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Home My WebLink About08-27-12 (2)1505610143 EX (01-10) i~ REV-1500 ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.28oso1 INHERITANCE TAX RETURN 21 12 0353 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 312 32 4881 03 09 2012 07 08 1937 Decedent's Last Name DOBISH Suffix Decedent's First Name NANCIE MI S (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 3. Remainder Return (date of death 0 1. Original Return ^ 2. Supplemental Return ^ prior to 12-13-82) 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) a 6 Decedent Died Testate (Attach Copy of Wilf) ^ ~ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ~ 1 p. Spousal Povert Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 12-31 ~1 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number T.T~n R pxILLIPS 208 720 7448 First line of address 509 SOUTH 4TH STREET Second line of address City or Post Office State ZIP Code BELLEWE ID 8 3 313 ~ _.::> pp ~~ -=- REGISTER OF'~t~fi USE OIIN~Y =-r- t ~T-.. W J ~''' 1 ~. _.' ~ } ~z.. L G .. +~~.. - y,. ~ ~ DATE FILED ~~ r- ~._..\ :. r~ .'T ..ti lisar hilli s cox.net Correspondent's a-mail address: P P Under penalties of perjury, I declare that l 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 hDA E y knowledge. SIGNATU E OF PERSON RESPON ISLE FOR FI G RETURN ~. ~ ~ /~ ~~ ~' ~~.,-~--- Lisa R Phillips 509 South 4th Street Bellevue ID 83313 DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS 15U5610143 Side 1 1505610143 ~~~,) J REV-1500 EX Decedent's Name: DObISh, Nancie S Decedent's Social Security Number 312 32 4881 RECAPITULATION 1. Real Estate (Schedule A) .................................................................................... 2. Stocks and Bonds (Schedule B) .......................................................................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)...... 4. Mortgages & Notes Receivable (Schedule D) .................................................... 5~ Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)............ 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested......... 7. Inter-Vivos Transfers & Miscellaneous ~ Probate Property (Schedule G) Separate Billing Requested......... g. Total Gross Assets (total Lines 1-7) ................................................................. 9. Funeral Expenses & Administrative Costs (Schedule H} ................................... 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) .......................... 11. Total Deductions (total Lines 9 & 10) ............................................................... 12. Net Value of Estate (Line 8 minus Line 11) ...................................................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................................... 14. Net Value Subject to Tax (Line 12 minus Line 13) .......................................... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 16. Amount of Line 14 taxable ~ . ~ 0 at lineal rate X .045 17. Amount of Line 14 taxable ~ . 0 ~ at sibling rate X .12 18. Amount of Line 14 taxable 0 . 0 0 at collateral rate X .15 19. Tax Due ........................................................................................................... 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 11 12 13 14. 15. 16. 17. 18. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505610243 165,000.00 18,053.92 183,053.92 20,625.68 165,136.69 185,762.37 -2,708.45 -2,708.45 0.00 0.00 0.00 0.00 0.00 Side 2 1505610243 1505610243 REV-1500 EX Page 3 rlennrlnnt~~ (' mm~lnto ArlrlraCC' File Number 21-12-0353 DECEDENT'S NAME Dobish, Nancie S STREET ADDRESS 6395 Stephens Crossing CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. (1) Total Credits (A + B) (2) (3) (4) (5) 0.00 0.00 0.~~ 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 ............................................................................................................... d. receive the promise for life of either payments, benefits or care? ............................................................ ^ 0 2. If death occurred after December 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?...,... ^ 0 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 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 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-1502 EX+ (11-08) SCHEDULE A i. REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ilnhi~h_ Nancie S FILE NUMBER 21-12-0353 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as 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 which is jointly-owned with right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages or ine same sl~e~ Copyright (c) 2009 form software only The Lackner Group, tnc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1508 EX+(6-98) SCHEDULE E ~~ CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE T.4X RETURN RESIDENT DECEDENT ESTATE OF Dobish. Nancie S FILE NUMBER 21-12-0353 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. pf more space is needed, addluonal pages or ine sai ~.C ~~~C~ Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA IN RESIDENTED ~ DENTRN ESTATE OF FILE NUMBER Dobish. Nancie S 21-12-0353 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative{s) Lisa R Phillips Street Address 509 South 4th Street city Bellevue state ID zip 83313 Year(sl Commission raid 2, Attorney's 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's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 4,977.43 15,000.00 648.25 TOTAL (Also enter on line 9, Recapitulation) 20,625.68 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Dobish, Nancie S 21-12-0353 ITEM NUMBER DESCRIPTION AMOUNT Funeral ExRenses 1 Auers Cremation Services -Harrisburg, PA 1,650.00 2 Mary Roth -Memorial Service Music 300.00 3 Pandora -Pendants for cremation remains 36.00 4 Various Locations -Meals for Lisa R. Phillips and Hans Phillips while in Pennsylvania for 599.35 estate and memorial purposes 5 Verde Lifestyles -Four Urns for remains 513.50 6 Visaggios -Memorial Service, Dinner and Fellowship 1,878.58 H-A 4,977.43 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 ,~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dobish, Nancie S 21-12-0353 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1 B 8~ B Locksmith 176.00 2 Boscovs -Bedding, Sheets, Towels 575.00 3 Colette Wert -Caregiver 400.00 4 Commonwealth of Pennsylvania - Bureauof Vital Statistics -Death Certificates for August 19.00 Dobish 5 Creative Edge -Memoirs for distribution to family and friends of decedent 2,653.49 6 Darren Barbacci, M.D. 52.37 7 Delta Airlines -Travel for Daughter, Lisa R.Phillips 1,678.71 8 Dugan Appraisal Services -Appraisal of Real Estate 350.00 108.00 9 Earl Grove -Moving Expense 10 East Pennsboro Ambulance Service 88.00 11 Enterprise Car Rental -Transportation for Lisa R. Phillips and Hans Phillips 208.71 12 Eric Deibler -Painting and repairs 2,530.00 13 Families First -Provide medical information for decedent's child that was adopted 300.00 14 Frank L. Ftoto - Videography and photography of memorial service 500.00 15 G. Angotti -Administrative Support and Cleaning Services 5,000.00 16 GMAC -Mortgage - 6395 Stephens Crossing -December, 2011 -June, 2012 100,000.00 11,119.25 17 Halima Pride -Caregiver Total of Continuation Schedules See attached pages TOTAL (Also enter on Line 10, Recapitulation) 165,136.69 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) Rev-1512 EX+ (6-98) SCHEDULE 1 s DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Dobish, Nancie S 21-12-0353 VALUE AT DATE ITEM NUMBER DESCRIPTION OF DEATH 18 Hampden Township -Trash and Sewer 116.33 19 Hampden Township -School Taxes 1,387.10 20 Home Depot -Paint and Supplies 554.37 21 Hospice House -Harrisburg, PA 2,960.00 22 Hospice of Central Pennsylvania 9,990.00 23 Hospice of Central Pennsylvania 500.00 24 Joseph Abate -Handyman services 250.00 25 Joyce Horn -Reimbursement for groceries and sundries 127'88 26 Mary Amu Abessi -Caregiver 600.00 27 Pathology Associates of Central Pennsylvania 11.40 696.10 28 Patriot News -Obituary 29 Pealer's Florist -Flowers for Memorial Service 455.75 782.33 30 Penn Power and Light 31 Pennsylvania American Water 533.58 32 Pennsylvania Department of Revenue -Pennsylvania State Tax 401.00 151.71 33 Physician Services 34 Postage and Shipping Expense -Shipment of various memorabilia; thank you notes 2,663.31 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) Rev-1512 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued ESTATE OF (FILE NUMBER Dobish, Nancie S 21-12-0353 ITEM DESCRIPTION NUMBER 35 Ramada Limited -Hotel Expense for Lisa R. Phillips and Hans Phillips 36 Register of Wills, Cumberland County -Filing Fee, Inheritance Tax Return and Inventory 37 Register of Wills, Cumberland County -Filing Fee, Estate Settlement Agreement 38 Sandra Huah -Caregiver Services 39 Screen Actors Guild -Health Insurance Premiums 40 Sleepy's -Beds 41 Sloan Kettering Memorial Hospital -Medical Care 42 Stanley Steamer Carpet Cleaning 43 Stephens Crossing Homeowner's Association Fees 44 Travelocity -Travel for Son, Hans Phillips 45 Treadway Termite -Pest Inspection 46 UPS -Shipments of memorabilia to various family members 47 Various business establishments -Bedding, clothing and sundries for decedent 48 Verizon -Internet, Television, Cell and landline services - 49 Waggoner Fruitiger -Accounting Services 50 West Shore EMS -Ambulance Services TOTAL (Also enter on Line 10, Recapitulation) VALUE AT DATE OF DEATH 512.78 30.00 20.00 4,675.00 450.00 741.97 1.55 300.00 1,250.00 740.00 78.00 1,500.00 3,985.94 2,443.96 350.00 118.10 165,136.69 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (11-08) t , COMMONWEALTH OF PENNSYLVANIA IAI LICOITAAI!`C TAY CACTI IRN SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Dobish, Nancie S 21-12-0353 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee s TAXABLE DISTRIBUTIONS [include outright spousal I• distributions, and transfers under Sec. 9116(a)(1.2)] Hans Phillips Son Fifty Percent 230 Pestana Avenue Santa Cruz, CA 95065 Lisa R Phillips Daughter Fifty Percent 509 South 4th Street Bellevue, ID 83313 Tota I Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 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 SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)