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Home My WebLink About11-07-11 (2) REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Hanisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth ~" ~" ~° ~' Decedent's First Name MI ~„ C O N N I E L w~ Spouse's First Nama MI ~~ .. , THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate. Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between t2-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DI Name RECTED T0: Daytime Telephone Number S 7 1 7 6 6,6 1 Firm Name ^f Aoolicablel REGISTER OF WILLS USE ONLY n First line of address .~ n ~? ~ ~r- ,-~- C/ Z r; r.. C7 "" ~ ~ ' Second line of address 2> r r ' < -T *~ r7 t 1 ... ~ .. .> G~ Cl? ~ ~ ,. r": _ r City or Post Office State ZIP Code FlLED ~' r .:' _ _.._ -- L - __ r r-r ~ ~ ~ Correspondent's a-mail address: Under penalties of perjury, 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 re arer th th th . p p f e er an e personal representative is based on all iMormation of which preparer has any know i ledge JIUrvN1UKG Vr Yt KYtlI1 KLSPOAASIRI F~II ul s AFTI IoAI_ THAN REPRESENTATIVE 3107 N. Front St., Harrisburg, PA 17110 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 15056051047 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN ' RESIDENT DECEDENT J REV-1500 EX rlwrtwdwnYc Name' RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 1 M 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3 } ,~ar~ ri 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 8. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7 1 8. Total Gross Assets (total Lines 1-7) .................................... 8. 3 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. ~„ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 8 10) ................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental BequestslSec 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. 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 .0_ 15. 18. Amount of Line 14 taxable at lineal rate X .0~ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052048 O Side 2 15056052048 15056052048 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21-09-0962 DECEDENT'S NAME _ Connie Lee Fahnestock STREETADDRESS 303 W. Maple Ave. CITY - STATE Shiremanstown PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit __ B. Prior Payments C. Discount Total Credits (A + B + C ) 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E ) 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) $9620.03 (2) (3) $428.39 (4) (5) $9620.03 (5A) $428.39 (5B) $10,048.42 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 December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ...................................................................................................... ........ 3. Did decedent own an "intrust 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? .................................. .............................................................................. ........ THE ANSWER TO ANY OF THE A BOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. REV-1502 EX+ (11-08) ;y. a? ~ pennsytvania SCHEDULE A DEPARTMENT OP REVENUE INHERITANCE 7Ax RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Connie Lee Fahnestock 21-09-0962 ~~would be exchanged between a willing buyeaand a willingosel er~ neitheebeir~g wmpelled to buy oaseil, both having reasonable~krwwledge of thearelevant facu~ Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the setNement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 ~ I Single family dwelling being known and numbered as 303 West Maple Ave., Shiremanstown, PA TOTAL (Also enter on tjne 1, Recapitulation.) I ~ If more space is needed, insert additional sheets of the same size. 160,000.00 160,000.00 REV-1503 EX+ (6.98) ~ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Connie Lee Fahnestock 1- 9-0962 All property jointly-owned with richt of survivorship must he disr.InsnA ~~ cG-h.n..r~ c ~~~ ~~MC ~ncx li f19Bp8p~ insert aWNpnal sneers Of the same SIZe) REV-~5o8 IX+ (13-10) Pennsylvania L~ DEVARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY W IA I C VF: FILE NUMBER: Connie Lee Fahnestock 21-0900962 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1 M&T Bank account no.1873 1,043.23. 2 , .Sovereign Bank account no. 5805 15,293.57 3 Sovereign Bank account no. 8346 1,157.75 4. Federal Income Tax refund for 2009 1,367.00 5. 1994 Plymouth Sundance Sedan - poor condition -over 100,0110 miles 500.00 6 Lady's 14k yellow gold diamond fashion ring` 270.00 7 Lady's 14k white gold diamond pendant 225.00 8. Ceramic cookie jar _ 5.00 9. Furniture -net sales price 638.70 TOTAL (Also enter on Line 5, Recapitulation} ; 2 0 , 5 0 0.2 5 If more space is needed, use addRional sheets of paper of the same sae. REV-1,509 EX+ (oi-io) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~E F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Connie Lee Fahnestock 21-09-00962 If an asset became jointly owned within one year of the decedent's date of death, it mwt be nBPorbed on Schedule G. SURVl1/tNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. tzora F. Roemer $03 West Maple Avenue Mother Shiremanstown, PA (at date of death) B. i i JOINTLY OIIYNED PROPERTY: LETTHt DATE DESCRIPTION OF PROPERTY ITEM FDR (DIN T MADE INCLUDE NAME OF FINANCIAL BiSTITUTlg1 AND BARK ACCOUlTT NIMKlER OR SIMBAR OY1TE ()F DEATH x qF DECEDENTS DATE OF DEATH NUMBER TENANT X/DPr.. ......IDENTIFYING NUMBER. ATTACH DEED FDR JOINTLY HEIR REAL ESTATE. VALUE OF ASSET .INTEREST VALUE OF DECEDENTS INTEREST 1. A. 03117/98 Sovereign Bank, acd. rro. 05711130985 2,100.75" 50 1,050.38 2. A. 0610?109 Sovereign Bank. acd no. 1684304221 4,001.77 100 4,001.77 TOTAL (Also enter on Line 6, Recapitulation) I ¢ 5,052.15 If mare space is needed, use additlonal sheets of paper of the same size, REV-1510 EX+ (OB-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAT( RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRAN5FERS AND MISC. NON-PROBATE PROPERTY ESTATE Of fILE NUMBER Connie Lee Fahnestock 21-0900962 This xhedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. 1TEM DESCRIPTION OF PROPERTY NUMBE INQUDE Tiff NAME OF THE TM16f81EE, THEIR RHA710NSHIP TO DECEDENT AND R DATE OF DEATH 96 OF DECD'S EXCLUSION TAXABLE THE DATE of TAAlISA<R ATTAQI A copy OF THE DEED R1R nEAI esrATE VALUE OF ASSE T INTEREST pr APPUG9IE) VALUE 1, Oppenheimer IRA account no 5036 1,473.0 6 100 0.0 0 1,473.06 Oppenheimer IRA account no. 1811 2. 9,726.9 9 100 0.0 0 9,726.99 Oppenheimer IRA account no. 9627 3.. 10,132.5 0 100 0.0 0 10,132.50 Oppenheimer IRA account no.1432_ 4. 663.19 100 0.0 0 663.19 America Funds IRA account no. 7865 5` 17,716.44 100 0.00 17,716.44' Herschel Lock Retirement Savings Plan 5` 110,868.27 100 0.00 110,868,27 TOTAL (Also enter on Une 7, RecapRulation) # 150,580.45 If more space fs needed, use additional sheets of paper of the same size REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF gEYENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE NUMBER ('.nnnip I an Fahnactru^Ir 7~ QD~62 Decedent's debts must be reported on Schedule I. ITEM A• I FUNERAL EXPENSES: 1. DESCRIPTION Myers Funeral Home, 37 E. Main St., Mechanicsburg, PA Gingrich Memorials- headstone e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) _ _.. ___. _.___ . __ Street Address Gty - _ _ _ State ZIP Year(s) Commission Paid: z• AttomeyFees: Flerschel Lock, Esq. 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation.) aaimant lzora-F-Hoemer - __ _ Street Address _~~ ~• __ Gty 'Gatttp -Frill _ _ _ _ ._ . _ ____ State _ pp ZIP 1701:1 ___ Relationship of Claimant to Decedent -JlAother----- _--- __-- _-------_-__. _-- (she resided with decedent at the time of death but a. Probate Fees: has since relocated to the above address) Register of Wills 5• Accountant Fees: Kelly Financial Services 6. Tax Return Preparer Fees: ~• Cumberland Law Journal-estate advertising 8. The Sentinel-estate adverting 9. Joseph James Jewelers- appraisals 10. Sovereign Bank-copies 11. M&T Bank-mortgage 12. Net settlement costs for sale of house $4040.00 $1060.00 $16,400.00 $3500.00 $327.00 $299.OQ $75.01 $208.7$ $106.00 $20.00 $95,680. $10,295 ~b TOTAL (Also enter on Line 9, Recapitulation) I $ 1 32, 01 2.33 If mare space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TA% RETURN RE57DENT DECEOEM SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER C Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER „«,..,.,.T,,.., VALUE AT DATE 1 2. Sadler Oil 3. Interstate Waste 4. PPL 5. Lower Allen Township-sewer bill 6. Pennsylvania American Water Co. 7. Cumberland County Tax Claim Bureau-real estate tax bill overdue aon date of death 8. MS Hershey Medical Center 9. PA Dept of Revenue-21x19 state income taxes due 10. Visa 11. Goodyear 12. Verizon TOTAL (Also enter on Line 10, Recapitulation} I $ 672 3.6 6 If more space Is needed, insert addRronal sheets of the same size. $9.26 $126.22 $37.02 $127.80 $38.00 $38.08 $2056.56 $2841.00 $5.00 $1343.66 $60.00 $41.06 ncv-a~is uc+ Lut-1uj ~ Pennsylvania SCHEDULE ) DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENr DECEDENT ESTATE 0 Connie I NUMBER I 1. 2. 3. F: _ee Fahnestock NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a] (1.2).] ~kki K. Swailes, 5 Pipeline Rd., Newville, PA 1 7241 .Came F. Zang 8~ Keaton Zang, 4705 Sears Run Rd., Mechanicsburg, PA 17055 Izora F. Hcen~er,10 House Ave..Camp k3i11, PA 17011 RELATIONSHIP Do Not List Horn -Blood Non -Blood Mother FILE NUMBER: 21-09-0962 AMOUNT OR SHARE OF ESTATE $ 230.00 $ 270.00 100% residuary estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. ~ 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 If more space is needed, use additional sheets of paper of the same size. 1 ~~°a"~