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Home My WebLink About10-15-14 (2) REV-1500 EX(02-11) - , 1505610143 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 13 0586 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 04 05 2013 09 28 1920 Decedent's Last Name Suffix Decedent's First Name MI O' HARA ROBERT D (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 ❑ 1. Original Return 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise ❑ 5. Federal Estate Tax Return Required (date of death after 12-12-82) 6 Decedent Died Testate Decedent Maintained a Living Trust (Attach Copy of Will) ❑ (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes F-19. Litigation Proceeds Received 10.s ousal PovertCredit Date of Death 11.Election to tax under Sec.9113(A) ❑ beptween 12-31- and 1<-1-95) ❑ (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOYLO BE DIRECTED TO: Name Daytime T@Ipphone Nundfiiir EDMUND G MYERS (717F &4 4�0 ca -t r REGISTEM OF Wfr-LS USE ONO r r— r-rx Cn J> 01 First Line of Address r-3 r-� —T3 '-r= I 301 MARKET STREET 7n ►= ` n I Second Line of Address PO BOX 109 Cit or Post Office DATE FILED Y State ZIP Code LEMOYNE PA 17043 Correspondent's e-mail address: egm[@jdsw.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,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN D TE �a--..—. Susan Ann Lindsey ADDRESS 935 Old Quaker Road, Etters, PA 17319 SIGNA E OF PREPARE OTHER THAN REPRESENTATIVEAT Edmund G. Myers I DI �Il ADDRESS 301 MARKET STREET, Lemoyne, PA Side 1 1505610143 1505610143 1505610243 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 10 ,200 . 00 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. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneouscoq Probate Property (Schedule G) u Separate Billing Requested............ 7, 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 10 ,200 . 00 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 165 . 00 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 165 . 00 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 10 , 035 . 00 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. 10 , 035 . 00 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.00 15. 0 . 00 16. Amount of Line 14 taxable 0 . 00 16. 0 . 00 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 10 , 035 . 00 18. 1 , 505 . 25 19. TAX DUE................................................................................................................ 19. 1, 505 . 25 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-13-0586 Decedent's Complete Address: DECEDENT'S NAME O'HARA, Robert D STREET ADDRESS 130 Hummel Avenue CITY STATE ZIP Lemoyne PA 17043 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 1,505.25 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 3. Interest (3) 35.28 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 1,540.53 Make Check Payable to REGISTER OF WILLS' AGENT as 7, <� 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;............................................................................... ❑ ❑x b. retain the right to designate who shall use the property transferred or its.income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ F d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 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 payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?.................................................................................................................. 1�1 ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ❑... �" ',3:.., ... ... ,u o,,,.:., $ < ,,,,,,, ",„�„,�,#,,; „_..,.., .. ? 'T"" O rte., ,. ,- ...�..,,_,.'.w�. r ' , 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 January 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 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+(6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER O'HARA, Robert D 21-13-0586 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 670928100 1,000 shares of Nuveen Municipal Value Fund Inc-Com - 10.20 10,200.00 Certificate Shares. Valued using EstateVal. A copy is attached TOTAL(Also enter on Line 2, Recapitulation) 10,200.00 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B(Rev.6-98) Estate Valuation Date of Death: 04/05/2013 Estate of: Robert D. O'Hara Valuation Date: 04/05/2013 Account: 17653-1 Processing Date: 10/14/2014 Report Type: Date of Death Number of Securities: 1 File ID: Ohara3 Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 1000 NUVEEN MUN VALUE FD INC (670928100) COM New York Stock Exchange 04/05/2013 10.25000 10.15000 H/L 10.200000 10,200.00 Total Value: $10,200.00 Total Accrual: $0.00 Total: $10,200.00 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 (818) 313-6300 or www.evpsys.com. (Revision 7.3.1) REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER O'HARA, Robert D 21-13-0586 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 165.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 165.00 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER O'HARA, Robert D 21-13-0586 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Cumberland County Register of Wills Office-Filing Fee for Supplemental Return 15.00 2 Reserves: Additional miscellaneous estate expenses 150.00 1-1-137 165.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)