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Home My WebLink About05-15-15 (2) 1505614134 EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 3 1 9 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 3 1 7 2 0 1 4 0 3 1 4 1 9 3 5 Decedent's Last Name Suffix Decedent's First Name MI ORN E R MERLE L (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 ❑X 2.Supplemental Return ❑ 3.Remainder Return(date of death Prior to 12-13-82) ❑ 4.Agriculture Exemption ❑ 5.Future Interest Compromise(date of1:16.Federal Estate Tax Return Required (date of 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 ❑ 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 R M A R K THOMAS 7 1 7 7 9 6 2 1 0 0 First Line of Address 1 0 1 SOUTH MARK E T STREET Second Line of Address City or Post Office State ZIP Code MECHANICSBURG P A 1 7 0 5 5 ,u Correspondent's e-mail address: RMARKTHOMAS@GMAIL.COM C,31 u m rrt o REGISTER OFuPdIIL USE ON=3 Cn REGISTER OF WILLS USE ONLY I� F-', M DATE FILED MMDDYYYY C.n C7 W r- ..rn DATE FILED STsAMP CD PLEASE USE ORIGINAL FORM ONLY Side 1 I IIIIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIII 1505614134 1505614134 J 1505614234 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: MERLE L. ORNER RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . .. . . . .. .. .. .. . . . . . . . . . . . . . . . . . . . .. . 1. 2. Stocks and Bonds(Schedule B) . . . .. .. . . . . . . . . . . . . .. . . .. .. . . . . . . . . .. . 2. 1 5 4 9 7 . 8 6 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) ❑ Separate Billing Requested .. . . . .. 6. 7. Inter-Vivos Transfers&Miscellaneous N -Probate Property (Schedule G) Separate Billing Requested .. . . . . . 7. 8. Total Gross Assets total Lines 1 through 7 8, 1 5 4 9 7 , 8 6 9. Funeral Expenses and Administrative Costs(Schedule H) . . .. . . . . .. . . . . . . . . 9. 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . .. . . . .. . 10. 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . .. .. . . . . . . . .. . . . . 11. 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . .. .. .. .. .. .. . . . . . .. . . 12. 1 5 4 9 7 . 8 6 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. 1 5 4 9 7 . 8 6 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 _ 15. 16. Amount of Line 14 taxable at lineal rate X.0_ o 16. 17. Amount of Line 14 taxable at sibling rate x.12 1 5 4 9 7 . 8 6 17. 1 8 5 9 . 7 4 18. Amount of Line 14 taxable at collateral rate X.15 o 18. 19. TAX DUE . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . .. .. .. . . . . .. . . . . . .. . 19. 1 8 5 9 . 7 4 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ 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. SGNfU!r Pc�S�PERSON RPLE FOR FILING RETURN DATE rADERRESS 421 PAWNEE DIRWE MECHANICSBURG PA 17050 S �PAR O THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS !�. P� V / c� ' i ' I- 7O�V �1 I IIIIII VIII VIII VIII VIII VIII VIII VIII VIII IIIII'lll IIII Side 2 1505614234 1505614234 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 21 14 0319 DECEDENT'S NAME MERLE L. ORNER STREET ADDRESS 21 LONESOME ROAD CITY STATE ZIP NEMILLE [A 17241 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,859.74 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 oval 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) 1,859.74 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 ...................................................................... ❑ ❑ b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑ c. retain a reversionary interest ..................................................................................................... ❑ ❑ d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑ 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? ......... ❑ ❑ 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[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+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER MERLE L.-ORNER 21 14 0319 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. WELLS FARGO STOCK-ACCOUNT 3402186398 15,497.86 DATE OF DEATH VALUE TOTAL(Also enter on Line 2,Recapitulation) $ 15 497.86 If more space is needed, insert additional sheets of the same size Shareowner Services Post Office Box 64874 • St.Paul,MN 55164-o874 sh a reown a ro n l i n e.com R MARK THOMAS February 27,2015 ESTATE OF MERLE L ORNER 1o1 SOUTH MARKET ST MECHANICSBURG PA 17055 Re:Share Balance Summary Account number.3402186398 Registration: MERLE L ORNER 55 LONESOME RD NEWVILLE PA 17241-9732 Account creation date: January 7,1999 Issue name of stock: Wells Fargo&Company Total share balance on March 17, 2014: 322.000 Certificate shares: .000 DRS/book-entry shares: 322.000 Plan shares: :000 Dividend Amount Paid YTD: N/A Closing price per share on March 17,2014: $48.1300 Estimated value: $15,497.86 Ticker symbol for the company: WFC Stock exchange: NYSE Please note that as a transfer agent,we are not directly connected to the stock market.The above price is.given as an estimate and is not a guarantee of a specific price.The estimated value may lose value and is not guaranteed. If you have any questions,you can send us an email by selecting"Contact Us"at any time while online at shareowneronline.com.You can also call 877-840-0492 to talk to a shareowner relations specialist Monday through Friday from 7:oo a.m.to 7:00 p.m.Central Time. Sincerely, Wells Fargo Shareowner Services 16 111111111111111 IT IN *ZFN00058I1661iIiIy'oIYIYIY*6