HomeMy WebLinkAbout05-11-07
-I
1505b01l11117
REV.1500 EX (06-05)
PA Deparbnent of Revenue
Bureau of Individual Taxes ~
PO BOX.280601 ~
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Sewrity Number Date of Death
OFFICIAL USE ONLY
County Code v_
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 7
File Number
0231
Date of Birth
161342217
01122007
08011941
Decedent's Last Name
Suffix
Decedent's First Name
ROSENBERRY
SHIRLEY
MI
A
(If Applicable) Enter Surviving Spouse'. Information Below
Spouse's Last Name
ROSENBERRY
Suffix
Spouse's First Name
L.
MI
E
Spouse's Social Sewrity Number
161323578
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
[!] 1. Original Retum 0 2. Supplemental Retum 0 3. Remainder Return (elate of death
prior to 12-13-82)
0 4. Umited Estate 0 48. Future Interest Compromise 0 5. Federal Estate Tax Retum Required
(d8Ie rI delIth after 12-12.a2)
00 6. 0ecedenI Died Testate 0 7 Decedent Maintained 8 Uving Trust 0 8. Total Number of Safe Deposit Boxes
(AIIach Copy of WIll) . (AIIach Copy rI Trust)
0 9. Litigation Proceeds Received 0 10. ==f::L~rdellth 0 11.Election to tax under See. 9113(A)
(Attach Sch. 0)
=ESPONDENT - THIS SEcnoN MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
RICHARD L. WEBBBR, JR. ESQUIRE 7175327388
Firm Name (If Applicable)
WEIGLE & ASSOCIATES, P.C.
1',,)
126 EAST KING STRBET
<::;)
REGISTER ~~S USE ~LY
.; --:1 ...
:I~"'::Q _':::
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,-'....
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-,-,
First line of address
..~,......
Second line of address
"'.)
City or Post Office
SHIPPENSBURG
State
PA
Z1PCoc:Ie
17257
DAn: FILED <.n
Correspondent's e-mail address:weigleattywebber@earthlink.net
Under penalties of Jl.8I:iury, I declare that I have examined this retum, includi~ accompanying schedules and statements, and to the best of my ~ and belief,
::.; ~~~/~ per&ona representative is based on all information of which preparer ::eny knoWledge.
~'--'"v"U"4" <)L~'O LEdwardRosenbony S-IO"tt>7
41 Foreman Mill Road, Shippensburg, PA 17257
SIGNATURE OF PREPARER OTHER THAN REPRESEtlTr DATE
~ ~ ...-1 .c..-...- ~ . 4- Richard L. Webber, Jr. Esquire :;- -/0-0 "/
126 East King Street, Shippensburg, PA 17257
L
Side 1
1505b01l11117
1505b01l11117
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J.SDSbDIf2J.1f&
REV-1500 EX
Decedent'sN8me: Shirley A. Rosenberry
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)D Separate Billing Requested............. 6.
7. Inter-VIvos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested............. 7.
8. Total Gross Assets (total Unes 1-7)....................................................................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9.
10. Debts of Decedent. Mortgage Uablllties, & Liens (Schedule I)................................ 10.
11. Total Deductions (total Unes 9 & 10)...................................................................... 11.
12. Net Value of Estate (Une 8 minus Line 11)............................................................. 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an e1ecl1on to tax has not been made (Schedule J)................................................. 13.
14. N.t Value Subject to Tax (Line 12 minus Une 13)................................................. 14.
TAX COMPUTATION - SJ:E INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under See. 9116
(a)(1.2)X~ 19, 837 . 6015.
16. Amount of Line 14 taxable
at lineal rate X .045 16.
17. Amount of Line 14iiiiCible
at sibling rateX.12 0 . 00 17.
18. AmountofUne 14 taxable
at collateral rate X .15 0 . 00 18.
19. Tax Du....... ........................... .................................................................... ................ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
J.SDSbOlf2:Llf&
-~-~--r
Decedenfs Social SeaJrlty Number
161342217
23,946.60
23,946.60
4,109.00
4,109.00
19,837.60
19,837.60
0.00
0.00
0.00
0.00
0.00
o
l.SOSbDlf2J.lf&
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-07-0231
DECEDENT'S NAME
Shirley A. Rosenberry
STREET ADDRESS
41 Foreman Mill Road, South Newton Township
CITY I STATE IZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
0.00
Total Credits (A + B + C)
(2)
0.00
3. InterestJPenalty if applicable
D. Interest
E. Penalty
TotallnterestJPenalty (D + E)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Une 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE.
A. Enter the Interest on the tax due.
B. Enter the total of Une 5 + SA. This Is the BALANCE DUE.
(3)
(4)
(5) 0.00
(SA)
(5B) 0.00
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 aa:ount or seaJrity at his or her death? ......... 0
4. Did decedent own an Individual Retirement Aa:ount, annuity, or other non-probate property which
contains a beneficiary designation? .................................~.................................................................................... 0 [!J
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
~ ~
[!]
[!]
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. S9116 (a) (1.1) (Ii)]. The statute does not exemDt a transfer to a surviving spouse from lax, and the statutory requirements
for dlsclosure of assets and filing a tax retum 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 decedenfs 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 decedenfs 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.
4T-~"
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Rev-1l1l13 EX+ (6-98)
*'
SCHEDULE B
STOCKS &.BONDS
COMMONWBAI.1HOF~V_
INHI!RITNICE TAX REIUIlN
RI!IIIlENT DECEDENT
ESTATE OF
Rosenberry, Shirley A.
FILE NUMBER
21-07-0231
All property Jolnlly-owned with rlghl of IlUrvIvorshlp muR be cIlscIoHd on SchIduIe F.
ITEM CUSIP DESCRIPTION VALUE AT DATE
NUMBER NUMBER UNIT VALUE QFDEATH
1 642 shares of Orrstown Bank Stock - 642 shares 37.3 23.946.60
common stock @37.30 per share
TOTAL (Also enter on Line 2, Recapitulation) 23.946.60
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 tonn software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
:::~;~.;:'"$:::f~'~:':. r~i1,,:~"((,;:--<;
. REV-1151 EX+ (12-19)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COUMONWEAlTH OF PENNSYLVANIA
INiERlTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Rosenberry, Shirley A. .
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-07-0231
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
L. Edward Rosenberry
Social SeaJrity Number(s) I EIN Number of Personal Representative(s):
Street Address 41 Foreman Mill Road
City Shlppensburg State
Year(s) Commission paid
PA
Zip 17257
2.
Attorney's Fees
Weigle & Associates, P .C.
500.00
3.
Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant L. Edward Rosenberry
StreetAddress 41 Foreman Mill Road, South Newton Township
City Shlppensburg State PA Zip 17257
Relationship of Claimant to Decedent . Spouse
3,500.00
4.
Probate Fees
94.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
15.00
TOTAL (Also enter on line 9, Recapitulation)
4,109.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
.
Rw-1502 EX+ (6-98)
'*
SCHEDULE H.B3
FAMILY EXEMPTION
continued
CClMMCINWl!W.1H OFPENNlM.VANlA
Hll!NfNCETAX RE1UAN
_DI!CEIlENT
Rosenberry, Shirley A.
FILE NUMBER
21-07-0231
ESTATE OF
ITEM
NUMBER
1
DESCRIPTION
L. Edward Rosenberry - 41 Foreman Mill Road, Shippensburg, PA 17257
AMOUNT
3.500.00
Subtotal
3.500.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H-B3 (Rev. 6-98)
.
Rev-1l1D2 EX+ 16-98)
.
SCHEDULE H-B4
PROBATE FEES
continued
COMMCNWEAI.lHOF_V_
NBUTANCETAXRE'I\Rl
_Dl!CED!!HT
ESTATE OF
Rosenberry, Shirley A.
FILE NUMBER
21-07-0231
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Register of Wills
94.00
Subtotal
94.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B4 (Rev. 6-98)
.
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEAI.:nt 01' Pl!NeYLVNM
Nt!RITIoNCETAX~
RI!IIIlENT DECBlSlT
ESTATE OF
Rosenberry, Shirley A.
FILE NUMBER
21-07-0231
ITEM
NUMBER
1
DESCRIPTION
Cumberland County Register of Wills - Filing Fee for Inheritance Tax Return
AMOUNT
15.00
Subtotal
15.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
REV-1513 EX+ (9-00)
'*
SCHEDULE .J
BENEFICIARIES
COa&lDNWEALTH OF PENNSYLVANIA
INiERlTANCE TAX RETURN
RESIDENT DECEDENT
1
Rosenberry, Shirley A.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS findude outright spousal
C1islrlbutlons. and transfers
under See. 9116(aX1.2)]
L. Edward Rosenberry
95 Walnut Bottom Road
Shlppensburg, PA 17257
RELATIONSHIP TO
DECEI:?ENT _ _
Do Nut u.t T..-.'
FILE NUMBER
21-07-0231
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
NUMBER
I.
Spouse
One Hundred
Percent
Total
Enter dollar amounts for dlslrlbutlons shown above on lines 15 through 18, as approor ate, on Rev 1500 cover sheet
ll. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR V\lHICH 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.
Fonn PA-1500 Schedule J (Rev. 6-98)
LAST WILL AND TESTAMENT
i, SHIRLEY A. ROSENBERRY, of Shippensburg Township, Cumberland County,
Pennsylvania, declare. this to be my L~st Will and Testament and revoke any will
or codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including
("
my.gravemarker and all expens~s of my last illness, shall .be paid from my
residuary estate as soon as practicable. after my decease as a pa~t of the
administration of my estate.
ITEM II: I give, devise and bequeath all of my estate of every nature.and
wheresoever situate to my husband, L. Edward Rosenberry, providing he shall
survive me by thirty days.
ITEM III: Should my husband, L. Edward Rosenberry, predecease me or die
on or before the thirtieth day following my death, I give, devise and bequeat~
all of my estate of every. nature and wheresoever situate to ~y issue per .
stirpes PROVID~D, however, that any property which passes under this..will or
: ',.;(L~~j::j~ '-~;:f;:)~'~ ..;:: . ~ '.
otherwise to my daughter, Noel1e C. Rosenberry and with respectt;2;J~~~e I am
authori.zed to appoint a guardian shall be held by Robert L. RosenDr;TY,IN
ITEM IV: In the event my spouse,
. ',' '/ii:}.'~)'~';>;:-;~~'-,:.:l:~.J",'L:~,;; ,~". :"i;.
+.... .
TRUST nevertheless. My said t!ustee, Robe;rt L. Rosenberry,
power to use principal as.H well as income from time to time for
Rosenberry's support, maintenance, medical care and educatiQn,
fpr these purpos~s, without fu~ther responsibility ~o
to any person t.9.king care.of Noelle C. Rosenberry.
me, then I appoint Robert L. Rosenberry guardian
Rosenberry and of any minor child. of mine who
".. ,:..'"'.lC.
ITEM V: I appoint Robert L. Rosenberry guardian of any proper~y which
passes either under this Will or otherwise to my daughter, Amanda E. Rosenberry,
so long as she is under the age of Ctwenty-one years and with respect to which I
am authorized to appoint a guardian ~nd have not otherwise specifically done
so, provided that this appointment of a guardian shall not supersede the right
of any fiduciary in its discretion to distribute a share where possible to
. Amanda E. Rosenberry .so long as she is under. the .age of twenty-one years or
to another for her benefit. Such guardian shall have the power to use principal
as well as 1ncome from time to time for Amanda E. Rosenberry so. long as she is
under the age of twenty-one years' support and education (including college
education, .both graduate and undergraduate) without regard to his or her
parent's ability to prov:Lde for such support and education, or to make payment
for these purposes, Without further responsibility to Amanda E. Rosenberry so
long as she is under the age of twenty-one years or to her parent or to any
person taking care of her.
ITEM VI: I direct that all-.tax.es that may be as s,ef;l sed in consequence of .
my death, of whatever nature and by whatever jurisdiction imposed, shall be
paid from'my residuary estate as part of the expenses of the administration of
("
my estate. ';' .
. ITEM.VII:. I ~p'point my husband, L. Edward Rosenberry, executor of. this my
Last :Will and Testament. Should he fail to q:ual'ify or cease to act as executor,
I appoint Robert L. Rosenberry executor of this my Last Will and Testament.
;TEM VIII: I direct that my executo~ or guardian or their successors
shall not be required to give bond for the faithful performance' of their duties
in any.jurisdiction.
-2-
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~.,.., ":' .",.,~.~..:,::-'.'
COMMONWEALTH OF ~ENNSYLVANIA:
SS
COUNTY OF CUMBERLAND
~ tiL;vIn / and
, the t statrix and the witnesses, respectivel ,
attached or foregoing instrument, being fi~st
duly sworn, do he~eby declare to the undersigned authority that the testatrix
signed and execu~ed the instrument as her Last Will and ~estament and that she
signed willingly (or willingly directed' another person to sign for her), and
that. she executed it as: her . free 'and voluntary act for the purposes therein
expressed, and that each of the witnesses, i~ the presence and hearing of the
testatrix, signed the will aswitnessel;! and that to the best of our knowledge,
the testatrix was at that time eighteen years or older, of sound'mind and under
. .
no constraint or undue influence.
,. \.... 'J
~rJ:.r hP:t./A~/<~A-4c(
'Shirley A. :R . enberry
0.W' .
,'.' J
l ~ - ;,
-:
Su~sc.i:'.:i.bed, sworn to and acknowledged,
Shirley A. Rosenberry,
sWd~" . bef ore me by
and
;:: .:. "'~...~:- 'i' '.~.,
..:. 'r~"';ii~~-':';~~
.-J i
1'_,1
-'",,;,' r'
My commission expires:
SUSAHE K.wittt;r..~AlV ,.,8&.10
SHIPPEJISBURG tWP.. CUIIBERlAND ClJurm
IY COIIllfSSIOl EXPlIBAPRIL 21. 1_
......... 'e.Moie WociatlO. of lotaries
-4-
ORRSTOWN
FINANCIAL ADVISORS
A Tradition of Excellence
Account Inquiry
ORRSTOWN FINANCIAL SERVICES, INC. # 5772
MAR 2 8 2007
ALPHA-KEY: ROSENBER SHI
A
SSAN: 161-34-2217
YTD INFORMATION:
DTV $134.82
TAX $0.00
BOOK
CERTIFICATES
REINVESTMENT
NO ACH
DRP ACCT: N
TOTAL SHARES HELD:
642.0000
SHARES HELD IN:
0.0000
642.0000
0.0000
SHIRLEY A ROSENBERRY
41 FOREMAN MILL ROAD
SHIPPENSBURG, PA 17257-0000
EXTERNAL ACCOUNT NO: 01915
BROKER NUMBER:
RIA BROKER CODE: CERTIFICATES
RT ACCOUNT NO: 0012350001 TAX INFORMATION
RT ACCOUNT TYPE: INDIVIDUAL FEMALE
, ... . . -... .... ....,..... '1 ...., , .. .., .... I . , ... ..... ...... ]
,. ,,' . .'. 'S~l ect ~'()f.1.J1~P:p,;.:.; :';,:,I:!"::):;99~j;,A\*:l;i~k~s.",, :,; .. ..ll. t. ':.9.',iJ,9:,ci.:.t..',.t. :':
Powered byzJWeb-H~~~ .,.'? .'", ""," . ..,.... ,- ". , .
11 :26:56 2007
PAYMENT HISTORY
Tue Mar 27
~
CHARLENE FEUCHTENBERGER
TRUST OPERATIONS OFFICER
i
~
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1
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I
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1
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,
ORRSTOWN
FINANCIAL ADVISORS
A Tradition of Excellence
Certificate Inquiry
ORRSTOWN FINANCIAL SERVICES, INC. # 5772
ALPHA KEY: ROSENBER SHI A
SHIRLEY A ROSENBERRY
CERT-NO PREF
01- 0000998 OB
02- 0025362
03- 0027252
04- 0029244
05- 0030831
06-
07-
08-
09-
10-
DENOM
00000030.000
00000279.000
00000013.000
00000014.000
00000306.000
ISS-DATE RSN SHEET
06/29/2005 02 888888
12/17/1999 16
09/15/2001 03
05/30/2003 03
02/10/2004 03
CAN-DATE RSN SHEET STATUS
NO MORE CERTIFICATES
"', ' ,~6~6il~t:~I1,:qui'ry.;:' . ,;:'1::' \1j9g<i,ij~1";;1
Powered by z/Web-Host
II :27:102007
Tue Mar 27
~~
CHARLENE FEUCHTENBERGER
TRUST OPERATIONS OFFICER
.
,
I
I
I
i
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Registrar and Transfer - Account Inquiry
Page 1 ofl
Account Inquiry
ORRSTOWN FINANCIAL SERVICES, INC. # 5772
ALPHA-I<EY: ROSENBER L
E
S~: 161-32-3578
YTD INFORMATION:
DIV $734.76
TAX $0.00
BOOK
CERTIIi'ICATES
REINVESTMENT
NO ACH
L EDWARD ROSENBERRY
OR SHIRLEY A ROSENBERRY
41 FOREMAN MILL ROAD
SHIPPENSBURG, PA 17257-0000
EXTERNAL ACCOUNT NO:
BROKER NUMBER:
R/A BROKER CODE:
RT ACCOUNT NO:
RT ACCOON'J! TYPE:
01898
CERTJ:Ii'ICATi:S
0012260002 TAX J:NIi'ORMATION
JOINT TENANTS, TENANTS IN COMMON
-
Powered by zlWeb-Host
09:12:11 2007
DRP ACCT: N
TOTAL SHARES HELD:
942.0000
SHARES HELD IN:
C"~
." 5142.00.00
0.0000"
0t4
TRANS HISTORY
PAYMENT HISTORY
Wed Feb 28
.
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"'YAEloor FINANCE
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Get Historical Prices for: I.
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Start Date: IJan :II h~ '" ,j I~q~! ,J ~go~an 1,
End Date: IJan.BiI (12",' I~OQ7
PRICES
Date
Open
12-Jan-07
37.30
First I Prev I Next I Last
High
Low
Close
Volume
Adj
Close*
37.30
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37.30
200
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* Close price adjusted for dividends and splits.
First I Prev I Next I Last
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