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HomeMy WebLinkAbout04-25-13 (2) 1505610140 �••I REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 1 0 5 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Sochi Security Number Date of Death MMODYYYY Date of Birth MMDDYYYY 1 2 3 0 2 0 1 2 1 2 2 2 1 9 3 2 Decedent's Last Name Suffix Decedent's First Name MI ROSE ROBERT S (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI R 0 S E J A N E T H Spouse's Social Security Number 1 6 4 2 8 0 3 9 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW I.Original Return F� 2.Supplemental Return ❑ 3.Remainder Return(date of death prior to 12.13-82) 4. Limited Estate F-1 4a,Future Interest Compromise(date of 5.Federal Estate Tax Return Required death after 12.12-82) QX 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) F1 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. 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number R I C H A R D L B U S H MA N , E S Q 7 1 7 3 4 9 7 6 5 7 REGISTER OF WILLS USE ONLY First line of address C O m Tn 1 67 6 7 PATH V A L L E ROAD maw, Second line of address _ 2 m e r rr16 E5 C7 P O BOX 5 1 " X C3 D FILE-51 City or Post Office State ZIP Code �c'>..c>. .—,. - _._ '-T � C S P R I N RUN PA 1 72 62b � ` <<_ M f co o '+f Correspondent's e-mail address: RLBUSHMANOINNERNET.NET 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. SIGNATURE OFINRSON RESPONSI LE FILING RETURN DATE ADDRESS 80 WEST IN SHIPPENSBURG PA 17257 SIGNATURE OF PREP E HAN EPRESENTATIVE DATE ADDRESS / PO BOX 51 SPRING RUN PA 17262 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Stocks and Bonds(Schedule B) . . . .. . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . 2. 3, Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . .. . 1 4. Mortgages and Notes Receivable(Schedule D) 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . _ _ . 5. 1 0 9 9 5 8 • 5 8 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested , . . . . . . 6, 7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property (Schedule G) Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . .. . .. . . . . .. . . .. . . . . . 8. 1 0 9 9 5 8 , 5 8 9, Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 1 2 7 6 5 , 2 1 10, Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . .... .. .... . 10, 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . .. . .. . . . . . . . . . . . .. . .. 11, 1 2 7 6 5 . 2 1 12, Net Value of Estate(Line 8 minus Line 11) . .. . .. . . . . . .. . . . . . . . . . . . . . . . 12. 9 7 1 9 3 . 3 7 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. 9 7 1 9 3 . 3 7 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 i 9 7 1 9 3 . 3 7 15, 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.0` 0 . 0 0 16, 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X A2 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X 15 0 . 0 0 18. 01 0 0 19, TAX DUE . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . .. . . . . . . . . . . . . . . .. . . 19. 0 . 0 0 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT R Side 2 1505610240 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 13 0105 DECEDENTS NAME ROBERT S. ROSE STREET ADDRESS 80 WEST KING STREET CITY -'STATE ZIP SHIPPENSBURG IPA 17257 Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 0,00 2. Credits/Payments A Prior Payments B.Discount Total Credits(A+B) (2) 0.00 3 Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. if Una 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; ...._................................................................ ❑ b. retain the right to designate who shall use the property transferred or its income: .............. ................. 171 Q c, retain a reversionary interest;or ..................................................... .. ❑ d. receive the promise for life of either payments,benefits or care? ................................................ ....... ❑ 2. If death occurred after December 12, 1982,did decedent transfer property within one year of death 3. wit out receiving decedent ing adequate uate consideration? .............._......_.............._._............................_.............. ❑ without receiving adequate cons "or payable-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?..........................................---......... .......................-........ ....... ❑ R 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)(11)(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)j.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 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.1508 EX+(1 t-10) Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDENT RETURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: ROBERT S. ROSE 21 13 0105 Include the proceeds of litigation and the date the proceeds were received by the estate. All proIt ar' Jointly owned with right of survlvorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Genworth Financial, long term insurance overpayment 1,560.21 2 Genworth Financial, long term insurance premium refund 2,535.97 1 USAA 257.64 4. USAA 653.59 5. M &T Bank, checking acct. 84,192.57 6. M &T Bank, savings acct. 20,758.60 TOTAL(Also enter on Line 5,Recapitulation) $ 109,958.58 If more space is needed,insert additional sheets of paper of the same size REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT S. ROSE 21 13 0105 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A FUNERALEXPENSES: Bricker Fogeisanger Funeral Home 6,758.58 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Janet H. Rose Street Address 80 W. King St. city Shippensburg state PA ZIP 17257 Year(s)Commission Paid: waived 2, AdorneyPees, Richard L. Bushman, Esq. 5,497.93 1 Family Exemption:(if decedents address is not the same as claimants,attach explanation.) Claimant Janet H. Rose Street Address 80 W. King St. city Shippensburg state PA zip 17257 Relationship of Claimant to Decedent Wife 4, Probate Fees: letters$210, will $15, short certificates$25, inventory$15, inheritance 308.50 tax return $15, JCS fee$23.50, automation fee$5 6 Accountant Fees: 6. Tax Return Preparer Fees. 7. The Sentinel, advertising 115.20 8. Cumberland Law Journal 75.00 9. One Heir Release, filing fee 5.00 10, Notary Public 5.00 TOTAL(Also enter on Line 9,Recapitulation) $ 12 76521 If more space is needed,use additional sheets of paper of the same size. REV-1513 EX�(01-10) pennsylvania SCHEDULE J DEPARTMENT of REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ROBERT S. ROSE 21 13 0145 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not ListTrustee{s} OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec.9118(a)(1.2).J Janet H. Rose Spousal 97,193.37 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 DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: i. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART 11 -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. =,,AST WS LL AND TESTAMENT C F RC'?BERT S _ RC1SE I, ROBERT S. ROSE of Cumberland County, Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby make, publish and declare this as and for my last will and testament, hereby revoking all other wills and codicils heretofore made by me. FIR.S'P I direct the payment of my debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefore funds from my estate, in such amount as my +: personal representative shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, in this connection, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. XKTM I give and bequeath all tangible personal property owned by me at the time of my death, together with all insurance policies thereon, unto my spouse, JANET N. ROSE if she survives me by sixty (60) days. In the event she fails to survive me, by sixty (60) days, I give and bequeath said tangible personal property and all insurance policies thereon in as nearly equal shares as is practicable unto such of my children as survive me by sixty (60) days, provided, however, that if a child of mine does not survive me by sixty (60) days, the share which that child would have received is bequeathed to that child's issue, per stirpes. TAD I give, devise and bequeath all the rest, residue and remainder of my estate unto my spouse, JANET H. ROSE if she survives me by sixty days. In the event she fails to survive me by sixty (60) days, I give, devise and bequeath all the rest, residue and remainder of my estate, in equal shares, unto such of my children as shall survive me by sixty (60) days, provided, however, that if a child of mine does not survive me by sixty (60) days, the share which that child would have received is bequeathed to that child's issue, per stirpes. I authorize my Executor to deliver such articles to which a minor may be entitled under this testament to the guardian of the minor or to the person having custody of the minor, or to retain such property until an age at which my Executor considers it appropriate to deliver the property to him or to her, provided in no event shall such property be retained by my Executor beyond the time the minor attains his or her majority. The receipt of such of the above enumerated persons as may be selected to receive delivery of such property shall be a full and complete discharge to my Executor. In the event my Executor at any time decides it is desirable to sell any item or items of tangible personal property held hereunder for a minor, the proceeds of such sale or sales shall be delivered to the guardian of the property of the minor appointed in paragraph SIXTH hereinafter to be held under the terms and conditions thereof. 2 FOURTH I direct that any and all Inheritance, Estate and Transfer Taxes imposed upon my estate passing under by will or 'otherwise, shall be paid out of the principal of my residuary estate. FDW In addition to the powers conferred by law, I authorize my Executor, in his or her absolute discretion: (a) to retain in the farm received, and to sell either at public or private sale any real or personal property; (b) to manage real estate; (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principle of diversification; i ' (d) to exercise any option or rights arising from ownership of investments; (e) to compromise claims without court approval, and without the consent of any beneficiary, and to abandon any property which, in my Executor's opinion, is of little or no value; (f) to ,join with my spouse, JANET H. ROSE, or my spouse's personal representative in the filing of any state or federal income tax return for any year for which I have not filed. such return prior to my death, and to consent to the treatment of any gifts made by my spouse as being made one-half by me for gift tax purposes notwithstanding the fact that such action may result in additional liabilities for my estate. Any income or gift taxes due on such returns and any deficiencies, interest, penalties or refunds thereon, shall be allocated between my -estate and my said spouse or my spouse's estate, or all to any of them, in such 3 manner as my Executor and my said spouse or my spouse's personal representative may agree. SUM I appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY of Harrisburg, Pennsylva- nia, guardian of any property, including but not limited to all proceeds of insur- ance on my life, which passes to a minor and with respect to which I am authorized ry to appoint a guardian and have not otherwise specifically done so. in addition to i the powers given by law, I authorize the guardian of the property: (a) to use such amounts of both income and principal as they in their sole discretion deem proper for the support, education and welfare of such minor without leave of any Court; (b) to invest in any property without leave of any Court; (c) to invest in any property without restriction to legal investments. The guardian shall not be required to give bond or furnish sureties in any f jurisdiction, and shall hold the property IN TRUST for the minor. I hereby direct majority to be defined as the age of eighteen and that no funds be turned over to the minor or adult until they attain the age of eighteen years. If my trustee, in its sole discretion, determines that it is desirable to do so, my trustee may end any trust under this deed. This may be done by paying the then-remaining principal and income of that trust to the person then eligible to receive the income. If any person is a minor or is, in my trustee's opinion, disabled by illness or other cause and unable to properly manage the funds, my trustee may pay the funds to his or her guardian or to any person or organization taking care of the person. In the case of a minor, my trustee also may deposit the 4 funds in an interest bearing account in the minor's name payable to the minor at majority, or appoint and pay the funds to a custodian for the minor under the Uniform Gifts to Minors Act of any state. My trustee shall have no further responsibility for funds so paid or deposited. I further direct my trustee distribute his or her share of the corpus and any accumulated earnings to the beneficiary upon the attainment of their majority. SEVEIV?'H b Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to the said beneficiaries or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and C pledge, and free from control by the creditors of any such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, pledge, or obligations of any beneficiary, and shall not be subject to any execution or attachment. EfGHM I nominate, constitute and appoint my spouse, JANET H. ROSE, Executrix of this my last will and testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said spouse, I nominate, constitute and appoint my daughter, NANCY LIN ROSE, Executrix of this my last will and testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said daughter, I nominate, constitute and appoint my daughter, ELLEN R. JESSEN, Executrix of this my last will and testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said daughter, I nominate, constitute and appoint my daughter, MARJORIE B. ROSE, Executrix of this my last will and testament. 5 In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said daughter, I nominate, constitute and appoint my son, ROBERT H. ROSE, Executrix of this my last will and testament. I hereby relieve my Executor from the necessity of posting security in connection with the Executor's duties as such in any jurisdiction in which my Executor may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last will and testament, consisting of eight pages, the first five of which bear my signature in the margin for the purpose of identification this 16th day of September, 1995. ROBERT S. ROSE Signed, sealed, published and declared by the above named Testator, ROBERT S. ROSE, as and for his last will and testament, in the presence of us, who, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. Address Address / 0# �l�ix"y+s L k rn/f"dye Addre s t ) ),-'a---cx S% 6 ACKNOWLEDGEMENT STATE OF PENNSYLVANIA SS. COUNTY OF FRANKLIN I, ROBERT S. ROSE, the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by ROBERT S. ROSE, the testator, this 16th day of September, 1995. ROBER SE re ator ha an, Attorney Admitted to the Bar of Pennsylvania COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF FRANKLIN We, Elaine L. Bushman and George Rae the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his Last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time iB or more years of age, of sound mind and under no constraint or undue influence. 7 Sworn to or affirmed and subscribed to before me by Elaine L. Bushman and George Rae, witnesses, this 16th day of September, 1995. Elaine L. Busshhmmann,W Witness j ZL. man,7�ttorney Admitted to the Bar of Pennsylva is STATE OF PENNSYLVANIA : . SS. COUNTY OF FRANKLIN On this, the luk Oay of September, 1995, before me, the undersigned officer, personally appeared RICHARD L. BUSHMAN, known to me or satisfactorily proven to be a member of the bar of the highest court of Pennsylvania, and certified that he was personally present when the foregoing acknowledgement and affidavit were signed by the testator and witnesses. In witness whereof, I hereto set my hand and official seal . )Not y P blic Milli L Clayton,N pll Pubffo FannaVWp�F Mn Camty MyCanmiselcn�gilroeAUB.30,1997 r,P a rmen�ahs- RICHARD LEWIS BUSHMAN Sherry A. Rosenberry Attorney at Law LacyJ S.Johnson Office Manager/Legal Assistant 16767 Path Valley Road Tammy L.Gilliland P.O. Box 51 Legal Secretaries Angela G. Peterson Spring Run, PA 17262-0051 Paralegal FAX [717]349.2982 [717] 349-7657 April 23, 2013 Register of Wills Cumberland County One Courthouse Square Carlisle PA 17013 RE: Estate of Robert S. Rose File No.: 2013-00105 Dear Sir/Madam: Enclosed please find 2 original PA Inheritance Tax Returns, Release and the $5.00 filing fee on the above named estate. If there is anything else you need please feel free to contact our office. Sinc ely, erry R senbe �G�� ry sar enc. Cc: Janet H. Rose, Executrix . • . © • ' � � � » �� } /} jI `cc ® ` � _ CO) � 0 Cf) - k � .LM / u .) ` C } qe \ &-� ~ � & me q �- 4kw $ a \\ {}% E $ § § k #2 \ ) @ at 2' e # � $ � $\ . . a$