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Home My WebLink About09-19-11J 1505610140 REV-1500 ~` (°'-'°) PA Department of Revenue Bureau of Individual Taxes OFFICIAL USE ONLY Po sox 2aosol County Code Year File Number INHERITANCE TAX RETURN Harrisbur PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 2 6 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MPotDDYYYY 2 0 2 2 6 5 4 3 3 0 1 2 4 2 0 1 1 0 2 1 4 1 '9 3 2 Decedent's Last Name Suffix Decedent's First Narne A N D E R S O N MI E L E A N O R E L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Sociaf Security Number THIS RETURN MUST BE FILED IN DIJPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate ~ prior to 12-13-82) 4a. Future Interest Compromise {date of ~ 5. Federal Estate Tax Return Required d ^ 6. Decedent Died Testate ~ A eath after 12-12-82) 7. Decedent Maintained a Livin Trust 0 ( ttach Copy of Will) 9 Liti atio P g 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) . g n roceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec 9113(Aj betw . een 12-31-91 and 1-1-95j (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED Name . ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: D A V I D W Daytime Telephone Number R E A L E R 7 1 7 7 6 3 1 3 8 3 First line of address 2 3 3 1 M A R K E T Second fine ofi address City or Post Office C A M P H I L L S T R E E T State ZIP Code REGISTER O ..- I~S USE ONLY_ ~_~ r. .., , ~~ TJ_, r- ,~.rR - - _~? ~ ~., ~--j =;_~ ~..~ ~ = DA FILED -- P A 1 7 0 1 1 -•~ C:., ;z Correspondent's e-mail address: DWREAGERaREAGERADLERPC • COM Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct an complete. Duration o repave other than the ersonal re resentative is based on au ~~r~r,.,~s,,...,~ ....:,... _.____ ~~ r e ~/¢ ~__ P P ADDRESS v 406 CKY ROA SIGNATURE OF PRFPARER 2331 MARKET STREET CAMP HILL PLEASE USE ORIGINAL FORM ONLY P A 17 011 Side 1 1505610140 1505610140 J ~~ 150561024^ REV-1500 EX Name: ELEANORE L • ANDERSON 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 and Notes Receivable (Schedule D) .... ........ . .. . .. .... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. 6. Jointly Owned Property (Schedule F Requested 7 ^ l .... . Inter-Vivos Transfers & Miscellaneous No n--Pro ate Prop erty (Schedule G) ~ Separate Billing Requested ... 6. .... ... 7. 8. Total Gross Assets (total Lines 1 throw h 7 9 ) ... ..................... ... 8. 9. Funeral Expenses and Administrative Costs {Schedule H) .......... , g 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10. 11. Total Deductions (total Lines 9 and 10) ........ . ................. 11. 12. Net Value of Estate (Line 8 minus Line 11) . ........... . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 an election to tax has not been made {Schedule J) ........... . 14. Net Vatue Subject to Tax (Line 12 minus Line 13) . ................... TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15 ..1a. . Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)X.0 0 , D 0 16. Amount of Line 14 taxable 15. at lineal rate X .045 1 6 0 1 8 0. 4 2 17. Amount of Line 14 taxable 16. at sibling rate X .12 0 . 0 0 17 18. Amount of Line 14 taxable . at collateral rate X .15 D 0 D 18 19. TAX DUE ......... ............................................ .19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 Decedent's Social Security Number i? 0 2 2 6 5 4 3 3 1 5 2 7 7 4. 0 0 2 1 0 4 5. 0 0 1 7 3 8 1 9. 0 0 9 2 9 0. 3 2 4 3 4 8. 2 6 1 3 6 3 8. 5 8 1 6 0 1 8 D. 4 2 1 6 0 1 8 0. 4 2 D. D o 7 2 0 8. 1 2 D. D o O. D D 7 2 0 8. 1 2 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENTS NAME 21 11 ELEANORE L . AND_E_R_SON STREET ADDRESS - -_ _ 1100 GRANDON WAY cirY - - - _ MECtiAtiICS9UftG STATE PA Tax Payments and Credits: t Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 6 , 8 0 0.0 0 B. Discount 357.88 3. Interest Total Credits (A + B ) 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. 0262 ZIP 17055 (1) 7,208.12 (2) 7,157.88 (3) {4) 0.00 {5) 5 0.2 4 ce p aya I _ _ e to: REGISTER OF WILLS, AGENT e... , _. _. c .. „.. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLA + CING AN "X" IN THE; APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; Yes No . .................................... X b. retain the right to designate who shall use the property transferred or its income; .................. c. retain a reversions interest; or ^ X^ ry ..................................... ^ d. receive the promise for life of either payments, benefits or care? ~~~~ ~~~~~~~~ ~~~~~~~~" ^ X .......... X Z. 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~eath 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? ........................................ ......................................................... ^ a THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE S CHEDULE 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 survivin 3 percent p2 P.S. §9116 (a) (1.1) (i)]. g spouse is 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 stafute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disGosure 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 c>r 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.;;. §9116(a)(1.3)]. Asibling is defined, under 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) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ELEANORE L. ITEM NUA4BER 1. SCHEDULE B STOCKS & BONDS R S 0 N FILE: NUMBER ~, ~y Ly All property jointly-owned with right of survivorship must be disclosed on Schedule F. a~scRiPrfav AMERITRADE - STOCK ACCOUNTS X757-719908 PO BOX 2209 OMAHA, NE 68103-2209 0 VALUE AT DATE CIF DEATH 152,774.OD TOTAL (Also enter on line 2, Rec~lpitulation) I ; (If more space is needed, insert additional sheets of the same s¢e) 15 2 , 7 7 4 REV-7508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ----~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ELEANORE L• ANDERSON FIL.ENUMBER InGude the proceeds of litigation and the date the proceeds were received by the ~~~~ 11 D 26 2 All property jointly-owned with right of survivorship must be dlscbsed on Schedule F. ITEM NUA4Bl:R VALUE AT DATE D!_SCRIPTION t• AMERITRADE - CASH ACCOUNT - #757-719908 OFDFATH P4 BOX 22D9 2,482•D^ OMAHA, NE 681D3-22D9 2• GIFTS GIVEN FROM MEMBERS 1ST ON 1/24/2011 18,ODD•DO 3• PERSONAL PROPERTY 5DD•DD 4• OMNI CARE (PHARMACY) REFUND 63•D^ TOTAL (Also enter on line 5, RE;capitulation) I ~ (IF more space is needed, insert addigonal sheets of the same size) 21, D 4 5 REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT DF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS is l A f t vF ELEANORE L• ANDERSON FILE NUMBER 21 11 0262 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. CREMATION - AUER CREMATION SERVICES 1,650.00 2• MINISTER SERVICES 200.00 3• MEMORIAL SERVICE DINNER - FIREHOUSE RESTURANT 3,621.82 B 2. 3. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) S1rP,ef Address City State Years} Commission Paid: AttomeyFees: REAGER 8 ADLER, PC Family Exemption: (If decedents address s not the same as daimanYs, attach explanation.) Claimant ZIP 3,500.0^ 4. 5. 6. 7. Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS Accountant Fees: Tax Retum Preparer Fees: 318.5^ TOTAL {Also enter on Line 9, Recapitulation} S If more space 's needed, use additional sheets of paper of the same size. REV-7512 EX~ (12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE'rAXRETURN MORTGAGE LIABILITIES, r~ LIENS RESIDENT DECEDENT to r A r t ur FILE NUMBER ELEANORE L• ANDERSON 21 11 ^262 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. OBITUARY - PATRIOT NEWS 251.97 2• PODIUM RENTAL - A-1 PARTY RENT-ALL 11.66 3• FINAL PHONE - VERIZON 6.00 '1- 2fll~fl TAXES - PA DEPARTI1ENT OF REVENUE 21•flfl 5• AMBULANCE - EAST PENNSBORO AMBULRANCE b8.25 6• GENESIS REHABILITATION 30.00 7• AMBULANCE - ADVANTAGE AMBULANCE INC• 150.00 8• FUNERAL FLOWERS - NANCY THOMPSON 583.00 9• JANUARY MEDICARE SUPPLEMENT - UNITED HEALTHCARE 127.8? 10• AMBULANCE - ADVANTAGE AMBULANCE 150.00 11• WEST SHORE EMS 81.89 12• CO-PAY/DEDUCTIBLE DUE - HEALTHSOUTH 750.00 13• PINNACLE HEALTH HOSPITALS 1,000.00 14• WEST SHORE EMS - ALS 1,001.62 15• 2LOTOFF, GILFERT 8 GOLD 8fl-flfl TOTAL (Also enter on Line 10, Recapitulation) 15 4 , 3 4 8 If more space 'rs needed, insert additional sheets of the same size. REV-1573 EX+ (01-70) Pennsylvania DEPARTMENT~OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: ELEANORE L. ANDERSON NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [Indude ouhhq' ht spousal distributions and Transfers under Sec. 91f6 {aj (1.2j.J 1• ROBERT B ANDE 2• 3• 4. 5• b• RSON 406 RICKY ROAD MECHANICSBURG, PA 17055 NANCY A- THOMPSON 7L122 SLEEPY ti0LL01~ ROAD HARRISBURG, PA 17112 DAVID J• ANDERSON 955 BURRWICK DRIVE GRAND RAPIDS, MI 49546 BRUCE M. ANDERSON 904 LANCELOT AVENUE MECHANICSBURG, PA 17055 SUSANNE D. ANDERSON 2300 BRANDERMILL PLACE CHARLOTTE, NC 28226 ti$ILLIAri C• ANDERSON 305 INDIAN CREEK DRIVE MECHANICSBURG, PA 17050 FILE NUMBI 21 11 ITIONSHIP TO DECED Do Not List Tirustee(s) Lineal Lineal Lineal Lineal Lineal Lineal 26,696.74 26,696.74 26,696.74 26,696.74 26,696.73 26,696.73 _ I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV 1'500 COVER SHEET, AS APPROPRIATE. NON TAXABLE DISTRIBUTIONS. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART lI -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size. D AMOUNT OR SHARE OF ESTATE