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Home My WebLink About04-28-08 --.J 1SDSbDlf11lf7 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 Veer INHERITANCE TAX RETURN DO RESIDENT DECEDENT 2 1 l> File Number OLigO Date of Birth 201 18 3429 02 23 2008 08 03 1929 FOGEL SANGER JOHN MI W Decedent's Last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name FOGEL SANGER Suffix Spouse's First Name MARY MI A Spouse's Social Security Number 198-30-0457 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS FILL IN APPROPRIATE OVALS BELOW [!] 1. Original Return 2. Supplemental Retum D D 3. Remainder Return (date of death priorto 12-13-82) 5. Federal Estate Tax Retum Required 9. litigation Proceeds Received D D D D 4a. Future Interest Compromise (date of deeth after 12-12-82) D D D 4. limited Estate 6. Decedent Died Testate (Attach Copy of Will) 7 Decedent Maintained a Living Trust . (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 10 Spousal Pover1}t Credit (date of death . between 12-31-91 and f-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JERRY A. WEIGLE ESQUIRE 717 532 7388 f',) Firm Name (If Applicable) WEIGLE & ASSOCIATES, P.C. 126 EAST KING STREET ::rJ REGISTE~~f1LLS U~NL Yf=g 8 ;-:-::1 -0 -0 (,'-:> 0 j , I -r:: 0 ::::0 ( /) :D .cl ~~ ~ ~ ~ll rjJj (")0 -0 ~~ ")9":x :I1 >-)::0 ~ M :::-0.-4 . ,--) ~E FILED.c- ';-'/i First line of address Second line of address City or Post Office SHIPPENSBURG State PA ZIP Code 17257 Correspondent's e-mail address: Under penalties of p,e~ury, 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN L-1Ji!/lJ' ~..i!A4'1f/A/ ADDRESS I Mary Ann Fogelsanger DATE c;-- Lj-/ )-~ 4 Jerry A. Weigle Esquire L-. o:2E I ') ~ 0 '(; Side 1 L 1SDSbDlf11lf7 1SDSbDlf11lf7 --.J ~ -' lSDSbD42148 REV-1500 EX Decedenl'sName: John W. Fogelsanger 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) D 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)....................................................................... 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. 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, of transfers under Sec. 9116 (a)(1.2)X ~ 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 0 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 19. Tax Due..... .......................................................... ...................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L l.5DSbD42l.48 Decedent's Social Security Number 201 18 3429 0,00 4.256 35 152 85 4.40920 -4.409,20 14. -4.409.20 15. 0.00 0.00 o 00 0.00 16. 17. 18. 0,00 D lSDSbD42148 -' REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-- DECEDENrs NAME John W. Fogelsanger STREET ADDRESS 304 East King Street CITY I STATE [ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) 0.00 (5A) (5B) 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 [!] 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 [!] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D [!] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..................................................................................... ................................ 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 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 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. ~9116 (a) (1.1) (ii)]. The statute does not exemDt 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 .5. ~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. 59116 (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-11~1 EX+ (12-99) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Fogelsanger, John W. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-- ESTATE OF ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 4,091.35 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees Weigle & Associates, P .C. 150.00 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. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 4,256.35 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) . Rev-1502 EX+ (8-98) . SCHEDULE H.A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESI>ENT DeCEDENT ESTATE OF Fogelsanger, John W. FILE NUMBER 21- ITEM NUMBER DESCRIPTION AMOUNT 1 Fogelsanger-Bricker Funeral Home 4,091.35 Subtotal 4,091.35 Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule H-A (Rev. 6-98) . Rev.150~ EX+ (8.98) . SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Fogelsanger, John W. FILE NUMBER 21- ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Register of Wills, Cumberland County - filing Insolvent PA Inheritance Tax Return 15.00 Subtotal 15.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) t Rev-161~ EX+ (1-98) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Fogelsanger, John W. FILE NUMBER 21- ESTATE OF Include unrelmbursed m.dlcal .xpen.... ITEM NUMBER DESCRIPTION 1 Harrisburg Pharmacy VALUE AT DATE OF DEATH 57.85 2 Shippensburg Area EMS - 2-5-08 service 75.00 3 Shippensburg Family Practice 10.00 4 Stoken Ophthamology 10.00 TOTAL (Also enter on Line 10, Recapitulation) 152.85 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-15Z3 EX+ (9.00) *' SCHEDULE .. BENEFICIARIES COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER Fogelsanger, John W. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal Ciistributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not Uat Truatee(e) FILE NUMBER 21- SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. Not relevant as estate is insolvent. Total Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate. 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)