HomeMy WebLinkAbout03-27-14 J 1505610143
REV-1500 EX(02-11)
PA Department of Revenue OFFICIAL USE ONLY
P pennsy lvania - County code Year File Number
Bureau of Individual Taxes DEPARTMENT OF eavEaaE
PO BOX.280601 INHERITANCE TAX RETURN 21 13 0725
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
06 17 2013 05 29 1951
Decedent's Last Name Suffix Decedent's First Name MI
EPLER CYNTHIA K
(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(Dale of Death
Prior to 12-13-82)
4. Limited Estate 4a,Future Interest compromise 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
S Decedent Died Testate 7 ppaceddeppt Mai netl a Living Trust O S. Total Number of Safe Deposit Boxes
(Attach Copy of Will (Attach GOpy bust) P
9. Litigation Proceeds Received 10. Spousal Povert Credit(Date of Death 11.Election to tax under Sec.9113(A)
between 12-31. and T-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GARY L JAMES ESQ 717 533 328.0 �s
n �
M
REGISTER 69VYYLS USEMILY O
Co n n i
First Line of Address rn fV v �
134 SIPE AVENUE v
T. O
I:J A O 'D rl
Second Line of Address —n n p Tt �
O � n
fV m I
A'aE
City or Post Office State ZIP Code D FILED O Ca m
HUMIDELSTOWN PA 17036 t
Correspondent's e-mail address: glipjsdc.com
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.
SIGNAT E OF ERSON RESP IBLE FOR FILING RETURN DATE
Gary L.James
ADDRESS
134 Si Av u H mmelstown PA 17113
SIGNATU 0 EPARER EPRESENTATIVE GATE
Gary L.James Esq. — DATE
ADDRESS
134 Sipe Av4 Q i4iJelstown, PA 17036
Side 1
L 1505610143 1505610143 J
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Epier, Cynthia K.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 103, 000 . 00
2. Stocks and Bonds(Schedule B)............................................................................. 2. 542 , 453 . 90
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. 214 , 933 . 44
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous -Probate Property
(Schedule G) Separate Billing Requested............ 7. 12 , 791 . 56
6. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 873 , 178 . 90
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 33 , 950 . 75
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 9,577 . 65
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 43 , 528 . 40
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 829, 650 . 50
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13. 6, 000 . 00
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 823 , 650 . 50
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 21 , 131 . 56 ts. 950 . 92
17. Amount of Line l4 taxable
at sibling rate X.12 280 r 881 . 63 17. 33 705 . 80
18. Amount of Line 14 taxable
at collateral rate X.15 521 , 637 . 31 16. 78 ,245 . 60
19. TAX DUE................................................................................................................ 19. 112 , 902 . 32
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 5
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-13-0725
Decedent's Complete Address:
DECEDENT'S NAME
Epler, Cynthia K.
STREET ADDRESS
13 Colgate Drive
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 112,902.32
2. Credits/Payments
A. Prior Payments 113,000.00
B. Discount 5,645.12
Total Credits(A +B) (2) 118,645.12
3. Interest (3)
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 5,742.80
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;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;........................ Lx
c. retain a reversionary interest;or............................................................................................................... ❑ x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ W
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ ❑x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ 0
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?.................................................................................................................. ❑x ❑
IF THE ANSWERTO ANY OF THE ABOVE QUESTIONSIS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of tleath 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
fling 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.
Rev-1502 EX+(01-10)
SCHEDULE A
pennsyivania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet If the property has been sold
Include acopy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate located at 13 Colgate Drive Camp Hill,Cumberland County, Pennsylvania- 103,000.00
valued per selling price
TOTAL(Also enter on Line 1, Recapitulation) 103,000.00
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule A(Rev.01-10)
Rev-f 603 EX.(6-96)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
All property jointly-owned with right of survivorship must bedisclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 100 shares of Altria Group Inc-held in the TD Ameritrade 35.79 3,579.00
brokerage account#885-009545;valued per letter dated
September 13,2013 and public listing
Accrued dividend on Item 1 through date of death 44.00
2 481.788 shares of American Beacon Large Cap Investor- 24.46 11,784.53
held in the National Services Incorporated brokerage
account#DFH-010138; valued per statement dated June 30,
2013 and public listing
3 546.852 shares of American Century Growth Investor -held 30.11 16,465.71
in the National Services Incorporated brokerage account#
DFH-010138;valued per statement dated June 30,2013 and
public listing
4 243.503 shares of Artisan International Investors Class- 26.95 6,562.41
held in the National Services Incorporated brokerage
account#DFH-010138;valued per statement dated June 30,
2013 and public listing
5 688.619 shares of Aston/Anchor Capital Enhanced Equity 9.14 6,293.98
Class N -held in the National Services Incorporated
brokerage account#DFH-010138;valued per statement
dated June 30,2013 and public listing
6 99.919 shares of Baron Asset Retail -held in the National 56.97 5,692.39
Services Incorporated brokerage account#DFH-010138;
valued per statement dated June 30,2013 and public listing
7 50 shares of Berkshire Hathaway Inc Class B-held in the 114.70 5,735.00
TD Ameritrade brokerage account#885-009545;valued per
letter dated September 13,2013 and public listing
Total of Continuation Schedules See attached
pages
TOTAL(Also enter on Line 2, Recapitulation) 542,453.90
(If more space is needed,additional pages of the some size)
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.6-98)
Re,1603 EX-(6-96)
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNMVANV
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
8 1,800 shares of Chico's FAS Inc-held in the TD Ameritrade 17.09 30,762.00
brokerage account#885-009545; valued per letter dated
September 13, 2013 and public listing
Accrued dividend on Item 8 through date of death 99.00
9 7 shares of Citadel Broadcasting (Bankruptcy)-held in the 0 0.00
TD Ameritrade brokerage account#885-009545;valued per
letter dated September 13,2013 and public listing
10 200 shares of Coca Cola Company-held in the Wells Fargo 40.66 8,132.00
brokerage account#3067-9146;valued per letter dated July
9,2013 and public listing
Accrued dividend on Item 10 through date of death 56.00
11 200 shares of Corning Inc-held in the TD Ameritrade 15.10 3,020.00
brokerage account#885-009545;valued per letter dated
September 13,2013 and public listing
Accrued dividend on Item 11 through date of death 20.00
12 352.913 shares of Credit Suisse Commodity Return Strategy 7.51 2,650.38
Instl Sh -held in the National Services Incorporated
brokerage account#DFH-010138;valued per statement
dated June 30,2013 and public listing
13 200 shares of E M C Corp Mass -held in the Wells Fargo 24.92 4,984.00
brokerage account#3067-9146;valued per letter dated July
9, 2013 and public listing
14 600 shares of Ericsson LM Tel Akta-valued per public 12.02 7,212.00
listing
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1600 Schedule B(Rev.6-98)
Rev-1503 EX.(6-96)
SCHEDULE B
STOCKS & BONDS
continued
COMMONV LTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
15 43 shares of GSI Group Inc-held in the TD Ameritrade 8.39 360.77
brokerage account#885-009545;valued per letter dated
September 13,2013 and public listing
16 89.376 shares of Harbor International Investor Shares-held 64.80 5,791.56
in the National Services Incorporated brokerage account#
DFH-010138;valued per statement dated June 30,2013 and
public listing
17 200 shares of Hersha Hospitality Trust-held in the TD 5.81 1,162.00
Ameritrade brokerage account#885-009545;valued per
letter dated September 13,2013 and public listing
18 23 shares of Kraft Foods Group-held in the TD Ameritrade 55.97 1,287.31
brokerage account#885-009545;valued per letter dated
September 13,2013 and public listing
19 4 shares of LSI Corporation-held in the TD Ameritrade 7.42 29.68
brokerage account#885-009545;valued per letter dated
September 13,2013 and public listing
20 17 shares of LSI Corporation-valued per public listing 7.42 126.14
21 116 shares of Merck&Co-valued per statement dated July 48.06 5,574.96
8, 2013 and public listing
Accrued dividend on Item 21 through date of death 49.88
22 341.687 shares of Merger Fund-held in the National 15.93 5,443.07
Services Incorporated brokerage account#DFH-010138;
valued per statement dated June 30, 2013 and public listing
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1503 EX.(6-98)
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
23 733.152 shares of Metropolitan West Total Return Bond 10.77 7,896.05
Class M-held in the National Services Incorporated
brokerage account#DFH-010138;valued per statement
dated June 30,2013 and public listing
24 69 shares of Mondelez International Inc-held in the TD 30.28 2,089.32
Ameritrade brokerage account#885-009545;valued per
letter dated September 13,2013 and public listing
25 100 shares of Nokia Corporation-held in the TD Ameritrade 3.72 372.00
brokerage account#885-009545;valued per letter dated
September 13, 2013 and public listing
26 328.015 shares of Northern Small Cap Value-held in the 19.03 6,242.13
National Services Incorporated brokerage account#DFH
-010138;valued per statement dated June 30, 2013 and
public listing
27 185.618 shares of Perkins Mid Cap Value Fund Class T- 24.25 4,501.24
held in the National Services Incorporated brokerage
account#DFH-010138;valued per statement dated June 30,
2013 and public listing
28 300 shares of PH Glatfelter Co-held in the TD Ameritrade 25.90 7,770.00
brokerage account#885-009545;valued per letter dated
September 13,2013 and public listing
29 100 shares of Philip Morris International Inc-held in the TD 92.41 9,241.00
Ameritrade brokerage account#885-009545;valued per
letter dated September 13,2013 and public listing
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1503 EX.t6-981
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
30 330.404 shares of PIMCO Foreign Bond Fund (Unhedged) 10.36 3,422.99
Class D-held in the National Services Incorporated
brokerage account#DFH-010138;valued per statement
dated June 30,2013 and public listing
31 329.339 shares of PIMCO Low Duration Class D-held in the 10.37 3,415.25
National Services Incorporated brokerage account#DFH
-010138;valued per statement dated June 30,2013 and
public listing
32 4,428.4 shares of PPL Corporation-valued per statement 29.26 129,574.98
dated July 2,2013 and public listing
Accrued dividend on Item 32 through date of death 1,627.44
33 200 shares of PPL Corporation-held in the TD Ameritrade 29.26 5,852.00
brokerage account#885-009545;valued per letter dated
September 13,2013 and public listing
Accrued dividend on Item 33 through date of death 73.50
34 317.266 shares of Sentinel Common Stock Class A-held in 39.52 12,538.35
the National Services Incorporated brokerage account#
DFH-010138;valued per statement dated June 30,2013 and
public listing
35 768.259 shares of Sentinel Small Company Class A-held in 7.51 5,769.63
the National Services Incorporated brokerage account#
DFH-010138;valued per statement dated June 30,2013 and
public listing
36 660 shares of Sirius XM Radio Inc-held in the TD 3.34 2.204.40
Ameritrade brokerage account#885-009545;valued per
letter dated September 13,2013 and public listing
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1503 EX-I6.961
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OFPENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
37 172.281 shares of SSGA Emerging Markets-held in the 18.89 3,254.39
National Services Incorporated brokerage account#DFH
-010138;valued per statement dated June 30,2013 and
public listing
38 2.44 shares of Sysco Corporation-held in the Fidelity 34.69 84.64
Brokerage account#X54525561; valued per letter dated
July 22,2013 and public listing
39 100 shares of Target Corp-held in the TD Ameritrade 69.55 6,955.00
brokerage account#885-009545;valued per letter dated
September 13,2013 and public listing
40 100 shares of Walt Disney Company -held in the TD 64.69 6,469.00
Ameritrade brokerage account#885-009545;valued per
letter dated September 13,2013 and public listing
41 1 $10,000.00 Series HH Savings Bonds 10,000.00
42 1 $25.00 Series E Savings Bond 108,27
43 2$5,000.00 Series HH Savings Bonds 10.000.00
44 29$1,000.00 Series HH Savings Bonds 29,000.00
45 4$50.00 Series I Savings Bonds 200.00
46 5$500.00 Series HH Savings Bonds 2,500.00
47 $5,000 Allegheny County PA Hosp Dev Aut 5.375%maturity 111.112 5,555.60
date 08/1512029-held in the Wells Fargo brokerage account
#3067-9146;valued per letter dated July 9, 2013
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1501 E%.)6-96)
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF FENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
Accrued interest on Item 47 through date of death 91.08
48 $20,000 Butler PA Area Swr Auth RE 4.9% maturity date 113.056 22,611.20
07/01/2034-held in the Wells Fargo brokerage account#
3067-9146; valued per letter dated July 9, 2013
Accrued interest on Item 48 through date of death 451.89
49 $15,000 Cumberland County PA Mun Auth Rv Diakon 101.483 15,222.45
Lutheran Ministries PJ Rev 5%maturity date 01/01/2036-
held in the Wells Fargo brokerage account#3067-9146;
valued per letter dated July 9, 2013
Accrued interest on Item 49 through date of death 345.83
50 $10,000 Delaware County PA IDA Rev Ref Wtr Face Aqua 101.732 10,173.20
PA Inc Ser B 5% maturity date 11101/2036 -held in the Wells
Fargo brokerage account#3067-9146;valued per letter
dated July 9, 2013
Accrued interest on Item 50 through date of death 63.89
51 $5,000 Farrell PA Area Sch Dist 4.6% maturity date 103.252 5,162.60
08/15/2033-held in the Wells Fargo brokerage account#
3067-9146; valued per letter dated July 9, 2013
Accrued interest on Item 51 through date of death 77.94
52 $25,000 Lancaster County PA Hosp Auth RE 6.5% maturity 105.375 26,343.75
date 07/01/2040-held in the Wells Fargo brokerage account
#3067-9146;valued per letter dated July 9, 2013
Accrued interest on Item 52 through date of death 749.31
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1503 EX-(6-98)
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
53 $15,000 Langhorne Manor Boro PA Higher Ed&Hlth Auth 90.537 13,580.55
Rev 4.125% dated 05/0212013;maturity date 1111512043-
held in the Wells Fargo brokerage account#3067-9146;
valued per letter dated July 9,2013
Accrued interest on Item 53 through date of death 77.34
54 $5,000 Mars PA Area Sch Dist G10 4% maturity date 98.449 4,922.45
09/01/2034-held in the Wells Fargo brokerage account#
3067-9146;valued per letter dated July 9, 2013
Accrued interest on Item 54 through date of death 58.89
55 $5,000 Philadelphia PA Hosps&Higher Ed Facs Auth Rev 101.434 5,071.70
Ser A 4.5%maturity date 07/0112033-held in the Wells
Fargo brokerage account#3067-9146;valued per letter
dated July 9, 2013
Accrued interest on Item 55 through date of death 103.75
56 $10,000 Puerto Rico Indl Tourist Ed[ Med/Envir Ctl Facs 5% 100.084 10.008.40
maturity date 08/01/2022-held in the Wells Fargo brokerage
account#3067-9146; valued per letter dated July 9, 2013
Accrued interest on Item 56 through date of death 188.89
57 $15,000 West Shore PA Area Auth Hosp Rev Holy Spirit 113.877 17,081.55
Hosp 6.25%maturity date 01101/2031 -held in the Wells
Fargo brokerage account#3067-9146;valued per letter
dated July 9, 2013
Accrued interest on Item 57 through date of death 432.29
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98)
Rev-1508 EX.(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 4,286.48 Bank Deposit Sweep Account -held in the Wells Fargo brokerage account#3067 4,286.48
-9146; valued per letter dated July 9, 2013
Accrued interest on Item 1 through date of death 0.02
2 7.84 Cash-held in the fidelity brokerage account#X54525561; valued per letter dated July 7.84
22, 2013
3 Metro Bank Savings Account#0410146901 4,983.82
4 1,742.09 Prime Fund Daily Money Class-held in the National Services Incorporated 1,742.09
brokerage account#DFH-010138;valued per statement dated June 30,2013
5 22,261.25 TD Ameritrade Money Market Account-held in the TD Ameritrade brokerage 22,261.25
account#885-009545;valued per letter dated September 13, 2013
6 Wells Fargo Crown Classic Banking#1010282454625-valued per statement dated June 30, 2,409.57
2013
7 Wells Fargo Crown Classic Banking#1010282454641 -valued per statement dated June 30, 9,812.62
2013
8 Wells Fargo Preferred Rate Savings Account#1010282454638-valued per statement dated 1,187.02
June 30, 2013
9 Wells Fargo Prime Checking Account#3548505183-valued per statement dated June 30, 100.04
2013
10 Wells Fargo Way2Save Savings Account#3000187645291 -valued per statement dated June 3,276.16
30,2013
11 1999 Buick Century -valued per Kelley Blue Book 3,400.00
Total of Continuation Schedule See attached page
TOTAL(Also enter on Line 5, Recapitulation) 214,933.44
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-1508 EX.(11-10)
SCHEDULE E
Pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT continued
ESTATE OF FILE NUMBER
Epler, Cynthia K 21-13-0725
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
12 2002 Mazda Protege DX Sedan -valued per Kelley Blue Book 3,440.00
13 Personal Property 1,500.00
14 AIS-refund of homeowners insurance 687.95
15 Bank of America-credit balance refund 18.49
16 PPL Electric Utilities-refund on recycled appliance 35.00
17 Travelers-refund of home owners insurance 467.00
18 National Life Group Annuity It 508058X-valued per letter dated August 5, 2013; beneficiary 155,318.09
is the Estate
TOTAL(Also enter on Line 5, Recapitulation) 214,933.44
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-7510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
This schedule must be completed and filed d the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF RANSFERSATACh A COPY OF TRELATIONSHIP
E DEIED FOR ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 TO Ameritrade IRA Account#885-025608-valued per 12,791.56 12,791.56
letter dated September 13, 2013; Beneficiary is Shirley
Kahler
TOTAL(Also enter on Line 7, Recapitulation) 12,791.56
(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)
REV-1611 EX.(10-09)
Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
______RESIDENT DEC ENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State ZiD
Year(s)Commission Paid
2. Attorneys Fees James, Smith, Dietterick& Connelly, LLP 27,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City Slate ZiD
Relationshio of Claimant to Decedent
4. Probate Fees 628.50
5. Accountant's Fees 425.00
6. Tax Return Preparer's Fees
T Other Administrative Costs 5,397.25
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 33,950.75
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 1st Advantage Settlement Servcies Inc -tax certification fee per HUD 1 10.00
2 AIS-homeowners insurance 939.00
3 Clauser Real Estate Appraisals LLC-real estate appraisal 375.00
4 Cumberland County Recorder of Deeds-transfer tax per HUD 1 1,030.00
5 Cumberland Law Journal -estate advertisement 75.00
6 Equity Services Incorporated -3rd quarter management fee 22.19
7 Equity Services Incorporated-2013 management fee 404.38
8 John R.Zimmerman-messenger service to Cumberland County Register of Wills Office 79.42
9 Lower Allen Township-sewer for residence 117.70
10 Lower Allen Township-4th qtr sewer/trash per HUD 1 less adjustment for items paid by 2.56
seller in advance
11 Pennsylvania American Water-service for residence 35.53
12 Pennsylvania American Water-service for residence 35.53
13 Pennsylvania American Water-service for residence 31.75
14 Pennsylvania American Water-service for residence 17.07
15 PPL Electric-service for residence 105.60
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
ITEM
NUMBER DESCRIPTION AMOUNT
16 PPL Electric-service for residence 104.47
17 PPL Electric-service for residence 68.16
18 PPL Electric-service for residence 44.29
19 Re/Max 1st Advantage-commission on sale of real estate per HUD 1 1,295.00
20 SOC Service Oil Company -air conditioner repair 279.00
21 The Sentinel-estate advertisement 178.92
22 Travelers-car insurance 60.34
23 Verizon -final bill 6.34
24 Wells Fargo-service fee 30.00
25 Wells Fargo-account valuation fee 50.00
H-137 5,397.25
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
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Epler, Cynthia K. 21-13-0725
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbumed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Creditech-past due medical expense West Shore Pathology 870.00
2 Laboratory Corporation of America-medical expense Holy Spirit Hospital 2,729.00
3 PA Department of Revenue-2012 income tax 15.00
4 PA Department of Revenue-2013 personal income tax 339.00
5 Pennsylvania American Water-service for residence 31.71
6 PPL Electric-service for residence 46.86
7 Sprint 39.26
8 Travelers-auto insurance check written prior to death, cashed after date of death 90.66
9 U.S.Treasury-2013 income tax owed on savings bonds 2,385.00
10 Verizon-service for residence 61.16
11 West Shore Anesthesia Associates-medical expense 2,000.00
12 West Shore Pathology-medical expense 970.00
TOTAL(Also enter on Line 10, Recapitulation) 9,577.65
(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-1617 EX.(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
E ler, Cynthia K. 21-13-0725
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT
(Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
See attached schedule
Total 823,650.50
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 Eberly's Mill Church of God 3,000.00
2 Hospice-Central Pennsylvania 3,000.00
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 6,000.00
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
SCHEDULE J
BENEFICIARIES
(Part I,Taxable Distributions)
ESTATE OF:
Cynthia K. Epler 06/17/2013 208-38-5001
Item Name and Address of Persons) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
1 Cynthia K. Epler T/W fbo Grayson J. Friend 15%of residue 120,377.84
Weidenhammer
c/o Gary L.James Esq.
P.O. BOx 650
Hershey, PA 17033
2 Cynthia K. Epler T/W fbo Halley Friend 15% of residue 120,377.84
Weidenhammer
c/o Gary L.James Esq.
P.O. BOx 650 ,
Hershey, PA 17033
3 Ashlyn M. Kahler Niece 35%of residue 280,881.63
4027 Cherrybrook Loop
Fort Myers, FL 33966
4 R.William Kahler Brother 35% of residue 280,881.63
200 Topanga Drive
Bonita Springs, FL 34134
5 Shirley 1. Kahler Mother IRA, personal property, 21,131.56
349 Furlong Lane cars
Camp Hill, PA 17011
Total 623.650.50
1