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Home My WebLink About12-27-13 J REV-1500 Ex`°Z-,,, 1505610143 � OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENTOFNEVENUE Po soxzsoso� INHERITANCE TAX RETURN 2 1 Harrisburg,PA 17128-0601 RESIDENT DECEDENT �'�� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 209 50 9468 11 11 2008 06 12 1969 DecedenYs Last Nacne Suffix DecedenYs First Name MI EISENHOWER III HENRY F (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 FIIED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ❑ 1. Original Return � 2. Supplemental Return � 3.Remainder Return(Date of Death Priorto 12-13-82) � 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Retum Required (date M death after 12-12-82) 6 Decedenl Died Testate ] Decsdent Maintained a Living T�usl 8. Total Number of Safe Deposit Boxes � (Attach Copy of Wilp � (Atlach Copy of Trust) � 9. Litigation Proceeds Received ❑ ��'be�een 12-31�91 andt'Da95)f Death ❑ ��'�AttachnSched le O)Sec.9113(A) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CORY L EISENHOWER ;�=� n �� rn c -,� ' ' E�STER OF�V�VILLS�SS�`�':�NLY —�° � sw.� �.' t" N �ti ; First Line of Address :�._ r''� -.,� , w _s ; '.� ._n 4475 PANZA DRIVE :� ,} �°� � �� _, : _.._. . -7 � ;, .;., �a . � , Second Line of Address � � = F_� _ . . __ . '' .,.;a C�7 .. ;�a � ._.; DA�ILE�' �> City or Post Office State ZIP Code MECHANICSBURG PA 17050 CorrespondenYs e-mail address: Under penalties of perjury,I declare that I have examined this retum,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 personai representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RES�OR FILING RETURN DATE ��, Cory L. Eisenhower ADD S 4475 Panza Drive, Mechanicsburg, PA 17050 SIGNATURE OF PREPAPE 0?HER THAN REPRESENTATIVE DATE � � �,.�,Cory L Eisenhower ADD SS 4475 Panza Drive, Mechanicsburg, PA 17050 Side 1 � 1505610143 1505610143 J � 1505610243 REV-1500 EX Decedent's Social Security Number oe�eda�rSNama: EISENHOWER, HENRY F. III 2 0 9 5 0 9 4 6 8 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&Notes Receivable(Schedule D).......................................................... 4. 5. Cash,Bank Deposits 8�Miscellaneous Personal Property(Schedule E)................ 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property 3 , 6 4 9 . 7 8 (Schedule G) ❑ Separate Billing Requested............. 7. g. Total Gross Assets(total Lines 1 through 7).......................................................... g, 3 , 6 4 9 . 7 8 520 . 00 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10. 11. Total Deductions(total Lines 9 and 10).................................................................. ��. 5 2 0 . 0 0 �2• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 3 , 129 . 78 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)................................................. 13. . 3 , 129 . 78 14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABIE 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 3 7 5 . 5 7 at sibling rate X .�2 3 . 129 . 78 ». 18. Amount of Line 14 taxable at col�ateral rate X .15 18• 19. TAX DUE................................................................................................................... 19. 3 7 5 . 5 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 � 1505610243 1505610243 � REV-1500 EX Page 3 File Number 21 Decedent's Complete Address: DE ED NT' AM Eisenhower, Henry F. III STREET ADDRESS 4821 Brian Road CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 375.57 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 0.00 3. Interest (3) 56.14 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) 43�_7� _ 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:.................................... � Ox c. retain a reversionary interest;or.................................................................................................................. ❑ � d. receive the promise for tife 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?....................................................................................................................... ❑ 0 3. Did decedent own an"in trust for" 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?...................................................................................................................... 0 ❑ IF THE ANSWER 70 ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. � � , .� ._,: � .�,��=w ar��.�F �� . , .; .. ...: ,� _ . .,` ,.. _ .. �.� . �.:; , ,;..�� ,....�.;�. , �, . , , ,.� ��r ,. �. .�� ,.� . . _ _. � ..� . .. . _ _,. ._ . � . � �, . . ,�_P e,.ti.., 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 pe{cent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the sunriving 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 decedenPs lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9115(a)(1)]. •The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent(72 P.S.69116(a)(1.311. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether by blood or adoption. REV-9590 EXi(08-09► ,� �3£.'�1�11$y�V8C1�S �°w g� /�a � OEPARTMEN?47FREYENUE p �{.rHEV��E 17 -�� INNERITRNCETAXRE7URN � �NTEf\-ViVC1S TRANSFERS & j RESiDEMTDECEDENT � ��,'y�CC, NaN-PRaBATE PRUP RTY � ___1__._............ __......1._ .._ __.._ ___.... _............_ EST�T�QF Ei�enhov�er, Nenry F. !I! �Fi�.�t�t3t��ER ...�... _. _.......... j �1 _.._..�. ThFs scheduCe must bs compfeted and filed if ths answer to any of questicsn�1 thraugh 4 on page 2 is yes. _____�__ . _......__ _................�._. --.._ � ._ ......_.___._ _.....T__ IT�IW! QE5CRtPT1DN OF PROPERTY DA7E 4F�EATki '�'OF EXC€.USION ! �� a.ndude±hena�a(thetransferes,thelrrelat;onshp�todereqam VAL'JE4FASSET ! �ECD'S T�1)CAB��VA�.UE ar�iha date af tranater. Attact�a copy of the deed for raa�estete. IH'fEREST (FF ApPCiCABi.E) _.. f..... ......... _ ...__. ................. .....___ .............. 1 � Frontier Trust Campany 401 {K)Account#1�9734�21 s,sas.�� 100°fo _..__._... 3,6�9.78 � Beneficiary: Estate. The ir�tes�ate he�rs of the Estate , '!, are Cary!�. Eisenhawer, Kei�h A. Eisenhower and � Cynthia �. Cundafl, sib(ings of the decedent. ' tYote: Rdministrator closed estate, unaware of this � I additi+anal non-probate asset. This 4Q1 (K)accaunt ; closed and check issued August 29, 2013. � I i + i � ', � I � 1 � 1 � i ' � I ; � 1 ; � � � , I � � I ; I � i � i ; ; I TOTAt.(Alsa er�ter an line 7,Recapltulation} �,��.7� REV-1611 EX+(10-09) ��. pennsylvania ��H � DEPARTMENT OF REVENUE ��p INHERITANCE TAX RETURN wry��q�.TpA�� RESIDENT DECEDENT r'WIr111�1�7 1 IV'1 FILE NUMBER ESTATE OF Eisenhower, Henry F. III 2� DecedenYs debts must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. B. ADMINlSTRATIVE COSTS: �, Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2, Attorney's Fees 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. AccountanYs Fees 6. Tax Return Preparer's Fees Kerwin & Kerwin, LLP 5�0.0� 7, Other Administrative Costs � Register of Wills-filing fee for Supplemental Inheritance Tax Return 15.00 See attached 5.00 TOTAL(Also enter on line 9, Recapitulation) 520.00 Schedu�H COMMONWEALTH OF PENNSYLVANIA Fw�� INHERITANCE TAX RETURN �'�'y��(',Q�,� RESIDENT DECEDENT ESTATE OF Eisenhower, Henry F. III FILE NUMBER 21 Z Register of Wilis-Short Certificate 5.00 Page 2 of Schedule H Fron tier dient!D: 215400 P 101734021 Gient: COMMONWEALTH ENGINEERING& Trust Payee: ESTATE OF HENRY E{SENHOWER Da#e: August 29,2013 an AstMSUi•�ompany Frontier Trust Company PO sox 10699 Check Type: Death Benefit Fargo,ND 58106 G�oss: $3,649.78 Loans: $O.OQ Federai Tax: $71�.96 Check Fee: $15.00 5tate Tax: $0.00 Distribution Fee: $45.00 Gty Tax: $Q00 Loan Fee: $0,00 �I�: �'� Net Amount: $2,87]..82 iNKtND: $0.00 '�.�s;� � �o�� l�-� �sr�,��e... f�c.G.a�n� �� SZ�3�� G�, �� i Zs'