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Home My WebLink About01-14-1115U561U14~ ' ~ REV-1500 Ex `°'-'°' ~ OF I CIAL USE ONLY PA Department of Revenue pennsylvania cou t y coae Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.2soso~ INHERITANCE TAX RETURN 1 10 0425 Harrisburg, PA 1712s-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 184 50 1092 04 18 2010 08 26 196 Decedent's Last Name Suffix Decedent's First Na a MI MOORHEAD DUANE R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Nam MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF ILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ^ 2. Supplemental Return ~ Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ~ 4a. Future Interest Compromise ^ (date of death after 12-12-82) Federal Estate Tax Return Required 6 Decedent Died Testate ~. Decedent Maintained a Living Trust _ 0 ^ (Attach Copy of Will) ^ (Attach Copy of Trust) Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. betweeri 12 31 91 anditl(datge5~f death ^ 1 1, Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL T X INFORMATION SHOULD BE DIRECTED TO: Name Da ime Telephone Number EDWARD P SEEBER 7 17 533 3280 R GISTER Q13 WILLS US1-L~NLY _._._ ;--~-~ _. ~ C~ _ - ',3 - - { First line of address ~ F y' ` , ~~? 555 GETTYSBURG PIKE ~- -'--'~~ ,~~• f -- b - Second line of address ~, ~--' ~' ,~ ; _° ~1 ~ a SUITE C400 - - _LL -'- ~' 'F1L.ED D City or Post Office State ZIP Code ~ _ MECHANICSBURG PA 17055 ~~~ Correspondent's a-mail address: eps c~jsdc.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statement 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 informatio of which preparer has any knowledge. SIGNATU OF PE SON RESP NSIBLE F R FILING RETURN DATE .~ Flora E. Moorhead C / ADDRESS 22 Birch St et Me a 'csbur PA 17050 SIGNATURE OF ARER OTH R T N R ESENTATIVE DATE Edward P Seeber ~ ADDR 555 Gett sbur Pike, Mechanicsbur , PA 17055 Side 1 1505610143 1 05610143 J J 1505610243 REV-1500 EX Decedent's Name: Moorhead, Duane R. ecedent's Social Security Number 18 4 5 0 10 92 RECAPITULATION 120,000.00 1. Real Estate (Schedule A) ....................................................................................... 1. 35,383.50 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) ........................................................ 4. 6,707.43 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7 6 , 6 65.5 8 7. Inter-Vivos Transfers 8~ Miscellaneous ty~o.q Probate Property Re uested te Billin ar S 7 31 , 644.52 ............ g q ep a (Schedule G) ^ . 8. Total Gross Assets (total Lines 1-7} ..................................................................... g, 2 7 0 , 4 01.0 3 38,240.81 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ....................................... 9. 1,058.25 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) .............................. 10. 39,299.06 11. Tota{ Deductions (total Lines 9 & 10) ................................................................... 11. 231,101.97 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 231,101.97 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 231 , 101.97 16. at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17. at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 18 at collateral rate X .15 . . 19. Tax Due ................................................. ................................................................ . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 10,399.59 0.00 0.00 10,399.59 Side 2 1505610243 1 05610243 J REV-1500 EX Page 3 rlni+n~Jnnt~c f`_nrr~nleata Or'il['1rac~' File Number 21-10-04 5 DECEDENT'S NAME Moorhead, Duane R, STREET ADDRESS 82 Ashford Drive CITY STA E ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 7,263.98 382.31 3. Interest 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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 ~(A +B) Make Check Payable to: REGISTER OF WILLS, AGENT. (1) 10,399.59 (2) 7,646.29 (3) (4) (5) 2,753.30 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TF~E APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No 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 :................................. ^ x c. retain a reversionary interest; or ............................................................................................................. d. receive the promise for life of either payments, benefits or care? ........................................................... ^ ^x 2. If death occurred after December 12, 1982, did decedent transfer property within one yea of death without receiving adequate consideration? .................................................................................................................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his o her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate propert which ^ contains a beneficiary designation ........................................................................................ . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G ND 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 oft nsfers 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 se 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 s tutory requirements for disclosure of assets and filing a tax return are stilt 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 de th 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 .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 dec dent, whether by blood or adoption. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE 7AX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined s 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 kn wledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be dtacloasd on ached le F. Attach a copy of the settlement sheet if the property has been sold Include a copy of the deed showing decedent's Interest if owned as tenant in common ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real estate located at 82 Ashford Drive, East Pennsboro Township, Cumber) nd County, PA 120,000.00 - valued per sales price TOTAL (Also enter on Line 1, Reca tulation) 120,000.00 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rwv.~60R FY+/R.9R1 SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 All property jointly-owned with right of survivorship must be disclosed on Schsdul F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 169.198 shares of Capital World Growth 8~ Inc held in RBC .46 5,830.56 Wealth Management Brokerage Account No. 311-71090 - valued per public listing 8~ letter dated 5/20/10 2 472.59 shares of First Eagle Global Fund held in RBC Wealth .35 20,014.19 Management Brokerage Account No. 311-71090 -valued per public listing 8 letter dated 5/20/10 3 148.018 shares of Growth Fund America held in RBC Wealth 2 .94 4,283.64 Management Brokerage Account No. 311-71090 -valued per public listing 8~ letter dated 5/20110 4 328.65 shares of Income Fund of Amer held in RBC Wealth 1 .99 5,255.11 Management Brokerage Account No. 311-71090 -valued per public listing & letter dated 5120/10 TOTAL (Also enter on Line 2, Recapitulation 35,383.50 (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) rtvr- i vvv cn= ~v-vv, SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 Include the proceeds of litigation and the date the proceeds were received by the eat All property jointly-owned with the right of survlvonship must be disclosed on ache te. uls F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Americhoice FCU Saved Change Account -valued per letter dated 5/18/10 14.84 2 Money Market held in RBC Wealth Management Brokerage Account No. 311- 1090 -valued 69.69 per public listing 8~ letter dated 5120/10 3 2005 Ford Escape -valued per sale 6,500.00 4 2010 County/Township Real Estate Taxes -per HUD1 122.90 TOTAL (Also enter on Line 5, Reca ituiation) 6,707.43 (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) R~v_16flA ~Yi IR.9R1 . SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 M an asset was made j oint within one year of the decedent's date of death, it must bs repo sd on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Flora Moorhead 22 Birch Street Mother Mechanicsburg, PA 17050 B. C. JOINTLY OWNED PROPERTY: ITEM LETTER DATE DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF EATH % OF DECD'S DATE OF DEATH VALUE OF NUMBER FOR JOINT TENANT MADE JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF SSE INTEREST DECEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. 1 A 2/5/1978 Americhoice FCU Draft Account -valued per 1,3 9.38 50.000% 664.69 letter dated 5/18/10 2 A 2/5/1978 Americhoice FCU Savings Account -valued 3,2 3.98 50.000°le 1,641.99 per letter dated 5/18/10 3 A 4I14I2003 Real estate located at 22 Birch Street, 148,7 7.80 50.000% 74,358.90 Mechanicsburg, Cumberland County, PA - valued per tax assessment * common level ratio (118,030 x 1.26 = 148,717.80) TOTAL (Also enter on Line 6, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 76,665.58 Form PA-1500 Schedule F (Rev. 6-98) Rdv.1610 EY+ (6_9A1 SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 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 C VER SHEET is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH °i° of EcD~s Exci_usloN TAXABLE NUMBER THE D ~TE OF RANSFERSATTACIi A COPY OF TORE DEIED FOOREREAL ESTATE. VALUE OF ASSET INT REST (IF APPLICABLE) VALUE 1 Annuity held by Ohio National Life Insurance 31,644.52 100. 00% 0.00 31,644.52 Company Contract No. E1637020 -beneficiary is mother; valued per statement ending 3131/10 TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 31,644.52 Form PA-1500 Schedule G (Rev. 6-98) ~~-- ~ ~-~ -~~ ~~- --~ ,. SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT R A, FUNERAL EXPENSES: See continuation schedule(s) attached 12,317.81 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission raid 2. Attorney's Fees James, Smith, Dietterick 8~ Connelly, LLP 10,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 304.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15,118.50 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitula ti n) 38,240.81 Copyright (c) 2009 form software only The Lackner Group, Inc. ~orm PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE OSTS continued ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Family Traditions -funeral luncheon 239.81 2 Myers-Harner Funeral Home, Inc. -funeral services 10,978.00 3 Parklawn Memorial Gardens -opening Bz closing of grave 1,100.00 -A 12,317.81 4 5 6 7 8 9 10 11 12 13 Other Administrative Costs Bretz's Carpet -carpet replacement for residence Cumberland Law Journal -estate notice publication fee Don Charles -painting >~ repairs for residence Don Charles -replacement of 2 toilets for residence HSA -home warranty James, Smith, Dietterick Sz Connelly, LLP -reservation for estate administratio closing costs PAWC -water service for residence PAWC -water service for residence PAWC -water service for residence PPL -electric service for residence 2,267.00 75.00 2,255.00 279.48 419.00 200.00 17.41 21.06 25.84 105.00 Copyright (c) 2002 form software only The Lackner Group, Inc. ~ Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE OSTS continued ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 ITEM NUMBER DESCRIPTION AMOUNT 14 PPL -electric service for residence 79.99 15 PPL -electric service for residence 4.94 16 Randy Waggoner - lawncare 8< preparation of taxes 290.00 17 Recorder of Deeds, Cumberland County -realty transfer tax 1,200.00 18 Register of Wills, Cumberland County -filing fee for Return & Inventory 30.00 19 Register of Wills, Cumberland County -short certificates 12.00 20 Remax -real estate commission 7,450.00 21 Salzman Hughes, PC -tax certification fee 10.00 22 Silver Spring Animal Clinic -vet expense for Decedent's dog 168.00 23 The Sentinel -estate notice publication fee 208.78 H B7 15,118.50 Copyright (c) 2002 form software only The Lackner Group, Inc. ,Form PA-1500 Schedule H (Rev. 6-98) I Rdv.?612 EX+ (12.AR1 SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, Including unrei bursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Flora Moorehead -repayment for debts paid on behalf of decedent for Feb. - arch 2010 1,058.25 TOTAL (Also enter on Line 10, Reca itulation) 1,058.25 DCV_~lK~ R CYa /1 ~ _f1A1 SCHEDULE J COMMNHERITANCEOT~ RETURNANIA T E D T BENEFICIARIES RESID N EN DECE ESTATE OF FILE NUMBER Moorhead, Duane R. 21-10-0425 NAME AND ADDRESS OF RELATIONSHIP TO SHA E OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT ( Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Flora E. Moorhead Mother Join assets, 231,101.97 22 Birch Street ann i ty, & Mechanicsburg, PA 17050 resi ue Tot I 231,101.97 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 cover heet, as a r o riate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TOT IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 OVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)