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Home My WebLink About08-04-08 R~ ~/ -1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box zaosol INHERITANCE TAX RETURN 2 l ~~ ~ j s{ Harrisburg PA 17128-0601 RESIDENT DECEDENT _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 ~ 1 _ ~' 'J ~ _ J ~~ i_ ~ 1 _ 1 Decedent's Last Name Suffix Decedent's First Name MI (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) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5 Federal EstatE=_ Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 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. ~~} C:UKKtSF'UNUtN I - I KIJ Jtl; I IUN MUJI tit I:UMNLt I tU. ALL I:UKKtJYUNUtNI:t ANU I.UNYIUtN I IAL IHA INYVKMHI IVN JI~VULU tSt UIKtI, I tU I V: Name Daytime Telephone Number U~ I~ L I ??. M P D O U G L A S E S Q i 1 _-~ Z 7 `~ ~~_ Firm Name (If Applicable) REGISTER OF WILLS US€ ONLY r ~- ~~ ~~ J (~ L ~. S L A W O r F I C E "' --, < .: :: ~ First line of address .. - ~ rf~ ~ O L T H S T `~ Second line of address °'~ City or Post Office correspondents e-mail address: dOUglaSlaw@earthllnk.net -*~ State ZIP Code DA~F~ FILED LJ _.t .. P A 1 7 0] 3 ~~ 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, ii is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. __~ f2~ERS0 ESPONSIBLE FOR FILING RETURN DATE ~ l . ~, /Z~ • t~-~-~ , F-~~~ i2~ 7 ~ 31 ~ 2 0 0 8 ADDRESS -30 Farl;er S~t., Carlisle P_A 17013 S,IGNATU OF PREP O ER T REPRESENTATIVE [)ATE aDDRESs PLEASE USE ORIGINAL FORM ONLY 1056091125 Side 1 1'~0~67,4] ~. -- ~~_,;~ 1~0~604?i%F REV-1500 EX Decedent's Sociai Security Number Decedent'sName FJlec~llOi R. berg - ~ ' - - ` RECAPITULATION Q 0 0 1 Real estate (Schedule A) 1. 2 Stocks and Bonds (Schedule B) 2. ~ ~ ~ 4 ~ ~~ 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) ^ Separate Billing Requested . . . 6. 7. Inter Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested . .. ... 7. 8 Total Gross Assets (total Lines 1-7) g_ 4 ~ ~ 4 9 6 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. 4 3 ~ ~ ti E~ 13. Charitable and Governmental Bequests/Sec 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. a r3 ~ 4 9 C1 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(t2) X.0 15- 16. Amount of Line 14 taxable at lineal rate X 0.045 16. 17 Amount of Line 14 taxable at sibling rate X .12 17. 18 Amount of Line 14 taxable at collateral rate X 15 18. 19 Tax Due 19. 20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 =Start 0 -~' 26 ~_ l 1 7 0 0 REV-1500 EX Pave 3 Decedent's Complete Address: File Number 0238 DEtiEDENT'S NAME Eleanor R. Berg STREET ADDRESS 130 Parker St_ CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: t. Tax Due (Page 2 Line 19) (1) _ $21? 00 2 CredilslPayments A. Spousal Poverty Credit B. Prior Payments C Discount Total Credits (A + B +C) (2) _ $0.00 3 InferesilPenalty if applicable D Interest E Penaliy Total Interest,'Penalty (D +E) (3) _ $0.00 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ S217 00 A Enter the interest on the tax due. (5A) _ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) _ $217.00 Make Check Payable to. ~ REG/STER OF W/L L S, 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; _ ............... _....................... _....... _ . .... ^ ^ b. retain the right to designate who shall use the property transferred or its income; ................. ..... ^ ^ c retain a reversionary interest; or ............................................._........_...._.................._...... _... ^ ^ d receive the promise for life of either payments, benefits or care? ................................................. ..... ^ ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. .._. ^ ^ 3. Did deceder~t own an "intrust for" or payable upon death bank account or security at his or her death? ^ ^ 4. Did decedent cwn an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................._.............................................._. ..... ^ ^ 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 I.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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for d sclosure 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)]. 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 Holed ir, 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. YKEV-1 Si)3 EX + (6-98j ~~ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DL=CEDENT ESTATE OF FILE NUMBER Eleanor R. Berg 0238 _ _ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM `/ALUE yT ~='~s~l E NUMBER DESCRIPTION OF DEATH _ 1. Ford Motor Co. stock. We reported 979 shares on the original return. There were $4.804 96 actually 1711.463 shares fora difference of 732.463 @ 6.56 TOTAL (Also enter on line 2, Recapitulation) ~ $ 4,804.96 (If more space is needed, inseii additional sheets of the same size) O 0001,2 ELEANOR R BERG & RICHARD A BERG TR U-W-O HERMAN BERG III 130 PARKER ST CARLISLE PA 17013 I~~rlll~~~lllr~~r~~ll~~llr~rl~ll~~l~~rlrlll~~~rrll~llrrrr~ll~l PaOe 1 of 2 ~omputershare Computersl~are-~u,[ Company, N.A. FO Eox 43078 Providence, Ri 029403078 With!n the US, Canada ~ Puerto Rico 800 279 " 237 Outside the US, Canada L Puerto Rico 781 575 2732 www.cornoutershare cor, rinvestor Holder Account Number 00000332194 I I~III~III IIII IIII IIII11911111Illllllllllhl ICI III II (III IC~lfll lll+_ti.l )1 )~LI_I I/S.li -111/~~I llil _'i~l if lfll i./~ ord Motor Company -Summary of Account Holdings and Transaction Form s important to retain this statement for tax reporting purposes, and for use as a reference ren you access your account online at our website or when contacting Computershare. Holder Account Number: 00000332194 ACCOUNT SUMMARY As of close of stock market on 05 May 2008 Stock Class I Certificated Sharesl I Direct Registration I Investment Plan I Total I Closing Price Market Description Units Held by You Book ShareslUnits Book ShareslUnits ShareslUnits Per SharetUnit ($) Value ($) >PP -Common Stock 0.000000 O.000OOG 1,711.463000 1,711.463000 ransaction History From: 01 Jan 2000 8.330000 14,256.49 To: 05 May 2008 pis section pertains onl to book-entry shareslunils. Date Transaption I Transaction I Deduption I Deducti; n ;et I Price +er I Transaction Total Book Descri tion Amount ($) Descri tion Amount $) Amount $) SharelUnit $) ShareslUnits ShareslUnits ~n Transactions DSPP -Common Stock Jan 2000 Balance Forward Aug 2000 Previous Agent Adjustment 194UDR 0.000000 1,711.463000 1,711.463000 FORD '~' ;D40019 OOTPPA