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Home My WebLink About05-18-101505610101 REV-1500 Ex~o~-~o, PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Off1FTNFNS ~7f kEVE4UF County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi Harrisburg, PA i~i28-0601 RESIDENT DECEDENT ~~- ~ ~ (~ ~ C~ 3 ~-. ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 196-60-8399 ? 02/18/2010 :06/01 /1976 Decedent's Last Name Suffix Decedent's First Name M- __ __ :Rhoads 'Renee '' L# _ _ (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 C7~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received (~ 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(Aj (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ~ Duane P. Stone, Esq. ... _ ` (717) 432-208 ~' ,.. "~" ~ ; '-~' CJ _ _~, -- ..__ ~ , REGISTER OF.,~(~E O ~. < ~.~} ~. .,... i : t First line of address ~_:: ~~ ~ .: C , 8 N. Baltimore Street ~~ ~ 3~' ~ ~ ~ - ~' ~> ` -~ --_ _ -----__ __ ._._._.__ .____~__ .__.__..__ ______ ___.___ _.. ~ ~ C i _, ~ 1 4' Second line of address ~' i P.O. Box 696 Cit or Post Office Y State ZIP Code DATE FILED Dillsburg __ _ _ ~ PA ~ ;17019 { __ _ . Correspondent's a-mail address: Duane@stoneatlaw.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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE - --- RESS f 8 N. Baltimore Street, Dillsburg, PA 17019 JIIiNHyurct r rtttF'AflERld ~~~~-PRESENTATIVE DATE ~/+~~-~. .,®` <._ :e ' , as ~ _• ~' ~ (g ~ C`1 __ .~ ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J REV-1500 EX Decedent's Name: RECAPITULATION 150561,0105 Decedent's Social Security Number 196-60-8399 1. Real Estate (Schedule A) ............................................. 1. 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2. ' 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E}....... 5. '', 159,506.21 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. ' 0.00 .` 8. Total Gross Assets (total Lines 1 through 7) ............................. 8.' 159,506.21 9. Funeral Expenses and Administrative Costs (Schedule H} ........... ........ 9. = 19,743.80 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... ........ 10. 0.00 '. 11. Total Deductions (total Lines 9 and 10) ......................... ........ 11. ' 19,743.80 12. Net Value of Estate (Line 8 minus Line 11) ...................... ........ 12. 139 762.41 13. Charitable and Governmental BequestslSec 9113 Trusts for which ~~~-~- ~ - ---~~~-~ °"~--~ - , -~ " ---~-~ " __.._,. _._".."..,__ _..w_.,.,,_, , 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. 139,762.41 TAX CALCULATION -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. 16. Amount of Line 14 taxable _s,...._ ...~.... ,..., ~~...r., .._~ ._ ,._..., _ r~ ...-,,,. _ ._~,._" . ~ .~~_......., " at lineal rate X .0 4 16. 5,590.50 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable ~"~ ~~" ~ W_,~~°- at collateral rate X .15 _. _ 1 g _. 19. TAX DUE .................................................. .......19. `, 5,590.50 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: File Number ~ ~`~ ~ ~f' '~ ¢ ' '~' .~ ~ ~:< DECEDENT'S NAME Renee L. Rhoads STREETADDRESS 85 Beetem Hollow Road CITY ;STATE 'i 2IP Newville PA ~ 17241 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ __.___ B. Discount 3. Interest 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. Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. 5,590.50 0.00 0.00 0.00 5,590.50 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 : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ x^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 0 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 beneficiary designations X IF TH_E ANS_ WER TO AN_ Y 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 far 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 21 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 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 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 12 percent [72 P.S. §9116(a)(1.3)J. 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-1S42 EX+ (11-08) ~... .=; ~ _~} Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RE5IDENT DECEDENT ESTATE OF FILE NUMBER Renee L. Rhoads 2010-00332 au real property ownea soie~y or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. It more space is needed, insert additional sheets of the same size. REV 1503 EX+ (6-98) )" .. ~ ~ SCHEDUL EB COMMONWEALTH OF PENNSYLVANIA srocKS & Borv~s INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Renee L. Rhoads 2010-00332 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1504 EX+ (6-98} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHED~ILE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Renee L. Rhoads 2010-00332 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (It more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER Renee L. Rhoads 2010-00332 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-108 EX+ (6-98) ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY - -.--- ESTATE OF FILE NUMBER Renee L. Rhoads 2010-00332 Indude 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Orrstown Bank 68,548.32 2. Union First Market Bank (transferred to Estate account) 31,559.02 3.' 'American Funds (transferred directly to Beneficiaries) 54,401.48 4. 2000 Jeep Grand Cherokee Laredo Sport Utility 4D 4,775.00 5. Refund- Magazine 5.64 6. 'Refund- Insurance 216.75 TOTAL (Also enter on line 5, Recapitulation) $ 159,506.21 (If more space is needed, insert additional sheets of the same size) REV-i5og EX+ (oi-so) a3,~ ~, ' ` pennsylvarna DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt~LE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Renee L. Rhoads 2010-00332 JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERLY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT ]DINT IDENTIFYING NUMBER. ATTACH DEED FOR ]oINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST __ _ _ 1. A. TOTAL (Also enter on Line 6, Recapitulation) $ 0.00 If more space is needed, use additional sheets of paper of the same size if an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. REV-1510 EX+ {08-09j ~~ ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Renee L. Rhoads 2010-00332 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. If more space is needed, use additional sheets of paper of the same size. ' REV-f 511 EX+ (10-09j ~' ~%~ Pennsylvania DEPARTMENT OFREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Renee L. Rhoads 2010-00332 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' Ewing Brothers Funeral Home 13,018.93 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) - Street Address City _ __ _____. _.._ _....... _.__.____... a e __---__...._..... ZIP _............_......____ .............._. Year(s) Commission Paid: 2• Attorney Fees: 6,380.25 3. Family Exemption; (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City --___-- _. - _ _ State __. ZIP -___--- Relationship of Claimant to Decedent 4. Probate Fees: 344.00 5• Accountant Fees: 6• Tax Return Preparer Fees: 7. _ _ __ _ _ _ TOTAL (Also enter on Line 9, Recapitulation) $ 19,743.18 If more space is needed, use additional sheets of paper of the same size ' REV-2512 EX+ (12-08) ~~ ~ ` ~ -' pennsyLvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Renee L. Rhoads 2010-00332 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. it more space is needed, insert additional sheets of the same size. ' REV-'1513 EX+ (01-10) ~. Pennsylvania SCHEDULE J ` DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT Renee L. Rhoads 2010-00332 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. _ _. - __ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00 If more space is needed, use additional sheets of paper of the same size