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Home My WebLink About09-10-09-~ REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 21 0 8 010 71 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 193129069 10232008 10031924 Decedent's Last Name Suffix Decedent's First Name MI ROSS BETTE p, (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 ^ 5. Federal Estate Tax Return Required (date of death aker 12-12-82) ^ 8 Decedent Died Testate ^ ~ Decedent Maintained a Living Trust 8. Total Number of Safe De osit Boxes (Attach Copy of VJII) (Attach Copy of Trust) P ^ 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. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT P. KLINE 7177702540 Firm Name (If Applicable) KLINE LAW OFFICE First line of address 714 BRIDGE STREET Second line of address P.O. BOX 461 City or Post Office State ZIP Code NEW CUMBERLAND PA 17070 Correspondent's a-mail address: REGISTER O~LS USE ~LY .o t r ~ . ~ _ - ~~ rrt ~ =~ i ~ x " ' ~7 f ~ C7 i ~O-n ~" c>C ~ - -- = :~ ~ DA~ FILED •• i = ; ', .C' .-.~~ i .a i ~'+.:J ,~. it '.> '`r~ _~ -'r 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, 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. SIGNAT OF ERSON RESPO IBLE F ILI TURN DAT i ~ Pennie A. Bohl 9 /a~n 4 Avenue, New Cumberand, PA 17070 w•~~ ~ n~rrt~xrvinirvt DATE Robert P. Kline ~ , ~ ) O ADDRESS a 714 Bridge Street, New Cumberland, PA 17070 1505607120 Side 1 1505607120 J .__.J REV-1500 EX 1505607220 oe~ede~rs Name: ROSS , B E T T E R 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 ii 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) ............................................................ ........... 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 .00 15. 16 Amount of Line 14 taxable . at lineal rate X .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. Decedent's Social Security Number 193129069 1,072.42 1,072.42 9,769.77 2,933.71 12,703.48 -11,631.06 -11.631.06 0.00 Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 08 - 01071 D D N A Ross, Bette A _ _ _ _ STREET ADDRESS 500 Park Avenue _ _ . _ STATE ,ZIP _ ITY New Cumberland PA 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 84.45 0.00 Total Credits (A + B + C) (1) 0.00 (2) 84.45 Total Interest/Penaity (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 84.45 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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 0 , 0 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 :.................................................................................~ c. retain ah evehsionary interest oo shall use the property transferred or its income :...::::.:.:.:::::.:.:::::....::::::: d. receive the promise for life of 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? .....................................................................................................................~ u 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ~J ~' 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 RETUR 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)J. 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. SCHEDULE F COMMONWEALTH OF PENNSYLVANIA ,JOfNTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE 2UM R Ross, Bette A 01071 08 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Pennie A. Bohl 500 Park Avenue Daughter q New Cumberland, PA 17070 JOINTLY OWNED PROPERTY: ITEM LETTER '' DATE f:~Ff.SCRIPTIO~V C~F PRO~ERTY Include name o manclal Ins Itu Ion an bank account number _ ~- % OF DATE OF DEATH DECD'S _ DATE OF DEATH VALUE OF NUMBER FOR JOINT MADE or similar identi in number. Attach deed for ointl held real fY 9 I Y- VALUE OF ASSET , INTERES DECEDENT'S INTEREST , TENANT JOINT estate -- 1 A 04/16/2001 . _ Susquehanna Valley Federal Credit Union Acct __ ___ ~ 2,144.84 50% ~ 1,072.42 No. 205 TOTAL (Also enter on line 6, Recapitulation) ~ 1,072.42 - SCHEDULE H FUNERAL D(POVSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~ /,r~~wACT~AT1~/C /'-MTC , RESIDENT DECEDENT r11d11•^~~K7 ~ Imo'\~ ~YG ~ILJ~7 ~ ~7 ESTATE OF Ross, Bette A FILE NUMBER _ , _ 21 - 08 -___01071 Debts of decedent must be reported on Schedule I. ITEM - -- - - -_ _ NUMBER 'FUNERAL EXPENSES: DESCRIPTION AMOUNT --- --~ -- - - _ _ _ __ I _ - - - -- A. 1 i Musselman Funeral Home & Cremation Services, Inc. 8,871.90 2 Misc expenses (minister's breakfast & photo display board) 30.87 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions I Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Kline Law Office 750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address ~I I i City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 117.00 5. I~ Accountant's Fees 6. I Tax Return Preparer's Fees 7. Other Administrative Costs 1 - -- _ _ TOTAL (Also enter on line 9, Recapitulation) 9 769.77 CnWMONWFALTH OF PENNSYLVANIA SCHEDULEI DEBTS OF DECEDENT, MORTGAGE 1 IAR11 ITIFS R I IFNS ESTATE OF ROSS, Bette A Include unreimbursed medical expenses. ITEM NUMBER 1 FILE NUMBER 21 -08-01071 HCR Manor Care of Carlisle DESCRIPTION AMOUNT 2,933.71 TOTAL (Also enter on Line 10, Recapitulation) ~ 2,933.71 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ross, Bette A RELATIONSHIP TO DECEDENT Do Not List Trustee(s) I NUMBER NAME AND ADDRESS OF PERSON(S) ~_ RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS[include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2}j 1 Theodore E. Clements 10 Ash Drive ~ Mechanicsburg, PA 17055 2 ' Pennie A. Bohl 500 Park Avenue New Cumberland, PA 17070 3 ~ Sharon Loper Weiglein 6700 105th Avenue Lot 934 Clearwater, FL 33764-7713 II. Son Daughter Friend FILE NUMBER 21 -08-01071 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER S 0.00 EXPLANATION FOR NEED FOR SUPPLEMENTAL RETURN This Supplemental Return is filed for the purpose of clarifying the classification of the limited assets of this estate and to include certain expenses that were not originally included by the Administrator of the estate in the original return. USQUEHANNA ALLEY FEDERAL CREDIT UNION December 11, 2008 Robert P. Kline, Esquire Kline Law Office 714 Bridge St. P.O. Box 461 New Cumberland, PA 17070 Re: Bette A. Ross Dear Mr. Kline: The following is the information in which you requested for Bette A. Ross's account at Susquehanna Valley Federal Credit Union. Pennie A. Bohl has provided copies of the Death Certificate and Short Certificate to our office. Account # 205 DOD Balance: -00 (savings): $5.00 -40 (checking): $2,139.84 Joint owner (on both savings and checking): Pennie A. Bohl Joint owner added 04/16/2001 Please let me know if you need any additional information. Kind regards, L~~ Kathy Jo Shoaff Member Services Supervisor 3850 HARTZDALE DRIVE • CAMP HILL, PA 17011-7809 ~~- C~~ - 00 948-1454 FAX: 717 737-0589 LOCAL: (717) 737 4152 TOLL FREE. (8 ) ( ) ROBERT P. KLINE, ESQ. Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse One Courthouse Square, Room 102 Carlisle, PA 17013 Dear Glenda: September 9, 2009 n ~ __ ca o ~ .,_, . , ,._~ ~ . ?z ~ ['~i r, ~. ~ O r-.; ~~.7 ; yA, c._, ~__ ~ z , .- Re: Estate of Bette A. Ross x- File No. 21-08-01071 I am enclosing with this letter the original and two copies of a Supplemental Return in regard to the above-referenced estate. A check in the amount of $15.00 to cover the filing fee is also enclosed. Please return atime-stamped copy of the document to my office in the enclosed postage paid envelope. If you have any questions concerning this matter, please do not hesitate to contact me at my office. Very truly y urs, Robert P. Kline, Esquixe RPK/srf Enclosures cc: Pennie A. Bohl 714 Bridge Street P.O. Box 461 New Cumberland. PA 17070 (717) 770-2540 (7I7) 243-5940 Fax (717)770-2553 ~7 ~_~ r'~ O ti . r rro ,_,{ r F - .J . -~1 ~~~ ...fit ~w,t 1 ~ `.1 1 . ~ a' ' 4 ~ i;-' ~ Li~aaoooaa # ti /~ P rnD ~ ° Q ~ a `~ ~ / ~M ~ ci / pa9 SEP t ~ ~~ ~ ` ~ ~4 Z ~'1 '.r J (<r T vt- ~ y . ~f ~1 pP? ~`~, , _ , PA ~~'~~~'~ r ^_ ;- .--- r-- ~---- ,-- r-- a~ ,~ o ~ cn ~ U ~ 'v cCf ,~ p~ M ~ }'' ~ ~ ~ _ ~ U ~ O '-' ~ ~ Q' , o ~ ~ a w ~ ~,~ ~~° ?~ -v ~ ~ .fl U N ~ ~ ~ N C7 t~U0 °tJ ~~ 1 -~~ _ -:k-