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Home My WebLink About04-02-12 (3)J 1505610101 REV-1500 Ex (°1-1°' ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~EO.N,ME~. ` County Code Year File Number PO BOXz8o6ot INHERITANCE TAX RETURN Harrisbur , PA 17128-0601 RESIDENT DECEDENT ~V ~~ ENTER DECEDENT INFORMATION BELOW ~ Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 209-20-1623 12/29/2011 07/28/1927 Decedent's Last Name Suffix Decedent's First Name MI Barner Rosie M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number 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 12-31-91 and 1-1-95) (Attach Scn. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number James M. Bach (7171 737-2033 First line of address Attorney At Law Second line of address 352 S Sporting Hill City or Post Office Mechanicsburg State ZIP Code PA 17050 -' ~ - REGISTER QF LS USE ~4L.Y " ~ ~`t . J - _ ~. t i ` . `~: ~_~`~ :) ;"+~ -i _ r7 ~~ DATE FILED 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 preparer other than the personal representative is based on all information of which preparer has any knowledge. S~NATUR~ OF PERSON RESPONSIBLE FOR FILING RE RN DATE ` 211 Ridgeview Dr., Marysville, PA 17053 SIG TURE OF P`REPARER O HE~ JR THAf~ REPRESENTATIVE GATE HU~f/'CCJJ 352 S. Sporting Hill Rd., Mechanicsburg, PA 17050 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J Z~ -,~ ~J C ~.. ;-ri ti 1505610105 REV-1500 EX Decedent°s Name: ROSie M. Barner Decedent's Social Security Number 209-20-1623 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. 24,437.76 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ... ........... ... ....... .. 8. 24,437.76 9. Funeral Expenses and Administrative Costs (Schedule H) ..... ..... ..... .. 9. 1 1,847.00 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ... ..... 10. 11. Total Deductions (total Lines 9 and 10) .... .................... 11. 11,$47.00 12. Net Value of Estate (Line 8 minus Line 11) 12. 12,590.76 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. 12,590.76 TAX CALCULATION -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. 16. Amount of Line 14 taxable at lineal rate X .0 1 g. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateralrate X 15 12,590.76 18 1,888.61 19. TAX DUE .... .. 19. 1,$88.61 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Rosie M. Barner _.._ - -- __ --- STREETADDRESS 211 Ridgeview Dr. -- - -- -__ CITY STATE 'ZIP Marysville PA 17053 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditsiPayments A. Prior Payments B. Discount 3. Interest 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. (1) 1,888.61 Total Credits (A + g) (2) (3) (4j (5) 1,888.61 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 :..................................... ... ^ Q c. retain a reversionary interest; or ......................................_....................................................................... ... ^ 0 d. receive the promise for life of either payments, benefits or care? .............................................................. .... ^ 0 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... .... ^ 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 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) 11.1) (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)J. • 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)]. 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, REV-1737-4 EX + (6-08) j i~ Pennsylvania DEPARTMENT DF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SC4IEDULE E, PART 1 MISCELLANEOYS PERSONAL PROPERTY ESTATE OF Rosie M. Barner FILE NUMBER Part 1 must include all tangible personal property having its situs in Pennsylvania. Examples of tangible personal property are jewelry, furniture, paintings, etc. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. Complete Part 2 on reverse side ONLY when the proportionate method of tax computation is elected. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~ Sovereign Bank Checking Account (See Exhibit A) 24,437.76 PART 1 TOTAL 24,437.76 PART Z TOTAL (From reverse side.) $ TOTAL (Also enter on Line 5, Recapitulation.) 24,437.76 $ (If more space is needed, use additional sheets of paper of the same size) Page: 1 Document Name: untitled ~DDHIST Demand Deposit Display History Acct 0921725558 Alpha key BARNERM.08 Request ALLTRANS Last stmt 01/13/12 6017 01/18/12 S --Date-- ----Description----- -Serial Nbr- -Reference- ------Amount------ * 12/16/11 UNITEDHEALTHCARE 00077900000 (180.00) EFT PULL 111214 800063443 * 12/16/11 DAILY BALANCE 31,782.46 * 12/21/11 #CHECK 1310 09703301205 (7,160.00) * 12/21/11 DAILY BALANCE 24,622.46 * 12/27/11 DEPOSIT 09018902225 135.00 * 12/27/11 DAILY BALANCE 24,757.46 * 12/28/11 #CHECK 1311 09945200245 (319.70) * 12/28/11 DAILY BALANCE 24,437.76 * 01/03/12 US TREASURY 303 00077900000 1,646.87 XXRR RET 010312 WA192145180 1 _ DDDHISTREQ _ DDDHISTBAL _ DDDMAIN DDDACCT DDDINT Th _ ere is additional information before and after this page. _ GN20000I03 COMMAND =__ > F2=Retrieve F3=Exit F4=CRFwindow F7=Backward F8=Forward IJafe ~~ ~ d l ~~u l~~ 1~a~~~~c~ ----~ ~__ ~ ~ ~~ ~ ~ ~ ~ ~~o Date: 1/19/2012 Time: 3:41:07 PM REV-1737-6 EX + (6-08) REVERSE Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCFIEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS Use Schedule H ONLY for proportionate method of tax computation. ESTATE OF FILE NUMBER Rosie M. Barner Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' Rice Memorial Works 190.00 2. St. John's Church 101.00 3. George P. Garman Funeral Homes, Inc. 8,657.00 B. ADMINISTRATIVE COSTS: t. Personal Representative's Commission(s) 1.222.00 Name(s) of Personal Representative(s) Herman W. Barner, Jf. (Submit requested information for additional personal representative's on additional sheets) Social Security Number(s) or EIN Number(s) of Personal Representative(s) 178-42-3968 street ,address(es) 211 Ridgeview Dr. ciry(ies) Marysville State(s) P'°` z1P(s) 17053 Year(s) Commission Paid 2013 Attorney Fees 800.00 3 Probate Fees 159.00 4 Accountant's Fees 5. Tax Return Preparer's Fees 142.00 6. Miscellaneous Expenses Pharma Care 576.00 TOTAL (Also enter on Line 9, Recapitulation.) I $ 11,847.00 (If more space is needed, use additional sheets of paper of the same size) Pennsylvania SCHEDULE ) DEPARTMENT OF REVENUE [NHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Rosie M. Barner FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RE oTNotSI st T~ st e(sjNT AMOOF ESTATE ARE I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Herman W. Barner, Jr. 211 Ridgeview Dr., Marysville, PA 17053 Nephew 100% i ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH i I 18 OF REV-1500 COVER SHEE?, AS APPROPRIATE. II 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. $ If more space is needed, insert additional sheets of the same size.