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Home My WebLink About12-05-08 1505607120 ~ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue ca~my tine veer File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 RESIDENT DECEDENT 2 1 0 8 0 8 9 3 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Dale of Death Date of Birth 170 22 1219 0 7 27 2008 03 05 1927 Decedent's Last Name SuRix Decedent's First Name MI MOSER DOR I S I"1 (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name SutFx 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 X 1. Original Return IL _, . i 2. Supplemental Return ~ ~ 3. Remainder Return (date of tleath prior to 12-13-92) Limited Estate j I 4 ~ qa. Future interest Compromise - 5. Federel Estate Tax Retum Required I . - _ (tlate of death after 12-12-92) ' X°~, g Decedent Dlad Testate r. J 7. (pt ach Copy of T ~)a Living Tmst O 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) - - 9. Lia anon Proceeds Received _, 9 - ~~~ 7p Spouses Poverty Credit tease or death 11. Election to tax under San 9113(A) ~ between lzaf-st and f-l-ssl (Attach Sch O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD eE DIRECTED TO: Name Daytime Telephone Number ALLEN K. TOMLINSON ESQ. 215 67~^591 ~ Firm Name (If Applicable) REGISTER OF11¢IL}~ USErO~VLY ~ TOMLINSON & GERHART --~,rn ~ -=u%~ ~ First line of address '."7 ~~ C~ --0 `~~~-n 919 MAIN STREET r ' r-SJ r-J -: Second line of address -~ { .-- 7. P. O. BOX 14 DATE FILED City or Post Office State ZIP Code EAST GREENVILLE PA 18041 Correspondent's a-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 knovedge and belie!, it is true, tarred and complete. Declareaon 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 `~1_ - ' . F _ 1/1~~,..e A j~/~/~~ Dennis E. Moser 314 Bayley Street Carlisle PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE / ~. ~ Allen K. Tomlinson Esq. 414 Main Street, East Greenville, PA 18041 Side 1 1505607120 1505607120 J ,,_j J 1505607220 REV-1500 EX Decedent's Social Secu rity Number oeceaeor:Name: Doris M. Moser 1 7 0 2 2 1 2 1 4 __ 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 Properly (Schedule E) ... ............. 5. 3 0 6 3 2 6. Jointly Owned Property (Schedule F) ~ ~ Separate Billing Requested ............. 6. 2 9 4 2 1 6 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) [ ] Separate Billing Requested ............. 7, 6. Total Gross Assets (total Lines 1-7) .......................................................... ............. 8. 2 7 9 8 4 8 9. Funeral Expenses & Administrative Costs (Schedule H) ........ . 9. 2 9 1 0 5 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule Q ................... ............ . 10. 1 1 8 0 9 9 8 9 11. Total Deductions (total Lines 9& 10) ........................................................ ............. . 11 _ 1 2 0 5 1 0 9 5 12. Net Value of Esfate (Line 8 minus Line 11) ............................................... ............. . 12. - 1 1 7 7 6 1 9 7 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. - 1 1 ~ ~ 6 1 9 ~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable al the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 0 0 0 16. 0 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 16. 0 0 0 19. Tax Due ....................................................................................................... ............. . 19. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505607220 150560722^ J REV-1500F~CPage3 File Number 21-08-0893 neredent's Complete Address: DECEDENT'S NAME Doris M. Moser __ --_ - - -- -__ STREET ADDRESS 422 Walnut Bottom Road CITY _._ _.. .STATE..... ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit ___ _ _ _ B. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable _- p. Interest _ ~ - E. Penalty -__ _. Total lnteresUPenalry (D+E) (3) -_ .. --.. q, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) 0.00 A, Enter the interest on the tax due. (5A) __ g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Q , 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 :................................................................................. x b. retain the ri ht to desi nate who shall use the roe transferred or its income :............................... ..... f ~,._xJ 9 9 P P rty ~, c. retain a reversionary interest; or. ....... 7 i x] d. receive the promise for life of either payments, benefits or care Lx.. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate censideralion? ..............................................._..................__.............................................._ -. li _~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ~ - ~ x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which containsabeneficiary designation?..........._ ...................................................._.................................._............... '' I ~x 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 dales 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 lax 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 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)]. 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-1698 EXF IB-99) I SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMAJMNEALTH OF PENNSYLVPIJIF INHERITFNCE TNX RETIRN RESIDEM DECEDENT ESTATE OF (FILE NUMBER Moser. Doris M. 21-08-0893 Inclutle the proceetls of litigation antl the tlate the pmceetls were receivetl by 0e estate. All property lolmlyownatl with the right o/ aurvlvonhlp must Da tllscloaetl on achetlula F. (If more space is needetl, atleitional pages o[ me same slzef Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) aev-1609 EXi (8-aB) SCHEDULE F COMAJNWEALTH OF PENNSYWPNIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RENRN RESIOEM °ECE°ENT ESTATE OF (FILE NUMBER Moser, Doris M. 21-08-0893 If an asael waa mane tolm wllhln one year of the tlecetlant'a Gale o1 °eatn, II must oe reportap on acna°me ~. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Dennis E. Moser 314 Bayley Street Son Carlisle, PA 17013 g. Larry R. Moser 121 Parker Street Son Carlisle, PA 17013 C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION ANO BANK ACCOUNT NUMBER OR SIMILAR IDENTtFVING NUMBER. ATTACH DEED FOR JOINTLV~HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET ~ OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1 A&B 1/10/2005 Wachovia Bank -JOINT Checking 7,327.22 33.330% 2,442.16 Account No. XXXXXXX1011, Joint with Decedent's sons, Larry R. Moser and Dennis E. Moser TOTAL (Also enter on Llne 6, Recapitulation) I 2,442.16 (If mare space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) REVd161 E%i (1P-99) COMMNHER ANCE TAX RETURNANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Moser, Doris M. 21-08-0893 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER q, rUNERALEXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Dennis E. Moser Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 314 Bayley Street city Carlisle state PA zip 17013 Year(s) Commission paid See continuation schedule(s) attached y. Attorney's Fees See continuation schedule(s) attached g, 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. I Probate Fees See continuation schedule(s) attached 5. Accountant's Fees 6. I Tax Relum Preparer's Fees 7. I Other Administrative Costs 822.56 650.00 850.00 88.00 TOTAL (Also enter on line 9, Recapitulation) I 2,410.56 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Moser, Doris M. 21-08-0893 ITEM AMOUNT NUMBER DESCRIPTION Funeral Expenses 1 Ann Moser -Reim. Funeral Expense 155.07 2 Dennis Moser -Reim. Funeral Luncheon 253.59 3 Jeffery Moser -Reim. Obituary in Carlisle Sentinel 99.90 4 Morrell Funeral Home -Funeral Bill Balance 314.00 H-A Subtotal 822.56 Personal Representative Commissions 5 Dennis E. Moser -Executor's Commission 650.00 H-B1 subtotal 650.00 Attornev Fees 6 Allen K. Tomlinson, Esq. -Attorney Fees 850.00 H-62 Subtotal 850.00 Probate Fees 7 Dennis Moser -Reim. Probate Costs - Register of Wills Office 88.00 H-B4 Subtotal 88.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev~1612 EXi (888) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS LOMAONWEPLTH OF RENNSVLV~INIR INHERITPNCE T~l% RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Moser. Doris M. 21-08-0893 Inclutla unrelm0unetl metllcal expenaea. (IF more space is needed, addigonal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1500 Schedule I (Rev. 6-96) REV-161] E%+te-0Ot I SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES RN IN N NT DECEDENT RE51 E ESTATE OF FILE NUMBER ~~~~~~ n,..~~ ne 21-08-0893 ,.,..ate,, .,....,, .... RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY DECEDENT Do Not Liat Trustees (Words) ($$$) T I, AXABLE DISTRIBUTIONS [include outright spousal distnbubons and transfers under Sec. ~116(a)(1.2)] 1 Phyllis E. Hartenstine Daughter 118 Residue 205 Hoffman Road Barto, PA 19504 2 Carl H. Moser Son 118 Residue 43 Park Drive Barto, PA 19504 3 Dennis E. Moser Son 118 Residue 314 Bayley Street Carlisle, PA 17013 4 Jeffrey A. Moser Son 115 Residue 187 Congo Niantic Road Barto, PA 19504 5 Larry R. Moser Son 118 Residue 121 Parker Street Carlisle, PA 17013 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 through 18, as approp riate, on Rev 1500 cov er sheet II. NON-TAXABLE DISTRIBUTIONS: USAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTI ON TO TAX IS NOT A. SPO BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS oov .cnn !`nyFR SNFFT 0.00 TOTAL OF PART II -ENTER TOTAL NON-i.vcArst_t via i,aR~. i.a.~ ..~. ~~~~~ • ~ .-• ~ ~- • •--- -- Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-96) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) :STATE OF: Doris M. Moser 07/2712008 170-22-1219 Share of Estate Item Name and Address of Person(s) (Words) Dumber Receiving Property Relationship Son 116 Residue 6 Marvin L. Moser 456 Elm Street Apt. C-303 Pottstown, PA 19464 Total Amount of Estate (SSS) INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA ___ COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland SS File Number 21-08-0893 Dennis E. Moser r7 o i Personal Representative(s) of the Estate of Doris M. Moser ~> ~ ~ ~ -~` ' deceased, depose(s) and say(s).that the items appearing in the following inventory include all of the personak~as~.e hereyar situate and all of the real estate m the Commonwealth of Pennsylvania of said Decedent, that the valuation pl$¢ayh osite each c ?~ item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent own~~ r I estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this~i~ ery. ~ _ ~, :.i .~ n? ._.~ I verify that the statements made in this Inven- ~ \ ~~;,,,~-~ ~ . ~~~_ - o~ tory are true and correct. I understand that false state- y menu herein are made subject to the penalties of Dennis E. MOSer ~" 18 Pa.C.S. § 4904 relating to unsworn falsification to } _.. _.__ authorities. Attorney- (Name) Allen K. Tomlinson Esq. (Supreme Court lo. No.) 07902 __ (Finn) Tomlinson & Gerhart (Address) _414 Main Street, East Greenville, PA 18041 __ -- -- - (7elephone) 215-679-5912 - - - DATE OF DEATH LAST RESIDENCE 422 Walnut Bottom Road DECEDENT'S SOC. SEC. N0. 07/27!2008 Carlisle, PA 17013 170-22-1219 FIGURES MUST BE TOTALED Personal Propertv Cash ............................................................................................... Personal Property ......................................................................... Stoc ks/Listed ................................................................................. StockslClosely Held ...................................................................... Bonds ............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... All Other Property ......................................................................... Total Personal Property ......................................... Total Real Property ................................................ Total Personal and Real Property ......................... 306.32 300.32 '308.32 i r NOTE: The Memorandum of real estate outside the Commonvrealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be eMended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b)) ,1. Fomr RW-09 Rev. fo-13-4006 ,V\-M~IL1\1 e .. • ~ INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland }SS File Number 21-08-0893 _. DATE OF DEATH IAST RESIDENCE 422 Walnut Bottom Road DECEDENTS SOC. SEC. N0. 07/2712008 Carlisle, PA 17013 170-22-1219 Cash PFB Health Services -Refund Total Cash 306.32 306.32 (Attach additional sheets if necessary) Total Personal Property and Real Estate 306.32