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Home My WebLink About04-24-14 � 1505610143 REV-1500 Ex�°�_,,, �. PA Department of Revenue OFFICIAL USE ONLY pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENTOFREVENUE Po Boxzsosoi INHERITANCE TAX RETURN 21 13 0529 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 04 24 2013 03 04 1922 DecedenYs Last Name Suffix DecedenYs First Name M� SHAFFER GLENN F (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 REGI�TEi� OF VJ{LLS FILL IN APPROPRIATE OVALS BELOW � 1. Originai Return � 2. Suppiemental Return � 3, Remainder Return(Date of Death Priorto 12-13-82) � 4. Limited Estate � qa Future Interest Compromise 5. Federal Estate Tax Return Re uired (date of death aRer 12-12-82) ❑ 4 a g Decedent Died Testate � Decedent Maintained a Living Trust 1 (Attach Copy of Will) ❑ (Attach Copy ot Trust) 8. Total Number of Safe Deposit Boxes � 9. Litigation Proceeds Received � 10.Spousal PovertY Credic�oa�e of Death ��,Election to tax under Sec.91�3 A betweenl2-31 91and -1-95) � (Attach Schedule O) � � � N � CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INF ATION SHOH�B BE E�'IED TO: Name Daytime'13Qe{�ne Nu�r � � WM D SCHRACK III ESQ '717 �� 3� cn � _.� a :-rJ y„ r N q_�� fYi r-.. "_ REGIST��.LS USE OI�,L,Y V n Q �J 'r� First Line of Address � � 'T7 3 � 124 W HARRISBURG ST � � � � Cn Second Line of Address � � DATE FILED City or Post Office State ZIP Code DILLSBURG PA 170191268 CorrespondenYs e-mail address: schraCklaw@COmcast.net Under penalties oi perjury,I declare that I have examined this return,inciuding accompanying schedules and statements,and to the best of my knowiedge 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. SIG TURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE i a�i��q� �� Donald L. Free h��9�id ADDRESS 3107 Meadow ane Harrisbur PA 17109 SIGNATURE OF PAR N REPR SENTATIVE DATE Wm. D. Schrack III Esq. �� /Y ADDRESS 124 W. Harrisburg St., Dillsburg, PA 17019-1268 Side 1 L 1505610143 1505610143 � � . J 1505610243 REV-1500 EX DecedenYs Social Security Number oe�ee�eSName: Shaffet'� Glenn F. 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 8�Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits 8�Miscellaneous Personal Property(Schedule E)............... 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous t�n-Probate Property (Schedule G) U Separate Billing Requested............ 7, 4 � 024 . 92 g. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 4 , 024 . 92 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 1 , 016 . 0 0 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ ��, 1 , 016 . 00 12. Net Value of Estate(Line S minus Line 11).......................................................... �2, 3, �0 8 . 92 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. 3 , 0 0 8 . 92 TAX COMPUTATION-SEE iNSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 �5 O . 0 0 (a)(1.2)X.00 16. Amount of Line 14 taxable 0 . 0 Q 16. 0 . 0 0 at lineal rate X .045 17. Amount of Line 14 taxable 0 . 0 0 17. 0 . 0 0 at sibling rate X.12 18. Amount of Line 14 taxable 3, 0 p 8 . 92 18. �,4 51 . 3 4 at collateral rate X.15 19. TAXDUE................................................................................................................ 19. 4rJ1 . 34 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 21-13-0529 Decedent's Complete Address: DECEDENT'S NAME Shaffer, Glenn F. STREET ADDRESS Manor Care 940 Walnut Bottom Road CITY STATE ZIP Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 451.34 2. Credits/Payments A. Prior Payments 6. Discount Total Credits(A +B) (2) 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) 451.34 Make Check Payable to REGISTER OF WILLS, AGENT � � , ��,,�,1., w.,.��'��;..��, ;a>�,,f .., . <. � , ,�,��.�� r . ._.2..��.sm'��'��„ . "�. � . �._, ..�" ,',',.�� ;;,. _ . 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:.................................. ❑ 0 c. retain a reversionary interest;or.............................................................................................................. . x 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 receivingadequate 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 containsa 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. ...�u'��.,s��'"�,� .,1,`,m�,�:'s�.,,,�...�,v, ';� �.,>.,, „�m��`..,��&�,rr,.,.h ..,> ..,,��,�-: ,��;s.�'��;>'',,,, . ":.: ;- ,- '::.., . ..�Y.;z ., �,k'�f-=b .,..,. .��:-.,,, �.� ::. .:,.. .,�r ,. . '� •�'`,".; 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[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 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-1570 EX+(08A9) SCHEDULE G pennsylvania lNTER-VIVOS TRANSFERS AND DEPARTMENT OFREVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Shaffer, Glenn F. 21-13-0529 This schedule must be compieted and filed rf 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 %OF DECD�s EXCLUSION TAXABLE NUMBER THE DA E OF TR,�4NSFER.SATfACNTA COPYEOF T�E DE�ED F�OREREAL ESTAT�. VALUE OF ASSET INTEREST ��F APPLICAB�E) VALUE 1 Citizens Bank IRA Plan#BXXXXX8618 4,024.92 4,024.92 TOTAL�Also enter on Line 7, Recapitulation) 4,024.92 (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 EXt(10-09) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND RESI ENTDEC�NT URN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Shaffer, Glenn F. 21-13-0529 DecedenYs debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER q, FUNERAL EXPENSES: B, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2_ Attornev's Fees Wm. D. Schrack III Esq. 500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationshiq of Claimant to Decedent 4. Probate Fees 5. Acco�ntanfs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 516.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 1,016.00 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 Shaffer, Glenn F. 21-13-0529 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Cumberland County Register of Wills-Supplemental Return filing fee 15.00 2 Federal fiduciary income tax liability 501.00 H-B7 516.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) a� CitizensBank�R� Retirement Services—MMF430 PO Box 42026 Providence RI 02940 208 620 Estate Of Glenn F Shaffer Bene Of Glenn F Shaffer Ira Donald Free Eaecutor 124 W Harrisburg St Dillsburg PA 1T019-1268 iiiil��ill�liii�i��ll„iilii�,�,iiili�l�iil�l�i�lili�i�„�,�i.��, R�TIREMENT PLAN WITHDRAWAL RETIREMENTPLAN: BZ%%%%8618 CHECKDATE: 03/Z7/ZO14 CHECKNUMBER: �434149772 GROSS FEDERAL STATE CHECK AMOUNT WITHHOLDING WITHHOLDING AMOUNT 4,024.92 .00 .00 4,024.92 LAW OFFICE OF WM. D. Scx�cK III 124 WEST HARRISBURG STREET DILLSBURG, PA 17019-1268 Telephone 717-432-9733 e-mail: Schracklaw@comcast.net Telefa�c 717-432-1053 Website: Schracklaw.com April 23, 2014 Register of Wills of Cumberland County � � � �� Cumberland County Courthouse � o � rn ,� { One Courthouse Square � -�'o � � �,°;, '; Carlisle, PA 17013 � � r`�'- N -� � . t�' � rr7 r�a rn � � � , —� ::� ca ,. Re: Estate of Glenn F. Shaffer c� �; '`` � `:� ° �' �` File#: 21-13-0529 �' ° � � �'' ;� �c f,,.. � � --� �~-' ,-''�-. �`''� �`- To Whom It May Concern: � � N o a ct�;., �:��' � � You will find enclosed herewith two original copies of the REV-1500 Inheritance Tax ' Return,submitted as a Supplemental Return,accompanied by a third cover page stamped"COPY". � Also enclosed is my trust account check for the sum of$15.00,which covers the cost of filing the Supplemental Return, and a trust account check for the sum of$451.34,payable to the Register of Wills - Agent, for the tax that is required on the net value of the IRA. Please accept the Return as submitted,and return the copy of the cover page to my office in the envelope provided. Thank you for your assistance. Sincerely, WM.D. Scxxacx III WDS/jsg enc. .�.,.�,� -�� ,� ��:��.� �: . ._. � � � � �. � Q' � �J � � � � �� a � �� q b � � �, ` � � � � � E � N p �� ....+�,y� �,7 (^T'� G C .� '�fst S'ct n � � � � � � � � !E � � �� ---�'-,� � � � ,.� � �r.r;= �� ,y,-� rn Y- � � , � �„ „;�-�- G� �.. _� � . ;'? ta , ;^C° :� �� , -n � � � �� C7 4 "� � � -- G7 p C^ �--+ �"' t'1'1 � � � �J � � O ' � � C� � � � _ � ' � � � � �, = v C� � w = O � • - �� _ yo � � - � C C� �3 = ,,,C� � G � = C;.� V.' � C, � � � n � � � ' -, .,� y �,r. �� . .,.s • � ' � � � : {�: C � ` , � ti''�iti't'.• �r:�i� � �^ �o ° uwrEo l � r—0 6,� ST9 � m , , µ�n�. � °�� `� `� � �� `-J :U N r'q O 4i vl � y `C � � a N � �� D � 9 O 'n O Z.�. .. �W � �� m -�N ,pO� ��,. oo � m �: co A O y t , �\ �,�.�� , �.-.. _..