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Home My WebLink About09-24-14 I IRUM36 J 1505611182 REV-1 500 EX(DZ-,,)(Fit PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes DEPARTMENT OF REVENUE County Cade Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 11 00797 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 07/12/2011 05/24/1947 Decedent's Last Name Suffix Decedent's First Name MI RUBERT WILLIAM 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 REGISTER OF WILLS MARK THE APPROPRIATE BOXES BELOW ❑X 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) ❑X 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 Schedule O) CORRESPONDENT—THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number -�{{ LISA D SHUGHART 717-P 5_1 03 U3 ' A m I RE �T 2OF WIW USE_XOq&y t� —O --O U"y '� i M CJ First Line of Address r rV In rn T -. FTI .x a o 204 BURNT HOUSE ROAD Second Line of Address o r' y, C:) :3 ..> r— M r rr1 � City or Post Office State ZIP Code y i GATE FIL N C> CARLISLE PA 17013 Correspondent's e-mail address: 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 h correct and complete,nectaranon of pr aver other than the personal representative is based on all information of wvch preparer has any krrowiedge. S RE OF P ON ES NSIB FOR Fi4 G RETURN DATE b-INADDRESS 2 R US AD C R ISLE PA 17 13 iGNATURE O PARER R AN R E DATE 09/12/14 390 ALEX Ii RD CARLISLE PA 17015 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611182 1505611182 11 RUB6836 1505611282 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: WILLIAM F RUBERT 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 and Notes Receivable(Schedule D) q ................................... 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E 51231 6. Jointly Owned Property(Schedule F) 11 Separate Billing Requested 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) 11 Separate Billing Requested ... 94 ,556 8. Total Gross Assets(total Lines 1 through 7) 8. 991 787 9. Funeral Expenses and Administrative Costs(Schedule H) 9. 1 1230 ........................ 10. Debts of Decedent,Mortgage Liabilities and Liens Schedule I 4 1074 11. Total Deductions(total Lines 9 and 10) 11. 5 ,304 12. Net Value of Estate(Line 8 minus Line 11) 12. 941483 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) 14. Net Value Subject to Tax(Line 12 minus Line 13) 941483 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 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 941484 16. 41252 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. 41252 20:-MARK THE APPROPRIATE BOXIF YOU ARE REQUESTING A REFUND-OF AN OVERPAYMENT- --- " - -- - -_ --0�, Side 2 1505611282 1505611282 J lraua6836 REV-1500 EX(FI)Page 3 File Number Decedent's Complete Address: DECEDENTS NAME WILLIAM F RUSERT STREET ADDRESS 204 BURNT HOUSE ROAD CITY STATE 21P CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 4 1 252 2, Credits/Payments A.Prior Payments 4,400 B.Discount Total Credits(A+B) (2) 41400 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference: his-is-the OVERPAYMENT. CMarkiie_tzbtTaq PageL2,-Line20:to request a refund.--- ----- -------------"--{4)�--_—.-- -_---_],4.8---� 5, if Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 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 t a.retain the use or income of the Property transferred ,...,,,.__,,,__.,,,_............................ X b.retain the right to designate who shall use the property bans(erred or Its Income —.................. X c.retain a reversionary interest O .......................................................................... El d.receive the promise for life of either payments,benefits or care? 0 0 2, if death occurred after Dec.12, 1982,did decedent transfer property Within one year of death without receiving adequate consideration?...._..._._,..._. ...... .......................4........__ Q ... .... 3. Did decedent own an'in trust for'or payable-upon-death bank account or security at his or her death? QX 4, Did decedent own an Individual refirement account,annuity or other non-probate property,which contains a 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 Jury 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 172 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 172 P,S.§9116(a)(1.1)(0)).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 lot 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 decedeats 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. 11RUB6836 REV-1508 EX.(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: WILLIAM F RUBERT FILE NUMBER: 00797 Include the proceeds of litigation and the date the proceeds were received by the estate. ITEM All propertyjointly owned with right of survivorship must be disclosed on Schedule F. NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1 MEMBER' S FIRST FCU CHECKING 2 , 505 ACCOUNT #350182-0011 2 HOFFMAN ROTH PREPAID FUNERAL 1 , 673 ACCOUNT # 16287-155 TOTAL COST: $7582 LESS PREPAID <9255 = REIMBURSMENT $1673 4 AHOLD 401K SAVINGS MG4K 35845 269 6 MEMBERS FIRST SAVINGS #350182- 5 0000 7 MISCELLANEOUS REFUNDS 779 UGI-$62 , AHOLD PRORATION-$294 , APT LS-$62 , GIANT PAYCHECK-$35 , SECURITY REFUND-$243 , COMCAST- $37 , OTHER $46 TOTAL(Also enter on Line 5, Recapitulation) $ 5 , 231 If more space is needed,use additional sheets of paper of the same size. 11RUB6836 REV-1510 EX.(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIAM F RUBERT 00797 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE, VALUE OF ASSET INTEREST IFAPPLICABLE VALUE 3 MEMBERS FIRST IRA #350182-0010 74, 853 74, 853 BENEFICIARIES: LISA D. SHUGHART - 50% & MICHAEL S. RUBERT - 50$ 5 TRUSTMARK INS #NG 97934 - 19, 703 19, 703 CONTRACT #W76078 - BENEFICIARIES - LISA D SHUGHART 50$ & MICHAEL S RUBERT 50% TOTAL(Also enter on Line 7, Recapitulation) $ 94, 556 If more space is needed,use additional sheets of paper of the same size. 11 RUB6836 REVD 511 EX-(08-13) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIAM F RUBERT 00797 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1 VFW FUNERAL RECEPTION 1 , 035 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representatives) Street Address City Slate ZIP Year(s)Commission Paid: 2. Attorney Fees: 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: - 5. Accountant Fees: 6. Tax Return Preparer Fees: 1 CUMBERLAND COUNTY REGISTER OF WILLS 195 TOTAL(Also enter on Line 9, Recapitulation) $ 1, 230 If more space is needed,use additional sheets of paper of the same size. 11RUB6836 RI=V-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 WILLIAM F RUBERT 00797 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 2011 FEDERAL INCOME TAX DUE 4, 074 TOTAL Also enter on Line 10,Recapitulation) $ 4, 074 If more space is needed,insert additional sheets of the same size. 11RUB6836 REV-1517 EX-(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WILLIAM F RUBERT 00797 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 LISA D SHUGHART DAUGHTER 47 , 242 204 BURNT HOUSE ROAD CARLISLE PA 17013 2 MICHAEL S RUBERT SON 47 , 242 7 AZALEA DRIVE MT HOLLY SPRINGS PA 17065 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: B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. cAwp51%Vr&VCub=*,.il O CO 0 C= 6 i<D r r r 'ir.-: CJ t y o CD Knot All altbi C)Tt#tant OF WILLIAM F. RUBERT, JR. 1, WILLIAM F. RUBERT, JR., of 331 Juniper Street, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECONb: I hereby give, devise and bequeath my entire estate, be it real, personal or mixed, of whatsoever kind and wheresoever situate, to my Daughter, LISA D. SHUGHART, of 204 Birdhouse Road, Carlisle, Cumberland County, Pennsylvania, and my Son, MICHAEL S. RUBERT, of 331 Juniper Street, Carlisle, Cumberland County, Pennsylvania, in equal shares, per stirpes. THIRD: in the event that either of my said children shall predecease me, and have children who have not attained the age of 18 years at the time of my death, I c:� p5l�WatUtunagr..B hereby nominate, constitute and appoint said child's surviving natural parent as Guardian of the estate of said child until they shall have attained the age of 18 years. . LASTLY: I hereby nominate, constitute and appoint my Daughter, LISA D. SHUGHART, of 204 Birdhouse Road, Carlisle, Pennsylvania, as Executrix of this my Last Will and Testament. In the event that my Daughter, LISA D. SHUGHART, shall be unable to serve as Executrix for any reason, I appoint, my Son, MICHAEL S. RUBERT, of 331 Juniper Street, Carlisle, Pennsylvania, as Executor. No Executor or Executrix shall be required to file bond in this or any other jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal this day of a aAi 1 1996. WILLIAM F. RUBE W,, ,, JR. SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: J - 107 2 a1wp311Wi1LlRubcrtjr.wil COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND t, WILLIAM F. RUBERT, JR., Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by WILLIAM F, RUBERT,JR., the Testator, this day of ' 1996. f WILLIAM F. RUBJR., Testator Notary Publ NOTARIAL SEAL MERLENE MARHEM Notary Pubrc Cafwe;CvrtrbetLitd O",Pa. My Commissbn Expires 4Rt"'e - 3 c:1s�p?i iWillalitubcnjr.wit - COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND We, James D. Flower, Jr. and Deborah J. Boyd the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we are present and saw Testator, WILLIAM F. RUBERT, JR., sign and execute the instrument as his Last Will, that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by James D. Flower, Jr. and Deborah J. Boyd witnesses this /L&I day of elf 11996. S Witnes i 1 wit Tess Not lic N07ARX SEAL MERLENE MARHEM Wary Pibfc CarfsM,Gu{taSeAasti CmsGy Pa - Mp Cwmnes�,E�rea 6� 4