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Home My WebLink About05-08-15 i iiin i �� e��g�T�o��Ea 1505618403 �X(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburq,PA 17128-0601 RESIDENT DECEDENT 21 (�j C�7?-- ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDVYYY 01 20 2015 04 06 1925 DecedenYs Last Name Suffix DecedenYs First Name MI BORGER CORA q (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 OVALS BELOW � 1. Original Return � 2. Supplemental Return � 3. Remainder Return(date of death prior to 12-13-82) � q. Agricultural Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) � 7. Decedent Died Testate � 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) — � 10. Litigation Proceeds Received �X 11. Non-Probate Transferee Return � 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) � 13. Business Assets � 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 LINDA J OLSEN 717 54❑ 4332 First Line of Address 2000 LINGLESTOWN ROAD Second Line of Address SUITE 202 City or Post Office State ZIP Code HARRISBURG PA 17110 ,-�> �-�� CorrespondenYs email address: �olsen(cahazenelderlaw.com n �' ",",� �� '.� C-� C:� REGj9jTE OF WILL ' E ONbY-�- ...,,�.� ....;. n ..._.a C::l REGISTER OF WILLS USE ONLY -"'.. '-.��" �"��" '��"�, (�"��1 DATE FILED MMDDYYYY - � �`� ; _ ,..,� _� '.,y ,. .� � -��1 , .. ' , ,.. t_.'J . fV t .,_ �-rl �._ DATE FILED ST AA� U� � Side 1 � I II�I�I III�I'llll�il�l�III��IIII II�II I�III IIIII I�I'�IIII IIII 1505618403 � � ,� i ' cii� � - -<--.: --- - -- _._ __ , , - -- _-----.------ - _ - -- _ -- , _ .. -- ! -- ---- - •-- -- I � 15056b843Z I� REb-1500 IX I DecedenCs Social Security Number ; DeeedenYs Name: Borger,Cora Alice RECAPITULATION i 1. Real Estate(Schedule A)....................................................................................... 1. � 2. StOcks and Bonds(Schedute B)............................................................................. 2. 3. Cbsely He�Corpora8on,Padne�shtp o�Sole-Propdetorship(Schedule C)......... 3. � � 4. MoR a es and Notes Receivable Schedule D � 9 S ( ).................................................... 4. � L 5. Cash,Bank Deposits and Misceilaneous Personal Property(Schedu�e E).......... 5. � 6. Jotn Owned Pro � tly perty(Schedule 6ng eq ` � separate ai� R uescea............ s. 8 8 2-3 2 � 7. Inter-VAros Transfers&MisceAan�ua Non-Probate Property i (Schedule G) . ❑ Separate BilGng Requested............ 7. • `I € 8. Total Gross Aaaets(total Unes 1 through 7j........................................................ 8. 882•32 ` 9. Fuoeral Expenses and AdmiNstrative Costs(Schedule Fn.................................... 9. 9 71•9 4 �- � 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule q............................ 10. b 5,13 5•3 4 h F 11. Total Deducdona total Lines 9 and 10 ' ( )........................................ .. �1. 16,107.28 �, ...................... i 12. Net Value of Estate(Line S minus Une 11).......................................................... 12. -15,2 2 4.9 6 i 13. Charitable and Govemmental 8equestsJSec 9113 Trusts for which � � an eledion to tax has not been mr:de Schedule J � ( )............................................... 13. ' 14. Net Value Subject to Tax(Une 12 minus Line 13)............................................... 14. -15,2 2 4.9 6 � TAX CALCULATION-SEE INSTRUCTiONS FOR APPLICABLE RATES 15. Amount of Li►�e 14 taxable at the spousal tax rate,or � transfe�s under Sea 9116 (a)(1.2)X.00 15. ��0� 16. Amow►t of Line 14 taxable at 6neal rate X .045 0•0 0 16. 0•00 1�. Amour►t of Line 14 taxable at sibiin9 rate x_�s 0•0 0 ��. p.p p ' 18. Amount of Line 14 taxable at collateral rate X.15 �•0 0 18. 0•00 0•00 �' 19. TAX DllE................................................................................................................ 19. ; 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Under penalqes of perJury,l deGare I have examlrted tlds reWm,indutling aCppmpanying echedules and statements,and to the besl of my knowledge and belief, ft fs We,oorrect and aomplete.Dedaratlon of preparer ofher tl�an the person respor�sible for Nling tl�e retum Is based on all iMonna�on of which preparer hes ' any knrnMedge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Mark C Borger /J� / /�Q`�^ �►� �i �� /S /�R-�. �- / � ADDRESS 2254 Canterbu Dr.,Mechanicsburg,PA 17055 SIGNATURE EPARER OT TNA ,P SENTA7IVE Linda J.Olaen on� _� � AO ' ' 2000 Ling estpwn Roa ,Harrishurg,PA 17110 ', � {III�I Ildl�II Ii�l IIIiI alll I(III IIIII IIIII IIIII Ila IIII S�e 2 ; � 15056b841b 15056Z84ZZ J i u oii� � REV-1500 EX Page 3 File Number 21 Decedent's Complete Address: DECEDENT'S NAME Borger, Cora Alice STREETADDRESS 100 Mt.Allen Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +g� (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �4� Check box on Page 2,Line 20 to request a refund 5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 0.0� Make Check Pa able to: REGISTER OF WILLS, AGENT. ��;�' , '';�� ,;a� ��„� .�� 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:................................ .............................................. ❑ � b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ ❑x d. receive the promise for life of either payments,benefits or care?............................................................ ❑ �x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ ❑x 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x 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. � �b �\\� � �� s �� A��, „�� , s'a � A�� . �0�� a��i`�\��a��i�0��`��, 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 January 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[72 P.S.§9116(a)(1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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. 1II 0 II.IIIII.11 . 1 Rev-1509 EX+(07-10) pennsylvania SCHEDULE F DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Borger, Cora Alice 21 If an asset was made joint within one year of the decedenYs date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Mark C. Borger 2254 Canterbury Dr. Son Mechanicsburg, PA 17055 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INUMB�ER 0 SEMILARNDENTIFY NG INUMB RAATT CHK EED�FOR DATE OF DEATH DECD�S DECE ENT'S NTEREST NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSE INTEREST 1 A 02/26/2003 PSECU checking/S4 174.84 50.000% 87.42 2 A 02/26/2003 PSECU cking/Reg share S1 399.77 50.000% 199.89 3 A 02/26/2003 PSECU Money Market/S7 1,190.01 50.000% 595.01 TOTAL(Also enter on Line 6, Recapitulation) 882.32 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10) � u i iiin � REV-1511 EX+�08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE F U N E RAL EXP E N S ES AN D INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Borger, Cora Alice 21 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N MB A. FUNERAL EXPENSES: See continuation schedule(s)attached 221.94 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2, Attorney's Fees Hazen Elder Law 750.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address Citv State Zin Relationshio of Claimant to Decedent 4. Probate Fees 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs TOTAL(Also enter on line 9, Recapitulation) 971.94 Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.08-13) I.IIV�iI. Ill 1111.11... 1 SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Borger, Cora Alice 21 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex ep nses 1 Funeral luncheon-Bert's Steakhouse 221.94 H-A 221.94 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) I.iIEBIIIIl.LII111 1 Rev-1512 EX+(12-12) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Bor er, Cora Alice 2� 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 PA Department of Human Services-Category 3 portion of estate recovery claim 15.135.34 TOTAL(Also enter on Line 10, Recapitulation) 15,135.34 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12) 1.11�tll. I11 1111��1�. 1 REV-7513 EX+(Ot-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Bor er, Cora Alice 2� RELATIONSHIP TO NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE PERSON(Sl RECEIVING PROPERTY i (Words) ($$$) I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 Mark C. Borger One-half of the 2254 Canterbury Dr. residue. Mechanicsburg, PA 17055 Susan D. DeCarlo One-half of the 101 Spruce Dr. residue. Fair Haven, NJ 07704 Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) imd ii n�n� � OO O15 Hazen Elder Law 2000 Linglestown Rd. Suite 202 Harris6urg;Pa 17 i]0 Re: CORA BORGER, Deceased. PSECU Reference#8509812783251 Dear Ms. Eggers Woodhouse: The above referenced person has an account with PSECU which was opened on 02/26/2003. The Share accounts were jointly heid by CORA BORGER and MARK BORGER. The following are the Date of Death Balances for CORA BORGER's account with PSECU: Account Date of Death Balances Interest—January 1-20th Savings (S1) $ 399.77 $ 0.09 Checkin� (S4) $ 174.84 $0.03 Money Market (S7) $1,190.01 $ I).13 The joint owner needs to close the decedent's account with PSECli at the earliest convenience. If you have any questions,please contact our department toll-free at(800 j 237-7328,press 6, extension 3120 or email accountservicesnu,psecu.com. Sincerely, ' W� Dana Willard Member Service Representative PSECU i�� ^ �---;� 5-� �'�, � �,; ,i�. � �`:> �__-t �� il'�` � l�,l �' f,�;=,;; •"y J �u i5 P. O. BOX 67013 HARRISBURG, PA 17106-7013 800.Z3�.7328 �=psecu.com __ _ _ _ _ THIS CREDIT UNION IS FEDERALLY INSURED BY THE NATIONAL CREDIT UNION ADMINISTRATION.EQUAL OPPORTUNITY LENDER. iiiou ii nin. i H�N LivJ� �W Estate Plartning �^ �;1��c�'e�r Law • Special Needs Planning 2000 Linglestown Road Te.►.:(71'� 540-4332 Suite 202 FaY: (71�540�313 Harrisburg, PA 17110 www.HazenElderLaw.com May 5, 2015 �v c� � �� -a �. � � Q :"� ��> � Register of Wills �, ,� � � �, ,;�, Cumberland County Courthouse ;: ��- ; r; '" �'' CQ 7 �») One Courthouse Square ' � Carlisle, PA 17013-3387 ` �_ -r� ;; r"r; , ,, � -;� _.::`.: c7 Re: Estate of Cora A. Borger ' '�`� ' �" �� File No.: 21- + �a � ._�',y -,� Social Security No.: 191-14-9632 Inheritance Tax Return To: The Register of Wills: Enclosed for filing please find the original and one copy of the above-referenced Inheritance Tax Return, along with a copy of the first page of the Inheritance Tax Return. Please date stamp the first page of the return and return it to iny office in the enclosed self-addressed envelope. Also enclosed is a certified Death Certificate and a check for the filing fee in the amount of$15.00. If you have any questions or require any additional information, please do not hesitate to contact me. Sincerely, ( �„�.�r c�.�' �`'�a��y`'y? � Corinne Eggers Woodhouse Paralegal Enclosures cc: Mark Borger, Personal Representative OK�'��(SS '91"IIIII I�IIII y - O � CC� 7� c � � � c� o CD � � � � � N � a � � � � � Z o Q- � � � o � o � �a � � � U � � � w� r � � � w � `� ,._, s�. 7� w ?� � � � � � � � ,_�� c � � `:__� � � `� �-, �3 m � c� � � _�.': � .:�3 �� n � N , .T �� . c� c� - - 4;�� --c �> :� , _.. . _ --'- � �. �__ ,:� . ., � � , �-r7 I ` ` '_:7 ? _.�"� t -C; j � w' < <:�`> �V �_._ t�l . C�) C+7 CJ -.,7 _r7 .. .� v± r ', uNITEps� ', '9.� 9V;� � r ,'-x '- N _ � z; ,:� ' �, � Y.P" �� y =r�-. =.:ex� � � � � `' z r .�� m 'E� y < ,. �p��q � yq � .. . �OY�lmi _., <.;iT !,;Y ��!mfl'�i�� .,_ �