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HomeMy WebLinkAbout12-30-11 (2)1505610101 - ~'~-:500 ~x~o>:-~o> ~ r OFFICIAL USI Fti~.t'Itrtter-t of Revenue ~ - Cotirity Code w , Burcau%lf Individual Taxes ~"`"`~`"~` Po i34ix 213osoi INHERITANCE TAJC RETURN ~ I Harrisburn. PA i~iz&o6os RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY ~`1T~oT3~5~7T~ I O _f $i2 ~Om Decedent's Last Name Suffix ~. (If Applicable) Enter Surviving-Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number File Number ~ i +' D(a~te o~f Birth MMDDYYYY S.1GL1. ' 0 De~ced~en~t's~Fi~rst Name MI Si..i'~i~i.'7 Spouse's First Name MI n~~-rrr~-n-~-r-rn o THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. driginal Return O 2. Supplemental Return Q 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) ~ 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. g113(A) between 12-31-91 and 1-1-95) (Attach Sch. Oj CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DHtECTED T0: Name Daytime Telephone Numt~er d~" 7 ~ ~ilr~liiiifil~ REGISTER OF WILLS FJSE ONLY r`~ First line of address ~. ~ r't-l ._ , - . ~; Second {ine of address ~ Cr3 C,O ; -T r °, , - , ~ City or PostOf~ice TE FILED... -~..: State ZIP Code ~ ~ ~ ~ ~ ~, ~~ Correspondent's e-mail address: 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, cortect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN~RE OF PE~SON RE~PON~I~iLE f,QR~ILIN~ RETURN ~ ~„` I~1~. ~~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610141 k~ J REV 1500 EX ,tst~: 1505610105 Decedents Social Security Number r~r~~~ s 1. Rea@ Estate. (Sd'redute A) ............................................. 1. 2. Stocks and Bonds (Sdredule B) ....... . ............................... 2. 3. Closely Held Corporation. Partnership or Sole-Propriefast~p (Schedule C} ..... 3. 4. Mort and Notes Receivable (Sc~eduie D) ........................... 4. 5. Cash, Bank [)eposits and Misc~tlaneous Personal Properly (Schedule E}....... 5. 6. Jointly Owned Property (Sdiedule F) O Separate Billing Requested ....... 6. 7. Inter-Vrvos Transfers 8~ M'iscetlaneous Non-Probate Property (Schedule G} O Separate Bi1Nng Requested........ 7. Q ,2 8. Total Gross Assets (total Lines'1 through 7} ............................. 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 3 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....:..:...... 10. " 14. Total. Deductions {total tines 9 and 10) ...........................:..... 11. 12. Net talus of Estate (Line 8 minus Line 11) .............................. 12. ~j "~ 13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which en election to taz has not been made (Schedule J) ........................ 13. 14, Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. rj , ~ ~j TAX CALCULATIQN -SEE INSTRUCTIONS FOR APPLICABLE RATES 45. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) X .0_ 16. Amount of Line 14 tax ble at lineal rate X .0 17. Amount of Line 14 taxable at sibling rats X .12 48. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. Tq)( pt)E .........................................................19.~ 20. FtLL IN T[iE OWL if YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 .1505610105 1505610205 O J f~V-f508IX • (1i~ SCHEDULE E CAtwONVVEALTHOFPENNSYLVANIA CASH, BANK DEPOSITS, Sr MISC. INHERITANCE TAX RE~uRN PERSONAL PROPERTY FILE NUMBER ''. I C pin r~3P_r Indude the proceeds of Nligation and the date the proceeds were received by the estate. All property joN~tlyowned wtlh 1M d8M of wNivonhip naat M dhcioad on tictaduk F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. (~sEcu Po (3~r ~70-3: ~{ar ri s bur I~R. ~ 10 9 , 7 (o Aeco~~ # 0372o3q~~s ~~e9u~arR S~areS ~tie~~;ng TOTAL (Also enter on line 5, Recapitulation)' ; (If more space is needed, insert additional sheets of the same size) 12,8c~~-43 80l~.43 Document Number: 2643160 *-'~ Account 0372 LICEiTENBERGER,PA Effect: 12/15/11 Post: la/15/11 Tlr: 0166 ID DUS DATE PRINCIPAL INTEREST FEES NSM BALANCE IRAN AMOUNT SSR Nithdrawal from REGULAR SHARES Prev Bal: 12,806.43 '.. O1 12 806 43- 0 00 0 00 0 00 12,806 43 #696588 ------------------------------------------------------------------------------ Check Disbursed BROOK$ L SHIFFSR 12,806.43- PAULINS F LIt~iTSN88RGSR C/O BROOKS L SHIFFSR 655 SAINT JOHNS DR CAMP HILL PA 17011-1338 Document Number: x643160 Account 0372XXXXXX LICSTSNB$RGBR,PA Effect: 12/15/11 Post: 12/15/11 T1r: 0166 ID DUE DATL PRINCIPAL INTEREST FEES NSN BALANCE TRAM AMOUI~IT SBQ oPithdrawai-from RsGt~rr.AR sa~,RES -- - Prev-Bale -- -1a, BFJ~ .43 - --..-- B1 12,806.43- 0.00 0.00 0.00 12,805.13 ~~96588, Cheek Disbursed BROOKE L SNIFFER 12rS06.43:- NO Si'OP PgYMENT PERM(TTEQ _.; PSE~CU is obligated to pay. this Cashier`s Check accnr~to hs terms at the. eras-issued. - ~# the; check is lost, stolen or destroyed p ase corrtact ~s at' ~~ ;, ~ , - ; 237-7,nationwide or t71712'~4-54~. REV-1510IX • (7.97) COMMONWEALTH OF PENNSYLVANIA ' INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY L; FILE NUMBER This schedule must be completed and filedrf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM N MBER DESCRIPTION OF PROPERTY Itk:LUDETHENAMEOFTHETRANSFEREE,THEIRREUTIONSHIPTODECEDENTANDTHE DATE OF TRANSFER ATTAD"ACDPY OF THE DEED FOR REAL ESrATE. DATE OF DEATH VALUE OF ASSET °6 OF DECD'S INTEREST EXCLUSION FAPPUCABLE TAXABLE VALUE 1. Ahnelr~IPri s~ I`1u~-c~~1 ~'undS Accoun~# o~aloo93~~0 8 002 28,020.104- 50% 1,01032 020148o777I o oQ2 34,E?~(.-5 So% I`1,y3`7.o~ 0201 4~I 21b8 I o02 O,o5,2y~ .S(o so%~ 32,(c23.2f AM@ri PrliSt? Ahnu i~'t PS Rccour~ ~ Q3oo yt~3 X57 (p ooh I`1,-1Colo•91 So°lo 8883.~~0 X300 ~I(~~(ooo q ooy 31,bo2.o9 ~% 15 $ol~o~ ~meriPriSe ©fJE r~ndne~~l Ae('Ounl 203,5(08.40 50% 101,~84.y TRANSFf:i~E~ (3~ooKF l.• SN 1~FF~R (oS 5 S'~~nt Torn s Dave Camp I-1 ~ II , ~~ ~ 1701 ~JAuC~ ~-rFR D~+e o~ T~nsrer 10~ l8~ I 1 TOTAL (Also enter on line 7. Recapitulation) (S 1 q'(1 ~~Q /;,7 5 (If more space is needed, insert additional sheets of the same size) a~x+s+ooc.~+ar- co~tarwEatH of I+EnNSVr.Vnran ue~arrAr~cE Tnx r+~ruRN ~7VHGWI.G INTER VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY FEE This sd~ed+de must be aompleied and lied ~ the erg th arty of queadorrs 1 through 4 on the reverse side at the REV-1500 COVER SHEET is yes. ITE~ DESCRIPTION OF PROPERTY nr<awEOFn~rnAn~ne+~Anox~+Proo~etrNCrieareoFrnaxs~a ATTACNACOW OFTHE OffDPORHFJIL.~TA7E. DATE OF DEATH V A % OF DECD'S I EXCLUSION - TAXABLE VALUE ~. /~11Yter~i Pr ~ s N I`~! u~' ~; ~ ~ Unc~S rlcci,sArt~~ ciciQO9~f~~S~L+ ~ cu2 2Z:+,o2o.b~1 so% 14,010.32 c2Q i ~~c? '~77 f O eaL 3~f,~7~{. i 5 50°/© 17, 437.0 c2cl ~f412i~;~, i cc2 (~,5,2,~{~ •~~ 50~/ 32,(023.28 Ahrt~ri priSw ~~nt~ ~-~•i ~S $$~3• ~ S t~crcurt~ ~ ~ 3cav y 1 ~ 3 ~~ ~ (~ ~~{ 1`Z,~lc,G~• ai f ~% Gi'3oo S ~~4 ~av ~ oaW 3f,1ca2. o~ 50 / 15, So ~.o`- Plmeripr~se ®~~ r~~-anr~~l ~cc~;nf 2~3,~foF.`~~ 50% to I,~S~.y ~TRAI~SFEr~C~ APF. H 813 5 ~'~ ix~ s Cedar 1.~ne SnN ~a~ o~ ~~ns~~r ~0' I8.1 TOTAL (Also artier an Otte 7, Rer~pih~iort) L__ ,~ (IF more space is needed. ir~ert addi6ortal sheets of the saute I 1 Mutual Funds i Account Nutr~ber Total Value # of shares Asset Value Per Share - 0 }010093654 8 002 ! 9lA,~~ 5,495.632 $5.09 020148Q77710 002 $fir~~4liiu 2,606.439 $13.38 020149 ~ 2168 1 002 ; $ii~lf~ii~ 6,190.376 $10.54 i j Annui~ies ~ Post 1+85 i Accoun Nu b r Total Value 930041 365 6 004 $~l~if~ 9300516400(9004 ~~ Life I»sur~nce ` ~ iJoT TAXAP,L.~ Acco N ber Total Value 909018839 9 004 ' $16,831.00 Amer~prise ONE ~inancial Account i Account N ber Total Value 000199 522 4 021 tliil~IMrlla lKcct M~AflletiDeiae t~F1E Asoaalt, F44tlUI~ F Tt)D /1ca:t ~pppi {~ Acct7yp~Hbn-mod M~JF~IAISS - A ~ Pr,~IAX $~ L GP ~ 1 !12777 10.!,16 7011Q11.l~ /~1tESi~RB CI1S1~ ! ; ~~ 71iA0D!10 1 ~0 20.06~~6 EY~1I~LENTS E3d_YI~-8 61'Pf31( BA~MiL~ 7,1Y1.81 1276 S4.a~: COL il.4IL70HT~O~rCa1YLi~-C /K1Qt2X I.flFIQtMBiA~i f90LtlAEMA 8.OE0.0Q 5.93 ~9Y lRET6iM Fi~DStiF7Dt~ E1k1DNi~L011TR1i!'EAWf'~-(+~ ; ~6F147( ~f~lE 2~k17# 1Q47 21,~0.>~ I C~ii.DiMDdlPill11411~-B ' flLy1~t M~IAILGP t~101.DiAll11 212.56 37!10 ~-~ _w SiRx'K IAtASSET SAt ~ BQ7Y ~ B J~1lIIS~t ilY[7ALO 57~Cf[ 1:4"A.'1~ 1 t_70 40.~.~ i Qpp MyL. BOI~b - A tlIBI~C ~ 2Aa7-~ OA1 77.?~ Pt,1~0 frUiV- - C PRR:1( ~~iC9<"l6AE PIiAf~O FlJMESS 186- 10.20 1w.072TZ Pueuc_s1o1~E oc°Eic~ 100J1D 717.28 1x179.$ VIIBLSF01f1.D8D-C wFtl+rx ' R ®/YB.D` ~~glRllO 243saA8 8~6 14,O~T.7T ,~.~,aw: The date of ~ eath values provided are for estate tax purposes and are not a value to be paid. Accounts maybe, subject to ket fluctuation as governed by each product. Please note that the values indicated for any Life Insuraice p oduct(s) with the insured deceased reflect the gross death benefit at date of death and not the cash value.. Values indi~ated for Life Insurance Products with only the owner deceased reflect the cash value as of the date of death. ! Values for any proprietary mutual funds include accrued dividends as applicable. Values provided for a brokerage products ate manually calculated, and should be used as estimates only. T'he prices used to provide values are est~mate~ obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a To Randall KShifter/Field/AMPF~AMPF cc bcc Subject x'2975800 9001 PAULINE F LICHTENBERGER -DATE O DEATH YAL'UES-PLS DC~ NOT DELEI`E Please do not reply to this email. This database does not support incoming mail. Please calf the phone # within the letter if you require assistance. Thank you. Life Events Team RiverSource Life Insurance Company Ameriprise Financial Company 70700 Ameriprise Financial Center Minneapolis, MN 55474 October 25, 2011 RANDALL K SHIFFER 214 SENATE AVE STE 604 CAMP HILL, PA 17011-2382 12975800 9 001 Dear RANDALL K SHIFFER; Thank you for your recent inquiry regarding PAULINE F LICHTENBERGER's accounts. Account Information Mutual Funds Account Number Ownership 01010093650 8002 Individual - TOD 02014807771 0 002 Individual - TOD 020149121.68 1 002 Individual - TOD Annuities -Post 1985 Account Number ersh' 93004183657 6004 Individual 93005164000 9 004 Individual Life Insurance Account Number a hi 9090186839$' 9 004 Individual Ameriprise ONE Financial Account A9 0~~~~~' ershi 00019905223 4' 021 individual - TOD REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDVLE 1~1 FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ~ FILE NUMBER q Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1. M u Sse ~ m ~~ Funer a I l~om2 ~.ernoyhp, 1~ ~ I`7oy3 `irCm C~T74n ~ 1JU1ri a ~ 3298, s2 ~~oorns ~y ~ icK~r ~1 P~}- y ~'C~'n° ~ ~ ~low~ rs ~~, ~ 7 B. ADMINISTRATIVE COSTS: /--~0 r 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip 2• Attorney Fees 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4• Probate Fees ~u-rberlant~ ~M.h~ Reg, s-~r o°~ Wt11S ~-{ 3 l , S O 5• Accountant's Fees s• Tax Return Preparer's Fees 7. - TOTAL (Also enter on line 9, Recapitulation) I S .~ ~ ~ ~ , (If mote space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scN~ou~E i DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed medical expensaa. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~~4-~2ny U i I Inge ASs;s~Pc! ~.- v- n ~' 1'Yl Pe ~,a n -` cs {~u r~ ~ ~j- ~.. 1`l0 ~ S ~ayq.15 un p ~ ~ d f~~ 11 for caYe ~I- -~~ me ~~ dea-~-h 2• Can+i n U i -'K3 V3r~, ~ ~ S 13 • ~ 8 unpaid drug ~i 4~S off' -t~-i me rr~ ~P~'t TOTAL (Also enter on line 10, Recapitulation) ; I ~ ~ tQ G • ~v~ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTIi OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF ( FILE NUMBER ~A 11 I I n i G ~ a! 1(~ IJ ~ ~.I R~(~ (~ G' (Z NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)j 1. rpp ~ ~, ~~il'~r ~5~ S`a~~fi .Sa~-n's l~r;~>/ ~~IuGN T~cR ~~~~p (~„-,p ~, -1,~A o ~~o ~ ~ ~o~j~.rT ~, ~-tC~~hbCrgtr Sl~n ~©~~ iAp-~: hi $135 ~ypYu~' Cedar ~,an~e ~1l~cc~~t C.-+y, Ned - 2103 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET lI NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS L TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) •S ~r REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Certificate of Grant of Letters No. 21-11-1317 PA No. 21-11-1317 ESTATE OF Pauline F. Lichtenberger a/k/a: Late Of: Lower Allen Township, Cumberland County, Deceased Social Security No. 372-03-9575 WHEREAS, on the 9th day of December, 2011, the instruments dated December 3, 1986 and June 25, 1990 were admitted to probate as the Last Will and Codicil of Pauline F. Lichtenberger, late of Lower Allen Township, who died on the 18th day of October, 2011, and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, Glenda Fanner Strasbaugh, Register of Wills in and for the County of Cumberland, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters Testamentary to Brooke L. Shiffer, aka Brooke B. Shiffer, who who duly qualified as Executor and who agreed to administer the estate according to law, all of which fully appeazs of record in my office at Cazlisle, Pennsylvania. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office the 9th day of December, 2011. Register of Wills ,, l~1 Deputy * *NOTE * * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) r_} n• c; ~~~x i11 ~n~ C~I~~~~n~ ~~ :;~~ ~ m ; j;_c Cf> ~ QD '. ;. PAULINE F. LICHTENBERGER ~-~~ ~ ""' '::" =~' `'~~ I, Pauline F. LICHTENBERGER, of the Borough of Camp Hill, Cumbe~~and County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate of every nature and wherever situate to my husband, Robert S. Lichtenberger, providing he shall survive me by thirty days. Should my husband, Robert S. Lichtenberger, predecease me or die on or before the thirtieth day following my death, I devise and bequeath all of my estate of every nature and wherever situate to my children, Robert S. Lichtenberger, Jr. and Brooke B. Shiffer, provided that the share for either child not living on the thirty-first day following my death shall be distributed to that child's issue, per stirpes, living on the thirty-first day following my death, and in default of any such then-living issue, shall be distributed as a part of the share for my other child or his or her then-living issue, per stirpes. ITEM II: I direct that in the distribution of my estate, the share of my son, Robert S. Lichtenberger, Jr., shall be charged with an advancement of Fifty-Five Thousand ($55,000.00) Dollars for funds which I have paid to him. ITEM III: I appoint CCNB Bank, N. A.. of New Cumberland, Pennsylvan~,a, ., :,., guardian of any property which passes either under this ilk;,. minor. ~~ ,w~l~ ~~e$p,+,.~tg 3±?lii;;ch I ~ $~ K o . r, ., ~ , . s guardian shaLi {not supersede the right of any fiduciary in its' ,, , ,~> distribute a share where possible to the minor or to .another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including ti college education, both graduate and undergraduate) without regard to his. or her parent's ability to provide for such support and education, or to make payment for these purposes, without further respons6~~£ the minor's parent or to any person taking care of the minor. ITEM IV: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ITEM V: I appoint my husband, Robert S. Lichtenberger, executor of this my last will. Should my husband, Robert S. Lichtenberger, fail to qualify or cease to act as executor, I appoint my son, Robert S. Lichtenberger, Jr., and my daughter, Brooke B. Shiffer, executors of this my last will. ITEM VI: I direct that my executors or guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this 3 ~ day of ~.Q~Q..~,r..~ 198b . ,.• ~J J'Z'auI'in" a F:'Zic en erger ~~ The preceding instrument, consisting of this and one other typewritten page identified by the signature of the testatrix, Pauline F. Lichtenberger, was on the day and date thereof signed, published and declared by Pauline F. Lichtenberger, the testatrix therein named, as and for her last will, in the presence of us, who, at her request, in her presence, and in the presence of '~' tr have subscribed our names as witnesses hereto. ..~1i ~ Y l 3 "4aL~Tl~~TU c ~ Y ... ... _ 1,~~ c~a 1v.. _ ~ ~.i_ r~~ i n + H 2 ` _ ~ r f _ ~.. A' ~. - ~r y}h ~,a~•ZMr..~,',t a ~'. ;~_ -_~. yi,t "1 ~'~rnr,r . ' , ~ ~ 3' ~~ ' r•-~ /~•~, Robert $. Licktenberger 3105 Yale lwenue Came Hill, Pennsylvania 17011 n . ~ , a.t~~ 'r.4 :'l..X ~, ~ i /J J ~ :. C ji~.CiYI•~ f~ i ~.~-f~LC .L?". ~..tr~C.-'iry~-..~.-ti.;L.: 1~ •'T •v/(/' /,.1-:'7'~J ,J i• ~~ ,• cx'.l y.~f.. •~ /K ~;1~ / , >~.J~ O C' C . '~ ~ ^^~-s~•~rf` /'u_ c .L, ,=, c .. ,* i ; i; _ ~;; . ~.u< ~ ~ T O ._ ....r., 1TM t n7 4~ ~...; ;-~-. ~ ~ ~ t ' CO ,. . r, G~7 ~ - - C~ . . ~.~ :: : ~ _ , . r.r. ~ r _. -'i - . ~ J .~' '.+`J r' .~~ REV 1500 EX Page 3 Decedent's Complete Address: File Number pECEDENT'S NAME 'cHT F3 R ~R STREETADOtiE3S s' `Vih 5 225 W ` SOIn ~ v~ °'{' S cln e ~ s STAT~~ ZIP ~~ ~ n r Tax Payments and Credits: L Tax Due .(Page 2, Lme 19) 2. Cre~dilslPayrrlents A. Prior Payments B. Discount ~ /p 3. Interest 4. th~ 2 is greater than Lirre 1 + Line 3, enter the difference. Thy is the OVERPAYMENT. FiM in oval on Page 2, Line 20 to request a refund. Total Credits (A + B) (2) CJ fp~. ~3 (3) (4) 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ ~p ~' 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 rk~ht to designate who shall use the property transferred or iG~ income : ............................................ ^ ~] c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate calsideration? .............................................................................................................. ^ 3. Did decedent own an ~n trust for" or payable-upon~death bank account or security at his or her death? .............. ® ^ 4. Did decedent ovlm an irxiividual retirement account, annuity or other non-probate property, which c;orrtains a benefx:iary designation? ........................................................................................................................ 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE .RETURN. For dates of death. on or after Jury 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 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) (u)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirelrlents for dime of assets and fi~ a tax return are still applicable even if the surviving spouse is the onty benefiaary. 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 [l2 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 beneftciaries is 4.5 percent, except as Hated 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)]. A sibling is defined, under Section 9102, as an Individual who has at least one parent in common with the decedent, whether by blood or adoption.