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Home My WebLink About12-19-13 J 1505610143 EX(02.11) REV-1500 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Cm,my Code Year File Mxnber Bureau of Individual Taxes ^E*•a^�e�6^�^@ PO BOX.280601 INHERITANCE TAX RETURN 21 13 1113 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 10 01 2013 09 14 1917 Decedent's Last Name Suffix Decedent's First Name MI RAY MABEL B (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 Rehm ❑ 2. Supplemental Return El 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a.Fmure Interest Com ❑ prom-82)ise 5. Federal Estate Tax Return Required (date of death after 12-12 ® 8. Decedent Died Testate ❑ 7. Decedam eyinl9rnalI Living Truri 0 po (Attach Coq ofwn) (Alta Mf 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received El 10.S P1p¢}pradii Da y�of Oeau; 11.Election to tax antler Sec.9113(-8)and (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION§HOULD BE DIRECTED TO: Name Daytirpq Telephone i nbe :M JAMES D BOGAR (7 `!fi 7377¢ � REGIST6 OF W14LS US�i NOttf y; Z M First Line of Address v` o ONE WEST MAIN STREET n o TT _' — Second Line of Address ?J tV r— M r— O —( CD O S° C:> *1 City or Post Office DATE FILED State ZIP Code SHIREMANSTOWN PA 17011 Correspondent's e-mail address: jbogar @bogarlaw.com Under penalties of penury,I declare that I have examined this return,Including accompanying schedules and statements,and to the best of my knowledge and belief, it is We,coned and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNgTURE O�SO�I RESfONSI�R FILING RETURN `—S_1/bJ,)K- K .., DATE Linda R. Cook 1 Cc . �o k'j ADDRESS - t 620 Wayne Drive Mechanicsburg, PA 17055 SIGNATUR EPAR O R THAN REPRESENTATIVE DATE James D. Bogar ADDRESS One West Main Stree , Shiremanstown, PA 17011 Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Name Ray, Mabel B. Decedent's Social Security Number ' RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 314 , 600 . 91 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. 22 , 508 . 99 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous�pq-Probate Property (Schedule G) (J Separate Billing Requested............ 7, 10, 023 . 46 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 347 , 133 . 36 9. Funeral Expenses and Administrative Costs(Schedule H).................................... s. 29, 915 . 74 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 29, 915 . 74 12. Net Value of Estate(Line 8 minus Line 11)............................. ..... 317 ,217 . 62 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. 317 ,217 . 62 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 at lineal rate X .045 317,217 . 62 16. 14 ,274 . 79 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. 14 ,274 . 79 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ L. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-13-1113 Decedent's Complete Address: DECEDENT'S NAME Ray,Mabel B. STREET ADDRESS 100 Mt.Allen Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 14,274.79 2. Credits/Payments A. Prior Payments B. Discount 713.74 Total Credits(A +B) (2) 713,74 3. Interest (3) 4, if Line 2 is greater than Line i+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) 13,561.05 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;_.....-........._............. c. retain a reversionary interest:or.............................._.........................--............---.............................. z 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?....................._....--................_......---...._..._................................_......... ❑ 3. Did decedent own an"in trust far" or payable upon death bank account or security at his or her death?.....- ❑ nx 4. Did decedent own an individual retirement account,annuity,or other non-probate property which containsa beneficiary designation?.................................................................................................................. 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. _ _ — — _ l For dates of death on or after Juty 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 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)(4)1. 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)(12)). • The tax rate imposed on the net value of transfers to of for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)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)1. 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. Re,1503 EX.(6-18) SCHEDULE B STOCKS & BONDS COMMONWEALTHOF PENNSYLVANIA INHERITANCE TAX RETURN RE.,DENTDECEOENT ESTATE OF Kay, Mabel B. FILE NUMBER 21-13-1113 All property jointly-owned with right of su"lvomhip must be disclosed 0n Schedule F. ITEM CUSIP NUMBER NUMBER DESCRIPTION VALUE AT DATE UNIT VALUE OF DEATH 1 Vanguard-Wellesley Income Fund Adm. -Account No. 0527 -88023540064. 314,600.91 TOTAL(Also enter on Line 2, Recapitulation) 314,600.91 Copyright(c)2002 form software only The(if more pace is Inc.ned,additional pages of the same size) Form PA-1500 Schedule B(Rev.6-98) Vanguarde October 23, 2013 P.O. Box 2600 Valley Forge, PA 19482-2600 www.vanguard.com LINDA R COOK 620 WAYNE DR MECHANICSBURG PA 17055-4986 Re: Estate of Mabel B. Ray Dear Ms. Cook: I am responding to the letter we received requesting a valuation of Mabel B. Ray's Vanguard account as of October 1, 2013. The information requested is included on the enclosed account value report. If you have any questions, please contact me at 888-237-9045, Ext. 27749. 1 will be pleased to assist you. You can reach me on business days from 11:30 a.m. to 8 p.m., Eastern time. Sincerely, Will Powell Transition Associate Enclosure(s): **Mabel B. Ray Individual Account Value Report 52470574 Vanguard' Page > I of I ipolc 1�0 F� Mabel 8 Ray 620 Wayne Dr Voyager Services:800-2154-7245 Mechanicsburg, PA 17055-4986 Total report value: $314,600.91 (Total report value includes any accrued dividends.) - .Mabel B Ray !n cpu •yalu�s`=mary �. =` Name Fu6d&Account Date Price Per Accrued N mb. Opened Value* Divicl6r;ds urn er Coen d `�S6ares,, Share 11 91 009 Wellesley Income Fund Adm 0527-88023540064 11109/2009 5,226197 $6019 $314,600.91 $314,600* t0.00 Doesn't include accrued dividends, 110530017310123/2013 15:57:01 Rev-1506 EX+(11.10) SCHEDULE E pennsylvania DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF Ra , Mabel B. FILE NUMBER 21-13-1113 Indudethe preceedsot litigation end the date the roceeds All property jointlyownetl with the right of survivorship matt be disc'1 sedyon schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1 PNC Bank-Checking Account No.5003548779. Date of death balance$18,738.23;accrued OF DEATH interest$0.11. 18,738.34 2 PNC Bank-Savings Account No.5001902631. Date of death balance$2,873.27;accrued interest$0.07. 2,873.34 3 Highmark-Prescription refund 113.20 4 Highmark-medical refund 775.65 5 Verizon -Refund 8.46 TOTAL(Also enter on Line 5, Recapitulation) 22,508.99 (If more space is needed,additional pages of...same size) -Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Oct. 30- 2013 3,03PM PNC Bank No. 8672 P, 1/2 October30,2013 James D BogarEsq_ One West Main St Shiremansw)h%,PA 17011 RE: Mabel B Ray SSN: 196-10-9730 DOD: 10-01-2013 Dear Mr. Bogar: In response to your request for Date of Death(DOD)balances for the customer noted above,our records show the following; Checking Account Account#5003548779 Established:04-15.2002 MABEL B RAY DOD balance: 3 18,73813 +0.11 accrued interest Interest paid 01-01-2013 thru 10-01-2013 S 0.44 YTD Savings Account Account#5001902631 Established: 04-15-2002 MABEL B RAY DOD balance: S 2,873,27+ 0.07 accrued interest Interest paid 01-01-2013 thru 10-01-2013 S 2.63 YTD Investment Account The decedent maintained Investment Account#4488089. For further information,you may call the Brokerage Department at 1-800-762-6111. Please note that this office provides date of death balances for deposit accounts QIZAs, CDs,Checking and Savings). We do not process any financial transactions or provide statements_ If you need assistance with any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC Page 1 of 2 Oct. 30. 2013 3: 03PM PNC Bank No. 8612 P. 2/2 This message is intended for the use ofthe individual or entity to which it is addressed and may contain it formation that is privileged, confidential and exempt from disclosure under applicable 1¢w. If the reader of this message is not the intended recipient or the emplovee or agent responsible for delivering this message to the intended recipient,you are hereby notified that am dissemination, distribution or copying of this communications is strictly prohibited If you have received this communication in error,please notify me immediately by reply or by telephone at 300-762-1775 and immediately destroy this faxed document. Page 2 of 2 Rev-1510 EX*(08419) SCHEDULE G pennsybani SCHEDULE TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF Ra , Mabel B. FILE NUMBER 21-13-1113 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, ITEM DESCRIPTION OF PROPERTY NUMBER THE DATE OF E OF TRANSFEREE ATTACH A EIR RELATIONSHIP OF THE DEED OR REAL ESTATE. DATE OF DEATH %OF DECD'$ EXCLUSION TAXABLE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 7 Transamerica-Annuity No. 02TF6054355. 10,023.46 10,023.46 TOTAL(Also enter on Line 7, Recapitulation) 10,023.46 (If more space is needed,additional pages of the same size) Copyright(C)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) �R-ANSAMERICA Administrative Office; ® L1FE INSURANCE COMPAN]' 4333EdgewoodRoadNE Cedar Rapids,IA 52499 www.tra nsa merica ann u i ti es.com October 22, 2013 LINDA R COOK 620 WAYNE DR MECHANICSBURG PA 17055 RE: Annuity Number(s) 02TFBOS4355 Dear Claimant : We have received notification of the death of Mabel B Ray. We extend our sincere condolences to you for your loss. The information in this letter is being provided to assist you in submitting death claim this annuity: Paperwork. Our records reflect the following information regarding Annuitant: Mabel B Ray Owner. Mabel B Ray Claimant : Linda R Cook 50% Annuity value: $10, 023 . 46 as of 10-01-2013 Annuity type: Non-Qualified Tax Information This letter includes general tax information that should not be relied upon for personal tax planning. Transamerica Life Insurance Company does not give legal, tax, or accounting advice. You may want to consult your attorney, tax advisor, or accountant with questions regarding the direct tax consequences when selecting c option, General Information The financial professional of record will remain on this annuity unless we are notified of a change in writing. Please be advised automatic operations such as Systematic Payouts and Automatic Payments have been stopped. an AEGON company REV-1511 EX-(10-0) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE N DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Ray, Mabel B. 21-13-1113 Decedents debts must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedules)attached 8,352.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Attorneys Fees Bogar& Hipp Law Offices 9,450.00 1 Family Exemption: (if decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 168.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 11,945.24 See continuation schedule(s)attached TOTAL(Also enter on line 9,Recapitulation) 29,915.74 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1600 Schedule H(Rev.10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Ray, Mabel B. 21-13-1113 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex eo nses 1 Country and Town Baptist Church-Bob Hylton-funeral service 130.00 2 Don Rettburg-grave closing fee 300.00 3 Eby Granite Works-headstone 2,910.00 4 Rick Musselman-grave opening fee 250.00 5 Weaver Funeral Home-funeral bill 4,762.00 H-A 8,352.00 Other Administrative Costs 6 Alert Pharmacy-prescription bill 294.73 7 Messiah Village-September bill 9,632.30 8 RESERVES:-Costs to conclude administration of Estate,including preparation and filing of 2,000.00 final personal income tax returns and fiduciary Income tax returns 9 Verizon-phone bill 18.21 H-B7 11,945.24 Copyright(y 2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) REV-1611 EX.(0140) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Ray,Mabel B. 21-13-1113 NAME AND ADDRESS OF RELATIONSHIPTO SHARE OF ESTATE AMOUNT OF ESTATE i NUMBER PERSONS)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List lann.&. j TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1. Linda R.Cook Daughter One-half of rest, 620 Wayne Drive residue and Mechanicsburg, PA 17055 remainder Jack A. Ray Son 'One-half of rest, 960 Alpine Road residue and Wellsville, PA 17365 remainder Tots[ Enter dollar amounts for distributions shown above on lines 15 through 16 on Rev 1500 cover sheet,as approp 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 ON LINE 13 OF REV-1500 COVER SHEE Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) LAST WILL AND TESTAMENT OF MABEL B. RAY I, MABEL B. RAY of Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I - I devise and bequeath all of my estate of whatever nature and wheresoever situate unto my issue per stirpes. II - All taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed shall be considered a part of the expense of the administration of my estate, and my personal representatives shall have the absolute power in his or her discretion to pay the same at once whetheror not the law under which they are imposed permits the postponement of all or part of them to a later time. III - I appoint my children Jack A. Ray and Linda 8. Hamilton, co-executors of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the f7r# day of February, 1971. � (SEAL)J � ay!� . Signed, sealed, published and declared by MABEL B. RAY, Testatrix therein named on this sheet of paper as and for her Last Will and Testament in our presence, who, in her presence, at her request and in the presence of each other, have hereunto subscribed our names as attesting witnesses. � � 922 N. Name Address ARmw lima "*��n•=u- Name C1 Address •awr esun