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Home My WebLink About07-05-12J 1505610143 REV-1500 Ex (a1-1o) OFFICIAL USE ONLY PA Department of Revenue pennsylvania Bureau of Individual Taxes County Code Year File Number DEPARTMENT OF REVENUE Po Box.2soso~ INHERITANCE TAX RETURN 21 11 0738 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 536 72 7310 06 15 2011 12 20 1974 Decedent's Last Name Suffix Decedent's First Name MI ROYER WENDY K (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 ^ 2. Supplemental Return ^ 3, Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa Future Interest Compromise 5. Federal Estate Tax Return Re wired (date of death after 12-12-82) ^ q ^ 8 Decedent Died Testate (Attach Copy of W II) ^ 7 Decedent Maintained a Living Trust 0 (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9 Lit f P Iga Ion roceeds Received ^ 1 p. Spousal PovertY Credit (date of death between 12-31-91 and 1-1-s5) ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number GARY L JAMES ESQ 717 533 3280 First line of address 134 SIPE AVENUE Second line of address City or Post Office State ZIP Code HUMNJELSTOWN PA 17036 Correspondent's a-mail address: gll@1SdC.C01T1 r~ ~~ ~- - ~F ,.-_; _:, _._ -:~ __t.-, _ri ~> ADDRESS REGISTER OF~,~WILLS USE QNLY ~ ~ ~ ~t~ ~ ~', -~ _ c_ ~_ ; ~ £~> r _ F i f r (p; V~..t' I -~~ r - ,.... DACE FILED a c •',~- 922 Willcliff Drive Mechanicsbur PA 17050 SIGNATIXtE OF PREPARER OTHER THAN REPRESENTATIVE !,T`~~'e~~'~ ~ ._~~'Q' DATE I"~.~t~l V +~ Gary L. James Esq. C,,_ 7~ ,. ~ ~„~ ADDRESS 134 Si mmelstown, PA 17036 1505610143 Side 1 1505610143 J I Ncl igIIICJ VI Nellury, I aeclare tnat 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 la nasari r,n nll ~.,r,,...,~4;,,.. ,.~,.,~:,.~..._______ ~__ _ 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: ROyer, Wendy K. 536 72 7310 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 & Notes Receivable (Schedule D) ..................................................... ... 4. 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............ ... 5. 30 , 163.74 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested.......... .. 6. 7. Inter-Vivos Transfers & Miscellaneous NQq-Probate Property (Schedule G) lJ Separate Billing Requested.......... .. 7, 0.00 8. Total Gross Assets (total Lines 1-7) .................................................................. ... g. 30 , 163.74 9. Funeral Expenses & Administrative Costs (Schedule H) ..................................... .. 9. 9 , 610.2 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................ .. 10. 21 , 110 , 22 11. Total Deductions (total Lines 9 & 10) ................................................................. .. 11. 30 , 720.4 9 12. Net Value of Estate (Line 8 minus Line 11) ........................................................ .. 12. -556 75 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. -55 6.75 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 .00 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .045 0. 0 0 16. 0, 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. Q, 0 0 19. Tax Due ................................................................................................................. . 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610243 Rev-7508 EX+I6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Royer, Wendy K. 21 11 0738 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Members 1st Federal Credit Union Savings Account # S 0000 -valued per statement dated 2 865 05 July 8, 2011 , . 2 Metro Bank Checking Account 4,450.94 3 USAA Savings Account 23.71 4 Waddell & Reed Money Market Account -beneficiary of account is Betsy Su s gg 5,385.40 5 2006 Hyundai Santa Fe GLS -valued per Kelley Blue Book 13,760.00 6 Personal Property 1,500.00 7 LL Bean -credit card refund 93.20 8 U.S. Treasury - 2011 personal income tax refund 2,064.00 9 USAA -refund 21.44 TOTAL (Also enter on Line 5, Recapitulation) I 30,163.74 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Royer, Wendy K. 21-11-~73A This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFERSATTACN A COPY OF TIHOE DEIED OR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Allegheny & Chesapeake Physical Therapy 401 K Plan 0.00 0.00 - not taxable because decedent had not attained age 59 1/2 years at age of her death 2 Cumberland Valley Retirement Fund -not taxable because decedent had not attained age 59 1/2 years age of her death 3 Tax Matrix Technologies 401 KPlan -not taxable because decedent had not attained age 59 1/2 years age of her death 0.00 ~ ~ ~ 0.00 0.00 ~ ~ ~ 0.00 TOTAL (Also enter on Line 7, Recapitulation) I 0.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+(10-06~ COMMONWEALTH OF PENNSYLVANIA IN RESIDENTEDE EC DENTRN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Royer, Wendy K. 21-11-0738 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission paid 2. Attorney's Fees James, Smith, Dietterick & Connelly, LLP 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Brandon Liddick Street Address 940 S. 30th Street City Camp Hill State PA Zio 17011 Relationship of Claimant to Decedent SOn 4. Probate Fees 115.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 994.77 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 9,610.27 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Royer, Wendy K. 21-11-0738 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Central Penna. Abstract Services Inc -fee for title searches on properties owned by the 210.00 Estate of Robert Liddick 2 Cumberland Law Journal -estate advertisement 75.00 3 James Smith Dietterick & Connelly LLP -reserve for estate administration closing costs 250.00 4 Members 1st Federal Credit Union -check ordering fee 15.95 5 The Sentinel -estate advertisement 232.02 6 USAA -auto insurance 70.60 7 USAA -auto insurance 70.60 8 USAA -auto insurance 70.60 H-B7 994.77 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+(12.08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Royer, Wendy K. 21-11-0738 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 H B McClure Co -oil plan 124.51 2 Members 1st Credit Union Loan Account # S 0001 -valued per statement dated July 8, 2011 4,529.37 3 Members 1st Credit Union Loan Account # S 0002 -valued per statement dated July 8, 2011 15,879.05 4 Municipal Taxes 44.00 5 PA American Water -final invoice 68.84 6 PPL -final invoice 271.86 7 USAA Credit Card Account # 5337 -balance 192.59 TOTAL (Also enter on Line 10, Recapitulation) I 21,110.22 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-OS) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Ro er, Wend K. 21-11-0738 NUMBER NAME AND ADDRESS OF PERSON(Sl RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE Do Not List Trustee s (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Robert P. Royer Father 922 Willcliff Drive Mechanicsburg, PA 17050 2 Brandon Liddick Son c/o Robert and Connie Royer 922 Willcliff Drive Mechanicsburg, PA 17050 3 Connie L. Royer Mother 922 Willcliff Drive Mechanicsburg, PA 17050 ~ ~ Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet, as a ro i NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)