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Home My WebLink About01-09-13J 1505610140 r REV-1500 Ex (°'-'°' PA Department Of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box zaosot INHERITANCE TAX RETURN Harrisburg PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 4 9 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date Of Death MMDDYYYV Date of Birth MMDDYYYV 1 4 2 U 1 2 0 7 1 9 1 9 1 9 Decedent's Last Name Suffx Decedent's First Name MI F E R T E N B A U G H G E O R G E p (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffx 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 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Return Required D ^X 6 d t Di d T death after 12-12-82) . ece en e estate (Attach Copy of Will) ~ 7. Decedent Maintained a Living Trust Att h _ 8. Total Number of Safe Deposit Boxes ( ac 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 INFO~IATION SHOUL~E DIR~A41 T0: N ame Daytime T~plmne Number m rn M U R R E L W A L T E R S I I I E S Q ~ ~- ~ C7 7 1 ~~~ 7 ~~ 6ui5aa0 REG C~=O; ILL$.17EE OyLY ':x vv ~~ First line of address ^z: . : ~ r, . 5 4 E A S T M A I N S T R E E T r ~ ~ .-;; Second line of address - ~ ~ ~ u~ +:ri City or Post Office State ZIP Code DATE FILED M E C H A N I C S B U R G P A 1 7 0 5 5 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schetlules 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 praparer has any knowledge. SIGt1~op~ERSO~ESPONSIBLE FO~FILING RETURN~j DATE ADIL//DJJooRSS~)ES II ~- ~ n._//lL.--..~ >3 a.iar6L„f ~ L~Y~ RAY L• FER ENBAUG 1249 HILLSIDE DR MECHANICSBURG PA 17055 SIGNATURE OF AR O E AN REPRESENTATIVE DATE ? ADDRESS ~- ~ ~ J MURREL R• ALTERS, III, 54 E• MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J Continuation of REV-1500 Inheritance Tax Return Resident Decedent GEORGE P. FERTENBAUGH 21 12 0496 Decedent's Name Page 3 File Number Correspondents Name First line of address Second line of address City or Post Offce Correspondent's a-mail address:_ Under penalties of perjury, I declare that I Y it is Vue, coned and complete. Declaration Daytime Telephone Number State ZIP Code this velum, ter than the schedules and statements, and to the best o is based on all information of which preparer ADDRESS 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: GEORGE P. FERTENBAUGH RECAPITULATION 1 . Real Estate (Schedule A) ....................................... .... 1. 2 . Stocks and Bonds (Schedule B) .................................. .... 2. 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. 2 2 5 9 8 1, 2 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property . (Schedule G) ~ Separate Billing Requested .... ... 7. 1 3 0 1 0 3, 8 8 8. Total Gross Assets (total Lines 1 through 7) ........................ ... 8. 3 7 6 0 8 5 , 1 1 9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9. 5 ~ 8 1 . ~ 6 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10. 2 7 1 . 8 4 11. Total Deductions (total Lines 9 and 10) ............................ ... 11. 5 3 5 2 . 9 0 12. Net Value of Estate (Line 8 minus Line 11) ......................... ... 12. 3 7 ~ 7 3 2 , 2 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .. 14. 3 7 ~ 7 3 2 . 2 1 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X• 0 0 0 0 15. ~ ~ ~ 16. Amount of Line 14 taxable at lineal rate X• ~ 0 0 0 16. ~. 0 0 17. Amount of Line 14 taxable at sibling rate x.t2 2 6 4 8 0 8. 4 6 17. 3 1 7 7 7. 0 2 18. Amount of Line 14 taxable at collateral rate x .15 1 0 5 9 2 3. 7 5 16. 1 5 8 8 8. 5 6 19. TAX DUE .................................................... ..19. 4 7 6 6 5. 5 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 L 1505610242 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 1z oass CITY STATE PA ZIP 17013 Tax Payments and Credits: 1 Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 40.000.00 B. Discount 2 000.00 3. Interest Total Credits (A +B ) (1) 47 665.58 (2) 42 000.00 4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 0 00 5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5 665.58 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRI A TE BLOCKS 1. Did decedent make a transfer and: a, retain the use or income of the property transferred : .............. ................................................. Yes ..... ^ No ^X b. retain the right to designate who shall use the property transferred or its income : ......................... ...... ^ Q c. retain a reversionary interest; or ....................... 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? ............... ^ 3. Did decedent own an'in trust for" orpayable-upon-death bank account or security at his or her death? .... ..... ^ ^X 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)). 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)]. 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 t !8-98? SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUM GEORGE P.FERTENBAUGH 21 12 All property jointly-owned vrith right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION (2) SERIES HH -EACH $10,000 TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE OF DEATH 20,000.00 (If more space is needed, insed additional sheets of the same size) REV-1508 EX+ (11-10) pennsylvania SCHEDULE E CtEPARTMENT OF REVENUE INNFRIrANCFrAX REruRN CASH, BANK DEPOSITS, & MISC. RtsloENruECeDENr PERSONAL PROPERTY ESTATE OF: FILE NUMBER: GEORGE P.FERTENBAUGH 21 12 0496 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned vrith right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 • PNC INVESTMENTS, LLC 123,991.25 ACCOUNT B ALANCE 2. PNC BANK CHECKING 3. HIGHMARK HEALTH INSURANCE REFUND 4. VETERANS ADMINISTRATION BENEFIT 5. UNITED CHURCH OF CHRIST HOME REFUND 96,786.35 423.07 100.00 4,680.56 _ TOTAL (Also enter on Line 5 Recapitulation) I $ If more space is needed, insert additional sheets of paper of the same size 4F_V-1510 EX+!08-0P1 Pennsylvania DEiRARTMENT OF REVENUE INRERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER GEORGE P. FERTENBAUGH 21 12 0496 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 NUMBER INCLUDE THE NAMEOF THE TRANSFEREE, THEIRRELATIONSHIPTODECEDENTAND GATE OF DEATH °/OF DECD'S EXCLUSION TAXABLE THE DATE OF TRANSFER. ATTACHACOPV OF THEDEED FOR REAL ESTATE. VALUE OF ASSET INTEREST pF nrPLlca&n VALUE 1 • TRANSAMERICAN LIFE INSURANCE COMPANY 65 051 94 100 00 RAY L. FERTENBAUGH-BROTHER , . . 65,051.94 ANNUITY 2. TRANSAMERICAN LIFE INSURANCE COMPANY 65 051 94 100 00 EARL E. FERTENBAUGH-BROTHER , . . 65,051.94 ANNUITY TOTAL (Also enter on Line 7 Recapitulation) ~ $ 130 103 88 If more space Is needed, use additional sheets of paper of the same size. RF_V-+511 EX+ ~i~-09 pennsylvania CEF gkTMENT OF REVENUE IflHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ca I Nr c ur FILE NUMBER GEORGE P. FERTENBAUGH 21 12 0496 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 • MYERS BUHRIG FUNERAL HOME & CREMATORY -MECHANICSBURG 296.56 2. TRINDLE SPRINGS LUTHERAN CHURCH -LUNCHEON 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)ofPersonalRepresentative(s) RAY L. FERTENBAUGH Street Address 1249 HILLSIDE DRIVE City MECHANICSBURG State PA ZIP Year(s)CommissionPaid: (RENOUNCED) 2 . Attorney Fees: MURREL R. WALTERS, III 3. Famify Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4. 5• 6. 7• Street Address Clty Slate ZIP Relationship of Claimant to Decedent Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS Accountant Fees: Tax Return Preparer Fees: 4,300.00 384.50 TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent GEORGE P.FERTENBAUGH 21 12 0496 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses 8 Administrative Costs - Bi ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative Commissions: 2. Name(s)otPersonalRepresentative(s) EARL E.FERTENBAUGH Street Address 1263 W. TRINDLE ROAD Ciry MECHANICSBURG State PA ZIP 17055 Year(s) Commission Paid: (RENOUNCED) SUBTOTAL SCHEDULE H•B1 RE'/-t 512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN P.ESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS co i r ~ ~ yr FILE NUMBER GEORGE P. FERTENBAUGH 21 12 0496 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MILLENIUM PHARMACY 120.06 PRESCRIPTIONS 2. MOBILEX USA 151 78 XRAY TOTAL (Also enter on Line 10, Recapitulation) I $ If more space is needed, insed additional sheeLS of the same size. REV-15+3 E%+ ~0+! C! pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TA% RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: GEORGE P. FERTENBAUGH ~~ ~~ nnna RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a)(1.2).) 1. MABEL R. McNULTY Sibling 124 HOGESTOWN ROAD MECHANICSBURG, PA 17050 2. PAUL N. FERTENBAUGH Sibling 222 S. YORK STREET MECHANICSBURG, PA 17055 3. MARTHA J. BOYER Sibling 936 W. TRINDLE ROAD MECHANICSBURG, PA 17055 4. RAY L. FERTENBAUGH Sibling 1249 HILLSIDE DRIVE MECHANICSBURG, PA 17055 5. EARL E. FERTENBAUGH Sibling 1263 W. TRINDLE ROAD MECHANICSBURG, PA 17055 6. JANE FAIRCLOTH Collateral 70 SCHOOLHOUSE ROAD GARDNERS,PA17324 7. DARLA HARLACHER Collateral 5203 SOUTHERN TRAIL MYRTLE BEACH, NC 29579 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. R. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 91 t3 FOR WHICH AN ELECTION TO TAX 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. $ If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent GEORGE P. FERTENBAUC;H 21 12 0496 Decedent's Name Page 2 File Number Schedule J -Beneficiaries - 1 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9176 (a) (1.2).] 8. WAYNE STEVENSON Collateral 1 STEVENSON DRIVE NEWVILLE, PA 17241 9. SHIRLEY STUPPY Collateral 476 ENDERS ROAD FISHERVILLE, PA 17032 10. RONALD STEVENSON Collateral 186 MARTINSVILLE FORD ROAD BOWLING GREEN, KY 42103 11. LINDA KINGSBOROUGH Collateral 928 ALEXANDER SPRING ROAD CARLISLE, PA 17013 12. BRIAN FERTENBAUGH Collateral 5103 S. DEERFIELD ROAD MECHANICSBURG,PA17050