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Home My WebLink About12-05-07 ~ .) --.J 15056041125 REV-1500 EX (OS-OS) PA Department of Revenue. Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONL V County Code Year 2 1 0 7 File Number o 8 0 1 Date of Birth 20220 383 1 o 8 132 007 10031923 RHOADS CARMEN MI J Decedent's Last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI WIDOW Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW [:&J 1. Original Return D 4. Limited Estate [:&J D 2. Supplemental Return D D o 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return 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 D 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~ D AWN M D E F U G E 7 1 7 ~ cY 6 i3 3 ~'ll:g i ;;0 0 r-l' i <;~5 Firm Name (If Applicable) REGISTERi~ LS USEXlNLV?;-; ~o , .~~ ~~ ~ t:tl Cg :;3~ ~ ~ o S? 1-' r-n ,~/) (-) '1', 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received D D D D 8. Total Number of Safe Deposit Boxes First line of address 114 LAN CAS T E R B 0 U LEV A R D .- JJ :<:J -l .J:> (..) (..) Second line of address City or Post Office State ZIP Code DATE FILED M E C H A N I C S BUR G P A 17055 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 knowledge 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. SI ATU OF PERSON RESPONSIBLE R FI.LING RETURN DATE 11/15/07 PA 17055 DATE 11/15/07 PA 17111 HARRISBURG PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 ---I '" ..) .....J 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: CARMEN J. RHOADS RECAPITULATION 202203831 2. Stocks and Bonds (Schedule B) .................................. 2. 165000.00 56763.76 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 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. 1 3 1 6 4 . 8 1 ...... . 6. Jointly Owned Property (Schedule F) D Separate Billing Requested . . . . . . . 6. 1 0 2 9. 3 3 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested. . . . . . . 7. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . .... ... .. . ...... 14. 2 3 5 9 5 7 . 9 0 1 3 8 2 7 . 4 8 1 2 3 o . 9 9 1 5 0 5 8. 4 7 2 2 0 8 9 9. 4 3 O. 0 0 2 2 0 8 9 9. 4 3 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 election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 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.O _ o . 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .04"L 2 2 0 8 9 9 . 4 3 16. 17. Amount of Line 14 taxable o . 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable o . 0 0 at collateral rate X. 15 18. o. 0 0 9940.47 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. o. 0 0 O. 0 0 9940.47 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT D Side 2 L 15056042126 15056042126 -.J REV-150] EX Page 3 ~cedent's Complete Address: File Number 21 07 0801 DECEDENrs NAME CARMENJ.RHOADS STREET ADDRESS 114 LANCASTER BOULEVARD - ~--- CITY I STATE I ZIP MECHANICSBURG I PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 9.940.47 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + 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) 0.00 0.00 9,940.47 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) A. Enter the interest on the tax due. 9,940.47 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 IZl b. retain the right to designate who shall use the property transferred or its income; ............................... D IZl c. retain a reversionary interest; or ................................................................................................ D IZl d. receive the promise for life of either payments, benefits or care? ....................................................... D IZl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... D IZl 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... D IZl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. D IZl 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 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. 99116 (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 zero (0) percent [72 P.S. 99116 (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 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. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(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-15d'2 EX + (6-98) - '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER CARMEN J. RHOADS 21 07 0801 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 DroDertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION DWELLING, 114 LANCASTER BOULEVARD MECHANICSBURG, PA 17055 VALUE AT DATE OF DEATH 165,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 165000.00 REV-1501'EX + (6-98) .J *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF CARMENJ.RHOADS FILE NUMBER 21 07 0801 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION MUTUAL FUNDS, WALNUT STREET SECURITIES, INC VALUE AT DATE OF DEATH 56,763.76 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 56 763.76 '- REV-1508 EX + (6-98) ~' '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF CARMENJ.RHOADS FILE NUMBER 21 07 0801 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. ITEM NUMBER 1. DESCRIPTION CASH AND CASH EQUIVALENTS, WALNUT STREET SECURITIES, INC VALUE AT DATE OF DEATH 13,164.81 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 13164.81 REV-15~ EX + (6-98) .; *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF CARMENJ.RHOADS FILE NUMBER 21 07 0801 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. DAWN M DEFUGE 114 LANCASTER BOULEVARD MECHANICSBURG, PA 17055 DAUGHTER B 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 DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrSINTEREST 1. A. 07/2000 PNC BANK, JOINT CHECKING ACCOUNT 2,058.65 50. 1,029.33 TOTAL (Also enter on line 6, Recapitulation) $ 1,029.33 (If more space is needed, insert additional sheets of the same size) .. REV-1511 EX + (12-99) .' . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CARMENJ.RHOADS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 07 0801 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME, 37 E MAIN STREET, MECHANICSBURG, PA 17055 9,092.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) 0.00 Social Security Numbe~s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees 0.00 3 Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) 3,500.00 Claimant DAWN M DEFUGE Street Address 114 LANCASTER BOULEVARD City MECHANICSBURG State P A Zip 17055 Relationship of Claimant to Decedent DAUGHTER 4. Probate Fees CUMBERLAND COUNTY, PA 310.00 5. Accountant's Fees 0.00 6. Tax Retum Pre parer's Fees JAMES H HESS, CPA 300.00 7. DEATH NOTICES, PATRIOT NEWS, HARRISBURG, PA 199.98 8 CEMETERY STONE INSCRIPTION 125.00 9 APPRAISAL COST FOR DWELLING 300.00 TOTAL (Also enter on line 9, Recapitulation) $ 13 827.48 (If more space is needed, insert additional sheets of the same size) . REV-1512 EX + (12-03) \.' '*' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CARMEN J, RHOADS FILE NUMBER 21 07 0801 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER t DESCRIPTION QUANTUM IMAGING, FINAL BILL NOT PAID BY INSURANCE VALUE AT DATE OF DEATH 1,025.00 2 CREDIT CARD PAYOFF 20.49 3 FINAL BILL ON CELL PHONE 185.50 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1 230.99 :""tx.,* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CARMENJ RHOADS SCHEDULE J BENEFICIARIES 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. DAWN M DEFUGE Lineal 220,899.43 114 LANCASTER BOULEVARD MECHANICSBURG, PA 17055 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. WIDOW 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. NONE 0.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 FILE NUMBER 21 07 0801 (If more space is needed, insert additional sheets of the same size) .. .,' .. ," ~/:''''I.~ Tl,e a' II DO . :-:--. L.~ 8,..,;, 'lJQi/7q! ~ . ~y G, ..~ . ~/4la //7 I~ T'OlI. 1.iver If ~ 8q4P ~ .,. ~JL tSbSlrlelslrtPo.rIl Do.t · , 4ft/o/',,% ~. ep\wl11s\rhoad8.cj\12",e ,,- , " '" LAS'!' WILL AND TESTAMENT OF CARKBN J. RHOADS I, CARMEN J. RHOADS, of the Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate to my daughter, DAWN M. OEFUGE. Should my daughter, DAWN M. OEFUGE, fail to survive me, I devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate, to my granddaugh- ter, WENDY DEFUGE. ITEM III: I appoint my daughter, DAWN M. DEFUGE, Executrix of this my last will. Should my daughter, DAWN M. DEFUGE, fail to qualify or cease to act as Executrix, I appoint my granddaughter, WENDY DEFUGE, Executrix of this my last will. Page 1 of 4 .- ...-...----.... z:0 39t1d 38I^~3S Xt1~ NOSdWIS B96896LL !L t E9:9t L006/9t/tt ~ . ~,~.. , f ... ITEM IV: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of her duties in any jurisdiction. IN WITNlSS WHERBOF, I, CARMEN J. RHOADS, have hereunto set my hand and seal this ~ day of ---i)bro~~ , 1998. ~ - f~~ ~~~_..; P r ,,'\ ~ CARMEN .fI, GADS SIGNED, SEALED, PUBLISHED and DECLARED by CARME J. RHOADS, the Testatrix above named, as and for her Last Will and and in the presence of us, who at her request, in her prese ce and in the have subscribed our names as witnesses. I Address ~G(r &?'k'/L(&~/4 Address COMMONWEALTH OF PENNSYLVANIA: ss: COUNTY OF CUMBERLAND I, CARMEN J. RHOADS, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according Page 2 of 4 " " to law do hereby acknowledge that I signed and executed this instru- ment as my last will; that! signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. G~ , /1// ,. ~~~ ,J c -C.--'fi:-4-er:~- CARMEN J. RHOADS Sworn to or affirmo~ t~ ~, ,,.iI a~k~~wle~g~~ before me by CARMEN J. RHOADS, the Testatrix, this ~ ~~~. . . 1998. .. eYf(~ Notary Public NOTARIAL SEAL CONSTANCE L KARU. Notary Public New Cumbel13nd. PA Cumberland Co. My CommISSion ExplrN April 13, 1999 COMMONWEALTH OF PENNSYLVANIA S5: COUNTY OF CUMBERLAND the /7 and iiltifA/!0 tt !frz. witnesses whose names are signed to the attached or foregoing We, ~~~. instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Page 3 of 4 10 39\Jd 30I^~3S X\J~ NOSd~IS 096S96LLtLt gp:gt L000/9t/tt . ......_lo, - will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Dw.<u~ Wit ill -k Y;f4J !/t,.LV/' .< Witness , Sworn to or affirmed to and acknowledged before me by ~)~ r-l ~ and witnesses, this ~ ().r';r~. , 1998. ~ ->;/( f{ad, Notary Public day of NOTARIAL SEAL CONSTANCE L KARU, Notary Public New cUf1ll)erland. PA Cumberland Co. My commtsalOn Explrea .U 13, 199& Page 4 of 4 S0 39'ii'd 38I^~3S X'ii'~ NOSdWIS 096BS6LL 1L l: BP:9l: L000!Sl:!l:l: J .~3ID-uO PeJ ~CoO .JD APO 5O.dO ~ 11cr3