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Home My WebLink About05-01-07 (2) ---I 15056051058 REV.1500 EX (06-05) PA Department d Revenue . BUr8llu d Individual Taxes PO BOX 280601 HBrrmbU~,PA171~1 ENTER DECEDENT INFORMATION BELOW ~I~rity Number Date of Death OFFICIAL USE ONLY ~_~c:cxte Year INHERITANCE TAX RETURN RESIDENT DECEDENT 21 06 File Number 0692 Date of Birth 178-07-6007 07/1012006 01/18/1918 Decedent's Last Name SHUL TZABARGER Suffix Mr Decedent's First Name MI GEORGE E (If Applicable) Enter Surviving Spou.... Information Below Spouse's Last Name Suffix ~llOusl"s First !'I1I~ MI Spouse's Social Security Number _._...........,. _m ,_ __n__..._____ ______n______.... ,_.._. THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ell:> 1. OrIgInal Retum c::::l 2. Supplemental Retum c::::l 3. Remainder Retum (date of death prior to 12-13-82) I). Federal Estate Tax Retum Required c::> 4. Limited Estate c::> 4a. Future Interest Compromise (date of death after 12-12-82) c::::l 7. Decedent Maintained a UvIng 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 IalST BE COIIPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ____'.._ ___ __ ___nm._'_ ~~ c::> c::::l 6. Decedent DIed Testate (Attach Copy of Win) 9. Litigation Proceeds Received 8. Total Number of Safe Deposl Boxes c::> Peter B Shuttzabarger Firm Name (If Applicable) . (717) 448-7305 REGISTER OF(wt~ USE ONL>j.:i ,. .~- ~T-) -"... ::-:i"1: -r:J First line of address -"..~ 341 Barnstable Rd Second line of address -: i . " I _......_1 N ___}<--i City or Post Office ___.__.._....__n._....___._Un_____.._ Carlisle State ZIP Code 17015 DATEf'ILED (.n PA Correspondenfs &-mail address: petbshultb@comcastnet SIGNAT -' ADDRESS 3lJ/ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE C ,,?,I"'),S Ie.- 07 j/A- DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 -.J ..J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAprrULATION GEORGE E SHUL TZABARGER 178-07-6007 1. Real estate (Schedule A). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 0.00 0.00 0.00 2. Stocks and Bonds (Schedule B) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 0.00 1,529.68 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 6. JoinUy Owned Property (Schedule F) C) Separate BilHng Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C) Separate Billing Requested.. . . . . .. 7. 0.00 0.00 8. Total Grou Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8., 1,529.68 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 1,395.62 0.00 1,395.62 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of EatldB (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been mede (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 134.06 14. Net Value Subjec:t to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. 134.06 TAX COMPUTATION - SEE ..STRUCTIONS 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 at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 134.06 17. 16.09 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 16.09 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYM,ENT C) L 15056052059 Side 2 15056052059 --.J REV-1500 EX Page 3 Decedent's Complete Address: Fl. Number ~~l0692 --.J DECEDENTS NAME DECEDENTS SOCiAl SECURITY NUMBER GEORGE E SHUL TZABARGER 178-07-6007 STREET ADDRESS Forest Park Health Center 700 Walnut Bottom Rd CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 16.09 Total Credits ( A + B + C ) (2) 0.00 3. InterestJPenalty if applicable D. Inlerest E. Penalty TotallnteresllPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPA YllENT. FiN in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 16.09 A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (5B) 16.09 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 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 I)(j d. receive the promise fur life of either payments, benefits or care? ...................................................................... 0 I)(j 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 1)(1 3. Did decedent own an "in trust tor" 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 ~ F 11IE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YEs, YOU MUST COMPLETE SCHEDULE G AND FlE IT M 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. ~9116 (a) (1.1) (i)). For dales 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 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 lax 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. ~116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lileal 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 oftransfers to or for the use ofthe decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)J. 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) * COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDUU E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF SHUL TZABARGER, GEORGE E. Include the proceeds d litigation and the date the proceeds were I8Clliv8d by the estate. AI pnlpIrty jointIyoCJWlllld with right fII surviwnhlp ..... be d___ on Schedule F. FILE NUMBER 2006-0692 ITEM NUMBER DESCRIPTION VALUE AT Ot.TE OF DEATH 1 Checking account 373.12 2 Prepaid Cremation account, Auer Memorial Home & Cremation Services, Inc 3 Refund - Somerset Rural Electric Cooperative, Inc 1,010.00 146.56 Lived in Nursing Home for 4 years all other personal properly given to family prior to death TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,529.68 REV.1511 EX+ (12-99. COMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETlJRN RESIDENT DECEDENT SCHEDULE H FUNERAl EXPENSES & ADMINISTRATIVE COSTS ESTATE OF SHUL TZABARGER, GEORGE E. FILE NUMBER 2006-0692 Debts of dlcecllnt mUll be reportld on Schld_ L ITEM NUMBER A. FUNERAL EXPENSES: 1. DESCRIPTION AMOUNT Auer Memorial Home & Cremation Services, Inc Harrisburg PA (cremation service) 2 Food Service for memorial service - Wesley Chapel Methodist Church Rockwood PA 3 Lettering on grave marter - Johnson Memorial Co - Rockwood PA 4 Flowers 1,010.00 200.00 95.00 28.62 B. 1. ADMINISTRATIVE COSTS: Personal Repl8S8n1Btive'S Commissions Name of Personal Repl8S8nlative(s) Peter B Shultzabarger Social Security Number(s)JEIN Number of Personal Repl8S8ntative(s) StreetAddlllSS 341 Barnstable Rd City Carlisle . State P A Zip 17015 0.00 Year(s) Commission Paid: 2. Attllrney Fees 0.00 3. Family Exemption: (If decedenfs addl8ss is not the same as c1aimanfs, attach explanation) Claimant 0.00 Street AddlllSS City Stala . Zip Relationship of Claimant to Decedent 4. ProbslB Fees 62.00 5. Accounlanfs Fees 0.00 6. Tax Return Pl8parer's Fees ~ QOO lOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,395.62