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Home My WebLink About06-09-091505607121 _~ RE~0-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 9 0 1 3 6 Po sox 2sosol RESIDENT DECEDENT Harrisbu , PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death 2 0 9 2 8 8 4 4 8 1 1 1 0 2 0 0 8 0 5 2 8 1 9 2 6 Suffix Decedent's First Name MI Decedent's Last Name R O S E N B E R R Y HARRY W (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return ^ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 6. Decedent Died Testate (Attach Copy of V4'ill) ^ 9. Litigation Proceeds Received ^ ^ ^ 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 between 12-31-91 and 1-1-95) 5. Federal Estate Tax Return Required ^ 0 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIADL dime TOelephoOne NumUberBE DIRECTED T0: Name Firm Name (If Applicable) H ANTHONY ADAMS First line of address 4 g WEST ORANGE STREET Second line of address S U I T E City or Post Office SHI PPENSBURG State ZIP Code ~ P A 1 7 2 5 7 REGISTER OF WILLS US ~ NLr ~,I C'? C ... '.'3 9 ` ` ~ , t , ~~~ ~ _ # 1 r ' ~~~ ~ _.. ILED ~ r ' ~ - ' -- - - .~' =z Correspondent's a-mail address: Under pe~Re~ ande~ pleteeCDeclaration of preparer other than the personal representative scbased on aldl nfotrmation~of wh ch preparer has any knowledge.belief, it is we, TE SIGNATURE QF PERSON RESPONSIBLE FOR FILING RET~~~ « /j~~~~~ ~ ~~~T~~Q Side 1 1505607121 1505607121 J 1505607221 REV-1500 EX Decedent's Social Security Number Decedent's Name: HARRY W. ROSENBERRY 2 0 9 2 8 8 4 4 8 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2. Stocks and Bonds (S~hedule 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) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) .... . ... . . . . . . ............ 8 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. 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. 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 _ 0 . 0 0 15. 16. Amount of Line 14 taxable 0 0 0 0 _ at lineal rate X . 16. 17. Amount of Line 14 taxable 3 7 7 9 6 3 at sibling rate X .12 . 17. 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 1 g, 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 6280,67 6 2 8 0, 6 7 1 7 9 3, 4 8 7 0 7, 5 6 2 5 0 1, 0 4 3 7 7 9. 6 3 3 7 7 9, 6 3 0. 0 0 0. 0 0 4 5 3. 5 6 0. 0 0 4 5 3. 5 6 1505607221 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 09 0136 DECEDENT'S NAME HARRY w. ROSENBERRY __ STREET ADDRESS - --- ___ -_ - ___ CITY --_-- T- -- Shippensburg sTATE - -- - ZIP - - __ _ _ Pa '17257 Tax Payments and Credits: ~ Tax Due (Page 2 Line 19) (1) 2. Credits/Payments 453.56 A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable 0 00 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 0 00 . 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) 453 56 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4 53 56 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE A PP ROPR IATE BLOCKS 1. Did decedent mak.~ a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income; ............................... ^ 0 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 decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... ^ ^ ^X ^X 4. Did decedent own 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 p2 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 childtwenty-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 ch?Id 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)]. Asibling is defined, under Section 9102, as an individual who has a! least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER HARRY w. ROSENBERRY 21 09 0136 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on srhpd~~io r ITEM NUMBER DESCRIPTION 1. CUMBERLAND VALLEY COOPERATIVE MEMBERSHIP SHARES CITIZENS BANK-CHECKING # 610079-449-0 I VALUE AT DATE OF DEATH 1,340.00 4,940.67 TOTAL (Also enter on line 5, Recapitulation) I $ 6 280 67 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & IN R SI DENTED ~ DENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER HARRY w. ROSENBERRY 21 09 0136 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1. B. State Zip 2, Attorney Fees 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant 4. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commission Paid: Street Address COY State Zip Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS 5 Accountants Fees 6. Tax Return Preparer's Fees 7. SHIPPENSBURG HEALTHCARE CENTER 8. PHARMA CARE 9. WEST SHORE EMS TOTAL (Also enter on line 9, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) AMOUNT 500.00 98.00 1,014.22 20.53 160.73 1, 793.48 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER HARRY w. ROSENBERRY 21 09 0136 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VAOF DEATHTE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF WELFARE 707.56 ESTATE RECOVERY PROGRAM CIS-710189593 TOTAL (Also enter on line 10, Recapitulation) I 3 707.56 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT , is I A I t ur FILE NUMBER HARRY w. ROSENBERRY ~, ,,., ,,,.,,. VN V IJV RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Earl D. Rosenberry Sibling 3,779.63 3 Longview Street Shippensburg, PA'i7257 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) WILL OF HARRY W. ROSENBERRY I, HARRY W. ROSENBERRY, of Shippensburg, Cumberland County, Pennsylvania, declare this to be my last Will and hereby revoke all prior wills and codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of =^•y res? duary e`tat_ . 3. I direct that my entire estate be divided as follows: A. I leave my entire estate of whatever nature and wherever situate to my wife, Eva M. Rosenberry, should she survive me. B. Should my spouse predecease me, I then leave all of my estate to my sister, Helen C. Martin. 4. I appoint my wife, Eva M. Rosenberry, as Executrix of this my last Will. If she should predecease me or cease to act in such capacity, I name my sister, Helen C. Martin to so serve. 5. The Executrix of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executrix acting under this Will shall be required to enter bond in any jurisdiction. ~N WITNESS EREOF, I have h eunto set my hand this z~- day of ~ lg~. 7slav~u~ ~ - ~ o~~ .. HARRY ROSENBERRY LAW OFFICES OF STEPHEN J. HOGG 401 E. LOUTHER STREET CARLISLE, PA 17013 r ~i~L'- The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by HARRY W. ROSENBERRY, as and for his last Will in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. LAW OFFICES OF s~pxFav J. xoc~ 401 E. LOUTHER STREET CARLISLE, PA 17013 ACKNOWLEDGMENT LAW OFFICES OF s~p~N J. xoc~ 401 E. LOUTHER STREET CARLISLE, PA 17013 Commonwealth of Pennylvania ss County of Cumberland I, HARRY W. ROSENBERRY, the testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ~~~~ ~~~~ T_3-~.R_~?`~ jti'. RJSENBERRY Sworn to or affirmed and acknowledged before me by Y W. ROSENBERRY, the testator, t s day of 1992. f StE~i7~~ E i-~~ i, ~ Sr~~7 ti r` s0'p , # G:;t~ i~~ ~, Gig ~:~ rt~i ~-, ~,,:y ~ ota 1 ' A for ~ 1'~ s Vii:;. .- Commonwealth of Pennsylvania ss County of Cumberland We, ~,iuk. J_ L,~-SS and o~c~S~T ~ ~'!~. CGt t~ U-e r the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to .law, do depose and say that we were present and saw the testator sign and execute the instrument as his last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the Will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~ .~7 Q ,~~ Sworn to or affirmed and s scribed to before me by witnesses, this ~.~-day of ~~.~, X992 , _ ~ .. .... 1 i• ,,;... Notar ; Public Att . _.. ~ ~,., ..._ CODICIL of HARRY W. ROSENBERRY I, Harry W. Rosenberry, of Shippensburg, Cumberland County, Pennsylvania, hereby declare this to be the first Codicil to my Will dated June 24, ~ y92. 1. I direct the following changes be made to my last Will. A. Paragraph 3, section B shall now read as follows: Should my spouse predecease me, I then leave all of my estate to my brother, Earl D. Rosenberry. g. Paragraph 4 shall now read as follows: I appoint my wife, Eva M. Rosenberry, as Executrix of this my last Will. If she should predecease me or cease to act in such capacity, I name my brother, Earl D. Rosenberry and Gary W. Rosenbeny as joint Executors to so serve. 2. In all other respects I ratify, confirm and republish the provisions of my last Will dated June 24, 1992 together with this Codicil as and for my last Will. IN WITNESS WHEREOF, I have hereunto set my t,~nd and seal in this Codicil consisting of two pages this ~- day of ~c,,r o , 200. LAW OFFICES OF STEPHEN J. NOGG ~~~~~ ~~ ~ ~ ~ 19 S. HANOVER STREET HARRY W. ROSENBER Y SUITE 101 CARLISLE, PA 17013 ~~~ This instrument consisting of two pages was on the day LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 and date set forth signed, published and declared by HARRY W. ROSENBERRY, to be the first Codicil to his Will in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. ~i~~ Witness ~~ ~. Witness 2 ACKNOWLEDGMENT Commonwealth of Pennsylvania County of Cumberland On this, the ~~~ day of ~ uciY~, 200 ~ ,before me, Stephen J. Hogg, the undersigned officer, personally appeared HARRY W. ROSENBERRY, known to me or satisfactorily proven to be the person whcse name is subscribed to the within instrument as my sole Codicil to my last Will and acknowledged that he executed the same for the purposes therein contained. ~`'` HARRY W. ROSENB RY IN WITNESS WHEREOF, I hereunto set my name and official LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 `/~ seal. h ~D M N R O N ~ M ~~ ~~ ti N r ~ ~~ ~ ~ CW7 P+ O ti ~~ ~~