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Home My WebLink About02-28-13 (2)1505610105 REV-1500 Exl~-""~''~ OFFlCIAL USE ONLY PA Department of Revenue P ~~~ County Code Year FIN Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~~ /~ ~J, / I PO BOx 28obot RESIDENT DECEDENT / a `r lp u~.N~n~~m oe ~weitnBm ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Data of Birth MMDDYYYY 05/06/2012 03/01/1936 Decedent's Lasl Name Suffix Decedent's First Name MI Rohr M. Lois (NApplleable) Enter SurvlWny 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 WRH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Orginal Return O 2. Supplemental Return O 3. Remainder Relum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death attar 72-12-82) O 6. Decedent Died Testate O 7. Decedent Makdainetl a Living Trust 6. Total Number of Sate Depoatt Boxes (Attach Copy of WIII) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. EleLtion to Tax under Sec. 9113(A) Between 12-31-91 and t-1-95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPDNDENCE AND CONFlDENTIAL TAx INFORAUTION SHW LD BE DIRECTED Tb: Name Daytime Telephone Number Sandra Shamansky (717) 605-6336 REGISTER OF YIIILL$--l~E ONLY c n w'O ~ C ' ' rn' First Llne of Address T I 6 ) ~ ~ r'r'+ 1906 North 3rd Street ~ = r m ~ a Second Llne of Address D Z ~ CO ~ v = 7c O Z t7 "~ ~ ~~ ILEQJ City or Poat Office State ZIP Code o c --- m Harrisburg ~ r PA 17102 ~ N Q -cs a ° -n ~ I Correspondent's e-mail sddreac shamdra gOn7~aOl.com Under penaltles of perjury, l declare that I hew ezemined HYe realm, InchMlrg exomparrylrg schedules end alatements, end to dre beet of my knowbdge erM belle!, e la We, coned and campbte, of preperer Deter tlun dre personal repreaentathre Is tuned on aN kdarmatbn of whkh Preparer has any kraMedga. SIGNAT ' OF PEpSON RESPO LE F 1 G RETURN DAT ADDRESS /90l>r /l/ 3rd Sf n~ / ~/ D rl ~arri~,~rr/Ls~ r ~- SI(,NATl1RE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 1505610105 Side 1 15056101D5 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedents Name: M. Lois Rohr 185-26-8012 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 0.00 2. Stocks and Bonds (Schedule B) .................................... ... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Propdatorship (Schedule C) .. ... 3. 0.00 4. Mortgages and Notea Receivable (Schedule D) ........................ ... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 908.79 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 35,240.43 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Properly (Schedule G) O Separate Billing Requested...... .. 7. 104,760.20 8. Total Grow Aawb (total Lines 1 through 7) ........................... .. 8. 140,909.22 9. Funeral Expenses and Adminislretive Cosfs (Schedule H) ................. .. 9. 15,752.57 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 2898.42 11. Total Dsductlons (total Lines 9 and 10) ............................... .. 11. 1$$4$.98 12. Nat Value of Estate (Line 8 minus Line 11) ............................ .. 12. 122260.23 13. Charitable end Governmental Bequesta/Sac 9113 Trusts for which en election to tax has not been made (Schedule J) ......... ............ .. 13. 0.00 14. Net Value SubJect to Tax (Line 12 minus Line 13) ...................... .. 14. 1222$0.23 TAX CALCULATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or trensfers under Sec. 9118 (a)(1.2) X .0_ 0.00 15. 16. Amount of Line 14 taxable et lineal rate x .o ~5 122260.23 16. 5501.71 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17, 18. Amount of Line 14 taxable at collateral rate X .15 0.00 18 19. TAX DUE ....................................................... .. 19. 5501.71 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV~1500 EX (FI) Page 3 Decedent's Complete Address: 0.00 DECEDENT'S NAME M. Lois Rohr STREET ADDRESS 1471 Hilicrest Court Apl# 704 CITY __ _._ -.. .. !STATE J- ZIP Camp Hill i PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPaymeMs A. Prbr Payments _ B. Discount 3. Interest A. If Line 2 Is greater than Line 1 + Line 3, enter the dffference. This is the OVERPAYMENT. FIII In oval on Paga 2, Line 20 ro reriueat a rePond. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Flla Number Total Credits (A+ B) (2) (5) (i) 5501.71 0.00 (3) (4) 5510.75 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 ar income of the Property transfened .......................................................................................... ^ b. retain the dght to designate who shall use the property transferred or its income ............................................ ^ c. retain a reversbnary interest .............................................................................................................................. ^ d. receive the Promise for life of either payments, benefits or rare? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer properly wiMin one year of death without receiving adequate consideretbn? ...................................................................................__....................... ^ 3. Did decedent own an "in trust for' or payable-upon-death bank account or security at his or her deaM? .............. ^ 4. Did decedent own an individual retirement accaurn, annuity or other rron-probate properly, which contains a benefidary 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 Vansfers 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 deaM 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)(t 2)]. The tax rate imposed on the net value of Vansiers to or for the use of the decedent's lineal benef~iaries is 4.5 percent, except as notes in [/2 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or far the use of the decedent's siblings is 12 percent [/2 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has al least one parent u1 common with the decedent, whether by blood a adoption. REV-i5o8 EX+ (oe-u) Pennsylvania SCREpULE E YJ DEPARiMENfOFREVENUE CASHr BANK DEPOSITS ~ MISC. INHERRANCE TRX RETURN PERSONAL PROPERTY RESIDENT DECEDE1rt ESTATE OF: FILE NUMBER: M. Lois Rohr Include the proceeds of Iitlgatlon and the date the Draeeds were received by the estate. All property jointly owned with right of survivorship must be disdwed on Sdrsdule F. If more space Is needed, use additional sheets of paper of the same slze. ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: M. Lois Rohr F ]OINTLY-OWNED PROPERTY If an sue! became ~oIM1Y owned wkhin one Year of the decedent's dste of death, k must be reported on Schedule G. SURVMNG JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Sandra Shamansky 1906 North 3rd Street Harrisburg, PA 17102 Daughter B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER IETn:R FOR %/INr TENANF DATE MADE mIm DESCRIPTION OF PROPERTY INCWDE NAME OF FINMlOAL INSfIIUfIDN AND BANK ACCWNr NUMBER 00. SIMf1AR [DENnFY1NG NUMBER ATTACH DffD FOR JOINRY MELD 0.FAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDBlT'S WTEREST 1. A. Members First CD (Acct202521-55) 28,840.52 50 14,420.28 2. A. Members First CO (Acct202521-54) 10,431.33 50 5,215.67 3. A. Member's First CD (Acct20252t-53) 10,467.17 50 5,233.59 4. A. Members First CD (Acct20252152) 10,467.17 50 5,233.59 5. A. Members First CD (Acct202521-02) 5,137.31 50 2,568.66 6. A. Members First CD (AccY102521-01) 5,137.31 50 2,568.66 TOTAL (Also enter on Line 6, Recapitulation) I; 35,240.43 If more space Is needed, use addi8onal sheets of paper of the same size. REV-1510 EX+ (08-09J ~ Pennsylvania SCHEDULE G DERARTMENTOF gEVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TA%RETURN MISC. NON-PROBATE PROPERTY RESIDEM DECEDENT ESTATE OF FILE NUMBER M. Lois Rohr This schedule must be completed and Bled if the answer to any of questlons I through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCWDE THE NAME OF INE TAANSrEREE, 1XE10. REIATIONSHIV TO DE[EDENr NIO THE DAIS of i0.AX5fE0. AiTADI A [D%OG iXE GEED F00. RELL ESrQE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION ^ AgRIGBIE TAXABLE VALUE 1. American Funds IRA (acct #83127833) 104,760.20 100 104,760.21 TOTAL (Also enter on Line 7, Recapitulation) ; I 104,760.20 If more space Is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) ra Pennsylvania DEP~gTMENT OF REVENUE INHERRFNCE TN( RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS M. Lois Rohr FILE NUMBER Decedent's debt must be reported on Schedule i. 1TEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Funeral Home (Parthamore Funeral Home - New Cumbedand PA) 11,419.57 2. Grave Opening (Slate Hill Cemetery Assoc -Camp Hill PA) 845.00 s. Florist (Old Town Florist -New Cumberland PA) 339.00 a. Headstone (Gingrich Memorial -Mechanicsburg PA) 470.00 B. 1. State ZIP Z. Attorney Fees: 0.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 0.00 Claimant 4. 5. 6. ~. e. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address 0.00 Ciry Year(s) Commission Paid: Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Moving & Storage Fees Apartment Fees (Country Walk Apartments) 0.00 0.00 0.00 1,794.00 885.00 TOTAL (Also enter on Line 9, Recapitulation) I; 15,752.57 If more space is needed, use additional sheets of paper of the same size. REV-lst2 Ex+ (tz-tz) '~i~pennsylvania SCHEDULE I ~~•.11~~ DEPARTMEMOFREVENUE DEBTS OF DECEDENT, INHERRANCE TA%RETURN MORTGAGE LIABILITIES $ LIENS RES[DENi DECEDENr M. Lois Rohr FILE NUMBER Report debts Incurred by the decadent prior to death that romainad unpaid at Ma data of death, induding unrolmbuned medical ezpenees. If more s0ace is needed, insert additional sheets of the same size.