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Home My WebLink About08-22-14 J 1505610105 REV-1500 Ex(w.ii)(FI) :l Y�7 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ' County Code Year File Number PO BOX 28o6o1 INHERITANCE TAX RETURN Harrisburg PA 17128-0601 RESIDENT DECEDENT 21 Li 6�U ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Dale of Birth MMDDYYYY 01/05/2014 01/01/1928 Decedent's Last Name Suffix Decedent's First Name MI Wagner Sr. Donald D I (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 O 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a.Future Interest Compromise(date of O S. Federal Estate Tax Return Required death after 12-12-82) (31D 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 11-95) (Attach Schedule O) CORRESPONDENT— THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Law Office of John C OszU5+OW(62 - _ (717)243-7437 REGISTER OF WILLS I�20NLY n s o m First Line of Address 104 S Hanover St. M = o cn t D r f V rn f Second Line of Address DNA N i r tj C.) o (''> 6RrE-FILED= City or Post Office State fZIP Code _ [Carlisle - - . -.._ . _._ - - PA 117013 1 ry � M i 111 (/) do Cl1 Correspondent's e-mail address: Under penalties of pefury,I declare that I have examined this return,Including accompanying schedules and statements,and to the Vest 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. SIG4NIAT��uFPER N RE$POINSI6�'OR�R FILING RETURN DATE ADDRESS 13.,Uf'U%r•L// 1209 Stra ord Dr., Carlisle, PA 170 SIGNA /P OTHER THAN REPRESENTATIVE ADDR 1 104 9 Hanover St., Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: RECAPITULATION ....... ...... 1. Real Estate(Schedule A). .... ......... .... ........................... 1. 2. Stocks and Bonds(Schedule B) ... ............... ... ...... ....... ..... 2. 172,733.77 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. 31,474.03 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6 .5,191.41 7. Infer-Vvos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets(total Lines 1 through 7)... ........... ... ... . ........ 8. 209,399.24 9. Funeral Expenses and Administrative Costs(Schedule H)........... ........ 9. : 17,276.12 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)..... ......... . 10. 2,940.02 11. Total Deductions(total Lines 9 and 10)........ ......................... 11. 20,216.14 12. Net Value of Estate(Line 8 minus Line 11) .. ............... ............. 12. 189,183.07 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. 189,183.07 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- 15. '.. 16. Amount of Line 14 taxable 8,513.24 at lineal rate X.0 45 189,183.07 16 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. 19. TAX DUE ................... ..... ........ ....... ... ...... 19. .... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-15M EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Donald D.Wagner, Sr. STREET ADDRESS 108 Strayer Dr. CITY STATE ZIP Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 8,513.24 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 3. Interest (3) 4. It Line 2 is greater than tine 1+Line 3,enter the difference. This is the OVERPAYMENT, Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If tine 1+line 3 is greater than tine 2,enter the difference.This is the TAX DUE. (5) 8,513.24 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.....................,..................... ❑ a retain a reversionary interest..................................................................................................................,........... ❑ - E 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 payabte-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 contains a beneficiary designation? ..............................._...................................................................................... ❑ E 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 3 percent(72 P.S.§9116(a)(1.1)(1)]. 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 PS.§9116(a)(1.1)(i)].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 a+(8-122) pennsytvania SCHEDULE B INHERFTANCE TAX STOCKS & BONDS INHERRANCE 7A%RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald D Wagner, Sr. 21-14-0580 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Morgan Stanley Brokerage Account(see attachment'A") 160,863.86 2 221 shares MetLife common stock 11,869.91 TOTAL(Also enter on Line 2, Recapitulation) $ 172,733.77 If more space is needed,insert additional sheets of the same size REV-1508 Ex+(DB-u) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INNEUTAnCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Donald D Wagner, Sr. 21-14-0580 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. IFEM - VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Insurance payment for totally destroyed 2003 Chrysler Pacifica owned at death 1 2 Wells Fargo Checking Account#4861-009033 18,551.57 6�3 `Metl-ife dividend '^ � 60.78 P 7 4 Comcast cable refund 260.13 5 Progressive Auto Insurance refund 309.00 6 Morgan Stanley dividends 2,601.80 1 r Misc personal property 2,400.00 f - TOTAL(Also enter on Line 5, Recapitulation) $ 31,474.03 If more space is needed,use additional sheets of paper of the same size. REV iSo9 EX+(Oi-To) 7 pennsytvania SCHEDULE F DEPARTMENT TAX REVENUE JOINTLY-OWNED PROPERTY INMERfrgNCE TAX RETURN RESIDENT DECEDENT ESTATE OF: - FILE NUMBER: Donald D Wagner,Sr. 21-14-0580 If an asset became jointly owned within one year of the decedent's date of death,it must be repbrted on Schedule G. SURVIVING JOINT TENANTS)NAME(5) ADDRESS RELATIONSHIP TO DECEDENT A•Mary Gronkiewicz #1209 Stratford Dr.,Carlisle, PA 17013 _ jDaughter C.� ❑ � � JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %0F DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTULMON AND BANK ACCOUNT NUMBER OR SIMI A DATE OF DEATH DECEDENTS VAJUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTAIN DEED FORJOINTLY NEtD REAL ESTATE. p VALUE OF ASSET ('INTEREST (DECEDENTS INTEREST I' A' 04/13/09 ORstown Bank Checking Account#106002779 10..3_822j i 501 I'� 5,191'41 �„_._.--•__' —�^'-- ! �� ,�+%F*`'—+S- LL�_... ......� PPP _ ❑ ❑ ❑ r ❑ ❑ �� . ❑ o EJ- F i _ ff C❑ ❑ ❑-❑C❑_�_ _ _ ___� _____. .❑ LL t El El ❑❑L_ __ --7 11 TOTAL(Also enter on Fine 6, Recapitulation) $ 5,191.41 ' If more space is needed,use additional sheets of paper of the same size, REV-1,511 EX+ (08-13) i� pennsylvania SCHEDULE H DEPARTMENT DE REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald D Wagner, Sr 21-14-0580 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Hoffman Roth Funeral Home•Carlisle, PA 14,003.42 ;, Z New Cathedral Cemetary-monument engraving— — - 198 00 j ❑ F ___ _� �,,,.. ❑ B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State—ZIP Year(s)Commission Paid: 2,500.00 2. Attorney Fees: —�. --- i 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address qty State—ZIP Relationship of Claimant to Decedent 4. Probate Fees: �I 383.50 5. Accountant Fees: 6. Tax Return Preparer Fees: - 1 7. ertising 116.20 j F18 (Cumb�eda d County Law Journal.Legal Advertising ki 17,276.12 TOTAL (Also enter on Line 9, Recapitulation) $i� � - If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ (12.12) 'ARE pennsytvania SCHEDULE I T•• DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDEM ESTATE OF FILE NUMBER Donald D Weigher, Sr. 21-14-0580 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. MIM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. f The Patriot-News 162.48 2 ;progressive Auto Insurance 570.00 3 Petro Oil-heating oil 1 1,211,51 _ -_4 Bank of America Visa card pay 40.00j{ 5 PPL,-electric 334.33 -- 6 Mary Gronkievncz-reimbursement for payment made on Don's behalf 325.00 1 7 William Svreei-Furnace Repair 130.00 ! 8 Comcast cable 170.-,01 — - - - - I. LJ El ❑ i TOTAL(Also enter on tine 18,Recapitulation) If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) f pennsylvania SCHEDULE ] !� DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: . Donald D Wagner, Sr. 21-14-0580 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 outright spousal distributions and transfers under Sec.9116(a)(1.2).) __ 1. Mary GronkiewlDZ 1209 Stratford Dr.,Carlisle,PA 17013 Daughter 100% �__ C� — ❑ F L--� 6 — L—I El I Li ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. 11 NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: ❑ F 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. Zviw-uo-u/ 76:24:Un tul 14432815650 From: Alex Humphries AUG-07-2014 13:25 MORGANSTANLEY A P.01/01 Ejch�b�� por�a\c1 b. Wa9ne,+� z1-14 - 0S8ft Estate Valuatior. Date of Death: 01/05/2014 Valuation Date: 01/05/2014 Report Type: Date of Death Processing Date: 08/07/2014 Number of Securities: 9 File ID: Donald Wagerner Sr 686-105669 Shares Security Heart and/Or Div and Int Security e: Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 6 ALCATEL-LOCENT (013904305) SPONSORED ADR New York Stock Exchange 01/03/2014 4.50000 4.46000 H/L 01/06/2014 4.50000 4.46000 H/L 4.480000 26.88 2) 24 COMCAST CORP NEW (20030N301) CL A The NASDAQ Stock Market LLC 01/03/2014 51.71000 50.85000 H/L 01/06/2014 51.62000 50.67000 H/L Div; 0.195 Ex: 12/30/2013 Roo: 01/02/2014 Pa y: 01123/2014 51.212500 4.6E 1,229.10 3) 11 FRONTIER COMMUNICATIONS CORI, (35906A108) CON New York Stock Exchange 01/03/2014 4.760DO 4.67000 H/L 01/06/2014 4.75500 4.68000 H/L 4.116250 51.68 4) 1824 PROCTER & GAMBLE CO (742718109) COM New York Stock Exchange 01/03/2014 80.85000 80.18500 H/L 01/06/2014 80.98000 80.30000 H/L 80.578750 146,975.64 5) 17 SMUCRER J H CO 1832696405) COM NEW New York stock Exchange 01/03/2014 102.32400 101.37000 H/L 01/06/2014 101.99000 300.61000 H/L 101.573500 1,726.75 6) 150 AT&T INC (G0206RI02) COM Ne$ York Stock Exchange 01/03/2014 35.16000 34.61000 H/L 01106/2014 35.05000 34.80000 H/L 34.905000 5,235.75 7) 12 VODAPONE GROUP PLC NEW (92857W308) SPNSR ADR NO PAR NASDAQ Stock Market 01103/2014 38.89450 38.39000 H/L 01/06/2014 38.80000 38.52010 JUL nlv: 0.57042 Ex: 11/2012017 Rec: 11/22/2013 Pay: 02/05/2014 38.651150 6.85 463.81 8) 53 VERIZON COKfMCATICNS INC (92343V1041 Cox New York Stock Exchange 01/03/2014 49.33000 48.22000 H/L OIJ06/2014 49.07000 40.20230 H/L 48.705575 2,581.40 9) 2572.65 Cash (CASH) 2,572.65 Total Value: $160,863.86 Total Accrual: 511.53 Total: $160,875.39 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have Questions, please contact EVP Systems at (838) 313-6300 or www.evpsys.com. (Revision 7.3.1) TOTAL P.01