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*' COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
DECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL)
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CONNER STEPHEN S.
DATE OF DEATH (MM-DD-Year)
OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
2 1 -0 6 1 0 1 1
COONTYCOOE -YEAR- - - iMiiiER- -
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 90- 5 4 - 5 8 5 0
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
10/25/2006 03/18/1960
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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00 1. Original Return
o 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Wil~
o 9. Litigation Proceeds Received
SOCIAL SECURITY NUMBER
o 2. Supplemental Retum
o 4a. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AllachcopyofTrust)
D 10. Spousal Poverty Credit (dale otdeath betWeen 12-31-91 and 1-1-95)
o 3. Remainder Return (dale of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A} (Attach Sch 0)
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NAME COMPLETE MAILING ADDRESS
LINUS E. FENICLE 2331 MARKET STREET
FIRM NAME (If Applicable)
REAGER & ADLER P.C.
TELEPHONE NUMBER
717-763-1383 CAMP HILL PA 17011
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Deceden~ Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
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5,518.36
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(7)
(8)
5,518.36
(9)
(10)
14,359.50
4,314.03
(11)
(12)
(13)
18,673.53
-13.155.17
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 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
(14)
-13.155.17
0.00 X _ (15) 0.00
0.00 X _ (16) 0.00
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 0.00
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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STREET ADDRESS .
317 North Baltimore Street
CITY S . I STATE I ZIP
Mt. Holly pnngs PA 17065
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
Total Credits (A + B + C)
(2)
D. iJO
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
5.
Total Interest/Penalty ( D + E)
If Line 2 is greater than Line 1 + Line 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 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
(3)
6.00
4.
0.07)
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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'
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 GJ
c. retain a reversionary interest; or ................... ........... ................ .................. ...................................... 0 0'
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 g
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?............. ................ ........... ....... .......................... ............. ........ 0 B
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 g
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 G
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of peljury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the aI representative is based on all information of which preparer has any knowledge.
'SIGNATUR OF SO R SIBLE FOR FILING RETURN TE
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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) (i)l.
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) (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 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 oftransfers to orfor 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)(1)].
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.
R~-1508 E~.+ (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
CONNER STEPHEN S.
FILE NUMBER
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.
1011
ITEM
NUMBER
1.
DESCRIPTION
PNC Checking Account # 5004924238
VALUE AT DATE
OF DEATH
1,385.41
2.
Refund of unused car insurance premium
126.00
3.
Sale of 2000 Dodge Dakota
4,000.00
4.
Mt. Holly Springs Bora - tax refund
6.95
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
5 518.36
RGV-1~11 EXl' (1.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CONNER STEPHEN S
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
06
1011
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Gingrich Memorials 1,550.00
2. Myers Funeral Home 8,100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees Reager & Adler, P.C. 4,4 78.50
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 71.00
5. Accountanfs Fees
6. Tax Retum Prepare(s Fees
7. Cumberland Law Journal - legal advertising 75.00
8, Sentinel - legal advertising 85.00
TOTAL (Also enter on line 9, Recapitulation) S 14.359.50
(If more space IS needed, insert addnional sheets of the same size)
Rdv-151i E;+ (6-98)
*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CONNER. STEPHEN S.
FILE NUMBER
21 06
Include unrelmbursed medical expenses.
1011
VALUE AT DATE
OF DEATH
ITEM
NUMBER DESCRIPTION
1. Pinnacle Health Hospitals
balance bill for services on 9/19/06
2. Comcast Cable
balance of accumulated unpaid monthly charges
3. Spring/Embarq
balance of accumulated unpaid montly charges
4. Board of Probation and Parole
unpaid Supervision Fees
5. Met-Ed
final bill
6. Bryant General Surgery
unpaid bill for outpatient visit
7. Three Springs Family Practice
unpaid bill for office visit
8. Walnut Bottom Radiology
unpaid bill for services
9. Carlisle ER Medicine
unpaid bill for services
10. T-Mobile
final bill
11. Carlisle Regional Medical Center
unpaid bill for services
12. Pinnacle Health
unpaid bill for services
13. Comcast
unpaid accumulated charges
14. 2006 Federal Income Taxes due
15. 2006 Local taxes due - West Shore Tax Bureau
111 .00
571.15
373.88
120.00
133.90
61.00
60.00
163.00
201.47
213.80
88.99
111.00
414.47
1,654.00
36.37
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4.314.03
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
- -... .-- ST.-..... ..-.. S '1 06 1011
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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 pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Meghan Conner Lineal
5253 Deerfield Avenue
Mechanicsburg, PA 17050
2. Matthew R. Conner Lineal
5253 Deerfield Avenue
Mechanicsburg, PA 17050
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n. 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 IT - 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)