HomeMy WebLinkAbout04-04-13 REV-1500 EX(02-11) 1505610143 OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 12 1190
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW -
Social Security Number Date of Death Date of Birth
08 17 2012 02 08 1930
Decedent's Last Name Suffix Decedent's First Name MI
RUEGG HERBERT J
(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
Supplemental Return 3.
1. Original Return 2. Remainder Return(Date of Death
Fx 0 Prior to 12-13-82)
4. Limited Estate 4a.Future Interest Compromise 5, Federal Estate Tax Return Required
1:1 (date of death after 12-12-82)
FX 6. Decedent Died Testate 7. DecedentoMaigVrned a Living Trust
(Attach Copy of Will) (Attach C Copy ust) & Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received 10,Spousal Poverty Credit(Date of Death 11,Election to tax under Sec.9113(A)
F between 12-31-91 and T-1-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
DAVID J LENOX 717n271 7115
c::
RE414ijR Pf Wl�US&I"Pi2y
First Line of Address r L-I
8 TRISTAN DRIVE SUITE 3 777)
t 'mot
Second Line of Address
4 City or Post Office State ZIP Code DATE FI(JD
DILLSBURG PA 17019
Correspondent's e-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 trun,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer haspny knowledge.
SIGNA RE OF PERSON ES LE FOR FILING RETURN D E
Susan L. Otto
ADDRESS
7741 Wertzville Rd.,Carlisle, PA 17013
SIGNATURE P PARE
PRESENTATt D TE
David J. Lenox
10
ADDRESS
—
8 Tristan Drive, Suite 3, Dillsburg, PA
Side I
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Ruegg, Herbert J.
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&Notes Receivable(Schedule D)........................................................ 4.
5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Ikon Probate Property
(Schedule G) �J Separate Billing Requested............ 7. 471 , 330 . 56
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 471 ,330 . 5 6
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 24 ,333 . 19
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 785 . 64
11. Total Deductions(total Lines 9 and 10)................................................................ 11 25 , 118 83
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 446,211 73
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. 446,211 . 73
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 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 446,211 . 73 16. 20, 079. 53
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 20 , 079. 53
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-12-1190
Decedent's Complete Address:
DECEDENT'S NAME
Ruegg, Herbert J.
STREET ADDRESS
I Longsdorf Way
CITY STATE =i[P
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 20,079.53
2. Credits/Payments
A. Prior Payments 17,000.00
B. Discount 894.74
Total Credits(A +13) (2) 17,894.74
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
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. (5) 2,184.79
Make Check Pa l! able to: REGISTER OF WILLS AGENT.
MygEff
pow
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;............ ................... ........._.................-..........._. 51 F-1
b. retain the right to designate who shall use the property transferred or its income;............... ............. .... El F-1
c. retain a reversionary interest;or........ ....... ............. ................................. ............................. ❑ F-1
d, receive the promise for life of either payments,benefits or care?......_...... ........... ...... ❑ ❑
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................................... ............................................................._ ❑ 0
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ Exl
4, Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?.............. ...._...._.......... ...... ......... ................. 0 ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
;1�,-,1 :, - 'NSNR -M11 "A -IV 1 '14
al bVIAGMEMSINX RNMEW -Kqmw I WIN A= ?t INUEN
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)(11)(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)(11)].
• 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(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-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ruegg, Herbert J. 21-12-1190
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 DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THE
INCLUDE
ATE OF TEROANSFERSATTACFi A COPY OF RELATIONSHIP DEIED FOR ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 ING Annuity Contract#409768: 12,911.41 12,911.41
2 J Hancock Venture III Annuity: 32,961.92 32,961.92
3 Lincoln Am Legacy III Annuity: 31,419.77 31,419.77
4 Merrill Lynch 872-49669-Herbert J. Ruegg Trust 265,392.70 265,392.70
Account:
5 Merrill Lynch IRA 872-76282: 120,348.57 120,348.57
6 PNC Bank 50-0368-3292-Herbert Ruegg Rev Til 8,296.19 8,296.19
TOTAL(Also enter on Line 7, Recapitulation) 471,330.56
(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 G(Rev. 08-09)
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENTDECEDENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Ruegg, Herbert J. 21-12-1190
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 11,276.60
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Susan L. Otto
Street Address 7741 Wertzville Rd.
City Carlisle State PA zip 17013
Year(s)Commission Paid 6,000.00
2. Attorney's Fees David J. Lenox 6,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State zio
Relationship of Claimant to Decedent
4. Probate Fees 130.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 926.09
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 24,333.19
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Ruegg, Herbert J. 21-12-1190
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 AUM Church: 200.00
2 Boyer Funeral Home: 8,309.00
3 Doug Boyer(headstone): 2,602.60
4 McGlaughlin: 40.00
5 Rev. Keith Beastly: 125.00
H-A 11,276.60
Other Administrative Costs
6 Cumberland Goodwill Fire/Rescue EMS: 124.13
7 Cumberland Law Journal(advertise estate): 90.00
8 PNC (Bank charges): 67.00
9 PSERS (overpayment) 404.18
10 Register of Wills (filing fee): 30.00
11 The Sentinel (advertise estate): 210.78
H-137 926.09
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
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ruegg, Herbert J. 21-12-1190
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 Cumberland Crossings: 767,82
2 Holy Spirit Phys Services: 5,82
3 Quantum Imaging: 12.00
TOTAL(Also enter on Line 10, Recapitulation) 785.64
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Rue , Herbert J. 21-12-1190
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S)RECEIVING PROPERTY (Words) ($$$)
I Do Not List Tr steets)I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Susan L.Otto Daughter 148,737.23
7741 Wertzville Rd.
Carlisle, PA 17013
2 Brenda A. Roland Daughter 148,737.09
408 Golden Oaks Court
Bel Air, MD 21015
3 Gary T. Ruegg Son 148,737.09
7809 Bryden Drive
Fishers, IN 46038
Total 446,211.41
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
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 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
'Jill IIWI IF I CI I IIUI I I 117 1011 r1bbVNi IL VLCZLIUI I IGi IL
For the period 08107=12 to 09/07/2=12
For 24-hour information,sign onto PNC Bank Online Banking HERBERT&NORMA RUEGG REV TRT
on pnc.com Primary account number 50-0368-3292
Account Number. 50-0368-3292 -continued Page 2 of 2
Other Deductions -continued
Date Amount Description
08/23 8,296.19 Funds Transfer To Acct 5003686362
Daily Balance Detail
Date Balance Date Balance Date Balance Date Balance
08/07 14,641.72 OS/17 �8,296-� 08!31 1,402.70 09/07 1,402.92
08/16 9,641.72 08/23
I
ING A�
ING USA Annuity and Life Insurance Company Annual Statement
909 Locust St As of 09/01/2012
Des Moines, IA 50309-280°
Phone: (800)369-5303
Fax: (515)698-2001
Internet:www.ingannuities r,i1
HERBERT J RUEGG
7741 Wertzville Rd
Carlisle PA 17013-9021
Contract Summary
Ccntract Number: 409768
Product: USG SPA 7 -4.5%
Contract Date: 09/01/1995
Annuitant Name: HERBERT J RUEGG
Initial Premium: $20,000.00
Non Qualified
Year-to-Date
09/01/2011 -09/01/2012
Starting Cash Value $13,804.94
Withdrawals ($1,468.88)
Interest $575.35
Endina Cash Value $12,911.41
Additional Information
As of 09/0112011 As of 09/01!2012
Cash Surrender Value $12,424.45 $11,620.27
Total Withdrawals ($23,115.75)
Cash Surrender Value-Includes Surrender Charge if applicable.
C' :rren# lr:,erest Rate as of 09/01/2012
Rate Effective Date Current Interest Rate
02/01/2012 4.50%
Transaction History 09/01/2011 to 09/01/2012
Date ransaction Type Amount
12/20/2011 ystematic Withdrawal
$1,468.88
If you have any questions about your Statement, please contact your agent or our Customer Service Center at
(800)369-5303. For additional information regarding your Contract you can also visit our website at
www.ingannuities.com.
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LAST WILL AND TESTAMENT
OF
HERBERT J. RUEGG
I, HERBERT J. RUEGG, of Perry County, Pennsylvania do hereby make, publish and
declare this, my last Will and Testament, hereby revoking and making void any and all Wills and
Codicils at any time heretofore made by me.
FIRST: I direct that my debts, the expenses of my last illness and the expenses of my final
services and burial be satisfied and fully paid out of my estate as soon as may be convenient after
my decease.
SECOND: I leave all funeral arrangements to my Executor hereinafter named. In the event I
have not already purchased a burial lot for my family and me, I hereby authorize and empower my
Executor to purchase such a lot, to erect a suitable memorial thereon, and to provide for the
permanent upkeep of same out of my estate.
THIRD: In as much as all items of household furniture and furnishings in our residence and
other items of personal property have been transferred to the previously created revocable living
trust described below, I make no disposition of the same in this, my Last Will and Testament, but
rather certify that all of the same are the property of the just-referenced revocable living trust.
FOURTH: I give, devise and bequeath the rest, residue, and remainder of my Estate, of every
nature and wherever situate, unto my wife, NORMA E. RUEGG, as Trustee, to be added to and
thereafter held in Trust as part of the Trust Estate pursuant to that certain Revocable Trust
Agreement dated November 5, 1997, and executed by me and NORMA E. RUEGG prior to the
execution of this, my Last Will and Testament, to have and to hold, IN TRUST NEVERTHELESS,
for the uses and purposes, and subject to the terms and provisions thereof, including any alterations
or amendments thereto, or any other Trust which may hereafter be substituted therefor.
FIFTH: I hereby name, constitute and appoint my wife, NORMA E. RUEGG as Executrix
of this, My Last Will and Testament. In the event my Wife, shall fail to qualify or cease to
continue to qualify as Executrix by reason of death, disability, incapacity or otherwise, I hereby
name, constitute and appoint Brenda Roland as Executrix. She is to serve without bond, and I
direct that my fiduciaries shall not be required to enter security in any jurisdiction in which they
may act.
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SIXTH: My Executor shall have the following powers in addition to those vested in him by
Law and by other provisions of this, my Last Will and Testament, to be exercised without court
approval, and effective until distribution of all property:
1. To retain any or all of the assets of my estate, real or
personal, without restriction to investments authorized for
Pennsylvania fiduciaries, as my Executor from time to time may
deem proper, without regard to any principle of diversification or
risk.
2. To invest in all forms of property without restriction to
investments authorized for Pennsylvania fiduciaries, as my Executor
from time to time may deem proper, without regard to any principle
of diversification or risk.
3. To sell at public or private sale, to exchange, or to lease for
any period of time, any real or personal property and to give options
for sales, exchanges or leases, for such prices and upon such terms
or conditions as my Executor from time to time may deem proper.
4. To allocate receipts and expenses to principal or income or
partly to each as my Executor from time to time may deem proper.
5. To borrow money from person or institution including my
Executor and to mortgage or pledge any or all real or personal
property as my Executor in my Executor's sole discretion shall
choose, without regard to the dispositive provisions of this
instrument.
6. To compromise any claim or controversy asserted by or
against my estate.
7. To make distribution in cash or in kind or partly in cash and
partly in kind, and in such manner as my Executor may determine,
and at valuations finally to be fixed by my Executor.
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SEVENTH: I direct my Executor to claim any expenses of administration of my estate as income
tax deductions upon any income tax return or returns whenever in said Executor's sole judgment
such action will achieve an overall reduction in the total income and death taxes. No compensating
adjustments between income and principal shall be made as a result of such action. I also authorize
my Executor to join my wife, or her personal representative in the filing of a joint income tax
return for any period for which such a return may be permitted, without requiring the estate of my
wife, to indemnify my estate against liability for the tax attributable to the income of my wife, and
to consent for Federal gift tax purposes, to having gifts made by my wife, during my lifetime
treated as having been made half by me.
EIGHTH: I direct that all estate, inheritance and other taxes in the nature thereof, together with
any interest or penalty thereon, becoming payable by reason of my death, with respect to property
forming my gross estate for tax purposes, whether or not passing under this, my Last Will and
Testament, shall be considered an expense of administration of my estate, and no legatee or devisee
or any person having a beneficial interest in any such property, whether under this my Last Will
and Testament, or any Codicil thereto, or otherwise shall at any time be required to refund any part
of such taxes; provided, however, that such taxes may be paid from the Trust Estate, in accordance
with the provisions set forth for the payment thereof in that certain Revocable Trust Agreement
dated November 5, 1997.
NINTH: Whenever used in this, my Last Will and Testament, the singular shall include the
plural, the plural the singular, and the use of any gender shall be applicable to all genders. As used
herein, the terms "child", "children" and "issue" and similar terms shall include children adopted
under the age of twenty-one (2 1) years, regardless of the date of adoption, with full effect as if they
were the natural children of the adopting parents.
IN WITNESS WHEREOF: I, HERBERT J. RUEGG, the Testator above named, have to this,
my Last Will and Testament, typewritten on our sheets of paper, which I have initialed, and below
hereunto set my hand and seal this day of /V)f)Ue_4-Y)
-, 199-2
HERBERT J. UEGG
SIGNED, SEALED, PUBLISHED, and DECLARED by the said HERBERT J. RUEGG, as and
for his Last Will and Testament, in the presence of us, who, in the presence of the Testator and
of each other, have hereunto subscribed our names as witnesses thereto.
t:)A0LC) L_e,,,ox J� n�ee C.
Address:.[ 5. e 5+. t(s Address: / S 8a/fr7c�/��Sf'
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THE STATE OF PENNSYLVANIA
SS
COUNTY OF YORK
We, HERBERT J. RUEGG, DAVID J. LENOX, ESQUIRE AND JANICE E.. YOCUM, the
testator and the witnesses, respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator
signed and executed the instrument as his last will and that he had signed willingly or directed
another to sign for him, and that he executed it as his free and voluntary act for purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the
will as witness and that to the best of our knowledge the testator was at the time 18 or more years
of age, of sound and mind and under no constraint or undue influence.
T s or
fitness
Witness
Sworn to and subscribed before me
this ,�j day of &)()U e,-y 1 Le r, 1997
LL" h- j'
NOTARY PU LIC
MY COMMISSION EXPIRES:
Notarial seal public
S.pawn GladfelteYork County
Dillsburg 130M,
My Commission Expires May 17,2001
Member,Pennsylvania Assoc ation of Notaries
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