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Home My WebLink About06-09-15 (2) 2010 1505614134 EX(03-14)(FI) REV-1 500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 5 0 1 4 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 1 0 2 2 0 1 5 0 4 2 8 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI Y O S T N O R M A R (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 ❑X 1.Original Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(date of death Prior to 12-13-82) ❑ 4.Agriculture Exemption ❑ 5. Future Interest Compromise(date of ❑ 6. Federal Estate Tax Return Required (date of death on or after 7-1-2012) death after 12-12-82) ❑X 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 D A V I D R GALLOWAY 717 697 4700 First Line of Address WALTERS & GALLOWAY , P L L C Second Line of Address 54 E . MAI N ST City or Post Office State ZIP Code MEC HA NI CS BU RG PA 1 7 0 5 5 C__ C) Correspondent's e-mail address: DAVID@WALTERSGALLOWAY.COM I_I REGISTER OF WILLS ONLY 3 4'^ REGISTER OF WILLS USE ONLY ,_, '"�7 •'r1 "'1 DATE FILED MMDDYYYY - >✓ r rn co T� DATE FILED STAMP PLEASE USE ORIGINAL FORM ONLY Side 1 IIIIII VIII VIII VIII VIII VIII VIII VIII VIII IIID IN IN 1505614134 1505614134 �\ Vv J 1505614234 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: NORMA R. YOST RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . 1. 2. Stocks and Bonds(Schedule B) 8 7 1 7 0 . 9 1 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. 7 1 4 0 1 4 6 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . .. . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . .... 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 5 8 5 7 2 , 3 7 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . .. . . . . . . . 9. 2 6 3 7 1 6 7 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 1 7 3 1 1 6 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . 11. 2 8 1 0 2 • 8 3 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . .. . . .. . . .. . . .. . 12. 1 3 0 4 6 9 . 5 4 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 3 0 4 6 9 . 5 4 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 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.045 1 3 0 4 6 9 . 5 4 16. 5 8 7 1 . 1 3 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 19. 5 8 7 1 . 1 3 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. SIG URE OF ERSO P SIBLE FOR FILING RETURN 0 THEE _ ADDRESS NDY L. ONEY 2 PINE GROVE RD NEW BLOOMFIELD PA 17068 SIG T REPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN ADDRESS DAVID GALLOWAY 54 E. MAIN ST. MECHANICSBURG PA 17055 1111111111111111111111111 IN Iill Side 2 1505614234 1505614234 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 21 15 0149 DECEDENTS NAME NORMA R.YOST STREETADDRESS 2100 BENT CREEK BLVD CITY STATE ZIP MECHANICSBURG PA 117050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 5,871.13 2. Credits/Payments A.Prior Payments 4,500.00 B.Discount 225.00 (See instructions.) Total Credits(A+B) (2) 4,725.00 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) 1,146.13 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 ............................... ❑ 0 c. retain a reversionary interest ..................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0 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?.................................................................................................. ❑ 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 NORMA R.YOST 21 15 0149 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CHARLES SCHWAB ONE ACCOUNT 87,170.91 ACCT NO.-x7648 TOTAL(Also enter on Line 2,Recapitulation) $ 87 170.91 If more space is needed, insert additional sheets of the same size REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER NORMA R. YOST 21 15 0149 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS-BUHRIG FUNERAL HOME 13,245.67 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) CINDY L. RONEY 7,340.00 Street Address 562 PINE GROVE RD City NEW BLOOMFIELD State PA Zip 17068 Year(s)Commission Paid: c.261 ir 2. Attorney Fees: WALTERS&GALLOWAY, PLLC 4,750.00 3, Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) Claimant NONE Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS, CUMBERLAND COUNTY 365.50 5 Accountant Fees: ALFRED WHITCOMB, CP 125.00 2014 Personal Income Taxes 6. Tax Return PreparerFees: FIDUCIARY RETURN (Reserved) 495.00 7. ESTATE CHECKS 10.50 8. FEDERAL EXPRESS-Distribution to Beneficiaries 40.00 TOTAL(Also enter on Line 9,Recapitulation) $ 26 371.67 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER NORMA R.YOST 21 15 0149 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. ALERT PHARMACY SERVICES, INC 77.55 2. ROBC LIMITED PARTNERSHIP 1,644.50 The Bridges Personal Care 3. QUANTUM IMAGING &THEAPEUTIC ASSN. 9.11 TOTAL(Also enter on Line 10,Recapitulation) $ 1,731.16 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NORMA R. YOST 21 15 0149 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. CINDY L. RONEY Lineal 562 PINE GROVE NEW BLOOMFIELD, PA 17068 2. CAROL J. MORROW Lineal 712 BENCRU AVE MECHANICSBURG, PA 17055 3. KATHI L. LAUBENSTINE Lineal 808 LANCELOT AVE MECHANICSBURG, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size.