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Home My WebLink About05-28-15 1],1pennsylvania 1505618403 rn1•wT' OE,g....OFREVENI�E1X(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 15 q Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 02 02 2015 Decedent's Last Name Suffix Decedent's First Name MI MCDOUGALL DONALD G (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI MCDOUGALL LOIS J THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW FRI 1, Original Return 2. Supplemental Return 3. Remainder Return(date of death prior to 12-13-82) 4, 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) R 7. Decedent Died Testate S. Decedent Maintained a Living Trust9. 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) D13. 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 EDMUND G MYERS (717) 761 4540 First Line of Address 301 MARKET STREET Second Line of Address PO BOX 109 City or Post Office State ZIP Code I LEMOYNE PA 17043 Correspondent's email address: egm@?Jdsw.com G o REGISTER OF WILLS US,E C1,N Y tv 1 REGISTER OF WILLS USE ONLY CDO DATE FILED MMDDYYYY W UO DATE FILED STAMP W r i Side 1 IIIII�IIIIIIIIIIIIII�IIIII�IIIIIII�IIIIIII�I�IIIIIIIIIIII�'I 1505618403 0/� 1505618411 REV-1500 EX Decedent's Social Security Number Decedent's Name: McDougall, Donald G RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 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 Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 214 ,687 - 34 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 214 ,687 - 34 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 15 - 00 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 15 - 00 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 214 ,672 - 34 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. 214 ,672 - 34 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.00 214 ,6 7 2 . 3 4 15. 11 - 00 16. Amount of Line 14 taxable at lineal rate X .045 0 . 00 16. 0 . 011 17. Amount of Line 14 taxable at sibling rate X.12 11 - 00 17• 0 . 011 18. Amount of Line 14 taxable at collateral rate X.15 11 - 110 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 0 . 00 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. SIGNAT RE OF PE ON RESPON LE FOR FILING RETURN Lois J McDougall DATE 15 AWE S 4833 Est rndle Road, nnicsburg, PA 17050 SIGN OF P P E H R THAN REPRESENTATIVE Edmund G. Myers DATE lu 512 W I S ADDRESS 301 MARKET STREET, Lemoyne, PA 11111111111111111111IIII III111111111111111111111111IN Side 2 1505618411 1505618411 ' REV-1500 EX Page 3 File Number 21-15 Decedent's Complete Address: DECEDENT'S NAME McDougall, Donald G STREET ADDRESS 4833 East Trindle Road Apt. 577 CITY STATE ZIP Mechanicsburg PA 17050 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 +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. (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) 0.00 Make Check Payable to REGISTER OF WILLS, AGENT NA X 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;............................................................................... ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ 0 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?.................................................................................................................... ❑ 0 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. „r, .. rte,,,,.,, .,,..i, 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 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-1510 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF MISC. NON-PROBATE PROPERTY RET INHERITANCE TAXAXRETURRNN RESIDENT DECEDENT ESTATE OF FILE NUMBER McDougall, Donald G 21-15 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THINCLUDE DATE OF TRANSFERS ATTACH THEIR COPYOF THE RELATIONSHIP FOR DECEDENT ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 American Century Investments IRA-IRA Fund 214,687.34 214,687.34 0000956 Beneficiary: Lois J. McDougall,Surviving Spouse Date of Death Letter from American Century Investments is Attached to this Schedule G TOTAL(Also enter on Line 7, Recapitulation) 214,687.34 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) American Century Investments® March 23,2015 Dear Client: This letter provides the value(s)of account(s)for Donald G Mc Dougall. As-of-Date Fund Accounts Account Account Share Registration Value Balance CUSIP IRA(Traditional, Not 02/02/2015 0000956 XXXXXXX0419 Rollover, SEP or $214,687.34 16,565.381 Provided SIMPLE) If any of the above accounts are IRAs, please note the following: Shares held in a retirement account that is registered under the Internal Revenue Code may not be assigned or pledged to a third party. It is possible that the above information should not be considered in any way in a financial institution's determination of eligibility for financing, including establishing creditworthiness. Loans are not an option for IRAs and Roth IRAs. The value of an account may fluctuate daily in accordance with changes in the market value of the mutual fund shares held in the account. You can calculate the share price for each account by dividing the account value by the share balance. For example, if the account value is$100 and the share balance is 5 shares,the share price is$20 ($100/5 shares). American Century Investments American Century Investments 555374 P.O.Box 419287 (800)345-7412 Kansas City,MO 64141-6287 americancentury.com REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER McDougall, Donald G 21-15 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationshio of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 15.00 Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER McDougall, Donald G 21-15 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Cumberland County Register of Wills Office-Filing Fee for Inheritance Tax Return 15.00 H-B7 15.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER McDougall, Donald G 21-15 NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List use s ITAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Lois J McDougall Spouse Entire Estate 4833 East Trindle Road Apt. 577 Mechanicsburg, PA 17050 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. 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 11 -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) American Century Investments® March 23, 2015 Dear Client: This letter provides the value(s) of account(s)for Donald G Mc Dougall. As-of-Date Fund Accounts Account Account Share CUSIP Registration Value Balance IRA(Traditional, Not 02/02/2015 0000956 XXXXXXX0419 Rollover,SEP or $214,687.34 16,565.381 Provided SIMPLE) If any of the above accounts are IRAs, please note the following: Shares held in a retirement account that is registered under the Internal Revenue Code may not be assigned or pledged to a third party. It is possible that the above information should not be considered in any way in a financial institution's determination of eligibility for financing, including establishing creditworthiness. Loans are not an option for IRAs and Roth IRAs. The value of an account may fluctuate daily in accordance with changes in the market value of the mutual fund shares held in the account. You can calculate the share price for each account by dividing the account value by the share balance. For example, if the account value is$100 and the share balance is 5 shares, the share price is $20 ($100/5 shares). American Century Investments American Century Investments 555374 P.O.Box 419287 (800)345-7412 Kansas City,MO 64141-6287 americancentury.com JERRY R.DUFFIE L A W O F F I C E S BARRIE B.GEHRLEIN RICHARD W.STEWART T W.DARREN POWELL EDMUND G.MYERS OH SON CAROYANTHONIY T.LucIDO B.MCCLAIN DAVID W.DELUGE �1 JOHN A.STATLER DUFFIE JOHN A.LUCY JEFFREY B.RETTIG MATTHEW RIDLEY MARK C.DUFFIE KAREN L.MASCIO JOHN R.NINOSKY BRIAN W.CARTER MICHAEL J.CASSIDY MELISSA P.GREF.VY OF COUNSEL WADE D.MANLEY 1914-2014 HORACE A.JOHNSON C.ROY WEIDNER,JR. May 27, 2015 Register of Wills Office F =; Cumberland County Courthouse ?' One Courthouse Square i Carlisle, PA 17013 ' ry 1 RE: Estate of Donald G. McDougall, Date of-Death: February 2, 2015 Our File No. 8295-1 y' Dear Register. , CA) Enclosed for filing, please find the following: 1. 2 Original Pennsylvania Inheritance Tax Returns. This is a spousal estate and there is no tax due. 2. Two (2) copies of Page 1 of the Inheritance Tax Return that we ask that you time- stamp and return to us. 3. Our check in the amount of $15.00 representing the filing fee for the Inheritance Tax Return. Thank you for your assistance in this matter. Should you have any questions, or require any additional information, please feel free to contact us. Very truly yours, HNSON, DUFFIE, STEWART &WEIDNER UVW Dana Wieseman Estate Administration Paralegal Enc. c: Lois J. McDougall :702478 301 MARKET STREET P.O.Box 109 LEMOYNE,PENNSYLVANIA 17043-0109 WWW.JDSWCOM. 717.761.4540 FAX: 717.761.3015 MAIL@JDSW.COM JOHNSON, DUFFIE, STEWART & WEIDNER, P.C. ■ FIRST-CLASS I:IAfL C f i ( ' 05/27!2015 Rcs � I z= �� s $01 .612 zQ 'S MRY 2 8 PM 2 53 6 r ZIP 17043 o1 621515 First Class Mail I LAW OFFICES 301 Market Street P.®.Bog 109 O li V SOl V Lemoyne,PA DUFFIE 17043-0109 TO: REGISTER OF WILLS OFFICE �. CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17013