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Home My WebLink About08-28-07 ....J 15056051058 REV-1500 EX (06-05) PA 0ep&rIment cI RftwIIII . BunlBu cllndividual TlIlllIli PO BOX 280601 HaIIisburg, PA 1712J.Gi01 ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year {)/ 07 Fie Number O/~?; Rollins Suffix Sr Date of Birth 04/15/1921 Decedenrs First Name MI Harry R spouse's First Name MI Virginia M 206-10-8373 1113012006 Decedent's Last Name (If ApplIcable) EnfIIIr Surviving s...... Information Below Spouse's Last Name Suffix Rollins Spouse's Social Security Number 160-16-2730 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. OrigInal Return c.=i 2. Supplemental Relum c::) 3. Remai1der Retum (date of death pIlor to 12-13-82) 5. Federal Estate Tax Return RequIred (=:J 4. LImited Estate C::J c=J 4a. Future Interest CompromIse (date of c::) death after 12-12-82) b 7. Decedent Maintained a UYIng Trust (AIIach Copy of Trust) c::J 10. Spousal Pawlrty CredI (date of death C'::) 11. EIeclIon to lax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sell. 0) CORRESPONDENT - THIS SECTION IIIST BE COMPLETED. ALL CORRESPONDENCE AND CONFIIlENT1AL TAX INFORMATION ~... BE BE D1~ TO: Name Daytime T~~ ::3 ", -~J ;b<o Harry R Rollins Jr (717) 697-0982; "TJ CJ C _ I '-" G"J Finn Name (If Applicable) REGISTEROF'~~EO~ .j J ~';"" 6. Decedent DIed Testate (AIIach Copy of WII) 9. LIIgalIon Proceeds Received 8. TolaI NI.Illber of Safe Deposit Boxes ca First Ine of addl'8SS '. ) C"") ") ".~ l.~ ,- -~- v 214 Westview Dr :_.1:' ....--1 w w CJ1 Second line of address J> City or Post Office Mechanicsburg State ZIP Code 17055-5756 DATE FILED PA Correspondenrs e-mail address: hrollins@comcastnet &:'7\. ~~ 4 Tb fJ- c:.....tn.~ ( c.. S DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 ....J C-n ....J 15056052059 REV-1500 EX Oecedent's Name: RECAPlTUl.A11ON Harry R Rollins 1. Real estate (Schedule A). .. .. .. ... ......... .. ... .. .. ..... ..... .. ..... 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held CoIporation, Partnership or SoIe-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 BlUing Requested . . . . . .. 6. 7. Inter-VIVOS TI'lIIISf8rs & Miscellaneous Non-Probate Property (Schedule G) C) Separate BiDing Requested.. ...... 7. 8. Total G.... Assets (tolal Lines 1-7). . . . . . . . . . . . . . . .. .. . . . . . . . . .. . . . . . .. 8. ---~_.'--'------~~'-~--------~-'_____~n~____.~~_ 9. Funeral Expenses & Admlnistnltive Costs (Schedule H).... ....... .. ... .. '" 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (tolal Lines 9 & 10). .. . .. .. . . . .. . . . . . . . . . ... . . . . . .. . . . 11. 12. Net Value of EstaI8 (Line 8 minus Line 11) . .. .. . . . . . . . . . . . . . . . .. . . . . . . . . 12. 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value SubJed to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. -------- TAX COMPUTA11ON - SEE IlfSTRUC110NS FOR APPLICABLE RATES 15. Amount of Line 14 laxable at the spousal tax rate, or tnInsfers under See. 9116 (aX1.2)X .0JL 158,753.76 15. 16. Amount of Line 14 laxable at lineal rate X.O _ 16. 17. Amount of Line 14 laxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at conateral rate X .15 18. 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. RLL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedenfs SociaJ Security Number 206-10-8373 130,298.60 28,455.16 158,753.76 0.00 158,753.76 158,753.76 0.00 0.00 C:l 15056052059 ....J REV-1500 EX Page 3 Ell Num_ Decedent's Complete Address: I Ii i DECEDENrs NAME DECEDENrs SOCIAL. SECURITY NUMBER Harry R Rollins 206-10-8373 STREET ADDRESS 20 N 12th 51 Apt 102 CITY I STATE I ZIP 17043 Lemoyne PA Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) (1) 2. CreditslPayments A. Spousal PowIrty Credit B. Prior Payments C. Dismunt 0.00 Talal Credits (A + B + C ) (2) 3. InI8nlstJPenalty if applicable D. Interest E. Penalty 0.00 TotaIlnterestlPenalty ( 0 + E ) (3) 4. If line 2 is gI8ater than Une 1 + Une 3, enter the diffeI8nce. This is the OVERPAYMENT. Fin in ovaJ on Page 2, Une 20 to nIqUe8I: a nmnt. (4) 5. If line 1 + line 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. EnI8r the interest on the tax due. (SA) B. Enter the Iotal of line 5 + SA. This is the BALANCE DUE. (58) 0.00 0.00 0.00 0.00 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESnONS BY PLACING AN -r IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... 0 [iJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 IiI d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 IiI 2. If death oa:tmld alter December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [iJ 3. Did decedent own an "in trust for" or payable upon death bank aa:ount or sea.rrity at his or her death? .............. 0 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or OCher non-probate property which contains a beneficiary designation? ........................................................................................................................ [iJ 0 f TIE 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 bebre January 1, 1995, the tax rate ill1>OSEKl on the net value of transfers to or for the use of Ihe surviving spouse is three (3) permnt (72 P.S. ~9116 (a) (1.1) 0)). For dales of death on or after January 1, 1995, the tax rate imposed on Ihe net value of transfers to or for the use of Ihe surviving spouse is zero (0) percent [72 P.S. ~116 (a) (1.1) f.J). The statute does not exempt a transfer to a surviving spouse from lax, and the statutory requirements for disclosure of assets and ling a tax retum are stiR appflC8bJe even if the surviving spouse is Ihe 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 br the use of a natural parent, an adoptive parent, or a stepparent of Ihe chid is zero (0) percent [72 P.S. ~116(a)(1.2)). The tax rate imposed on the net value of transfers 10 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. ~116(1.2) (72 P.S. ~9116(a)(1)). The tax rate imposed on the net value of transfers 10 or for the use of the decedent's siblilgs is twehe (12) percent (72 P.S. ~116(a)(1.3)J.Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by bJood or adoption. REV-1503EX+ (6-98. COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE . STOCKS & BONDS ESTATE OF Harry Ross Rollins Sr FILE NUMBER All praperly joIn11y-..ed with right of survivorship must be disclosed 011 Sc:hedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2591.686 Sh B1krok Mogd Inc Port 26,098.27 2. 76810.71 Sh BlacklOCk Liquidity 76,810.71 3. 580.238 Sh Eaton Vance Spllnvt 12,277.83 4. 443.161 Sh Growth Fund Amer 100 15,111.79 TOTAL (Also enter on line 2, Recapitulation) $ (If more &pllce is needed, insert additional sheets of the same size) 130,298.60 REV-151O EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDUU G INTER-VIVOS TRANSfERS & MISC. NON-PROBAtE PROPERTY ESTATE OF Harry Ross Rollins Sr This schedule must be complelBd and filed if the 811_ to any of questions 1 through 4 on the I8Y8IS8 side of the REV-15011 COVER SHEET is yes. FILE NUMBER DESCRIPTION OF PROPERTY ITEM INCI.IIE 1HE _ OF 1HE llWCSfBlEE, lMER ABATKNHPlllllECElBIT NIl DATE OF DEATH " OF DECD'S EXCLUSION TAXABLE NUMBER 1HE ~ OF 1RNlSfER /iTW:H ACfP'fOF 1HE IlEEIl RlRREAI. ES1JIIE. VALUE OF ASSET INTEREST OF N'Pl.ICMlEI VALUE 1. Metflfe Invs USA Fixed Annuity 28,455.16 100 28,455.16 TOTAL (Also enter on line 7 Recapitulation) $ 28,455.16 (If more space is needed, insert additional sheets of the same size)