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Home My WebLink About08-16-12 (2)J 1505610140 REV-1500 EX ~°'-'°) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO Box 2aosol INHERITANCE TAX RETURN Harrisbur PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 1 2 8 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 2 3 0 8 0 6 9 1 5 1 0 3 1 2 0 1 1 0 4 1 6 1 9 5 5 Decedent's Last Name Suffix Decedent's First Name 0 R S E MI M A R Y E (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 0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 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 ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4 6 5 0 First line of address 5 4 E A S T M A I N Second line of address City or Post Office M E C R A N I C S B U R G S T R E E T State ZIP Code P A 1 7 0 5 5 _ __ ~.~_ REGISTER OF LS USE ONL3C_' - Q y~ ,~,._ rv ~ ~ , , _ ~ ~ V t-: . ~ ` ~~ -- C7C'~ "~ I , , ,} - S' - ~~ ~ -- ~ ~ DA~FILED ~ _ ,^ I r'r`i r- c,, r Correspondent's a-mail address: Under penalties of perjury, I declare that I have exa 'ned this re n, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declarati of er other n the personal representative is based on all information of which preparer has know) ge. SIGNATURE OF PERSON RES O L F ING ETURN D ~. r 'Z. ADDRESS MURREL R• WA T I I, 54 E• MAIN ST MECHANICSBURG PA 17055 SRGN7t~~OF PR PARER OTHER AN REPRESENTATIVE ~„r~ DAVID R• ~ALLOWAY,ESQ• 54 E• MAIN ST MECHANICSBUR PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 /b//z- PA 17055 150561D140 J REV-1500 EX 1505610240 Decedent's Social Security Number decedent's Name: MARY E• O R S E 2 3 0 8 0 6 9 1 5 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 3 3 8 5 0 0, 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. 1 6 2 B , 6 4 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... . 8. 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 11. Total Deductions (total Lines 9 and 10) ............................... 11. 12. Net Value of Estate (Line 8 minus Line 11) 13. ......................... Charitable and Governmental Bequests/Sec 9113 Trusts for which ... 12. an election to tax has not been made (Schedule J) ....... . . .... 13 14. Net Value Subject to Tax (Line 12 minus Line 13) ....... ............. .. 14. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 _ 0 . 0 0 16 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 4 2 0 6 3 8 . 1 g. 19. TAX DUE ...................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 1 4 9 7 2 6, 8 6 6 1 3 1 8, 1 0 5 5 1 1 7 3, 6 0 3 8 2 0 9. 0 5 1 9 8 5 7 0. 3 9 2 3 6 7 7 9. 4 4 3 1 4 3 9 4. 1 6 3 0 0 1 8 7. 7 8 1 4 2 0 6. 3 8 0. 0 0 0. 0 0 0. 0 0 2 1 3 0. 9 6 2 1 3 0. 9 6 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: MARY E. ORSE __ STREET ADDRESS 28 STONE RUN DRIVE CITY MECHANICSBURG Tax Payments and Credits: ~• Tax Due (Page 2, Line 19) 2. Credits/Payments 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. File Number 21 11 1281 STATE i ZIP PA X17050 (1) 2 130.96 Total Credits (A + B) (2) 0.00 (3) (4) 0.00 (5) 2 130.96 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; ^ .. .. ........................................ ^ 0 b. retain the right to designate who shall use the property transferred or its income; ................ ............... 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, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ O 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? ......... ^ 0 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) (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 stilt 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)J. • 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-1502 EX+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT tS 1 ATE OF: FILE E. All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defineda s the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointlyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 28 STONE RUN DRIVE MECHANICSBURG, PA 17050 ESTIMATED NET SALE PRICE 338,500.00 _ TOTAL (Also enter on Line 1 Recapitulation) I ; 338 500 00 If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUM MARY E. ORSE 21 11 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION ~~ DOMINION DIRECT NET SALE PRICE 28 TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE OF DEATH 1,628.64 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (~ 1.10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ca ~ Hr t ur: MARY E. OR ITEM NUMBER 1. 2 3. 4. 5. 6. 7. SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY FILE NUMBER: iE Include the proceeds of litigation and the date the proceeds were received by the estatel 1281 All property jointly owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION JOSEPH JAMES JEWELER JEWELRY, GROSS SALE PRICE FOR ITEMS SOLD HAAR'S INC. AUCTION PERSONAL PROPERTY, GROSS SALE PRICE AAA REFUND STATE FARM REFUND,AUTOINSURANCE FORD EXPLORER 2003 KELLEY BLUE BOOK VALUE JOSEPH JAMES JEWELER JEWELRY, APPRAISED VALUE FOR ITEMS ON CONSIGNMENT HAAR'S INC. AUCTION P. BUCKLEY MOSS PRINTS, NET SALE PRICE VALUE AT DATE OF DEATH 4,216.00 116,944.75 50.00 104.76 5,000.00 16,500.00 6,911.35 TOTAL (Also enter on Line 5 Recapitulation) I $ 149 If more space ~s needed, insert additional sheets of paper of the same size REV-1510 EX+ (08-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON•PROBATE PROPERTY WIAIt VF' FILE NUMBER MARY E. ORSE 21 11 1281 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY INCLUDE THE NAME DF THE TRANSFEREE, THEIR RELATIONSHIPTO DECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 1. UNITED STATES TREASURY (~FAPPLICABLE) VALUE 39,795.01 100.00 39,795.01 RETIREMENT -Messiah Village Endowment Fund 2. UNITED STATES TREASURY 19,228.06 100.00 THRIFT SAVINGS PLAN -Messiah Village Endowment Fund 19,228.06 3. COMMONWEALTH OF VIRGINIA 2,295.03 100.00 RETIREMENT -Lynnwood Schultz 2,295.03 TOTAL (Also enter on Line 7 Recapitulation) ~ $ 61 31 If more space Is needed, use adddlonal sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ~~ ~., ~ ~ yr FILE NUMBER MARY E. ORSE 21 11 1281 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A, FUNERAL EXPENSES: 7. NEILL FUNERAL HOME, INC., CAMP HILL, PA ($14,414 - $6,776.90 PAID BY AMERICAN MEMORIAL INSURANCE) B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) MURREL R. WALTERS, III, ESQ. Street Address 54 E. MAIN STREET City MECHANICSBURG State PA ZIP 17055 Year(s) Commission Paid: 2012 7,63 7.10 14, 750.00 2, AttomeyFees: DAVID R. GALLOWAY, ESQ. 14,750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address Cdy State ZIP Relationship of Claimant to Decedent 4• Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 880.50 5 I Accountant Fees: 6. I Tax Retum Preparer Fees: 7. PATRIOT NEWS - ESTATE NOTICE PUBLICATION I 116.45 8. CUMBERLAND LAW JOURNAL -ESTATE NOTICE PUBLICATION 75.00 TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. AMOUNT 05 REV-1512 EX+ (12-OS) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT INHERITANCE TAX RETURN RESIDENT DECEDENT , MORTGAGE LIABILITIES ~ LIENS , ESTATE OF FILE NUMBER MARY E. ORSE R 21 11 1281 eport debts incurred by the decedent prior to death th t a remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE 1• PNC MORTGAGE OF DEATH 121, 787.07 2• COMCAST CABLE 200.77 3• EHLRICH PEST CONTROL 136.15 4, PPL ELECTRIC 1, 048.50 5. PENN WASTE REFUSE 133.05 6• STATE FARM CAR INSURANCE -FORD EXPLORER 116.53 7. UGI GAS 706.20 8• UNITED WATER WATER 155.70 9• VERIZON TELEPHONE 380.76 10. SILVER SPRING AUTHORITY SEWER 459.80 11. MEMBERS 1ST FEDERAL CREDIT UNION HOME EQUITY LOAN 14,634.22 12. UNITED STATES TREASURY INCOME TAX 576.00 13. PA DEPARTMENT OF REVENUE INCOME TAX 2.00 14. LAND LOVERS LAWN CARE 216.13 15. SCOTTS LAWN SERVICE LAWN CARE 55.97 TOTAL (Also enter on Line 10, Recapitulation) I E If more space is needed, insert additional sheets of the same size. 198 570 39 Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARY E. ORSE Decedent's Name 21 11 1281 Page 1 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION 16. S & Z PAINTING & GENERAL CONSTRUCTION AMOUNT PAINT AND REPAIRS 750.00 17. CASTLE CLEAN CARPET CLEANING 177.02 18• PHIL WEIGEL CLEAN-UP AND TRASH REMOVAL 1,070.00 19. TRUE RATE CONSTRUCTION ROOF REPAIR 75.00 20. DEBRA BASEHORE WIEST 2012/2013 SCHOOL TAXES 3,080.74 21 • MEMBERS 1ST FEDERAL CREDIT UNION CREDIT CARD AND PERSONAL LOAN 2,684.12 22. PNC MORTGAGE MONTHY PAYMENTS 11,435.67 23. DREW RICHARDS INVENTORY OF COLLECTIBLES 660.00 24. BARBARA BEAVER INVENTORY OF COLLECTIBLES 600.00 25. HAAR'S AUCTION ADVERTISING & COSTS OF SALE FOR PERSONAL PROPERTY 24'792'99 26. JOSEPH JAMES JEWELER COST OF SALE FOR ITEMS SOLD 2,896.00 27. JOSEPH JAMES JEWELER COST OF SALE FOR ITEMS ON CONSIGNMENT 9,740.00 SUBTOTAL SCHEDULE I GRAND TOTAL SCHEDULE I $ 57,961.54 198, 570.39 REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT wiHitur: NUMBER I. II. 2. 3 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 91 6 (a) (1.2).J LYNNWOOD SCHULTZ 66 ASPEN RD DILLSBURG, PA 17019 COMM OF VA. RETIREMENT 2295.03 2003 FORD EXPLORER 5000.00 P. BUCKLEY MOSS PRINTS 6911.35 FILE NUMBER: RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE I Collateral I Collateral 14,206.38 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: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS COUNTRY AND TOWN BAPTIST CHURCH 1822 SOUTH MARKET STREET MECHANICSBURG, PA 17055 VIRGINIA WESLEYAN COLLEGE 1584 WESLEYAN DRIVE NORFOLK, VA 23502 MESSIAH VILLAGE 100 MT ALLEN DRIVE MECHNICSBURG, PA 17055 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 79,678.02 159,355.73 59,023.07 If more space is needed, use additional sheets of paper of the same size. S 298.056-82