HomeMy WebLinkAbout02-11-09'-~ REV-7500 1505607120
PA Department of Revenue EX (06-OS)
Bureau of Individual Taxes
OFFICIAL USE ONLY
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H ounty cone veer Flla "amher
INHERITANCE TAX RETURN
arrisburg, PA 77128-D602
ENTER DECEDENT INFORMATION BEL RESIDENT DECEDENT 2 1 0 8 12 1 2
OW
Social Security Number
Date of Death
188 12
ROLLER Suffix Decedent's First Name
DOROTHY MI
(If Applicable) Enter Surviving Spouse's Information Below L
Spouse's Last Name
ROLLER Suffix Spouse's First Name
JR. JOHN MI
Spouse's Social Security Number K
FILL INAPPROPRIATE OVALS BELOW
1. Original Return
4. Limited Estate
g. Decadent Dietl Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise
(date of death after 12-12-82)
] Decetlent Maintainetl a Living Trust
(Attach Capy of Tlusp
70, Spousal Poverty Cretlil (date of tleath
behvean 12-31-91 antl 1-1-95j
3. Remaintler Return (date of death
prior t0 12-13-82)
5. Federal Estate Tax Return Required
Name ...._ __...,.,~. ~.~~~
JERRY R. DUFFIE
Firm Name (If Applicable)
JOHNSON, DUFFIE,
First line of address
301 MARKET ST.
Second line of address
PO BOX 109
City or Post Office
LEMOYNE
e. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
DEN7IAL TAX INFORMATION SHOULD BE DIRE
Daytime Telephone Number
(717) 761 4540
STEWART & WEIDNER REGISTEROFIML~uSEOnh~
~Li I'r1
i_:i
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State ZIP Code DATE AILED r
PA 17043-0109
Correspondent's a-mail address:
U sdhueeeorreet and eo pletde cDeclehration o(preparer other than the pelrsolnaleepresenta[ive Is based on aldl Informatlon'of which preparerfhas any knowl
SIGNATj1R~t p~gON~~pON~LE FpRp~J~. ING RETU/RjN
/RL/E}/SS v, L '~~YLJJClc 1 fjy JOHN K Rf11 1 CC R DATE
f ~- r7//Z~'aj
42 ONEIDA ROAD, amp Hill, PA 17011 f
SIGNA OFP RER HE THAN REPRESENTATIVE
JERRY R. DUFFIE DA E
A RE A ^O a
3 MARKET ST., Lemoyne, PA 17043-0109 U e
I___ Side 1
1505607120
1505607120
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_I 1505607220
REV-1500 EX
oeceaeors Nama:
DOROTHY L. ROLLER
1. Real Estate (Schedule A) ...............................
.................................................... ....... 1.
2. Stocks and Bonds (Schedule B)
......................................................................... ...... 2.
1,951.22
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C
).... ...... 3,
4. Mortgages & Notes Receivable (Schedule D) .................
................................... ...... q.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........... ..... 5. 1 6 , 7 7 7 0 4
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested
........
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ..... 6.
~ Separate Billing Requested
......... ....
7.
8. Total Gross Assets (total Lines 1-7) ............
....................
e.
18,728.26
9. Funeral Expenses 8 Administrative Costs (Schedule H).. 4
6 3 2
s. ,
0 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
............................ .... 10,
11. Total Deductions (total Lines 9 8 10)
................................................................... ...
11.
4,632.00
12. Net Value of Estate (Line 8 minus Line 11) .
....................... ..
13. Charitable and Governmental Bequests/Sec 9113 Trusts for whi
h
12'
1 4 , 0 9 6 2 6
c
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 R
14
1 4 , 0 9 6 . 2 6
ATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2> X .oo 14 , 0 9 6. 2 6 15
16. Amount of Line 14 taxable .
~ ~ ~
at lineal rate X .045 0 ~ 0 0 16
17. Amount of Line 14 taxable 0 0 0
at sibling rate X .12 0 0 0 17
18. Amount of Line 14 taxable .
0 . 0 0
at collateral rate X .15 0 0 0 1g
.
0.00
19. Tax Due ...................
.................................................................................................. 19.
0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
I_ Side 2
1505607220
15056D7220 J
REV-1500 EX Page 3
Decedent's Complete Address:
DOROTHY L. ROLLER
42 ONEIDA ROAD
File Number 21-08-1212
Camp Hlll STATE Zip --~
PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments (1) 0.00
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 0.00
3. Interest/Penalty if applicable Total Credits (A + B + C) (2)
D. Interest 0.00
E. Penalty -----~- ---
4. If Line 2 is greater than Line 1 + Total InteresUPenalty (D+ E) (3)
Line 3, enter the difference. This is the OVERPAYMENT. ----
5. If Line 1 + Line 3 is greater han Lineo2, enteah a diffle ence.oThstisshe TAX DUE. (q)
A. Enter the interest on the tax due. (5) 0.00
B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5A) -
(sB) 0.00
Make Check Payable to: REG/STER OF W/LLS, AGENT
,,
-w
PLEASEANSWEy-fir, ~~'~;~nxH:~~= ~ ,
R THE FOLLOWING QUES ONS BY PLACING AN "X" IN THE APPROPRIAT .x ~~~
E BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred :.............................. Yes No
b. retain the right to designate who shall use the property transferred or its income :.................................... ~ 0
c. retain a reversionary interest; or .................................................................................................................. .L~JI O
d. receive the promise for life o(either payments, benefits or care? .........................
.................................... X
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^
receiving adequate consideration? ...........................................................
............................. x
3. Did decedent own an "in trust foi' or payable upon death bank account or security at his or her death?......... ^ ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^
contains a beneficiary designahon~ .......
X
THE ANSWER TO ANY OF THE ABOVE gUESTIONS IS YES YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July i, 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)]. ~ - .M~~ ~ ~~ ~ -
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
(O) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not ezemot a transfer to a surviving spouse from lax, 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 taz 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
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,
( )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.
Hev-7688 E%t (6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWFgLTH OF PENNSYLVANIA
INHERITANCE TA%gETURN
RESIpENT pECEpENT
ESTATE OF
ROLLER, DOROTHY L. FILE NUMBER
21-08-1212
All property lolntly-ownetl with rlghf of survlvorshlp mull be tlisclosetl on ScheEUle F.
ITEM CUSIP
NUMBER NUMBER DESCRIPTION
UNIT VALUE VALUE AT DATE
1 33 Shares - MetLife Inc. Trust Interests GF DEATH
@ $59,127950 1,951.22
TOTAL (Also enter on Line 2, Recapitulation)
(If more space is needetl, additional pages of the same size) 1.951.22
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form Pq-1500 Schedule B (Rev. 6-98)
Rev-1508 E%+t6-a9)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TA%RETURN
RESIDENT pECEpENT
ESTATE OF
ROLLER, DOROTHY L.
IndNtle the proceeds of litigation entl the dale the proceeds were received py Iha estate y
All property jolntly.ownetl with the right of survivorship must he disclosetl on schetlule F.
NUMBER DESCRIPTION
1 Delta Equity Services, Corp. -Investment Account No. 39K-220166 -consisting of
4,237.760 Shares -General Money Market Fund CL B - $4,237.76;
$13,000.00 Household Fin. Corp. Internotes @ 96.4560 = $12,539.28.
LUE AT DATE
OF DEATH
16,777.04
TOTAL (Also enter on Line 5, Recapitulation)
16,777.04
Copyright (c) 2002 form software only The Lackner G oupnlnc ed, adtlitional pages of the same size)
Form PA-7500 Schedule E (Rev. 6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-08-1212
REV-1161 EXa (1I-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT pECEDENT
__
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ROLLER, DOROTHY L.
vents of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. I FUNERAL EXPENSES:
AMOUNT
B• I ADMINISTRATIVE COSTS:
~~ Personal Representative's Commissions
Social Security Number(s) / EIN Number of
Street Address
City
State Zip
Year(s) Commission paid '
2. Attorney's Fees
See continuation schedule(s) attached
3. Family Exemption: (I(decedent's address is not the same as claimant's, attach explanation)
claimant JOHN K. ROLLER JR.
Street Address 42 Oneida Road
City Camp Hill state PA
Relationship of Claimant to Decedent SpOUSe Zip 17011
See continuation schedule(s) attached
<~ Probate Fees
See continuation schedule(s) attached
8~ Accountant's Fees
0, Tax Return Preparer's Fees
~~ Other Administrative Costs
See continuation schedule(s) attached
Copyright (c) 2002 (orm software only The Lackner Group, Inc.
TOTAL (Also enter on line 9, Rec
FILE NUMBER
21-08-1212
1,000.00
3,500.00
102.00
30.00
4,632.00
Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF
ROLLER, DOROTHY L.
ITEM
NUMBER
LE NUMBER
21-08-1212
DESCRIPTION
AMOUNT
Attorn,~y Fames
1 Johnson, Duffie, Stewart & Weidner
1,000.00
H-B2 Subtotal 1,000.00
Family Exemption
2 John K. Roller, Jr. -Spouse
3,500.00
H-B3 Subtotal 3,500.00
Proba_ to Fees
3 Register of Wills -Cumberland County
702.00
H-ea Subtotal 102.00
Other Administrative Costs
4 Register of Wills -file Inventory and Inheritance Tax Return.
30.00
H-67 subtotal 30.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form Pq-7500 Schedule H (Rev. 6-98)
REV-1513 EX+Ig-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TA%RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
ItvLLER, DOROTHY L.
NUMBER PERSON S) REOCEIVINGEPROPERTY
I, TAXABLE DISTR18unnnls o..,.i..w_ _...__..
1 JOHN K. ROLLER JR.
42 ONEIDA ROAD
CAMP HILL, PA 17011
1
FILE NUMBER
21-08-1212
-ATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
DECEDENT
Not Liat Trustee(s) (Words) ($$$)
Husband ~ RESIDUE
Enter dollar amounts (or distributions shown above on lines i5 throw h 18, as a I TOtal
II. NON-TAXABLE DISTRIBUTIONS: g PPropriate, on Rev 150
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
i OTAL OF PgRT II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2002 form software only The Lackner Group, Inc. 0.00
Form PA-1500 Schedule J (Rev. 6-98)
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1~..
~~z~Y ~ii1 ~zn~ C7~ P~t~cmPnt
OF
DOROTHY L. ROLLER
I, DOROTHY L. ROLLER, o£ Lower Allen Township, Cumberland
County, Pennsylvania, declare this to be my last will and revoke
will previously made by me.
1. I direct that all my just debts and funeral expenses,
including my gravemarker and all expenses of my last illness,
shall be paid from my residuary estate as soon as practicable
after my decease as a part of the expense of the administration
of my estate.
2. I devise and bequeath all of my estate of every nature
and wherever situate to my husband, JOHN K. ROLLER, JR., providing
he shall survive me by thirty (30) days.
3. Should my husband, JOHN K. ROLLER, JR., predecease me or
die on or before the thirtieth (30th) day following my death, I
devise and bequeath all of my estate of every nature and wherever
~s ituate in equal shares to such of my children, EUNICE M. ROSS and
PATRICIA Y. ROLLER, as survive me by thirty (30) days.
4. Should either of my daughters, EUNICE M. ROSS or PATRICIA
Y. ROLLER, predecease me or die on or before the thirtieth (30th)
day following my death, I devise and bequeath the share of such
child to her issue, per stirpes, living on the thirty-first (31st)
day following my death; and should either of my said daughters,
EUNICE M. ROSS or FATRICIA y. ROLLER, leave no such issue living
on the thirty-first (31st) day following my death, I devise and
bequeath the share of such child to my other child or her issue,
per stirpes, living on the thirty-first (31st) day following my
death.
5. I appoint DAUPHIN DEPOSIT TRUST COMPANY, o£ Lemoyne,
~0~~~~
Pennsylvania, Guardian of any property which passes either under
this will or otherwise to a minor and with respect to which I am
authorized to appoint a guardian and have not otherwise specifically
done so provided that this appointment of a guardian shall not
supersede the right of any fiduciary in its discretion to dis-
tribute a share where possible to a minor or to another for the
minor's benefit. Such guardian shall have the power to use princi-
pal as well as income from time to time for the minor's support and
education (including trade school and college education, both
graduate and undergraduate) without regard to his or her parent's
ability to provide for such support and education, or to make pay-
ment for these purposes wi trout further responsibility to the minor
or to the minor's parent or to any person taking care of the minor.
6• I direct that all taxes that may be assessed in consequenc
of my death, of whatever nature and by whatever jurisdiction impose
' shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
7• I appoint my husband, JOHN K. ROLLER, JR., Executor of
this, my last will. Should my husband, SOHN K. ROLLER, JR., fail '
to qualify or cease to act as Executor, I appoint my daughters,
EUNICE M. ROSS and PATRI CIA Y. ROLLER, Executrices o£ this, my last
will.
8• I direct that my Executor, Executrices or Guardian shall
not be required to give bond for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal I
this ~~ day of `~7 ~ <c~ 1976.
~;
~~
~~~~~2' (SEAL)
Dor by L. Roller
.,
Signed, sealed, published and declared by the above-named
Testatrix as and far her Last 4Vi11 and Testament in the presence
of us, who, at her request, in her presence and in the presence
of each other, have hereunto subscribed our names as witnesses.
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