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Home My WebLink About08-15-121505610105 REV-1500 EX (o2-ii) (FI) ,'~a {y OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes ~t INHERITANCE TAX RETURN PO BOX z8o6ot RESIDENT DECEDENT Harrisburg PA i'J128 0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 202-20-3250 12/23/2011 09/20/1916 Decedent's Last Name Suffix Decedent's First Name MI ARBEGAST DOROTHY E (If Applicable) Enter Surviving Spouse's Information Below MI Spouse's Last Name Suffix Spouse's First Name 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 O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 8. 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 (Date 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 DayOftmeTTe ephone NumbleECTED T0: Name JEFFREY S COHICK EA (717) 249-5321 REGISTER Ot`c~Y1LL5 USE ONE ~~ ~ ~ rU of '~'~ `CJ ,rr'1 ~-'t1 ~ _ ivy First Line of Address ~ - 390 ALEXANDER SPRING RD r~ Second Line of Address C'> C.: ~ ~ _' 'r~~ ~_- _ri ~ '~' GJ D- ~'f~ED ' ' f -ri City or Post Office State ZIP Code GI'1 CARLISLE PA 17015 rn Correspondent's a-mail address: jCOhICk COhICkBSSOC COfTI Under penalties of perjury, 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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT F PER RES SI E FOR FILI Tl~- ~j DAT ~ ./J".1r /~~ I> /// / Z 15484_ SIGNATURE OF MFRIES, Z 390 ALEXANDER SPRING, CARLISLE, PA 17015 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056101D5 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number DOROTHY E ARBEGAST ' 202-20-3250 s Name: decedent 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 and Notes Receivable (Schedule D) ......................... 4. . . 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... 5 . . 7,632.16 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property O Separate Billing Requested..... ... 7. (Schedule G) 8 7,632.16 8. .......... Total Gross Assets (total Lines 1 through 7) ............... . . ... 9. ........... Funeral Expenses and Administrative Costs (Schedule H) .... . ... s. 2,058.18 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 38,767.99 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 40,826.17 12 . Net Value of Estate (Line 8 minus Line 11) ........................... ~ 2. .. . -33,194.01 13 . Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 an election to tax has not been made (Schedule J) ..................... ... . 14. ........ Net Value Subject to Tax (Line 12 minus Line 13) .......... . .....1a. 0.00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. (a)(1.2) X .0_ 16. Amount of Line 14 taxable 16. at lineal rate X .0 _ _ 17. Amount of Line 14 taxable 17 at sibling rate X .12 18. Amount of Line 14 taxable 18 at collateral rate X .15 0.00 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: DOROTHY E ARBEGAST STREET ADDRESS 210 BIG SPRING ROAD File Number _...._.. _ ZIP - _...._. _...._._. ~~ STATE CITY PA 1724 NEVIIVILLE Tax Payments and Credits: 1. Tax Due (Page Z, Line 19) 2. CreditslPayments A. Prior Payments _ _ . B. Discount Total Credits (A + B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) (1) 0.00 0.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: 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" 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)J. 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)j. 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-i5o8 EX+ (i>_-io) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt~iLE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: DOROTHY E ARBEGAST FILE NUMBER: 21-120074 Include the proceeds of litigation and the date the proceeds were received by the estate. _.. ,_,_.._. _..._..a ..,:«~ .,.,ti* ~f aurvivnrshin must be disclosed on Schedule F. It more space ~~ ~icc~cu, we u...+~~~..~~~• -••---- - ~ ~- REV-SS11EX+(10-09} SCHEDULE H ;; ;1~ pennsylvania ~: DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAx RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT FILE NUMBER ESTATE OF 21-120074 DOROTHY E ARBEGAST Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION NUMBER q, FUNERAL EXPENSES: 1' BALANCE DUE AFTER DEDUCTION OF PREPAID AMOUNT TO EGGER FUNERAL HOME 15 W BIG SPRING AVENUE, NEWVILLE, PA 17241 g, ~ ADMINISTRATIVE COSTS: I, Personal Representative Commissions: Name(s) of Personal Representative(s) .IAN R ARBEGAST _ ______ - --.._ _______ Street Address 15484 GOLF CLUB DRIVE DUMFRIES State VA ZIP 22025 city Year(s) Commission Paid: 2012 -- - 2. Attorney Fees: 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address --- - City State __ ZIP Relationship of Claimant to Decedent _-_ -____- _.__._.-_.-- - - - --- ------- -- -- 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 58.18 1,000.00 1,000.00 2,058.18 REV-1512 EX+ (12-OS) pennsylvania ~- DEPARTMENT OF REVENUE INHERITANCE TAX RETURN aF9IDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21-120074 ESTATE OF DOROTHY E ARBEGAST . _~ .-___:~ _...we a~+e „f doarh- including unreimbursed medical expenses.