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Home My WebLink About04-10-14 � 150561�105 REV-150Q EX(or�i)�FI) � OFFfC1AL USE ONLY PA Deparkment of Revenue pennsylvania Bureau of Individuat Taxes ``P R ,�� County Code Year File Number �O�Oxzso6oi `� INHERITANCE TAX RETURN �I �' C 0�� Harrisburg,PA i�i28-o6oi RESIDENT DECEDENT `T ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 01142014 01261951 Decedent's Last Name Suffix DecedenYs First Name MI DONALD ROBERT 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.Originai Return �C� 2.Supplemental Retum �,=� 3. Remainder Return{Date of Death Prior to 12-13-82} �� 4.Limited Estaie �^� 4a.Future lnterest Compromise(date of �= 5. Federal EstaYe Tax ReIum Required death aRer 12-12-82} �� 6.Decedent Died Testate �C� 7.Decedent MaiMained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Capy of Will) (Attach Copy of Trust.) �� 9.l.itigation Proceeds Received +C� 10. Spousal Poverty Credit(�ate of Death �� 11. Election to Tax under Sec.9113(Aj Behveen 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT— THIS SECTION MUST BE COMPLETED.AlL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ELEANOR D ALSPAUGH 717-243-76[�C''i''' �„ c'! ° � � ' REGI R�WILLS USE ONLjA'� � � � :� ..� � (n First Line of Address � y,=, � � � 220 VALLEY DRIVE Dr- � � � � � . �c � Second Line of Address n ri � `D "�7 - n O -s� 3 � O � �7 N t� City or Post Of(ice State ZIP Code �E FILED �— �' � '!1 CARLISLE PA 17013 � . � Correspondent'�e-maii address: elalspaugh@gmail.com Under penalties of perjury,I dedare 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.Dedaration of preparer other than the personai representative is based on all information of which preparer has any knowledge. SIGNgT{)RE O��N f'�5P0 18LE FOR FILIN RETURN Z/�/�I ( %V ADDRESS I —_ 2�z-o 11a (�P,v `��v�. ► �C r�l��s le , �,�- ! 7 v l3 SIGNATURE OF PREPARER OTH R THAN REP�ATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 � Z5056101Q5 1�Q�#��D]�L�� i J 1505610205 REV-1500 EX(FI) 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 and Notes Receivable(Schedule D).. . . . . . . ... . . . ............. 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). 3034.67 6. Jointly Owned Property(Schedule F) 1= Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C- Separate Billing Requested........ 7. 8. Total Gross Assets(total Lines 1 through 7).......... . .. . . . ..... . ....... 8. 3034.67 9. Funeral Expenses and Administrative Casts(Schedule H).. ...... ........... 9. 3345.52 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)... ............ 10. 57882.67 11. Total Deductions(total Lines 9 and 10).............. ... . . . . . . .. . . ... . .. 11. 61228.19 12. Net Value of Estate(Line 8 minus Line ti) ....... ... . .. .. . . . . ........... 12. (58193.52) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . .. . ... P14.'Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . .... .............. 14. 0 aTAX CALCULATION-�,!EC4N3TRUCTIONS FOR APPLICABLE RATES 15. 'Amourif of Line^a4'.taxable t 'at the sP0usalTdx*a1e(:6r t.. �transf4irs8lnder Sec:9115 (a)(1.2)X.0_ I `. 15. )6, -Amour r of Line 14 taxable r at lineaf rate X.0 � 16. }71 Amourn,df Line 14'tazable (sibling rate X.12° t,+- 100% 17. 0 18' Amountpf Line 14 taxarrb at collateral rate X.15 18 19. TAX DUE ............ . . . . .. . . ..................................... 19. 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT k_ Side 2 ',�, 1505610205 1505610205 REV-1500 EX(W40(Fi' 1505610105 OFFICIAL USE ONLY PA Department of Revenue P ^^^" Yavania County Code Year File Number Bureau of individual Taxes INHERITANCE TAX RETURN Box Harrisburg,P PA 1 7xz8 o6Dx RESIDENT DECEDENT Ha ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYyyy Date of Birth MMDDYYYY 188-42-7655 01142014 01261951 Decedent's Last Name Suffix Decedent's First Name MI DONALD ROBERT 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 m 1.Original Return 2.Supplemental Return _ 3. Remainder Return(Date of Death Prior to 12-13.82) O 4.Limited Estate °+ 4a.Future Interest Compromise(date of 1= 5. Federal Estate Tax Return Required death after 12-12.82) �Cr 6.Decedent Died Testers +=+ 7.Decedent Maintained a Living Trust — 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Adach Copy of Trust.) +_+ S.Litigation Proceeds Received =+ 10.Spousal Poverty Credit(Date of Death += 11. Election to Tax under Sac.9113(A) Between 12-31-91 and 1-1.95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST SE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ELEANOR D ALSPAUGH 717-243-76A:' REG1�WILLS USE ONI- m b fn First Line of Address � y r F--. --f i rn 220 VALLEY DRIVE 3> CD o Second Line of Addresses - .A City or Post Office State ZIP Code BATE FILED T— ) CARLISLE PA 17013 CD Correspondent's e•ma8 address: elaispaugh @gmail.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 Belies, it is true,coned and complete.Dedamtion of preporer other than the personal mpresentaflve is based on all Information of vfikh Preparer has any knowledge. SIGNATURE OF PERSON SPO POLE FOR FILtRETURN ATE, 7,,�jAnvn� I{ , J fq/I I il ADDRESS Z-2-b-U vii I/ Z)r4VC.. x it r-h-s le- 17 013 SIGNATURE OF PREPARER 0TH R THAN REPRESS TATNE OATS ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15Q56101f35 1505610105 1 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME ROBERT G DONALD STREET ADDRESS --------- --------------- -------_ ----- ------ - 76 EAST POMFRET STREET 1 ST FLOOR CARLISLE - - -- --- ?sTATE i z�P ; PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (i)0 2. CreditslPayments A.Prior Payments —._.._—___-----.----- B.Oiscount Totai Credits{A+B) {2)0 3. ►nterest 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. {3) Fill in oval on Page 2,Line 20 to request a refund. {4) 5. �f Line 1+Line 3 is greater k�an Line 2,enter the di(ference.This rs the TAX DUE. (5)0 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 inierest................................................................................................... ........................... ❑ � 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 for"or payable-upon-death bank account or security at his or her deatfi?.............. ❑ � 4. Did decedent own an individuai retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ � IF TNE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU NUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Far dates af death on or after Jufy 1,1994,and before Jan.1,1995,the tax raie imposed on the net valve of transfers to or for the use of the s�rviving spouse is 3 percent[72 P.S.§9116(a){1.1)(i)). For dates of death on or after Jan. 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 ftom tax,and the statutory requirements for disciosure of assets and filing a tax rettssn are sti44 applicab4e even if the surviving spouse is the only bensficiary. For dates of death on or after,luly 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 naturai parent,an adoptive parent or a stepparent af the child is 0 percent[72 P.S.§9116(a}(1.2)J. • The tax rate impased on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(aj(1)). • The tax rate imposed on the net value of transfers to or for the use of the decedenPs sibiings is 12 percent[72 P.S. §9116(a){1.3)J.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-15a8 EX+(o8-i2) i pennsytvania SCHEDULE E � DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDEN7 DECEDENT ESTATE OF: FILE NUMBER: ROBERT G DONALD Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH � M&T Bank, 1 W.High St.,Ca�lisle,PA 17013 Account Number 9838784974,checking acct. ��564.67 2 1999 Oldsmobile Bravada, 130,000 miles,rough condition 1470.00 i TOTAL(Also enter on Line 5, Recapitulation) $ 3034.67 If more space is needed,use additional sheets of paper of the same size. REV-15ll EX r (�8-73; �' pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OP FILE NUMBER ROBERT G DONALD DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Hoffman-Roth Funeral Home& Crematory, Inc., Acct ID 17085-016 -funeral exps 2996.92 2. Funeral Fiowers, Royers Fiowers and Tartan Ribbon 348.60 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State___ZIP Year(s)Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.) Claimant Street Address City _ State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Other Administrative Costs: TOTAL(Also enter on Line 9, Recapitulation) $ 3345.52 If more space is needed,use additional sheets of paper of the same size. ,.'.`_4`°1.^.LL C�"' :,LL'1:; i pennsytvania SCHEDULE I � DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT G DONALD Report dabts incurred by the decedent prior to death that remained unpeid at the date of death,including unreirnbursed medical expenses. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1• Internat Revenue Service 2012 Balance$1599.98 AND 2013$5369. 6968.98 2. PennState Hershey Medical Center(inpatient and outpatient bills) 40020.15 3. PennState Hershey Medical Center Physicians 682.00 4. Carlisle Regional Medical Center 5370.45 5. Carlisle Physicians Services 1167.00 6. Hospitalists of Central Pennsylvania 300.00 7. CareCrediUGECRB 1860.02 8. PayPal SmartConnect 672.53 9. Quanfum Imaging and Therapeutic Associates 668.00 10. PPL 173.54 TOTAL(Also enter on Line 1Q, Recapitulation) $ 57,882•67 If more space is needed,insert additional sheets of the same size. REV-1513 EX+ (Oi-10) � pennsylvania SCHEDULE � DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX REfURN RESIDENT DECEDEN7 ESTATE OF: FILE NUMBER: ROBERT G DONALD RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS Of PERSON(S)RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBtlTIONS[Intlude outright spousal distributions and transfers under Sec.9116(a)(1,2),] 1. Eleanor D Alspaugh, 220 Valley Drive, Carlisle, PA 17013 Sister 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 Of REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size.