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Home My WebLink About07-05-13 � � r, � I Y ..�� / ' � 1505610143 �`°� REV-1500 EX�o2-,,, ,�` O(�I G� PA De artment of Revenue OFPICIAL USE ONLY P pennsylvania co�nycwa vear FneN�mea, Bureau of Individual Taxes ^��M*M�*�A� ao sox.2aoso� INHERITANCE TAX RETURN 21 � /��t(� Harrisburg,PA 17128-0601 RESIDENT DECEDENT I V � � ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 22 2012 04 21 1960 DecedenPS Last Name Su�x Dacedent's First Name M� KEPNER CATHERINE g (If Applicable)Enter Surviving Spousa's Information Below Spouse's Last Name Suffix Spouse's First Name ry�� Spouse's Socfal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS PILL IN APPROPRIATE OVALS BELOW X� 1. Odginal Retum � 2, SupplemenWl Return ❑ 3� Prioraiond2r 3e82)(Oate ot Death � 4. Limitetl EsWte � qa,Future Intaresl Compromise 5. Federal Estate Tex Retum Re wretl (aate W aeath e%er 1242A2) ❑ q � � 6 Decadent Died Teatate � oecede t Mein nad e Living Trust � (n��ach copy w wilq ❑ 1qt�scn`�opy o��n,at) - 8. Total Number of Safe Deposit Bozes � 9. LitigationProceeESReceivetl � �O.pg°�eenl2��fi�i�a�t{oe��tDea�h � ��,ElecllontotaxunEe�Sec.B113(A) (Attach Schedule O) CORRESPONDENT•THIS SECTION MUST BE COMPIETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE OIRECTED TO: Name Daytlme Telephone Number LEE C SWARTZ 7b7�234 �321� rn �-..�--_,_ .y � R�ISTEI�F V1��S U6£WILY � � � —� c� First Line of Address D 2 n'� i" �`� Cll -�• r� � � � 2 LEMOYNE DRIVE SUITE 2 ° ��' o �, � -� -,-i -,z Sacond Line of Address n `� ". � �--� t7 � :' , a7 � r" tTi � � � �-+ G7 � City or Post Otfice State ZIP Code n DATE�qED '�1 �'EM�Y� PA 17043 correspondenes e•man addresa: �SWartz�tuckerlaw.com Under penalties o�perjury,I declare Nat I have examine0 this return,inWuding accompanyi,ng schetlules and sta[ements,and to the 6est at my knowledge afW beliH, �t is true,correct and rqmplete.�eGaration ol preparer other than the peraonal reprasenMa4ve Is basetl on all inFOrmatlon of which preparer has any knowletlge. SI ATU OF PERSON RES ONSIB FILING RETURN DA7E ' Julia Persik ADD SS 73 O sum Lake Road Carllsle PA 17013 SIGNA PREP OT RTHANREPRESENTATIVE OATE Lee C. Swartz 3 ADDRES 2 Lemoyne Drive Suite 200 Lemoyne PA 17043 Side 1 � 15�5610143 1505610143 J � • � 15�561D243 REV-1500 EX OecedenYs Social Security Numbar o�a�,rswama: Kepner, Catherine R. RECAPITULATION 1. Real Estate(Schedule A)..........................................................._.......................... 1. 2. Stocks and Bonds(Schedule B)..._........................................__............................ 2. 3. Cbsely Held Corporetion,Padnership or Sole-Pmprietorship(Schedule C)......... 3, 4. Mortgages 8 Notes Receivable(Scheduie D)........................................................ 4. 5. Cash,8ank Deposits&Misceilaneaus Personal Property(Schedule E)............... 5. 1 � 897 . 82 6. Join4y Owned PropeRy(Schedule F) ❑ Separate Billing Requested............ 6. 7. IntervVivos Transfers B Miscellaneous tyaq-Probate Property (SChedula G) LJ Separate Billing Requested..........,. 7, 8. Toql Gross Assets (total Lines 1 throu9h 7)........................................................ 6. 1 , 8 97 . 82 9. Funeral Expenses and Administrafive Costs(Schedule H).................................... 9. 1� 034 . 00 10. Debts of Decedent,Modgage LiabitiGes and Liens(Schedule p....._..................... 10. 3 � 82 6. 62 t i. Totat Deductions(total Lines 9 and 10)............................................._................. 11. 4 , 8 60 . 62 t2. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -2 � 962 . 80 13. Charitabie and Governmental BequestslSec 9113 Trusts for which an election to tsx has not been matle(Scheduie J)............................................... 13. 14. Net Yaiue SubJect to Tax(Line 12 minus line 13)............................................... 14, ^2 � 9 62 . 80 7AX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at ths spousal tax rate,or transfers under Sec.9116 0 . 00 (a){12)X.00 15. 16. Amount ot Line t4[axable 0 . 00 16. 0 . 00 at lineal rate X .045 17. Amount of Line 14[axable at sibling rate X.12 0 . 00 17. 0 . 00 18, Amount of Line 14 faxable at collaterel rate X.15 0 . 00 18. 0 . 00 �9. TAXDUE................................................................................................................ 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND Of AN OVERPAYMENT. � Side 2 � 15�561�243 b505610243 � REV-1500 EX Page 3 Ffle Number 21 DecedenYs Complete Address: DECEDENT'S NAME Kepner, Catherine R. STREETADDRESS 730 Opossum Lake Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax�ue(Page 2, Line 19) (1� 0.00 2. Credits7Payments A. Prior Peyments B. Discount 0.00 Total Cretlits(A +B) (2) 0.00 3. Interest �g� 4. It Line 2 is greater than Line 1 +Line 3,enter the tliNerence. This is the OVERPAYMENT. �q� 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) �.00 Make Check Payabfe to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTtONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 7. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred:.................................................._.........................,. x b. retain fhe right to tlesi9nate who shall use the property transferred or its income:.................................. � � c. retain a reversionary interest;or............................................................................................................... x d. receive the promise for life of either paymants,beneflts or care?............................................................ x 2. If death occurred after Dec. 12, 1982, did decedent transfer property wdhin one year of death without ❑ ❑ receiving adequate consideration9.................................................................................................................... x 3. Did decetlent own an"in trust for" or payable upon death 6ank account or sewriry at his or her death7....... ❑ 0 4. Did decedent own an individual retirement account,annuRy,or othar non-probate propedy which . containsa beneticiary designaGOn?.................................................................................................................. ❑ 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, For dates of death on or after July 1, 1994 and before Jan. 1, 7995,the taz rate imposed on tha net value ot transfers to or for the use of the survivi�g spouse is 3 percent[72 P.S. §9116(a)(1.1)(i)1. For dates of death on or after January 1, 1995,the tax rate imposed on the nef value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S.§9116(a)(1.1)(iip, 7he statute does not exempt a trensfer to a surviving spouse trom tax,antl the stafutory requirements for disclosure of assets end filing a tac retum are still appiicable even if the surviving spouse is the onty beneficiary. For dates of death on or aker July 1,2000: • The tax rate imposed on the net value of transters from a deceesetl 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)(12)j. . The tax rate imposed on the net value ot transfers to or forthe use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in [72 P.S. §9N6(a)(1)1. . The fax rate imposed on the net vaWe of transfers to or for the use of the decedeM's sibiings is 12 percent p2 P.S.§9116(a)(1.3)]. A sibling is defined u�der Section 9102,as an individual who has at Ieast one parent in common with the decedent,whether by blood or adoption. � �Rev4508 E%+�17-00) SCHEDULE E pennsylvania CASH, BANK DEPOSITS & MISC, OEPARTMENT OF REVENUE � INHERITANCETA%ftETURN PERSONAL PROPERTY ftESiDENi DECEDENT ESTATE OF FILE NUMBER Kepner, Catherine R. y� InciuOe Na proceeds a(litipstion end Ne dete the proceatle wara receivad by tf»eetata. All propMy)ohrtlycwnstl wlth the tlyht of�uMvon�ip must be dbclo�etl on achadub F. ITEM VALUE AT DATE NUMBER pESCRIPTION OF DEATH 1 Members First Credit Union-Account No. 290016 �,gg�,gy TOTAL(Also eMer o�line 5, Reoapituiation) 1,897.82 (If more space is neatle0,aCditional pegc�s of the same size) Copyright(c)2010(orm software only Tha Lackaer Group, Inc. Portri PA-1500 Schedule E(Rev, t t•1o) !y P f ! 5E f 9 � ; REVd51t FX�(10.09� pennsylvania SCHEDULE H oEPARTMENT OF REVENUE FUNERAL EXPENSES AND R SEDENTDECEOENT URN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kepner Catherine R. Decedent's debts must be reported on Schedule I. ITEM M DESCRIPTION AMOUNT q. FUNERAL EXPENSES: See continuaYion schedule(s) attached 6a5.00 B. ADMINISTRATIVE COSTS; 1. Personal Representacive's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attornev's Fees TuCke�A►BnSb@�g, P.C. 300.00 3. Family Exemption: (If decedant's address is not the same as claimant's,attach explanation) Claimant Sueet Address City State 2ip Relationshio of Claimant to Decedent 4. Probate Fees 5. AccountanYs fees 35.00 6. Tax Return Preparers Fees 7. Other Administrative Costs 54.00 See continuation schedule(s) attached TOTAL(Also anter on Iine 9, Recapitulation} 1,034.00 Copyright(c)2009 form software only The Lackner C,roup, Inc. Form PA-7500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kepner Catherine R. ITEM NUMBER DESCRIPTION AMOUNT Funerai Exnenses 1 Greve Marker 645.00 H-A 645.00 Other Admini$trativ -��Q+c 2 Death Certi�cates 24.00 3 Register of Wills-Filing fees for Inheritance Tax Retum and Petition to Settle Small Estate 30.00 H-67 54.00 Copyryht(c)2002 form soRware onty The Lackaer Group,Mc. Porm PA-7500 Schedule H(Rev.6-96) Rawt5t2 EX<(1TA0) SCHEDULE 1 pennsyivania DEBTS OF DECEDENT, DEPARTMENTOFREVENUE iN�eR�rANCET,ixReruaN MORTGAGE LIABILITIES AND UENS ftE510ENT�ECEDENT ESTATE OF FILE NUMBER Kepner, Cathe�ine R. Raport tlabta 4wurretl by the tlaeeUant prlo�ro tleatM<hrt nma{ned unpNd at ttw dale of tleath,IlwluMfp umolmbursetl metlicel sxpenses. ITEM VAWE AT DATE NUMBER DESCRIPTION OF DEATH 1 Ciaremont Nursing Home&Rehab Center-Nursing Home 3,826.62 TOTAL(Also enter on Line 10,Recapitulatlon} 3,826,82 (it rtwre spaca is neetled,addRional pagas of the same size) ;opyright(c)2008 form software unly The Lackner Gmup,Ina Form PA-1500 Schedule I(Rev. 12-08) � } j: i° i,'. ): � a � �,: � � ��. .. . � ,.�'.�"' ° n.^ y:'; CLAREMONT NURSING & REHAB CTR � 1000 CLAREMONT ROAD CARLISLE PA 17013-8845 Statement Date 4/16/2013 (711)243-203� Piease remit payment by May 1, 2013. Services Provided For: Thank you. NER, CATHERINE R 5577 NLIA PERSIK Admitted:08l28I2012 Discharged: 09/22/2012 730 OPO5SUM LAKE RD CARLISLE, PA 17015 Pay this Amount: 3,826.62 � Make checks payable CLAREMONT NURSING&REHAS CTR Please detach stub portion and use the enclosed pre-addressed envelope for payment. --- ----- --- --- KEPNER, CATHERINE R 5577 Statemeet Date 4l16l2013 Date Description of Service Current Balance 04/01/13 BALANCE FORWARD 3,826.62 BALANCE DUE 3,826.62 ;;��;s E k `�� " _" .. .� �'-:c e 4�y:. �y Rd� ` '^ i .,.z¢k s. TU�l�,it;1 Sl�l VSIJEl\G Faith D Henry,paralegal . A t t o r n e y s fhenry(c,�tuckedaw.com July 3, 2013 � �=: � �.., x+ rn VIA FIRST CLASS MAIL � o � � � � c= a r^ a n ' U.'j cz � ryr' r� r�� Glenda Farner Strasbaugh, Register of Witls n � rn �,�, =-; �, Cumberland Gounty Courthouse 2 • � a �' One Courthouse Square ° o ° � " °n Carlisie, PA 17013 0 � �-�= �� , � r-' r - rn � � n �' °' -Qn cr-i Re: EsWte of Catherine Kep�er, deceased Social Security No. DOD: 9122/2012 Dear Ms. Glenda Farner Strasbaugh: Enclosed for filing please find an original and two (2) copies of the Pennsylvania inheritance tax return in the above-referenced estate. Probate was not opened for this estate. Also enciosed is a check payable to Register of Wills for$15.00 for the anticipated filing fee for the tax return. Please time-stamp one copy of the tax retum and forward to me in the enclosed self-addressed stamped envelope. Shouid you have any questions, piease do not hesitate to contact me. Sincerely, TUCKER ARENSBERG, P.C, � Faith D, Hen Paralegal to Lee W. Swartz /fdh Enclosures HBGD6:136822-1 028763•159744 Tucker Arensberg,P.C. 2 Lemoyne Drive Suite 200 Lemoyne,PA 17043 p.717234.4721 t.717232.6802 www.tuckerlaw.com 75000ne PPG Place Pittsburgh,PA i5222 p.412.566.i212 f.412.594.5619 A.: � ,I �C.� �; ; �� j �3 ��t � � �`,( . ��x - ��'; .,.j+;�'y�..�.�:. , 3 ��.5 � 3"��i' Ki' �� l: ", e �� 1 a . 4"�• 3pK, r �;y+ x �T ': - - -- - -- - --- -- - . --.� o� � N <�ti � �� , � a- r O N � �. � o � M � � O y N � n� ' 0 c o N > ' w O O V,> c"'� R�,. m y . u, f ' o II7 N � � ^ � �'_ '- _� r� �N a. 7 i�._ - � u_ c.� c... �^ Q O t_ '�- ;�_ ti c� r W� a � t c': :_y c �i'' �,� !-1 U7 �yj Z � �Q° o�• � O N �.; ;_ --� a cr �a °; N V � �� 4, _ , c.� xw � � v CG � ? � [T] G.I] g � C � M a— � � `-' � _ � `� � U � � - " '� c o `- � � v � o � m � a � 0 U �, � � U y •� E y � N �� [-1 � C� UOU