HomeMy WebLinkAbout08-25-11 (2)1505610105
~. Dc (~~i ~ ~ USE ~Y F~
RSV 1500 ~ Y~
PA Departrnent of Rever-ue ~1i1ii1e„ Q,~,,. r ~ S(
Bureau ofi Individual Taxes 1NHERRANC~E~ DR SRN ~ i (1
Po Box Zso6oi RESIDEN l
~ - , PA i s28-oE~l
TiON BELOW ~p,~yy pate of Birth ~~~
ENTER DECEDENT INFORMA Date of Death
Soc-a- Security Number 03!23/1922
05127!2011 MI
187-16-5132 Decedents First Name
Suffix B
Decedent's last Name MARY
ARBEGAST
g se's Ir~orrnatlon Below MI
(ff p-PPlicaele) ErrLer Surviving ifs Suffix Spouse's First Name
Spouse's last Name
UST BE FltED 1N DUPLICATE WITH THE
Spouse's Social Security Number THIS RETURN M
RSGiSTER OF W1LL.S
IN APPROPRIATE OVALS BELOW O 3. Remainder Retum (Date of Death
FILL
p mental Retum
2. Supple Prior to 12-13-82)
~ 1. Original Retum
Federal Estate Tax Retum Required
5
O
.
4a. Future Interest Comprori~se (date of O
p 4. Limited Estate death after 12-12-82) it Boxes
Total Number of Safe Depos'
8
O
.
7. Decedent Maintained a Living Trust
t Died Testate
~ 6 (Attach COPY of wli) (Attach COPY of Tit (Date of Death O 11. Election to Tax under Sec. 9113(A)
rt
Oj
P
l
9. Litigation Proceeds Received O
p ove
e
y (,Attach Schedu
10. Spousal
Between 12-31-91 and 1-1-95)
DIRECTED T0:
F~tMA'~
tESpONDQICE AND CONFlDENTUIL TAX
- -,
~~~ Nu
SECTION M!l.ST ~ COID'L.ETED. ALL ~I
D
- TINS aytirr+e
Name r-- T
.._._ ~ ,_....
,x.
SALLY J. WINDER
N--t
LYE:
~ ~ tiYtt
~' ~
4-~-~
/~'~
First Line of Address __
~.,.,,,
221 DOUBLING GAP ROAD ..'o -'~ ~~
~
,
_
SecAnd Lme of Address ~- .
BOX 341
O
P DATE FILi=o
.
. State ZiP Code
City °r Post Office pA 17241
NEWVILLE
~~
~f;`'-'~
T <`.",~
-~~.
_'~ ;"-
.: _' T`t
~.~~ ~
~-r~
ppndent's e-mail address: anti to the hest of my ~ and belief,
this return, including acoanpanyrn9 schedules and statements. has any knovuledge.
Urxier penalties ~ perjury. I declare that I have examined ~ based on as information of which preparer
it is true, cored and complete. Dedarabon of pry other than the personal rE:presentative ATE
p~ p~SON RESPONSIBLE FOR FILING RETURN $'` 2~ Z~ + ~
SI. GN=TUBE f"L \ 1 rl / ~ _ _
ADDRESS pq 17241
10 CREEK ROAD, NEWVILLE,
ADDRESS ~
P.O. BOX 341 NEWVILLE, PA 17241 PLEASE USE ORIGINAL POfRM iDNLY
Side 1
L 1505610105
1505610105
J
1505610205
peCedent's Social Securrt~+ Number
REV 1500 EX (FI)
187-16-5132
MARY B. ARBEGAST
p~denYs tom:
RECAPfTUt-~-Ti~
........
--- 1.
.
1. Real Estate (schedule A) ............. . ................... 17,882.04
..... ... 2.
.
2. Stocks and Bends (Schedule B) .......................... . .. .
3. Closely Held Corporates. para~erslup or Sole-Pn~xietorship (Schedule C) - • - - • 3-
4. Mortgages and Notes Receivable (Schedule D) ......... . . . . . . • • - ...... 4.
, ..
72,184.65
5. Cash, Bank Deposits and Miscellaneous Peal ~ (mule E)....... 5.
3,000.00
O Separate BiNing Requested ...
Jointly Owned Property (Schedule F)
6
.... 6•
.
7. Inter-Vivos Transfers 8~ Miscellaneous O ~P~~ R~u~• - .. .... 7.
(Schedule G} 93,066.69
total Lines 1 through 7) . ....... - - - • - ....
8. Total Gross Assets ( ........ .... 8.
12,411.29
Costs (Schedule H) . .......
g. Funeral Expenses and Administrative ... _ ... .... 9'
495.26
10. Debts of Decedent, Nlort9a9e Liabilities and Liens (Schedule 1)• • • - • • • • • •
... 10.
- .
12,906.55
11. Total peductians (total ones 9 and 10) .......................... . .
11
.
80,160.14
12. Net Value of Estate(Line8minusL'me11).--••••-•---•-••--•'-""
i Bequestsl~ 9113 Trusts for which
t 12
-'•~
.....
a
13. Charitable and Govemmen
n rrta~e (Schedule J) ... .
b .... .
13.
ee
an election to tax has not 80,160.14
12 minus Line 13) .............. 14.
14. Net Value Subject to Tax (Line ......... .
TAX CALCULATION -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 .o_ 3,607.21
1 &. p-cnount of one 14 taxable 80,160.14 16.
at lineal rate X A 45
17. Amount of Line 14 taxable 17.
at sibling rate X .12
18. Amount of Line 14 taxable 18.
at collateral rate X .15 3,607.21
................19.
19. TAX DUE .........................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610205
Side 2
1505610205
O
J
~e 1~mber
REV ~ yop p( (F{) Page 3
Decedent's Complete Address:
MARY B_ ARBEGAST
STREET ADDRESS
210 BIG SPRING ROAD
aTY
ryEVWILLE
STATE
ZIP
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Paymer-ts 180.36
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the ~itlerence. This is the OVERPAYMENT
Ali in oval on Page 2, Une 20 to request a refu
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(3)
(4)
(5) 3,426.85
Make check payable to: REGISTER OF WILLS, AGENT.
LOWING QUESTIONS BY PLACING AN "X" iN THE APPROPRIATE BLOCKS
PLEASE ANSWER THE FOL Yes No
1. Did decedent make a tr~sfer and:
tl,e use or income of the property transferred ..._.....•-•-•-••-•-......
a. retain transferred ~ its incwrr{e
to who shall use the (xopertY ............................................
b. retain the right to designs ^
interest ..................
c. retain a rew,rs{onary ................... ^
........................
for life of either payrr{er-ts, a care ............................
d. receive the protn-se did d ~~ ProP~ wwitfiin one year ofi death
2. If death oecxur'ed after Dec• 12,1982, ^ ^
......................................
.. a .............................
lion ......................
vwtnout rece,wng dequath oauidera ...................... ^
n-death bank aa:otmt or security at tas or her death? ..............
3. Did decedent o~rm an'in trust fa" or ~~rable'uP° rotate property, which
4. Did decedent own an individual retirement aaount, annuit)r or other non-p ^
. ...........................
ca{tains a benefiaairy designation • ..................................
VE ESTIONS iS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN.
IF THE ANSWER TO ANY OF THE ABO 4U
r Ju 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
For dates of death on or afte ly ,
is 3 percent [72 P.S. §9116 (a} (1.1) (i)]. se is 0 percent
death on or after Jan. 1, 1995, the tax rate on the net value of transfers to ~ for the use of~ ~ d~ re of assets and
Far dates of a transfer m a sut~v~9 spouse from tax, and the stabtrtary ~
[72 P.S. §9116 (a) (1.1) (a)]. The statute does riot exempt ~ ~ ~ ~~
filing a tax return are still apptigble even if the survnnng spouse
For dates of death on or after July 1,2000: ~ ~ death to or for the use of a natural parent, an
The tax rate on the net value of trar>sfers from 2 Pde 12) ~ ~ ~~
adoptive parer>t ~ a sl~paa~'ent ~ the ithtld {s 0 percent (l
y~ ~ fi^s to or for the use of the decedert's benefice ~ 4.5 p exc~t ~ r#ed in [72 P.S. §9116(a)(1)J.
The tax rate rmposed on the net 13 A sibl{ {s defined,
to im on the net value of transfers to or for the use of the decedent's siblings is 12 per'c~t~2 P~S•~§ ~fiona)~ • )]• n9
The tax ra p~ {n comrrmn with the decedent, Y
under Section 9102, as an individual who has at feast one Parent
pq ~ 17241
(1} 3,607.21
Total Credits (A + B) (2) 180.36
RE~1503 EX+ (6-~)
SCNENt~1.E B
~a„ IM,~T,., of ~NNSnvANIA STOCKS & BC)1~IDS
IN RF~r)ENT DECEt~ RN
ESTATE OF
MARY B. ARBEGAST ~ ~ sd> F
~ P ja,Mdy-a~,ed ~!, ,;fit of ~a'vi+
ITEM ~SCRIP'TiON _
NUMBER
~- 25 US SAVINGS BADS PER ATTACHED DETAILED UST OF NUMBERS AND VALUES
18 US SAVINGS BONDS PER ATTACHED DETAILED UST OF NUMBERS AND VALUES
2.
3. ADAMS ELECTRIC CO-OP, PATRONAGE ACCT
FlLE NUMBER
21-11-0681
VALUE AT DATE
OF DEATH
8,455.28
9,350.52
76.24
17,882.04
TOTAL {Also ever on dine 2, Recapitutafron) i
(If more space ~s needed. insert addfional streets of the same sae)
Calculated Value of Your Paper Savings Bond(s)
ted Value of Your Paper Savings Bond(s)
Caicula
Calculator Results for Redemption Date 05/2011
Total Value Total Interest YTLI Interes#
Total Price 7 236.53 $0.00
X1.218.75 $8 455 28 $
Bonds: 1-25 of 25
Page 1 of l
Issue Next Final Issue Interest
Interest Rate Value Note
Serial # Series Denorn Date d-ccruai Ma#urity
005 Price
$75 00 526.28 MA
c1050293758e
91 E
E $100 01/1975
08/1974
$100 01/2
6 0 445.08 $520.08
08
$520 MA
MA
e
c10369707
c1031111375e E .
.
$100 06/1974 2004
0
/
004 $75 00
00
$75 $445.08
$438.92 .
$5
I
c1026168548e
791e E
E 100 04/1974.
$
$100 02/1974 04/2
02/2004 .
$ 13.92
04
$527 MA
MA
c1026179
c1023772864e E $100 11/1973 11/2003
09/2003 75 00
$
$75.00 $452.04
$452.04 .
.
$
c1020395653e
c1014118292e
E
E
$100 09/1973
$100 07/1973
07/2003
$75.00
$450.84
$x
525.84
519.56
MA
MA
c10106609873 E $100 04/1973 04/2003
/ $75 00 •56 $519.56 MA
c100g876070e
c1005270278e E
E $100 02/1973
$100 10/1972 2002
10
/ $75.00 $.20
4
0 $512.20
525.04 MA
MA
c1042125522e E
E $100 11/1974
1972
$100 12/ 11/2004
12/2002 $75 00
$ 2
3
$438. $513.32 MA
c1006687048e
88e
120292101
E .
$50 07/1976
07/2006
$37.50
$235.14
$127.
MA
g5026757320e E
E $25 07/1972
$25 05/1972 05/2002
0 I $18.75 $107.44. $126.19 MA
g5011926555e
2634833802e
q
E
$25 03/1972
03/2002
$18.75
. $10~'~91
$126.66
MA
g2621421283e
2603063176e E
E $25 12/1971.
$25 10/1971 1%2001 $18.75 $107.61
61
07 $126.36
$ MA
g
2584428381e
q
E
E
$25 08/1971
$25 06/1971
08/2001
,
$18.75
.
$1
7
126.95
60
6
MA
MA
g2576397266e
g2551475487e E $25 03/1971 2001
03
/
01 $18.75
75
$18 .85
$10
$107.55 .
$12
$
544042924e
q2
37
E
E
$25 01/1971
$25 11/1970
01/20
J
.
139 69
MA
MA
e
Q25258730
g2512743425e E 08
2000
$25 08/1970 /
Totals for 25 Bonds $18.75
1 218.75 $120.94
7 236.53 $139.69
8 455.28
Notes
NI Not Issued
NE Not eligible for payment
P5 Includes 3 month interest Penalty
MA Matured and not earnin interest ,.~
http://www,treasurydirectgov/BCISBCPrice 8/4/2011
Calculated Value of Your Paper Savings Bond(s)
Iculated Value of Your Paper Savings Bond(s)
Ca
Calculator Results for Redemption Date 05 J 2011
T®tal Price Iota! Value Total Interest
$1.312.50 $9,350 52 $8,038.02
Bonds: 1-18 of 18
Pagelofl
YTD Interest
X0.00
Issue Next Final Issue
Serial # Series Denom date Accrual Maturity Price
12029210187e E $50 07/1976 07/2006
04/2008 $37.50
$75.00
c2057675424e
c2057675102e E
E $100 _04/1978
$100 02/1978 .0212008 $75.00
c2053093838e E $100 1211977 12/2007
09/2007 $75.00
$75.00
c2052772726e
c2042114586e E
E $100 0911977
$100 05/1977 .
05/2007 $75.00
c2046298819e E $100 07/1977 07/2007
02/2007 $75.00.
$75.00
c2038888743e
c2032340878e E
E $100 02/1977
$i00 12/1976 12/2006 $75.00
c2029840355e E
E $100..10/1976
$ 10/2006 $75.00
c2025106522e
c2019558957e
E i~ 05/1976
$ 05/2006 $75.00
c2015018399e E $100 03/1976 03/2006
12/2005 $75.00
$75.00
c2009966926e
c200982815e E
E $100 12/1975
$100 10/1975 .
_
10/
c2002052845e
E
$100 08/1975 2005
08/
06/2005 $75.00
$75.00
c2002036369e
c1051518567e E
E $100 06/1975
$100 04./i975
04/2005 .
Tabis for 18 Bonds 1 312.50
$
Notes
NI Not Issued
NE Not eligible for payment.
P5 Includes 3 month interest penalty
MA Matured and not earnin interest
s~~~r ssaz
Interest: iRate
$235..14
$359.1.6
$438.80
$438.80
$483.68
$482.60
$483.68
$477.16
$477.16
$470.28
$470.28
.$469.16
$464.04
$464.00
$457.60
$457.60
$457.60
$451.28
Value Note
$272.64 MA
$434.16 MA
$513.80 MA
$513.80 MA {
$558.68 MA {
$557.60.. MA {
$558.68 MA
$552.16 MA
$552.16 MA
$545.28 MA
$545.28 MA
$544.16 MA {
$539.04 MA {
$539.00 MA
$532.60 MA {
$532.60 MA {
$532.60 MA I
$526.28 MA I
(9.350.52
http;//www.treasurydirectgov/BC/SBCPrice 8/5/2011
~ pennsylvan~a
DEPARTMENT OP REVE['!Uf
I17'ANCE TAX RETt)RN
nccrr~.liLr oE~NT
EsTaTE oF;
MARY B. ARBEGAST
scN~ou~ E
~, BANK DEPOSITS &~/MISC.
PE~~u.7V`~ ~1/~R, 1
FILE NUMBER:
21 _11-0681
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~ pennsylv~arria
~~~a 70INT~-Y-0WNE~ PR~ER"i'Y
~ N~s~:
21-11-0681
ESTATE OF: to 6.
MARY B. ARBEGAST ~ one ~ ~ the wt's dabs of death. ~ ~ ~ °~
If an asset bed ] ~'"~~` with ~-RONSHIP TO DECEDENT
ppDRESS _
SURVMNG JOINT TENAtVT(S) NgME(S)
Gp~.ST,111 10 CREEK ROAD, NEV1M11E, PA 17241
A• pAN1EL H. ABBE
B- HARRY ROt_HFS
C.
SON
~pOWER OF SUSAN
13 SYI._VESTER ST., E_ I.ONGMEADOW. MA 01028 Ft01-tLFS, NAMED
BENEFICIARY
30IHTLY OWNED PROPERTY:
rr~ ~ ~ ~ nrciuoE ~ ~ ~ ~mY
stx~ ~ ~
1• A- 04101199 ADAMS C~NTY NATIONAL ~-NK, CD
B_ 04A1J'99 Cp~IY NAT10!`IAL BANK. CD 1
~ of oar of od-~r+
orctf aF ors o ~~s`r
vuu~ of ~ n
3,000 ~ 50 1,500.00
3,000 ~ 50 1,500.00
TOTAL (Also enter on Line 6, Recap'~tufabon~ ~
If more space is needed, use additional sheets of PaP~ ~ ~ sart-e size.
3,000.00
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. ~~,. SCHEDULE H
pennsyl~nia FuNERp~, EXPENSES AND
DEPARTMENT OF REVENUE ppN1INISTRA'TIVE COSTS
A"~ Tax ~~' FILE NUMBER
aesn~ o
21-11-0681
ESTATE OF
MARY B. AR6EGAST p~ents debts ~~ ~ ~, sd>tedule i.
ITEM ~ESCRIP'TION
NUMBER
A Fl1NERAI- EXPENSES:
t. EDGER FUNERAL HOME
g. ADMINISTRATIVE COSfS=
1. personal Restive Commrs=
Name(s) of p~satal Rtative(s)
Sheet Address State ____-.ZIP -
Year(s) Commiss~- Pa+d'
2, Attorney Few:
s address is not the same as daimar~t's, atbch ~"~•~
3, family Exernpti-on: {If decedet~
Claimant
Street ~~ ZIP ___--
State
~Y -
Relation~-ip of Claimant to Dement
4. Probate Fees:
5. Accotm~ ~:
6, Tax Return preparer Fees:
~. CUMBERLAND LAW JOURNAL, Ap~RTISE LETTERS
g. VALLEY TIMES STAR, ADVERTISE LETTERS
g. RESERVE FOR FIDUCIARY INCOME TAX 2011
AMOUNT
7,045.02
4,649.52
276.50
200.00
85.00
55.25
100.00
tulation 1211.29
TOTAL {Also enter on une 4, Recapi ) $
If more space is needed, use additional sheets of paper of the same size.
~:~ -...:4 _~.= ;.-- SCHEDULE I
~ pennsyLvania ~,~ of D~~~•
pEPARrMEN7 OF REVENUE ~pRTGAGE LIABII-3TI~ S~ LIENS
~ arx pILE NUMBER
21-11-0681
E51'ATE OF indudin+3 unreimbursed medical expenses
MARY B. ARBEGAST ~ dead that remained unpaid at the date of VALUE AT DATE
Report debts inatrred by the deced~ Rte' OF DEA7ti
rrEM DESCiuarto~ 5.50
NUMBER
1 • DEBORAH PfP~, TAX CpLLECT~, ~- TAX 88.82
M1U.ENIIUM PHARMACY,'~~f~~ ~~~ ACCT 238.94
2.
MII_LENIUM P'HARMACY,1sRESCRIPTION MEDf~" ACCT 162.00
3.
4. DARRYL GUISTUfTE, MD, OUTSTANDING BALANCE
495.26
TOTAL (Also enter on Une 1.0, Recapitulation) ~
If more space is needed, insert additional .sheets of the same size.
REV-1513 E)C+ (Ol-1D)
Pennsylvania
pEpARTMENT OF REVENUE
~,~{~~ TAX REItIRN
o~r~rr o~
SCHEDULE ~
BENEFICIARIES
ESTATE OF:
MARY B. ARBEGAST
NUMBER NAME AND ADDRESS OF PBtSON{S) RECEIVING PROPB~
I TAXABLE DLL ~ °~~ M~ ~ ~
Sec 9116 (a) (1.2).]
i. DANIEL H. gRgEGAST,111,10 CREEK RD, NEVYVIU-E~ PA 17241
2. DANIEL H. ARBEGAST, N,10 CREEK RD, NEYWii-LE~ PA 17241
3 ~BE~ ~SCAIIEET, 21210AKDALE RD, CH~LO~, NC 28216
4. ABBY R. LAGERVAL, 51 PARK AVE, EAST BRIOGEWATER, MA 02333
5. ZACHARY ROHLFS,178 TOWN FARM ~• COVENTRY, RI
g_ BARRY ROLL-IFS,13 SYLVESTER ST, E LONGNIEADOW, MA 01028
RELATIONSHIP TO DECEDENT
FILE NUMBER:
21-11-pfi81
AMOU1~(T OR SHARE
of ESTATE
Do NO[ use
~--~-
sa+
c,RnN~or~
c~rsnNOOnuc~R
GRpNDDAUGHiER
GRANDSON
SON IN LAW
112 RESIDUE
1/4 BONDS
1 i4 BONDS
1/4 BONDS
114 BONDS
HEIR AT LAIN
SHOWN ABOVE ON LINES 15 T1{ROt1GH 18 OF REV-1500 COYER SHEET, AS pppROPRIATE.
ENTER DOLLAR AMOUNTS f~R DLSTRIStTTIONS
NON-TAXABtF DISTRIBUTIONS
A. SPOUSAL DISTRIBUnONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT T
1.
B. CHARITABLE AND GbYERNM{B~ffAL Di~iTRIBUTIONS=
1.
mTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 Of REV 1500 COVER SHEET. $
0
If more space is needed, use add'fional sheets of Paper or me sa~~~ ~«.