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� 15�561�1,05
REV-15 C10 EX C��_��,t�,� .
PA Department of Revenue P��n�Y����» OFFIClAL U5E ON�Y
Bureau of Individual Taxes OEPAaTMENTQFqEVENl78 eo�r,ry cod� Y�a� File Number
�,Q g�X�g���� 1NHERlTANCE TAX RETURN �"" 1
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;
Harrisbur ,PA 1�12$-060�. RESiDENT DECEDENT ' �� ' l � 'o�'
ENTER DECEDENT ENFQRMATION BE�C}W
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
� 11/�4/2012 �08I061�920
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Decedent's l.ast Name Suffix aecedent's First Name MI
...................._................_......_..........____............_._......_....._............._....__............_.........._.._.....__....._._._....._.....__..........:. .,_.............._.__....._._.............., <.....__..__.........._..........._...................._..._..........._. ....._.._.._................._.............._........ .......................: ;.._r�,...,:..
Sanders ; �William ' H '
3
_._ ___...._.........__.............._..............._......_........_........: ..............................: _....._._ ......._._.._..........___.._....__...........__....__........__................_....._............. :.............;
....___........................._......................__. ..........._.. ........ ..
{if Appl�cab3e�Enter Sunriving Spause's Infarmation Beiaw
Spouse's Last Name Suffix Spouse`s First Name M(
n/a £
� w.�..�.,..,�. ..... .��.. _v
Spause's Soc�a1 Secunty Number
.��----..� -° °�-- .�� ° THIS RETURN MUST BE FILED IN DUPL(CATE WITH TNE
REGISTER OF WI�L.�
F1�L IN APPROPRlATE OVALS BE�OW
� 1.Original Return O 2.Supptementat Return p 3. Remainder Return(Date of Death
Prior ta 12-13-82}
O 4. Limited Estate O 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
p B. Decedent pied Testate O 7.Decedent Maintained a Living Trust 8. Tataf Number of Safe Deposit Boxes
{A#tach Capy af Will} (Attach Copy of Trust.) �-.
C� 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Dafe of Death O 1 fection to Ta�der�.��13(A)
Between 12-31-91 and 1-1-9�} ��ACtdch Schedule Q} � �
CORRESPONDENT— 7HIS 5ECT10N MUST BE COMPLE7ED.ALL CORRESPONDENCE AND CONFIDEN7IAL TAX INFO TI�N SMOULIS�DIR�T r 0:
Name yt3�e�l�o�e N�t mbeK--� c'�
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Adam R DeEuca, Esq {7'E�j'�9��^17?"�
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�RE�3E R O�Ll.S,� E°$�tLY
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F�rst Line of Address �
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`:�1 West Louther Street �
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Second Line o€Address
_..................._.........._._.................._..._....._..............._.............___._............_........................__._......_.__......_..._...._....._.__...._...__..._....._.......
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City or Post Qffice State ZIP Code DATE FILED
Carli�le PA 17013
Corresponden#'s e-mail address:�rdel�iCa$5 a��C�I.C�i"11
Under pena(ties of perjury,1 declare that I have examined this return,including accompanying schedules and statements,and to the best of my knawledge and belief,
it is true,carrect and complete.Declaration of preparer other than the personal representative is based on all informatian a#which preparer has any knowledge
' �!G TURE OF PER ON SPC7NSl LE FOR FILING RETURN DATE �� �
Q� � G�--rt.r' �
ADDRESS
(Richard} �110 Cortgress Drive, Mechanicsburg, PA 1705� (Barbara}2859 Mimosa Ln., �ancaster, PA 17�01
S1GN C?F P R TH EPRESENTATlVE D � �
ADDRESS
�1 W. Louther St., Carlis(e, PA 17�13
PLEASE USE QRtGINAL F4RM ONi.Y
Side 1
� 150561,�105 150561,�1L15 �
� 15056102�5
REV-1500 EX(FI)
DecedenYs Social Security Number
�ecedent's►varne: WILLIAM H. SANDERS
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. ; 13,140.11 ;
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. ;
...w�,. _,.... .:: ,.. ,........ _ ._�.. �..._,..
7. Inter-�vos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. 33,943 08 :
8. Total Gross Assets(total Lines 1 through 7)................. .... ...... .. 8. 47,083.19
9. Funeral Expenses and Administrative Costs(Schedule H)...... .... . ... ..... 9. ; 11,904.25 :
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).. ............. 10. 401.13
11. Total Deductions(total Lines 9 and 10).................. .. . .......... .. 11. 12,305.38
12. Net Value of Estate(Line 8 minus Line 11) ................. .... . .. .... . . 12. 34,777.81
; .:. . ....... .. ...: . ..:::.. .. .,,., :.::.;
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. 34,777.81
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfersunder Sec.9116 ____..._.........._.........._._........___._._..___............................_.._._................._..._.. ........._...._...................._............._....__..............._..... ...._........._......_............._.._........
(a)(1.2)X.0_ 15.
__ __,._.... ,.... ,,., , .,:_.. . _ . .._...: ..:.,...... _ ....,...,. , ,�.., .:..:.:
.._.,
16. Amount of Line 14 taxable '
at lineal rate X.0 45 34,777.81 ' �6. 1,565.01
.... ... . .. ...... .,__..: .. ... .,. .. .. .. . ........ _ .,........_.... ,_ .� .....,
..:... . : ..
17. Amount of Line 14 taxable
at sibling rate X.12 17. `
.::, . :..._ . ::,:: ..... . .:..:..._:..., , ,..,..... , .:._.,... ... ........... . . _.. __.,.
18. Amount of Line 14 taxable
at collateral rate X.15 18•
19. TAX DUE ... ... .. .................. .................. ......... .. .. 19. 1,565.01
__........._......._.___..__._...._................._.._......._.....____._....._............._.........._.._....................:
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C�
Side 2
� 15�561�2�5 1,50561,02�5 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
WILLIAM H. SANDERS
STREET ADDRESS
2100 BENT CREEK BLVD.
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,565.01
2. CreditslPayments
A.Prior Payments 1,800.00
B.Discount 90.00
Total Credits(A+B) (2) 1,890.00
3. Interest
(3) 0.00
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) 324.99
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUf. (5)
Make check payable to: REGISTER OF WILLS,AGENT.
r '.:: :.: '�` -� . -.: .:.;� _ � �:-E i Z .
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRlATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income af the property transferred.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest .............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If death occurred after Dec. 12,1982,did decedent transfer properry within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ �
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 C4MPLETE SCHEDULE G AND F1LE IT AS PART OF THE RETURN.
:f 2 :..i'�C ?S-� k h`f^`t R -?t 2 +C' ;�:�-,; 3 '[..�Si' '� .l�
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-y' .�': € �{� & k2 ': 3 �- u �' 2. � 'Y..."�,.�) n'a .i`x^'_;.• x
_...,.� :.,.;;....<..,..,✓<. d,..,.w.'i. ,.,.......:a.....> ... ..... ..............b. .,,F,,....�..,., ..,.....-:..,.. .:..;:. .-,s�,.,�:�;. a,.,_�,..... .Cs,.a__�..__�..... xa..�..._� �c .,.,.2 u >.s_r......,,.....,..... a'a� ....,....,,,,3,.,_...r ,.a ,...x....,iHn.,w.�..�.,xi.z`ri�t;$:.,. a.:.3.,�........,> .�.<�R...
�•:
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 retum are still applicable even if the surviving spause 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 far 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.
i �
REV-lso8 EX+(o8-u.)
� pennsytvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
WILLIAM H. SANDERS 21-12-1312
Inciude the proceeds of litigation and the date the proceeds were received by the estate.
Ail property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
�. M&T Bank 6560 Carlisle Pike#500,Mechanicsburg,PA-Checking 75468492 7 524.31 .
,
__ _ _
__ _ _ _ _ __ __ _ ___ _ _ _ _ _.
__ __ _ _ _ _ _ _ __
_ _ __
_ _ _ ___
_ _ _ _ _
2. M&T Bank 6560 Carlisle Pike#500,Mechanicsburg,PA-Savings 015004208552049 2,600.57
_ -
_ _ , _ _ _ __ ___ _ __ _ _ _ __
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _
_ _ _
3, Refund from RBOC the Bridges at Bent Creek(retirement home) ' 3,015.23
_ __ _ ___ :
_ _ _ __ _ _ _
_ _ _ _ _
_ _ _
_
_ _ _ _ _ __ _ _ __ _ _ _ _ _ _ _
_ _ _ _
_ _ _ _
_ _ _
_ _ _ _ _ _
TOTAL(Also enter on Line 5, Recapitulation) $ 13,140.11
If more space is needed,use additional sheets of paper of the same size.
, �
REV-151Q EX+(08-09)
i pennsylvania SCH E DU LE G
DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
WILLIAM H. SANDERS 21-12-1312
This schedule must be compieted and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE T}iE NAME OF THE TRANSFERg,7HQR RELATi0N5HID TO DK�ENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFBt.ATfACH A COPY OF THE 0�FOR REAL ESfATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
32,387.26 100 33,943.08
_
1• Prudential Gibraltar Fund Annuity#084900A01:Transferees:Richard W.
Sanders(son)and Barbara S.Clingan(daughter)Transfer on 1/28/13
__ _ __ __ _ _ ___._ _ _ _ _ __
_ _ _ _ _ _ __ _ __
_ _ __ _ _ _ , : _ _
_ _ _ _ _ _ __ _ __ _
_ _ _ _ __ _ _
_ __
_ _ _
TOTAL(Also enter on Line 7, Recapitulation) $ 33,943.08
If more space is needed,use additional sheets of paper of the same size.
i �
REV-1511 EX;-(10-Q9)
� pennsylvania SCH E DU LE H
DEPARTMENT OFREVENUE F U N E RAL EX P E N SE S AN D
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
WILLIAM H. SANDERS 21-12-1312
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: __ _ _ _
1' Hoffman-Roth Funeral Home&Crematory,Inc. 8,747.16
_ __ _ _ _ _ _ __ __ _ _ __ _ _ _ _ ___ _ _ _
_ _ _
_ _ __
_
B. ADMINISTRATIVE COSTS:
_ _ _ _ _
1. Persanal Representative Commissions:
___ ,
Name(s)of Personal Representative(s)
Street Address
�ity State ZIP
Year(s)Commission Paid:
2,825.00 '
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
�ity State ZIP
Relationship of Claimant to Decedent •
4. Probate Fees: : 150.50
5. Accountant Fees:
_ _ _
6. Tax Return Preparer Fees:
�� Cumberland Law Journal advertisement 75.00
__ _ _
_ __ _ _ _
s. Patriot News Company advertisement : 106.59 '
_ _
_ _
_ __
_ ___
_ ___
_
_ _ _ _ _ _ _ _
__ _ _ _
_ _ __ __ _ _ _ __ _ _
_ _
_ _ _
__ _ :
TOTAL(Also enter on Line 9, Recapitulation) $ 11,904.25
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
� pennsylvania S�HEDU�E I
DEPARTMENTOFREVEIVUE DEBTS OF DECEDENT,
IPIHERITANCE TAX RETURN MCIRTGAGE LIABII.ITIES &LIENS
RESIDENT DECEDENT
ESTATE�F FILE NUMBER
WILLIAM H. SANDERS 21-12-131�
Report debts incurred by the decedent prior to death that remained unpaid a#the date of dea#h,Enclud�ng unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER f}ESCRIPTION QF DEATH
�. Montgomery Medical Equipment Company: Invoice number 3278444 _ 2.07
2. Alert Pharmacy Services,Inc. 112.58
3. Rasa's Team: R�sa Lucidon&1'eam of��r�ified Nurses 21 fi.UQ
4. Gomcast Cable final bill and account eancellation : 70.48
T�'fAL(Also enter on E.ine 10,Recapitulation� $ 441.13
If more space is needed,insert additiona)sheets of the same size.
, . , •
REV-1513 EX+(01-10)
� pennsylvania SCH EDU LE �
� DEPARTMENT OF REVENUE
INHERITANCETAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
WILLIAM H. SANDERS 21-12-1312
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. Richard W.Sanders:110 Congress Dr,,Mechanicsburg,PA 17050 son 50%
_ _ _ ___ __ _, _
_ _
_ _
__ __ _ ___ __ _
2. Barbara S.Clingan:2859 Mimosa Ln.,Lancaster,PA 17601 daughter 50°/a
_ :
_ _ _ _ _ _ _
_
_ _ _
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPkIATE.
Ij NON TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
L
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.