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Home My WebLink About05-28-08 -1 15056051058 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 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year d.J og File Number 061Jv Date of Birth 172-32-0304 03/04/2008 02/22/1941 Decedent's Last Name Suffix Decedent's First Name MI Dore Colleen M (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 . 1. Original Return 2. Supplemental Return 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 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 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8. Total Number of Safe Deposit Boxes Brooke A. Weaver (717) 761-5721 3 Bridle Lane ......, REGISTER O~:~ILLS USE ON~ co :x ::u.. -< N co . <J Firm Name (If Applicable) City or Post Office State ZIP Code _.;~_l ^ '1;:_~3~ -~ r ._-.~ 'c .:0 DAT~i'ld:D ):> -0 :Ji:: First line of address () r- ;n Second line of address (...) Camp Hill PA 17011 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 tr correct and complete. D ar on f preparer other than the personal representative is based on all information of which preparer has any knowledge. 5 /:J.E3 /O~ AD ESS Bridle Line, Camp Hill, PA 17011 ~~~/~THANREP~=~<o. f;v~ Cf>A 1 Country Club Place East, Camp Hill, PA 17011 PLEASE USE ORIGINAL FORM ONLY DATE p~~8. Side 1 L 15056051058 15056051058 -1 ~ --.J 15056052059 REV-1500 EX Decedent's Name: Colleen M Dore RECAPITULATION 1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . . . 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . . 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) . . . . . . . . . . . . . . . . . . . . . . . . 14. 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.O 45 32,931.37 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . .................... 1~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L Decedent's Social Security Number 172-32-0304 2. 3. 4. 5. 6. 7. 39,421.73 8. 39,421.73 9. 6,490.36 6,490.36 32,931.37 15. 16. 1,481.91 17. 18. 1,481.91 15056052059 .-J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Colleen M Dore STREET ADDRESS 3 Bridle Lane File Number DECEDENT'S SOCIAL SECURITY NUMBER 172-32-0304 CITY Camp Hill STATE I PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,481.91 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + 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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) 1,481.91 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. 1,481.91 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 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 00 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 00 0 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 PS. 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-1510 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER ESTATE OF Dare, Colleen M. 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 ITEM INCLUOE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEOENT ANO DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE OATE OF TRANSFER. ATTACH A COPY OF THE OEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1, Cash Gifts, Brooke Weaver, Daughter 18,975,00 0 3,000,00 15,975,00 Various dates between 12/29/08 - 02/08/08 2. Cash Gifts, Paige Paules, Daughter 11,000,00 0 3,000,00 8,000,00 Transfer date 12/29/08 3. Certificate of Deposit, Members 1st FCU, Cert, No. 223608-41, 15,335,44 100 0,00 15,335.44 Brooke Weaver, Daughter, Became Joint Account on 10/18/07 4. Checking Account, Members 1st FCU, Acct. No. 223608 84,73 100 0,00 84.73 Brooke Weaver, Daughter, Became Joint Account on 10/18/07 5. Savings Account, Members 1st FCU, Acct. No. 223608 26,56 100 0,00 26,56 Brooke Weaver, Daughter, Became Joint Account on 10/18/07 TOTAL (Also enter on line 7 Recapitulation) $ 39,421.73 (If more space is needed, insert additional sheets of the same size) .. REV-1511 EX+ (12-99>W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Dare, Colleen M. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Wiedeman Funeral Home Creative Catering - Food for Funeral Reception 4,802.56 1,462.80 2. 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 225.00 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,490.36 Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.members1st.org Statement of Accounts Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TOO: (717) 697-5312 or (800) 283-2328 ex!. 5312 TeleBranch: (717) 795-6049 or (8tlO) 237-7288 Feb 25, 2008 thru Mar 24, 2008 Account Numbe~f////--~23;;S~ Account Balan'e~ at a Glance: \ Che.cking:! ' 84.73 : Savings: \ 26.56 Certificates: 15,335.44 Loans: o.~/ Money Management: -----0-;00 MEMBERS 1st FEDERAL CREDIT UNION /COLLEEN M DORE BROOKE WEAVER CIO BROOKE WEAVER 3 BRIDLE LANE CAMP HILL PA 17011 Page: 1 of 2 Your current Member Loyalty Reward level is Gold Membership has its advantages! Your FREE VIP pass for Carlisle Events accompanies this statement. CHECKING ACCOUNTS 11 . CHECKING Date Transaction Description Additions Subtractions Balance Feb 25 Balance Forward 149.44 Mar 03 Check 000510 Tracer 0001425545 90 . 00- 59.44 Mar 04 Deposit by Check 25.29 84. 73 Mar 24 Ending Balance 84.73 CHECK SUMMARY Check # Amount Date Check # Amount Date 000510 90.00 Mar 03 SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date Feb 25 Feb 27 Transaction Descri tion Balance Forward Deposit ACH SOC SEC ID: 3031036030 CO: SOC SEC Withdrawal Members 1 st Online Transfer To WEAVER, BROOKE A XXXXXXXXXX Share 00 Deposit Members 1 st Online Transfer From WEAVER, BROOKE A XXXXXXXXXX Share 00 Feb 29 Deposit Dividend 1 . 000% Annual Percentage Yield Earned 1. 010% from 02/01/2008 through 02/29/2008 Mar 24 Ending Balance ///A.dditions Subtractions Feb 27 '- 1~~~~-j~'.32~ 20. 00 ~_~~~ 1.56 Balance 36.32 1,467 .32 5.00 Feb 27 25.00 26.56 26.56 CERTIFICATE ACCOUNTS 41 - 7 MONTH CERT Maturity Date. May 18, 2008 Date Feb 25 Transaction Description Balance Forward Additions Subtractions Balance 15,275.48 - - - Continued on following page - - - Send Inquires to: 5000 Louise Drive PO Box 40 Mechanlcsburg, PA 17055 www.members1sl.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TOO: (717) 697-5312 or (800) 283-2328 ex!. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 Feb 25, 2008 thru Mar 24, 2008 Account Number: 223608 Page: 2 of 2 Date Transaction Description Feb 29 Deposit Dividend 4. 940% Annual Percentage Yield Earned 5.050% from 02/01/2008 through 02/29/2008 Mar 24 Ending Balance Additions Subtractions 59.96 Balance 15,335. 44 15,335 . 44 YTD SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 11 CHECKING 41 7 MONTH CERT 9.35 0.00 123.78 Total Year To Date Dividends Paid NOTE: Total includes closed shares Total Year To Date Interest Paid NOTE: Total includes closed loans 133. 13 0.00 Add Your Photo For Security Your personal safety and financial security are top priorities at Members 1st. As a result of increased scams and fraudulent activity throughout the entire country, we are strongly encouraging members to have their photos adCled to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are. experiencing an increasin~ number of attempted fraudulent activities. and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show additional forms of identification basecf on the type of transaction you are seeking. 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