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Home My WebLink About05-29-08 (2) --.J 15056041125 REV-1500 EX (06-05) PA Department of Revenue '* ~~~~~~~~:o~uaITaxes INHERITANCE TAX RETURN 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 5 File Number o 999 Date of Birth 192017250 1 103 2 0 0 5 04271916 Decedent's Last Name Suffix Decedent's First Name MI AKERS D . R I C H A R D (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 OVALS BELOW o 1. Original Retum o 4. Limited Estate o o 2. Supplemental Return o o 3. Remainder Return (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 0 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 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received IZI o o o 8. Total Number of Safe Deposit Boxes PET E R R W I L SON 717 763 1 3 8 3 Firm Name (If Applicable) C AMP H ILL P A 17011 ---_.__._~_.- REGISTER OF WILLS USE ONL vl I ,~ Ii t:..:.:.;,:) .'":-'~ I ~. .'. r:-r - . . - '. ::g :! DAiiF~t~D 5~ :j.., -----~ ._-.;~~--------:---: ~ D '~& ~-~~ :1 c-) ,-. REAGER & ADLER, P C First line of address 2 3 3 1 MARKET STREET Second line of address City or Post Office State ZIP Code "..) \.0 ') Correspondent's e-mail address:PWILSON@REAGERADLERPC.COM Under penalties of pe~ury,1 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. SIGNA RE OF PERSON RESP- NSIBLE FOR FILING RETURN DATE . Jvv- ~ /. BERRYHILL STREET HARRISBURG SIGNATURE 0 ER THAN REPRESENTATIVE ADDRESS 2331 MARKET STREET CAMP HILL PLEASE USE ORIGINAL FORM ONLY PA 17011 Side 1 L 15056041125 15056041125 --I q ....J 15056042126 REV-1500 EX Decedent's Social Security Number Decedenl'sName: D. RICHARD AKERS RECAPITULATION 192017250 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) D Separate Billing Requested. . . . . .. 7. 1284.99 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 1 2 8 4.9 9 380.00 8. Total Gross Assets (total Lines 1-7) ........................... 8. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) ...........................11. 380.00 904.99 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental 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) .. . . . . . . . . .. . . . . .. 14. 9 0 4 . 9 9 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. O. 0 0 16. Amount of Line 14 taxable 9 0 4 . at lineal rate X .042...... 9 9 16. 4 o . 7 2 17. Amount of Line 14 taxable o . 0 0 at sibling rate X .12 17. O. 0 0 18. Amount of Line 14 taxable o . 0 0 o . at collateral rate X .15 18. 0 0 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 4 o . 7 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o Side 2 L 15056042126 15056042126 ---' REV-1500 EX Page 3 Decedeht's Complete Address: DECEDENT'S NAME D. RICHARD AKERS STREET ADDRESS 100 MT. ALLEN DRIVE File Number 21 05 0999 I STATE PA -IZIP 117055 -- CITY MECHANICSBURG Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 40.72 Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty ~. T otallnterest/Penalty ( D + E ) If Une 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. (3) (4) (5) (5A) (58) 0.00 0.00 40.72 0.64 41.36 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 Une 5 + 5A. This is the BALANCE DUE. 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; ...................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 00 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)). 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 or for 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-1508 EX + (6-98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF D. RICHARD AKERS FILE NUMBER 21 05 0999 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 THE FIDELITY MUTUAL LIFE INSURANCE COMPANY (DISTRIBUTION OF DISTRIBUTABLE EQUITY, SEE COpy OF CHECK ATTACHED, PER TELEPHONE CALL WITH PAUL DIBERT INTEREST CHARGED FROM DATE CHECK ISSUED, WHICH IS MARCH 11, 2008) VALUE AT DATE OF DEATH 1,284.99 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1 284.99 REV-1511 EX + (12-99) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF D. RICHARD AKERS SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 05 0999 Debts of decedent must be reported on Schedule I. ITEM _ NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions .- Name of Personal Representative (s) Social Security Numbe~s)IEIN Number of Personal Representative(s) Street Address City State Zip Yea~s) Commission Paid: 2. Attomey Fees REAGER & ADLER, PC 350.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 7. FILING FEE - REGISTER OF WILLS 30.00 TOTAL (Also enter on line 9, Recapitulation) $ 380.00 (If more space is needed, insert additional sheets of the same size) ''''.''''''.'* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF D RICHARD AKERS 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 pnclude outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] 1. ROSEMARIE THOMAS Lineal 113.13 116 PARKVIEW DRIVE NEW CUMBERLAND, PA 17070 2. PATRICIA CALLAHAN Lineal 113.13 93 GREENWOOD CIRCLE WORMLEYSBURG, PA 17043-1140 3. ROBERT AKERS Lineal 113.13 2300 HARVARD AVENUE CAMP HILL, PA 17011-5331 4. MARY JO ROWLES Lineal 113.12 2127 BIRCH STREET WHITE BEAR LAKE, MN 55110-4307 5. JAMES R. AKERS Lineal 113.12 2344 BERRYHILL STREET HARRISBURG, PA 17104-2009 6. JOHN AKERS Lineal 113.12 1012 CHIPPEWA ROAD JOHNSTOWN, PA 15904-2440 7. MICHAEL AKERS Lineal 113.12 444 NORTH 25TH STREET CAMP HILL, PA 17011 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ .. FILE NUMBER 21 05 0999 (If more space is needed, Insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent D. RICHARD AKERS Decedent's Name Page 1 21 05 0999 File Number Schedule J - Beneficiaries - 1 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) 8. RICHARD AKERS Lineal 113.12 442 BOB STREET JOHNSTOWN, PA 15904-2704 f The Fidelity Mutual Life Insurance Company (-in Rehabilitation) Initial Distribution This check represents your share of the initial distribution of tI:1e Distributable EQuity under The Fourth Amended Plan For The Rehabilitation Of The Fidelity Mutual Ufe Insurance Company. A Notice Package fully explaining the reason you are receiving this check along with an Individual Allocation Statement estimating the amount of your share of Distrib!Jtable Equity was previously mailed to you in July 2007. Distributable Equity is fully taxable and will be reported to the. IRS on a 1099DN. yoU will receive a copy of this 1099 DIV in early 2009. Questions concerning the taxation of this distribution should be discussed with your personal tax advisor. . 16UDC F M L + OiJ2CD70001 OOUCKC PlEASE CASHi1)EPOSIT lllIS CHECK PROl.FTl y. ."'l~~IL."I_.O:III__.--.. .._.....1*.tuI!J.&--.:I.:r.,I'.~_.!I...-..,... _",.'.......::In:.:.I~.,.T. '1'f!'Irdli:"."""I"H.-=cIo.'UI~_:J.;;._..tIl-.slIll:il=-:'I.._...m::::__-..-=:t2~__'._"~"'~"".)I~.:tll~"~"""'_~."""-""'_""'~.'_,,,... The Fidelity Mutual Life Insurance Company (in Rehabilitationt Bank of Amertca Atlanta. Oekalb County, Georgia 64-1278 611 GA VOO.AI'11iR I fotCW!if$ Pay 10 ESTATE OF RICHARD D AKERS CIQ JAMES R AKERS EXECUTOR' 2344 BERRYHill S1 HARRtSBURG PA 17104 CIledt Nllmi'w 0000fJ17779 11 Mar 2008 $**--*1,284.99**** The sum 01 '-ONE THOUSAND lWO HUNDRED AND EIGHTY FOUROOu.ARS AND NINETY N1NE ams- . ~Inc. 25O.RoyaIt Street, Canton MA 02021 , . ~~ ~~.. ~..._~~ AllIIOdaIl ~.Sj u-ooooo .??? l1u- .1:0 b . '. 12 ?881: 3 ~ 5 1100 5 25 bU-