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Home My WebLink About03-21-14 (2) 1505610140 REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 1 4 0 0 8 3 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 9 2 2 2 0 1 3 0 7 1 2 1 9 8 1 Decedent's Last Name Suffix Decedent's First Name MI H 0 M E R I C H B R U C E T (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Ml 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 Prior to 12-13-82) ❑ 4.Limited Estate ❑ 4a. Future Interest Compromise(date of 5.Federal Estate Tax Return Required death after 12-12-82) 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) 9. Litigation Proceeds Received 10.Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A) Between 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 Telephep Number o G E R A L D J S H E K L E T S K I E S Q 7 1 7 = A� I 4 7 3r5 C> p S O O REGISTE FWL US - LY C z m rr M First Line of Address Z Cn W tb CD 4 1 4 B R I D G E S T C7:1 c Second Line of Address 4 w r .m P - 0 8 0 X E 4 W co O City or Post Office State ZIP Code DATE FILED N E W C U M B E R L A N D P A 1 7 0 7 0 Correspondent's e-mail address: GSHEKLETSKI@STONELAW - NET Unde enaltles 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 t e,correct and complete.Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIG TUBE OF HERS RE O SIBLE FOR FILING RETURN DATE VA ODRES GAYLE JD - HOMERICH, ADMIN • 312 SUNSET DR • , NEW CUMBERLAND PA 17070 SIGNA F P RER,4Tf5TER T R TATNE DATE -ADDRESS �� GERALD J . SHEKLETSKI, ESQ • 414 BRIDGE ST - , NEW CUMBERLAND PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 1505610140 ��\ J 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name. BRUCE T • HOMERICH RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . 2. Stocks and Bonds(Schedule B) . . . . . 2. 2 4 2 1 , 4 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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). . . . . . . 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) 8. 2 4 2 1 , 4 1 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 3 5 8 8 . 4 2 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3 5 8 8 . 4 2 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. - 1 1 6 7 , 0 1 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. - 1 1 6 7 . 0 1 TAX CALCULATION-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.0 _ 0 . 0 0 15. 0 . 0 0 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 , 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 J I�OI REV-1500 Ex(FI) Page 3 Fite number Decedent's Complete Address: 21 14 0083 DECEDENT'S NAME BRUCE T . HOMERICH STREET ADDRESS 320 BRIDGE ST- APT - 206 CITY STATE 73P NEW CUMBERLAND PA 1?070 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (i) 0 . 00 2. Credits/Payments A.Prior Payments S.Discount 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. Fill In oval on Page 2,Line 20 to request a refund. (4) 0 .00 5. if Line 1 +Line 3 is greater than Line 2,enter the difference.This is(he TAX DUE. (5) 0 . 00 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 interest ..................................................................................................... ❑ ❑X d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ ❑X 1 Did decedent own an'intrust for or payable-upon-death bank account or security at his or her death? ......... ❑ 4. Did decedent oven 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 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 172 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 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-1503 EX+(e-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER BRUCE T . HOMERICH 21 14 0083 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. 31 SHARES PRUDENTIAL FINANCIAL, INC . COMMON STOCK 2, 421 . 41 SEPTEMBER 20, 2013 CLOSING PRICE - $ 78 . 24 SEPTEMBER 231 2013 CLOSING PRICE - $ 77 . 98 $ 78 . 24 + $ 77 . 98 = *$ 156 - 22/2 = $ 78 . 11 $ 78 . 11 X 31 SHARES = $ 2, 421 . 41 TOTAL(Also enter on Line 2,Recapitulation) $ 21421 - 41 If more space is needed, insert additional sheets of the same size REV-1511 EX-(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BRUCE T • HOMERICH 21 14 0083 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: PARTHEMORE FUNERAL HOME AND CREMATION SERVICES, INC . 2,739 . 92 1303 BRIDGE ST . , NEW CUMBERLAND, PA 17070 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Years)Commission Paid: Z AftomeyFees: STONE LAFAVER 8 SHEKLETSKI 750 - 00 3. Family Exemption:(If decedents address is not the same as claimants,attach explanation.) Claimant Street Address city State ZIP Relationship of Claimant to Decedent - 4. Probate Fees: LETTERS OF ADMINISTRATION 98 - 50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9,Recapitulation) $ 31588 - 42 If more space is needed,use additional sheets of paper of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: BRUCE T . HOMERICH 21 14 0083 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include ouMgght spousal distdbubons and transfers under Sec.9116(a)(1.2).] 1. GAYLE D • HOMERICH Lineal 0 . 00 312 SUNSET DRIVE NEW CUMBERLAND, PA 17070 2 • GEORGE E • HOMERICH Lineal 0 , 00 12 SUNSET DRIVE NEW CUMBERLAND, PA 17070 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 11- 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. till nu unit 11111101111 Martin 111111 Hill Hill IN VOICE I Prudential Computershare Computershare PO Box 43033 Providence,111 02940-3033 Within USA.US territories B Canada 800 305 9404 Outside USA,US territories 6 Canada 732 512 3782 000681 www.computershare.corrVinvestor 111PIutt11i1drPrPllluftl'tI1141Pbrtrl'll'Irrr�lltrunl BRUCE T HOMERICH 312 SUNSET DR NEW CUMBERLND PA 17070-3063 Date 10 Dec 2013 Re: BRUCE T HOMERICH Company Name:Prudential Financial,Inc. Account Number:0002980126 'DRS book-entry shares:31 "'Closing Price per Share as of 10 Dec 2013:889.03 "Certificated Shares:0 Dear Sir or Madam: Thank you for notifying us that the owner of the Prudential Financial stock account noted above has passed away.On behalf of Prudential and myself,I would like to express my sincerest condolences for your loss. I understand that this is a difficult time and the process of transferring the assets of a loved one who has passed away can seem overwhelming at times.We want to help in any way possible and have enclosed the fors you will need to transfer the Prudential shares to a new owner.We have also included detailed instructions,as well as a set of Frequently Asked Questions,to guide you Through the process.I hope this information will be helpful as you make decisions regarding this account. Most of Prudential's registered shareholders received their shares as a result of Pruderfal's demutualization in December 2001.Although some individuals were given shares as a result of their policy ownership, the shares are completely separate from the policy and they must be transferred to a new owner,even 0 you have already claimed the policy benefits. We understand that,in some situations,the new owner may wish to sell the shares as soon as the transfer is completed.If the new owner wishes to sell through Computershare,it offers a voluntary sales facility for eligible shareholders to conveniently liquidate their shares.A copy of the terms of this sales facility will be enclosed with the new account statement that will be mailed once the transfer is completed.Once the transfer is complete and the new account materials are received,shareholders wishing to sell their shares may do so by contacting Computershare directly at the number contained within those materials. Please do not hesitate to contact us if we can be of any help to you during this difficult time.If you have any questions regarding the transfer process,please tail 800305-9404 and select menu option 4.After the automated message,you may then press 2 to reach a Computershare representative for assistance. Again,please accept our sincere condolences. Sincerely, T�YAA , rv,. � Margaret M.Foran Chief Governance Officer, Vice President and Corporate Secretary DRS book-entry shares-a recardkeeping option for you to retard your ownership electronically on the books of The company. "Shares for which a physical stock certificate has been issued. Account value subject to market nucluation, tN11r:CMa3.d.rniu.84dM d�M.MfiFFi Una 010AVA Prudential Financial, Inc. - Investor Relations - Historical Price Lookup Page I of 1 Prudential Historical Price Lookup Stock Quote i Stock Chad I Historical Price Lookup Investment Calculator Symbol PRU(Common Stock) Closing Price $78.340 Lookup Date Volume 3,360,772 SeptemberE 201, 2013Qv Split Adjustment Factor 1.0000:1 look up; Open $78350 Day's High $79.240 Day's Low $78.000 Actual Price $76.240 Date Requested 09/20/13 NOTE.(he woaLq Pdm).Oev@ Hrqu,Days low.eml Dey's Pohnrm Hove neon annrsfonlo accninn rF",,r)'SPNS"a"oi"""OS wbiM moy neon ocnunen(o�mn tmlR8y2hVe ma Here.Viown nmve.fir acmxr q{x "nor ar0"rr sma,ormvMenos.me SPm Ar l,s.,m I.Om,rs n m.n...01—rncrn,A'd, an F F,smon me Hera anown shwa me11O—n unoa vi Ie nor necos5ny:nniMi nr mhe a wlyy per6umance. http://www.investor.prudential.com/phoenix.zhtml?c=129695&p=irol-stockLookup&t=Hi... 2/12/2014 Prudential Financial, Inc. - Investor Relations - Historical Price Lookup Page 1 of 1 Prudential Historical Price Lookup Stock Quote I Stock Chan I Historical Price Lookup I Investment Calculator Symbol PRU(common Stock) Closing Price $77.980 Lookup Dale Volume 2,218221 September[w 230) 2013C1) Split Adjustment Factor 1.0000:1 look up Open $78.120 Day's High $78500 Day's Low $77.720 Actual Price $77.980 Date Requested 09123/13 n<IE 'M1n C! 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