HomeMy WebLinkAbout11-03-10 (3)""~ REV-1500 EX (°'-'°'
PA Department of Revenue
Bureau of Individual Taxes INHE
Po Box zeosDl RE
Harrisbur PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death b
2 1 4 5 8 3 6 4 5 1 0 2 7 2
Decedent's Last Name
R O C K E Y
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
1505b10140
OFFICIAL USE ONLY
County Code Year File Numl>Er
TAX RETURN 2 1 0 9 1 0 1 9
)ECEDENT
MDDYYYY Date Of Birth MMDDYYYY
0 0 9 0 2 2 5 1 9 5 0
Suffix Decedent's First Name MI
R A N D M
Suffix Spouse's First Name MI
Spouse's Social Security Number
THI
RETURN MUST EIE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
l
l Return
t ~ 3. Remainder Return (date of death
1. Original Return ^ em
2. Supp n
a prior to 12-13-82)
tate
it
d E
i ^ 4a. Future In Brest Compromise (date of ~ 5. Federal Estate Tax Return Required
s
m
a L
e death aft r 12-12-82)
d T
state
Di ^ 7. Deceden Maintained a Living Trust . - 8. dotal Number of Safe Deposit Boxes
e
e
6. Decedent
(Attach Copy of Will) (Attach opy of Trust)
f death
nder Sec. 9113(A)
ax
^ 11.
^ 9 Litigation Proceeds Received ^ 10 between 12 31 91 and 1~1 ~95) O}
EAl~ach Sch
THIS SECTION MUST BE COMPLETED. ALL
T BE DIRECTED TO:
ORRESPONDENCE AND CONFIDENTIA
L YA mle ~
O
U
o°
e~
-
CORRESPONDEN D
ber
e Nu
m
l
h
Name
H A
R T
M A N
E S Q
7 1 7 3 3 4 3 1 0 5
G A R Y E _ _ _
_._._
____
REGISTER OF WILLS USE ONLY N
C~
G
~' ~ -j-?
~'
t
~.
~ l C~
i`7'
~> ~.~
First line of address
H A R T M A N &
Y A
N N E
T T I t~ ~ +C
~ ~
~,}
~ ~_ { ~ 7
t~'x i,
x i ._
Second line of address ~CC''~~~('~
~ 'Ei
C
1 2 6 B A L T I M O R E S T R E E T Tr1 ~+ .. Tr
City or Post Office State ZIP Code DATE FI
--- - - . ~ ~;+?
' r-" ~
.:.+?
G E T T Y S B Y R G P A 1 7 3 Q ~
2 5 3" ~,,~
C r.rrnennndent'S 0-mail address: GEHaHARTMAf~-YANNETTI•
Under penalties of perjury, I declare that I have examined this return,
it is true, correct and complete. Declaration or praparer other than the
:ytiCNATURE OF PERSON RES ON BLE FOR FILING RETURN
1~763A LANCASTER R
SIGNA7,Yr~ OF PREBkRtR'O
126/BALTIMORE ST
1505610140
accompanying schedules ane sraremencs, anu .u ~~ ~~ ~_~ ~~ ~ ~n ••~ ~~--•~°*+- °~
representative is based on all intormation of which preparer has any knowledge.
MANHEIM
NT!_TIVE
GETTYSBURG
PLEASE US ORIGINAL FORM ONLY
Side 1
PA 17545
! ATE t~,
~. r
PA 17325
150561014p
J belief,
a~
~'
8~~~ ~~~
~~~o~ ~\
J
1505610240
REV-1500 EX Decedent's Social Security Number
2 1 4 5 8 3 6 4 5
oeceaenPs Name: RAND M• R O C K E Y
RECAPITULATION
0. D D
1. Real Estate (Schedule A) ....................... .................. .. 1.
2. Stocks and Bonds (Schedule B) .................. .................. .. 2. •
3. Closely Held Corporation, Partnership or Sale-Proprieto ship (Schedule C) ... .. 3.
4. Mortgages and Notes Receivable (Schedule D) ...... .................. .. 4.
7 5 4 7 9 , 0 1
5. Cash, Bank Deposits and Miscellaneous Personal Prop rty (Schedule E).... ... 5.
6. Jointly Owned Property (Schedule F) ^ Separate illing Requested .... ... 6. 9 8 3 3 2 . 3 5
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Pr erty
. (Schedule G) ^ Separate illing Requested .... ... 7.
8 1 7 3 8 1 1 . 3 6
8. Total Gross Assets (total Lines 1 through 7) ...... ................. ...
.
9. Funeral Expenses and Administrative Costs (Schedule ) .................. 9.
10. Debts of Decedent, Mortgage Liabilities, and Liens (Sc edule I) ............. 10.
11. Total Deductions (total Lines 9 and 10) .......... .................... 11.
12. Net Value of Estate (Line 8 minus Line 11) ....... .................... 12.
13. Charitable and Governmental Bequests/Sec 9113 Trus s for which
an election to tax has not been made (Schedule J) .................... 13.
1d Nar value Suhiect to Tax (Line 12 minus Line 13) .................... 14.
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLIC
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X • D
16. Amount of Line 14 taxable
at lineal rate X • 045 1 1 5
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE ................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A
8 5 9 0. 1 0
4 9 9 6 1. 9 5
5 8 5 5 2. 0 5
1 1 5 2 5 9. 3 1
1 1 5 2 5 9. 3 1
RATES
o . D a 15.
2 5 9. 3 1 16.
0 . D 0 17.
0 . 0 0 1 a.
1 s.
.....................
D. D o
5 1 8 6. 6 7
D. D 0
D. D D
5 1 8 6. 6 7
OF AN OVERPAYMENT
Side 2
15D5610240 150561D240 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
RAND M• ROCKEY ___
STREET ADDRESS
334 OLD STONEHOUSE RD, APT 4
CITY
BOILING SPRINGS
Tax Payments and Credits:
t. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the
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
Make check payable
1019
ZIP
17007
(1) 5,186.67
Total Credits (A + g) (2) 0 • 0 0
(3) 5 4 •2 0
RPAYMENT.
(4) 0.0 0
DUE. (5) 5 , 2 4 0.8 7
REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIbNS 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 : .................................................................
i
i ..... ^
^
^
b. retain the right to designate who shall use the grope ncome : ..........................
y transferred or
ts .....
^ ^X
c. retain a reversionary interest; or ...................... ........:.......................................................... .....
^
d. receive the promise for life of either payments, bene its or care? .................................................. .....
If death occurred after December 12,1982, did decade
2 t transfer property within one year of death
.
without receiving adequate consideration? .............
"
" ..................................................................
d
th?
hi
h ...... ^
^
0
orpayable-upon-dea
intrust for
3. Did decedent own an ...
er
ea
s or
h bank account or security at ......
Did decedent own an individual retirement account, an
4 ity or other non-probate property, which
.
contains a beneficiary designation? ......................... .................................................................. ...... ^ ^X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, th
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 th
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to
filing a tax return are still applicable even if the surviving spouse is the
For dates of death on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a deceasec
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9
• The tax rate imposed on the net value of transfers to or for the use
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
Section 9102, as an individual who has at least one parent in comn
MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
tax rate imposed on the net value of transfers to or for the use of the surviving spouse
net value of transfers to or for the use of the surviving spouse is 0 percent
I surviving spouse from tax, and the statutory requirements for disclosure of assets and
mly beneficiary.
child 21 years of age or younger at death to or for the use of a natural parent, an
16(a)(1.2)].
~f the decedent's lineal beneficiaries is 4.5 percent, except as noted in
f the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, unde
m with the decedent, whether by blood or adoption.
File Number
21 09
STATE
PA
REV-1508 EX + (6-98)
SC EDULE E
CASH, BAN p ~+//..
DEPOSITS, 8t M~$li.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSO AL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RAND M• ROCKEY 21 09 1019
Include the proceeds of litigation a d the date the proceeds were received by tha estate.
All properly jointty-owned with rig t of survivorship must be discbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DES RIPTION OF DEATH
1• METRO BANK ACCOUNT 0537862 01 61,455.61
2• PROCEEDS FROM SALE OF CARS - 1978 FORD TRUCK AND 500.00
1986 CAMARO
3• REFUNDS FROM VERIZON, COMC ST, OTHER REFUNDS 478.12
4• BALANCE OF INHERITANCE FRO ESTATE OF MARDEL ROCKEY 13,045.28
TOTAL (Also enter on line 5, Recapitulation) $ 7 5 , 4 7 9 • 01
(If more space is needed, insert addftional sheets of the same size)
REV-1509 EX+ (01-10)
pennsylvania SC EDULE F
DEPARTMENT Or REVENUE JOINTLY OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RAND M• ROCKEY 21 09 1019
If an asset was made jointly owned within one year f the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. CRAIG F- ROCKEY 1370 KNOXL N-ORRTANNA ROAD BROTHER
GETTYSBURG PA 17325
e. JANET K- ROCKEY 126 CHAMBE SBURG ROAD SISTER
ARENDTSVIL E, PA 17302
c.
JOINTLY-OWNED PROPERTY:
ITEM LETTER
FOR JOINT DATE
MADE DESCRIPTION OF P
INCLUDE NAME OF FINANCIAL INSTITUTION AND 8 PERTY
NK ACCOUNT NUMBER OR SIMILAR
DATE OF DEATH % OF
DECEDENT'S DATE OF DEATH
VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR OINTLY-HELD REAL ESTATE. VALUE OFASSET INTEREST DECEDENT'S INTEREST
1- a. 3/09 REAL ESTATE INHERITE FROM ESTATE 295,000.00 33.333 98,332.35
OF MARDELL F• ROCKEY
PARCELS F15-44 AND F 5-26
(APPRAISALS ATTACHED
TOTAL (Also enter on Line 6, Recapitulation) $ 9 8 , 3 3 2 •3 5
If more space is needed, I)se additional sheets of paper of the same size.
RFJMAX of Gettysburg
18 Carlisle Street, Suite 300
Gettysburg, PA 17325
June 5, 2009
Gary Hartman
128 Baltlmore Street
Gettysburg, PA 17325
RE: Cedl L & llAardel F. Roduty
Blacksmith Shop Road (lot)
Gettysburg, PA 17325
File No.
Case No. 2009-024
Dear Gary,
In accordance with your request, I have personally
property located at:
and prepared an appraisal report of the real
Blacksmith Shop Road (lot), Gettysburg, PA 17325
The purpose of this appreisal is to estlmate the mai
appreisel report.
value of the property desk:ribed In the body of this
Endosed, please find the apprefaal report which de
of the property. The methods of approach end rear
economic factors of the subject property are contain
An inspection of the property end a study of pertirre.
neighborhood data, led the appraiser to the eondua
is:
The opinion of value expressed in this report Is con
~~
It has been a pbesure to assist you. If I may be of
Respectfully sulxniltsd,
Signature:!. i
Jaffrey A. Shaffer
RF_IMAX of Gettysburg
xibes certain data gathered during our investigation
ping in the valuation of the various physical and
d in this report
factors, inducting valuation trends and an analysis of
n that the market value, as of June 5, 2009
45.000.00
upon the limiting conditions attached to this
service to you In the future, please let me know.
cx:
RF_/MAX of Gettysburg
18 Carlisle Street, Suite 300
Gettysburg, PA 17325
June 5, 2008
Gary Hartman
126 Baltimore Street
Gettysburg, PA 17325
RE: Cecil 1.8 Mendel F. Rodcey
1084 TarleytoMm Road
Gettysburg, PA 17325
File No.
Case No. 2009.025
Dear Gary,
In accordance with your request, I have personalty
Property iocatsd at
1084 Teneytown
The purpose of this appraisal is to estimate the mark
appreisal report.
Endowed, Please find the appraisal report which deal
of the properly. The methods of approach end r~so
economic factors of the subject Property are contains
An inspection of the property and a study of Pertinent
neighborhood data, led the. appreiser to the conduaio
is:
3
The opinion of value e~grresaed in this report is contin
report
It has been a pksasure to assist you. ff 1 may be of fui
Respectfully submitted,
Jeffrey A. Shaffer
RE/MAX of Gettysburg
and prepared an appraisal report of the real
Gettysburg, PA 17325
value of the property described in ttre body of this
bas certain data gathered during our investigation
ng in the valuaton of fhe various physical and
in this report,
rctore, inducting valuation trends and an analysis of
that the market value, as of June 5, 2009
250.000.00
upon the Iimitlng conditions attad,ed to this
service to you In the future, please let me know.
CC:
REV-1511 tX+(l U-U9)
Pennsylvania SC EDULE H
°EPARrnneNr of Reve"uE FUNE L EXPENSES AND
INHERITANCE TAX RETURN ADMINI TRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RAND M• ROCKEY 21 09 1019
Decedent's debts must a reported on Schedule [.
ITEM
NUMBER
DES
RIPTION
AMOUNT
A.
1• FUNERAL EXPENSES:
AUER CREMATION SERVICES
1,995.00
2• BLOOMS BY VICKERY 250.43
3• REIMBURSEMENT TO JILLIAN F ORBES FOR FUNERAL EXPENSES 127.67
B. ADMINISTRATIVE COSTS:
1 Personal Representative Commissions:
Name(s) of Personal Representative(s) CAS A N D R A L• R O C K E Y 3, 0 0 0. 0 0
Street Address 1763 LANCASTER ROAD
City MANHEIM State PA ZIP 17545
Year(s) Commission Paid: 2 0 D 9
2 . Attorney l=ees: HARTMAN & YANNETTI 3, 000 • DO
3, Family Exemption: (If decedent's address is not the same as taimants, attach explanation.)
Claimant
Street Address
Ciry State ZIP
Relationship of Claimant to Decedent
4 • Probate Fees: CUMBERLAND COUNTY EGISTER OF WILLS 217.00
5 • Accountant Fees:
6 - Tax Return Preparer Fees:
7•
TOTAL (Also enter on Line 9, Recapitulation) E 8 , 5 9 0.10
If more space is needed, ~se additional sheets of paper of the same size.
~~'
~ .~~.
REV-1512 EX+ (12-08)
pennsylvania SC EDULE
DEPARTMENT OF REVENUE DEBT OF DECEDENT,
wHERITANCE rAx RETURN MORTGAGE LIABILITIES, Sr LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RAND M• ROCKEY 21 09 1019
Report debts incurred by the decedent prior to death that rem fined unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DES RIPTION OF DEATH
1• MET-ED 263.61
2• COMCAST 133.38
3• VERIZON 117.84
4• DECEMBER RENT PAYMENT 700.00
5• MONROE TWP SEWER BILL 441.00
6• MS HERSHEY MEDICAL CENTER 1,660.50
7• CENTRAL PA PULMONARY ASSOC ATES 344.25
8• CARLISLE RESIONAL MEDICAL ENTER 10,567.27
9• MASLAND ASSOCIATES 17.72
10• KINETIC IMAGING 568.00
11• WEST SHORE EMS 936.58
12 YELLOW BREECHES INC• 620.00
13 ALEXANDER SPRINGS EMERGENC PHYSICIANS 1,411.00
14• QUEST DIAGNOSTICS 49.00
15- CARLISLE NEURO CARE 514.00
TOTAL (Also enter on Line 10, Recapitulation) $ y 9 , 9 61.9 5
If more space is needed, inert additional sheets of the same size.
~ ;,,.:
' , .r
Continuation of REV-1500 Inh ritance Tax Return Resident Decedent
RAND M. ROCKEY 21 09 1019
Decedent's Name Page 1 File Number
Schedule I -Debts of Decedent, Mortgage Liabilities, Liens
ITEM
NUMBER
DES
RIPTION
AMOUNT
L6• CARLISLE HOSPITALISTS 544.00
17• HOLY SPIRIT HOSPITAL 2,318.00
18• PINNACLE HEALTH 18,505.80
19• SETTLEMENT WITH PNC BANK 10,000.00
(CIVIL ACTION NO. 07-5947)
20• DEBT OWED TO NEIGHBOR PAME A HUTLO 250.00
SUBTOTAL SCHEDULE I 31, 617.8 0
GRAND TOTALSCHEDULEI E 49,961.95
REV-1513 EX+ (01-10)
pennsylvania SC EDULE J
DEPARTMENT OF REVENUE B NEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RAND M- ROCKEY 21 ^9 1^19
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING ROPERTY Do Not List Trustee(s) OF ESTATE
[ TAXABLE DISTRIBUTIONS [Include ouVight spousal distributions
Sec. 9116 (a) (1.2).] nd transfers under
1• CASSANDRA L• ROCKEY Lineal 57,629.66
1763A LANCASTER ROAD, MANHEIM , PA
2• JILLIAN FORBES Lineal 57,629.65
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN BOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
[[ NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR HICH AN ELECTION TO TAX IS NOT TAKEN:
1•
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1•
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DIS RIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is neede~, use additional sheets of paper of the same size.