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Home My WebLink About08-21-12J 1505610140 REV-1500 EX (°'-'°' PA Department of Revenue OFfIC1ALUSE ONLY Bureau of Individual Taxes Coun ry Code Year File Number Po eOx 280501 INHERITANCE TAX RETURN Harrisbum. PA 17128.0501 RESIDENT DECEDENT 2 1 1 2 0 8 2 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of bath MMDDYYW Date of Birth MMDDYYYY 5 7 8 4 0 6 2 7 2 1 1 2 1 2 0 1 1 0 9 1 6 1 9 2 9 Decedent's Last Name Suffix Decedent's First Name M1 R 0 8 E R T S O N T H E O D O R A F (If Applicable) Enter Surviving Spouse's Informatlon 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 INAPPROPRIATE OVALS BELOW O 1.Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death pnorto 12-13-82) d. 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 ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D A V I D W R E A G E R 7 1 7 7 6 3 1 3 8 3 First line of address 2 3 3 1 M A R K E T S T R E E T Second line of address City or Post Office State ZIP Code REGISTER OF WILLS USE ONLY ~j~~ t'r't ~ - `~ ~ ~ c ` !V Ca ~ . .,' Cwt DA ~ `, ; ~p {~ G~ p ~r r '? f.,.r:.i _7,7 `r:~ C_7 - `Tn C A M P H I L L P A 1 7 0 1 1 ~~`' N '=~ crt c~a Correspondences-malladdross: DWREAGERBREAGERADLERPC.COM Under penalties Of pery'ury, I dedare that I have examined this return, indudinq accompanying schedules and statemerds, etxl to the beat of my knavAedBe and belkF it is e, cOrred and complete. Dedaretlon of preparer other than the personal representatlve is based on all information of which preparer has any knowledge. ' URE OF P SPON BLE FOR F0.1NG RETURN DATE m ~ r r-~,.. ~~lG ~ /Z ADDRESS 1031 C SIGNATURE 2331 MARKET STREET CAMP HILL ~-PLEASE USE ORIG{NAL FORM ONLY 1505610140 Side 1 1505610140 J J 1505610240 REV-1500 EX Decedent's Social Security Number oecedenfsName: THEODORA F• ROBERTSON 5 7 8 4 0 6 2 7 2 RECAPITULATION 1. Real Estate (Schedule A) ...... . .................................... 1. 2. Stocks and Bonds (Schedule B) ............................ . . . .... ... 2. 2 8 1 6 , 0 0 3. Closely Hek1 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. 8. Jointly Owned Property (Schedule F) ~ Separate Billing Requested .... ... 8. 7. Inter-Vhros Transfers & Miscellaneous N -Probate Property (Schedule G) ~ Separate Billing Requested .... ... 7. , 8. Togl Gross Assets (total Lines 1 through 7) ........................ ... 8. 2 8 1 6 , 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9. 2 0 9 0 . 5 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... . .. ... 10. 1 7 2 4 . 3 7 11. Total Deductions (total Lines 9 and 1 p) ............................ ... 11. 3 8 1 4 . 8 7 12. Net Value of Estate (Line 8 minus Line 11) ......................... ... 12. - 9 9 8 . 8 7 13. Cherkable and Governmental Bequests/Sec 9113 Trusts for which an election [o tax has not been made (Schedule J) .................... .. 13. , 14. Net Value SubJeet to Tax (Line 12 minus Line 13) .................... .. 14. - 9 9 8 . 8 7 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.z) x.o _ 0. 0 D 15. 0. 0 0 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. 0. 0 0 19. TAX DUE .................................................... ..19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505610240 Side 2 1505610240 J REV-1500 EX Papa 3 Decedent's Comalete Address_ Fiie Number 21 12 OA?L, DECEDENTS NAME THEODORA F. ROBERTSON STREET ADDRESS -- 100 MT. ALLEN DRIVE clTV sraTE Z1P MECHANICSBUR6 PA 17055 Tax Payments and Credits: ~. 7ax Due (Page 2, line 19) (1) 0 • D D 2. CredltslPaymenls A. Prior Payments B. Discount Total Credits (A + B) (2) 0.0 0 3. Interest (3) 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 +Une 3 Is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.0 0 Make check payable to: REGISTER OF WILLS, AGENT _._. ... "" :~,~~.-- _ .. ..... ' ~ ,'~;St~F~Y.i;d.:~xCrtnx~e~v~s,~eit~::r~.y.,: :, 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 dght to designate who shall use the property transferted or its income : ........................ ....... ^ ^X c. retain a reversionary interest; or ......................................................................................... ....... ^ d. receive the promise for fife of either payments, benefits or care? ................................................ ....... ^ 2. If death occurred after December 12,1982, did decedent transfer propedy within one year of death without receiving adequate consideration7 ................................................................................ ....... ^ X^ 3. Did decedent awn 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 designation7 ........................................................................................... ....... ^ 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. .~~z~sF .. ;~-'~: ~`^ `.~ ' Irk` . , ;' '.~. ': ~"_~ ~ ' ' ~'~~;w~~`"~~1°'."~~ r~~a` ~° ~. 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 far disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficlary. 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)J. • The tax rate imposed on the net value of transfers to or for the use of the decedent's Ilneal beneficlaries 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)]. 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•1503 EX + (8.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS $ BONDS """' ` "' FILE NUMBER THEODORA F• ROBERTSON 21 12 D826 All propeAy Joinflyowned with right of curvivorehip must bo d~closed on Schedule F. (It more space b needed, Insert additional sheets of the same size) REV•1511 EX~ (10.09) pennsylvania DEPARTMENT OF REVENUE INHERRANCE TAX RETURN RESroENroECEOENr SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS _ ~ ESTATE OF FILE NUMBER THEODORA F. ROBERTSON 21 12 0826 Decedent's debts must lre repoRed on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: L B. 1 2. 3. 4. 5. s. 7. City State ZIP ADMINISTRATIVE COSTS: Personal Representative Commissions; Name(s) of Personal Representative(s) Street Address City Stain _ Year(s) Commission Pafd: AnomeyFeas: REAGER 8 ADLER, PC Family Exemption: (It decedents address is not the same as claimanCs, anach explanatbn.) Claimant Sheet Address Relationship of Claimant to Decadent Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS Aaountant Fees: Tax Retum Preparer Fens: ZIP 2,000.00 90.50 TOTAL (Also enter on Une 9, Recapitulation) I S It more space b needed, use addilbnal sheets of paper of the same sbe. REV-1512 EXi (12-0B) Pennsylvania DEPARTMENT OF REVENUE INHERYtANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE t7P FILE NUMBER THEODORA F• ROBERTSON 21 12 Ua26 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unrelmbuned medical expenses. If more space is needed, hselt addMional sheets of the same site. REV-1513 EX* (Ot-10) Pennsylvania DEPART6~NT OF REVENUE INHERITANCE TA%RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES NUMBER: THEODOR A F• ROBERTSON 21 12 0 826 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llat Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Indude wlUlpht I distributions and Uansters urWer Sec. 91 6 (a (1.2).J 1. JOHNA MALAMUD Lineal 351 MARTINGALE DRIVE CAMP HILL, PA 17D11 2. NANCY HORSTMAN Lineal 1D31 CHESTNUT PLACE HUMMELSTOWN, PA 17036 3• MARY LYNN ROBERTSON Lineal 586 IRISHTOWN ROAD NEW OXFORD, PA 1735D ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHIGH AN ELECTION TO 7AX 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. S It more space is needed, use additional sheets Dt paper or the same srze.