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Home My WebLink About01-15-10 (2) Social Security Number Date of Death 204 28 1936 04 15 2009 Decedent's Last Name ROMBERGER (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Xn 1. Original Return 4. Limited Estate X^ 8. Decedent Died Testate (Attach DdPY ur Will) 9. Litigation Proceeds Received Date of//Birth 0 4 ,,0'7 19 3 Suffix Decedent's First Name JEAN Suffix Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Cgnpromiae (date d death ener 12-12-82) 7. (~~ Ct Maintained a Living Trust opy ar Trust) 10. ~I P2ov~etrty Credit (date of death 91 and f f-BS) Name "'- °"" "'^ mus t ere COMPLEI J• RONALDO LEGASPI Firm Name (N Applicable) GOLDBERG KATZMAN, p,C. First line of address 320 MARKET STREET Second line of address 1268 City or Post Office HARRISBURG Correspondent's e-mail address: _ Under penalties of perjury, I dedare that 1 have it is true, correct and complete. Dedaretion of r Hans S. 5225 Wilson State ZIP Coda PA 17108 schedules and is based on all .,. rconalao Leaasoi L 1505607120 Side 1 n ° 0o ~ ~ 0 b .. ~, `- ' r , ,,, - ~' .. --- ~ - . ~ - -* 1 ILED ~ , -r = _ ; ; a ~-~ ~ t:1Q _.. w , end to the best of my knowledge and belief, of which preparer has any knowledge. 1505607120 J V v REV-15pp 1505607120 PA Department of Revenue EX (08-OS) Bureau of Individual Taxes OFFIC4gL USE ONLY PO BOX.280601 INHERITANCE TAX RETURN ~+a code Y~r F~a Number Harrisburg, Pq 17128-0601 RESIDENT DECEDENT 21 NT INFORMATION BELOW (1 9 0 4 0 6 3. Remainder Return (date of death prior to 12-13-62) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec, 9113(A) (Attach Sch. O) DENTIAL TAX INFORMATION SHOULD BE DIRE Daytime Telephone Number (717) 234 4161 MI L MI REGISTER OF WILLS US~ONLY .J 1505607220 REV-1500 EX oecedenrs Name: Jean L. Romberger Decedent's Social Security Number RECAPITULATION 2 0 4 2 8 19 3 6 1. Real Estate (Schedule A) .................................. ........................................................ 1. 2. Stocks and Bonds (Schedule B) .......................... ..................................................... 2. 25,576.79 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 (sor,edule E) ................ 5. 6. Jointly Oovnod property (Schedule F Request 7 d 2 1 , 8 6 3.91 e ............. g, . Inter-Vivos Transfers & Miscellaneous Non-Pro ate prom, (schedule G) 4 4, 2 6 8. 8 2 Separate Billing Requested ............. 7~ 8. Total Gross Assets (total Lines 1-7j ............................. 67,257.73 ................. ......................... s. 9. Funeral Expenses & Administrative Costs (Schedul H 158, 967.25 e ) ................. ........................ s. 10 , 2 31.12 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .. ............... 10 11. Total Deductions (total Lines 9 8 10) .................................. 2,507.05 .................................... 11. 12. Net Value of Estate (Line 8 i 12, 738.17 m nus Line 11) ......................... . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12' an election to tax has not b 1 4 6 , 2 2 9 , 0 g een made (Schedule J) ........... ...................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ....... .......... 14 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICAB 1 4 6 , 2 2 9 . Q $ LE RATES 15. Amount of Line 14 taxable at the spousal tau rate or , transfers under Sec. 9116 (a)(1.2) X .00 16. Amount of Line 14 taxable 0 0 Q 15. 0 . 0 0 at lineal rate X .045 17. Amount of Line 14 taxable 0 0 Q 16. 0 00 at sibling rate X .12 14 6, 2 2 9. 0 8 17. 18. Amount of Line 14 taxable . 1 7 5 4 7 at collateral rate X .15 , . 4 9 0.00 18• 19. Tax Due ........................... 0.00 .......................................................................................... 19. 17,547:49 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OV ERPAYMENT. ' 1505607220 Side 2 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: Jean L. Romberger 5225 Wesley Drive Ftle Number 21.09-0406 Mechanicsburg STATE zIP PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 17,547.49 A. Spousal Poverty Credit B. Prior Payments 17,055.00 C. Discount 877.37 3. Interest/Penalty if applicable Total Credits (A + g + C D. Interest ) (2) 17,932.37 E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENTPenalty (p + E) (3) 5. If Line 1 + Line 3 is greater than Line 2, enteathe difference ~Th stis the TAX DUE. (4) 384.8 8 A. Enter the interest on the tax due. (5) B. Enter the total of Line 5 + 5q, This is the BALANCE DUE. (5A) (56) Make Check Payable to: REGISTER OF W/LLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :........................... Yes No x b. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest; or ................. _ x ..................................................................................... d. receive the promise for life of either a ............................ 2. If death occurred after December 12, 1982, didedecedent transferf a p••e ..~~~~ x ...................... x receiving adequate consideration? ................ P P rtY within one year of death without ....................... . ................................ .... ~ ^ ............ X 3. Did decedent own an "In trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ contains a benefiGary designationl ............................................................................................ IF THE ANSWER TO qNY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS pq~ 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. §91 i6 (a) (1.1) (i)j. 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 ex R+~~ for disGosure of assets and filing a tax return are still applicable eeven if the surviv ng spouse9s tphe only beneficiary the statutory requirements 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 (O) 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 except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. ( )percent, 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)], q 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. Rev-7501 F~(+ (B~8) CCLeAONWFALTN aF cENNSnvnNw INHERRANCE TA1(RETURN RESDENT OECEOENT ESTATE OF SCHEDULE B STOCKS 8 BONDS ~, Jean L. All property )olntly~0wned wIN right oT survWorship must M dbWOSed on Schedule F. ILE NUMBER 21-09-0406 ITEM CUSIP NUMBER NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE 1 466.63 shares of American Balanced Fund - Class A 13.36 OF DEATH 6,234.18 2 291.8758 shares of Chevron Corporation 66.27 19,342.61 TOTAL (Also enter on Llne 2, Recapitulation) (If more space is needed, addifional 25.576.79 Copyright (c) 2002 form software only The Lackner Group, Inc. pages of the same size) Form PA_1500 Schedule B (Rev. 6-98) aevtsoe ex, ts.sel CDLIMONwEALTN OF PENNSYLVANw WHERRANCE TAX RETURN REatDENT DECEDENT MATE OF ', Jean L. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY LE NUMBER 99_AUJfwn~ mDp,tle Die prDCeetls of I"dipadon and the date the WDCeeds were recervetl by d,e estate. All properly Jolntlycwned with the rIOM ofsurvivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Stifel Nicolaus -Money Market Account 2 Susquehanna Valley Federal Credit Union -Checking Account opened on 5/28/96 3 Susquehanna Valley Federal Credit Union -Savings Account opened on 9/16/77 4 Susquehanna Valley Federal Credit Union -Savings Account opened on 10/14/1998 VALUE AT DATE OF DEATH 846 17 10.260.00 10,374.86 382.88 TOTAL (Also enter on Line 5, Recapitulation) (If more specs is needed, additional a 21,663.91 Copyright (c) 2002 form software only The Lackner Group, Inc. p 9es of the same size) Form Pq_1500 Schedule E (Rev. 6-98) t:OANgNM'EMTH OF PENNSYLVANW PIHERRANCE TA7( RETURN RESIDENT UECEpI'NT ESTATE OF ,Jean L. "" -""`~ ..as mws JDlnt WIMin ons year of tM dscsdsnt's tlab of dwth, k must 1 SURVIVING JOINT TENANT(S) NAME ADDRESS A. Hans S. Romberger 5525 Wilson Lane Mechanicsburg, PA 17055 B. C. otoLnet JOINTLY OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY NUMBER FOR JOINT MADE TENANT JOINT INCLUDE NAME OF FINANCIAL INSTITUTION AND tJANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUM DATE OF DEATH % OF DATE OF DEATH BER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE ALUE OF ASSET DECD'S VALUE OF 1 , Lincoln Variable Annuit .G INTEREST DECEDENT`S INTEREST y uaranteed Minimum Death Be fi $8,537.64 50.000% 44 Y6 ne t Received , 8 82 TOTAL (Also enter on Llne 6, Recapitulation) (If more space is needed, additional 44,268.82 Copyright (c) 2002 form software only The Lackner Group, Inc. pages of the same size) Form Pq_1800 Schedule F (Rev. 6-98) SCHEDULE F JOINTLY-OWNED PROPERTY LE NUMBER 21-09-0406 _._ .......o~I°c;. RELATIONSHIP TO DECEDENT r , COMMONw61LTH OF PENNSYLVANN WHERfr.WCE TN(RETURN RESDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY rcomperger, Jean L. (FILE NUMBER This schedule must be caDpleted and 1~7ed if the answer to an of 0 L7 -U,y-04011 Y queslsxis 1 lhrou h a On the reverse side of the REV-1500 COVER SHEET is yes. ITEM DE I I N P R NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEI THE DATE OF TRANSFER g77gCH A COPY OF THE DEED FOR REA 1 Thrivent Annuity -Settlement Agreement 9041877 2 I US Allianz Qualified Annuity -Guaranteed Minimum Death Benefit Received DATE OF DEATH % OF DECD'S VALUE OF ASSET INTEREST (IF gtppl-UICAeLE) 27,083.84 TOTAL (Also enter on Line 7, Recapitulation) Copyright (c) 2002 form software only The La kner Group n~ ~~~ additional pages of the same size) 40,173.89 TAXABLE VALUE 27, 380 84 40,173.89 67,257.73 Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EXa (12A8) COMMONWEALTH OF PENNSYLVANIA INHERITANCE Tqx RETt1RN RESIDENT DECEDENT ESTATE OF SCFIEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS rcomrerger, Jean L. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: See continuation schedule(s) attached 2. I Attorneys Fees Goldberg Katzman, P.C. 3,595.00 B• I ADMINISTRATIVE COSTS: ~ • Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent FILE NUMBER 21-09-04011 AMOUNT 5,300.00 4• Probate Fees 185.00 5• Accountant's Fees 6• I Tax Return Preparer's Fees ~• Other Administrative Costs See continuation schedule(s) attached 1,151.12 TOTAL (Also enter on line 9, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. 10,231.12 Form Pq_~500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF ,Jean L. FILE NUMBER 21-09-0406 ITEM NUMBER DESCRIPTION Funeral Expenses AMOUNT 1 Myers Funeral Home 3,595.00 Other Administrative C H-A Subtotal 3,595.00 osts 2 Cumberland Law Journal -Legal Advertising 3 The Sentinel -Legal advertisin 75.00 g 4 Trinity Evangelical Luth 198.16 eran Church -Funeral Luncheon 877.96 H-67 Subtotal 1,151.12 Copyright (c) 2002 Corm software only The Lackner Group, Inc. Form PA_g500 Schedule H (Rev. 6-98) • Rw-1512 EX~ (g;g) ESTATE OF SCFIEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ', Jean L. InUUdg unnlmburgad m~dieal eiPaRSes. ITEM NUMBER DESCRIPTION 1 Continuing Care Rx • Medical costs 2 Progressive Medical -Medical supplies for wheelchair 3 Waggoner, Frutiger and Daub • Tax Preparation TOTAL (Also enter on Line 10, Recapitulation) Copyright (c) 2002 form software only The Lackner Group nl~~ additional pages of the same size) COMMONWEALTH CF PENNSVtVAN1A WHERRANCE TA%RETURN RE9DENT DECEDENT ILE NUMBER 21-09-0406 VALUE AT DATE OF DEATH - 1 425.00 575.00 2,507.05 Form PA-1500 Schedule I (Rev. 6-98) ' REV-1513 EX+ty-0p) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Romperger, Jean L. NUMBER _ PERSO~S) RECEWGEPROPERTY Hans S. Romberger 5225 Wilson Lane Mechanicsburg, PA 17055 1 FILE NUMBER 21-09-0406 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT Do Not Ust Trustssc (WOrdS) (~$$) Brother 146,229.08 _~~~. Dooar amounts for distributlons shown above on lines 15 through 18, as appropriafeTon Rev 1500 cove) sheet II. NON-TAXABLE DISTRIBUTIONS: 146,229.08 A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OP 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_7500 Schedule J (Rev. 6-98) SCHEDULE J BENEFICIARIES r.1 Goldberg Katzman Afull-service law firm. January 15, 2010 Arthur L. Goldberg Glenda Farner Strasbaugh, Register of Wills "~ n9si-2ooo) Cumberland County Courthouse Cp 4 ~., ;~"~• Harry B. Goldberg One Courthouse Square ~ ~ ? ~ ~_j c196~-i99a) ~ Carlisle, PA 17013-3387 `=' ~~'' _ ~j ~ Cal ". r-"3 L Ronald M. Katzman RE: Estate of Jean L. `~~n s> Romberger :~ ~'rl `~ \ ... .. ' Paul J. Esposito ~ ~~ ~ 7 t .. ~' r_'"} 1. Jay Cooper Dear Ms. Strasbaugh: ~ ~ ~:,~ Thomas F,. Brenner W ~ April i. strang-xntay Enclosed for filing please find the following: Jerry J. Russo Michael J. Crocenzi 1. An original and one copy of the REV-1500 Pennsylvania Thomas J. weber Inheritance Tax Return with exhibits. One copy of REV- Steven E. Grubb 1500 without exhibits. Royce i. Morris 2, An original and one copy of the Inventor Joseph M. Sembrot y. J. Ronaldo Legaspi 3• A check payable to Cumberland County Register of Wills Jennifer z. Mundy in the amount of $30.00 for filing fees. S. Baker Kensinger Kindly time-stamp the extra copy of the REV-1500 and Inventory and return them to our office in the self-addressed stamped envelope. COUNSF.I, Joshna 1z Lock If you should have any questions, please do not hesitate to contact m Arnold B. Kogan y office. Thank you for your attention to this matter Heather L. Paterno . Very truly you rs, ~ - J L~~~~t~'~gas i p JRL/stw Enclosures cc: Hans S. Romberger (w/encl.) 18$639,1 H A R R I S B U R G ~ 1, A N C A Sr F. R~ C A R L I S L E 320 Market Street, Strawberry Square ~ P.O. Box 1268 ~ Harrisburg, PA 17108-1268 ~ 717-234-4161 ~ 717-234-6808 (tax) ~ wivw.goldbergkatzman.corn