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Home My WebLink About07-26-101505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 2 1 0 8 0 8 1 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 07 28 2008 06 O1 1938 Decedent's Last Name Suffix Decedent's First Name MI RUDBERG THEODORE (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 1NITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate 1-ax Return Required (date of death after 12-12-82) g. 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 TO: Name Daytime Telep~ne Number _. ,. EDWARD P . SEEBER 7 17 5 3~3=~'~ 2 8 0~~' --~-- ~-•~! '..~ f r ~ .':l ~.., t°~ . , ~> Firm Name (If Applicable) JAMES, SMITH, DIETTERICK & CONNELLY, L First line of address SUITE C-400, 555 GETTYSBURG PIKE Second line of address City or Post Office MECHANICSBURG Correspondent's a-mail address: State ZIP Code PA 17055 DATE FILED . _~ ~.::? -1 ..; z .~_ 7 :,.~ c-~7 _~.~ 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, ~ is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. GNATURE F PERSON RESPONSIBLE FOR FILING RETURN DATE ___.._ , it d-, .~r~c~--~--_.; ~ . ~ Joan Beattie - ~-1 ~ ~ ~ ~ 1 ~ `7i5 P 'r' ge Circle, Carlisle, PA 17013 SIGN OF REPARER OTH REPRESENTATIVE DATE ~' Edward P. Seeber --~'~ ~ ~ 1 ~ -?` ~' - /Suite C-400, 555 Gettysburg Pike, Mechanicsburg, PA 17055 Side 1 1505607120 1505607120 ~ ~` ~ - J REV-1500 EX oewdem~sN.m.: Theodore Rudberg Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 4 0 9, 7 8 0. 4 0 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 4 4, 3 2 1. 2 9 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 3 5 , 5 9 2 . 2 3 5. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7. 2 7 0, 9 8 0. 7 1 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 7 6 0, 6 7 4. 6 3 '1 9. Funeral Expenses & Administratlve Costs (Schedule H) ......................................... 9. 6 0 , 8 0 4 . 1 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 9 4 , 2 7 5 . 0 3 11. Total Deduetlons (total Lines 9 & 10) ...................................................................... 11, 1 5 5 , 0 7 9.13 12. Net Valw of Estate (Line 8 minus Line 11) ............................................................. 12. 6 0 5 , 5 9 5 . 5 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. i 13. 14. Nat Valw Subject to Tax (Line 12 minus Line 13) ....................:............................ 14. 6 0 5 , 5 9 5 . 5 0 TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICA9LE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) X .00 0 . 0 0 15. 1 B. Amount of Line 14 taxable 18 at lineal rate X .045 0 . 0 0 . 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0, 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 6 0 5, 5 9 5. 5 0 18. 19. Tax Dus .................................................. .................................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505607220 1505607220 Side 2 0.00 0.00 0.00 90,839.33 90,839.33 1505607220 J REV-1.500 EX Page 3 Decedent's Complete Address: File Number 21-08-0819 DECEDENT'S NAME Rudberg, Theodore STREET ADDRESS 75 Partridge Circle CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1, Tax Due (Page 2, Line 19) (1) 90,839.33 2. Credits/Payments A. Prior Payments 86,523.54 B. Discount 4,315.79 Total Credits (A + B) (2) 90,839.33 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request arefund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Q ~~ Make Check Pa able to: REGISTER OF WILLS, AGENT. t ;,',/ 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 :.................................. ^ ]x c. retain a reversionary interest; or ............................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? ............................................................ ^ 0 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?....... ] 0 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 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 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. §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 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)]. . 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)]. 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-1502 EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 All real property owned solely 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 which Is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real estate located at 1402 Mountainview Drive, Tredyffrin Township, Chester 207,500.00 County, PA -valued per sales price 2 Real estate located at 75 Partridge Circle, North Middleton Township, Cumberland 202,280.40 County, PA -valued per tax assessed value (160,540 * 1.26) TOTAL (Also enter on Line 1, Recapitulation) ~ 409,780.40 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) Rev-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 All property Jointly-owned with right of survivorship must be disclosed on Scfiedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 98 shares of MetLife -common stock -valued per 51.49 5,046.02 public listing 2 281 shares of Prudential Financial -common stock - 63.455 17,830.86 valued per public listing 3 Various Series E & EE U.S. Savings Bonds -valued 6,687.50 per Savings Bond Calculator 4 Various Series E & EE U.S. Savings Bonds, accrued 14,756.91 interest -valued per Savings Bond Calculator TOTAL (Also enter on Line 2, Recapitulation) 44.321.29 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA {NHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Commerce Bank Checking Account No. 513131730 -valued per letter dated 8/21/08 909.89 2 Commerce Bank Checking Account No. 513131730, accrued interest -valued per 0.01 letter dated 8/21/08 3 Commerce Bank Savings Account No. 513131730 -valued per letter dated 8/21/08 842.99 4 Commerce Bank Savings Account No. 513131730, accrued interest -valued per 0.16 letter dated 8/21/08 5 Orrstown Bank Checking Account No. 143000095 -valued per letter dated 8/22/08 7,198.28 6 Orrstown Bank Checking Account No. 143000095, accrued interest -valued per 0.03 letter dated 8/22/08 7 Pentagon Federal Credit Union Savings Account No. 28921690108 -valued per letter 660.22 dated 10/27/08 8 Wachovia Bank Checking Account No. 1000079200283 -valued per statement 25,480.65 ending 7/25/08 9 Miscellaenous personal property -valued per Executrix 500.00 TOTAL (Also enter on Line 5, Recapitulation} I 35,592.23 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE NAME OF 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 Exct_u:ilON (IF APPLI('ABLE) TAXABLE VALUE 1 Equity Services, Inc. IRA No. DFH-003409 - 106,737.96 100.000 0.00 106,737.96 beneficiary is Joan Beattie, friend; valued per letter dated 9/4/08 2 ESI/NFS IRA -beneficiary is Joan Beattie, friend; 4,921.00 100.000 (1.00 4,921.00 valued per letter dated 914!08 3 LWS IRA No. 611348X -beneficiary is Joan 45,268.01 100.000 0.00 45,268.01 Beattie, friend; valued per letter dated 9/4108 4 North American IRA No. 8000014006 -beneficiary 114,053.74 100.000 0.00 114,053.74 is Joan Beattie, friend; valued per letter dated 9/4/08 TOTAL (Also enter on Line 7, Recapitulation) 270,980.71 (If more space is needed, additional pages of the same size) Copyright (c} 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (12.99) ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached 9,387.80 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Numbers} / EIN Number of Personal Representatives}; Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees 9,500.00 See continuation schedule(s) attached 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 518.00 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 41,398.30 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 60,804.10 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) . SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hoffman-Roth Funeral Home & Cremation, Inc. -funeral services 8,887.80 2 TBI -memorial plaque 500.00 H-A Subtotal 9,387.80 Attorney Fees 3 James, Smith, Dietterick & Connelly, LLP -attorney fees 9,500.00 H-62 Subtotal 9,500.00 Probate Fees 4 Register of Wills, Cumberland County -probate fee 418.00 5 Register of Wills, Cumberland County - addtional probate fee 100.00 H-B4 Subtotal 518.00 Other Administrative Costs 6 Audrey Cover -reimbursement for fixtures 276.13 7 Boguslaw Skuza -seller's assistance 1,109.00 8 Chester County Glass, Inc. -glass repairs for Wayne, PA property 930.00 9 Chester County Treasurer -tax duplicates per HUD1 16.00 10 Coldwell Banker Preferred -real estate sales commission 5,706.25 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150() Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 ITEM NUMBER DESCRIPTION AMOUNT 11 Coldwell Banker Preferred -document preparation & certificates 896.00 12 Cumberland Law Journal -estate notice publication fee 75.00 13 Dale Haynes -appliance repairs for Wayne, PA property 265.00 14 Dale Haynes -electrical repairs for Wayne, PA property 3,069.00 15 David Bennet -repairs for Wayne, PA property 170.49 16 Don Moyer -basement repairs for Wayne, PA property 4,725.00 17 Fresh Looks by Gina -home staging & interiors for Wayne, PA property 550.00 18 Fresh Looks by Gina -home staging & interiors for Wayne, PA property 197.00 19 Fresh Looks by Gina -home staging & interiors for Wayne, PA property 52.97 20 George Rogers -painting for Wayne, PA property 300.00 21 Home Depot -flooring installation for Wayne, PA property 1,369.48 22 James, Smith, Dietterick & Connelly, LLP -reservation for estate administration 250.00 closing costs 23 John Kostukovich, CPA -individual income tax return preparation - 2006 & 2007 950.00 24 John Kostukovich, CPA -individual income tax return issues 515.00 25 Lowes -carpet installation for Wayne, PA property 1,039.33 26 Lowes -appliances for Wayne, PA property 4,450.79 Copyright (c) 2002 form soffinrare only The Lackner Group, Inc. Form PA-150!) Scheduie H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 ITEM NUMBER DESCRIPTION AMOUNT 27 Mt. View Association -homeowners association fees 810.16 28 Mt. View Association -homeowners association fees 375.00 29 Mt. View Association -homeowners association fees 334.37 30 Mt. View Association -water service & final reading for Wayne, PA property per 132.92 HUD1 31 Mt. View Association -homeowners association fees per HUD1 1,981.32 32 Mt. View Association -homeowners association fees 177.53 33 PECO -electric service for Wayne, PA property 100.00 34 PECO -electric service for Wayne, PA property 100.00 35 PECO -electric service for Wayne, PA property 82.27 36 Prudential Fox & Roach -real estate sales commission 5,706.25 37 Recorder of Deeds, Chester County -satisfaction fee for mortgage per HUD1 38.50 38 Recorder of Deeds, Chester County -realty transfer fee per HUD1 2,593.75 39 Register of Wills, Cumberland County -filing fee for Return & Inventory 30.00 40 Register of Wills, Cumberland County -short certificates 16.00 41 Richard Ginnona -electric repairs per HUD1 171.96 42 Shannon Ragazzone -notary fees per HUD1 15.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 ITEM NUMBER DESCRIPTION AMOUNT 43 Steve Oxenfelt -repairs 1.026.32 44 The Sentinel -estate notice publication fee 190.34 45 Tredyffrin Township Sewer -sewer services for Wayne, PA property per HUD1 261.92 46 USAA -homeowners insurance premium 306.25 47 Vital Records -death certificates 27.00 48 Vital Statistics -Florida -death certificates 9.00 H-B7 Subtotal 41,398.30 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) ' Rev-1512 EX+ (6-98) ~• ,~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 A. Merands -repairs -check written prior to death; cashed in after death 357.23 2 CitiMortgage Account No. 1120061376-5 -valued per statement dated 7/4/08 83,530.15 3 Claremont Nursing & Rehab -unreimbursed nursing home service 1,106.00 4 Greg Thomas -painting services -check written prior to death; cashed in after 300.00 death 5 Greg Thomas -painting services for Wayne, PA property 300.00 6 Health South -telephone service at nursing home 7.00 7 PA Department of Revenue - 2006 individual income tax 397.96 8 PA Department of Revenue - 2007 individual income tax 75.00 9 Tredyffrin School Tax Collector -school real estate taxes (less reimbursement) 1,365.65 10 United States Treasury - 2007 individual income tax 6,075.90 11 United States Treasury - 2006 individual income tax 635.92 12 West Shore EMS -unreimbursed ambulance service 124.22 TOTAL (Also enter on Line 10, Recapitulation) I 94,275.03 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-15(10 Schedule 1(Rev. 6-98) REV-1513 EX+ (9-00) ' ' ~ ~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Rudberg, Theodore 21-08-0819 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words ) ($$$) Do Not Llst Trust s I • TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Joan Beattie Friend Residue 605,595.50 75 Partridge Circle Carlisle, PA 17013 Total 605,595.50 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r sheet II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 70TAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150() Schedule J (Rev. 6-98)