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HomeMy WebLinkAbout03-19-09 (4) 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.28oso1 2 1 0 8 0 1 2 2 2 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 06 2008 11 15 1915 Decedent's Last Name Suffix Decedent's First Name MI REBERT JOSEPHINE E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Securiity Number FILL IN APPROPRIATE OVALS BELOW ~ X i, 1. Original Return '~ 4. Limited Estate g Decedent Died Teastate - (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) ~. Decedent Maintained a Living Trust (Attach Copy of Trusq ''. --1 1 Q Spousal Poverty Credit (date of death . -. I 'between 12-31-91 and 1-1-95) cUrclteSPVNDENT -THIS SECTION MUST BE COMPLETED. ALL Name JAN M WILEY Firm Name (If Applicable) THE WILE~i' GROUP , PC First line of address 130 W. CHURCH STREET Second line of address City or Post Office State DILLSBURG'~ pA Correspondent's a-mail address: 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) AND CONFIDENTIAL TAX INFORMATION SHOULD BE},QyRECTED TO: Daytime Telephr~ Number ~ 717 43~~666 ~ ,-,_~ -' r REGISTER OF INI~~~~SE ONtY i ,,r; ~~ ~.o t. .__ :- ~ -Q i ~ ..1'I - , ~ _...~ .. ~ i~ ~,- _I -s . ~ - -"~ hl _ ~ _ . i T i ~~ ~ ~ DATE FILED ZIP Code 17019 ~~~~c~ pciiaiues or per)ury, I aeciare rnat I nave 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. SIGNATURE OF PERSON RESPONSIBLE F ING RETURN DATE -~;_A~~-~~ Kenneth F. Rebert ~~/~~(~ 4 1 Church Street, Barnesv \ S'G TURE OF PREPARER OTHER THAN REPI PA 18214 -i--~ Jan M Wiley 30 W. Church Street, Dillsburg, PA 17019 MATE ~~0 Side 1 L 15056041147 15056041147 J 15056042148 REV-1500 EX Decedent's Social 5066 RECAPITULATIONI 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) ~ 'i 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) .................. .................................................. ... s. 9. Funeral Expenses & Administrative Costs (Schedule H) ......... ......... ....... ... s. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 11. Total Deductions (total Lines 9 8 10) ......................... .......................................... ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ............. ............................................. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ... 12. an election to ta:c has not been made (Schedule J) . .............................................. .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES .. 14. 15. Amount of Line 14 taxable at the spousal ta:K rate, or transfers under ~~ec. 9116 (a)(1.2) X .00 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 1 7 6 4 7 2 3 0 1s. 17. Amount of Line 14 taxable at sibling rate X .'12 0 0 0 17. 18. Amount of Line 1~4 taxable at collateral rate }C .15 0 0 0 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 15056042148 9,969.29 196,288,47 206, 257. 76 22 754. 27 7, 031. 19 29, 785. 46 176, 472. 30 176,472.30 0.00 7,941.25 0.00 0,00 7,941.25 15056042148 J REV-1500 EX Page 3 Decedent's Complete Address: Josephine E. Rebert -- STREETADDRESS .Golden Living West CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 1t3) 2. Credits/Payments A. Spousal Poverty Credit __ _ __ -- B. Prior Payments 2,992.50 C. Discount 157.50 3. Interest/Penalty if applicable D. Interest E. Penalty File Number 21-08-01222 STATE Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (2> 3,150.00 (3) (4) (5) 4,791.25 (5A) (5B) 4,791.25 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 :.................................... ' x c. retain a reversionary interest; or .................................................................................................................. i~ z d. receive the promise for life of either payments, benefits or care? .................. ~ J ........... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................................. 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 property which x contains a beneficiary designation?............ ..... .... ... .............................................................. 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 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 (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 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)]. sibling is definedounder Sectiont9102, as an individual whothas at least one patlent in clolmmon ~hlthe(decedent nwh7 the by blood(or ado)tion. P ZIP PA 17011 (1) 7,941.25 Rev-1508 EX+ (5-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Rebert, Josephine E. FILE NUMBER 94_AQ_AA~fOa Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Fulton Bank CD#400-3426543: 9,969.29 TOTAL (Also enter on Line 5, Recapitulation) I 9 969 29 (If more space Is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) ~~ B~~~lYlk P.O. B OX 1189 • HARRISBURG, PA 17108 LISTENING . fultonbank.com 1 800 FULTON 4 December 17, 2008 The Wiley Group Attn: Jan Wiley 130 W Church St, Suite 101 Dill;b~rg, PA_ 17019 IN RE: JOSEPHINE E. REBERT, DECEASED Dear Mr. 'Wiley: Per your request, here is the information concerning the account Ms. Rebert had with Fulton Bank. She had one CD account with us. Her CD #400-3426543 was closed on O1 /02/2008 in the amount of $9,969.29. The CD was originally opened on July 7, 1989 in the amount of $6,083.41. This CD was held in Josephine"s name alone. - -~ If you need further information, please call me at 717-432-9771. Thank you.. regards,. .` ,, ~C-reta t/~ Slagill Dillsburg Branch Manager COMMONWEALTH OP PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Rebert, A. Kenneth F. Rebert B. C. ECEDENT 401 Church Street Son Barnesville, PA 18214 JOINTLY OWNED PROPERTY: DESCRIPTION OF ITEM LETTER DATE PROPERTY NUMBER FOR JOINT TENANT MADE JOINT INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR DATE OF DEATH % OF DECD'S DATE OF DEATH . JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A 5/2/19 94 Adams County National Bank Account 20,005.42 0.500% 10 002 71 Number 640110359: , . 2 A 5/2/1994 Adams County National Bank Account 60,016.25 0.500% 30 008 13 Number 640110360: , . 3 A 5!24/1994 Adams County National Bank Account 15 018 65 0 500% Number 640110382: , . . 7,509.33 4 A 6/16/1966 Citizens Bank Account Number 1 402 91 0 500% 6100747034: , . . 701.46 5 A 11!4/1996 Citizens Bank Account Number 62,720.17 0.500% 31 360 09 6140708362: , . 6 A 11/4/1996 Citizens Bank Account Number 34 996 35 0 500% 6140781264: , . . 17,498.18 7 A 11/4/1996 Citizens Bank Account Number 15 000 88 0 500% 6140869145: , . . 7,500.44 8 A 11/4/1996 Citizens Bank Account Number 37 798 49 0 500% 6247405826: , . . 18,899.25 Total of Continuation Schedule TOTAL (Also enter on Line 6, Recapitulation) fee attached page 196,288.47 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form softwart; only The Lackner Group, Inc. ~ephine E. FILE NUMBER 21-08-01222 If an asset was made Jolnt wlthln one year of the decedent's date of death, It must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO D Form PA-1500 Schedule F (Rev. 6-98) Rev-1609 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY continued ESTATE OF Rebert, Josephine E. LE NUMBER 21-08-01222 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. JOINTLY OWNED PROPERTY ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 9 A 12/31/1999 MST Bank Account Number 52,158.01 0.500% 26 079 01 31003910617083: , . 10 A 12/31/1999 M&T Bank Account Number 52,158.01 0.500% 26 079 01 31003910617132: , . 11 A 11/5/2005 PNC Bank Account Number 41,301.72 0.500% 20 650 86 31500277093: , . TOTAL (Also enter on Line 6, Recapitulation) 196,288.47 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Q M~ B~ 499 Mitchell Road Millsboro, DE 19966 Mail Code DE-MB-12 The Wiley Group Attorneys At Law 1.30 W Church Street, Suite 101 Dillsburg., Pennsylvania 17019 Pho,~e (888) ~02~349 Ear: (302)934-29~i October 7, 2008 RE: Estate of Josep/tine E Rebert Social Security Number: 166-12-5066 Date of Death: September 06, 2008 Dear Sir or Madam: Thank you for your inquiry dated September 30, 2008, addressed to M & T Bank; however, we are unable to locate any open files for the above-mentioned decedent. "[here are two Certificate of Deposit accounts, (:;1 0039 106 1 7083 & 31003910617]32) in our files in which both accounts were closed February O5, 2008. Please contact the Dillsburg Branch @ 717-432-2850 for any information regarding accounts closed prior to the date of death. If you feel that any other should exist, please provide us with an account number and/or the name of any possible joint account holder. Si~t~urciy, '~,_J~~ < c ~_ ~_, ~ ~c~Zi~, - hc~~ ICS ~, ~ ~n~ \ ~ -~-- 1\s ~i,~~ Trade I fare Worn ~~.. . Records Management cat Cap Ci ~~~' . ------, ~~C. €. 2008 ' 1:49A.~1 ~~~,~ ~~ 17ecember 8, 2008 S. DAWN GC,ADFEL~'ER 130 W. CI3CJRC~I STREET SUITE 101 DILLSBURCi PA 17019 Estate of J0.3BPT~NE E R.EBERT Date of l~eatl~: Sep O6, 2008 SSN: 166-12-5066 N0. 02 i P. 7 525 'VVx~liam Penn Place Suite 153-2618 Pittsburgh, PA 15219 1:3ear Sir/Madarn: AT_.~, ACCOLiNTS WERE JOINT ACCOI'_TNTS WITH THE TI'ITrE OF JOES)?I-IINE REBERT or KENNETH R'.EBERT. ACCT # DATE CLOSER BALANCE IN`IEREST 6140708362 07/09/2008 $62720.17 $28.80 6140781264 05/12/2008 $34996.35 17.02 6140869145 03/03/2008 ~ 15000.88 $0.88 6247405826 03/I 1/2008 $37798,49 $114.71 ~~ a C... ~C ~ w~~!- S ~~~2,n ems-- 1 ~ ---'~{ - ~ o~ c~ , Sincerely, Robert Roos Operations Services ~~'c~~ ' ~. 2~~C8 ' : 22FM °~dC B~,~tiK 412-?;)~-2747 ~~~ l;.lfnl;~tly~ ~tl~ v~s~ October 15., 2008 S Dawn G1Ftcifelter C/O The Whiley Group 130 W Church St, Ste 101 Dillsburg, PA 17019 RE: Josephine E Rebert SSN: 166-12-5066 IllOf): 09-06-2008 ~~~~, 2289 P. 1 Dear Ms. Gladfelter: Tn response t:o your request for Date of Death (DOD) balances for the customer noted above, our records shove the fallowing: Cet~fieate cif Deposit Account # 3 ]500277093 Established: 11-OS-?005 JOSEPI-TINE E REBERT KENNETH F REBERT DpD balance: $ 41,295.44 + 6,28 accrued interest Interest paid 01-01-2008 tluu 09-06-2008 $1,217.84 YTD Please note that this office provides elate of death balances far deposit accounts (IR.As, CDs, Checking and Savings). We do not process any financial transactions or provide statements. Ifyou need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center FNC Bank, N.A. Member FDIC: Page 1 of 1 G.~ __ _- LJNTI' October 8, 2008 NATIONAL BAVh The Wiley Group Attn: S Dawn Gladfelter 130 W Church St, Ste 101 Dillsburg PA 17019 RE: Estate of Josephine E Rebert Dear Ms. Gladfelt:er: The following infi~rmation is bein g provided as per your request: Acct. Type Account No. Account Accrued Ownership Date Principal on Interest to Opened D.O.D. D.O.D. Certificate of 6401 i 0382 $15,000.00 $18.65 Jt/w Kenneth 5/24/9y Deposit Rebert Certificate of 640110360 $60,000.00 $16.25 Jt/ w Kenneth F 5/2/94 Deposit Rebert Certificate of 640 1 1 0359 $20,000.00 $5.42 Jt/w Kenneth F 5/2/94 Deposit Rebert Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5122. Sincerely, ,~ ~, Barbara J War ~er~ Adams County Pd'ational Bank Deposit Services Representative II PO Bux 3129, Gr_i ivtii;i,R~,, P,a 1732 ~ rHO,~i 71 .' )3~ 3161 ~ i,~~~ ~xref3tS8 33 F?262 ~ w~nvacnb.cuin ~~~ Account Number Account Title Date Opened Account Type Principal Balance as of DOD Interest from Last Posting to DOD Account F3alanc~ as of DOD YTD Interest to DOD 6100747034 JOSEPHINE REBERT OR KENNETH REBERT 6/6/ 1966 $1402.91 $ .00 $ i 402.91 $1 62 5 REV-1151 EX+ (12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Rebert, Josephine E. FILE NUMBER 21-08-01222 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. ~ FUNERAL EXPENSES: See cantinuation schedule(s) attached I 12,754.27 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) ! EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Feiss The Wiley Group, PC 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Adldress City _ State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 10,000.00 TOTAL (Also enter on line 9, Recapitulation) 22,754 27 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-A FUNERAL EXPENSES continued calAlt Vr Rebert, Josephine E. ITEM NUMBER 1 American Legion -After dinner meal: 2 Dodori Memorials: 3 Monahan Funeral Home: DESCRIPTION FILE NUMBER 21-08-01222 AMOUNT 138.77 135.00 12,480.50 Subtotal ~ 12,754.27 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1512 EX+ (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Rebert, Josephine E. 21-08-01222 Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Golden Living Center Nursing Home: 7,031.19 TOTAL (Also enter on Line 10, Recapitulation) I 7,031.19 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1613 EX+ (9-0O) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DF_CEDENT ESTATE OF Rebert, Josephine E. NAME AND ADDRESS OF NUMBER PERSON(S) RECEIVING PROPERTY I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Kenneth F. Rebert 401 Church Street Barnesville, PA 18214 FILE NUMBER 21-08-01222 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT Do Not List Trusteets) (Words) ($$$) Son 176,472.30 Enter dollar amounts for distributions shown above on lines 15 throw h 18, as a I Total 176,472.30 9 pproprlate, 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 CHARITABLE: AND GOVERNMENTAL DISTRIBUTIONS SCHEDULE J BENEFICIARIES TOTAL OF PART 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)