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Home My WebLink About03-19-15 J 1505614134 E*Iw-iauFp REV-1500 OFFICIAL USE ONLY Bureau o(IndiviEoalTazes Counly CoOe Vear FikNumber Poeoxzeasot INHERITANCETAXRETURN 2 1 1 5 115 Hamsbura, PA nt28-osot RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Securiry Number Date of�eath Mhroovrrv Date of Bitln MM�DYYYv 1 2 2 9 2 0 1 4 0 5 0 8 1 9 2 4 Decetlenfs Last Name Sufflx Decetlenfs First Name MI F E G A N H E L E N L (If Applicable)Enter Surviving Spouse's Intormation Below Spouse's Last Name SuKx Spo�se's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1.Original ReWrn � 2. Supplemen�al ReWm � 3.Remain0er ReNm(tla�e of tleath Prior�o 12-03-82� � 4.AgriculWre Exemption � 5. FUNre In�erest Compmmise(tlate of � fi Federal Es[a[e Tax ReNm Requiretl (daleoleeallonoratle�]4d012) tleaMaRer124&ffi) � ]. Decetlent Dietl Testate � 8. Decetlen[Mainlainetl a Living Trust _ 9.Total Number of Safe Deposit Boxes (Atlachropyo(will) (Atlachmpyo(�mst) � 1�. L'Rigation Pwceetls Receivetl � 11. Non-Pmbate Transferee Return � 12 DeferraVElection of Spousal Trusts (Schedule F and G Assets only) ❑ 13.Business Assets ❑ 14.Spouse is Sole Bene(ciary (No�ms�involvetl) CORRESPoNDENT�THIS SECTION MUST BE LOMPLETED.ALL CORRESPONDENCE ANO CONFIDENTIAL TAX IXFORMATION SHOUL�BE DIRECTED T0: Name Day[ime Telephone Number M IJ R R E L W A L T E R S , I I I E S Q 7 1 7 6 9 7 4 6 5 0 First Llne ofAtltlress W A L T E R S 8 G A L l 0 W A Y , P L L C Second Line of Adtlress 5 4 E • M A I N S T R E E T City or Post OKce State ZIP Cotle M E C H A N I C S B U R G P A 1 7 0 5 5 CorresponCen['se-mailadtlress: fflUff¢I(1DW21[¢fS92110W2y.com � I RE615T€StOFWILL5U5EONLY� � REGISTFROFWILLSOSEONLY � � � �RTE FlLEU MMOOYYTY � CJ _.-1 OATE FlLE�$ hIP �' �_� l ri � i W PLEASE USE ORIGINAL FORM ONLV Side 1 IIIIIII IIIII IIIII I�IIIIIII�IIIII II�II�II'I IIIII IIIII IIIIIIII � L 1505614134 1505614134 J J 1505614234 REV-1500 EX(Fl) Decetlenfs Social5ecurity Number o�ae�r:Hame: HELEN L • FEGAN RECAPITULATION t. Real Estate(Schetlule H) .. . . . . . . .. . . .. . . . . .. . . . . .. . . . .. .. .. .. .. .. .. 1. • 2. Stocks antl Bontls(ScheEule B) . . . . . . . . . .. .. .. .. . . .. .. . . . . . . . . . .. . . . . 2. • 3. posely Heltl Corporation,Patlnership or Sole-Pmprietorship(Schetlule C) . . . . . 3. • G. Mortga§es and Notes Receivable(Schedule D) . . .. . . . . . . . . . . . . . . . .. . . . . . 4. • 5. Cash,Bank Deposi�s anE Miscellaneous Personal Propetly(Schetlule E�. . . . . . . 5. 4 8 2 9 . 4 7 s. �omuy ow�ea aro�ny�soned�ie F� ❑ sePare�e s�n��q Req�esrea . .. . . . . s. 5 9 8 9 3 . 9 0 ]. Inter-Vivos Transfers 8 Miscellaneous N n-Proba�e Prope�y (Schetlule G) � Separale Billing Requesled . .. . . .. 1. . e. ro�i c�o::ns:e�Rocai u�es i m�o�yn�� _ . . .. .. .. . .. . . . . . . . a. 6 4 7 2 3 , 3 7 4 W neral Expenses antl Ftlminis[rative Cosis(Schetlule H) . .. .. . . .. . . . . . . . . . 9. 2 7 4 � . Q 0 10. Debts of Deceden[, Mortgage Liabili[ies,anE Liens(Schedule I) . . .. .. . . .. .. . 10. 1 � 1 $ • 4 $ t t. iotai oeaucuons(roroi u�es 5 a�a to) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i t 3 7 5 5 . 4 8 12. Ne[Value ot Es[ate(Line B minus Line 11) . .. . . .. .. . . . . . .. . . .. . . . . . . . . 12. 6 � 9 6 7 . 8 9 13. CharilaEle antl Govemmen[al Bequesls/Sec 9113 Trusls forwhlch an election to tax has no�been made(Schetlule J) . .. .. . . .. . . . .. .. .. .. .. 13. . t4. Ne[Value Subject to Tae(Line 12 minus Line 13) .. 16. 6 0 9 6 7 . 8 9 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at�he spousal tax rate,or �ransfers untler Sec.9116 (a)(12)%.0 _ � . � 0 15. 0 . Q 0 16. Amoun�of Line 10�axa0le atnneairate x.o45 6 0 9 6 7 . 8 9 is. 2 7 4 3 . 5 6 1]. Amount of Line 1A taxa�le atsiblingra[e %.12 0 . 0 0 iZ 0 . 0 0 18. Amoun�of Line 16 taxable atcoilaceralrate x.0 0 . 0 0 ib. 0 . 0 0 19. TAX DUE . . . . .. . . . . . . . . . . . . . .. . . . . . . . .. .. .. .. .. .. 19. 2 7 4 3 . 5 6 20. FILL IN THE OVAL IF YOU ARE REpUESTING A REFUND OF AN OVERPAYMENT ❑ Unoer penaWes oi perjury,I oeclare I nave examineU tnls reWrq IrJu0ing accompanying sUeOules anG statemenls,antl to Ne besl of my knowle0ge an0 Oelie[ i�Is We,wrtect ane mmplele.De Jaratlon M preparer ol�er t�an��e p¢Ron responsible lor(Jinq tM1e reW m Is baseE on all lnformalbn of wlilc�prepdRf M1as any knowleEge. SIGNAT EOFPER50 RESPONSIBLEfORFIUNGRETURN DATE `�-w�q��T._� a-��/� ADDRE55 ` � FREDERICK W• FEGA II, 601 W. MAIN ST MECHANICSBURG PA 17�55 SIGNATUftEOFPRyAl�pf19�HE HRNPERSONRESPONSIBLEFORFlLWGTHERETORN n� _/'f "/S %� �� AD�RE55 MURftEL . WALTERS III, 54 E • MAIN ST MECHANICSBURG PA 17055 I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIIIIIIII IIIII I'll IIII Sitle 2 L 1505614234 1505614234 J REV-1500EX (Fl� Gage3 FileNumber DecedenYs Complete Address: 2� is a DECEDENTSNAME HELEN L. FEGAN ___ _ . STREETAODRESS 1000 CLAREMONTROAD GITV STATE 21P CARLISLE PA '17013 Tax Payments and Credits: �� TaxDue(Page2,Line19) (1) 2,743.56 2. Credi�s/Paymen�s A.Prior Payments 2,500.00 B.Discount 125.00 (SeeinsWdionsJ TotalCredits�A+B) (2) 2,625.00 3. Inleres� (3) 4. It Line 2 is grea�er Ihan Line 1 +Line 7,enter the ditterence.This is Ihe OVERPAYMENT. Fill in oval on Page 2,Line 10 to request a refund. (4) 0.00 5. IfLinel .Line3isgrealerthanLine2,enterthetliRerence.Thisis�heTAXOUE. (5) '118.56 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Diddeceden�makealransferantl'. Yes No a. relainlheuseorincomeofthepmpetlylransfened ._. ._........ ...... ._. ❑ � b. re�ainlhengh�IoOesignalewhoshallusethepmpetlytransfenetlorilsincome _..... ._.. ❑ ❑X c. relain a rever5ionary interest ............ . .......... . . . . ..... . _..... . ........... ❑ ❑X d. receive�hepmmireforlifeofeitherpayments beneflsorcare? .. . ..... . .. _..... .. ..._.._... ❑ � 2. If dea�h occurred aRer Oec.12,1982,ditl decedenl lransler pmpetly wilhin one year o(death withoutreceivingadequateconsideralion? ................ ................ .. . ...._.._._.. .. ........_... ❑ � 3. Diddecedentownan'inWs�foforpayable-upon-0eath6ankawounlorsecunlyathisorherdeath? ......... ❑ ❑X 4. Oid decetlenl own an individual retiremen�accounl,annuity or olher non-pmbale Dmpetly,which an�ainsabenefcia70esignation?......................................................................_.._....._.._._.._.... ❑ � IF THE ANSWER TO ANY OF THE ABOVE�UESTIONS IS YES,VOU MUS7 COMPLETE SCHE�ULE G ANO FILE IT AS PART OF THE RETURN. For tlates of tlea�h on or atterJuly 1, 1994,and before Jan. 1, 1995,ihe tax rate imposetl on Ihe ne�value oi�ansiers�o or forihe use of ihe surviving spouse is 3 perceN[72 P.S.§9116(a)(1.1)(i)I. Por dates of tleaM on or after Jan. 1, 1995,the tax rate imposed on the net value of Vansfers to or for ihe use of ihe suniving spouse is 0 percent �72 P.S.§9116(a)(1.1)(ii)�.The staN�e does not exempt a transierto a surviving spouse irom tax,and ihe sWMory requirements for disclosure of assets antl filing a tax retum are still applicable even if Me surviving spouse is ihe only benefciary. Por dates of death on or afler July 1,2000: • The tax rate imposed on the net value of transfers hom a tleceased child 21 years of age or younger at death to or tor ihe use of a natural parenl,an adoptive parent or a s�ep-paren�of Me child is 0 percent[72 P.S.§9116(a)(12)]. • The W rate imposed on ihe net value o�iransiers to or for ihe use of ihe 4ece�enTs lineal 6eneficiaries is 4.5 percent,except as notetl in �72 P.S. §9116(a)(1)]. • The taz rate imposed on�he net value of transfers lo or for ihe use of ihe decedenfs si6lings is 12 percent�72 P.S.§911fi(a)(1.3�].A sibling is defned, under Secfion 9102,as an individual who has at leas�one parent in common with the decetlent whether by blootl or adoption. REV-0508 E%+(OB42) pennsylvania SCHEDULE E oeanx*Me�roF aevexoc CASH� BANK DEPOSITS & MISC. iNNERIiANCEiF%REiURN aesioervroecEoeNr PERSONAL PROPERTY ESTATE OF: FILE NUMBEk: HELEN L. FEGAN 2'I 15 0 Inclutle[he proceetls of lifigation antl ihe tlate the proceetls were received by Ue es�a�e. All properryloin[ly ownetl wilh right of survivorship mus[be tlisclosed on Schedule F. REM VAWE AT DATE NUMBER �ESCRIPTION OF DEATH 7. MYERS-BUHRIG FUNERAL HOME&CREMATORY 3,575.66 REFUND 2. CLAREMONTNURSINGHOME 853.13 REFUND 3. MARSH U.S. CONSUMER 400.68 REFUND TOTAL(AlsoenteronLineS,RecapiWlalion) S qgpg,q7 If more space is needetl,use aGtlitional sheets of paper olt�e same s¢e. REV4509 EY�(01-10) pennsylvania SCHEDULE F oEraarmervr oF acvEHUE JOINTLY-OWNED PROPERTY INHERIiANCE iA%REiUftN RESI�ENiDELE�ENi ESTATE OF: FILE NUMBER: HELENL. FEGAN 21 15 0 If an asset was made joinlly ownM vriUin one year oi ihe decedenfs date of death,il musl be reported on Schedule G. $URVIVING JOINT TENNNT�S�NAME(5) q�ORE55 REIAiION$HIP TO DECEOENT n. FREDERICK W. FEGAN, II 601 W. MAIN STREET SON MECHANICSBURG, PA 17055 e. C. JOINTLV-OWNED PROPERTY: LEnER DAiE DESCRIPilONOiPROPEfttt %OF pqiEOF�FAiN IiEM FORJOINi MApE INCLU�ENAMEOFFlNANQALINSilipilONFNOBNNKACCOUNiNlIMOERORSiMIIAR pAiEOF�EAiN pECEDENi'S VAWEOF NIIMBER iENnNI JOINi IOENiIfYINGNUMBER. AtiPCH0EE0PoRJ01NilY-HEL�REALESiAiE VqWE0FA55H INiERESi DELE�ENTSINiERE51 1. A. 5/sns55 FULTON BANK 119,787.80 50. 59,893.90 CHECKING TOTAL(Also enter on Line 6,Recapilula�ion) E 59 893.90 Ii more space is neMeC,use atldifional sheets of paper ol Ne same 5¢e. NEV-1511 E%�(0&13) pennsylvania SCHEDULE H oEPnarmc�+roFREVEH�e FUNEf�LEXPENSESAND wHERirarvcErnxaEruaN ADMINISTRATIVECOSTS aEsioErvroECEOENr ESTATE OF FILE NUMBER HELEN L. FEGAN 21 15 0 OeceEent'S Oebis must be reporled on Schetlule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES'. 1. MYERS-BUHRIG FUNERAL HOME&CREMATORY-PREPAID B. A�MINISTRATNECOSTS: 1. PersonalRepresentativeCommissions'. Name�s�olPersonalRevresemative�s) FREDERICKW. FEGAN. II Sveetntltlress 60� W. MAIN STREET Ciry MECHANICSBURG S�ate PA ZIP ��055 veaqs�CommissionPaie�. (RENOUNCED) p nnomeyFees�. MURREL R.WALTERS, III 2,400.00 g FamllyExempla¢(ODextlenPsatltlresslsno[IhesameasdaimenPs,atlachexplanalion.) Claiman� StreetAdOress Ciry State ZIP Rela�iorehip ol qaimanl b Deceeen� a. a�ona�eFees: CUMBERLAND COUNN REGISTER OF WILLS 15.00 FILING FEE FOR INHERITANCE TAX RETURN 5 Am�vnlanlFees: 6. TaxReWmPreparerFees�. ALFREDL.WHITCOMB, EA 325.00 7. TOTAL(Also enler on Line 9,RecapiWla�ion) E p 7q0.00 II more space is nwtletl,use adeitional shee6 ol paper oi Me same size. REK�512 EX�(12-12) pennsylvania SCHEDULE I pEP"fTA1ENTOFiE"E""E DEBTS OF DECEDENT, iHnERirnHce rnxREruRH MORTGAGE LIABILITIES&LIENS aEsioErv*oECEOENr ESTATE OF FILE NUMBEk HELENL. FEGAN 21 15 0 Report tlebis incurred by the tleceEent pnor to death that remainetl unpaid al the dale of deaN,Including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER OESCRIPTION OF DEATH 1. MEDOPTIONS 40.�4 MEDICAL 2. PENNSYLVANIADEPARTMENTOFREVENUE 874.00 2014STATEINCOMETAXES 3. DR. WELMAN Z6.92 MEDICA� 4. DR. PINKER z3.a2 MEDICAL 5. DR. STOKEN �8�9� MEDICAI 6. PHYSICIANSMOBILEXRAY 3'1.90 MEDICAL TOTAL�AIsoenteronLinelO,RecaDiiulalion) S � 015.48 If more space is needed,inseh adEi�ional shee�s otihe same sixe. aev-is�3�x.iovioi pennsylvania SCHEDULE J OEPFRTMENT OFREVENUE BENEFICIARIES INHERRhNCE iA%0.ETURN FESIDENI�ECE�ENi ESTATE OF: FILE NUMBER: HELENL. FEGAN 2'I 15 0 RELATIONSHIPTO�ECE�ENT AMOUNTORSHARE NUMBER NAMEAN�AODRESSOFPERSON(S�RECEIVINGPROPERTY DoNatListTrustee�s) OFESTATE � TAXABLEDISTRIBUTIONSpndudeauNghlspousalGisNbNionsanelranskrsunder Seu 9116(al P.2)J t. FREDERICK W. FEGAN, II Lineal 601 W. MAIN STREET MECHANICSBURG, PA 17055 EMER DOLIARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18OF REV-1500 WVER SHEET,AS APPROPRIATE. ❑. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNOER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN'. 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTION51 1. TOTAL OF PART II-EMER TOTAL NON-TAXABLE DISTRIBUTIONS ON LWE 13 OF REV-1500 COVER SHEET. S I�more space is needed,use additional shee�s of paper o(the same size.