name Your social security number
(See instructions.) Vivial L Berg 162-34-9882
If a joint return. spouse's first name MI Last name Spouse's social security number
Use the
IRS label.
Otherwise, Home address (number and street). If you have a P.O. box. see instructions. Apartment no. You must enter your
please print pine Road ! social security !
or type. 232 number(s) above.
City, town or post office. If you have a foreign address, see instructions. State ZIP code
Presidential Hollv S'Prinqs Checking a box below will not
lit PA 17065 change your tax or refund.
u.s. Individual Income Tax Return
( ~<AF/)
2006
1(99)
IRS Use Only - Do not write or staple in this space
Form 1040
DECEASED Vivial L Berg 08/29/2005
Department of the Treasury - Internal Revenue Service
ElectIon
Campaign
If more than
four dependents,
~ Check here if you, or your spouse if filing jointly, want $3 to go to this fund? (see instructions) . . . . . . . . . . . . . . . . ~ 0 You 0 Spouse
1 X Single 4 Head of household (with qualifying person). (See
2 Married filing jointly (even if only one had income) instructions.) If the qualifying person .is a child
but not your dependent, enter thiS child's
3 Married filing separately. Enter spouse's SSN above & full name here. ~
name here. . ~ 5 0 Qualifying widow(er) with dependent child (see instructions)
~O:~~~f..I.f. ~~~~~~.e. ~~.~ ~.I~i.~. ~~~. ~~. ~ .~~~~~.~~~~'. ~~. ~~.t.~~~~~. ~~~. ~~: : : : : : : : : : : : =~ ::~:a:;I::'
(2) qependent's (3) Depend~nt's (4) if ~n ~c who:
C Dependents: social secunty relationship qualifyinQ. hved
number to you child for child with you . . . . .
tax credit . did not
1 First name Last name (see IOstrs) live with you
due to divorce
or separation
(see Instrs) . . .
Dependents
on 6c not
entered above .
1
Filing Status
Check only
one box.
Exemptions
see instructions. I Add numbers .\ 1\
. . on lines ~
d Total number of exemptIons claimed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . above.. . . .
7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Income 8a Taxable interest. Attach Schedule B if required. . ....... . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . 8a 2,260.
b Tax-exempt interest. Do not include on line 8a. . . . . . . . . . . . . .l!!!1
Attach Form(s) 9a Ordinary dividends. Attach Schedule B if required. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9a 12,777.
W-2 here. Also b ~~If~~~ .................................................1 9bl 12, 777 .
attach Forms 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) . . . . . . . . . . . . . . . . . . . . . . 10
W-2G and 1099-R
if tax was withheld. 11 Alimony received ............................ I....................................... 11
12 Business income or (loss). Attach Schedule C or C-EZ.... " . . .. . . . . . . . . . . . . .. . . .. . . .. . . 12
If you did not 13 Capital gain or (loss). Att Sch D if reqd. If not reqd, ck here. . . . . . . . . . . . . . . . . . . . . . . . . . ~ 0 13 90,103.
get a W-2,
see instructions. 14 Other gains or (losses). Attach Form 4797 . . . . . . .. .. ....... . . . . . . . . . . . . . . . . . . . . . . . . . . .. 14
15a IRA distributions. . . . . . . . . . .~ I b Taxable amount (see instrs) . . 15b
16a Pensions and annuities .... 16a. b Taxable amount (see instrs) . . 16b 1,277.
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E. . 17
Enclose, but do 18 Farm income or (loss). Attach Schedule F. . . . .. . . . .. . ., . .... . . . . . . . . . . . . . . . . . . . . .. . . . . . 18
not attach, any 19 Unemployment compensation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
payment. Also, 20a Social security benefits. . . . . . . . . ~I 9,464.1 b Taxable amount (see instrs) . . 20b 8,044.
please use
Form 1040-V. 21 Other income 21
--------------------------------------
22 Add the amounts in the far rioht column for lines 7 through 21. This is vour total income~ 22 114,461.
23 Educator expenses (see instructions). . . . . . . . . . . . . . . . . . . . . . . 23
Adjusted 24 Certain business expenses of reservists, performing artists, and fee-basis . ..
Gross government officials. Attach Form 2106 or 2106-EZ . . . . . . . . . . . . . . . . . . . . 24
Income 25 Health savings account deduction. Attach Form 8889.. " . . . . 25
26 Moving expenses. Attach Form 3903 . . . . . . . . . . .. . . . . . . . . . . . 26
27 One-half of self-employment tax. Attach Schedule SE. . . . . . . 27
28 Self-employed SEP, SIMPLE, and qualified plans. . . . . . . . . . . 28
29 Self -employed health insurance deduction (see instructions) . . . . . . . . . . . . . 29
30 Penalty on early withdrawal of savings. . . . . . . . . . . . . . . . . . . . . 30
31 a Alimony paid b Recipient's SSN . . . . ~ . . 31 a
32 IRA deduction (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
33 Student loan interest deduction (see instructions) . . . . . . . . . . . 33
34 Tuition and fees deduction (see instructions). . . . . . . . . . . . . . . . 34
35 Domestic production activities deduction. Attach Form 8903 . . . . . . . . . . . . . . 35
36 Add lines 23 - 31 a and 32 - 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............. . 36
37 Subtract line 36 from line 22. This is your adjusted gross income. . . . . . . . . . . . . . . . . . . . . ~ 37 114,461.
BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
.5'C.H L J I~ 3
FDIA01l2 11/07/05
Form 1040 (2005)
Form 1040 (2005) Vivial L Berg 162-34-9882 Page 2
Tax and 38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 114,461.
Credits 39. Check -[ ~ You were born before Janua,!, 2, 1941, B Blind, T olal boxes to!
If: Spouse was born before January 2, 1941, Blind. checked ~ 39a 1
Standard I b If your spouse itemizes on a separate return, or you were a dual-status
Deduction _ allen, see instructions and check here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 39b 0
for -
· People who 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin). . . . . . . . . . . . . . . . . . . . . 40 6,250.
checked any box r-41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 108,211.
on line 39a or 42 If line 38 is over $109,475, or YOu~rovided housing to a person displaced by Hurricane Katrina, see
39b or who can
be claimed as a instructions. Otherwise, multiply ,200 by the total number of exemptions claimed on line 6d . . . . . . . . . . . . . . . . 42 3,200.
dependent, see 43 Taxable income. Subtract line 42 from line 41.
instructions. If line 42 is more than line 41, enter -0- ....................................................... 43 105,011.
44 Tax (see instrs). Check if any tax is from: a o Form(s) 8814 b 0 Form 4972 .. . . . . . . . . . . . . . . . . . . . . . . 44 12,889.
· All others: 45 Alternative minimum tax (see instructions). Attach Form 6251. . . . . . . . . . . . . . . . . . . . .. . . . . . 45
Single or Married 46 Add lines 44 and 45. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... . ~ 46 12,889.
filing separately, 47 Foreign tax credit. Attach Form 1116 if required............. 47
$5,000 .....
48 Credit for child and dependent care expenses. Attach Form 2441 .......... 48
Married filing 49 Credit for the elderly or the disabled. Attach Schedule R. . . . . 49
jointlx or
Qualifying 50 Education credits. Attach Form 8863 . " . . . . .... . . . . . . . . .... 50
widow(er), 51 Retirement savings contributions credit. Attach Form 8880. . . 51
$10,000
52 Child tax credit (see instructions). Attach Form 8901 if required. . . . . . . . . . . 52 ;'
Head of 53 Adoption credit. Attach Form 8839 . . . . . . .... .. . . ., . . . . . .. .. 53
household, Credits from: a 0 Form 8396 b 0 Form 8859 . . . . . . . . . . . . . . . .. 54 ;
$7,300 54 ':;
55 Other credits. Check applicable box(es): a D Form 3800 iC'!]i.;i! i. 'j
b 0 Form c DForm 55
8801
56 Add lines 47 through 55, These are your total credits..... ... .. .. .. . '" . . .. . . . . . . . . . . . . . 56
57 Subtract line 56 from line 46. If line 56 is more than line 46, enter -0-. . . . . . . . . . . . . . . . . . ~ 57 12,889.
58 Self-employment tax. Attach Schedule SE ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Other 59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 . . . . . . . . . . . . . . . . . . 59
Taxes 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required. . . . . . . . . . . . . . . . . . . 60
6l Advance earned income credit payments from Form(s) W.2. .. . . . . . .. . . .. . .. ....... . . . . . 61
62 Household employment taxes. Attach Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
63 Add lines 57-62. This is your total tax. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 63 12,889.
Payments 64 Federal income tax withheld from Forms W-2 and 1099...... 64 ....
65 2005 estimated tax payments and amount applied from 2004 return . . . . . . . . 65 .ii)
If you have a L
qualifying 66a Earned income credit (EIC)................. ............... 66a b\>>:
child. attach I b Nontaxable combat pay election. . . . . ~~ >:~/:,~{j;-';'-
Schedule Erc. ~'<. ....
67 Excess social security and tier 1 RRTA tax withheld (see instructions). . . . . . . 67 .....
68 Additional child tax credit. Attach Form 8812. . . .. ., . . " ... . . 68 ...
69 Amount paid with request for extension to file (see instructions) . . . . . . . . . . 69 .......
70 Payments from: a 0 Form 2439 b D Form 4136 c D Form 8885 70 .....>C
71 Add lines 64. 65. 66a. and 67 through 70. ~ 71
These are your total payments ....,.......................................................
Refund 72 If line 71 is more than line 63, subtract line 63 from line 71. This is the amount you overpaid. . . . . . . . . . . . . . . . 72
Direct deposit? 73a Amount of line 72 you want refunded to you. . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . '. . . . . . . . . ~ 73a
See instructions ~ b Routing number. . . . . . . ., I ~ c Type: llihecking D Savings .<
and fill in 73b, .....
73c, and 73d. ~ d Account number ....... I
74 Amount of line 72 you want applied to your 2006 estimated tax. . . . . . . . ~l~
Amount 75 Amount you owe. Subtract line 71 from line 63. For details on how to pay, see instructions. . . . . . . . . . . . . . . ~ 75 12,917.
You Owe 76 Estimated tax penaltv (see instructions) . . . . . . . . . . . . . . . . . . ..1 76 I 28 . '. .' > ....
:
hird Pa Do you want to allow another person to discuss this return with the IRS (see instructions)? . . . . . . . . .. U Yes. Complete the following. ~No
T rty
Designee
Sign
Here
Deslgnee's Phone Personalldentlflcabon
name ~ no. ~ number (PIN) ~
Under penalties of perjury. I declare that I have examined this return and accompanying schedules and statements. and to the best of my knOWledge and
belief, they are true. correct. and complete. Declaration of preparer (other than taxpayer) IS based on all information of which pre parer has any knowledge.
Joint return? Your signature Date Your occupation Daytime phone number
See instructions. ~ Retired (717) 486-4347
Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation
for your records. ~
I Date I Check if self-employed n Preparer's SSN or PTIN
Pre parer's ~
Paid signature
Preparer's Firm's name Self-Prepared
(or yours if ~
Use Only self.employed) EIN
address. and
ZIP code Phone no.
Form 1040 (2005)
FDIA0112 11/07/05
-I
0500210398
PA.40 - 200f
Social Security Number
162349882
Name(s) V i V i alL Be r 9
12 PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307).
13 Total PA Tax Withheld. See the instructions.
14 Credit from your 2004 PA Income Tax return.
15 2005 Estimated Installment Payments.
16 2005 Extension Payment.
17 Nonresident Tax Withheld from your PA Schedule(s) NRK.1. (Nonresidents only)
18 Total Estimated Payments and Credits. Add Lines 14, 15, 16, and 17.
Tax Forgiveness Credit.
19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased
19b Dependents, Part B, Line 2, PA Schedule SP
20 Total Eligibility Income from Part C, Line 11, PA Schedule SP.
21 Tax Forgiveness Credit from Part D, Line 16. PA Schedule SP.
22 Resident Credit. Submit your PA Schedule(s) G and/or RK.1.
23 Total Other Credits. Submit your PA Schedule OC.
24 TOTAL PAYMENTS and CREDITS. Add Lines 13 and 18,21,22, and 23.
25 TAX DUE. If Line 12 is more than Line 24, enter the difference here.
26 Penalties and Interest. See the instructions.
If attaching form REV-1630, mark the box.
27 TOTAL PAYMENT. Add Lines 25 and 26.
28 OVERPAYMENT. If Line 24 is more than the total of Line 12 and Line 26, enter
the difference here.
The total of Lines 29 through 35 must equal Line 28.
29 Refund - Amount of Line 28 you want as a check mailed to you. Refund
30 Credit - Amount of Line 28 you want as a credit to your 2006 estimated account.
31 Amount of Line 28 you want to donate to the Wild Resource Conservation Fund.
32 Amount of Line 28 you want to donate to the Military Family Relief Assistance Program.
33 Amount of Line 28 you want to donate to the Governor Robert P. Casey Memorial
Organ and Tissue Donation Awareness Trust Fund.
34 Amount of Line 28 you want to donate to the Juvenile (Type 1) Diabetes Cure
Research Fund.
35 Amount of Line 28 you want to donate to the Breast and Cervical Cancer
Research Fund.
(/)I!.A PI)
L
12
13
3228
o
14
15
16
17
18
o
o
o
o
o
19a
19b
20
21
00
00
o
o
22
23
24
25
26
o
o
o
3228
113
y
27
28
3341
o
29
30
31
32
33
o
o
o
o
o
34
o
35
o
Your Signature
Date
Spouse's Signature. it tilmg jointly
Preparer's Name and Telephone Number
Self-Prepared
Page 2 of 2
L
0500210398
~H I > -L~ L/
Preparer's SSN/PTIN/EIN
I
I
PAIA0412 01111/06
0500210398
-I
df ,0(0 - 6~SS
LAST WILL AND TESTAMENT
OF
VIVIAN L. BERG
I, Vivian L. Berg, of Delmont, Pennsylvania, revoke my former Wills and Codicils and declare
this to be my Last Will and Testament. g
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I am married to Ralph Berg and all references in this Will to "my spouse" are referel1~ to Ral$.
. ~ ..
B~ ~ ~
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ARTICLE I
IDENTIFICATION OF FAMILY
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The names of my children are:
R. David Berg
Thomas W. Berg
All references in this Will to "my children" are references to the above-named children.
ARTICLE n
PAYMENT OF DEBTS AND EXPENSES
I direct that my just debts, funeral expenses and expenses of last illness be frrst paid from my
estate.
ARTICLE m
DISPOSmON OF PROPERTY
A. Residuary Estate. I direct that my residuary estate be distributed to my spouse, Ralph Berg.
If my spouse does not survive me, my residuary estate shall be distributed to my child( ren) in
equal shares. If a child of mine does not survive me, such deceased child's share shall be
distributed in equal shares to the children of such deceased child who survive me, by right of
representation. If a child of mine does not survive me and has no children who survive me, such
deceased child's share shall be distributed in equal shares to my other children, if any, or to their
respective children by right of representation. If no child of mine survives me, and if none of my
deceased children are survived by children, my residuary estate shall be distributed to the
following beneficiaries in the percentages as shown:
50.00% to my heirs-at-Iaw, their identities and respective shares to be determined under
the laws of the State of Pennsylvania, then in effect, as if I had died intestate at the time
fixed for distribution under this provision.
50.00% to my spouse's heirs-at-Iaw, their identities and respective shares to be
determined under the laws of the State of Pennsylvania, then in effect, as if my spouse
Initials: ~_
.
had died intestate at the time fixed for distribution under this provision.
Percentages Total- 100.00%
ARTICLE IV
NOMINATION OF EXECUTOR
I nominate R. David Berg, of Germantown, Maryland, as the Executor, without bond or security.
ARTICLE V
EXECUTOR POWERS
My Executor, in addition to other powers and authority granted by law or necessary or
appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or
otherwise encumber any real or personal property that may be included in my estate, without
order of court and without notice to anyone.
My Executor shall have the right to administer my estate using "informal", "unsupervised", or
"independent" probate or equivalent legislation designed to operate without unnecessaty
interv~ntion by the probate court.
ARTICLE VI
MISCELLANEOUS PROVISIONS
A. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for
reference purposes only and are not to be considered as forming a part of this Will in interpreting
its provisions. All words used in this Will in any gender shall extend to and include all genders,
and any singular words shall include the plural expression, and vice versa, specifically including
"child" and "children", when the context or facts so require, and any pronouns shall be taken to
refer to the person or persons intended regardless of gender or number.
B. Thirty Day Survival Requirement. For the purposes of determining the appropriate
distributions under this Will, no person or organization shall be deemed to have survived me
unless such person or entity is also surviving on the thirtieth day after the date of my death.
C. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of
fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my
estate shall indemnify such natural person from any and all claims or expenses in connection
with or arising out of that fiduciary's good faith actions or nonactions as the fiduciary, except for
such actions or nonactions which constitute fraudulent conduct or bad faith.
D. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or
among two or more beneficiaries, the specific items of property comprising the respective shares
shall be determined by such beneficiaries if they can agree, and if not, by my Executor.
-2-
Initials: J/8 _
.
t1-:
IN WITNESS WHEREOF, I have subscribed my name below, this -1...:" day of
oft-tAbu ,19~.
4/~ -A~A/X b~~
Vivian 1.:. Berg
We, the undersigned, hereby certify that the above instrument, which consists of
pages, including the page( s) which contain the witness signatures, was signed in our sight and
presence by Vivian 1. Berg (the "Testator"), who declared this instrument to be his/her Last Will
and Testament and we, at the Testator's request and in the Testator's sight and presence, and in
the sight and presence of each other, do hereby subscribe our names as witnesses on the date
shown above.
Name:
City:
State:
CLi97f2-U~
(7/;~/ /1J4~f ~ dA-
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r;,"~aU...S.6v 1ft Pi /Sb 0 I
,
Witness Signature:
Witness Signature:
~
Name:
City:
State:
-3-
Initials: ;/9_
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
OTTO IVO VICTOR III
10 E HIGH STREET
CARLISLE, PA 17013
nn____ fold
ESTATE INFORMATION: SSN: 168-01-6846
FILE NUMBER: 2106-0855
DECEDENT NAME: BERG VIVIAN L
DA TE OF PAYMENT: 11/22/2006
POSTMARK DATE: 11/22/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 08/29/2006
NO. CD 007468
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $19,742.60
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$19,742.60
REMARKS:
CHECK#109
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS