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Home My WebLink About11-20-14 1505610105 REV-9500 °`(02-11)(Fl) OFFICIAL USE ONLY PA Department of Revenue �nn1S7VB*ewe Courcy Code Year File Number Bureau a2 PO BOX 8060801vidWlTaxea INHERITANCE TAX RETURN ftarrisburs.PA1712s-oeol RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMODYYYY 07292014 09181947 DecedenCs Last Name Suffer Decedent's First Name MI ROCKEY VIVIAN Of Applicable)Enter Surviving Spouse's infomnatlon 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 BOXES BELOW 0 1 Original Return Q 2 Supplemental Return Q 3. Remainder Return(Date of Death Prior to 12.13.82) Q 4. United Estate Q 4e. Future Interest Compromise{date of Q 5. Federal Estate Tax Return Required death after 12.12.82) x0 8 Decedent Died Testale Q T Decedent Maintained a Living Trust O 8. Total Number of Safe Deposit SWee (Attach Copy of Will) (Attach Copy of Trust.) 0 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 Schedute O) CORRESPONDENT-THIS SECTION MUST BE COMPLETEO.ALL CORRESPONDENCE AND CONFIDENTIALTAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT G. FREY 7172435830) REGISTER O WILLS USE LY First Line of Address T C-13 C O it 5 S. HANOVER ST. Second Line of Address DATE FILED City or Post Office State ZIP Code —r W O CARLISLE PA 17013 Correspondent'se-mailaddress: RFREY@FREYTILEY.COM Under penalties of per ury,I declare that I have Wnlined this return,including aeoomparrong schedules and stateme its,and to the best of nV knowledge and belief. A is true correct and complete Declaration of preparef other than the personal rearesentative is based on all information of which preparer has any knowledge S1G TURE OF PERSON S 1 Fa FILING RETURN DATE ADDRESS r/ 155Q LON S GAP ROAD CARLISLE PA 17013 SIGN E OF P R P ESENTATIVE DATE 6 ADD ESS 5 SOUTH HANOVER STREET LRLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX(Fl) RECAPITULATION 1. Real Estate(Schedule A).......................................... 1. 0.00 2. Stocks and Bonds(Schedule B)..................................... 2. 2660.97 3. Closely Held Corporafion,Partnership or Sale-Proprietorship(Schedule C)... 3. 0.00 4. Mortgages and Notes Receivable(Schedule D)......................... 4. 13.00 S. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).... S. 4090-27 6. Jointly Owned Property(Schedule F)[M Separate Billing Requested....... S. 0.Eli] 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested....... 7. 0.00 6. Total Gross Assets(total Lines 1 through 7). B. 6751.24 9. Funeral Expenses and Administrative Costs(Schedule H)................. 9. 4785.76 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule t).............10. 2523.54 11. Total Deductions(total Lines 9 and 10).............................. Yl. 7309.30 12. Net Value of Estate(Line 8 minus Line 11)............................12. -558.06 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J).......... ............ 13. 0.110 14. Net Value Subject to Tax(Line 12 minus Line 13)...................... 14. -558-06 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. 0.00 16. Amount of Line 14 taxable at Lineal rate X.o 45 16. 13.00 17. Amount of Une 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 18. 0.0 0 19. TAX DUE.. ..................... ................................. 19. 0.130 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 1505610205 1505610205 RE51•ttwO ETC(Fe) ?age 3 Fifa Number 184-38-0807 Decedent's Complete Address: 21-14-0756 DECEDENT'S NAME VIVIAN 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 8,Discount Total Credits(A+8} (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 S. If Lire 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 WILLSi AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS I. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred....................:............__........................................... .,..... ❑ 21 b. retain the right to designate who shall use the property transferred or its income............................................ ❑ c. retain a reversionary interest................ .......... ,.,... ❑ M d. receive the promise for life of either payments,benefits or care?..................................................................... MX 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?_._,.._.. ❑ 0 4, Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?................................................................................:....... ....... ❑ 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 21years 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.§91 16(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.§91116(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 RS,§9116(a)(1 3)l.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-ISM D(•(8-1Z pennsylvania SCHEDULE B 0VPR 1W OsIkEVVQE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Vivian Rod(ey 21-140756 All property Jolntly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Invesco IRA. Estate is beneficiary 2,660.97 TOTAL(Also enter on Line 2,Recapitulation) $ 2,660.97 If more space is needed,insert additional sheets of the same size REV-IW8EX+(08.12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTM CETAX RETURN PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Vivian Rockey 21-14-0756 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. Orrstown Bank checking account 1,706.84 2. Accrued interest on checking account 0.48 3. Refund from Highmark 2.07 4. Van. Sate price 300.00 5. Personal property sold at yard sale 35.01 6. Coin collection,sale price 356.02 7. EZ Pass refund 21.48 8. Jewelry. net of appraisal fee 270.00 9. Miscellaneous personal property sold at auction(net of auctioneers fee) 1,150.53 10. Miscellaneous cash found 222.71 11. Insurance refund 20.00 12. Sentinel refund 5.13 13. Order of Eastern Star pin TOTAL(Also enter on line 5,Recapitulation) E 4,090.27 If more space Is needed,use additional sheets of paper of the same size. REV-1511 EC+(08.17) SCHEDULE H pennsylvania DEPARTMEW OF REVENUE FUNERAL EXPENSES AND 1141-161WANCE TAX RETURN RESIDWI'DECEDFM ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER _Vivian Rockey 21-14-0756 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman Roth Funeral Home 2,651.61 B. ADMINISTRATIVE COSTS: 1. Personal Representative Comnussions: 150.00 Name(s)of Personal Representatrve(s) Barbara Oyler Street Address 1.5.50 Long Gap Road crty Carlisle state PA tip 17013 Year(s)Commisawn Paid: 2014 2. AttomayFees: 1,500.00 3. Family Exemption,(It decedenre address is not the same as etaimanrs,attach explanation,) Claimant Street Address Cty State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 180.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Advertising Costs to Cumberaind Law Journal and the Sentinel 303.65 TOTAL(Also enter on Une 9,Recapitulation) $ 4,785.76 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX-(12.112) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES 81 LIENS ESTATE OF FILE NUMBER Vivian Rockey 21-14-0756 Repot debts Incurred by the decedent prior to death that remained unpaid at the date of death,Including unretmbureed medical expemes. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH i. Verizon,final gill 17.43 2. CenturyUnk,final till 333.19 3. Comcast 117.36 4. PPL 103.96 5. Pinker Associates 40.00 6. Pinnacle Health 40.00 7. Carlisle Regional Medical Center 1,315.00 8. Forest Park Nursing Home 433.00 9. Community Life Team,ambulance transport 123.60 TOTAL(Also enter on Une.10,Recapitulation) $ 2,523.54 It more space Is needed Insert additional sheets of the same size.