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Home My WebLink About03-12-07 (2) ~ 15056051047 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 INHERITANCE TAX RETURN RESIDENT DECEDENT OFfiCIAL USE ONLY County Gode Year File Number 2 1 6 5 3 Date of Birth 2 3 1 7 o 0 3 Decedent's Last Name Suffix Decedent's First Name MI W I E R (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 qgc 1. Original Return c:::::;, 4. Limited Estate c:::::;, 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::> 2. Supplemental Return c::> c::> c::> 4a. Future Interest Compromise (date of death after 12-12-82) c::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::> 10. Spousal Poverty Credit (date of death c::> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received ..lL 8. Total Number of Safe Deposit Boxes c:::::;, City or Post Office State ZIP Code " K E I T H o B R N N A N Firm Name (If Applicable) S N E L B A K R R EN.. N E First line of address 4 4 W EST T R E E Second line of address M E C H A N I C S BUR P 1 705 5 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, 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 ali information of which preparer has any knowledge. 'SIGN"RE OF "pERSON RESPON?IBLE FOR FILING RETURN DATE - 7 . LLd1Jj) tA.!.-A/1J1.L) , Administratrix 3 - ~ 0_ A66RESS 18725 Washington Street, Tontogany, OH 43565 SIGNr,r F PREPARER OTHER THAN REPRESENTATIVE ADDRESS 44 West Main Street, Mechanicsburg. PA 17055 PLEASE USE ORIGINAL FORM ONLY DATE , ~,() 7 Side 1 L 15056051047 15056051047 ~ q) .-J 15056052048 REV-1500 EX Decedent's Name: Ray A. W ire s RECAPITULATION 1, Real estate (Schedule A), ",......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . .. 2. 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. 6. Jointly Owned Property (Schedule F) c::::;) Separate Billing Requested. . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::::;) Separate Billing Requested,. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . 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, or transfers under Sec. 9116 (a)(1.2) X .0_ . 16, Amount of Line 14 taxable at lineal rate X.O_ 17, Amount of Line 14 taxable atsiblingrateX.12 2,29 1e9..7 18, Amount of Line 14 taxable at collateral rate X .15 19, TAX DUE. , . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 Decedent's Social Security Number 2 5 6 1 9 7 7, 5 9 .3. 8 8. 9. 6 4,5 1 6.9 4 2,2 9 1.9 7 e 15. . 16. 17. 2. 7 5 eo 4 18. 2 7 5 eO 4 c::::;) 15056052048 -.J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Rav A. Wires -STREET ADDRESS 111 Sheet Iron Roof Road I CITY I STATE I ZIP Gardners PA 17324 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 275.04 Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty .47. 4. Total Interest/Penalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (3) (4) (5) (5A) (58) .42 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 275.04 .42 275.46 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 [K] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 IX] c. retain a reversionary interest; or.......................................................................................................................... 0 IX] d. receive the promise for life of either payments. benefits or care? ...................................................................... 0 [X] 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................................. 0 IX] 3 Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 IX] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 00 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. 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. S9116 (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. S9116 (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 zero (0) percent [72 P.S. s9116(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. S9116(1.2) [72 P.S. s9116(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. s9116(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-1508 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Ray A. Wires FILE NUMBER 21-06-00653 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 2004 Cherokee Model 38G trailer 2. Miscellaneous personal property, furnishings and furniture 3. Portable shed and deck 4. Truck 5. Refund on LP gas tank return 6. Orrstown Bank, Account No. 785857 7. Amerigas refund 8. Uncashed money order 9. Wages due from Schreiber Foods 10. Foremost Insurance refund 11. Sears - refund on account overpayment $14,500.00 250.00 500.00 150.00 238.84 574.19 9.88 25.00 1,301.24 35.75 8.92 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 17,593.82 REV-1510 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Ray A. Wires FILE NUMBER 21-06-00653 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 NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A copy OF THE DEED FOR REAL ESTATE. Schreiber Foods, Inc 401K, Trust No. 8700. Beneficiary: Patti Wires, sister of Decedent. Date of transfer: June 2, 2006 (date of death) 24,886.M DATE OF DEATH % OF DECO'S EXCLUSION VALUE OF ASSET INTEREST (IF APPLICABLE) 100% 100% (r.ecedent 53 years old, not a nomal retiremant age) . 100% 100% -{}- (r.ecedent 153 years pld, not at namal retiremant 1ge) N/A 2. Schreiber Foods, Inc. 401K, Trust No. 130 402 9,021.39 00 Benefidi.ary:.: Patti Wires, sister of Decedent. Date of transfer: June 2, 2006 (date of death) 3. Schreiber Foods, Inc. Employee Stock Option, 9,215.09 Beneficiary: Patti Wires, sister of Decedent. Date of transfer: June 2, 2006 (date of death) 100% 4. Merit Life Insurance Company, life insurance 760.92 benefit, Account No. 001 3505460. Beneficiary: Patti Wires, sister of Decedent. Date of transfer: June 2, 2006 (date of death) 5. Union Life Insurance Company, life insurance 141,520.46 benefit, Account No. 137732. Beneficiary: Patti Wires, siter of Deced~at~- Date of transfer: June 2, 2006 (date of death) 100% 100% 100% 100% TOTAL (Also enter on line 7 Recapitulation) $ 9.215.m (If more space is needed, insert additional sheets of the same size) TAXABLE VALUE -{}- 9,215.09 -{}- -{}- REV-1511 EX+ (10-06). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Ray A. Wires FILE NUMBER 21-06-00653 ITEM NUMBER A. Debts of decedent must be reported on Schedule I. DESCRIPTION 1. FUNERAL EXPENSES: Hollinger Funeral Home and Crematory Rev. Rick Hoff, honorarium Flowers for service Marker engraving - Peinert Funeral Home Burial fee - Washington Township Transtees B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Waived Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees Snel baker & Brenneman, P. C. 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 to Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees, miscellaneous pro ba te expenses, reserve 7. Bond for personal representative- Community Banks Ins. Service 8. Advertise grant of Letters Testamentary: a. The Patriot News: b. Cumberland Law Journal: $241.24 75.00 AMOUNT 2,308.00 50.00 90.53 150.00 200.00 4,500.00 145.00 350.00 500.00 241.00 316.24 TOTAL (Also enter on line 9, Recapitulation) $ 8,850.77 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Ray A. Wires FILE NUMBER 21-{x)-{xx)53 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Airerican General - JBynEIlt due on trailer (Schedule E, Item 1) $12,13).11 2. Verizon Wireless - paynEIlt on accotmt of telephone bill 72.02 3. Bank of Airerica - balance due on credit, card account 3,362.61 4. 01ase - JBynEIlt on account of balance due 39.00 5. PaynE11t on account of electric service 62.43 TOTAL (Also enter on line 10, Recapitulation) $ 15,666.17 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Ray A. W:ires FILE NUMBER 21-06-00653 NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Patti L. W:ires 18725 Washington Street Tontogany, 0 H 43565 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE Sister 1/2 of residue Renita M. N ohej1 4716 Fa:irway Drive Brooklyn, 0 H 44144 Sister 1/2 of residue 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 $ (If more space is needed, insert additional sheets of the same size)