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Home My WebLink About10-10-13 _! 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue Oode Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN /3 / �y PO BOX 280601 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 07152013 09081932 Decedent's Last Name Suffix Decedent's First Name M I MANGUM HELEN J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I MANGUM RALPH T Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) ® 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) ❑ 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.) ❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to TWunder SeW9113(A) Between 12-31-91 and 1-1-95) (Attach Sche�ute O)M CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TA 11,FORMATION ST{OULDR 1 ECTED TO: Name Daytil T2Iephone NiJinber C , rn R . THOMAS MURPHY 71?Z 7 T1073� RE I§TER OF WILLS USE PNLY First Line of Address d rJJ 14 N . MAIN STREET �a Second Line of Address SUITE 306 City or Post Office State ZIP Code DATE FILED CHAMBERSBURG PA 17201 Correspondent's e-mail address: T O M M a@ R T H O M A S M U R P H Y- C O M 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. SIGNAZURE O F PE6_&;.k RSOIES-ON LE FOR FILING RETURN DATE - 13 ADDRESS 12861 SANDY MOUNT RD-A.D.------ ORRSTOWN, PA 17244 SIGNAT4RE OF PREP HER THAN REPRESENTATIVE (6 DA)7,E_l� RESS �( 14 N. MAIN STREET, SUITE 306 CHAMBERSBURG, PA 17201 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 1505611185 J 1505611285 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: 11 A N G U 11 HELEN J RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 . 00 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. 0 . 00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3. 0 , 00 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4 0 .00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5. 0 , 00 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested , , , , 6. 0 , 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . 7. 661406 - 00 8. Total Gross Assets(total Lines 1 through 7) , , , , , , , , , , , , , , , , , , 8 66-A06 • 00 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9. 5-,800 - 00 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) , , , , . . . . . 10. 0 • 00 11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11 5,800 • 00 12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , . . , 12 60,606 • 00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , 13. 0 .00 14. Net Value Subject to Tax(Line 12 minus Line 13) , 14, 60,606 •00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers unSfer Sec.9116 (a)(1.2)X.06 0.00 15. 0 .00 16. Amount of Line 14 t xable at lineal rate x.0 i_5 60,606.00 16. 21727 . 00 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. 2,727 . 00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505611285 1505611285 OM4648 3.000 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME MANGUM HELEN J STREET ADDRESS WALNUT 0 CUMBERLAND CITY STATE ZIP SHIPPENSBURG PA 17257- Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 2,727 - 00 2. Credits/Payments A.Prior Payments 0 . 00 B. Discount 136 - 00 Total Credits(A+B) (2) 136 - 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 box on Page 2,Line 20 to request a refund. (4) 0 . 00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,591 , 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 . . . . . . . . . . . . . . . . . . . . . . . . ❑ FRI 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 property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ FRI 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? . ❑ Ek 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 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)(1.1)(1)]. 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 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.§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. OM4671 2.000 REV-1510 EX+(08-09) SCHEDULE G pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC.NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen J. Mangum 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. DESCRIPTION OF PROPERTY ITEM INMUDETHE"EOF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBE THE DATE OF TRANSFER ATTACHACOPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IFAPPLICABLE VALUE 1• . Orrstown Bank Account No. 101379327, being the only asset held in a Revocable Trust dated July 1, 2013 executed by Helen J. Mangum, Settlor; Ralph T. Mangum, surviving spouse, income only beneficiary; Debra T. Toth, daughter, T. Michael Mangum, son, and P. Carol Mangum, daughter, remainder beneficiaries; See Schedule K 121,718 100.0000 55,312 66,406 TOTAL(Also enter on line 7,Recapitulation)$ 66,406 If more space is needed,use additional sheets of paper of the same size. 9W46AF 2.000 REV-1517EX+(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen J. Mangum Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 None B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: **Paid from children's percentage of estate** 5,800 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) ' Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. None TOTAL(Also enter on Line 9,Recapitulation) $ 5,800 9W46AC 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+(01-10) SCHEDULE J pennsylvania DEPARTMENT OF REVENUE BENEFICIARIES - - INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Helen J. Mancrum 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. Ralph T. Mangum 121 Walnut Bottom Road Shippensburg, PA 17257 Surviving Spouse 2 Debra J. Toth 12861 Sandy Mount Road Orrstown, PA - 17244 Daughter 3 P Carol Mangum PO Box 3103 Bunnell, FL 32110 Daughter 4 T Michael Mangum Sandy Mount Road Orrstown, PA 17244 Son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. It NON-TAXABLE DISTRIBUTIONS A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 9W46AI 2.000 If more space is needed,use additional sheets of paper of the same size. . a + REV-1514 EX+(4-09) SCHEDULE K Pennsylvania LIFE ESTATE ANNUITY DEPARTMENT OF REVEMIE 1 Bureau oflnclMdualTaxes &TERM CERTAIN Po B (CHECK BOX 4 ON REV-1500 COVER SHEET) P 1 Harrisburg sburg P A 1 7128-0601 ESTATE OF FILE NUMBER Helen J. Mangum This schedule should be used for all single-life,joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457,Actuarial Values,Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest below and attach a copy of it to the tax return. ❑Will ❑Intervivos Deed of Trust ❑Other CALCULATION LIFE ESTATE INTEREST NAME OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH LIFE ESTATE IS PAYABLE Ralph T. Mangum 08/06/1931 82 X Life or Eherm of Years Life or ElTerm of Years Life or Term of Years Life or ElTerm of Years Life or Term of Years 1. Value of fund from which life estate is payable , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , $ 121,718 2. Actuarial factor per appropriate table . . . . . . . . . . . . . . . . . . . . 0.45443 Interest table rate- 3.5% ❑ 6% .� 10% .❑ Variable Rate 0.00000% 3. Value of life estate(Line 1 multiplied by Line 2) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , $ 55,312 CALCULATION ANNUITY INTEREST NAME OF LIFE ANNUITANT DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH ANNUITY IS PAYABLE Life or ElTerm of Years Life or ElTerm of Years Life or Eherm of Years F__]Life or n Term of Years 1. Value of fund from which annuity is payable , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , $ 0 2. Check appropriate block below and enter corresponding number . , , , , , , , , , , , , , 0.000 Frequency of payout-❑Weekly(52) Bi-weekly(26)F—] Monthly(12) ❑Quarterly(4) ❑Semi-annually(2) B Annually(1) Other( ) 0 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 4. Aggregate annual payment, Line 2 multiplied by Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . 0 5. Annuity Factor(see instructions) Interest table rate-❑ 3 1/2% ❑ 6% ❑ 10% ❑Variable Rate 0.00000% 0.00000 6. Adjustment Factor(See instructions.) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 0.00000 7. Value of annuity-If using 3.5%, 6%, or 10%,or if variable rate and period payout is at end of period, calculation is:Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . $ 0 If using variable rate and period payout is at beginning of period,calculation is: (Line 4 x Line 5 x Line 6)+Line 3. . . . . . . . . . . . . . . . . . . . . . . , , , , , , , , , , , , $ 0 NOTE:The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return.The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. If more space is needed,use additional sheets of the same size. 8W46AJ 1.010