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Home My WebLink About01-11-13J 1505610140 REV-1500 EX (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box 28oso1 INHERITANCE TAX RETURN ~ ~ ~ ~ ~ C~'-~~/ _ Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW - Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 6 4 2 8 0 7 8 6 0 7 1 2 2 0 1 2 0 9 0 4 1 9 3 1 Decedent's Last Name; Suffix Decedent's First-Name MI W 0 0 D R ~0 W G L E N A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI W 0 0 D R 0 W D O R I S A Spouse's Social Security Number 1 6 7 4 0 1 2 1 7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATh_ 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 R'.eturn Required 6 D d t Di death after 12-12-82) . ece en ed Testate (Attach Copy Hof Will) ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe; Deposit Boxes 9 Litigation Proceed R i d (Attach Copy of Trust) . s ece ve ~ 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 -PHIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N 7 1 7 2 4 9- 2 3 5 3 ~ :ci n ~ _ ~~ IQ}fER OF WI~,LS USE~IIC1p First line of address C:J1 - - - .; ~ I R W I N & M c K N I G H T P C '~'° c 3 : Second line of address ~. .. r~ ~ 4 ~ - , i _ 6 0 W E S T P O M F R E T S T R E E T _ City or Post Office State ZIP Code .'„i ~ _DATE F FAD ;: ~ r~; P A 1 7 0 1 3 Correspondent's a-mail address: 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. SIG RE OF P I~ESPO R FILING RETURN DATE t nnn c c _ / ~~~'-/~ 20 HA SIGNATUE GROVE ROAD NEWVILLE i nr~rv rttrrctStN I A I IVE 60 WEST POMFRET STREET CARLISLE PLEASE USE ORIGINAL FORM ONLY Side 1 150 ~i610140 PA 17241 ATE ~~~~~~~_ PA 17013 1505610140 .~ J REV-1500 EX 1505610240 Decedent's Social Security Number Decedent's Name: GLEN A• W O O D R O W 1 6 4 2 8 0 7 8 6 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 3 9 ~ 4 . 8 9 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................ ... 8. 3 9 0 4 . 8 9 9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9. 5 4 9 2 . 4 8 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10. 11. Total Deductions (total Lines 9 and 10) ............................ ... 11. 5 4 9 2 . 4 8 12. Net Value of Estate (Line 8 minus Line 11) ......................... ... 12. - 1 5 8 7. 5 9 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. - 1 5 8 7 . $ 9 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .045 ~ ~ ~ 16. 17. Amount of Line 14 taxable ~ 0 ~ 17 at sibling rate X .12 . 18. Amount of Line 14 taxable ~ ~ 0 at collateral rate X .15 18. 19. TAX DUE ...................... ................ .. . ... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1505610240 ~. ~ ~ o. 0 a o. o a ~. ~ ~ o. o a J REV-1500 EX Page 3 File Number Decedent's Complete Address: 0 0 DECEDENT'S NAME GLEN A. WOODROW __ _ STREET ADDRESS - 7 ALPINE DRIVE CITY STATE Ij~ CARLISLE _ PA 1'7015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest 0.00 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) 0.00 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 : ......................... ................................... ..... a a b. retain the right to designate who shall use the property transferred or its income; ......................... ..... ^ : c. retain a reversionary interest; or ......................... . ............................................................... ...... ^ XQ 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 . . ....... ..... ^ ^ X 3. Did decedent own an "intrust for" orpayable-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? ............................................................................................. ..... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS tS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. . ~, .~~ _ x 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 survi~ng pouse 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)]. ,4 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-1509 EX+ (01-10) . •pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY GLEN A. WOODROW FILE NUMBER: 0 0 If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(i3) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. DORIS A. WOODROW 7 ALPINE DRIVE SPOUSE CARLISLE, PA 17015 e. JOY SHOCKLEY I20 HAYS GROVE ROAD NEWVILLE, PA 17241 c. JOINTLY-OWNED PROPERTY: ITEM LETTER FOR JOINT DATE MADE DESCRIPTION OF PROPERTY INI;LUOE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL E DATE OF DEATH - STATE. VALUE OF ASSET 1. A.B 10/2002 MEMBERS 1ST FEDERAL CREDIT UNION SAVINGS ACCOUNT #43019-00 40 82 2. A. B. 10/2002 MEMBERS 1ST FEDERAL CREDIT UNION CHECKING ACCOUNT#43019-11 11,685.59 DAUGHTER OF DATE OF DEATH DECEDENT'S VALUE OF INTEREST DECEDENT'S INTEREST 33.3 13.59 33.3 3,891.30 TOTAL (Also enter on Line 6, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 3, 904 REV-'1513 EX+ (01-10) , , • Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES t51 A 1 t UF: GLEN A. WOODROW NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. DORIS A. WOODROW 7 ALPINE DRI\/E CARLISLE, PA 17015 2. JOY SHOCKLE:Y 20 HAYS GRO`~E ROAD NEWVILLE, PA 17241 -FILE NUMBER: 0 0 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustees) OF ESTATE Spousal Lineal JOINT ACCOUNT JOINT ACCOUNT ~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV 1500 COVER SHEET, AS APPROPRIATE II. NON-TAXABLE DISTRIBUTIONS. A. SPOUSAL DISTRIIBUTIONS UNDER SECTION 9113 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 I $ If more space Is needed, use addltlonal sheets of paper of the same size. St MEMBERS 1St FHDfiRAL CRHDTf UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Added *Doris ceceased DOD 12/14/2012 CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Added *Doris deceased DOD 12/14/2012 Estate of: GLEN A WOODROW Date of Death: 07/12/2012 Social Security Number: 164-28-0786 43019-00 05/01/1984 $40.82 $0.00 $40.82 Doris Woodrow" 05/01 /1984 43019-11 06/01 /1984 $11, 685.24 $0.35 $11,685.59 Doris Woodrow* 05/01 /1984 I' ~• ,; _ w Rl~~lf~ ~ iYicdtl~I(iii~,1 ~ll~' ~~~I~d Joy Shockley 10/29/2002 Joy Shockley 10/29/2002 MEMBERS 1ST FEDERAL CREDIT UNION Tessa L Klugh Lending Insurance Support Specialist January 3, 2013 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 v'u'Wmetnberslst.org .; ,, ~. ~ r J ~, ~~- FUNERAL HOME & CREMATORY, INC ~' 219 North Hanover Street C:ariisle, Pennsylvania 17013 717.243.451 1 toll free 1.866.451.451 1 fax 717.243.3723 www,hoffmanroth.com info~hoffmanrofh.com Joy Shockley August 2, 2012 20 Hays Grove Road Newville, PA 17241 Statement of Funeral Expenses for: Glen A. Woodrow Date of Geath: July 12, 2012 Account Id: 16603-166 PACKAGE: Traditianal Funeral Service TRADITIONAL FUNERAL SERVICE PACKAGE $ 4 850.00 Sub Total: $ 4,850.00 TOTAL FDNERAL HOME CHARGES: CASH ADVANCES:. $ 4,850.00 8 Certified Death Certificates at $ 6 00 each . Newspaper Notice -Valley Times Star ~ $ 48.00 Clergy ~ 50.00 Flowers $ 120.48 $ 159.00 Sub Total: $ 377.48 Total Funeral Expense: $ 5,227.48 Balance: 27 48 ----- _ ---------------------- Please return this portion with your Remittance. $ Amount Enclosed Glen A. Woodrow Service ID;~: 16603-166 SERVING OUR COMMUNITY SINCE 1 907