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Home My WebLink About07-16-13 (2) ro2-11) 1505610143 REV-1500 IX Ur OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes 0o`MiMoiTO AEw UE PO 80X.280601 INHERITANCE TAX RETURN 2 1 12 01243 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 11 24 2012 04 23 1925 Decedent's Last Name Suffix Decedent's First Name MI SHAFER VERNA R (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 ®. 1. Original Return ® 2. Supplemental Return ❑ 3.Remainder Retum(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a.Future Interest Compmmse ❑ 5. Federal Estate Tax Return Required (date of death after 12-1282) 8 Decedern Died Testate 7, Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes ® (Attach Copy of NAq ❑ (Attach Copy of TrL" ❑ 9. Litigation Proceeds Received ❑ 1o.Spousal Poverty Credit(Date of Death ❑ 11.Election to tax under Sec.9113(A) between 12-3151 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT G FREY 717 243 5838 REGISTER OF WILLS USE ONLY ,-i M First Line of Address O c M C'i 5 SOUTH HANOVER STREET �1 m ° C Second Line of Address r- M cri ;;a c7 V o n MATE F40D O -� City or Post Office State 21P = n CARLISLE PA 17013 c� m O Correspondent's e-mail address: rfrey @freytiley.com 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, h 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 OF PERSON RESPONSIBLE FOR FILING RETURN DATE j r( -d K�p,u Michael Lee Railing 7 & 3 ADDRESS 67 Courtyard Drive, Carlisle, PA 17013 SIGNAT R FPREP E OTHERTHA REPR ATIVE ATE I Robert G Frey / ADDRESS Frey and Tiley 5 South Hanover Street, Carlisle P 17013 Side 1 1505610143 1505610143 j -1 1606610243 R EVA 500 EX RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................... 2. 3. Closely Held Corporation,Partnership or Sale-Proprietorship(Schedule C).......... 3. 4. Mortgages&Notes Receivable(Schedule D).......................................................... 4. 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 651 . 00 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. B. Total Gross Assets(total Lines 1 through 7).......................................................... B. 651 . 00 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 11. Total Deductions(total Lines 9 and 10).................................................................. 11. 0 . 00 12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 651 . 00 13. Charitable and Governmental Bequests/Sec 9113 Trusts forwhich an election to tax has not been made(Schedule J)................................................. 13. 162 . 75 14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 488 . 25 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. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at collateral rate X .15 488 . 25 18. 73 . 24 19. TAX DUE....................................................................................................I.............. 19. 73 . 24 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1606610243 1606610243 J REV-1500 EX Page 3 File Number 21 - 12 - 01 243 Decedent's Complete Address: DECEDENTS NAME Shafer, Verna R STREETADDRESS 68 Magaw Avenue CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 73.24 2. CreditsrPayments A. Prior Payments B. Discount Total Credits(A +B) (2) 0.00 3. Interest (3) 0.00 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) 73.24 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;................................................................................ ❑x b. retain the right to designate who shall use the property transferred or its income;............... x c. retain a reversionary interest;or................................................................................................................. d. receive the promise for life of either payments,benefits or pre?.............................................................. e x 2. If death occurred after Dec. 12, 1982, did decedent transfer property 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?...................................................................................................................... ❑x ❑ 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 forthe use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(1)]. For dates of death on or after Januarryy 1, 1995,the tax rate imposed on the net value of transfers to or forthe use of the surviving spouse is 0 percent F2 P.S.§9116(a)(1.1)((n)]. The stafute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and fling 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(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.691161a)(1.311. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether y blood or adoption. Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH BANK DEPOSITS AND MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY FILE NUMBER ESTATE OF Shafer, Verna R 21 - 12-01243 Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointlyowned with the right of survivorship must be disclosed on schedule F. ITEM NUM ER DESCRIPTION VALUE DEAT DATE OF 1 Sovereign Bank Certificate of Deposit 1675369241 651.00 TOTAL(Also enter on Line 5, Recapitulation) 661.00 REV-1513 EX-(w-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Shafer,Verna R FILE NUMBER 21 - 12- 01243 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not ust Truss) I� TAXABLE DISTRIBUTIONS[include outright ousel distributions,andTa nsfers under Sec.9116(a)(1.2)] 1 Enter dollar amounts for distributions shown above on lines 15 through 16 on 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 B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Second Presbyterian Church Carlisle, 25% of residue 162.75 TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 162.75 Fr*m: SHARON DEVOS<SHARON(ii?FREYTILEY.COh" SubIF—t. Fwd:Shafer Estate ');n: m. July 1,2013 1:13:23 PIVI EDT A."mc.rAllent.73,KS ——------------------ cy- Certificate of Deposit Renewal Notice MAY 28, VERNA a CFA-F.R C;RT,TFT,R PA. 17013-49C.2 Account Number: 1675369241 Dear Valued Customer, Renemal Notice. 3 YEAR PROM-.0 CD Ifs a great time to continue to save with Sovereign, Your CD is Ion up for nenewal. Isue Date JUNE 2?.2010 Gracc Period 7 D--3s Matui-ft Date JUNI,2712013 Renewal Meturity Date(it CD rolls over to Some 10.1hi)...........:U-NF 27;2016 Renewal Instructions:Ron"Principal and Interest,Interest Credited Monthly Yntir Srvera;gn CID is set to renew On the date noted above. ttMilautomat:callyr.sreo;,,tiJL:Nzi-7,2 l..13 for an additional term Of 10913 days, To renew this CID automatically,you do not Flood to take any action. The iritersst rate and annual perv6stage yield(APY•for'Ile new ierm hays not y-I been determined. will be aval'able On the day after the maturity date of your account and can be otitaired by stopp:-.19-,y Your local branch or cat."g-is at thariumber bam. ...... .......... if we do nn;bear from you,your cerl.TTIeate A14i aullorraitoally bifrenewed to.,the sameleFm Slated above. Withdrawal Instructions if you wish to A,..Ihd-,Tw funds from this CD wIthout penally,you must do so within Fne 7.03j,,0,,F-djy gf,3M,period that starts + r! -;.if you the day after the maturity date, Funds withdrawn do not earn interest past the maturity date(Withir.the Grace penix" wish to Witildnaw your CD funds.pease call us or slop by the nearest bra-=K You-at%dOPIC-Sn Your(Unn into 8 rew CO ivith a new tarrin Or transfer your CD funds to your Sovervxgrl chmAing,savings,OF money mwkat savings rl�=vht. Ta receive your funds via check,you must visit a branch or dose the CD via mail.See nar.-e,paragraph for ease-by-male instruCtfOnS. If you vrish to dose your CD via mail, please send a notarized letter indicating your roques'.to the address befow.We must receive this iafter(wmmparilsd by a oopy of this srowa;notice)BEFORE the end of the grace porl'od.so you do riot incur a peiiai,y. notiiij-'all la t*ar a-S;t IS required in Order;o dose by mail.If you no longler havethe passbook available,please contact us at 1-877-768-2265 a:)that pre may provide you with a lost rassbnoK;WidavIt For Trust Acmunts,a ropy if the Trust Agreement Is W-ilrer tRA CDs must be cillied in pansor.In the branch. If you have questions regarding this notice or would like inforiln.alion On other produce and services we offer,stop by yout local boeich,contact us at the address iismd ba'ow or visit weerelgribank com.Additionally,you may call 1-877-SOV-BANK, I`a.m. to 8 p.m.EST,7 days e weak. For cvs-olners will hearing ng Impairments,please wit 1-800-128-9121 (TTYiTDDj. Thank you 4.br bankirlI;,Mth Sovereign.