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Home My WebLink About02-19-08 -I 15056041169 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO Box 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year .~\ Olo File Number o~L/ ~ Social Security Number Date of Death Date of Birth 387-18-3635 04022006 01051922 LEINENKUGEL CHARLES MI H 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 Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW o 04 [Xl 6. o 9. limited Estate [Xl 2 Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82) 0 4a. Future Interest Compromise (date of 0 5 Federal Estate Tax Return Required death after 12-12-82) [Xl 7 Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 0 10. Spousal Poverty Credit (date of death 0 11 Election to tax under Sec 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) Original Return Decedent Died Testate (Attach Copy of Will) litigation Proceeds Received CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RONALD S. KEARNS Firm Name (If Applicable) REGISTER OF WILLS USE ONLY SMITH ELLIOTT KEARNS & COMPANY,LLC 804 WAYNE AVENUE t~~) First line of address Second line of address 1..:;) i; City or Post Office State ZIP Code , DATE FILED -' J _oj CHAMBERS BURG PA 17201 C) C) 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 SIGNfI'f'tfE OF PERSON RE,?p'PNSI8LE FOR FILING RETURN DATE _ (~?lL 71l,4/L-H!/A.? <i:~ead~ {~//q/D8/' 1,00 SS (, ' 106 STONEHEDGE DRIVE, CARLISLE, PA. 17013 SIGNATURE OF P :t\RE 0 HER TH N R P SENTATIVE DATE c.A19 -&-0' ,ADDRESS 804 WAYNE AVENUE, CHAMBERSBURG, PA. 17201 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041169 15056041169 -I --' 15056042160 REV-1500 EX Decedent's Name CHARLES H LEINENKUGEL RECAPITULATION 1. Real estate (Schedule A) . . . . . 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) 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested . . . . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested. . . . . .. 7. 8. Total Gross Assets (total Lines 1 - 7) . . . . . . . . . . . . . . . . . . . . . . 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . 11. Total Deductions (total Lines 9 & 10) . . . . . 12. Net Value of Estate (Line 8 minus Line 11). . . . . . . . . . . . . 113. Charitable and Governmental 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) . . . . . . . . . . . . . . . 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 .045 176 , 363 . 89 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 19. TAXDUE .......... 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042160 1 5. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Decedent's Social Security Number 387-18-3635 19,549.08 8. 2,716.96 167,409.86 189,675.90 10,855.63 2,456.38 13,312.01 9. 176,363.89 176,363.89 7,936.38 7,936.38 o 15056042160 --' REV-1500 EX Page 3 Decedent's Complete Address: File Number 2 1 - 0 6 - 0 4 4 2 DECEDENT'S NAME Charles H. Leinenkugel STREET ADDRESS 442 vialnut Bottom Road CITY I STATE \ ZIP Carlisle Pa 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 7,936.38 7,095.52 342.10 Total Credits (A + B + C) (2) 7,437.62 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 498.76 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) A. Enter the interest on the tax due. 498.76 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 !Xl b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . D ~ c. retain a reversionary interest; or ............................ .......... ......... D ~ d. receive the promise for life of either payments, benefits or care? ...................... . . . . . . . D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . .' ..... . . . . . . . . . . . . . . . . . . . . . . . . . .. D [XJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . .. 0 !Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D IX] 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. ~9116(a)(1.1.)(i)). For dalies 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. ~9116(a)(1.1 )(ii)l. The statute does nol 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. ~9116(a)(1.2)1. 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. REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Charles H. Leinenkugel 21-06-0442 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 exchange between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEeM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 8 STOCKS & BONDS -.-----.. -- ~---_.. '-"'-'---.---.-.--,..---.. . -'- ------- --....-- ---~ ESTATE OF FILE NUMBER Charles H. Leinenkugel 21-06-0442 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. None DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1504 f:X+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Charles H. Leinenkugel 21-06-0442 Schedule C- j or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER j None DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1S0S EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF Charles H. Leinenkugel - FILE NUMBER 21-06-0442 1. Name of Corporation State of Incorporation Address Date of Incorporation City State _ Zip Code Total Number of Shareholders 2. Federal Employer I.D. Number 3. Type of Business Business Reporting Year Product/Service c STOCK TYPE TOTAL NUMBER OF PAR VALUE NUMBER OF SHARES VALUE OFTHE Voting/Non-Voting SHARES OUTSTANDING OWNED BY THE DECEDENT DECEDENT'S STOCK ommon $ referred $ 4. p Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? . . . . If yes, Position Annual Salary $ . . . . . . . . . . . . . . . . 0 Yes 0 No Time Devoted to Business 6. Was the Corporation indebted to the decedent? If yes, provide amount of indebtedness $ . . . . . . . . . . . . . . 0 Yes 0 No 7. Was there life insurance payable to the corporation upon the death of the decedent? " .. .. . . . . . DYes ONo If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer any stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes ONo If yes, o Transfer OSale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? . . . . . . . 0 Yes 0 No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? . . . . . . . . . If yes, provide a copy of the agreement of sale, etc. . . . . 0 Yes 0 No 11. Was the corporation dissolved or liquidated after the decedent's death? . . . . . . . . . . . . . . . . . . . . . . 0 Yes 0 No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . . . . . 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. c THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) REV-1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF Charles H. Leinenkugel FILE NUMBER 21-06-0442 1. Name of Partnership Date Business Commenced Address Business Reporting Year City State Zip Code 2. Federal Employer 1.0. Number 3. Type of Business Product/Service 4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $ E PARTNER NAME PERCENT PERCENT BALANCE OF OF INCOME OF OWNERSHIP CAPITAL ACCOUNT L .. 5. A c D 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? If yes, provide amount of indebtedness $ . . . . . . . . 0 Yes 0 No 8. Was there life insurance payable to the partnership upon the death of the decedent? . . . . . . . . . . . . 0 Yes D No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes DNo Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. If yes, DTransfer DSale Percentage transferred/sold Consideration $ Date 10. Was there a written partnership agreement in effect at the time of the decedent's death? . . . If yes, provide a copy of the agreement. . DYes DNo 11. Was the decedent's partnership interest sold? If yes, provide a copy of the agreement of sale, etc. . . . . . . . DYes D No 12. Was the partnership dissolved or liquidated after the decedent's death? . . . . . . . . . . . . . . . . . . . . . . 0 Yes D No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? If yes, explain . . . . . . . . . . . . . . . . . . . . . . DYes D No 14. Dild the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . . . . . DYes D No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. c THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a fist showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER Charles H. Leinenkugel 21-06-0442 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Charles H. Leinenkugel 21-06-0442 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 2 3 4 5 DESCRIPTION Thornwald Nursing Home-Refund of Prepayment Dr. Michael Camlinde-Refund Physicians Bill US Treasury-Social Security Benefit in Transient Furniture IRA Orrstown Bank Alc Lo23588 VALUE AT DATE OF DEATH 6,461.82 12.00 1,266.90 25.00 11,783.36 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets ofthe same size) 19,549.08 ORRSTOWN FINANCIAL ADVISORS A Tradition of Excellence February 11, 2008 Charles 11. Leinenkugel Estate c/o Ron Keams 804 Wayne Avenue Chambersburg, PA 17201 RE: ORRSTOWN BANK STATEMENT SA VINGS ACCOUNT # 606000044 Dea.r Ron: This letter will conf1rm that the date of death balance or ML Le;ncnkugel'::; above relerenced savings account as of April 2,2006, was $11, 783.J6. In addition, accrued income on this account to date of death wac;; $12.84. Should you have any further questions, please feci fi'cc to contact me. 01/18/2008 13:19 71 72400804 1/18/08 Charles H Leinenkugel Over 70 1/2 Redeemed Original balance: Current balance: l=View 6=Print T;Tset Opt Post~ed InputSrc 2/04105 G 5/06/05 G 5/06/05 G 8/05/05 G 8/05/05 G 11/04/05 G 11/04/05 G 2/06/06 G 2/06/06 G 5/05/06 G 5/05 0 G 04/06 8/04/06 G 11/06/06 G ORRSTOWN BANK Time Deposi t Inquiry Account number: Due to Death Has messages 11,662.33 YTD interest: .00 Next pmt date: Control: From Rate TIc AFF 671 C B 670 D I 671 C B 670 D I 671 C B 670 D I 671 C B 670 D I 671 C B 670 D I 671 C B 670 0 I 671 C B 670 D I Amount 43.73 42.45 42.45 44.05 44.05 44.22 44.22 44.38 44.38 43.10 43.10 44.71 44.88 F4=Red.isplay F7=Scan forward F8~Scan backward F17=Top F18=Bottom F20=Fold/Unfold PAGE 04/05 1J.:01:03 606000044 1 of 1 - .00 2/06/08 To Balance 11,608.26 11,608.26 11,650.71 11,650.71 11,694.76 11,694.76 11,738.98 ~ .1-/ 3.36 11,826.46 , .' 11,871.17 11,871.17 More. . . F16=Sort F22"=Tran Codes REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Charles H. Leinenkugel FILE NUMBER 21-06-0442 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINTTENANT(S) NAME A Jane M. Bellinger ADDRESS RELATIONSHIP TO DECEDENT 106 Stonehedge Drive Carlisle, Pa. 17013 Daughter B. C. JOINTLY-OWNED PROPERTY: 1 2 LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DEeDS VALUE OF TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST A. 06/12/01 Orrstown Bank Checking A/C#2102 5,433.61 50 2,716.81 A Accrued Interest on #1 .29 50 0.15 Bank Statement Attached TOTAL (Also enter on line 6, Recapitulation) $ 2,716.96 ITEM NUMBER (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY _"__m__.. "'_,_'____ ____ .._____ _____. _____ ______,_______ _____.___._.__".~_..____.,..._.., __..._~_ _____.._,___ ESTATE OF FILE NUMBER Charles H. Leinenkugel 21-06-0442 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ~ INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER " THE DATE OF TRANSFER ATIACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. CH Leinenkugal Trust-Orrstown Bank A/c#1331007-Valuation Attached 16 7,409.86 100 167 ,409.86 TOTAL (Also enteron line 7, Recapitulation) $ 167,409.86 (If more space is needed, insert additional sheets ofthe same size) REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Charles H. Leinenkugel FILE NUMBER 21-06-0442 ITEM NUMBER A. 1 Debts of decedent must be reported on Schedule I. DESCRIPTION 2 FUNDERAL EXPENSES: Memorial Service Costs-Schedule Attached Travel Expense-Kansas Funeral-Schedule Attached 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. Attorney Fees 3. Family Exemption (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7 Register of Wills-Estimated Filing Fees Jane M. Bellinger-Reimburse Postage&Stationery The Sentinel-Advertising Letters Testamentary Cumberland Law Journal-Letters Testamentary B 9 10 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) AMOUNT 504.68 2,842.55 67.00 7,220.00 15.00 23.41 107.99 75.00 10,855.63 REV-1512 E::X+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ______m__ _.._________ -...--.----- _.~-'--'- -~-.-...--------.--.-.--...--- -----.- ,---------- FILE NUMBER 21-06-0442 -~ ESTATE OF Charles H. Leinenkugel Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. 2 3 4 5 6 7 8 VALUE AT DATE OF DEATH DESCRIPTION Belvedere Medical Group-Nursing Care Pa Dept of Revenue-2005 Income Taxes Pa Dept of Revenue-2006 Estimated Income Taxes Pharmerica-Drugs Orrstown Bank-Preparation 2005 Income Tax Returns Orrstown Bank-Trustee Fee 3/31/06 paid 4/25/06 Dr. Hartzell Pa Dept of Revenue-2004 Income Taxes 25.91 478.00 232.00 585.58 250.00 373.89 50.00 461.00 2,456.38 TOTAL (Also enter on line 10, Recapitulation) $ (II more space is needed, insert additional sheets olthe same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Charles H. Leinenkugel NUMBm NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Jane M. Bellinger 106 Stonehedge Drive Carlisle, Pa 17013 2 Janet P. Gockerman 1110 Oakleigh NW Grand Rapids, Mi 49504 FILE NUMBER 21-06-0442 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Daughter . 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART" - 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) AMOUNT OR SHARE OF ESTATE One-Half One-Half REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN __---1c~~c!_130x 4 o"-REV-1_500 Cove,"-~h~et) ESTATE OF FILE NUMBER Charles H. Leinenkugel 21-06-0442 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. o Will o Intervivos Deed of Trust o Other I LIFE ESTATE INTEREST CALCULATION l NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH LIFE ESTATE IS PAYABLE o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which life estate is payable ................ $ 2. Actuarial factor per appropriate table. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Interest table rate - 031/2% 06% 010% OVariable Rate 3. Vallue of life estate (Line 1 multiplied by Line 2) . . . . . . . . . . . . . % .. $ c ANNUITY INTEREST CALCULATION I NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH ANNUITY IS PAYABLE o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which annuity is payable ...... ... $ 2. Check appropriate block below and enter corresponding (number) . . . . . . . . . . . . Frequency of payout - o Weekly (52) OBi-weekly (26) OMonthly (12) o Quarterly (4) DSemi-annually (2) DAnnually (1) DOther ( ) 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . ........ $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate - D 3 1/2% 06% 010% DVariable Rate % 6. Adjustment Factor (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 7. V;alue of annuity -If using 31/2%,6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 . . $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 . . . . . . . . . . . $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest{s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 I::X+ (3-04) I INHERITANCE TAX SCHEDULE L COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT _ _ IN~~~~~~~~~E~~~~~.~ OR I_~XA~ION OF TRUST. PR~NCIP~k_. .~ILE~UMBER 21-06-0442 I. ESTATE OF LEINENKUGEL CHARLES H (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on 8. Name(s) of Life Tenant(s) or Annuitant(s) (Date) Date of Birth Age on date of election C. Assets: Complete Schedule L-1 1. Real Estate. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ 2. Stocks and Bonds ........................ $ 3. Closely Held Stock/Partnership . . . . . . . . . . . . .. $ 4. Mortgages and Notes. . . . . . . . . . . . . . . . . . . . .. $ 5. Cash/Misc. Personal Property . . . . . . . . . . . . . .. $ 6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . . .. $ 2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . . .. $ 3. Value of Unincludable Assets. . . . . . . . . . . . . . .. $ 4. Total from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ E. Total Value of trust assets (Line C-6 minus Line D-4) ............................... $ F. Remainder factor (see Table I or Table" in Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . . G. Taxable Remainder value (Line E x Line F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ (Also enter on Line 7, Recapitulation) Term of years income or annuity is payable A. Invasion of corpus III. INVASION OF CORPUS: (Month, Day, Year) B. Name(s) of Life Tenant(s) or Annuitant(s) Date of Birth Age on date corpus consumed C. Co~usconsumed ...... ...................... .............. .......... ...... $ D. Remainder factor (see Table I or Table II in Instruction Booklet) .. . . . . . . . . . . . . . . . . . . . . . . E. Taxable value of corpus consumed (Line C x Line OJ .............................. $ (Also enter on Line 7, Recapitulation) Term of years income or annuity is payable REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I SCHEDULE M FUTURE INTEREST COMPROMISE _(Chec\( Box ~a of! R_ev-1 ~OO C()ver Stl.eet) _ - ESTATE OF FILE NUMBER Charles H. Leinenkugel 21-06-0442 This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. o Will 0 Trust 0 Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. 0 Unlimited right of withdrawal 0 Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One 0 6%, 0 3%, 0 0% .................. $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One 0 6%, 0 4.5% ........................ $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) $ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . .. $ (If more space is needed, insert additional sheets of the same size) REV-1648 EX (11-99)(1) SCHEDULE N SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94) ESTATE OF Charles H. FILE NUMBER Leinenkugel 21-06-0442 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. I PART I - CALCULATION OF GROSS ESTATE I 1. Taxable Assets total from line 8 (cover sheet) ......... . ....... . ....... . ........... . ....... . 1. 2. Insurance Proceeds on Life of Decedent. . .... . .... . ......... -. ...... . ........... . ........ . 2. 3. Retirement Benefits ... . ....... . ..... . ... . ... -.. ......... . ...... -. ............ . ..... -.' 3. 4. Joint Assets with Spouse ..... . ......... . .................. . ... . .. -. ..... . ... . . -........ 4. 5. PA Lottery Winnings . . . . ... . - . . . . . . . . . . . . . . . .............. . .. . ....... . ............... . 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary). . . 6a. 6b. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ...... . .. . ........ . ..... - .... . .. . ... . . . . . .... . ......... . 6. 7. Total Gross Assets (Add lines 1 thru 6) ..... . ....... . ........ . ..... . .. . . . ............. -. 7. 8 Total Actual Liabilities. . . . . . . . . ..... . .. . ........... . .... . .......... . ...... . ........ . 8. 9. Net Value of Estate (Subtract line 8 from line 7) ........... . ...... . ..... . . . ..... . ........ . 9. If line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part II. I PARTn- CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income Tax l Return for decedent and spouse.) Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse .... . ...... . 1a. 2a. 3a. b. Decedent ....... . 1b. 2b. 3b. c. Joint ... . ..... . ... . 1c. 2c. 3c. d. Tax Exempt Income 1d 2d. 3d. e. Other Income not listed above .. . ... . 1e. 2e. 3e. f. Total .... . ..... . 1f. 2f. 3f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1f) + (2f) + (3f) ( -c-3) 4b. Average Joint Exemption Income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not. continue to Pari III !PART 1. 1m III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES I ;ert amount of taxable transfers to spouse or $100,000, whichever is less. . . . ... . ..... . .... . 1. Jltiply by credit percentage (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . ... . ..... . .... . ...... . 2. is is the amount of the Resident Spousal Poverty Credit. Include this figure the calculation of total credits on line 18 of the cover sheet. . . . . . . . . . ..... . .. . .. . ....... . 3. r Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the cedent's gross estate . . . . . . . . . . . . . ...... . .......... . ........... . ..... . ... . ........ . 4. Jltiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Iverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. ...... . 5. 2. Ml 3. Th in 4. Fa de 5. Ml Pc COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I SCHEDULE 0 ELECTION UNDER SEC. 9113(A.).. (SPOUSAL DISTRIBUTIONS) .-, -_...,._---_._~._- ....--.----.----...., .____. ___0._'.._- _ ---- REV-1649 EX+ (6-98) ESTATE OF FILE NUMBER Charles H. Leinenkugel 21-06-0442 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) ofthe Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the tnust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113(A) trust or similar arrangement. Description Value Part A Total $ Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A) election to tax is being made. Description Value Part B Total $ (If more space is needed, insert additional sheets of the same size) REV-1511 f:X+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBEF{ DESCRIPTION AMOUNT A FUNDERAL EXPENSES: 1. 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. Attorney Fees 3. Family Exemption (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ~ ZIP Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) February 13, 2008 Commonwealth of Pennsylvania Department of Revenue Bureau of Individual Taxes Inheritance Tax Division Dept. 280601 Harrisburg, Pennsylvania 17128 Re: Estate 0/ Charles H. Leinenkugel Supplemental Form 1500 I am filing a supplemental Pennsylvania Inheritance tax return as a result of Orrstown Bank recently disclosing to me an IRA account not previously reported to me by the bank. Please do not assess a penalty to the estate for the additional tax due of$ 498.76 which was paid upon the filing of the supplemental tax return since I was unaware of the IRA account. Thank you for your consideration. Very truly yours, ~m~r 1ane M. Bellinger Executrix