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Home My WebLink About04-17-12 1505610105 REV-1500t:x(oa-1 1,(l, . SE ONLY FFI IA PA Department of Revenue L U O C penrlsylvaMa County Code Year File Number "~"""~~`~ Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN h ~ ~ 0 ~ z 3 Harrisburg, PA 1']128-0601 RESIDENT DECEDENT O[., ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDOYYYY 184-24-3840 04/23/2010 10/25/1923 Decedent's Last Name Suffix Decedent's First Name MI Romberger Ralph L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Romberger Josephine L Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 141-20-3228 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OD 1. Original Return O 2. Supplemental Retum O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Llmiled Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Ratum Required death after 12-12-82) QD 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 (Data of Death O 11. Election to Tax under Sec. 9113(A) Between 12.31-91 and 1-1.95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Barbara R. McLemore (717) 763-7211 First Line of Address 323 N. 27th St. Second Llne of Address City or Post Office Camp Hill State ZIP Code PA 17011 ~., REGISI~ OF WILLS ~ ONLY y ~ :z~ Ti ~L7 ~ ~ ~ ~ ~~ --~ ~~p --r .. `~ .~eATE FILED N Correspondent's a-mall address: bmclemore~gfnet.com Under penalties of perjury, I declare that I have examined this return, including aa;ompanying 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 represenlatlve is based on all information of which preparer has any knowledge. SIGN RE OF PE ONRESPOySI~LE~s~R FILIN~r RETURN DATE 1 i~„r~~~T" ~5".~,./~.r ii.. _ ~o~~ ft .r,.i 04/07/2012 1 DATE 04/07/2012 323 N. 27th St., Camp Hill, PA 17011 PLEASE UaE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 ~~ \~. ~~ ~~ .~ k V_ n~ \~~. a~/~~ 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Neme: Ralph L. Romberger 184-24-3840 RECAPITULATION 1. Real Estate (Schedule A) ............................................ . 1. 0.00 2. Stocks and Bonds (Schedule e) ..................................... .. 2. 461,520.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) .......................... . 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 0.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ' 53,290.00 7. Inter-Vlvos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested....... . 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) ............................ . 8. 514,810.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 6,000.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 0.00 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 8,000.00 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 508,810.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. 0.00 14. Net Value SubJect to Tax (Line 12 minus Line 13) ...................... .. 14. 508,810.00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 508 810 00 , . (a)(1.2) X .0_ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 18. 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 0.00 O sae z 1505610205 1505610205 REV-1500 EX (FI) Page 3 1 Decedent's Complete Address: Fils Number E EDENTS NAME Ralph L. Romberger STREET ADDRESS 508 Penn Ayr Road CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments - 0.00 B, Discount 0.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Page 2, Llne 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 0.00 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS t. 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 .............................................................................................................................. ^ 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 consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" orpayable-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? ........................................................................................................................ ~ ^ 0.00 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 alter 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)j. 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 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 ai 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 benefiaaries is 4.5 percent, except as noted in [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)]. 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+(y-s~) { `- ~ pennsytvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Ralph L. Romberger 2010-0493 All property jointly owned wfth right of survivorship must be discbsed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTIQN OF DEATH I' Waddell 8 Reed Account #35062486 172, 346.00 2 Morgan Stanley Dean Witter - Account #410010424 184,193.00 3 Dreyfus Mutual Funds Acount # 0265-0557839537 & 0265-0557839545 86,372.00 4 American Century Investments (IRA) Acount#020-30381-4507 12,768.00 5 Met Life/AXA Common Stcok 5, 841.00 TOTAL (Also enter on Line 2, Rei If more space is needed, insert additional sheets of the same size 461,520.00 REV-isDg EX+ (oi-io) ~' Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCIIIEpULE F 70INTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Ralph L. Romberger 2010-0493 If an asset became jointly owned within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Josephine L. Romberger 1508 Penn Ayr Road I Spouse B. C. JOINTLY OWNED PROPERTY: ITEM NUM9ER LETTER FOR JOINT TENANT DATE MADE 101NT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUM9ER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST I. A. Z~( Joint Account -Metro Bank Acount # S,3G pZ 777`11 6,580.00 50% 3,290.00 ~ 2 A iiou5 Household goods 100,000.00 50% 50,000.00 TOTAL (Also enter on Line 6, Recapitulation) I $ 53,290.00 If more space is needed, use additional sheets of paper of the same slze. • REV-1513 EX+ (O1-10) ~ V' Pennsylvania DEPARTMENT OF REVENUE INNERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF: FILE HUMBER: Ralph L. Romber er 2010-0493 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Ust Tru>otee(s) OF E5TATE I TAXABLE DISTRIBUTIDNS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• Josephine L. Romberger Spouse 508,810.00 ENTER DOLLAR AMOUNTS FDR DISTRIBUTIDNS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I; If more space Is needed, use additional sheets of paper of the same size. w J' a N ~,~a~ ~, ~-..-,- ins dt, cJO~ nxr_-o •'--~o •[. N ~.,a 2 7~0 ~ ¢ 2 U k ~.~~~ ~~~~ ~~~` M ~~~~i~ o _ n ~.~~~, ~.~- N r> o ~ ~ o wa ~g ~~,~ v ~\ ~ c ,~~~~ ~ ~--~ s '. 1` ~ ~ ~~ v a U H a w N 0 L O ~ M U ~ c~ m ri c ~~ ~ ~o U~~ a~ ~ NQ ~ o n- ~~ a~ ~ ~ ~ ~ .~ ~ o ~U U ~ U i ~ ~ Barbara R. McLemore 323 N. 27th Street Camp Hill, PA 17011 717-763-7212 ext. 2227 April 16, 2012 Cumberland County Register of Wills 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Ralph Romberger Deceased April 23, 2010 Inheritance Tax Return File # 2110-0493 Filing Fee To Cumberland County Register of Wills: Enclosed please find the filing fee for the Estate of Ralph L. Romberger, who passed away on April 23, 2010. The Estate Tax Return was filed last week. If you have any questions or require additional information, you can contact me at 717-763-7212 ext. 2227 or bmclemoreCcr)afnet.com if you need additional information. Thank you. Sincerely Yours, c Barbara R. McLemore n i- w., `~ N n ~O ~ GJ~ ~,.' ; .. ~~~ _ J .., f~:i`~. ,~ r ~~ rn $ N ~7 .F` • d , , t ;~, ?a ,~ r ~ s ` ,~} ~ F> v.3 ~ i ~.~ . ~'~Rt `1yp.. . ~ li ~ m.3 r 'yp ;~ ,~'4 0 n ~? ~ w '~+ N R N ~ ac m v -_Z 7 fl Q~ N_ .~ T ~ ~ t ~v)) ~ 0 U ~~ c ~ `L Boa v $'~~n ~u ~ U ~- V ... ..r ..~ .,r ..» ..~ r :r r r {7 !'° „~