HomeMy WebLinkAbout08-07-14 (2) J �p 1505610105
REV-1500 EX(02-11)(FI)I iT
Yi OFFICIAL USE ONLY
PA Department of Revenue pea nnsylvania
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN F�7L I`T
Harrisburg PA 171284601 RESIDENT DECEDENT �p
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
3095 05/08/2014 8/30/193'
Decedent's Last Name Suffix Decedent's First Name MI
LILLIAN _ F—
w]
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
(31E) 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate C=:) 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
CZ) 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
C=:) 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 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
SYLVIA M BAKER, EXECUTRIX (570) 278-3379 N�
o—
REGISTER O [CC,LjS USE ONL4' 3-j'('r-1
M G11
First Line of Address 1�n t
'r %n rrJ
16660 STATE ROUTE 3001 v -°- r'„
M
^_� ' T7
Second Line of Address �C— _ T
�FILED N �'
City or Post Office State ZIP Code OAT
_
MONTROSE — PA
118801
Correspondent's e-mall address:Sbakerl I@stny.rr.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 true,coned and complete.Declaration of preparer other than the personal representative Is based on all Information of which preparer has any knowledge.
SIGNA,JURE OF.PERS SPO SIRLE OR FILING RETURN ATE O
Z(0(,
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
1 1505610205
_J REV-1500 EX(Fl)
Decedent's Social Security Number
Decedent's Name: LILLIAN W ROUSH
RECAPITULATION
1. Real Estate(Schedule A). .. .. . ..... . . . .. .. . .... . . . ... .. . .... . . . ..... . 1. 0.00
2. Stocks and Bonds(Schedule B) .._.. . . . . .. . . . .... . .. ... . . . .. .. . .. .. . . 2. 0.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .... . 3. 0.00
4. Mortgages and Notes Receivable(Schedule D). . . . .. .. . . .... . . . ..... . . . .. 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . .. . 5. 131,567.19
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ... . . . . 6. 0.00
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. . .... 7 27 717.64
8, Total Gross Assets(total Lines 1 through 7). . . ..... .. . .... . . . . .. . . . .. .. . 8. 159,284.83
9. Funeral Expenses and Administrative Costs(Schedule H). .... . . . ..... . . . .. . 9. 4,761.51
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). .. .._. .. . . .. . 10. 1,449.52
11, Total Deductions(total Lines 9 and 10). . . . .... . . . . .. . . . . .... .. ....... . . 11. 6,211.03
12. Net Value of Estate(Line 8 minus Line 11) ..... . . .... . . . . ..... . . . .... . . . 12. 153,073.80
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. 153,073.80
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- 0.00 15 ! 0.00
16. Amount of Line 14 taxable ����' '"-
at lineal rate X.0_ 0.00 16. ^ 0.00
17. Amount of Line 14 taxable
at sibling rate X.12 94,017.12 17. 11,282.05
_ �e
18. Amount of Line 14 taxable 5905668 8,858.50
, .
at collateral rate X.15 18.
19. TAX DUE . . . .. ...... . . . .. . .. . ..... . . . .... . . . ... 20,140.55 '..
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
LILLIAN W ROUSH
STREETADDRESS
CUMBERLAND CROSSINGS RETIREMENT COMMUNITY
1 LONGSDORF WAY
CITY STATE ZIP
CARLISLE PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 20,140.55
2. CreditslPayments
A.Prior Payments
B.Discount 1,007.03
Total Credits(A+B) (2) 1,007.03
3. Interest
(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) 19,133.52
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.......................................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest .............................................................................................................................. ❑ 0
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?.............................................................................................................. ❑ 0
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
contains a beneficiary designation? ........................................................................................................................ 0 ❑
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)(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
[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 it 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-i5oR EX+(oS-Iz)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RErURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
LILLIAN W ROUSH 21-14-0526
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. M&T BANK 5219 SIMPSON FERRY RD MECHANICSBURG,PA 17050 PH 717-697-1515 130,392.30
CHECKING ACCOUNT#38375427
2. PA PROPERTY TAX REBATE CLAIM#137001515940 750.00
3. PA 2013 TAX REFUND 50.00
4. CAPITAL BLUE CROSS REFUND OF UNUSED PREMIUM 217.63
5, AMERICAN WATER CO REFUND 10.46
6. CHECK FROM AUCTIONEER FOR SALE OF PERSONAL BELONGINGS 49.80
7. REFUND FROM NATIONWIDE INSURANCE 97.00
TOTAL(Also enter on Une 5, Recapitulation) $ 131,567.19
If more space is needed,use additional sheets of paper of the same size.
REV-1510 E%+(06-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHEWANCE TM RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LILLIAN W ROUSH 21-14-0526
This schedule must he completed and filed if the answer to any of questions I through 4 on page three of the REV-1500 is yes. -
DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
TEEM INODOE THE NPME OF T,E TRANSFFRFE,TNEIR REUTIONSNiPTO DECEDENT AND -
"- NUMBER T�DATE OF TRnxsFER ATIA A[D XTNEDEEDFDIR ESTAM. VALUE OF ASSET INTEREST If u,;uaNE VALUE
1. I WESTERN&SOUTHERN LIFE ASSURANCE CO 2771,6411 100 r.. 27,71764y
[CONTRACT#VV0021512325
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TOTAL(Also enter on Line 7, Recapitulation) $
If more space is needed,use additional sheets of paper of the same size.
' REV-1511 EX+(08-13)
o pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND .
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LILLIAN W ROUSH, 21-14-0526
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:_.. — — ------------------------ ------ ---... —
1. r -
INEILL FUNERAL HOME INC 3501 DERRY ST HARRISBURG,PA
CREMATION,URN,COPIES OF DEATH CERTIFICATES,AND BURIAL PERMIT r
2 DAVID DI RADDO-MINISTER AT GRAVESIDE SERVICE
-----
3.1 (BRAD BEAVER-BURIAL OF URN tl ^� T�35�0:00j
- ----------------------------------- _ - . _. .:
--------------- - . - -- I .
4. IROLAND MARTIN RE -SERVCE .::_
250.00
5.1 IWITMER S MEMORIAL CEMETERY-OPENING OF GRAVE 100 00
i 3. OBITUARY-HARRISBURG PATRIOT NEWS
1,189 67
7
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: N 0.00 P
Name(s)of Personal Representative(s)
Street Address
City State—ZIP
Year(s)Commission Paid:
—AIAf.NtlY5f-3lWtllmYNan,L
M. 0.00 k
2. Attorney Fees: 61•,a�,...-, :_tl�m_ ..,,.�.a
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) mm,r.,^ •.�`�r�.—O:OmO
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
.i 348.50
5. Accountant Fees: 0.000
i. R„�nm-31
6. Tax Return Preparer Fees:
2• LEGAL ADVERTISING-HARRISBURG PATRIOT NEWS - � 208.3
!_.. — - -- ---
4
<i
e LEGAL ADVERTISING-CUMBERLAND LAW JOURNAL 75.00.��
i r
r a
TOTAL(Also enter on Une 9, Recapitulation)
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LILLIAN W ROUSH 21-14-0526
Report debts Incurred 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. CUMBERLAND CROSSINGS RETIREMENT COMMUNITY-FINAL BILL 541.55
2. OMNICARE KING OF PRUSSIA-FINAL BILL-MEDICINES 824.82
3. CUMBERLAND GOODWILL AMBULANCE 83.15
TOTAL(Also enter on Line 10, Recapitulation) $ 1,449.52
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE ]
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
LILLIAN W ROUSH 21-14-0526
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).]
.. _ _. _ _ -_____________________
—_ __.-___--_ ____.--_ .__ _ _________ I i '
I. {CAROLE WEIKERT 17770 MILL CREEK DRIVE DERWOOD,MD 20855 1 !SISTER u 25%
— ---- -----------------------------------— ----- — _
1.-----, --------------------------- _-- _ - i
2.; RICHARD WHITTINGTON 791 AUBURN MILL RD HOCKESSIN,DE 1971 ;BROTHER 250%
RICHARD ------- --- -- ---— —----I ___:—
3.1 JOEL WHITTINGTON 3780 MAIN BAYVIEW RD SOUTHOLD,NY 11971 I (BROTHER J 25%]
..._—..i ____ ____ _ __ _ _.._.__ .., i i _..... _... .. _.l �::24IL_aPiuIl•u:::,.li2co ..O..m
4.1 SYLVIA BAKER 16660 S R 3001 MONTROSE,PA 18801 ;FRIEND 25/o
1
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_--------
- - - - --
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IB OF REV-1500 COVER SHEET,AS APPROPRIATE.
It NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1.
I h 4
___----------________ -- _ .. _-- ... _._.
E
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
I
I ,
, ._.rte.,.-�...,9—.��•�
i
, I e
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ •ro^^ Y- ^ter mmn•s
If more space is needed,use additional sheets of paper of the same size.
n ?
` O
LAST WILL AND TESTAMENT -
r
OF
LILLIAN W. ROUSH
m
KNOW ALL MEN BY THESE PRESENTS, That I, LILLIAN W. ROUSH,
being of sound mind, memory and understanding, do make, publish
and declare this instrument to be my Last Will and Testament,
hereby revoking and making void any and all former Wills by me
at any heretofore made.
FIRST: All just debts, funeral expenses and taxes of any
kind, including Federal and State Inheritance, Transfer and
Succession taxes with which my estate is properly chargeable
or otherwise, shall be paid promptly by my Executor and charged
out of my principal residuary estate as soon as it conveniently
may be done after my decease.
SECOND: In the event that my father, RAYMOND C. WHITTINGTON,
is living, and living with mr at the time of my death, I hereby
direct that he shall have the right to continue living at my
residence, 77 West Vine Street, Shiremanstown, PA 17011, for and
during his lifetime or as long as he is able to do so, as he
determines, on the condition that he pay the realty taxes,
insurance and utilities and then at his death or be unable to
live at the house, the house be sold and the proceeds divided as
hereinafter set forth. If he is not living at the time of my
death, this bequest shall lapse.
THIRD: All of the rest, residue and remainder of my estate,
real, personal and mixed of whatsoever nature and wheresoever
situate, I hereby direct be sold and converted to cash and divided -
as follows:
a. One-fourth to SYLVIA M. BAKER and GARY A. BAKER, her
husband, as tenants by the entireties, if they are living at
the time of my death, if not, their share shall be divided among
their issue, per stirpes;
b. The remaining three-fourths of my estate shall be divided
equally between CAROLE S. WEIKERT, JOEL R. WHITTINGTON and RICHARD C.
WHITTINGTON, if they are living at the time of my death, if not,
to their issue, per stirpes.
LASTLY, I hereby nominate, constitute and appoint SYLVIA M.
BAKER to be the Executrix of this, my Last Will and Testament,
if living, if not, I hereby nominate, constitute and appoint
RICHARD C. WHITTINGTON to be the Executor hereof.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of September, 1995.
(SEAL)
LILLIAN W. ROUSH
Signed, sealed, published and declared by the above named
Testatrix as and for her Last Will and Testament, in the presence
of us, who, at her request and in her presence and in the presence
of each other have hereunto subscribed our names as witnesses,
all being present at the same time.