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Home My WebLink About01-03-131505610143 REV-1 ~ OFFICIAL USE ONLY County Code Year File Number PA Department of Revenue pennsylvania Bureau of Individual Taxes pepARTMENT OF REVENUE PO 80X.28060 17128-0601 iNHR S'IDENTEDI~ DENTRN 21 12 0390 Harrisburg, ~A ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death n43 16 8636 O1 O1 2012 12 29 1919 Decedent's Last Name WAY Suffix Decedent's First Name ROBERT MI E (If Applicable) Enter Surviving Spouse's Information Below MI Suffix Spouse's First Name Spouse's Last Name Spouse's Sociaf Security Number THIS RETURN MUST BE AILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW rn ~ 3. Remainder Return (Date of Death R t ^ 1. Original Return u e 2 Supplemental Prior to 12-13-82} - ~ 4. Limited Estate 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required fter 12-12-82) (date of death a dent Died Testate ~ D tt ~ • ~q~a~e~opy ~of~Tn~ist)a t_iving Trust ~ S. Total Number of Safe Deposit Boxes ece ((~~ 6 J (Attach Copy of Will) L ~ _ _ r 9. litigation Proceeds Received ~ t_ C~ 10~ bs~°tw"een1~ 31~- 1 and~t~(Da95~ f Death ~ 11 •Attach Schedule O) S~ 9113(A} BE DIRECTED TO: ~ ~~ ALL CORRESPONDENCE AND CONFIDENTIAL ETED D ' . Telephone Numbe CORRESPONDENT -THIS SECTION MUST SE COMPL Name -r17 697 3223 JESSICA L FISHER _ REGIS. @•„~ WILLS fIS~ OI'+f C ~ k„~: C~ -~__ e: First Line of Address '`'~ '"`" ~ ~ ~ ~ + ~ ~ ~ 555 GETTYSBURG PIKE ,~ ~' ,- ~ ; c:.w Second Line of Address ::: ~ ,4.:~ ,-, - , ~~~ -.. : S TE CLOG e D"ATE FILED- :T , r City or Post Office State ZIP Code .1 } __,, ~,~~ ~':`::» .. ,t c.~~ PA 17055 MECHANICSBURG Correspondent's a-mail address: Jessica c~keyStOneelderlaW.COm Under penalties of perjury, 1 declare that.! n ofe a amrler o e than henp~ersOnala p esentative is~l~dsed on all Intfofmatlon'of whf~ch prepares haD~sTEY knowledge.bel1e{~ it is true, correct and complete. Declaratl~ M p _T Richard F 67 Painter Avenue West Haven CT 0fi51fi DATE SIGNATURE OF PREPARER O~HER THAN REPRESENTATIVE ~ % ~ ...._ - -• ~ - Jessica L. Fisher .. - A RESS 555 Gettysbur Pike, Mechanicsburg, PA 1505610143 Side 1 1505610143 h~~ J 15D561D243 REV-1500 EX Decedent's Social Security Number 043 16 8636 Decedent's Name: Way, Robert E RECAPITULATION ........... 1. ........................ 1. Real Estate (Schedule A) .................................................... 963 .49 ......................•--- 2. Stocks and Bonds (Schedule B) .....................•-•-••••••-•••••••••••-~~--~~- 2. • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. ............................... 4. Mortgages & Notes Receivable (Schedule D} ......................... 4. Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ............... Cash 5 5. , . 6 43,505.44 Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6 - . 7. Inter-Vivos Transfers 8~ Miscellaneous N,on; Probate Property ^ Separate Billing Requested............ 7. Jr 0 0 0 . Q 0 r (Schedule G} 468.93 49 .................. g. Total Gross Assets (total Lines 1 through 7) ..................•--.•-•••••-•~~~~••- 8. , 6,844.00 . ........................ Funeral Expenses and Admrnrstrative Costs (Schedule H)............ 9 9. . 5,326.57 Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............................ 10 10. . 12 ,170.57 11. Total Deductions (total Lines 9 and 10) ................................................................ 11. 298.36 37 ...................................... 12. Net Value of Estate (Line 8 minus Line 11) ................... - ental Bequests/Sec 9113 Trusts for which 12. , 13. Charitable and Governm an election to tax has not been made (Schedule J) ............... . 13. 37 , 298.36 ...................... 14. Net Value Subject to Tax (Line 12 minus Line 13)........-•-•••~•~•••••••- 1a. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or 0 . 0 0 transfers under Sec. 9116 15. (a)(1.2) x .o_ 1, 67 8 . 4 3 16. Amount of Line 14 taxable 3'] ~ 2 9 $ . 3 6 16. at lineal rate X .0_,45 0 . 0 0 17. Amount of Line 14 taxable 0 . 0 0 17. at sibling rate X .12 0 . 0 0 18. Amount of Line 14 taxable 0 . 0 0 18. at collateral rate X .15 1 ~ 6 ") $ . 4 3 ...... 19. 19. TAX DUE ........................................... E OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPA YMENT. 20. FILL IN TH L 1505610243 Side 2 155610243 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Way, Robert E STREET ADDRESS 102 Cherry Lane CITY Carlisle Tax Payments and Credits: 1. Tax Due (Page 2, Line 19} 2. Credits/Payments A. Prior Payments B. Discount 3. Interest STATE ZIP PA ~ 17015 (1) 1,678.43 1,627.40 38 92 1,711.32 Total Credits (A + B) (2) (3) 4. If Line 2 is greater than Line 1 + Line 3, enteat` funderence. This is the OVERPAYMENT. Check box on Page 2, Line 20 to request 5• If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) 32.89 (5) LLS, AGENT. - . Make Check Payable to: REGISTER OF W~ . TIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS PLEASE ANSWER THE FOLLOWING QUES Yes No 1. Did decedent make a transfer and: •.-.• ................. ^ 0 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; or ....................... ...................................... d. receive the promise for life of either payments, benefits or care...-.-.within one year of death without ^ ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property x receiving adequate consideration? .................................................................................................. st for" or ayable upon death bank account or security at his or her death?....... ^ 0 3. Did decedent own an "in tru P which ^ ^ 4. Did decedent own an individual retirement account, annuity, or other non-probate property contains a beneficiary designation? ...................... HE ABOVE 4UESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RET .. , IF THE ANSWER TO ANY •F T net v ' ., I 1 1994 and before Jan. 1, 1995, the tax rate imposed on the alue of transfers to or for the use of the surviving For dates of death on or after Ju y , spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. r Janua 1, 1995, the tax rate imposed on the net value of transfersax a d the st tut ryhequire'ment for disclosuee ofn For dates of death on or afte rY [72 P.S. §9116 (a) (1.1) (ii)). The statute does not en f the surv vSngrspouse s' the only benfefic ry. assets and filing a tax return are still applicable eve For dates of death on or after July 1, 2000: e net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural paten , an • The tax rate imposed on th adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a} (1.2) he net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in . The tax rate imposed on t [72 P.S. §9116 (a) (1)]~ ed on the net value of transfers to or for the use of then decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3) . ne arent in common with the decedent, whether by blood or adoption. . The tax rate impos sibling is defined under Section 9102, as an individual who has at leas p Fite Number 21-12-0390 Rev-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN occinFNT DECEDENT ESTATE OF H-a ,Robert E All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP UNIT VALUE DESCRIPTION NUMBER NUMBER 19 shares of Prudential Financial, Inc. Stock- Richard Way 50.71 1 named as beneficiary on stocks TOTAL (Also enter on Line 2, Recapitulation) (lf more space is needed, additional pages of the same size) Copyr-9ht (c) 2002 form software only The Lackner Group, Inc. FILE NUMBER 21-12-0390 VALUE AT DATE OF DEATH 963.49 963.49 Form PA-1500 Schedule B (Rev. 6-98) Rev-1509 EX+(01-~0- SCHEDULE F ~ I JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN avsinFNT DECEDENT ESTATE OF FILE NUMBER 21-12-0390 Wa ,Robert E N an asset was made joint within one year of the decedents date of death, it must be reported on schedule _ ADDRESS RELATIONSHIP TO DECEDENT SURVIVING JOINT TENANT(S) NAME Son 67 Painter Avenue A. Richard F Way West Haven, CT 06516 Daughter 1901 Cherry Lane g, Margaret G Way Carlisle, PA 17015 C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY % OF ' DAVAOF pOEFTH T ' LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT ATTACH DEED FOR FYING NUMBER DATE OF DEATH ALUE OF ASSE S DECD INTEREST S INTERES DECEDENT ITEM FOR JOINT NUMBER TENANT MADE JOINT . NUMBER OR SIMILAR IDENTI JOINTLY-HELD REAL ESTATE. 3% 2 g$1.13 8.943.38 33.33 , AB 03/05/2010 PNC Bank Checking 1 507.35 33.333% 169.12 2 Ag 03!2312010 PNC Bank Savings 80,710.37 50.000% 40,355.19 3 I A 102/22120101 TD Bank I 43,505.44 TOTAL (Also enter on Line 6, Recapitulation) (lf more space is needed, additional pages of the same size) Form PA-1500 Schedule F (Rev. 01-10) Copyright (c) 2010 form software only The Lackner Group, Inc. Rev-1510 EX+ (08-09) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN __.....~.,r ncr Gl'1FNT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF - FILt Numacr~ 21-12-0390 a ,Robert E 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. °rb OF DECD'S EXCLUSION TAXABLE DESCRIPTION OF PROPERTY DATE OF DEATH INTEREST (IF APPLICABLE) VALUE ITEM INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OFOOO OO 5,000.00 5, ~ Southern Connecticut Gas Company IRA 5,000.00 TOTAL (Also enter on Line 7, Recapitulation) (If more space is needed, additional pages of the same size) Form PA-1500 Schedule G (Rev. 08-09) Copyright (c) 2009 form software only The Lackner Group, Inc. REV-1151 EX+ (10-09) COMMN ~ ~~~~ ~ RF~T~.RNANIA SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ~~- .^^~r-o rc~TATC nG ITEM Nt MBE A. Robert E Decedent's debts must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: k Cremation Services of Central Pennsylvania, Inc. - 3125 Walnut Street Hetr~c Harrisburg, PA 17109 AMOUNT 111.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address Zio State City Year(s) Commission Paid 2 Attorney's Fees Keystone Elder Law P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3. Claimant Mar aret Wa Street Address 102 Cher Lane 17015 State Pp- Zio ~;~, Carlisle Dau hter Relationshio of Claimant to Decedent 4. ~ Probate Fees 5 Accountant's Fees 6. Tax Return Preparer's Fees 7. ~ Other Administrative Costs Waived 3,218.00 3,500.00 15.00 6,844.00 TOTAL (Also enter on line 9, Recapitulation) Form PA-1500 Schedule H (Rev. 10-09) Copyright (c) 2009 form software only The Lackner Group, Inc. f ILC Ivv~nv.-~~ 21-12-0390 Rev-1512 EX+(12-08) SCHEDULE ~ DEBTS OF DECEDENT, TENS MORTGAGE LIABILITIES AND L COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RET TRN ~c~reTF nF Robert E FILE NUMBER 21-12-0390 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimdursea ~~~~~~~~~ ~~~ ITEM DESCRIPTION NUMBER 1 Cable Bill for October through January 2 Cumberland Goodwill Fire Rescue EMS- Medical Bill 3 Manor Care- Medical Bill 4 Mount Rock Inpatient Service- Medical Bill Power of Attorney Agent's Hotel Stay in Carlisle, PA for 1013012011 5 Power of Attorney Agent's Hotel Stay in Carlisle, PA for 1111212011 6 Power of Attorney Agent's Hotel Stay in Carlisle, PA for 1112012011 7 Power of Attorney Agent's Hotel Stay in Carlisle, PA for 111512011 8 Power of Attorney Agent's Hotel Stay in Carlisle, PA for 12/10/2011 9 Power of Attorney Agent's Hotel Stay in Carlisle, PA for 121312011 10 Power of Attorney Agent's Hotel Stay in Carlisle, PA for 1213112011 11 12 Power of Attorney Agent's Meals from 1012912011-1211012011 of Attorney Agent's Mileage from 1013012011-1213112011 from CT to PA 13 Power VALUE AT DATE nf` HEATH TOTAL (Also enter on Line 10, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2008 form software only The Lackner Group, Inc. 789.15 81.58 771.00 91.72 196.64 51.70 51.70 47.76 51.70 51.70 49.05 452.87 2,640.00 5,326.57 Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+(01-10) COMMONWEALTxi OF~PXEN~NTgYRNANIA INh1EFj,ITAN, ~ cn N RLV~V~•. --- _ ESTATE OF Wa ,Robert E NAME AND ADDRESS OF NUMBER PERSONISI RECEIVING PROPERTY TAXABLE DISTRIBUTIONS ainstnbutionsr~ ahnd tansfers I• under See= 9116(a)(1.2)] 1 Margaret G Way 102 Cherry Lane Carlisle, PA 17015 2 Richard F Way 67 Painter Avenue West Haven, CT 06516 FILE NUMBER 21-12-0390 RELATIONSHIP TO SHARE OF ESTATE AMOL DECEDENT (Words) Daughter Son f OF ESTATE ($$$) 10.00 31,697.87 I I Total I 31,707.87 ounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro riate. Enter dollar am NON-TAXABLE DISTRIBUTIONS: AL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKE II• A. SPOUS B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS SCHEDULE J BENEFICIARIES II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 F O~EP 1500 Schedule J (Rev. 01-10) TOTAL OF PART Copyright (c} 2010 form software only The Lackner Group, Inc.