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Home My WebLink About07-19-07 .-J 15056051058 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 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 21 07 0424 Date of Birth 186-28-2973 03/30/2006 02/25/1917 Decedent's Last Name Suffix Decedent's First Name MI LAUTSBAUGH MS IRENE M (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 . 1. Original Retum 2. Supplemental Retum 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 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 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 CONFIDENTlAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes SALLY J. WINDER (717) 532-9476 Firm Name (If Applicable) SHIPPENSBURG PA 17257 REGISTER OF WILLS USE P IV ~ yO Q?;:il' ~?;:i Ql:TJn OJ", "'-100 ~~Pc~6 , z tT1 t"" tTJ tT1 0v)~......?;:ib /, -;r, \C b n,...,,'..... Q 0 r-- 0 v ... "J 'Tl ,jC"TJ~~:::J P?;:i tJ.l'"-"n DATE FILED '" .....; ~ F::: tT1 ;;.. Ih.......... [fJ 0 , jvlJ 'Tl ATTORNEY AT LAW First line of address 9974 MOLLY PITCHER HWY Second line of address City or Post Office State ZIP Code 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 knowtedge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. '4~~~;~~R;~~&VV/jt;f? A tI a'ti--f; ~~ . SIGNATU~/ER OTH DM-E I a 7- ADDRESS. 4QO?r L {Jut?" ,J.d.v- IF;;1J 57~s"'~ fA t7cJ.i7- I PLEASE USE ORIGINAIf FORM orlY' Side 1 L 15056051058 15056051058 .-J CY\ --.J 15056052059 REV-1500 EX Decedenfs Name: IRENE M LAUTSBAUGH 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) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an eleetion 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 at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 .. Decedent's Social Security Number 186-28-2973 0.00 0.00 0.00 0.00 0.00 9,580.79 0.00 9,580.79 9,940.00 6,346.96 16,290.96 -6,710.17 0.00 15056052059 ---I REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME IRENE M LAUTSBAUGH -- - .--.--...------- . -- ------- STREET ADDRESS CIO NANCY TRITT File Number 21 07 0424 DECEDENTS SOCIAL SECURITY NUMBER 186-28-2973 75 FARM ROAD ~--- ----------- CITY NEWVILLE 1 STATEpA-- --TZU> . ----- - I 17241 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 0.00 Total Credits (A + 8 + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty ------- - -------- Total Interest/Penalty ( D + E ) (3) 4. 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) 0.00 A. Enter the interest on the tax due. 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: Yes No a. retain the use or income of the property transferred;.......................................................................................... D [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ D [i] c. retain a reversionary interest; or.......................................................................................................................... D 00 d. receive the promise for life of either payments, benefits or care? ...................................................................... D 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D [i] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [i] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D D 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 atter 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 atter 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 exempt 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 atter 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. ~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 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 of transfers to or for the use of the decedent's siblings is twelve (12) percent [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. ~.,,".,,~; '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LAUTSBAUGH. IRENE M Include unreimbursed medical expenses. ITEM NUMBER 1. 2. 3. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 07 SHIPPENSBURG HEALTH CARE CENTER, NURSING CARE BALANCE DESCRIPTION DIAMOND PHARMACY, OUTSTANDING ACCOUNT CHAMBERSBURG IMAGING ASSOCIATES, OUTSTANDING BALANCE 04244 AMOUNT 6,154.00 184.20 8.76 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6 346.96 REV.1511EX+(1.97) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LAUTSBAUGH. IRENE M FILE NUMBER 21 07 04244 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FOGELSANGER-BRICKER, FUNERAL ACCT 8,320.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees SALLY J. WINDER, ESQUIRE 1,500.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS 109.00 5. Accountanfs Fees 6. Tax Retum Prepare~s Fees MOONEY'S TAX SERVICE 15.00 7. TOTAL (Also enter on line 9, Recapitulation) $ 9 944.00 (If more space is needed, insert additional sheets of the same size) ';',~".";,, . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF LAUTSBAUGH IRENE M FILE NUMBER 21 07 04244 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. MARY C. TRITT 75 FARM ROAD NEWVILLE, PA 17241 DAUGHTER B MARY OTT 4 AIRPORT LANE SHIPPENSBURG, PA 17257 DAUGHTER c JOINTLY-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 identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A., B. 4/1/03 M&T BANK CHECKING ACCOUNT NO. 97356085 28,745.25 33.33 9,580.79 TOTAL (Also enter on line 6, Recapitulation) $ 9.580.79 (If more space is needed, insert additional sheets of the same size) ACCOUNT NO. ACCOUNT TVPE STATEMENT PERIOD 97356085 RELATIONSHIP CHECKING WITH INTEREST "AR.2S-APR.26,2006 00 0 06825" ~ 117 477 IRENE M LAUTSBAUGH OR MARY E OTT NANCY C TRITT 5 AIRPORT LN C/O MARY OTT SHIPPENSBURG PA 17257 INTEREST PAID YEAR TO DATE 11.04 WALNUT BOTTO" CU R NT INTEREST PO 28,745.25 2.19 ING DATE TRANSACTI 03-25-06 BEGINNING BALANCE 04-03-06 US TREASURY 303 RR RET 04-03-06 CHECK NU"BER 0727 04-04-06 REVERSE DIRECT DEPOSIT 04-04-06 CHECK NUMBER 0728 04-18-06 CHECK NUMBER 0730 04-21-06 CHECK NUHBER 0732 04-26-06 INTEREST PAY"ENT 1,057.00 6,154.00 1,057.00 15.00 184.20 8.76 2.19 ENDING BALANCE PAGE 1 OF 2 END NG BALANCE 22,385.48 $28,745.25 23,648.25 22,576.25 22,392.05 22,383.29 22,385.48 [ CHECKS. pAlO. Sl.J""ARY $22,385.48 727 04-03-06 732. 04-21-06 6,154.00 8.76 728 04-04-06 15.00 730. 04-18-06 ANNUAL PERCENTAGE YIELD EARNED 0.10 % LOCK IN A GREAT LOAN RATE. UNLOCK THE POSSIBILITIES. WITH "&T CHOICEQUITY, YOU GET THE ABILITY TO LOCK IN A LOAN WITH A GREAT FIXED RATE, AS WELL AS A LINE OF CREDIT - ALL IN ONE ACCOUNT. HOW.S THAT FOR SECURITY AGAINST RISING INTEREST RATES? BEST OF ALL, YOU.LL ONLY HAVE ONE HONTHLY PAY"ENT, WITH NO CLOSING COSTS, NO APPLICATION FEE AND NO REAPPLYING. SO WHY WAIT? START EN~OYING THE FLEXIBILITY OF "&T CHOICEQUITY TODAY. TO APPLY, STOP BY ANY "&T BRANCH, VISIT WWW."ANDTBANK.COH, OR CALL THE "&T TELEPHONE BANKING CENTER AT 1-800-724-3222. 184.20 "v_"u~.(* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER LAUTSBAUGH IRENE M 21 07 04244 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. MARY C. TRITT DAUGHTER 100% 75 FARM ROAD NEWVILLE, PA 17241 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 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)