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Home My WebLink About06-03-15 (2) Jis pennsylvania 1505618403 DEPARTMENT OF REVENtX(03-14) REV-150110 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 14 00947 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 09 21 2014 10 25 1934 Decedent's Last Name Suffix Decedent's First Name MI LEBO L R (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI LEBO CAROLYN M THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return 51 2. Supplemental Return 1:1 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) FRI 7. Decedent Died Testate 8. Decedent Maintained a Living Trust 0 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) EJ13. 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 IVO V OTTO III 717 243 3341 First Line of Address 10 EAST HIGH STREET Second Line of Address City or Post Office State ZIP Code ,v CARLISLE PA 17013 r � � C:) M r iotto martsonlaw.com C=r:^r �� Correspondent's email address: I -I i -REGISTER OF,VVILL&USE ONLY REGISTER OF WILLS USE ONLY 3 DATE FILED MMDDYYYY I" rn DATE FILED STAMP Side 1 I��I�I II��I�IIII 1505618403 5056114I3 1505618403 1505618411 REV-1500 EX Decedents Social Security Number oeoedenra Name: Lebo, L Robert 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 Misceflaneous Personal Property(Schedule E).......... 6. 4,748-85 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivol Transfers S Miscellaneousol�[kProbate Property (Schedule G) L J Separate Billing Requested............ 7. 8. Total Gross Assets(total Unes 1 through 7)........................................................ 8. 4,798-85 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 163-41 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Unes 9 and 10)................................................................ 11. 163-41 12. Net Value of Estate(Line 8 minus Una 11)...............:.:..::.....:.....:............... .....:.... 12. 4-e635-44 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Une 12 minus Line 13)............................................... 14. 4-v635-44 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 0.00 15. 0.00 16. Amount of Una 14 taxable at lineal rate X.045 41635.44 16. 208-59 17. Amount of Line 14 taxable at sibling rate X.12 0.00 17. 0-00 18. Amount of Line 14 taxable at collateral rate X.16 0.00 18. 0.00 19. TAX DUE................................................................................................................ 19. 208-59 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Under penalties of per►ury,I declare 1 have examined this retum,including accompanying schedules and statements,and to the best of my knorAedge and belief, it is true,correct and complete.Declaration of preparer other own the parson responsible for filing the return is based on all Infomration of which preparer has any knowledge. SIGNATU P SONESPOrNSIIBLE OR RUNG RETURN Barbara Jo Lebo Massam OLIV- � 30/is .. _ ADDRESS 27 Broadview TaAace.Chatham NJ 07928 SIGNATURE OF PREPARER REP SEN7~ATNE Ivo V.Otto III cis- -ADDRESS 10 East High Street,Carlisle,PA L 111111 IN IM IM 111111IN In II�IIq MI Side 2 1505618411 .J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Lebo,L Robert 21.14-00947 Under penalties of perjury,I declare that 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 personal representative is based on all Information of which pwarer has any knowledge. Signature#2 -Z L Name Debra Ann Lebo Addressl 1808 Dellabrooke Farm Lane Address2 City,State,Zip Brookeviile,MD 20833 Date 5.2 8 •15 Signature#3 Name MarclaLynne Lebo Baker Addressl 3419 Canyon Creek Address2 City,State,Zip Mechardcsbu!%Pk 17055 Date PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Lebo,L Robert 21.14-00947 Under penalties of perjury,I declare that 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 personal representative Is based on all information of which preparer has any knowledge. Signature 02 Name Debra Ann Lebo AddreBsl 1806 Dellabrooke Farm Lane Addm992 City,State,Zip Brooksville.MD 20833 Date Signature#3 4� Name Marell Lynne Lebo Baker Addregsl 3419 Canyon Creek Address2 City,State,Zip Mechanicsburn.PA 17055 Data 2 Ol 11S REV-1500 EX Page 3 File Number 21-14-00947 Decedent's Complete Address: DECEDENT'S NAME Lebo, L Robert STREET ADDRESS 58 Round Ridge Road CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 208.59 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 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) 208.59 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;................................................................................ ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ F. 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. 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-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OFPERSONAL PROPERTY INHERITANCE TAXAXRETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lebo, L Robert 21-14-00947 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 American Express 79.17 2 Commonwealth of PA State Treasury Department-Refund from 2014 PA-40 return 303.00 3 Encompass Insurance-Refund of homeowner's premium 321.00 4 Highmark-Premium refund 72.00 5 United States Treasury-Refund 436.68 6 United States Treasury-Refund from 2014 1040 return 3,587.00 TOTAL(Also enter on Line 5, Recapitulation) 4,798.85 (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 E(Rev.08-12) REV-1511 EX+(08-13) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DEC ENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Lebo, L Robert 21-14-00947 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 Zia Year(s)Commission Paid 2, Attorney's Fees 143.97 See continuation schedule(s) attached 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio RelationshiD of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 19.44 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 163.41 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 Lebo, L Robert 21-14-00947 ITEM NUMBER DESCRIPTION AMOUNT Attorney Fees 1 Martson Law Offices-Estimated Attorney Fees for Supplemental PA Inheritance Tax 143.97 1-1-132 143.97 Other Administrative Costs 2 United States Postal Service-Certified delivery fees to mail letters, releases and partial 19.44 distribution checks to beneficiaries H-B7 19.44 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 Lebo, L Robert 21-14-00947 NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) DoTrust I TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Marcia Lynne Lebo Baker Daughter 3419 Canyon Creek $1 , 545 . 15 Mechanicsburg, PA 17055 2 Debra Ann Lebo Daughter $1 , 545 . 15 1806 Dellabrooke Farm Lane Brookeville, MD 20833 3 Barbara Jo Lebo Massam Daughter $1 , 545 . 14 27 Broadview Terrace Chatham, NJ 07928 Total $4535 .44 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appopriate, 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)