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Home My WebLink About02-23-111505610148 -' REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box zsosol INHERITANCE TAX RETURN 21 10 0 9 8 5 Harrisburg, PA 1 7 1 2 8-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY 205-01-7718 09122010 Decedent's Last Name Suffix DOUGHERTY (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth MMDDYYYY 03091918 Decedent's First Name M I WILLIAM R Spouse's First Name M I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - . - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death ^ 4 Limited Estate ^ 4 F t prior to 12-13-82) ^ . a. u ure Interest Compromise (date of death after 12-12-82) 5. Federal Estate Tax Return Required 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) ^ 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 MNFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RICHARD C• SNELBAKER, ES Q 71'7-697-8528 First line of address 44 WEST MAIN STREET Second line of address P•0• BOX 318 City or Post Office State ZIP Code MECHANICSBURG PA 17055 Correspondent's a-mail address: REGISTER WILLS USE OfAY C ~ a r ~ E 7 p ~a ~ rn- ;.i f i'°t c70 - r.__ ~. rT.t ~C17~ ~ W ~,~°, (, ~ ~ ...n.. 4 - ~ ~ ~ r C,.. Under penalties of perjury, I Clare that I hav examined this retur ,including accompanying schedules and statements, and to the best of my knowledge and belief, it is tr a correct and cam I e. Declaration of reparer an the personal representative is based on all information of which preparer h s any kn ledge. SI R OF P S E PONSIBLE R IL G RETURN !~ / / ESS / ROBF,.~j J • DOUGHER Y, ECUTOR 9 NORTH ENOLA DRIVE, ENOLA PA 17p25 SIGi'~vy~ v~~trr rc v i ntrt 11,HIV KtYKtJtN IAI IVt DATE f RICHARD C• SNELBAKER, ESQ 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 7 55 Side 1 15 0 5 61014 8 sMasa7 a.ooo 15 0 5 61014 8 J .J REV-1500 EX 1505610248 Decedent's Social Security Number 205-01-7718 _ Decedent's Name: DOLIGHERTY W I I TAM R RECAPITULATION 1. Real Estate (Schedule A) 1 0 0 0 2. Stocks and Bonds (Schedule B) . 2 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3 4. Mortgages and Notes Receivable (Schedule D) _ 4 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) 8 Side 2 9. Funeral Expenses and Administrative Costs (Schedule H), _ 9 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 1 1. 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 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) , 14. 1505610248 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 16. Amount of Line 14 t xable at lineal rate X 0 4 ~ . 12 , 7 3 2 • 0 4 16 17. Amount of Line 14 taxable , at sibling rate X .12 0 • 0 0 18. Amount of Line 14 taxable 17. at collateral rate X .15 0 . 0 0 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610248 0.00 0.00 0.00 26,159.88 6.41 300.96 26,467.25 12,964.35 770.86 13,735.21 12,732.04 0.00 ~,2,7~2.n~ 0.00 572.94 0.00 D•00 572.94 9M4648 4.000 REV-1500 EX Page 3 Decedent's Cmm~lPtp Orirlracc• File Number ~ 1 , n non r V ! V J DECEDENTS NAME DOUGHERTY WILLIAM R STREET ADDRESS HAh1PDEN TOWNSHIP, CUMBERLAND COUNTY CITY STATE Zip MECHANICSBURG PA 17050- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) _ 57 2. 9 4 2. Credits/Payments A. Prior Payments 7 0 0.0 0 B. Discount 3 5. 0 0 Total Credits (A + B) (2) _ 7 3 5.0 0 3. Interest (3) _ 0 •0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 16 2 • 0 6 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ 0 , 0 0 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; ^ 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 Dec. 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 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. X9116 (a) (1.1) (i)]. For dates of death on or after Jan. 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. X9116(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 adcption. 9M467~ 2.000 REV-1508 EX+ (rrg8) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER William R. Doucrherty 21 10 0985 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Various coins owned by the Decedent, appraised value (see attached appraisal) 563.50 2 Member's First Federal Credit Union 584.15 savings account #2743-00 3 Member's First Federal Credit Union 24,022.92 checking account #2743-11 4 Member's First Federal Credit Union 616.14 certificate of deposit #2743-40 5 Member's First Federal Credit Union 373.17 credit due the decedent on visa credit card ending in 3822 TOTAL (Also enter on line 5 Recapitulation) $ ~ 26 , 159.88 3was,4o i.ooo (If more space is needed, insert additional sheets of the same size) REV-1509 IX+(Ot-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: William R. Dougherty 21 10 0985 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURdNINGJOINTTENAM'(S)NANE{S) I ADDRESS I RELATIONSHIP TO DECEDENT A Dougherty, Robert J 9 North Enola Drive, Enola, PA 17025 Son JOINTLY OWNED PROPERTY: fiFJvl NUNBER FOR ~aNT TENANT Ivt4DE ,JOIN DESCRIPTION OF PROPERTY INCLUDE NAtrE OF FINANCIALINSTITUTIDN 0.ND BANK ACCOUM NUM3ER OR SIMLAR IDENTIFYINGNUNHERATTACHDEEDFIXiJOINTLVHELDREALESTATE DATE OF DEATH VALUE OFASSE~ % OF DECE!)ENT'S INTEREST DATE pF pEgTH VALUE OF DECEDENTSINiEREST 1 A 4/14/2009 Metro Bank 12.82 50.0000 6.41 checking account #537854317 in which the decedent was the secondary owner. TOTAL (Also enter on Line 6, Recapitulation) $ 6.41 swasAE z.ooo If more space is needed, use additional sheets of paper of the same size. REV-151 D EX + (OS-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY William R. Douuherty c:l 10 0985 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 NUMBS DESCRIPl10N OF PROPERTY INtxI.OETFEN4AEOFTFETRANSFEREE,7HEIRRELATIONSHIPTODECEDEMAND TIf DATE OF TRANSFER ATTPCHACOPY OF THE DEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET %OFDECD~S INTEREST E}~CLUSION IF 4PPLICABLE TAXABLE VALUE ~• 6 EE Savings Bonds, $100.00 face value 300.96 100.0000 0.00 300.96 Payable on death to Robert J. Dougherty (see attached listing) • TOTAL (Also enter on line 7, Recapitulation) $ I _ If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+(10.09) pennsylvania DEPARTMENiOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS William R. Dougherty 21 10 0985 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ James A. Rabe Funeral Home, Inc. funeral services 8,728.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: z. Attorney Fees: Snelbaker & Brenneman, P. C. 1, 637.25 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4. 5. 6. 7. 1 City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Thomas J. Dougherty reimbursement for following: a. Funeral luncheon $138.87 b. Minister's fee $140.00 c. Travel Expenses to return home for funeral $810.83 Total from continuation schedules . 119.50 1,089.70 1,389.40 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 12 , 964.35 swasnc z.ooo If more space is needed, use additional sheets of paper of the same size. Estate of: William R. Dougherty 21 10 0985 Schedule H Part 7 (Page 2) 2 Jim Lenigs Jewelry & Coins coin appraisal 80.00 3 Cumberland Law Journal advertise Executor's Notice 75.00 4 Register of Wills filing fee for Inheritance Tax return 15.00 5 The Sentinel advertise Executor's Notice 219.40 6 Reserve for filing fees, accountant fees and other miscllaneous costs associated with the administration of the decedent's estate 1,000.00 Total (Carry forward to main schedule) 1,389.40 REV-1512 EX+ (12-08) pennsylvania SCHEDULE I DEPARTMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8c LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER William R. Dou herty 2'L 10 0985 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' West Shore EMS ambulance service 170.86 2 Manor Care resident care 600.00 TOTAL (Also enter on Line 10 Recapitulation) ~$ 770.86 ewasAH z.ooo If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: SCHEDULE J BENEFICIARIES R 1. 2 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] Robert J. Dougherty 9 North Enola Drive Enola, PA 17025 '6 EE Savings Bonds, $100.00 face value Inventory Value: 300.96 Metro Bank Inventory Value: 6.41 One Half of Residue: 6,212.34 Thomas J. Dougherty 493 Burnt Tree Lane Apopka, FL 32712-3930 One Half of Residue: 6,212.34 FILE NUMBER: 21 10 0985 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Son Son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 6,519.71 6,212.34 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 $ 0.00 swasAi z.ooo If more space is needed, use additional sheets of paper of the same size. LEN1G'S JEWELRY & COINS 104 LINCOLNWAY E. NEW OXFORD PA 17350 ESTATE OF: WILLIAM R. DOUGHERTY ADDRESS: PHONE: 717-732-0509 BY °~ ~ Y glue of Your Paper Savings l~ona~s~ ~ ~ ~d Value of Your Paper Savings Bond(s) .alculator Results for Redemption Date 09/2010 ~fA~c~ ~r~Cd~ $300.00 Bonds: 1-6 of 6 Issue Next final Issues Inter~:st Interest ~alu~ N~t~ Seriiai # Seroes [~~;rxor~a late Accrual Mate~rlt l~ri~e late C863471266EE ' EE $100 03/2010 10/2010 03/2040 $50.00 $0.16 1.20% $50,16 NE NE C863471265EE ': EE $100 03/2010 10/2010 03/2040 $50.00 00 50 $0.16 16 $0 1.20% 20% 1 $50.16 $50.16 NE C863471264EE ' EE EE $100 $100 _03/2010 0 03/201 10/2010 10/2010 03/2040. 03/2040 . ,.$ $50.00 . $0.16 . 1.20% $50.16 NE C863471263EE C863471262EE EE $100 . 03/2010 10/2010 , . 03/2040 $50.00 $0.16 .. 1.20% $50.16 NE C863471261EE EE . . $100 03/2010 , 10/2010 03/2040 $50.00 $0.16 1.20% $50.16 . NE Totals for 6 Bonds $300.00 $0.96 _ $300.96 NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA .Matured and not earnin interest ~"otal alp Td~ial Intres~ ~ a ~ ae~r.~~~~ $300.96 $0.96 $0.96 .-~..~.. LAST WILL AND TESTAMENT 1, WILLIAri R. DOUGHERTY, of the Township of Lower Allen, County of Cumber- land and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codi- cils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever a:nd wheresoever situated, unto my wife, PATRICIA DOUGHERTY, absolutely and in :Eee simple, if she sur- vives me by as many as sixty (60} days. THIRD. If my wife., PATRICIA DOUGHERTY, does not survive me by as many as ~ sixty (60) days, then and in that event,. I give, devise and bequeath all the rest, residue and remainder of my .Estate, real, personal and mixed, whatsoever ,~ and wheresoever situated, in equal shares unto my two (2) sons, namely, ROBERT '' J. DOUGHERTY and THOMAS J. DOUGHERTY, share and share alike, absolutely and in fee simple. If my son, namely, THOMAS J. DOUGHERTY, should predecease me, I order and direct that the foregoing residuary disposition to h:im shall lapse and be void, without substitution of issue, and I further order and direct that my entire residuary estate shall be distributed to my son, namely, ROBERT J. DOUGHERTY. If my son, namely, ROBERT J. DOUGHERTY, should predecease me and leave lawful issue to survive me, I.order and direct that said share of my deceased son shall be distributed unto his lawful issue per si:irpes by representation and not per capita, subject, however, to tl~.e protective provisions of Ttem attributable to any beneficiary who has not attained the age of twenty-three (23) years at the time of my death, shall be distributed and paid over to DAUPHIN DEPOSIT BANK .AND TRUST COMPANY, of Harrisburg, Pennsylvania as m , y testamentary Trustee, in a separate trust, nevertheless, to hold, manage, invest, accumulate income and reinvest until said beneficiary attains the age of twenty-.three (23) years, at which latter time said trust shall be terminated and the then remaining net assets thereof shall be paid over to the beneficiary absolutely and free of such trust. During the existence of any such trust, (A) I order and direct that the beneficiary's interest therein shall not be subj ect to pledge, assignment, sale or hypothecation by said beneficiary nor subject to the attachment, levy or execution of any purported assignee, purchaser ar creditor of such bene- ~ ficiar y, and (B) I authorize and empower my said TYUStee to use, expend, consume and apply from time to time such amounts of both invoice and principal ~~ as said Trustee shall deterimne in the exercise of its sole discretion to be necessary and proper for the beneficiary's education [the term "education" ~1 1 shall be interpreted to include colle e or other g post-highschool training r -~ which is intended to enhance the beneficiary's productivity as an adult or improve his or her quality of life].. ~y'~ LASTLY. I nominate, constitute and a ppoint my wif e, PATRICIA DOUGHERTY, to be the Executrix of this, my Last Will and Testament, but if for any reason. she should. fail to qualify as .such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint my son, namely, ROBERT J. DOUGHERTY, to be the Executor hereof. If both of the above named persons should fail to qualify as my personal representative hereunder or cease so to serve, then and in tl-~at ultimage event, I nominate>_, constitute and appoint my son, namely, THOMAS J. DOUGHERTY, to be the Executor of -this, my Last Will and Testament. I order and direct that none of the above named persons shall be required hand and seal to this., my Last Will and Testament which consists of three (3) typewritten pages to each of which Z have affixed my signature this w`~ray of r'"'~~' ,A.D.,.One Thousand Nine Hundred Eighty-seven (1987). -~-_.... i n ~.,c.E,~~EZ,~.-y.,~.; ~' - ~: (SEAL ) The preceding instrument, consisting of this and two (2) other typewritten pages, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by WILLIAM R. DOUGHERTY, the Testator tlZerein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in-the presence of each ether. h~va subscribed our .names as witnesses her LAW OFFICES COr1MONWEALTH OF PENNSYLVANIA) . SS. COUNTY OF CUMBERLAND) We, WILLIAM R. DOUGHERTY, RICHARD C. SNELBAKER and JANET M. FORRY, the Testator and the witnesses, respectively, whose names are signed to the attachec or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed. and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and :hearing of the Testator, signed the Will as witness and that to the. best of his or her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ffies for .~- if i ess G __ ~/~ . ~ 4-_-~ 1..1 Witness Subscribed, sworn to and acknowledged before me by WILLIAM R. DOUGHERTY, the Testator, and subscribed and sworn to before me by RICHARD C. SNELBAKER and ~, JANET M. FORRY, witnesses, this ~'=~'~~ `day of ~~G~~.~~- 1987 . Notary Public - CATNbR#PtE E. ~30USUtA, RQTARY PU9llC ~;~GHAt!lCSgURG P!1R0, ctl~ae~~t~~+a couo+tp qtr ca~~lssla~ ~xalR~s F~a. a.~. 1890 ~~,.>.taar. •' ~,tc~yira~~s ~s.~aeiati;,~ ~! ~':~.a=ins