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Home My WebLink About09-10-14 (2) � 15056051058 REV-1500 EX(06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ' PO BOX 280601 �] � /�� 4�+/ Harrisburg,PA17128-0601 RESIDENT DECEDENT /�� / O�� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of BiRh 07/23/2014 01/30/1920 DecedenYs Last Name Suffix DecedenYs First Name MI Zeiders Orville , C (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffx 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 Retum 2.Supplemental Retum 3. Remainder Return(date of death prior to 12-13-82) 4.Limited Estate 4a. Future Interest Compromise(date of 5. Federal Estate Tax Retum Required death after 12-12-82) _' 6. Decedent Died Testate 7. Decedent Maintained a Living Trust � 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 Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIR�`ED T0: �`� Name Daytime Telephc�Number � � m �' _ rn c^� Amanda Snoke Dubbs,Esq. (717)430-6�� r.,' � � Firm Name(If Applicable) � s n � � c.�� REGISTE�FAVIL�S USE�,}W!_Y �.,�„� � ` "c." C7 � C:7 �� C,r.� :�:. � � a First line of address - -., 'T] ••:� "ri 294 Dew Drop Road ' ^ r -� �Y � '� � . .:., w r- m Second line of address y� -`' �` ,, ^��. N ft) CJ ' C,p '=I City or Post Office State ZIP Code oAre F�� ' York PA 17402 ' Correspondent�s e-ma�i aadress: mandasnokedubbs@comcast.net 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 true,coRect and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU SON RESPONSIBL FOR FILING RETURN AT �• ��,� - - - � a°i - ADDRESS 140 Roosevelt Avenue, Suite 210,York, PA 17401 SIGN �2E OF PREPA R OT AN EPRE TATI �. DATE -- - - �1�8.7-�� - ADD S 294 Dew Drop Road,York, PA 17402 PLEASE USE ORIGINAL FORM ONLY Side 1 � 15056051058 15056051058 � J15056052059 REV-1500 EX DecedenYs Social Security Number DecedenYs Name: ONIII@ C Zeiders RECAPITULATION, . _ 1. Real estate(Schedule A). .... ......... ...... ... ..... ................. L ' 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. 3,438.44 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. Totat Gross Assets(total Lines 1-7)................................... . 8. 3,438.44 9. Funeral Expenses&Administrative Costs(Schedule H)..................... 9. 4,500.00 10. Debts of Decedent, Mortgage Liabilities,&Liens(Schedule I)...... .......... 10. 155,762.99 11. Total Deductions(total Lines 9&10).. .................... ............. 1L ' -160,262.99 12. Net Value of Estate(Line 8 minus Line 11) ........... .............. ... .. 12. -156,824.55 13. Charitable and Govemmental 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. -156,824.55 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.0_ 15. 16. Amount of Line 14 taxable at lineal rate X.0_ 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. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 � 15056052059 � REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Orville C Zeiders 199-07-1007 STREETADDRESS c/o Law Office of Amanda Snoke Dubbs 294 Dew Drop Road CITY STATE ZIP York PA 17402 Tax Payments and Credits: 1. Tax Due(Page 2 Line 19) (1) 0.00 2. CreditslPayments A.Spousal Poverty Credit B.Prior Payments C.Discount Total Credits(A+B+C) (2) 0.00 3. InterestlPenalty if applicable D.Interest E.Penalty Total InteresUPenalty(D+E) (3) 0.00 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) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 A.Enter the interest on the tax due. (5A) B.Enter the total of Line 5+5A.This is the BALANCE DUE. (5B) 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;or.......................................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0 2. If death occurred after December 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 death?.............. ❑ � 4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which containsa beneficiary designation? ........................................................................................................................ ❑ ❑X 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 January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three(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 zero (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 retum 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 twenty-one 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 zero(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 four and one-half(4.5) percent,except as noted in 72 P.S.§9116(1.2)[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 twelve(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-1508 EX+(6-98) SCNEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS� ot MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Orville C. Zeiders 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 1. HCR Manor Care Refund Check 1,031.25 2. HCR Manor Care Refund Check 2,186.23 3. Heartland Healthcare Services Refund Check 71.gg 4. M&T Checking Account-Balance 148.97 TOTAL(Also enter on line 5, Recapitulation) $ 3,438.44 (If more space is needed,insert additional sheets of the same size) REV-1511 EX+(12-99) SCNEDULE FI COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Orville C. Zeiders Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Malpezzi Funeral Home 4,500.00 2. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 400.00 Name of Personal Representative(s) GOOd NBWS COt1SUltillg, InC. Social Security Number(s)IEIN Number of Personal Representative(s) _ StreetAddress 140 ROOSevelt Avetlue City York State PA Zip 17401 Year(s)Commission Paid: 2014 2. Attorney Fees 400.00 3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State .Zip Relationship of Claimant to Decedent 4. Probate Fees 70.50 5. AccountanPs Fees 6. Tax Retum Preparer's Fees 7. TOTAL(Also enter on line 9,Recapitulation) $ 5,370.50 (If more space is needed,insert additional sheets of the same size) REV-1512 EX+(�p-03) SCHEDIJLE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Orville C. Zeiders Report debts incurred by the decedent prior to death which remained unpaid as of the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �� Pennsylvania Department of Welfare 155,762.99 TOTAL(Also enter on line 10,Recapitulation) a 155,762.99 (If more space is needed,insert additional sheets of the same size)