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Home My WebLink About07-05-12 (2)J 1505610143 REV-1500 ~"°'-'°"~ PA De artment of Revenue OFFICIAL USE ONLY P Pennsylvania coumy code veer File Number Bureau of Individual Taxes ~^^^*-Nrorsemus Po Box.zeosot INHERITANCE TAX RETURN 21 12 0296 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2010 02 13 1933 Decedent's Last Name BROLLY Suffix Decedent's First Name JOHN MI E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name BROLLY BEVERLY Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate 8 Decetlent Dietl Testate (Attach Copy of Wilh 9. Litigation Proceeds Received MI L THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return ~ 3. Remainder Return (date of tleath prior to 12-13-82) 4a. ~ uture Interest Compromise) ~ 5. Federel Estate Tax Return Required tlale of death seer 2-72-a2 7 D~ do r~oPyio~T ee)a Living Trust ~ a. Total Number Of Safe Deposit Boxes 1 p 3 usel Poverty predit (tlate pf tleath 11, Election to tax under Sec. 9113(A) between 12-3191 antl t<-1-95) ~ (gmaCh SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES D BOGAR (717) 737 8761 REGISTER OF~S USE ONLY rn ~ C G> ~-~ First line of address ~~ ~ r ~ l , 1 ~~'~~ _~- -i~~ ONE WEST MAIN STREET z ~ rrt U; :: i r .,174.7 Second line of address 0 n~j~-. '. ~ <~`:.i ;~--r. O 1 N -~ DATE~LED tV C~ Cit or Post Office y State ZIP Code SHIREMANSTOWN PA 17011 Correspondent's a-mail address: Jbogar@bogarlaw.com Untler penalses of perjury, I tleclare that I have examined this return, inclutling accompanying schedules antl statements, and to the best of my knowledge antl belief, it is tme, correct antl complete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. OF PREPARFfi OTHER James D. Boger DATE One West Main Street, Shiremanstown, PA 17011 Side 1 L, 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number oeceeern'sNeme: Sholly, John F. 200 22 7114 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. 1 , 12 7.14 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous t~oq-Probate Property (Schedule G) u Separate Billing Requested............ 7. 8. Total Gross Assets (total Lines 1-7) .................................................................... . 8. 1 , 127.14 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) .................................................................. . 11. 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 1 , 127.14 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. 1 , 12 7.14 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 l 12 7.14 15 0 . 0 0 , (a>(1.z) x .oo . 16. Amount of Line 14 taxable 0 0 0 16 0 0 0 . at lineal rate X .045 . . 17. Amount of Line 14 taxable at siblingrateX.12 0.00 t7. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 0.00 18. 0 . 0 0 19. Tax Due ................................................................................................................. . 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-0296 DECEDENT'S NAME Sholly, John F. STREETADDRESS 335 Wesley Drive, Apt. 127 CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits (A + B) (2) 0.00 3. Interest (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) Check box 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. (5) 0,00 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 :............................................................................... ^ x b. retain the right to designate who shall use the property transferred or its income :.................................. x c. retain a reversionary interest or ............................................................................................................... x d. receive the promise for life of either payments, benefits or care? ............................................................ x 2. If death occurred after December 12, 1962, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ ^x 3. Did decedent awn an "in trust for' or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................... ^ ^x 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 January 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 fling 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)]. . 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-1808 F~(e (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMON W EALTH OF PENNSYL VANIA INHERITANCE TA%RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Sholly, John F. 21-12-0296 Indutle the proceetls oflitigation and the tlate Ne proceatls were receivetl by the estate. All property Jolrrclyrownetl wlth the right of survlvanhip moat ba dlaeloaed on aehetlule F. (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-1513 EX+111-081 SCHEDULE J COM INO ERIEALTnNT I~QF PFnNET$VLNANIA RES DEP ~~EIJ~` BENEFICIARIES ESTATE OF FILE NUMBER Sholl ,John F. 21-12-0296 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Beverly L. Sholly Spouse $30,000.00, plus 335 Wesley Drive, Apt 127 one-half of rest, Mechanicsburg, PA 77055 residue and remainder 2 Roxann L. Baker Daughter Twelve and one- 4 Kingswood Drive half percent of Lewisberry, PA 17339 rest, residue and remainder 3 Kim S. McMeans Daughter Twelve and one- 625 Bosler Avenue half percent of Lemoyne, PA 17043 rest, residue and remainder 4 Keith A. Sholly Son Twelve and one- 625 Bosler Avenue half percent of Lemoyne, PA 77043 rest, residue and remainder 5 Steven C. Sholly Son Twelve and one- Csokorgasse64/Stigell/TOr24 half percent of 1110 Vienna, Austria rest, residue and remainder Total Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 cover sheet as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9713 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 SHEE Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-7500 Schedule J (Rev. 11-OB)