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Home My WebLink About12-02-14 I 1505610105 REV-1500 EX(02-11)(FI) J.] PA Department of Revenue pennsytvania OFFICIAL USE ONLY �F^^^,ExroF =« County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN --7 Harrisburg,PA 17128-0601 RESIDENT DECEDENT � ' 16w I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 07/13/2013 01/03/1955 Decedent's Last Name Suffix Decedent's First Name MI Strohman Donald . 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 (40 1. Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 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.) O 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 0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Andrew C. Sheely, Esquire 717-697-7050 .... ...... REGISTER OF WILLS USE ONLY First Line of Address ry ca 127 South Market Street C � O M ............ _ __. ' O 6, Second Line of Address O P.O. Box 95 r— r-` � = r� N rr n't L7 City or Post Office State ZIP Code bATVFII,•E04 J O Mechanicsburg PA 17055 =� N p _.I r ttt Correspondent's e-mail address:.andrewc.sheely@verizon.net cn O C-) 'T1 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. GNATURE OF PERSON RPO �BLn OR FILING RETURN ^ J n L-yi l✓.� N l i [A C1 n::J ADDRESS Francine A. Strohman,Administratrix, 7 Hill Boulevard, Mechanicsburg, PA 17055 SIGN RE OF PR THA REPRESENTATIVE pA:[E 1 i 2s z.o A ES Andrew C. Sheely, Esq 7 South Market Street, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J s h .J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Strohman, Donald D. RECAPITULATION 1. Real Estate(Schedule A). .. . . . ... .. . ........ ...... . ... .... ... . .. . .. . 1. 2. Stocks and Bonds(Schedule B) ... ...... .. ... . .. . ... . . . . . . .. . .. . .... . . 2. $696.20 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .. .. 3. 4. Mortgages and Notes Receivable(Schedule D). .. .. . . . .. .. . .. .. . . . .. . .. . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. .. .. . 5. 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ... .. .. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. .. .. .. 7. 8. Total Gross Assets(total Lines 1 through 7). .. . . .. ...... . .. ... .... ... . .. 8. $696.20 9. Funeral Expenses and Administrative Costs(Schedule H). . . .. ... ... ...... .. 9. 13,062.86 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1).... . . ... . . .. . . 10. 11..Total Deductions(total Lines 9 and 10). .. . ..... .. . .... .. .. ..... .. . .. . . 11. 13,062.86 12. Net Value of Estate(Line 8 minus Line 11) .. . .. . . .. . ... .. . . . . .. . .. .. ... . 12. 0.00 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. 0.00 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 0.00 15, 0.00 16. Amount of Line 14 taxable at lineal rate X.0 45 0.00 16. 0.00 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 p Side 2 1505610205 1505610205 REV-1500 EX(9) Page 3 File Number Decedent's Complete Address: c:)] — 7 DECEDENT'S NAME Donald D. Strohman .............. ...... ............... ....... .......___................ STREET ADDRESS 7 Hill Boulevard .......... ........ ...............__............ ......... ..................... ............. ...... ....... ............... .......__..__.______._....... ........... ...... ZIP Mechanicsburg CITY STATE PA 17055 55— Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 0.00 2. Credits/Payments A.Prior Payments ...................... .............. B.Discount Total Credits(A+B) (2) 3. Interest 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3) 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 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.......................................................................................... El N b. retain the right to designate who shall use the property transferred or its income ............................................ 0 0 c. retain a reversionary interest ............................................................................................................................ ❑ 0 d. receive the promise for life of either payments,benefits or care?...................................................................... El N 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?.............. El N 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ El N 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: • 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,(7-11) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald D. Strohman 21-14-1067 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, DST Systems,Inc.common stock- 10 shares @$69.62/share at date of death $696.20 p i TOTAL(Also enter on Line 2, Recapitulation) $ $696.20 If more space is needed, insert additional sheets of the same size ZQ00040523|DST|C01|CUS1292081°AVVRD1100110830414 COM MOR STUQK GAN MW Ty, i AT "IX Shares Certifidate Number DST : tit DST SYSTEMS R�TED UNDER THE LAWS OF THE STATE OF DELAWARE Tt ESA -32 W-"WNAUrOSTROH"""OONALOO-STOORtAW-DOk4LD"TROWAOkN"-OONAV"TFOHMAW'-OOM&0*trMMW"VOMALD- SEE REVERSE FOR CERTAJN DEFINITIONS is the owner of SH AM FULLY PAID AND NON-ASSESSABLE SHARES OF THE COMMON STOCK OF DST.Systems, Inc. transferable,on the books of the Corporation, in person or by duly authorized attorney, upon surrender of this Certificate properly endorsed. This Certificate and the shares represented hereby are issued and shall be held subject to the conditions and limi6tions of the Certificate of Incorporation of the Corporation and all amendments theteto. This Certificate is not valid unless countersigned by the Transfer Agent and registered by 6-06 oratton,`and, he signatures of its duly authorlZeC1,10M rs�_ stc RE G - REV-1511 EX+(10-09) �_f► pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND . INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald D. Strohman 21-14-1067 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Funeral Home $12,708.27 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: $0.00 Name(s)of Personal Representative(s) Francine A. Strohman street address 7 Hill Boulevard City_Mechanicsburgstate_..._PA_ZIP_17055 __..... Year(s)Commission Paid:_.__. __......"__.__._.__......_ 2. Attorney Fees, ,�%lcfr�W wheel Dec ree/�e�7 $225.00 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: $110.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Postage,certified mail costs,notary fees $19.09 TOTAL(Also enter on Line 9, Recapitulation) $ 13,062.86 If more space is needed,use additional sheets of paper of the same size. Malpezzi Funeral Home 8 Market Plaza Way _ L Jt (717)697-4696 Mechanicsburg,PA 17055 www.MalpezziFunera]Home.com Jeremy 3.Shartzer,FD Michael J.Malpezzi,Owner,FD Kyle C.Knipe,FD July 22,2013 Francine Strohman 7 Hill Boulevard Mechanicsburg,PA 17055 This is the final statement for the funeral services of Donald D. Strohman Jr. We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way. PROFESSIONAL SERVICES: Services of Funeral Director/Staff $5,475.00 FUNERAL HOME SERVICE CHARGES $5,475.00 SELECTED MERCHANDISE: Casket 20 Gauge Casket $3,200,00 Outer Container Gaurdian $1,450.00 Rustric Retreat Register Package $195.00 THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE THAT YOU HAVE SELECTED $10,320.00 CASH ADVANCES: At the time funeral arrangements were made,we advanced certain payments to others as an accomodation. The following is an accounting of those charges. Opening Grave $1,050.00 Cemetery Equipment $200.00 Certified Death Certificates $60.00 Newspaper Notices-Patriot $206.47 Newspaper Notices-Sentinal $227.70 Newspaper Notices-Altoona Mirror $229.10 Clergy/Mass Offering $150.00 Flowers $265.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $2,388.27 SUB-TOTAL $12,708.27 INITIAL PAYMENT/DISCOUNT/CREDITS $0.00 TOTAL AMOUNT DUE BY August 13,2013 $12,70817 If you have any questions or concerns regarding this bill,please call our office at(717)697-4696. RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ. Receipt Date : 11/10/2014 Cumberland County - Register Of Wills Receipt Time : 11 : 35 : 36 One Courthouse S ware Receipt No. : 1079663 Carlisle, PA 1713 STROHMAN DONALD D Estate File No. : 2014-01067 Paid By Remarks : FRANACINE STROHMAN HMW ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 20 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 35 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 10 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 9502 $110 . 50 Total Received. . . . . . . . . $110 . 50 a s :The, U S Store -_#3764 5,� berland Parkway` Ab Mechanics, urg, PA 17055- 677 (7` ) 795-8818 , 10/25/14 12:52 PM; Mechanicsburg Main Post Office MECHANICSBURG, Pennsylvania WE: are i:he r.;re Stop for E l YJUr 170559998 ` shippirlp, postal a'business 4134870055 -0098. ar. pU"'p�s, needs. 11/17/2014 (717)697-4641 . 11:27:33 AM We offer all h'z services you need Sales Receipt to keep your business going, Product Sale Unit Final Description Qty Price Price COLLEGE STATION TX 77845-4470 $1.19 Zone-6 First-Class Mail Large Env 1.90 o2. 001 000003 (011) Expected Delivery: Thu 11/20/14 Notary TO $ 5. Return Rcpt (Green Card) $2.70 a0'Cert ified $3.30 002 500062 (011) USPS Certified Mail #: TO $ 2 ADMIN FEE $2,00 70132630000067201879 Issue Postage: $7.19 -- 7 19-- SubTotal $ 7.00 �TaT- 7.00 Total: $7.19 Cash $ 7,00 Paid by:Cash $20.19 - Change Due: -$13.00 Receipt ID 82941902563440888849 002 Items N For tracking or inquiries go to CSH: parvinTran: 1774 Reg: 002 USPS.com or call 1-800-222-1811. Thank you for visiting our store. BRIGHTEN SOMEONE'S MAILBOX. Greeting cards Please come back again soon. available for purchase at select Post Offices. �rrre�r�errx�crcererzrcrrcr:e:��xrx�z�erc:�rcrc:exxrcrre:�r: Whatever your business andsonal "� * needs, we are here to sere ou, In a hurry? Self-service kiosks offer We're here help, quick and easy check-out.. Any Retail Join our FREE email p Associate can show you how. great. offers and rresources,e", Order stamps ata,usps..,com/shop or call 1-800-Stamp24. Go to usps.com/cli-cknship www.theupsstore.com/signup . . . . REV- DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER, Donald D. Gtnohnnen 21-14-1067