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Home My WebLink About11-02-09 (3) 15056051058 REV-1500 EX (os-05) PA Department of Revenue OFFICIAL U3E ONLY Bureau of Individual Taxes Coun Code Year File Number ty PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 21 09 0714 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 197-26-4163 07/25/2009 10/22/1928 Decedent's Last Name Suffix Decedent's First Name MI STEPHAN DOROTHY g (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A 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 (date of 5. Federal Estate Tax Return Required death after 12-12-82) ~: 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 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 T0: Name Daytime Telephone Number Nathan F. Abromson, Esq (724) 547-22p~ ~'~ Firm Name (If Applicable) ;_- ~~ `-~"~ ~-~ ;°~*~ REGISTER OF WtI~.LS US E oI~LY C 'z C"7 Abromson 8r Abromson "~ ~~~' -~ ~= ~-=~ ~~~ ~ I ~~ ~ First line of address - r , 653 West Main Street -~: , ~ {'~~> Second line of address _~ ~~ ~~~ ~ _,~~ y ,.. _.. _~ ~.e` ., f ~,~ ~...._..- . 1 City or Post Office State ZIP Code DATE FILED ` ~ Mount Pleasant PA 15666 Correspondent's a-mail address: Under penalties of perjury, I deGare 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. SIGNATURE P N RESPONSIBLE FOR FILING RETURN DATE __ --- - - -- -_ ADD 121 ross Creek Drive, Mechanicsburg, PA 17050 SI TUR / PREPARER ER T N P E ECJT,~!'VE - DA E ,, ---- -- 653 West Main Street, Mount Pleasant, P r 15666 15056051058 PLEASE USE ORIGINAL FORM ONLY Side i 15056051058 I ~. 1 J 15056052059 REV 1500 EX Decedent's Social Security Number decedent's Name: DOROTHY B STEPHAN . 197-26-4163 .. _ RECAPITULATION __ _ _ 1. Real estate (Schedule A) . ............................................ 1. 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 11,617.52 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 0.00 5. Cash, Bank Deposits $ Miscellaneous Personal Property (Schedule E) ........ 5. 46,383.61 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 7,941.00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested........ 7. 0.00 8. Total Gross Assets (total Lines 1-7) .................................... 8. 65,942.13 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 10,259.23 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. 441.80 11. Total Deductions (total Lines 9 8~ 10) ................................... 11. 10,701.03 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 55,241.10 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 55,241.10 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_ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 45 55,241.10 16. 2,485.84 17. Amount of Line 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 0.00 19. TAX DUE ......................................................... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0714 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER _ DOROTHY B STEPHAN 197-26-4163 STREET ADDRESS 1217 Cross Creek Drive CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 2,426.14 (3) (4) (5) (5A) (5B) (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E ) 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. 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 Payab{e to: REG{STER OF VIIILLS, AGENT 2,485.84 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 :............................................................................ .............. ^ 0 b. retain the right to designate who shall use the Property transferred or its income : .............................. .............. ^ c. retain a reversionary interest; or ............................................................................................................ .............. ^ d. receive the promise for life of either payments, benefits or care? ........................................................ .............. ^ 2. ff 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? .......................................................................................................... .............. ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 (O) 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(x)(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(x)(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. REV-1503 EX; (1-97) SCHED ULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy B. Stephan 21-09-0714 All property jointly-owned with Right of Survivorship must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 200 shares Marathon Oil Corporation Stock, Acct. No. 7371690639 10/24/09 High 32.19, Low 31.50, Close 32.15, Mean 32.17 10/27/09 High 32.58, Low 31.90, Close 32.51, Mean 32.54 Average of Mean, 32.35 6,470.00 2. U.S. Savings Bonds Series EE - $500.00 Date of Issue Bond No. 04/86 D11454563 874.00 08/86 D11454587 856.80 10/86 D 11454609 856.80 U.S. Savings Bonds Series EE - $200.00 Date of Issue Bond No. 05/86 8027387947 349.60 06/86 8027387954 349.60 07/86 8027387968 349.60 08/86 8029150681 342.72 09/86 8029150694 342.72 10/86 8029150698 342.72 11/86 8029150716 308.16 U.S. Savings Bonds Series EE - $100.00 Date of Issue Bond No. 04/86 C 109132498 174.80 TOTAL (Also enter on Line 2, Recapitulation) 11,617.52 ---- (Ifmore space is needed, insert additional sheets of same size.) REV-1508 EX+ (1-97) SCHED ULE E CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy B. Stephan 21-09-0714 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 Schedule F ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Members First Federal Credit Union Checking Acct. No. 2182899340 14,994.07 2. Members First Federal Credit Union Money Management Acct. No. 88800050000289934 26,311.53 3. Members First Federal Credit Union Savings Acct. No. 88800000000289934 54.50 4. The Huntingdon National Bank Checking Acct. No. 02533048074 5,023.51 TOTAL (Also enter on Line 5, Recapitulation) 46,383.61 If more space is needed, insert additional sheets of same size.) REV-1509 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHED ULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Dorothy B. Stephan 21-09-0714 If an asset was made joint within oue year of the decedent's date of death, it mast be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT I A. F. Hope Stephan s. c. 1217 Cross Creek Drive Mechanicsburg, PA 17050 Daughter I ~o~ntty-owned property: ITEM LETTER DESCRIPTION OF PROPERTY NUMBER FOR JOINT DATE Include name of financial institution and bank account DATE OF DEATH % OF TENANT MADE number or similar identifying number. Attach deed for VALUE OF ASSET DECEDENT'S JOINT jointly held real estate. INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 1 /18/08 Members 1St Federal Credit Union Certificate of Deposit No. 289934-41 5,229.21 50% 2. A. 1 / 18/08 Members 1St Federal Credit Union Certificate of Deposit No. 289934-42 10,652.80 50% TOTAL (Also enter on Line 6, Recapitulation) (If more space is needed, insert additional sheets of same size.) 2,614.60 5,326.40 7,941.00 REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy B. Stephan 21-09-0714 Debts of Decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffinan Roth Funeral Home 2,319.91 2. Mount Pleasant Cemetery 250.00 3. Davis Memorials 135.00 4. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative Social Security Number Number of Personal Representative Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Nathan F. Abromson, Esq. 3,370.00 3. Family Exemption: (If Decedent's address is not the same as claimant's, attach explanation) Claimant F. Hope Stephan Street Address 1217 Cross Creek Drive City Mechanicsburg State PA Zip 17050 Relationship of Claimant to Decedent Daughter 3,500.00 4. Probate Fees Glenda Farner Strasbaugh 82.00 5. Tax Return Preparer's Fees 300.00 6. Cumberland Law Journal 75.00 7. The Senteniel 8. Copy and miscellaneous expense 15.00 9. Register of Wills: a. Balance due on Letters 115.00 b. Filing Family Settlement Agreement 20.00 c. Filing Family Exemption 15.00 d. Inheritance Tax Return filing fee 15.00 e. Inventory filing fee 15.00 f. Release filing fee 5.00 ~ 1. Postage 27.32 TOTAL (Also enter on Line 9, Recapitulation) 10,259.23 (If more space is needed, insert additional sheets of same size REV-1512 EX+ (1-97) SCIIED ULE I DEBTS OF DECEDENT, COMMONWEALTH OF PENNSYLVANIA MORTGAGE LIABILITIES & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy B. Stephan 21-09-0714 Include unrcimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. PA Bureau of Vital Statistics -death certificates 80.00 2. University Health Associates -medical bill 57.02 3. West Shore EMS -outstanding bill 164.81 4. Hampden Physicians -outstanding bill 77.98 5. Associated Cardiologist -medical bill 61.99 TOTAL (Also enter on Line 10, Recapitulation) 441.80 (If more space is needed, insert additional sheets of same size.) REV-1513 EX+ (8-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHED ULE J BENEFICIARIES ESTATE OF FILE NUMBER Dorothy B. Stephan 21-09-0714 NAME AND ADDRESSES OF PERSON(S) RELATIONSHIP TO DECEDENT AMOUNT OR RECEIVING PROPERTY Do Not List Trustee(s) SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers Under Section 9116 (ax 1.2) 1. F. Hope Stephan 1217 Cross Creek Drive Mechanicsburg, PA 17050 Daughter Entire Estate I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV. 1500 COVER SHEET 11. NUN= TAXABLE DISTRIBUTIONS: A. Spousal distributions under section 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVENRNMENTAL DISTRIBUTIONS None r~rAL ur' rAK'1' li -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ~_ (If more space is needed, insert additional sheets of same size.) f LAST WILL AND TESTAMENT ____ I, DOROTHY B. STEPHAN, of the Borough of Mount Pleasant, County of Westmoreland and Commonwealth of Pennsylvania, being of sound mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, in manner and form following, hereby revoking any will or wills heretofore made by me. First. I direct that all my just debts and funeral expenses be fully paid and satisfied, as soon as conveniently may be, after my decease. Second. I give, devise and bequeath my entire estate, both real and personal, of whatsoever kind or nature and wheresoever situate, unto my husband, John P. Stephan, in fee simple. Third. Should my said husband, John P. Stephan, predecease me, I give, devise and bequeath my entire estate, both real and personal, of whatsoever kind or nature and wheresoever situate, unto my daughter, F. Hope Stephan. Fourth. Should my said daughter, F. Hope Stephan, predecease me leaving issue, my said husband, John P. Stephan, also having predeceased me, I give, devise and bequeath my entire estate, both real and personal, of whatsoever kind or nature and wheresoever situate, unto her issue, ,-~ Dorothy St ph Page One of a Two-Page Wi11. share and share alike. Fifth. Should my said husband, John P. Stephan, and I die under such circumstances that it cannot be determined who died first, let it be presumed that I died first. Sixth. I do hereby make, constitute and appoint my husband, John P. Stephan, to be my executor of this my Last Will and Testament. Should my said husband, John P. Stephan, predecease me, I do hereby make, constitute and appoint my daughter, F. Hope Stephan, to be my executrix of this my Last Will and Testament. IN WITNESS WHEREOF, I, Dorothy B. Stephan, the Testatrix above named, have hereunto subscribed my name and affixed my seal, the 9th day of May in the year of our Lord one thousand nine hundred and eighty. ., ~~ %" ;/ .~..... SEAL Dorot B. Step n Signed, sealed, published and declared by the above named Dorothy B. Stephan, as and for her Last Will and Testament in the presence of us., who have hereunto subscribed our names at her request as witnesses there- unto, in the presence of said testatrix, and of each other. .- i ~ r°-'~~ ~~ r ., ..-' Page Two of a Two-Page Will. ~~l ao . o~ ~t'~`~j , cSv ~ a~ zs