The URL can be used to link to this page

Home My WebLink About04-07-11 (2)1505610140 REV-1500 EX (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box 28oso1 INHERITANCE TAX RETURN 2 1 0 9 0 6 3 2 Harrisburg, PA 17128-OS01 RESIDENT QECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ], 8 1 0 3 6 3 1 2 0 6 1 3 2 0 0 9 0 2 1 9 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name MI B E E R S M A R J O R I E W (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 WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 1. Original Return Q 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-EI2) 4. Limited Estate ~ 4a. Future interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number o~f Safe Deposit Boxes (Attach Copy of WII) (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) VV~[RC~7rV19NC19 1 - 1111? JGV I IVt~ R1VJ1 DG NVnIrLGI CV. nLL vv~r~LVrvnv~.nv~. nnv vvn~ ~v~.~• ~ ~~~ ~~~ ~~~~ v.•mr~~ ivy. v.~vv~v vr. v.~..-v. ~v . v. Name Daytime Telephone Number D A V I D H S T O N E E S Q U I R E 7 1 7 7 7 4 ? 4 3 5 REGISTER ~1~VtIj.LS USE t3NEY ;~-.~ i ~ i .) ~ .. ' ..,? , t First line of address i '.. ~ ~~-~ .~ 4 1 4 B R I D G E S T R E E T ::~ -=. "~-: ,.a _. -. _ . Second line of address ~ ~"~ T ~ _- ~::i - --_ t_ _:; ~4 -I ~'4 t T~ l :.~ 1 ....:~ __ City or Post Office DATE FILED ~ ~ ~i N E W C U M B E R L A N D State P A ZIP Code 1 7 0 7 0 Correspondent's a-mail address: D S T O N E a S T O N E L A W• N E T Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of rriy knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on a!I information of which preparer has any knowledge. SIGNAT F ER N RESPONSIB E F R ILING RETURN DATE a s ADDR S 23 D G AY CAMP HILL PA :1701,1 NAT OF E OTHER THAN REPRESENTATIVE DAT ~ /~ '\ ES 414 BRIDGE STREET NEW CUMBERLAND PA :L7070 PLEASE USE ORIGINAL FORM ONLY Side 1 150561,01,40 1,5056101,40 J , ~l J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: M A R J O R I E W~ BEERS 1 8 1 0 3 6 3 1 2 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1 2 2 ? 2 ? 2 ' 1 9 2. Stocks and Bonds (Schedule B) ...................................... . 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 8 Miscellaneous N Probate Property uested arate Billin Re ~ S h d l G S 7 2 6 2 0 5 7. 5 9 ....... g q ep e ) ( c e u . 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 2 8 9 :3 2 9 . ? 8 9. .................. Funeral Expenses and Administrative Costs (Schedule H) 9. 8 4 ' 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. • 11. Total Deductions (total Lines 9 and 10) ...... . ........................ 11. 8 4 . 0 D 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 2 8 9 2 4 5 . 7 8 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. 2 B 9 2 4 5 • ~ 8 TAX CALCULATION -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 .0 0 . 0 0 15. 16. Amount of Line 14 taxable at lineal rate x .045 2 8 9 2 4 5. ? 8 1 s. 17. Amount of Line 14 taxable at sibling rate X .12 D D D 17. 18. Amount of Line 14 taxable at collateral rate X .15 D ~ D D 18. 19. TAX DUE .................. ........................... .. ..... ..19. 20. FILL 1N THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0. 0 0 1 3 0 ~, 6. 0 6 0. 0 0 0. 0 0 1 3 0 1 6. 0 6 Side 2 ],505610240 15D5610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0632 DECEDENT'S NAME MARJORIE W• BEERS STREETADDRESS 419 CANDLEWYCK ROAD CITY CAMP HILL STATE ~ 'LIP PA i1?D11 Tax Payments and Credits: 1• Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. interest 4. If Line 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. Total Credits (A + B) (2) (3) (4) (5) Make check payable to; REGISTER OF WILLS, AGENT ],3,016.06 0.00 0.00 13,016.06 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 : .................................................................... .. ^ ^ 0 0 b. retain the right to designate who shall use the property transferred or its income; ............................. .. ^ 0 c. retain a reversionary interest; or .............................................................................................. .. ^ 0 d. receive the promise for life of either payments, benefits or care? ..................................................... .. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..................................................................................... " " .. ^ ^ or payable-upon-death bank account or security at his or her death? ....... in trust for 3. Did decedent own an .. 4. Did decedent own an individual retirement account, annuity or other non-probate property, which ....................................................................... contains a beneficiary designation? ........................ .. X ^ ^ 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 3 percent [72 P.S. §9116 (a) (1.1) (i)J. 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 c-f 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)). Asibling is defined, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) SCHEDVLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARJORIE W• BEERS 21 09 Ci632 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~, Principal Financial Group, Inc• stock-1,331 shs ~ 27,272.19 $20.49 per share TOTAL (Also enter on line 2, Recapitulation) ~ $ 2 7 , 2 ? 2.19 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (OS-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER•VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY -_ ESTATE OF FILE NUMBER MARJORIE W• BEERS 21 09 0632 This schedule must be completed and filed if the answer to any of questions 1 through Q on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT ANO THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °~ OF DECD'S INTEREST EXCLUSION (if aP~ica~~ TAXABLE VALUE 1. Principal Financial Group Annuity 262,057.59 100.00 62,057.59 Contract #5319021 - beneficiary Rebecca 8• Lingenfelter TOTAL (Also enter on Line 7, Recapitulation) ~ a 2 6 2, 0 5 7. 5 9 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARJORIE W• BEERS 21, 09 []632 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representatives} Street Address 2. 3. City State ZIP Year(s) Commission Paid: Attorney Fees: 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: Reg of Wills-Cumberland Co• (add'1 fees) Accountant Fees: Tax Return Preparer Fees: Register of Wills-filing Supplemental ITR & Inv 54.00 30.00 TOTAL (Also enter on Line 9, Recapitulation) (~ 8 4 • 0 0 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: MAR~ORTE W. BEERC 21 ^9 f1632 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. 9116 (a) (1.2),J 1. REBECCA B LINGENFELTER Lineal 289,245.78 236 WINDING WAY CAMP HILL, PA 1711 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18.OF REV-1500 COVER S HEET, AS APPROPRIATE. jj, NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ Ir more space is neeaea, use additional sneers of paper of the same size. Principal Financial Group Inc (PFG) -Stock chart, Index chart - MSN Money ~~.r r, . Page 1 of 1 l1 S rnarkets open a. Historica{ Prices PFG 32.27 i -0.01 -0.03% E?E ~~~ t~ nr. principal Financial Group Inc ~r;,~>~.•. ~"~" ~i!"4 r~al~'r'~ ~ ~ ~ (~ Find pricus for PFG Q OTE i FUNt~AMENLAL5 EA.RNING5 AtdALYSfS FINANL`iALS OWNERSHIP ~~;t.iCv11':1t~}iY (3t' f IC}NS HISTORICAL PRICES F PRINCIPAL FINANCIAL GROUP INC DATE HIGH LOW OPEN CLO5E VOLUME 6!17/2009 18 9500 17 9600 18.7500 18.2900 4,154.800 6/18/2009 19 9200 18.7800 19 8900 18.9'00 3,097.900 --- 6/15/2009 20 7300 1$„700 20.4300 19,4800 5,695.900 6/12/2009 215'00 20.4600 213400 20,8900 4,423;700 6i11i2009 22 020C 2.1.2400 21 3600 21.3300 3,835;8UU 6/10/2009 22 3825 21.3600 22.1300 21.6400 4,564.400 6(912009 :2.3000 214850 22.1200 219700 3,568;800 6/8/2009 '1.2.4500 21.1200 21.8300 22.1500 4,903.000 ~Go ~~~,yR:, .:;:~.... ':iti?rj ii..''t1L(: . . ~ ., i'h:1 E~,:,.. .rr~ ;ii ~drr(: ! i:'1'Ir; DATA PROVIDERS Copyright ~~ 2011 Microsoft. All rghts reserved. Quotes are real-tirne for NASDAQ NYSE and AMEX. See delay times for other exchanges. Fundamental company data and hislarical chart data provided by Thomson Reuters (click for restncticns) Reat•time quotes provided by BATS Exchange. Real-time index quotes and delayed quotes supplied by Interactive Data Real-Time Services. Fund summary; fund performance and dividend data provided by Morningstar Inc. Analyst recommendations provided by Zacks Investment Research. iP0 data provided by Hocver's Inc. Index membership data provided by SIX Telekurs. Japanese stock price data provided by ~OIT1Ufa Research Institute Ud.; quotes delayed 20 minutes. Canadian fund data provided by CANNEX Financial Exchanges Ltd. ~o, 4~ ~ l 9 ~7 ~j.9~ .~ , ~b . ~-s ~ a =- ~v. ~ 9 ~s~ ~ o. y 9 ~ sh. x / 3 3 I . Un slu ---___ http://moneycentral .msn.com/investor/chartslchartdl.aspx?PT=7&compsyms=&D4=1 &D... 1 /21 /2011 ~. financial Group February 22, 2011 STONE LAFAVER & SHEKLETSKI 414 BRIDGE STREET PO BOX E NEW CUMBERLAND, PA 17070 Re: Marjorie Beers Contract No. 5319021 Dear Stone LaFaver & Shekletski: .. Principal Life Insurance Company Princor Financial Services Corporation You recently requested a summary of the date of death values for Marjorie Beer's annuity contract. As of 06/13/2009 the value of the above mentioned annuity was $262,057.59. If you have questions about this letter, a customer service representative can be reached at :l -800-852- 4450, Monday through Friday, 7 a.m., to 6 p.m., CST. Thank you for this opportunity to be of service. Sincerely, Your representative The Principal Financial Group® RIS Annuity Services (800) 852-4450 Enc: Corporate Center: Des Moines, Iowa 50392-1770 (800) 852-4450 Securities offered through Princor Financial Services Corporation, (800) 247-1737, member SIPC. Principal Life and Princor~ are members of the Principal Financial Group®, Des Moines, lA 50391. EES>»-s ~ • . financiai Principal Life Group Insurance Company Princor Financial Services Corporation February 22, 2011 STONE LAFAVER & SHEKLETSKI 414 BRIDGE STREET PO BOX E NEW CUMBERLAND, PENNSYLVANIA 17070 Contract No. 5319021 Decedent - MARJORIE W BEERS Dear STONE LAFAVER & SHEKLETSKI, Please accept our sympathy in the loss of MARJORIE W BEERS. We know this can be a difficult time and hope this letter will help explain the choices you have regarding this annuity contract. The Contract beneficiary is Rebecca B Linjenfelter. - We need one copy of the death certificate. This copy does not need to be certified. - Each beneficiary must complete a separate Beneficiary's Statement (enclosed) providing his/her social security number/tax ID. If you have any questions, please contact the financial representative below or you may contact one of our Customer Service Representatives at (800) 852-4450. Thank you. Sincerely, Adam Draayer RIS Rnnuity Services (800) 852-4450 Your representative: Sharon Ott 000387-00086 Corporate Center: Des Moines, Iowa 5039?_-1770 ~800- 852-4450 Securities offered through Princor Financial Services Corporation, (800) 247-1737, member SIPC. Principal Life and Princor~ are members of the Principal Financial Group', Des Moines, IA 5D392. EE6717-6