HomeMy WebLinkAbout12-06-06
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
SEEBER EDWARD PETER ESQUIRE
SUITEE 200
1 205 MANOR DRIVE
MECHANICSBURG, PA 17055
-------- fold
ESTATE INFORMATION: SSN: 174-20-0476
FILE NUMBER: 2106-0687
DECEDENT NAME: VIERING ARLENE M
DA TE OF PAYMENT: 12/06/2006
POSTMARK DATE: 1 2/06/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 07/03/2006
NO. CD 007527
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,838.38
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$4,838.38
REMARKS:
CHECK#1006
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
December 5, 2006
Glenda Farner Strasbaugh, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, P A 17013-3387
Re: Estate of Arlene M. Viering, deceased
File No. 2006-00687
Dear Ms. Strasbaugh:
Enclosed are the following documents for filing with your office for the above-
referenced Estate:
1. An original and two (2) copies of the Pennsylvania Inheritance Tax
Return.
2. An original and two (2) copies of the Inventory.
3. A check in the amount of Four Thousand Eight Hundred Thirty-eight
and 38/100 Dollars ($4,838.38) payable to the "Register of Wills,
Agent" representing the additional Pennsylvania Inheritance Tax due.
4. A check in the amount of Thirty Dollars ($30.00) representing the
filing fee for the Return and Inventory.
Please time-stamp the extra copies and return them to me in the enclosed self-
addressed, stamped envelope.
If you have any questions, please feel free to contact me.
(")
<:=0
S:s :0
'!1 -0 ("")
-~~gj
~:=::- Cf) ^
..Joo
CyOIi
.::;c
~ ::0
::-0-4
).>
-_....~-..-'~'-~ ," .,.,
Enclosures
cc: Fae Sturn McMillen, Executrix
THE
ESTAtE
SECURITY
FORMULAn.!
Gary L. James
glj@jsdc.com
........,
c:;)
<=:)
~
o
f'T1
(""')
I
C"\
"
:x
~
::0
:I:Jrn
f"T-! C)
(;)0
G ::tJ
-; c.:::J
['Irq
:no
(:~ c::>
; 1 ,.'1
.,
~
1
(. r.o _.)
_f ...- {~._ ,
U1
134 SIPE AVENUE
HUMMElSTOWN, PA 17036
MAILING ADDRESS
P.O. BOX 650
HERSHEY, PA 17033
TOll FREE 1.800.942.3660
TEL. 717.533.3280
FAX 717.533.7771
www.jsdc.com
~
r
11
. '.
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of
Arlene M. Viering
No.
Date of Death
2006-00687
07/03/2006
also known as
Arlene K. Viering
, Deceased
Social Security No. 174-20-0476
Fae Stum McMillen
The Personal Representative{s} of the above Estate, deceased, verify that the Items appearing In the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each Item of said Inventory represents Its fair value as of the date of
the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except
that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made In this Inventory
are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S.
Section 4904 relating to unsworn falsification to authorities.
I.D. No.:
Gary L. James, Esq.
27752
Personal Reoresentative
~
Signature: 4CUL ~ me. ()1.1'On~<.
Fae Stum McMillen
Attorney:
Signature:
James, Smith, Dietterick & Connelly,
LLP
Signature:
Firm:
Address:
Telephone:
134 Sipe Avenue
Hummelstown, PA 17036
717/533-3280
Address: 116 Horners Road
Carlisle, PA 17013
Telephone: 717-243-3634
Dated:
1~~-oL
Personal ProDertv
Cash.............................................................................................. .
Personal Property....... ..................................................................
Stocks/Listed.................................................................................
Stocks/Closely Held. ........ ..... ....... ..... ........... ..... ................. ...........
Bonds. ............ .................... ............ ........... .................. .... ....... ..... ...
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable...............................................
All Other Property................ .........................................................
23,038.21
Total Personal Property............................... ..........
(")
~S5
,~-o
~~!~
..::; r-;. 0
:-) 0 11
23;_1
-;
~
,....,..,
c:::3
c:::::>>
0"\
o
f'l1
("')
I
O'l
-0
:x
~
--.0
~:..r:) rn
r-r-, C)
~~
(:)
....,....,
::!J
o
f- rn
~~".? i~
~1
Total Real Property................................................
<.n
Total Personal and Real Property.........................
Total Out-of-State Real Property..........................
,
..
Register of Wills, Cumberland County, Pennsylvania
INVENTORY
Estate of Arlene M. Viering
also known as Arlene K. Viering
No.
21-06-0687
07/03/2006
Date of Death
I Deceased
Social Security No. 174-20-0476
Cash
Blue Shield - reimbursement of health insurance policy premium
186.95
Sovereign Bank Checking Account No. 1671021762 - valued per letter dated
8/11/06
22.809.90
Sovereign Bank Checking Account No. 1671021762, accrued interest - valued
per letter dated 8/11/06
41.36
Total Cash
23.038.21
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
23.038.21
-- - -, rr - --.-
. ~
OFFICIAL USE ONLY
REV.1500 EX + (6.00)
REY-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
.
FILE NUMBER
II 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
0687
N MBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Viering, Arlene M.
DATE OF DEATH (MM-DD-YEAR)
174-20-0476
I-
Z
W
o
w
o
w
o
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
DATE OF BIRTH (MM-DD-YEAR)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
01-04-1922
07 -03-2006
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
D 3.. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
o
D
[iJ
o
2. Supplemental Return
[!] 1. Original Return
D 4. Limited Estate
[!J 6. Decedent Died Testate (Attach
copy of Will)
D 9. Litigation Proceeds Received
w
.....
:.:<CCI)
oii::':
wll.g
:J:~..J
Oll.lD
II.
<C
4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal Poverty Credit (date of death between
. 12-31-91 and 1-1-95)
COMPLETE MAILING ADDRESS
.....
z
w
Q
Z
o
II.
CI)
w
It:
It:
o
o
NAME
Gary L. James, Esq.
FIRM NAME (If applicable)
James, Smith, Dietterick & Connelly, LLP
TELEPHONE NUMBER
717/533-3280
134 Sipe Avenue
Hummelstown, PA 17036
(1 ) None oOFFICIA SE ONl.:}j
CI'" ".~.rn
(2) None S;;o 0 p3nC)
.. ::0 G)O
63-00 fT'l c:?:; ::0
(3) None -=:.:r: -' ("") -."....\ ..........
.:_)J:>~ I r'-l
.._z (1'\ :'0 C
- ::rJ
(4) None (/) 7' (-.
00 ~ ;-i:~ I
(5) 23,038.21 -) C) 11 :%
;>-) c::
(6) None :-~ ~
v
:yo CJ1
(7) 195,145.21
(8) 218,183.42
(9) 10,055.74
(10) 1,141.22
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) D Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
z
o
5
:::J
t::
a.
4(
fd
a::
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11,196.96
206,986.46
(11)
11. Total Deductions (total Lines 9 & 10)
(12)
12. Net Value of Estate (Line 8 minus Line 11)
None
(13)
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)
206,986.46
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0
~ 16.Amount of Line 14 taxable at lineal rate 0.00 x .045 (16)
.-
:::J
a. 17. Amount of Line 14 taxable at sibling rate 206,986.46 x .12 (17)
::E
0
(J 18. Amount of Line 14 taxable at collateral rate 0.00 (18)
a x .15
19. Tax Due (19)
0.00
0.00
24,838.38
0.00
24,838.38
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
Form REV-1500 EX (Rev. 6-00:
Copyright 2002 form software only The Lackner Group, Inc.
Decedent's Complete Address:
STREET ADDRESS
442 Walnut Bottom Road
CITY Carlisle
ISTATE PA
I ZIP 1 701 3
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
24,838.38
19,000.00
1,000.00
Total Credits (A + 8 + C)
(2)
20,000.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This Is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
4,838.38
4,838.38
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;.................................................................................. ~x B
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or.................................................................................................................. x 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
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 perjury, 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 infonnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Fae Sturn McMillen
'.:fLL. ~ Tf\c.~
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
"
~
~
DATE
116 Horners Road
Carlisle, PA 17013
; :2 -'() ,,-()~
ADDRESS
DATE
/2....r4
N REPRESENTATIVE
ADDRESS
DATE
134 Sipe Avenue
Hurnmelstown, PA 17036
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 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 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.
99116 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.
Rev-1S01 EX+ (I-el)
*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Viering, Arlene M.
FILE NUMBER
21-06-0687
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 must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Blue Shield - reimbursement of health insurance polley premium
VALUE AT DATE
OF DEATH
186.95
2 Sovereign Bank Checking Account No. 1671021762 - valued per letter dated 8/11/06
22,809.90
3 Sovereign Bank Checking Account No. 1671021762, accrued interest - valued per
letter dated 8/11/06
41.36
TOTAL (Also enter on Line 5, Recapitulation)
23,038.21
(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-1510 EX+ (6-88)
*
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
Viering, Arlene M.
FILE NUMBER
21-06-0687
ESTATE OF
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DE:s(;RIPTION OF PRut"t;t'( I T DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 LSW Annuity Contract No. 479424X - beneficiary 43.432.62 100.000 0.00 43.432.62
is Arlene M. Viering Living Trust; valued per
letter dated 8/2/06
2 North American Annuity Contract No. 59.511.25 100.000 0.00 59.511.25
8000011863 - beneficiary is the Arlene Viering
Living Trust dated 7/11/02; valued per letter
dated November 9, 2006
3 Jena Snare - cash gift on 6/6/06 50.00 100.000 50.00 0.00
4 Kristin McMillen - cash gift on 5/27/06 100.00 100.000 100.00 0.00
5 Fidelity Advisor Float Rate Hi Income Trust held 92.201.34 100.000 0.00 92.201.34
by Equity Services Inc. Brokerage Account No.
F2P-001007 - titled in the Arlene M. Veiring Living
Trust dated 7/11/02; valued per public listing &
statement ending 6/30/06
TOTAL (Also enter on Line 7, Recapitulation) 195.145.21
(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 G (Rev. 6-98)
REV.1151 EX+ (12....)
I
*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Viering, Arlene M.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-0687
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 5,159.74
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees James, Smith, Dietterick & Connelly, LLP 4,500.00
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 98.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 298.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 10,055.74
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1S02 EX+ (8-118)
'*
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESDENT DECEDENT
ESTATE OF
Viering, Arlene M.
FILE NUMBER
21-06-0687
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Dickinson College - food for funeral reception
242.74
2
Funeral reception
295.00
3
Sullivan Funeral Home - funeral services
4,622.00
Subtotal
5,159.74
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.B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
~HERrrANCETAXRETURN
RESIDENT DECEDENT
Viering, Arlene M.
FILE NUMBER
21-06-0687
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
James, Smith, Dietterick & Connelly, LLP - reservation for estate/trust
administration closing costs
250.00
2
Register of Wills, Cumberland County - filing fee for Return and Inventory
30.00
3
Vital Records - death certificates
18.00
Subtotal
298.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
f .
Rev-1512 EX+ (8-88)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYlVANIA
INHERrrANCE TAX RETURN
RESDENT DECEDENT
ESTATE OF
Viering, Arlene M.
FILE NUMBER
21-06-0687
Includ. unr.lmbursed medical exp.n....
ITEM
NUMBER DESCRIPTION
1 PharMerica - unreimbursed prescription bill
VALUE AT DATE
OF DEATH
432.34
2 PharMerica - unreimbursed prescription bill
15.03
3 Thornwald Home - unreimbursed nursing home bill
597.20
4 Thornwald Home - unreimbursed nursing home bill
96.65
TOTAL (Also enter on Line 10, Recapitulation)
1,141.22
(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-1513 EX+ (9~)
*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1
Viering, Arlene M.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
. Clistributions. and transfers
ul'1der Sec. 9116(a)( 1.2)]
Helen Stum Gutshall
Box 123
Loysville, PA 17047
RELATIONSHIP TO
DECEDENT
Do Not List Tru....I.)
FILE NUMBER
21-06-0687
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
NUMBER
I.
Sister
1/4 of residue
51,746.61
2
Fae Stum McMillen
116 Horners Road
PA 17013
Sister
1/4 of residue
51,746.62
3
Nancy Stum Neely
4243 Copeechan Road
Schnecksville, PA 18078
Sister
1/4 of residue
51,746.61
4
Robert Stum
12105 Old Pen Mar Road
Waynesboro, PA 17268
Brother
1/4 of residue
51,746.62
Total 206,986.46
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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
M <Ow
o 0'(0 ge>
R MOr--<t
o CX)~~.-.
~ ---een
N ~ LO 00
r O~!to..
CD N 'tl
o L.L!'!J... ~ ~ en
~ ~:J
JalseH
-
._~
)FFICE 01'
,J WIl.LS
2006 DEe -6 PH 2: 16
C'EDI/ 'JF
Onc:".' ; "'QURT
h~ I ;" J I
CU\ ' co.. PA
D.
.J
.J
~
...I
W
~ ~
8 ~
oa~~
~CQO
~lIC~
a:~<
W ,D.
E C! ~
_D.Q)
Q i
]: ...
t:: :!
:E:
en
en
w
:E:
~~~
~\~~~
~~f2
.~
-
-
-
...
.
.~
"":
-
"":
-
-
~
~
en
~
'5
'-
Q)
en
'0, Q)
(1)en
cx:g
~~
-s,t
:]~ ~
caO ('I')
.QUQ)('I')
~~fficJ>
'-~:]T""
CiS ~ C" 0
0(/)'"
~UQ)--
E'Oen<(
ca~ga..
u. 't:.c: ~
caQ)~~
'O.Q:]en
~EO:C
~~Uca
c:>u--o
--
,-
....
.....
,,",,,,,
--.
...
-
~
:::
~
-
"
"
REV-1500 EX + (6-00)
.
W
~!clll
Ui2~
Wo.g
~i...l
Uo.llI
0.
c:
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
z
w
c
w
o
w
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Viering, Arlene M.
DATE OF DEATH (MM-DD-YEAR)
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
17 -20-0476
06
0687
NUMBER
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
REGISTER OF WillS
sac AL SECURITY NUMBER
134 Sipe Aven
Hummelstown
None
195,145.
10,055.
1,141.
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
[!J 1. Original Return
D 4. Limited Estate
[!J 6. Decedent Died Testate (Attach
copy of Will)
D 9. Litigation Proceeds Received
2. Supplemental Return D 3.. R mainder Retum (date of death prior to 12-13-82)
4a. Future Interest Compromise (date of death after D 5. F deral Estate Tax Return Required
12-12-82)
7. Decedent Maintained a Living Trust (Attach I Number of Safe Deposit Boxes
copy of Trust)
10 Spousal PovertY Credit (date of death between
. 12-31-91 and 1-1-!)5)
17036
OFFICIA"-YSE ONLY
C) g :n
~ ~ ~ f}1 f.Ii
J--" "u J'T1 (.J ') 0
:r C) n (.") ::0
1 ,...;: I .~_..{ CJ
. "S.....m I f"\ rn
; -':1] 0"' ~~D 0
(/)7' ''J 0
C)O -0 ~n -n
-,I'J-n:x "
,j C: (-,
..:::a ~ r- rT1
:'0 ----1 U) C)
;;> -T1
U1
(8) 218,183.42
(11 )
11,196.96
206,986.46
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0
~ 16.Amount of Line 14 taxable at lineal rate 0.00 x .045 (16)
I-
::I
l:1. 17. Amount of Line 14 taxable at sibling rate 206,986.46 x .12 (17)
2
0
(,) 18. Amount of Line 14 taxable at collateral rate 0.00 x I (16)
~
19. Tax Due (19)
DATE OF BIRTH (MM-DD-YEAR)
07-03-2006
01-04-1922
(12)
(13)
None
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
....
z
w
c
z
o
0.
III
~
II:
o
to)
NAME
Gary L. James, Esq.
FIRM NAME (If applicable)
James, Smith, Dietterick & Connelly, llP
TELEPHONE NUMBER
717/533-3280
(14)
206,986.46
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
z
o
~
::I
I:
a.
4:
fd
0::
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) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
0.00
0.00
24,838.38
0.00
24,838.38
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)
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00;
..
Decedent's Complete Address:
STREET ADDRESS
442 Walnut Bottom Road
CITY Carlisle
STATE P A
ZIP 1 701 3
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
24,838.38
19,000.00
1,000.00
Total Credits (A + 8 + C)
(2)
20,000.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penal (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
4,838.38
4,838.38
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TH APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. ~ 8
b. retain the right to designate who shall use the property transferred or its income;.................................... ~
c. retain a reversionary interest; or........................................................................................ ......................... ~ 0
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 er death?......... D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property hich
contains a beneficiary designation?........................................................................................... ......................... [!] 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND LE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my owtedge and belief, it is true, correct and
complete. Declaration of rer other than the personal representative is based on all information of which preparer has a knowted e.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Fae Stum McMillen
~
~
DATE
116 Horners Road
Carlisle, PA 17013
; :2 -'() ..-dG:.
ADDRESS
DATE
12..-S-4
N REPRESENTATIVE
ADDRESS
DATE
134 Sipe Avenue
Hummelstown, PA 17036
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net val e 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 th~ 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: i
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or young,r 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. ~9116 (a) (1.2)]. ~
I
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is r5%' 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. . ~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, wh ther by blood or adoption.
Rw 1508 EX+ (8-98)
.
'* SCHEDULE E i
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Vierlng, Arlene M. 21"()6"()687
Include the proceeds of litigation and the date the proceeds were received by the estate
All property jolntly-owned with ths right of survivorship must be disclosed on schedt IsF.
.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Blue Shield - reimbursement of health insurance policy premium 186.95
2 Sovereign Bank Checking Account No. 1671021762 - valued per letter c ated 8/11/06 22.809.90
3 Sovereign Bank Checking Account No. 1671021762, accrued interest - lfalued per 41.36
letter dated 8/11/06
TOTAL (Also enter on Line 5, Recapitulation) 23.038.21
(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-1510 EX... (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Viering, Arlene M.
FILE NUMBER
21-06-0687
ESTATE OF
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVE~ SHE~T is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF ;CD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTE EST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE.
1 LSW Annuity Contract No. 479424X - beneficiary 43.432.62 100~000 0.00 43.432.62
is Arlene M. Viering Living Trust; valued per
letter dated 8/2106
.
2 North American Annuity Contract No. 59.511.25 100jOOO 0.00 59.511.25
8000011863 - beneficiary is the Arlene Vierlng
Living Trust dated 7/11/02; valued per letter
dated November 9, 2006
3 Jena Snare - cash gift on 6/6/06 50.00 1 OO.~OO 50.00 0.00
I
i
4 Kristin McMillen - cash gift on 5/27/06 100.00 1 OO.~OO 100.00 0.00
5 Fidelity Advisor Float Rate HI Income Trust held 92.201.34 1oo.boo 0.00 92.201.34
by Equity Services Inc. Brokerage Account No.
F2P-001007 - titled in the Arlene M. Veiring Living
Trust dated 7/11/02; valued per public listing &
statement ending 6/30/06
TOTAL (Also enter on Line 7, Recapitulation) 195.145.21
(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 G (Rev. 6-98)
REV-1151 EX+ (12-89)
I
*
. SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Viering,Arlene M.
FILE NUMBER
21 ;.06-0687
ESTATE OF
Debts of decedent must be reported on Schedule I. i,
ITEM DESCRIPTION AMOUNT
NUMBER ,
FUNERAL EXPENSES: T
A.
See continuation schedule(s) attached 5,159.74
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees James, Smith, Dietterick & Connelly, LLP 4,500.00
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 98.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 298.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 10,055.74
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (....)
*
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
tlHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Viering, Arlene M.
FILE NUMBER
21-06-0687
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Dickinson College - food for funeral reception
242.74
2
Funeral reception
295.00
3
Sullivan Funeral Home - funeral services
4,622.00
Subtotal
5,159.74
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev.1S02 EX+ I'....)
*
SCHEDULE H.87
OTHER
ADMINISTRATIVE COSTS
continued
~~THOFP~Nsnv~~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Viering, Arlene M.
IFILE NUMB~R
21-06-0687
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
James, Smith, Dietterick & Connelly, LLP - reservation for estate/trust
administration closing costs
250.00
2
Register of Wills, Cumberland County - filing fee for Return and Inventory
30.00
3
Vital Records - death certificates
18.00
Subtotal
298.00
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA.1500 Schedule H.B7 (Rev. 6-98)
, ,
Rev-1512 EX+ (8-88)
*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Viering, Arlene M.
FILE NUMBER
21-06-0687
Include unrelmbur.ed medical expen....
ITEM
NUMBER DESCRIPTION
1 PharMerica - unreimbursed prescription bill
VALUE AT DATE
OF DEATH
432.34
2 PharMerica - unreimbursed prescription bill
15.03
3 Thornwald Home - unreimbursed nursing home bill
597.20
4 Thornwald Home - unreimbursed nursing home bill
96.65
TOTAL (Also enter on Line 10, Recapitulation)
1,141.22
(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-i5i3 EX+ (~)
*'
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1
Viering, Arlene M.
. NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnclude outright spousal
. C1istributions, and transfers
under Sec. 9116(a)(1.2)]
Helen Sturn Gutshall
. Box 123
Loysville, PA 17047
RELATIONSHIP TO
DECEDENT
Do Hot List Trust8efsl
FILE NUMBER
21..()6.0687
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
NUMBER
I.
Sister
1/4 of residue
51,746.61
2
Fae Sturn McMillen
116 Horners Road
PA 17013
Sister
1/4 of residue
51,746.62
3
Nancy Sturn Neely
4243 Copeechan Road
Schnecksville, PA 18078
Sister
1/4 of residue
51,746.61
4
Robert Sturn
12105 Old Pen Mar Road
Waynesboro, PA 17268
Brother
1/4 of residue
51,746.62
Total 206,986.46
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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copynght (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)