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Home My WebLink About07-13-07 REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ z w c w (J w c ~ :ll::~lI) oll::ll:: wll.O :1:00 011:... ~1lI C DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) SHELLENBERGER SHIRLEY D. DATE OF DEATH (MM-DD-YBa') A1KJA SHIRLEY A. SHELLENBERGER DATE OF BIRTH (MM-DD-Year) OFFICIAL USE ONLY FILE NUMBER 2 1 -0 6 0 3 6 3 COONTY'CoiiE -YEAR- - - NuMaER- - SOCIAL SECURITY NUMBER 1 8 0 - 2 6 - 6 6 8 6 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (dale of deaIh prior to 12-13-82) D 5. Federal Estate Tax Retum Required !!... 8. Total Number of Safe Deposit Boxes D 11. Election to tax under See. 9113(A) (AlIach Sch 0) z o ~ :5 ::>> ~ ii: c( (J W 0:: z o S ::>> l1. :IE o (J ~ X _(15) X _(16) 112,907.10 X .12 (17) 13,548.85 112,907.10 X .15 (18) 16,936.07 (19) 30,484.92 04117/2006 12/11/1935 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [X] 1. Original Retum D 4. Limited Estate 00 6. Decedent Died Testate (AlIachcopyofWll) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 4a. Future Interest Compromise (daIB of death aftIlr 12-12-82) D 7. Decedent Maintained a Living Trust (AlIach copy of Trust) D 10. Spousal Poverty Credit (dale of deaIh be1ween 12-31-91 and 1-1-95) 132,839.24 PA 17055 OFFICIAL USE ONLY NAME MURREL R. WALTERS III FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS ,.~o (;15 '..J~?2 101,802.07 _ ~ ~B -c.J^ , r-.... ~.JO 15,215.2). l ? -'-" =0 ---j ~ <:::::) <:::::) -.. C- c:: ,- _.=V ._",j rn friO ~?9 C" -.0 I:~~] ~ --. CJ o '" =,:=: :n -,- C"J ;:-::: fTl C/) (:) 54 EAST MAIN STREET TELEPHONE NUMBER 717-897-4850 MECHANICSBURG w > ::r '!? en 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or SoIe-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Groll As.... (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under See. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0 CHECK hERE If \OlJ ARE FiEQUESTING A REFUND OF AN OVERPAYMENT (8) 249,856.54 18,786.00 5,256.33 (11) (12) (13) 24,042.33 225,814.21 (14) 225,814.21 Decedent:s Complete Address: STR'EET ADDRESS 10 SUSSEX ROAD ____........_,,-...o_...-....._._'_ ._.,__ I STATE PA I ZIP 17011 CITY CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 30,484.92 Total Credits (A + B + C) (2) 3. I nterestlPenalty if applicable D. Interest E. Penalty 900.00 5. T otallnterestlPenalty ( 0 + E ) If Line 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 (4) 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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT (3) 900.00 4. 0.00 31,384.92 31,384.92 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 l&l b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00 c, retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 l&l 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................... .......................................... 0 00 3, Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 l&l 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS DENNIS R. SHELLENBERGER, P.O. BOX 394, 811 EAST STREET, LEWISBERRY SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE PA 17339 DATE ADDRESS MURREL R. WALTERS III, ESQUIRE, 54 EAST MAIN STREET, MECHANICSBURG PA 17055 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) (ill. 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) (iill. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure 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 0% [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 4.5%, except as noted in 72 P,S. ~9116(1.2) [72 P.S. ~9116(a)(111. 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-1502 EX + (6-98) . '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SHELLENBERGER SHIRLEY A 21 06 0363 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real Drooertv which is iointIY.owned with riaht of survivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 132,839.24 10 SUSSEX ROAD, CAMP HILL, PA PROCEEDS OF SALE TOTAL (Also enter on line 1. Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 132.839.24 REV-1508 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHELLENBERGER SHIRLEY SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER A 21 06 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. 0363 ITEM NUMBER 1. M&T BANK 2. PSECU 3. THRIVENT 4. THRIVENT 5. DESCRIPTION 2001 TOYOTA. SALE PROCEEDS 6. COMCAST CABLE REIMBURSEMENT FOR OVERPAYMENT 7.. FEDERAL INCOME TAX REFUND 6. ALLSTATE INSURANCE REFUND. OVERPAYMENT VALUE AT DATE OF DEATH 17,190.23 5,002.09 62,106.97 9,570.66 6,000.00 6.70 1,692.00 231.20 TOT At (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 101,802.07 REV-1509 EX + (6-98) 'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL V-OWNED P~()PERTY ESTATE OF SHELLENBERGER SHIRLEY A FILE NUMBER 21 06 0363 If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. DENNIS R. SHELLENBERGER 811 EAST STREET LEWISBERRY, PA 17339 BROTHER B c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 8/11/05 SOVEREIGN BANK 10,090.12 100. 10,090.12 SAVINGS ACCOUNT 2. A. 8/11/05 SOVEREIGN BANK 5,125.11 100. 5,125.11 CERTIFICATE OF DEPOSIT TOTAL (Also enteron line 6, Recapitulation) $ 15,215.23 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(12-99) . .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHELLENBERGER SHIRLEY A SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 06 0363 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. RICHARDSON FUNERAL HOME 5,707.00 2. GINGRICH MEMORIALS - ENGRAVE MARKER 125.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) DENNIS R. SHELLENBERGER 4,000.00 Social Security Numbe~s)JEIN Number of Personal Representative(s) StreetAddress P.O. BOX 394,811 EAST STREET City LEWISBERRY State PA Zip 17339 Yea~s) Commission Paid: 2. Attomey Fees MURREL R. WALTERS III 8,250.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS - CUMBERLAND COUNTY 379.00 5. Accountants Fees 6. Tax Return Prepare~s Fees 7. MARK HILBERT - APPRAISAL OF HOUSE 325.00 TOT At (Also enter on line 9, Recapitulation) $ 18,786.00 (If more space is needed, insert additional sheets of the same size) ,"}. ... RE\1,-15;12 EX ~ (6-98) . SCHEDUL~.I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHELLENBERGER SHIRLEY A FILE NUMBER 21 06 0363 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. UGI . GAS 398.18 2. PP&L . ELECTRIC 3. PA AMERICAN WATER 4. DENNIS SHELLENBERGER LAWN CARE, STAMPS 5. ROBERT SHELLENBERGER LAWN CARE 6. VERIZON PHONE BILL 7. ENGLE PRINTING AD FOR SALES 8. WEST SHORE SCHOOL TAX 9. LOWER ALLEN TOWNSHIP SEWER/REFUSE 10. DERR'S TRASH SERVICE REMOVE TRASH 11. JOHN WATTS HOUSE CLEANING 12. R.B. HOBAUGH & SON INSTALL NEW ELECTRICAL BOX 13. DIVISION OF VITAL RECORDS DEATH CERTIFICATES 14. 2005 FEDERAL INCOME TAXES 267.64 202.87 631.00 440.00 24.66 46.40 1,008.23 179.55 65.00 160.00 680.80 45.00 1,107.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,256.33 ~;:"~"". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~HFII FNBFRGER ~HIRI EY A NUMBER I. SCHEDULE J BENEFiCIARiES 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] DENNIS R. SHELLENBERGER 811 EAST STREET LEWIS BERRY, PA 17339 ROBERT C. SHELLENBERGER 725 HUMMEL AVENUE LEMOYNE, PA 17043 FILE NUMBER 21 06 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) O~A~ AMOUNT OR SHARE OF ESTATE 1/2 1/2 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 BROTHER 2. NEPHEW 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - 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)