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Home My WebLink About12-12-13 REV-1500 EX(02.11) V, 1505610143 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania cowry Dade Year File Number Bureau of Individual Taxes W. W� PO BOX.280601 INHERITANCE TAX RETURN 21 13 00447 Harrisburg,PA 1712 8-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 04 10 2013 03 17 1926 Decedent's Last Name Suffix Decedent's First Name MI OELSCHLEGEL CATHERINE G (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. Odginal Return n 2. Supplemental Return 3, Remainder Retum(Date of Death Prior to 12.13.82) 4. Umited Estate O 4a.Fwxa {riteafde wrath _12. 2y en cmnpro Ise S. Federal Estate Tax Return Required after 21 g Oecatlem Died Testate T, Der Nah�i�lnetl s UOV TNat Q 8. Total Number of Safe Deposit Boxes (Attach Copy of NAl) An aPY rasp Q' s. Litigation Proceeds Received behveeili .2 i�J1 .NIP%es7 ineem 13 1 t.�Atta SGteaule O)sac.91 13(A) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name - Qaytim�Telsphone Number BRUCE 3 WARSHAWSKY 717438 654b m rn z r:n RE0J&TFy'[� "° •'ecrr r� Fs .L 7-R t'Yi 1nT First Line of Address � 2320 NORTH SECOND STREE cyo ° Z3 ,Second Line of Address c -" -q r �-1 N rri ' W "rt City r Post Office VA crrccv tY State ZIP Code , HARRISBURG PA 17110 Correspondent's e-mail address: bjW @&cclawpc.com UIS er penalties of oand cejury.I declare thhaatiGhof examined a Der tneturn.indudinp accompanying schedules and statements,and to the best of my knowledge and belief, complete, p p personal representative Is based on all Information of which prepare(has any kr o ledge- SIGNATU PERSON RESPONSIBLE APR F ING TUN TE eexm� ,fs ` Norman E. Oelschlegel ADDRESS 2269jWnoord Circle, Harrisbur PA 17 SIGN P P R FIT EJENTAT DA Bruce J.Warshawsky &/,?// ADDRESS 2320 North Second Street, Harrisburg, PA Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number 13..denrs Name: Oelschlegel, Catherine G. 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&Miscellaneous Personal Property(Schedule E)............... 5. 27 . 49 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non,-Probate Property (Schedule G) a Separate Billing Requested............ 7, 8. Total Gross Assets (total Lines 1 through 7). - .. .. .. .. .. - ......... 8. 27 . 49 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 1, 184 . 00 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 1 , 184 . 00 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -1 , 156 . 51 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. -1 , 156 . 51 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. 0 . 00 16. Amount of Line 14 taxable 0 . 00 i6. 0 . 00 at lineal rate X .045 17. Amount of X.12 taxable -1 156. 51 17. - -138 . 78 at sibling rate X.12 r 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18, 0 . 00 19. TAX DUE................................................................................................................ 19. -138 . 78 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. FK Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-13-OD497 Decedent's Complete Address: DECEDENT'S NAME Oelschlegel, Catherine G. STREET ADDRESS 325 Wesley Drive Apt. 3132 CITY STATE ZiP Mechanicsburg PA 17055 Tax Payments and Credits: 1. -Tax Due(Page 2,Line 19) (1) -138.78 2. Credits/Payments A. Prior Payments _ B. Discount Total Credits(A +B) (2) 1 Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 138.78 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) 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;.............................................................................. ❑ ❑ b. retain the right to designate who shall use the property transferred or its income;.......___......_...._...... D c. retain a reversionary interest;or................_._.......,........._..-................_..................................._. ......... ❑ 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?...............................-............................................__.....-...............__.....- ❑ 1 Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ Q 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 172 P.S.§9116(a)(11)(1)]. 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 surviving spouse is 0 percent 172 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 172 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 172 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. t Rev-1M EX.n1 fe) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY _ C IAIJC HEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Oelschiegel, Catherine G. 21-13-00497 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sunAvorsbip most be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Omnicare 27A9 TOTAL(Also enter on Line 5, Recapitulation) 27.49 (it more space is needed,additlonat pages o`the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1812 EX.(12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COMMON0 LT OF PENNSYLVANIA aafEPfTANO£TAX RET WiN REetOENr DEOESIENT ESTATE OF FILE NUMBER Oelschlegel, Catherine G. 21-13-00497 Report debts Incurred by the decedent Prior to death that remained unpaid at the dot,of death,Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Pinnacle 1,184.00 TOTAL(Also enter on Line 10,Recapitulation) 1,184.00 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) REV.1 bt 3 EX+(07-td) SCHEDULE J COMM IIQENT\ECE�I A BENEFICIARIES ESTATE OF FILE NUMBER Oeischle el,Catherine G. 21-13-00497 RELATIONSHIP TO NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) {588} Do Not List Trust"(81 i TAXABLE DISTRIBUTIONS (include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Norman E.Oelschlegel Brother All 2269 Concord Circle Harrisburg, PA 17110 Lawrence E.Oelschlegel Brother None-Interest 100 Faculty Lane disclaimed Romeoville,IL 60446 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as apPrOD riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Fonn PA-1500 Schedule J(Rev.01-10) Omnicare, Inc. - National A/P -613-719-2657 ~iNVOtCENUM6ERtCOMMEIVT ;"-dNVOtCE DATE,'',•; GROSS;AMOUNT; OISCOUNT,j., - NE'T AMOUNT. . KOP7002-141_1310 10/31/13 27.49 0.00 27.49 iw I �•r �r i I 1 ; i I I I I I � a . CHECK NO '" VENDOR NUMBER �" CHECK DATE '�`TOTAL GROSS TOTALDISCOUN CHCK°AMOUNT s., f I y101861695a ` t -... e 1,450 u.• 11/19/lr3 r ti M1$27'49;, . u0 ,00 } ';.t. $27 99 � THE FACE OF ••CUMENT HAS A BLUE BACKGROUND ON WHITE PAPER OMNICARE INC ., a SunTnust Bank i# 64z79 r" ° -�.•�• 1+= i`J` _ 900 Omnicare Cen#er- - w S savaeavtita,TN 611 Na 141$89§ 6,a 261.East Fourth Stralat,) '� e r .: 1 ..' i�.'r .•' N" a t7 .F'7J'.' i' Ci�nannatl OH 45202 xM. ! ' VOID AFTER 120 OAY$ its DAYE` _ 1 '; f y f N ° y b . -.i a.1• ;. .. a .} * `� .4 *s„ r. *» Mi=M D D+4Y Y:!cY:� cY „•;3;f' a Y "f�lkr, ,'F 1 a • y`L 5..h .r. ,'1 - 'M1 9 7d�••�ey'ys°`,rp,"� "'" tv�vr '. ' µ�' z, � d�`t N a ;CWf,'NTY SGS/FN LAND .9.9/100 ; DOL�,ARS �.Y "j27"x"44 +. • f "'"#': " '�#+ x. ` 1 } ^ t 4 ;44♦ µdo ,t ,r. -.Yr h•Yr x.. kirk,' r+'AT+.. }. .. 44 7,y1 THEO, 'RDER� ,.i,_ OF Omf5000ORr Fe Y •, y .,� . 1 - .ty*` r+ .� �t ,��a ry ^rnmo nsa4uvoaSawn d ESpn•eu• y $ - fir t 4" rT d i r. � I+�• S .[ YtM1l.^� .}. a, OEHLE LSCGEL,CATHERINE. �. 325,WESLEY DRIVEAPT;3132 t* ? MECHANICSBURG PA.17056' a r sane PER' . t. - Atfi}rt%U2P.0 8tGNANRB .y''#1 yA� _ • 111010113 616950 1.061100?901. ?019006266iI' STATEMENT The amount shown below represents r To discuss payment, call- your financial obligation to: PINNACLEHEALTH Y-2� Pinnacle Health Hospitals Hospitals 1 10 (717) 221-1294 PO Box 2353 - (888)467-2563 For all other inquiries: Harrisburg, PA 17105- (717)221-1294 MESSAGE: ID V Thank you for choosing Pinnacle Health Hospitals.The balance on your account is due. If you need assistance or have insurance coverage, please call our customer service department. If you need to make arrangements for payment,we have representatives available to assist you. Financial assistance is available for the uninsured or underinsured who apply and qualify. For more information, please call or see our website at www.pinnaciehealth.org/billi)ay. You may also pay online at httos://billnay.oinnaclehealth.ora HOSPITAL SERVICE DATE PATIENT NAME BILL NUMBER 03/02/13 CATHERINE OELSCHLEGEL 130297407 FOR YOUR HOSPITAL SERVICES: Room/Bed $13425.00 Supply Pharmaceutical $5852.85 Physiology $6600.00 Lab/Blood $7938.00 X-ray/Nucmed $5704.00 Med Resp $3731.00 MISC $4410.00 Clinic $2907.00 Oriqinal Billed Amount $50567.85 Total Payments and Adjustments $-49383.85 Patient Responsibility $1184.00 MMMEM0011111i, $ $1184.00 805ONAMSY011001 T PLEASE DETACH AND RETURN LOWER PORTION WITH YOUR PAYMENT Do not send Correspondence to this address. IF PAYING BY MASfERCARD DISCOVER MSAa AMERICAN UPREB FILL OUTBELOW ONAMSY01 CARD NUMBER EXP.DATE El PO Box 1022 LAST THREE DIGITS FROM BACK OF CARD ADDRESS SERVICE REQUESTED gMOUNT Wixom CARDHOLDER'S STREET ADDRESS CARDHOLDER'S ZIP CODE SERVICE SIGNATURE BILL NUMBER STATEMENT DATE 130297407 OCTOBER 11 2013 PATIENT: CATHERINE OELSCHLEGEL AM$" oOWE PLEASE INCLUDE BILL NUMBER ON CHECK,MAKE PAYABLE TO: 56864365-1001 153723079 11111 1 11111111 ii111111 1111111111111111111111111111111111111111111 Pinnacle Health Hospitals Catherine Oeischlegel PO Box 2353 2269 Concord Cir Harrisburg PA 17105-2353 Harrisburg PA 17110-9230 L11111111111111111111111$111111111111.11111 hi is 1111111111111 https://billpa v.oinnaclehealth.oro