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Home My WebLink About02-20-14 1505610143 REV �+0 EX(01-10) . w -1500 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Cade Year File Number Bureau of Individual Taxes �ENTaFRE UE PO BOX.280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 161 60 0542 06 17 2012 04 24 1963 Decedent's Last Name Suffix Decedent's First Name MI ROSENBERRY RICK E (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 Return(date of death priarto 12-13-82) ❑ 4. Limited Estate 41.Futuna Ieterast Compromise ❑ 5. Federal Estate Tax Return Required (date dof death after 12 12-82) f 1 6. Decedent Copy Died Testate 11) ❑ 7 (gjjachaCoMaintained u a Living Trust _ 8. Total Number of Safe Deposit Boxes Deed Copy of ) L7((7 9. Litigation Proceeds Received 16.bsgoougi Poyel£�}tdate of death ❑ 11 Election to tax Under See.9113(A) ❑ beNreen 12-3151 and f-1-95) (Attach Soh.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ,TERRY A WEIGLE ESQUIRE 717 532 7388 REGISTER OF WILLS USE C}NJLY 17E 1 First line of address -r C0 126 EAST KING STREET �,_ _ _ ❑ ;. Second line of address CD r n . City or Post Office DATE*LED State ZIP Code `- 7 PA 17257 SHIPPENS$URG s „T f_o Correspondent's e-mail address: 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 primerer has any knowledge. �SiGNA PIECE PERSON RESPONSIBLE OR FILING RETURN DATE nr.o Bonnie R. Halter -1 -/y AC DRESS 3 Burket Road Shippentsburcll PA 1 257 SIGNATqEOFPREP ER OTHER THA EPRE ENTlt IV DATE Jerry A.Weigle Esquire -2--18'-1 E 126 East Kin Street, Shippen s r PA Side 1 1505610143 1505610143 r f J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name Rosenberry, Rick E. 161 60 0542 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. 2 , 095 . 19 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Nt Probate Property (Schedule G) a Separate Billinq Requested............ 7, 15 , 892 . 09 8. Total Gross Assets (total Lines 1-7)...................................................I................. 8. 17 , 987 . 28 9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 3 , 405 . 00 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I).............................. 10. 3 , 865 . 31 11. Total Deductions(total Lines 9&10)................................................................... 11. 7 ,270 . 31 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 10 716. 97 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, 10 , 716 . 97 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 10 , 716 . 97 16. 482 . 26 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. 482 . 26 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 e REV-1500 EX Page 3 File Number 21 Decedent's Complete Address: DECEDENT'S NAME Rosenberry, Rick E. STREETADDRESS -- --- -- --- --- 3 Burket Road -- --- - - CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 482.26 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0,00 3. Interest (3) 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) 482,26 tt.,4h,.�'' ,$�� Make Check Payable to REGISTER OF WILLS, AGENT. :, r �..+rWV ;�;i'Jv"s:,.a+aJw.omn i. i'fii:+ s. }u ,R', 6m- 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;........_..................................................................... ❑ 1Z b, retain the right to designate who shall use the property transferred or its income;-......__----------- ....... ❑ x c. retain a reversionary interest;or........................_..................................................................................... ❑ x d. receive the promise for life of either payments,benefits or cam?............................................................ ❑ ❑x 2. If death occurred after December 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?............___.......................................................'"----........_................_... ❑ 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)(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 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 p2 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 1.2)[72 P.5.§9116(a)(i)]. • 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. Rey-1608 EX.16-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERNLANCETARRETURN RESIDENTOECEDENT ESTATE OF FILE NUMBER Rosenberry Rick E. Y7 ICCIi de the p.oceeds of I b9ation and the date the proceeds were rece�vetl by the estate. All property jointly-owned with the right of sund,mrship must be disdosod on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Commonwealth of Pennsylvania-2012 state income tax refund 83.67 2 McCoy Brothers General Contractors-vacation pay owed decedent at date of death, 967,70 received 6-28-2012 3 U.S.Treasury-2012 federal income tax refund 1,04182 TOTAL(Also enter on Line 5,Recapitulation) 2,095.19 (if more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.6-98) Rev 1510 EX.(6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH VLVANIA INHERITANCE TAX RETURN TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rosenberry Rick E. 21 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse s,do of the REV-1600 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH ^c of oECO•s NUMBER THE DATE OF TRANS ERSATTACH A COPY E OF RELATIONSHIP DEED FOR REAL ESTATOE. VALUE OF ASSET INTEREST (IF APPLICABLE) TAXABLE VALUE 1 McCoy Brothers General Contractors-proceeds of 2,902.05 2,902.05 profit sharing plan received 12-7-2012 paid to estate 2 McCoy Brothers General Contractors-additional 352.63 352.63 proceeds of profit sharing plan received 8-6-2013 paid to estate 3 McCoy Brothers General Contractors-proceeds of 12,637.41 12,637.41 employee stock ownership plan received 7-24-2013 paid to estate TOTAL(Also enter on Line 7, Recapitulation) 15,892.09 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.6-98) REV-0i01 EX.(10-06) SCHEDULE H y�v� TRH y� FUNERAL. EXPENSES & COMM N ITA�NCEOFq�� ETUWANIA WIDEPEDT PENT ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF Rosenberry, Rick E. 21 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 2,090.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Yeartsl Commission paid 2. Attornev's Fees Weigle&Associates, P.C. 1,200.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4.. Probate Fees 5. Accountant's Fees 6. Tax Return Preparers Fees T Other Administrative Costs 115.00 See continuation schedule(s) attached TOTAL(Also enter on line 9,Recapitulation) 3,405.00 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1600 Schedule H(Rev, 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Rosenberry Rick E. 21 ITEM NUMBER DESCRIPTION AMOUNT 1lneral Expenses 1 Fogelsanger-Bricker Funeral Home,Inc. 2,090.013 H-A 2,090.00 Other Administrative Costs 2 Register of Wills, Cumberland County-filing PA Inheritance Tax Return 15.00 3 Register of Wills,Cumberland County-filing Family Settlement Agreement 100.00 H-B7 115.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) SCHEDULE 1 DEBTS OF DECEDENT, COMMONWEALTH PENNSYLVANIA MORTGAGE LIABILITIES, 81 LIENS TAX RE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rosenberry Rick E 21 Report debts incurred by the decedent prior to death that remained unpaid at the data of death,including unraimbumed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 McCoy Brothers General Contractors -medical insurance May and June, 2012 450.00 (reimbursement paid to Bonnie R. Halter) 2 U. S.Treasury-income tax on profit sharing and employee stock ownership plans 3,415.31 TOTAL(Also enter on Line 10, Recapitulation) 3,865.31 (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 I(Rev. 12-08) � REV-1513 EX.(11A8) SCHEDULE J COMMON RFALTOFXE ENSYLVANIA BENEFICIARIES INHE SAN ETAXRETURN RE IDEN OECED NT ESTATE OF FILE NUMBER Rosenberry, Rick E. 21 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Not I• TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Bonnie R. Halter Mother 50% 5,358.49 3 Burket Road Shippensburg, PA 17257 2 John S. Rosenberry,Jr. Father 50% 5,358.48 3005 Ritner Highway Carlisle, PA 17013 Total 10,716.97 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appr o 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 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2009 form software only The Lackner Group, Inc. Farm PA-1500 Schedule J(Rev. 11-08) tIACCOY BROTHERS INC ESOP PLAN#.002 E��AuIGJT�?IPcl��m 203 1514 COMMERCE AVE CARLISLE,PA 17015 25-80/44D aawcH m July 24, 2013 DATE PAY TOTHEORDEROF Estate of Rick Rosenberry I $ 12,637.41 Twelve Thousand Six Hundred Thirty Seven---41 100 DOLLARS 8 " =O wares MoD0al400-75 W FOP 0:0440008040. 474774286 0111 0 MGCOY BROTHERS INC PSP#0o1 �� 201 ;.,.1514 COMMERCE AV E., - 25-801440 GARL.ISLE,PA 17015 December 6, 2012 DATE PAS Estate of Rick E. Rosenberry --------- $ .0 1 to rEORGEROF ry , 0.. Two Thousand Nine Hundred Two;and W'90 ----------- DOLLARS MBBWn NA 6 eCnk - -`: �l. .. Ks�uast�'htt3 fm CFmdtPorNCahu4CB01d0a75?9M � ~ x r 3 — +:0440008041: 474 T74 MGCOX,BROTHERS INC PSP spot a 209 ,,1614 GGMMERGEAVE _ YMp�cT ..> r GARt1SLE PA°17015 �r r x - _ - _ e25-W440 ,4 Aug 6 298 -4 DATE . w ToiEORDER>�Estate of..'Rick E Rosenberry I 352.63 -p7h erHundr l Fifty Two -- 6V100 .t"'"h'e}s+Krem�`Q3'!q .FctGtlY7tYe 4411$JP7:&97Hf: ' , e - �y.�. i�." 9, tla�SU� tgyv! no O00$ii;' 474008'Silb-6209 ` s