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Home My WebLink About06-18-10i D ^Oi i i REV-1500 Ex (01-10} OFFICIAL USE ONLY pennsytvanfa PA Department of Revenue 4C°abi!MF.M10fPCUCYJ( County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 21 10 00076 PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYY Date of Birth MMDDYYYY 188 12 5293 01 19 2010 11 16 1924 Decedent's Last Name Suffix Decedent's Frst Name MI Shuey P John R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse'sfFrst Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REG~~STER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return C~ 2. Supplemental Return I~ 3. Remainder Retum (date of death prior to 12-13-82) D 4. Limited Estate p 4a. Future Interest Compromise (date of C] 5. Federal Estate Tax Retum Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) C] 9. Litigation Proceeds Received L~ 10. Spousal Poverty Credit (date of death D 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 to: Name Daytime Telephone Number Stephanie Kleinfelter, Esq. 717 901 7786 First line of address 635 N. 12th Street, Suite 400 Second line of address City or Post Office Lemoyne State ZIP Code PA 17043 Correspondents a-mail address: skleinfelter@keeferwood.com REGISTER OF WILLS USE ONLY ~"~ . r.. , t,...,,. ~+.~ z:7 ~ "...u.. _) '~ ~ ; 'T •lw ~ ~~~~ ~ ~ ~1 .. f t ` ` --~.7 ....,., .:La: .: .C"` W , ~ ...y ,. ~ r ,., a "~J ~~ ~ ~i .,. a ..~,~ 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 and belief, it is trufe, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowled e. SIGNATUR F E~~}}SON RESPAN~BLE F ~.I G RETUR DATE ADDRESS` 104 greenwood unve New Cumberland, PA 1707Q SIGNATURE OFPREPARER0I~HERTHAIy EPRESENTATIVE DATE I ~ ^~i i i PLEASE USE ORIGINAL FORM ONLY Slde 1 I C] ~~i i I J y'` ~~ J I 0 ^^i i ^ Rev-1500 EX Decedent's Social Security Number Decedent's Name: John R. Shuey P 188 12 5293 RECAPITULATION 1. Real estate (Schedule A) •.••••.•.••••••••••••••••••••• 1• ~'~~ 2. Stocks and Bonds (Schedule B) ••••••••-•••••••••••••••-•••••• 2• ~~~~ 3. 4. 5. 6. 7. 8. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . Mortgages and Notes Receivable {Schedule D) . • . • • • • • • • . • • • • • • • • • Cash, Bank Deposits and Miscellaneous Personal Property {Schedule E) • . Jointly Owned Property (Schedule F) D Separate Billing Requested . • • Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested ... Total Gross Assets (total Lines lthrough 7) ... • .... • .. • • . • . • • • • • • • 3. 4. 5. 6. 7. 8. ~•~~ ~' ~~ 142,407.69 0.00 0.00 142,407.69 547' S0 4 9. Funeral Expenses and Administrative Costs (Schedule H) .......... • • . 9. ' 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) . • • • .. • • 10. 1,160.12 11. Total Deductions {total Lines 9 and 10) .......... • • .. • • .. • .. • . • • 11. 5,707.62 12. Net Value of Estate (Line 8 minus Line 11) ......... • .............. 12. 136,700.07 13. Charitable and Governmental BequestslSec 9113 Trusts for which ~ ~~ an election to tax has not been made (Schedule J) ....... • ... • .... • . 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. ,4. 136,700.07 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 .00 • 15. • 16. Amount of Line 14 taxable at lineal rate X .045 136,700.07 16. 6,151.50 17. Amount of Line 14 taxable 0 00 0 00 at sibling rate x .12 . 17. . 18. Amount of Line 14 taxable 0 00 ll l x 1s 0 00 rate . at co atera .15 . . 19. TAX DUE ............................................... 19. 6,151.50 20. FILL IN THE OVAL IF YOU ARE REGIUESTING A REFUND OF AN OVERPAYMENT 0 Slde 2 I ^ ^^I I ^ I ^ ^^I 1 ^ Rev-1500 EX Page 3 Decedent's Complete Address: Fle Number 21 10 00076 DECEDENTS NAME John R. Shue P STREET ADDRESS Manor Care 1700 Market Street CITY STATE ZI P Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Prior Payments 5, 800.00 B. Discount 305.25 Total Credits (A + B) 3. Interest 4. If Llne 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. (1) 6,151.50 (2) 6,105.25 (3) (4) (5) 0.00 46.25 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;,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, , Q b. retain the right to designate who shall use the property transferred or its income : ............... . Q c. retain a reversionary interest; or ............................................... . Q d. receive the promise for life of either payments, benefits or care? .......................... . 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................ . Q 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? . . Q 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 3 percent [72 P.S. Sect. 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 0 percent [72 P.S. Sect. 9116(a)(1.1)(ii)]. The statue 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 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. Sect. 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. Sect. 9116(1.2) [72 P.S. Sect. 9116(a)(1)). • 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. Sect. 9116(a)(1.3)]. A 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-1508 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER John R. Shuey P 21 10 00076 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 Scheduel F. (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(10-09) i ~~ Pennsylvania pi G"ARTNIF.NT pF RtiVEN13F INHERITANCETAX RETURN RESIDENTDECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER John R. Shuey P 21 10 00076 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Funeral Reception 600.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4. 5. 6. 7 City State Zip Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Retum Preparer Fees: Cumberland County Register Of Wills Will - $15.00 Short Certificates $12.00 JCS Fee $23.50 Automation Fee $ 5.00 Inheritance Tax Return Fee $15.00 Inventory $15.00 3,600.00 260.00 87.50 TOTAL (Also enter on Line 9, Recapitulation) ~ 4,547.50 If more space is needed, insert additional sheets of the same size. J REV-1512 EX+(12-OS) ~ Pennsylvania C~F,t'ARTMFNT (7F' R4 YENUE INHERITANCETAX RETURN RESIDENTDECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER John R. Shuey P 21 10 00076 Report debts Incurred by decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. REV-1513 EX+(01-10) i~ pennsylvan~a SCHEDULE J fJt PARTMFt~fT Cif RfVt~NUF INHERITANCE TAX RETURN BENEFICIARIES RESIDENTDECEDENT ESTATE OF: FILE NUMBER: John R. Shuey P 21 10 00076 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not Ust Trust s OF ESTATE z TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116(a)(1.2).] Debra G. Sisk Daughter 136,700.07 104 Greenwood Drive New Cumberland, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUG H 180E REV-1500 COVER SH EET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, insert additional sheets of the same size. ROBERT L. WELDON EUGENE E. PEPINSKY. JR. JOHN H. ENOS ~ GARY E. FRENCH BRADFORD DORRANCE JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER ELYSE E. ROGERS CRAIG A. LONGYEAR JOHN A. FEICHTEL STEPHANIE KLEINFELTER DONALD M. LEWIS ~ TODD F. TRUNTZ LAUREN S. WELDON KEEPER WOOD ALLEN &RAHAL, LLP ATTORNEYS AT LAW 635 NORTH 12T" STREET, SUITE 400 LEMOYNE, PA 17043 PHONE 717-612-5800 FAX 717-612-5805 EIN No. 23-0716135 www.keeferwood.com ESTABLISHED IN 1878 OF COUNSEL: N. DAVID RAHAL SAMUEL C. HARRY CHARLES W. RUBENDALL II HARRISBURG OFFICE: 210 WALNUT STREET HARRISBURG, PA 17101 PHONE 717-255-6000 (717) 901-7786 Fax: (717) 612-5805 E-mail: skleinfelter@keeferwood.com June 17, 2010 Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 ~ ~ ~ . ~' -~ Re: Estate of John Shue Deceased ~~ ~ ~""' "~' '~~ ~' Date of Death: January 19, 2010 '~~ ~ ~. ~ ~~, f ,~~ File No. 2010-00076 =~ -~ ~ «~ I ~ ~ ~-} Dear Glenda: r~~~~ =~ ~ ~~-~_ Please file the enclosed two Pennsylvania Inheritance Tax F~~turns and- one'' Inventory, and date stamp and return the enclosed copies thereof for my reco~s. I have also enclosed a $46.25 check for the balance of the Inheritance tax and a $30 check in payment of your filing fees. Very truly yours, KEEPER WOOD ALLEN &RAHAL, LLP l By: Stephanie Kleinfelter S K/waw Enclosures cc: Debra G. Sisk, Executrix (w/o enclosures) ' ` ' ~~ F _ ~ 4 ' ' t s A~~ ~ ` ~ ~ ti ~~ i ' H ;~,, , ~~'~~ ~. ~~$~ C ~. ~ ss. A r~~ b ~~c~ ~oc ~~~~ m3 .~ ' ~ w ,n ~r ~. ~- N ~, -D~~ o ~ ~ Q ~ 0 ~ R~ r'i' ~ ~ ~ ~ ~ `G 'Z7 ~ i3 C C C3" ~" ~ tU O v ~ C ~ ~"'' cr -.a .. ~ ~ ~~ p W co N o 0 O Y •r