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Home My WebLink About05-19-1015056041114 ~ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 172-40-6220 Decedent's Last Name 03072010 06081916 Suffix Decedent's First Name WEIGARD RUTH (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return 0 2. Supplemental Return MI K MI Q 3. Remainder Return (date of death prior to 12-13-82) 4 Limited Estate Q 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death 0 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 EILEEN M. CONLEY Firm Name (If Applicable) First line of address 335 CONLEY ROAD Second line of address City or Post Office LEWISBERRY State ZIP Code PA 17339 7179383862 REGISTER OF WILLS USE ONLY r~,~ ,.7 :=~ cJ -:; -, -~: - - - .___ v:~ _.., ~ 1 _ ,,., - . ~. DATE F LED --+ c.•. --~ =_.=1 ~> ,_, ~ Correspondent's a-mail address: 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 co lete. Declaration of re arer other than the ersonal re resentative is based on all information of which preparer has any knowledge. _ SIGNAT E O~ ERSON RE~~ONSIBLF~bR FILI~F"t~ RETURN DATE /~ ,v ,; d ~'.~ f~ mss. .l/ ~ ~,~~ ~J•- .~,- ~f.~' 335 CONLEY RD, LEWISBER~Z~, PA. 17339 SIGNATUF,3~ EPAR R THAN REPRESENTATIVE DATE ADDRESS 3425 SIMPSON FERRY RD, CAMP HILL, PA. 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041114 15056041114 J 15056042115 REV-1500 EX Decedent's Social Security Number Decedent's Name: RUTH K WE I GAR D 17 2 - 4 0- 6 2 2 0 RECAPITULATION 1. Real estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4 Mortgages & Notes Receivable (Schedule D) ............................ 4. NONE 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. NONE 6 Jointly Owned Property (Schedule F) OSeparate Billing Requested ........ 6. NONE 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ........ 7 2 7 3 0 0 7. 0 0 8 Total Gross Assets (total Lines 1-7) .................................. 8. 2 7 3 O O 7. O O 9. p ( ) ................... Funeral Ex enses & Administrative Costs Schedule H 9. 15 7 5 . O 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. 4 3 8 2 . O O 11. Total Deductions (total Lines 9 & 10) ................................. 11. 5 9 5 7 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................ . 12. 2 67 0 5 O . 0 0 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which . an election to tax has not been made (Schedule J) ....................... 13. 0 . 0 O 14 Net Value Subject to Tax (Line 12 minus Line 13) ................ 14. 2 6 7 O 5 0 . 0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 (a)(1.2) X .0 0 1 5. . 16. Amount of Line 14 taxable at linealrateX.O 45 267050.00 16. 12017.00 1?. Amount of Line 14 taxable at sibling rate X • 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X , 15 18. 0 . 0 0 19. TAX DUE ...................................................... . 19. 12017.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 15056042115 15056042115 REV-~ 500 EX Page 3 172-40-6220 Decedent's Complete Address: DECEDENT'S NAME ;UTH K WEIGARD STREET ADDRESS CITY Y Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 601.00 File Number (1) 12017.00 Total Credits (A + B + C) (2) 601.00 3. Interest/Penalty if applicable D. Interest E. Penalty 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. (3) 0.00 (4) 0.00 (5) 11416.00 (5A) (5B) 11416.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: X a. retain the use or income of the property transferred : ....................................... ~ ^ 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. 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? .. ~ ^ 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 PP eceased child twenty-o (ej pars of [ge or yo§ nger( )( eajj to or for the use of a natural parent, an adoptive parent, or a ste arent of the child is zero 0 ercent 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. DECEDENT'S SOCIAL SECURITY NUMBER STATE ZI P PA 17339 REV-1510 EX+(08-09) SCHEDULE G pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS & RESIDENT DECEDENT URN MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER RUTH K WEIGARD 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION uF naaucne~el TAXABLE VALUE 1. PNC BANK CHECKING ACCOUNT 51-1168-8947 14,621 100.00% 14,621 TRANSFEREES -TRANSFERED ON DEATH 3-7-2010: 0 EILEEN M. CONLEY, DAUGHTER 0 RICHARD E. CONLEY, GRANDSON 0 CAROL L. CLINE, DAUGHTER 0 2. PNC BANK CERTIFICATE OF DEPOSIT 000011020023554 18,141 100.00% 0 18,141 TRANSFEREES -TRANSFERED ON DEATH 3-7-2010: 0 EILEEN M. CONLEY, DAUGHTER 0 RICHARD E. CONLEY, GRANDSON 0 CAROL L. CLINE, DAUGHTER 0 3. FEDERATED FUND US GOVT SECURITIES A FUND 29,683 100.00% 0 29,683 NASDAQ SYMBOL - FUSGX 0 TRANSFEREES -TRANSFERED ON DEATH 3-7-10: 0 EILEEN M. CONLEY, DAUGHTER 0 RICHARD E. CONLEY, GRANDSON 0 CAROL L. CLINE, DAUGHTER 0 0 4. PRIMERICA PINR MIDCAP VAL A FUND 154,246 100.00% 154,246 NASDAQ SYMBOL - PCGRX 0 TRANSFEREES -TRANSFERED ON DEATH 3-7-10: 0 EILEEN M. CONLEY, DAUGHTER 0 RICHARD E. CONLEY, GRANDSON 0 CAROL L. CLINE, DAUGHTER 0 0 5. PRIMERICA PINR SEL MIDCAP GW A FUND 56,316 100.00% 56,316 NASDAQ SYMBOL - PMCTX 0 TRANSFEREES -TRANSFERED ON DEATH 3-7-10 0 EILEEN M. CONLEY, DAUGHTER 0 RICHARD E. CONLEY, GRANDSON 0 CAROL L. CLINE, DAUGHTER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on Line 7 Recapitulation) $I 273 007 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX + (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER RUTH K. WEIGARD Decedent's debts must be reported on Schedule I. ITEM A. FUNERAL EXPENSES: 1. COCKLIN FUNERAL HOME B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant CTfPP} A(T('IfPSS 4. 5. 6. 7. City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: State ZIP ZIP AMOUNT 375 1.200 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 1,575 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-OB) pennsylvania DEPARTMENT OFREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER RUTH K. WEIGARD Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. BONNIE MILLER, TREASURER -PERSONAL TAX 10 2. EAST PENNSBORO AMBULANCE SERVICE 94 3. ASSOCIATED CARIOLOGIST 20 4. CONTINUING CARE 84 5. BETHANY VILLAGE SKILLED NURSING CARE 4,039 6. HAMPDEN PHYSICIANS ASSOC 135 TOTAL (Also enter on Line 10, Recapitulation) I $ 4,382 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OFREVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RUTH K. WEIGRARD 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).] EILEEN M. CONLEY 1 ~ 335 CONLEY ROAD, LEWISBERRY, PA. 17339 DAUGHTER 1/3RD RICHARD E. CONLEY 2~ 555 YEAGER ROAD, WELLSVILLE, PA. 17365 GRANDSON 1/3RD CAROL L. CLINE 3. 39 SHIRLEY DRIVE, MIDDLETOWN, PA 17057 DAUGHTER 1/3RD 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. I $ 0 If more space is needed, use additional sheets of paper of the same size. OCAL... REGISTRAR'S CERTIFICATION OF DE~#TH, .WARNING: It is illegal to duplicate this copy by photostat or photograph ~ee for this certificate;'$6.00 This is to .certify that the information •here given ..correctly copied from an original Certificate of Dea duly filed with me as Local Registrar. The oriel n certificate will' be fanvarded to the State Vii Records Office for permanent :filing. P 10204507 ~ MAR-~~~~~ ,.-- - Certification Number Iregis ' , . 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