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Home My WebLink About04-09-14 � 1505610143 REV-1500 Ex�°2_,,, :�;� OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENTOFREVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 13 1222 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 22 2013 12 27 1926 DecedenYs Last Name Suffix DecedenYs First Name MI SOUCY RENE (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 Priorto 12-13-82) � 4. Limited Estate � 4a. Future Interest Compromise � 5. Federal Estate Tax Return Required (date of death after 12-12-82) � g Decedent Died Testate � � (qttacheCoMaintained a Living Trust 8. Total Number of Safe De osit Boxes (Attach Copy of Will) py of Trust) P � 9. Litigation Proceeds Received � �p.Spousal Povert Credit(Date of Death 11.Election to tax under Sec.9113 A between 12-31�J1 and T-�-ss� � (Attach Schedule O) � � CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephane Number EDWARD P SEEBER 717 5�3 328� � _c � rn REGISTE�I�WILLS U�ONL� �"1 � � � � —°! First Line of Address �e� � � � � SUITE C400 ,- �`.' ;� t:-� � nc, -v _;� Second Line of Address � o -� 3 .,� 555 GETTYSBURG PIKE � � �—' � TE FILED rV C!) City or Post Office State ZIP Code MECHANICSBURG PA 17055 � Correspondent's e-mail address: epsCcil�sdc.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 tru , rrect and mplete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG TUR OF PERS RESPO�SI E FOR FILING RE RN D T �, � � Jennifer E. Soucy 1,.� ADDRES 321 So view DriveC�lAechanicsbur CPA 17055 SIGNATUR AF P RER OTHER THAN REPRESENTATIVE DATE f Edward P Seeber 3 �y )� ADD SS Suite C-400❑555 Gettysburg PikedVlechanicsburgCPA 17055 � Side 1 � 150561U143 1505610143 � 1505610243 REV-1500 EX DecedenYs Social Security Number Decedent's Name: SOUC�/, Rene 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. 14 , 332 . 81 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous�nn�Probate Property (Schedule G) U Separate Billing Requested............ 7. rj, 433 . 7$ g. Total Gross Assets(total Lines 1 through 7)........................................................ g. 19, 7 6 6 . 5 9 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 12 ,241 . 36 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 9, 4 8 5 . 0 6 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 21 � 72 6 . 42 12. Net Value of Estate(Line 8 minus Line 11).......................................................... �2. -1 , 95 9. 83 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)............................................... �4. -1 , 959. 83 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 . D O 16. Amount of Line 14 taxable at lineal rate X .045 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. � . 0� 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE................................................................................................................ 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-13-1222 DecedenYs Complete Address: DECEDENT'S NAME Soucy, Rene STREET ADDRESS 940 Walnut Bottom Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 0.00 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�l.ine 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) 0.0� Make Check Payable to REGISTER OF WILLS❑AGENT "�i ,� . s i � r��" �� ' ' r � �' ��: � 9;� � ' �� y �� `�a� � ;°��. , .� y,��•.� � :,,,, , ,�F<a.i. . .,,.,,.<.� ��.. ✓i.,i;,ds, i �.....: a�;, ...�... •�„, . ,,,, ,,,,,, ,,,,,� ... ,�i� , . 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:.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ ❑X d. receive the promise for life of either payments,benefits or care?............................................................ 0 � 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?.................................................................................................................. ❑ � IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES�YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. /a� i �;r%.� �i ; ii, � ,ic/r,i,...._ . ��\�;��,: . .��.��✓%,. �":.... :: . � .;. _.. ,/,'�. r��i�.:: /,. ,il/.. ....... „ , :c.i� .....� o,%..........��., , .,.. �.,,,,.„...�.... .,, .\ ......:,,p� . . .,., ,.,.,...,. . a , ... . 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.t)(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[72 P.S.§9116(a)(1.2)). • The tax rate imposed 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(a)(1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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-7508 EX+(71_70) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE pERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Souc , Rene 21-13-1222 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 7 Santander Checking Account No. 1421088827-valued per bank statement 2,660.38 2 Santander Checking Acco�ant No. 1661224474-valued per bank statement 5,176.84 3 Geisinger Health Plan -payment for Holy Spirit-medical provider 1,303.00 4 Social Security-monthly payment 301.00 5 The Woods-refund of security deposit . 1,378.59 6 US Treasury-2013 income tax refund 3.513.00 TOTAL(Also enter on Line 5, Recapitulation) 14;332.81 (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-1510 EX+�OS-09) SCHEDULE G pennsylvania lNTER-VIVOS TRANSFERS AND DEPARTMENT OFREVENUE INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT �� ESTATE OF FILE NUMBER Souc , Rene 21-13-1222 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 DATE OF DEATH r oF�ECO�s EXCLUSION TAXABLE NUMBER THE DATE OF^TRANSFERSATTACIiTA COPY OF T�E DEIED OR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Parthemore Funeral Home&Cremation Services Inc. - 5,433.78 100.000% 0.00 5,433.78 prepaid funeral TOTAL(Also enter on Line 7, Recapitulation) 5,433.78 (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-1511 EX+�10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE F U N E RAL EXPE N S ES AN D RESIDENTDEC ENT URN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Soucyd2ene 21-13-1222 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N MBER q. FUNERAL EXPENSES: See continuation schedule(s) attached 6r277.94 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attomey's Fees JSDC Law Offices -� 5��00.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zin Relationship of Claimant to Decedent 4. Probate Fees 298.50 See continuation schedule(s) attached 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 564.92 See continuation schedule(s)attached TOTAL(Also enter on line 9!72ecapitulation) 12i241.36 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 Soucy, Rene 21-13-1222 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex eq nses 1 BJs-food for funeral reception 341.81 2 Joanne Fabrics-display at funeral 12.69 3 Oldtowne Florist-funeral flowers 38.16 4 Parthemore Funeral Home&Cremation Services Inc. -funeral services 5,311.04 5 Premier Catering-food for funeral reception 127.00 6 Rolling Green Cemetery-grave opening 225.00 7 Route 15 Beverage-drinks for funeral reception 166.11 8 Wine 8�Spirits-drinks for funeral reception 56.13 H-A 6,277.94 Probate Fees 9 Register of Wills, Cumberland Cbunty-probate fee 108.50 10 Register of Wills,Cumberland County-reservation for additional probate fee 190.00 H-B4 298.50 Other Administrative Costs 11 Cumberland Law Journal-estate notice publication fee 75.00 12 JSDC Law Offices-reservation for estate administration closing costs 300.00 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 Soucy, Rene 21-13-1222 ITEM NUMBER DESCRIPTION AMOUNT 13 Santander -check fee 10.00 14 The Sentinel-estate notice publication fee 179.92 H-B7 564.92 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 INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Souc , Rene 21-13-1222 Report debts incurted by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Camp Hill Emergency Physicians-unreimbursed medical bill 1,303.00 2 Community LifeTeam Inc-unreimbursed ambulance bill 705.20 3 Darryl Guistwite, DO-unreimbursed medical bill 318.75 4 Heartland Care Partners PA -unreimbursed medical bill 118.00 5 Heartland Care Partners PA -unreimbursed medical bill 150.00 6 Heartland Pharmacy of PA-unreimbursed pharmacy bill 45.41 7 Holy Spirit Hospital -unreimbursed hospital bill 1,006.40 8 HSH-unreimbursed hospital bill 120.15 9 Kantor&Tkatch Assoc PC-unreimbursed medical bill 331.00 10 Manor Care-unreimbursed nursing home bill 4,483.59 11 Orthopedic Institute of PA-unreimbursed medical bill 53.35 12 Orthopedic Institute of PA-unreimbursed medical bill 10.91 13 Peril Diagnostics Inc.-unreimbursed medical bill 182.00 14 Pinnacle Health Hospitals-unreimbursed medical bill 100.00 15 Quantum Imaging&Therapeutic Associates-unreimbursed medical bill 142.74 16 Spartan Pharmacy-unreimbursed pharmacy bill 23.56 17 State Collection Service Inc.-unreimbursed medical bill 991.00 TOTAL(Also enter on Line 10, Recapitulation) 9,485.06 (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-1513 EX+�01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Souc , Rene 21-13-1222 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(Sl RECENING PROPERTY (Words) ($$$) I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 Joshua S. Kopp,Jr. Grandson 9.596%of FEGLI 1090 Yocumtown Road,Apt. 1 life insurance Etters, PA 17319 proceeds Joshua S. Kopp,Sr. Son 6.734%of FEGLI 2550 Old Trail Road, Lot 28 life insurance York Haven, PA 17370 proceeds Peyton Kopp Granddaughter 9.596%of FEGLI 2550 Old Trail Road, Lot 28 life insurance York Haven, PA 17370 proceeds Timothy R. Kopp Stepchild 6.734%of FEGLI 118 Paddington Way NE life insurance Leesburg,VA 20176 proceeds Jennifer E.Soucy Daughter 67.34%of FEGLI 321 Southview Drive life insurance Mechanicsburg, PA 17055 proceeds&100% of the residue Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro 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 SHEET Copyright(c)2010 form software only The Lackner Group,�nc. Form PA-1500 Schedule J(Rev.01-10) � ��.� �.� -- ��,� _. � � � �U" c� � � � r� z � � 9 � � n � °� 0 � � � � � � bro � 9 � � � 0 � � 9 0 �, � � � � � � � r� � roo � o 9 � d � � � n � o � Orr., W � � � N 9 �.-� � ° � "� � ° ., -� ,�' r, ' n � an . � � o . O � s � .. � cn � �, �s �. r- -i ° r� rn � � � � � •,.� v �' �- - "r`� t;? O � � n J � "� � �+ n p � � � 'rt � C O �'-== C") C�7 - � ►�' � rTi D � � -4i� O � !�° � �E � �, �. F �'f. .�L�,.' F��. ,::'� i HASLE� � �� o � I� cn i„ A t,� � I : ,a r� , _ �� a �, N nI � � �,.� � N � � i� { I I