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Home My WebLink About09-10-0915056041114 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 280601 ~ , C ~ ~ C» __ Harrisburg PA 17128-0601 RESIDENT DECEDENT ~ S ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 187-16-6573 12192008 11171921 Decedent's Last Name Suffix Decedent's First Name MI STAMBAUGH JEAN W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI STAMBAUGH GLENN A 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 Retum 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 0 2. Supplemental Retum 0 4a. Future Interest Compromise (date of death after 12-12-82) 0 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) 3. Remainder Return (date of death prior to 12-13-82) 0 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT G. FREY Firm Name (If Applicable) FREY & TILEY First line of address 5 SOUTH HANOVER STREET Second line of address City or Post Office CARLISLE State ZIP Code PA 17013 REGISTER OE ILLS USE ~Y ?~~ "U rn --- _ ~~, 7C7=1 ~ ~i ~ D C.ft DATE FILED ~ -:., -, , -. ~. > ._i . ,, . fy-`+ i - ~.~ `= ~ -,-; TI ~--_.) _ .`~ -T:~ Correspondent'se-mail address: RFREY@FREYTILEY.COM 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 SIGNP~IRE OF PERSON RESPOySIBLE FOR FILING RETURN DATE ADDRESS S j 171 GP.~-,,~- y2 ~ t~ tp l ~7 o i 5 SIGNAT RE F PRE RE HER T N R ESENTATIVE ~ ~ ~ ~T~ _I - ADDRESS 5 SOUTH HANOVER STREET, 717243583-fl, ISLE, PA 17013 SE USE ORIGINAL FORM ONLY Side 1 15056041114 15056041114 ~,~, REV-1500 EX 15056042115 Decedent's Social Security Number Decedent's Name: JEAN W S TAMBAU GH 18 7 -16 - 6 5 7 3 RECAPITULATION 1. Real estate (Schedule A) .... . ............... . ...................... 1. NON. 2. Stocks and Bonds (Schedule B) ............................ . ... . ... .. 2. 9 9 2 2 7 5.10 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. NONE 4. Mortgages & Notes Receivable (Schedule D) .......................... .. 4: NON: , 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. NON~~ 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ....... . 6. 4 710 8 2 . 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ....... . 7 NONE 8. Total Gross Assets (total Lines 1-7) ................................. . 8. 14 6 3 3 5 7.10 9. Funeral Expenses & Administrative Costs (Schedule H) . . ................ . 9. 3 719 O . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. . 10. NONE 11. Total Deductions (total Lines 9 & 10) ................................ . 11. 3 719 O . O O 12. Net Value of Estate (Line 8 minus Line 11) ........................... .. 12. 14 2 6167.10 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... . 13. 0 . O 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... . 14. 14 2 6167.1 O 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.o 0 471082.00 15. 0.00 16. Amount of Line 14 taxable at linealrateX.o 45 955085.10 16. 42979.00 17. Amount of Line 14 taxable at sibling rate X • 12 17. O . 0 0 18. Amount of Line 14 taxable at collateral rate X • 15 18. 0 . 0 0 19. TAX DUE ....................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042115 15056042115 42979.00 REV-1500 EX Page 3 187-16-6573 Decedent's Complete Address: File Number 21-09-0025 DECEDENT'S NAME JEAN W STAMBAUGH DECEDENT'S SOCIAL SECURITY NUMBER 187-16-6573 STREET ADDRESS 1169 CLAREMONT ROAD CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 45000.00 C. Discount 2176.00 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 42979.00 Total Credits (A + B + C) (2) 47176.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 4197.00 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. (5) 0.00 (5A) (5B) 0.00 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 right to designate who shall use the property transferred or its income : ................ ~ ^X c. retain a reversionary interest; or ..................................................... . ~ ~X d. receive the promise for life of either payments, benefits or care? ............................ . ~ QX 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 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 [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)]. 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 at least one parent in common with the decedent, whether by blood or adoption. 217 REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Jean W Weidner Stambaugh 21-09-0025 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Exelon Corporation, 813.3218 shares, $53.06 ave. price 2. ATT, 9,984 shares, $27.98 ave.price 3. Vodaphone, 1,268 shares, 19.35 ave. price 4. Owest Communications, 1,305 shares, 3.35 ave. price 5. Teco, 492 shares, 12.08 ave. share price 6. Frog & Switch, 25 shares @ $70/share 7. 160 Delta Natural Gas 5.75% bond, Ave. price on 12/17.08, closest day where traded: 87.57 8. 50 GE 6.75% bond, 110.06 high, 99.75 low, 104.91 ave. 9. 100 Pa. State Turnpike Com. 5.00% bond, 108.52 high, 105.59 low, 107.06 ave. 10. 50 Del. County PA Auth. Bond, Catholic Health, closest trade to date of death, 76.11 11. 100 Del. County PA Auth. Bond, Mercy Health, trade on date of death: 99 12. 50 PA State Univ. Rfdg Ser. A bond, High: 81.01: Low: 79.01, Ave.: 80.01 13. Verizon, 2,486 shares, 33.78 ave share price 14. Comcast, 880 shares, 18.57 ave. share price 15. Southfork Municipal Authority Bond, 5000 Face, no trading 16. American Water Works, 200 shares, ave price 20.72 17. Aqua America, 2416 shares, 20.05 ave. price 18. Atmos Energy, 1270.40779 shares, 23.46 ave. share price 19. Berkshire Hathaway B, 5 shares, 3,243.99 ave. share price 20. Cisco Systems, 1200 shares, 16.78 ave. share price 21. ConocoPhillips, 214.14641 shares, 52.02 ave share price 22. Duke Energy, 813 shares, 14.86 ave. share price 23. Energen Corp, 1756 shares, 28.89 ave share price 24. Exxon Mobil Corp, 1188 shares, 76.68 ave share price 25. FPL Group, 322.56141 shares, 50.94 ave share price 26. Freeport McMoran, 200 shares, 23.18 ave. share price 27. Genuine Parts Co., 300 shares, 37.58 ave. share price 28. Hess Corp, 227 shares, 48.01 ave. share price 29. Illinois Tool Works, 210.28442 shares, 33.37 ave share price 30. Integrys Energy Group, 349 shares, 42.5 ave share price 31. Intel, 800 shares, 14.59 ave share price 32. Live Nation, 12 shares, 4.21 ave share price 33. Middlesex Water Company 34. Piedmont Natural Gas, 400 shares, 31.27 ave share price 35. Progress Energy, 500 shares, 39.57 ave. share price 36. Royal Dutch Shell, 1000 shares, 53.19 ave share price 37. Spectra Energy, 300 shares, 15.51 38. Sun Microsystems, 100 shares, 4.13 ave share price 39. United Technologies, 200 shares, 51.33 ave share price 40. US Bancorp, 610 shares, 25 ave share price TOTAI (If more space is needed, insert additional sheets of the same size) 43,155 279,352 24, 536 4, 372 5,943 1, 750 14,011 5,246 10, 706 3, 806 9,900 4,001 83,977 16,342 5, 000 4,144 48,441 29,804 16,220 20,136 11,140 12,081 50,731 91,096 16,431 4,635 11,274 10,898 7, 017 14, 833 11,672 50 3,511 12,508 19, 785 53,190 4, 653 413 10,266 15,250 217 REV-1509 EX+(6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER W Weidner Stamba 21-09-0025 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 A. Glenn A. Stambaugh B C. JOINTLY-OWNED PROPERTY: 1169 Claremont Road Carlisle, PA 17013 ADDRESS RELATIONSHIP TO DECEDENT Husband 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 1. A. Real Estate, 1169 Claremont Road, Carlisle, PA 494,852 50.00% 247,426 2. A Real Estate, 816 Forbes Road, Carlisle, PA 176,249 50.00% 88,124 3. A JP Morgan Chase 50.00% 0 4. A HJ Heinz, 75 shares, 38.155 ave. price 2,862 50.00% 1,431 5. A Emerson Electric, 400 shares @35.35 ave. price 14,140 50.00% 7,070 6. A PNC Bank, 5614 shares @ 45.255 ave price 254,062 50.00% 127,031 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 6 Reca'pitulation)I $ 471 082 (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 RES DENTEDECEDENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Jean W Weidner Stambaugh 21-09-0025 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman Roth Funeral Home 8,858 2. Headstone inscription 200 B. 1 2. 3. 4. 5. 6. 7. NINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Final medical expenses. See attached statement Zip 25,000 252 included w/ atty. fee included w/ atty. fee 1,880 TOTAL (Also enter on line 9, Recapitulation) ~ $ 37 190 (If more space is needed, insert additional sheets of the same size) Final Medical Expenses Pinnacle Health 1,024 Carlisle Regional Emergency Room 180 Moffitt Heart & Vascular 132 Associates in Kidney Diseases 118 Pulmonaary and Critical Care 95 West Shore EMS 90 West Shore EMS 88 Lehigh Anesthesia Assoc. 52 Moffitt Hear & Vascular 51 Alexander Spring Emergency Physicians 32 Cardiovascular Surgical Institute 14 Kinetic Imaging 2 Cardiology Diagnostic LLC 2 Total 1.880 DISCLAIMER I, GLENN A. STAMBAUGH, being the surviving spouse of JEAN W. STAMBAUGH, absolutely disclaim and renounce any right, title, and interest in the estate of JEAN W. STAMBAUGH without condition or reservation of any kind. I have not in any way acted to accept the property or any of its benefits„ This Disclaimer is irrevocable and unequivocal, and constitutes a complete and unqualified refusal to accept any right, title and interest in the property. ~ /~ INTENDING TO BE LEGALLY BOUND, witness my hand and seal this day of Janrr /~99`~. S a~7 ! t y„~, 'l ''Zf` ~V~ \\ J Wltn .~~~/~'~^ ~•~~`''``'iit;" (SEAL) GLENN A. STAMBAUGH Acknowledgment of Receipt We, Glenn E. Stambaugh Tan^" T ~r criiiai, Administrattors of the Estate of Jean W. Stambaugh, do hereby acknowledge receipt .~ the foregoing Disclaimer of Interest in the Estate by Glenn A. Stambaugh, this %~1` day of ?.~ ~`~~---~~'' 2009. State of Pennsylvania } ss. County of Cumberland ~~~ GLENN E. STAMBAUGH On this, the 1 c3 ~ day of .Se ~'e ~^--~ ~r , 2009, before me, the undersigned officer, personally appeared GLENN ~ STAMBAUGH known to me (or satisfactorily proven) to be the persons whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained, IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~~ ( AL) ~, +vor,~~ s~-c ieoa~t~rr a. ~; -vos.~+ ~/~ er Carids eoe~Sy M My Cow~itdon Ernie k,..., a ~n w n