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Home My WebLink About05-05-11 (3)1505610143 REV-1500 EX (01-10) PA De artment of Revenue OFFICIAL USE ONLY p pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTI~NT OF REVENUE PO 80X.280601 INHERITANCE TAX RETURN 21 11 0356 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 207 34 9695 12 29 2010 10 12 1912 Decedent's Last Name Suffix Decedent's First Name MI JOHNS ROSEMARY (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Return ^ 2. Supplemental Return ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ g Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 9. litigation Proceeds Received ^ 1 p, Spousal Povertyy Credit (date of death between 12-31 zJ1 and T-1-95) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ZIP Code CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number WM D SCHRACK III ESQ 717 432 9'733 First line of address 124 W HARRISBURG STREET Second line of address City or Post Office State DILLSBURG pA Correspondent's a-mail address: ^ 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tex Return Required 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) r-- _. REGISTER OF 1~111tCS USE OW~f ~7 - - - ~-~ _ _I f J,--, Y ~~ r -....~ ;~ - . :-~--, - . ._':; DATE~'FILED ,'J ~•: c 170191268 {.'t f •,J ~~ '~~ unaer penalties of penury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the persona-I representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPON~LE FOR FILING RETURN DATE ADDRESS anne Fritz 516 Allenview Drive, Mechanicsburg, PA 17055 SIGNATURE OF PREP THER THAN REPRESENTATIVE Wm. D. Schrack III ~"~ ADDRESS 124 W. Harrisburg Street, Dillsburg, PA 17019-1268 1505610143 Side 1 1505610143 a~ J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: JOhr1S, Rosemary 2 0 7 3 4 9 6 95 RECAPITULATION ------ ------ ---- 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) .......................................... 2 ................................... . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. $ 6 63 9. 4 3 7. Inter-Vivos Transfers 8~ Miscellaneous I~nq Probate Property (Schedule G) S , ^ eparate Billing Requested............ 7. 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. $ 6 , 63 9.43 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... --- 9. 1.2 , 4 2 5.90 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11 12 , 425.90 12. Net Value of Estate (Line 8 minus Line 11) ................... ....................................... 12. 7 4 213 5 3 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. 7 4 , 213.5 3 TAX COMPUTATION -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 .00 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X .045 74 , 213.53 16. 3 , 33 9.61 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. 0. 0 0 19. Tax Due .................................................................................................................. 19. 3 , 3 3 9.61 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ~^ Side 2 1505610243 150561U243 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Johns, Rosemary STREET ADDRESS 100 Mt. Allen Drive, Messiah Village CITY Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 2,900.00 152.63 File Number 21-11-0356 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. STATE ZIP PA- 17055 (1) 3,339.61 Total Credits (A + g) (2) 3,052.63 (3) (4) (5) 286.98 ~.~ , Make Check Pa able 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 :................................ [_] .... .. x b. retain the right to designate who shall use the property transferred or its income :.................................. [_] c. retain a reversionary interest; or ............................. [_] [~ . .... ......................................... x ................................... 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? ............... [_] ^ ............................................................ x ......................................... 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? ................ ~_~ 0 ............. ... . .... ............................................................................. 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)J. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blr~od or adoption. Rev-1509 EX+ (6-98) ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Johns, Rosemary 21-11-0356 It an asset was made joint within one yearof the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP' TO DECEDENT A. Roseanne Fritz 516 Allenview Drive Daughter Mechanicsburg, PA 17055 B. C. JOINTLY OWNED PROPERTY: ITEM LETTER FOR JOINT DATE MADE DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH % OF DATE OF DEATH VA NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSE DECD'S INTEREST LUE OF DECEDENT'S INTEREST 1 A 1/04/2007 PSECU -Account #8885506645 - C50 12 82,710.84 50.000% 41,355.42 month Certificate of Deposit 2 A 1/04/2007 PSECU -Account #8885506645 - C51 12 21,827.88 50.000% 10,913.94 month Certificate of Deposit 3 A 1/04/2007 PSECU -Account #8885506645 - C52 6 month 60,863.20 50.000% 30,431.60 Certificate of Deposit 4 A 01/04/2007 PSECU -Account #8885506645 - S01 Regular 124.34 50.000% 62 17 Shares . 5 A 1/04/2007 PSECU -Account #8885506645 - S04 7,343.72 50.000% 3,671.86 Checking Account 6 A 1/04/2007 PSECU -Account #8885506645 - S07 Money 408.87 50.000% 204.44 Market Account TOTAL (Also enter on Line 6, Recapitulation) 86,639.43 (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 F (Rev. 6-98) REV-1151 EX+ (10-06) ,.~ INHEf31 AN~ T ET RN COMMORE~DENH DE~EDNEN~YLVANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS tSTATE OF ITEM NUMBE A. Johns, Rosemary Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: See continuation schedule(s) attached FILE NUMBER 21-11-035fi AMOUNT 10,645.90 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(sl Commission paid 2. Attorney's Fees Wm. D. Schrack III 1,750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zia Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 30.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 12 425.90 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Johns, Rosema FILE NUMBER 21-11-0356 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Cocklin Funeral Home 9,745.90 2 Honorarium for Pastor, Sexton and Organist at Memorial Service 400.00 3 Luncheon following funeral Service 500.00 H-A 10,645.90 Qther Administrative Costs 4 Miscellaneous expenses during administration 5 Register of Wills -file Inheritance Tax Return H-B7 15.00 15.00 30.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (11-08) ~~ COM IKONEERITANCEOFq~PERKETS RNANIA RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Johns, Rosema NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)1 FILE NUMBER 21-11-0356 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT 0 of 'st tee (Words) ($$$) Roseanne Fritz Daughter 50% of residuary 516 Allenview Drive estate Mechanicsburg, PA 17055 Kim William Johns Son 50% of residuary Post Office Box 126 estate Waymart, PA 18472 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 ovOeasheet, as a ro II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET Copyright (c} 2GG9 form software only The Lackner Group, Inc. Form PA-15nn SchedulP,~ (RPV 11-08) January 31, 201 1 Account # 888XXXXXX WILLIAM D SCHRACI{ III 124 W HARRISBURG ST DILLSBURG, PA 17109 Dear MR. SCHRACK: The following is the status of ROSEMARY JOHNS's account with PSECU as of the date of death Joint Owner's Name ROSEANNE FRITZ, ADDED 01.04.2007 AS JOINT TENANT W/ROS Date of Death 12.29.2010 Date of Birth 05.10.1912 Share Description Open date Balance Accrued Dividend S O1 Regular Shares 08.04.2006 $ 124.30 $ 0.04 S 04 Checking 08.16.2006 7,343.55 0.20 S 07 Money Market 08.20.2007 406.22 2.65 C 50 12 Month Certificate 08.23.2006 82,641.74 69.10 C 51 12 Month Certificate 01.03.2007 21,802.96 24.92 C 52 6 Month Certificate 08.23.2007 60,821.21 41.99 The dividend earned from January 1, 2010 through the date of death was $2,515.72. The decedent had no loans with us. We do not have safe deposit boxes for our members. lfyou have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu pt-ompt, enter 6 and then extension 2227. Sincerely, ,a . ,7° ~ . ~ ~. - ~Gi,u`li. Meade Fairfa~e Member Service Representative Finance Support Unit ~enevsylwanla ~p~ate I~a~~9~~e~~ ~r~~9av 4~~ua~69 Main Address: 1 Credit Union Place, Harrisburg, PA 1 71 1 0-2990 • 71 7.234.8484 • 800.237.7328 n'!ai!ing Address: PO. Scx 67013 Harrisburg, PA 1 71 06-701 3 a 71 7 777 21 L1~ Trl~l • Pnn o o /T nt (~~ ) ...,,..47.1 67,,D , This credit union is federally insured by the Nationol Credit Union Administration. E ual O ~®~~~~~~®699 q pportunity Lender