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Home My WebLink About04-23-15 J pennsylvania 1505618148 DEPAR1.1.1 REVENUE EX(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT o2 15 3� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 02212015 03201921 Decedent's Last Name Suffix Decedent's First Name MI SHUGHART RUTH W (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI 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. Agriculture Exemption(date of Q 5. Future Interest Compromise(date of Q 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) 7. Decedent Died Testate Q 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) Q 10. Litigation Proceeds Received Q 11. Non-Probate Transferee Return Q 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) Q 13. Business Assets 0 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT—THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT G. FREY 7172435838 First Line of Address 5 SOUTH HANOVER STREET Second Line of Address City or Post Office State ZIP Code CARLISLE PA 17013 Correspondent's email address: R F R E Y o9 F R E Y T I L E Y .C O M REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY C� DATE FI=D TAMP r7 �' O PLEASE USE ORIGINAL FORM ONLY Side 1 rr-- 1505618148 1505618],48 Cn 1505618155 REV-1500 EX Decedent's Social Security Number Decedent's Name: RUTH W SHUGHART RECAPITULATION 1. Real Estate(Schedule A). . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . .. . . . . . . . . . 1. 0. 00 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. 2. 11.011 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C). . . . . . . 3. 0 .00 4. Mortgages and Notes Receivable(Schedule D). . . . .. . . . . . . . . . . . . . . . . . . . . . . 4. 0 . 00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . .. . . 5. 839. 20 6. Jointly Owned Property(Schedule F) =Separate Billing Requested. . . . . . . . 6. 0 .00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) =Separate Billing Requested.. . . . . . . 7. 0 . 00 8. Total Gross Assets(total Lines 1 through 7).. . . . . .. . . . . . . .. . . . . . . . . . . . . . . 8. 839. 20 9. Funeral Expenses and Administrative Costs(Schedule H). . .. . . .. .. . . . . . . . .. . 9. 860. 50 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). . . .. . . . . . . . . . . . 10. 12495 . 34 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .11. 13355. 8 4 12. Net Value of Estate(Line 8 minus Line 11). . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . 12. -12516. 6 4 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. -12516 . 64 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.0 45 16. 0 . 00 17. Amount of Line 14 taxable at sibling rate X . 12 17. 0. 00 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0 . 00 19. TAX DUE. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 19. 0. 0 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNATURE ERSON Fe.PONSl,4LE FOR FLING RFETURN DATE 5 ADDRESS 16 ORIONROAAD BOILING SPRINGS PENNSYLVANIA SIGNATURE � EPARE R THA PER RESPONSIBLE FOR FILING THE RETURN r 2 -,7,,/ ADDRESS 5 SOUTH HANOVER STREET ARLISLE PENNSYLVANIA 1111111111 III1I 111111111111111111111111 Jill Side 2 1505618155 1505618155 REV-1500 EX Page 3 File Number 205-07-0197 Decedent's Complete Address: 21-15-373 DECEDENT'S NAME RUTH W SHUGHART STREETADDRESS 770 SOUTH HANOVER STREET CITY STATE 717013 P CARLISLE PA Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount (See instructions.) 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............................................................................... ❑ K b. retain the right to designate who shall use the property transferred or its income................................. 11 IN c. retain a reversionary interest.................................................................................................................. ❑ Xr d. receive the promise for life of either payments,benefits or care?.......................................................... ❑ Rr 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of deathrv� without receiving adequate consideration?.................................................................................................. ElzI 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?................................ ❑ 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 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a step-parent 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 F2 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-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT TOF AX RET PERSONAL PROPERTY INHERITANCE TAX RETURNRN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Ruth W Shughart 21-15-373 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. Ewing Brothers Funeral Home overpayment 191.83 2. M&T Bank 392.07 3. Chapel Pointe personal account 255.30 TOTAL(Also enter on line 5, Recapitulation) $ 839.20 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(02-15) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Ruth W Shughart 21-15-373 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 500.00 Name(s)of Personal Representative(s) Mary Gensler Street Address 16 Orion Road city Boiling Springs State PA zip 17007 Year(s)Commission Paid: 2015 2. Attorney Fees: 250.00 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: I 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 860.50 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(02-15) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEBTS OF DECEDENT, RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Ruth W Shughart 21-15-373 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. Department of Welfare 12,495.34 TOTAL(Also enter on Line 10, Recapitulation) $ 12,495.34 If more space is needed,insert additional sheets of the same size. EWING BROTHERS FUNERAL HOME, INC. 16079 STEVEN A.EWING,PRESIDENT/SUPERVISOR 630 SOUTH HANOVER STREET 60-7269/2313 CARLISLE, PA 17013 2/26/2015 (717)243-2421 PAY TO THE 6i ORDER OF Mary E. Gensler $ *"191.83 '`' One Hundred Ninety-One and 83/100************************************************************************ DOLLARS Mary E. Gensler b� G MEMO E Refund for Ruth W. Shu hart 1120000016079n' 4231372690: 289 L04SIB 2Ila HOLD DOCUMENT UP TO THE LIGHT TO VIEW TRUE WATERMARK•( 8 t .� •HOLD DOCUMENT UP TO THE LIGHT TO VIEW TRUE WATERMARK M&T Bank 200499359 -� i Manufacturers and Traders Trust Company BUFFALO,N.Y.14240 {- � 10-4/220 DATE 04/07r•'2015 ' REMRTER 8tM. PAY TO THE ORDER OF r•1a.,-•,,, E Gensler Exe $ **'Tl='•.REE HIJF.1DF'.ED NINETY TI;ICS r:11 1.1 i,'2�u r#::k I_i:,f. 11•�r:_• TWO AUTHORIZED SIGNATURES REQUI F MOUNTS OVER w AUTHORIZED SI NATURE w Ila 200499 3 5911' i:0 2 20000461: 1700 20 199 2604 711' ��. gag 0- = 1Ba`nk = anua urer� Trace TruUZo mpany. -----�— = ltosna F'A60_ 01 0300001712 Ch apel Po in to at Carlisle: TM 313 . 770 South Hanover Street,Carlisle, PA IM13-41m, April 10, 2015 TWO HUNDRED FIFTY FIVE DOLLARS AND THIRTY *******255.30 CENTS Pay to fhe order of Mary Gensler Mary Gensler 16-Orion Road Boiling Springs, PA 170( 7 -