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Home My WebLink About11-26-14 1505610105 REV-1500 EX(02-11)IFI' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania DEPARTMENT OF REVENUE County Code Year File Number eau PC BO 2806 X 2806 0 01 Individual Taxes PO INHERITANCE TAX RETURN BO Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 02282013 12081935 - Decedent's Last Name Suffix Decedent's First Name MI ROCKEY CHARLES (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 INAPPROPRIATE BOXES BELOW 0 1. Original Return 0 2. Supplemental Return Q 3. Remainder Return(Date of Death Prior to 12-13-82) Q 4. Limited Estate 0 4a. Future Interest Compromise(date of Q 5. Federal Estate Tax Return Required death after 12-12-82) Q 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) Q 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit(Date of Death Q 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 ROBERT G. FREY 7172435838 REGISTER OF WILLS USE ONLY r'v First Line of Address a ? n 5 S. HANOVER ST. c Second Line of Address ` fY; Cn C7) _z) DATE FILED t> CD City or Post Office State ZIP Code ; CARLISLE PA 17013 Cn Correspondent's e-mail address: R F R E Y@ F R E Y T I L E Y . COM C 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 cafrect and c e .Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG AT E OF PE SON ESPONSIBLE FOR FILING RETURN DATE J I 3 1 �- AD 1539 THIRD STREET ENOLA PA 17025 SIGNT OF REP RE OHER T R P SENTATIVE 1 f ATE 3 c ADD SS 5 SOUTH HANOVER STREE ARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J J 150561.0205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: CHARLES ROCKEY 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. 01 . 00 4. Mortgages and Notes Receivable(Schedule D).. ..... .. .. .... .. .. .. .. .. 4. 0 . 00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. ... 5. 9660. 18 6. Jointly Owned Property(Schedule F) =Separate Billing Requested. .. . . .. 6. 0. 00. 7. Inter-Vvos Transfers&Miscellaneous Non-Probate Property (Schedule G) =Separate Billing Requested. .. .. .. 7. 01 . 00 8. Total Gross Assets(total Lines 1 through 7). .. .. ... .. .. .. .. .. .. . . .. .. . 8. 9660. 18 9. Funeral Expenses and Administrative Costs(Schedule H). . .... .. .. . . .. ... 9. 10924 . 3 4 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). .. ... .. .....10. 1083.50 11. Total Deductions(total Lines 9 and 10). . .. . .... .. .. .. .. .. .. .. .. .. .. . 11. 12007.84 12. Net Value of Estate(Line 8 minus Line 11)..... .. .. .. ... .. .. .. .. .. .. ..12. -2347. 66 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J).... .. .. .. .. .. .. .. .. .. 13. 0. 00 14. Net Value Subject to Tax(Line 12 minus Line 13). .. .. .. .. .. ... .. .. .. .. 14. -2347. 66 TAX CALCULATION-SEE INSTRUCTIONS FORAPPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 01 15. 01110 16. Amount of Line 14 taxable at lineal rate X.0 45 16. 0. 00 17. Amount of Line 14 taxable at sibling rate X . 1+2 17. 11. 00 18. Amount of Line 14 taxable at collateral rate X .15 18, 0 . 001 19. TAX DUE.. .. .. .. .. ... .. :... . ... .. .. .. .. .... .. .. .. ... .. .. .. .. .. . . 19. 0 . 001 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT = Side 2 L 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number 171-28-2079 Decedent's Complete Address: 21-14-898 DECEDENT'S NAME CHARLES ROCKEY STREETADDRESS 22 MCBRIDE AVENUE CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments B. Discount Total Credits(A+B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 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......................................................................................... ❑ ❑X b. retain the right to designate who shall use the property transferred or its income............................................ ❑ ❑Z c. retain a reversionary interest............................................................................................................................. ❑ 0 d. receive the promise for life of either payments,benefits or care?..................................................................... ❑ Q 2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................................ ❑ M 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?............. 0 4. Did decedent own an individual retirement 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 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 if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: 0 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 decedents lineal beneficiaries is 4.5 percent,except as noted in[72 PS.§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-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMUE NHERTANCETAX RETT OF EURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Charles Rockey 21-14-898 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. Wells Fargo account 1010104991363 2,332.84 2. Wells Fargo account 1010106843545 1,648.48 3. Wells Fargo account 3000066073557 2,385.60 4. Refund payable from the U.S. Department of Treasury 1,940.00 5. Final pension payment payable from Cumberland County 1,337.26 6. EZ Pass Refund 16.00 TOTAL(Also enter on line 5, Recapitulation) $ 9,660.18 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDEN�URN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Charles Rockey 21-14-898 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman Roth Funeral Home 9,118.84 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 1,000.00 3. Family Exemption:(If decedents address is not the same as claimant's,attach explanation.) 660.00 Claimant Shane Colvin Street Address 1539ThirdStreet city Enola State PA zip 17025 Relationship of Claimant to Decedent - 4. Probate Fees: 145.50 5. Accountant Fees: 6. Tax Return PreparerFees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 10,924.34 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 INHERITANCE TAX RETURN DEBTS OF DECEDENT, RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Charles Rockey 21-14-898 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. City of Casselberry,water bill 163.59 2. Duke Progess,final bill 211.68 3. Casselberry Utilities,final bill 163.59 4. Verizon Wireless,final bill 457.95 5. Univita,final bill 86.69 TOTAL(Also enter on Line 10, Recapitulation) $ 1,083.50 If more space is needed,insert additional sheets of the same size. 4 REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Charles Rocke 21-14-898 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] Vivian I. Rockey 1: 22 McBride Avenue, Carlisle, PA 17013 Sister 1/4 of remainder Shane Colvin 2' 1539 3rd Street, Enola, PA 17025 Son 1/4 of remainder George Colvin 3' 19 Hawthorn Street, Bristol, CT 06010 Son 1/4 of remainder Sean Colvin 4' 247 East Louther Street, Carlisle, PA 17013 Son 1/4 of remainder 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: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. 0.00 If more space is needed,use additional sheets of paper of the same size.