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Home My WebLink About07-24-12 1505611185 REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes Po Box zaosot INHERITANCE TAX RETURN 21 11 0339 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 210-26-9840 03052011 12291933 Decedent's Last Name Suffix Decedent's First Name M I HOUSE ROSELLA JEAN (If Applicable) Enter Surviving Spous e's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ^ 1. Original Return ~ 2. Supplemental Return ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ ^ ^ 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ^ ^ ^ 9. Litigation Proceeds Received 10. Spousal Poverty Credit (Date of Death 1 1. 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 TO: Name Daytime Telephone Number RICHARD C• SNELBAKER 717-697-8528 First Line of Address Second Line of Address 44 WEST MAIN STREET City or Post Office REGISTER OF WILLS USE ONLY r~.? ~ ~,,: r~J C17^=9 C T s" ~ ~ D FILED' ~~ ' r ~c,~~ _ " 'a'1 ~.r.l :~ State ZIP Code ~ C .,.,, .:: ~ : Y .~ MECHANICSBURG PA 17055 ~,_~; ~. _, -,-, --, +~ Correspondent's a-mail address: ~' ~_ ~n C Under penalties erjury, 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, cor ct nd complete. f~Claration of pr~parer other than the personal representative is based on all information of which preparer has any knowledge. .~l /~ ROBERT LEE STRAYER, EXECUTOR 1003 PARK PLACE, MECHANICSBURG, PA SIG E OF~?$F,b2ARER OTHER THAN REPRESENTATIVE ATE / 17 5. ADDRESS - RICHARD C• SNELBAKER, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 Side 1 1505611185 OM46473000 1505611185 ~,1.! 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 210-26-9840 DecedenYsName: HOUSE ROSELLA JEAN RECAPITULATION 1. Real Estate (Schedule A) 1 0 • 0 0 2. Stocks and Bonds (Schedule B) . 2 0 , 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3 0 , 0 0 4. 5. 6. 7. 8. Mortgages and Notes Receivable (Schedule D) _ _ Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) Jointly Owned Property (Schedule F) ~ Separate Billing Requested Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested Total Gross Assets (total Lines 1 through 7) 4 5. g. 7. 8 0 • 0 0 550 • 50 0 . 0 0 0 . 0 0 .550 • 50 9. Funeral Expenses and Administrative Costs (Schedule H). g. 5 2 2 , ], ], 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 813 • 00 11. Total Deductions (total Lines 9 and 10) , 11 ], , 3 3 5.11 12. Net Value of Estate (Line 8 minus Line 11) 12 (784 .61) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 13, 0 • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . 14 (7 8 4 .61) TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a>(1.2>x.o- 0.00 15. 0.00 16. Amount of Line 14 t xable 4~ at lineal rate x .0 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. 0. 0 0 19. TAX DUE 19. 0 • 0 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT XD Side 2 1505611285 1505611285 J OM4648 3.000 REV-1500 EX (FI) Page 3 Decedent's Comolete Address: File Number ~1, 1, 1, 11~~9 DECEDENT'S NAME HOUSE ROSELLA JEAN STREET ADDRESS TOWNSHIP CUMBERLAND COUNTY CITY STATE ZIP MECHANICSBURG PA 17 55- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) ~ • ~ ~ 2. Credits/Payments A. Prior Payments ~ • ~ ~ B. Discount ~ . ~ ~ Total Credits (A + B) (2) 0 • 0 ~ 3. Interest (3) o • i) o 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) ~ - 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) () • (] (] 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 ^ ^X b. retain the right to designate who shall use the property transferred or its income ^ 0 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? . ^ ^X 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? ^ 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) (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 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(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. 0 M4671 2.000 REV-1508 EX+ (t ~ -10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDENTTURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Rosella Jean House 21 11 0339 Include the proceeds of litigation and the date the proceeds were received by the estate. oW46AD 2.000 If more space is needed, use additional sheets of paper of the same size. REV-7511 Ex+(10.09) pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Rosella Jean House 21 11 0339 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State PA ZIP 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Year(s) Commission Paid: Street Address 4. 5. 6. 7. 1 City State PA ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Haars Auction commission paid on sale of household goods Total from continuation schedules . 137.11 385.00 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 522.11 swasnc z o0o If more space is needed, use additional sheets of paper of the same size. Estate of: Rosella Jean House Schedule H Part 7 (Page 2) 2 Register of Wills filing fee for Supplemental Inheritance Tax Return 3 Snelbaker & Brenneman, P.C. additional attorney fees for preparation of Supplemental Inheritance Tax Return 21 11 0339 15.00 370.00 Total (Carry forward to main schedule) 385.00 REV-1512 EX+(12-08) SCHEDULE pennsylvania DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8~ LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Rosella Jean House 21 11 0339 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. BW46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) SCHEDULE J pennsylvania DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Rosella Jean House 21 11 0339 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1' Karen LaDawn House Daughter 15 Palmer Drive Camp Hill, PA 17011 One Half of Residue 2. Robert Lee Strayer Son 1003 Park Place Mechanicsburg, PA 17055 One Half of Residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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. ~ $ 0.00 9W46AI 2.000 If more space is needed, use additional sheets of paper of the same size. Estate of: Rosella Jean House 21 11 0339 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 3 Margaret Marie Erickson 123 Church Street Taylor, PA 18517 Household goods Inventory Value: 90.00 Niece 90.00 4 Ray Richard Strayer 889 King Street Lewisberry, PA 17339 Household goods Inventory Value: 180.00 Brother 180.00