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Home My WebLink About06-12-15 (2) Jr i Pennsylvania 1505618403 DEPARTMENT OF REVEIN(03-14) REV-15010 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN r^onff ^4� 2 Harrisbur , PA 17128-0601 RESIDENT DECEDENT 21 C7Gu� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 09 26 2014 11 28 1935 Decedent's Last Name Suffix Decedent's First Name MI EBNER GEORGE H (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) 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) EJ7. Decedent Died Testate 8. Decedent Maintained a Living Trust0 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 LINDA J OLSEN 717 540 4332 First Line of Address 2000 LINGLESTOWN ROAD Second Line of Address SUITE 202 City or Post Office State ZIP Code HARRISBURG PA 17110 Correspondent's email address: lolsen(cD_hazenelderlaw.com � ti REGISTER OF W�LS USE QNLY Ml r;7 _T3F? C3 REGISTER OF WILLS USE ONLY try *7 DATE FILED MMDDYYYY <7 7 ;D C DATE FIL=ED STAMPI—A i7 r' G) CJ> O Side 1 I IIIIII VIII VIII VIII VIII VIII VIII VIII VIII 11111 1111 IN 1505618403 1505618403 1505618411 REV-1500 EX Decedent's Social Security Number Decedents Name: Ebner,George Howard RECAPITULATION 1. Real Estate(Schedule A)...................................................................................... I 2. Stocks and Bonds(Schedule 8)............................................................................. 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).......... S. 41430-19 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 I through 7)........................................................ a. 414 3 0. 19 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 41494-67 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 21370-00 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 6,864-67 12. Not Value of Estate(Line 8 minus Line 11).......................................................... 12, -2-%434 - 48 13, Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made(Schedule J)............................................... 13. 14. Not Value Subject to Tax(Line 12 minus Una 13)............................................... 14. -21434 -48 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 16. Amount of Line 14 taxable at the spousal tax rate,or transfers under See.9116 (a)(1.2)X.00 16. 0.00 16, Amount of Una 14 taxable at lineal rate X .045 a-aa 16, 0.00 17. Amount of Line 14 taxable at sibling rate X.12 (1-1111 17, 0.00 18. Amount of Line 14 taxable at collateral rate X AS 0.130 18. 0.0 ) 19. TAX DUE................................................................................................................ 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1:1 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"edge S!tMRE 0 PE So PONSIBLE FOR FILING RETURN George D.Ebner QATE ADD 179119okshire Ct.,Fink oburg,MD 21048 SIG OF PREPARERTEr P ESENTATNE Linda I Olson DATE 4 4�0-W-A 61 410/ "A�f kss I 2000 Linglestown aad,Harrisburg,PA 17110 111111111111111111111111111111111111 IN Side 2 1505618411 1505618411 REV-1500 EX Page 3 File Number 21-14 Decedent's Complete Address: DECEDENT'S NAME Ebner, George Howard STREET ADDRESS 20 N. 12th St.#109 CITY STATE ZIP Lemoyne PA 17043 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. 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............................................................................................................... ❑ ❑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?.................................................................................................................. ❑ 0 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 OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Ebner, George Howard 21-14 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 PA Department of Unclaimed Property 45.66 2 Centric Bank Cking.Act.#1902758 4,384.53 TOTAL(Also enter on Line 5, Recapitulation) 4,430.19 (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) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERRESIDENT EDENAX TURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Ebner, George Howard 21-14 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 1,212.84 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 Hazen Elder Law 2,200.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,081.83 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 4,494.67 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 Ebner, George Howard 21-14 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Funeral luncheon-Harrisburg Hilton Raspberries 434.76 2 Hetrick Funeral Home 669.01 3 Pealers Flowers-for funeral 109.07 H-A 1,212.84 Other Administrative Costs 4 Big Red Box Dumpster Rental -to clean out apartment 395.00 5 Essex House-Apartment cleaning service 265.00 6 Essex House-Apartment cleaning supplies 124.30 7 U-haul to move remaining personal belongings 297.53 H-137 1.081.83 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-12) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Ebner, George Howard 21-14 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 Essex House-rent 2,200.00 2 Mike Beardsley-payment for help with odd jobs and driving decedent 170.00 TOTAL(Also enter on Line 10, Recapitulation) 2,370.00 (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) REV-1613 EX+(01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Ebner, George Howard 21-14 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT Do Not List Tatstoo(s) (Words) ($$$) TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] I Christopher Ebner Child Half of the 13655 Blooming Neck Rd Residue. Worton,MD 21678 2 George D. Ebner Child Half of the 1798 Brookshire Ct. Residue. Finksburg,MD 21048 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: 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) � ^��/� � xvI�� BANK, � � �� «.� eo.So"oone ^Harrisburg,PA 17106-2090 (717)657-7727 womeentricbankxom UENDER ^^**^**^*'****^AUTOu^3-DIGIT I70 526 0,8180 AT 0.405 2 I 309 GEORGE H. E8NEn 20 N. 12TH STREET APT# 109 LEMUYN[ PA I7043-I449 oate I0/15/I4 Page l of 2 Account Number 1902758 Enclosures 3 Exciting News! Text message Alerts are now available. Set up and schedule alerts via your Internet Banking account to receive text message alerts on your mobile phone to inform you of current events, balance infnrmatinn, clearing i1ems, and personal alerts. [heck with your phone provider for more details and specific text messaging fees. Please visit your local Financial Center for more information. ---- CHECKING ACCOUNTS ---- NEW BILL PAY SERVICE TO SUIT ALL OF YOUR NEEDS pLsxSs [ALL 657-7727 OR VISIT wwW.[ENTRI[8ANK.[OM H Affinity Checking Number of Enclosures j Account Number I902758 statement oares 9/16/14 thru 10/15/14 Previous stmt Balance 3,305,53 Days in the statement period 30 I Deposits/credits 1.589.00 Average Ledger 4'033 3 Checks/Debits 778.00 Average collected 4'023 Service charge .UU " Interest Paid .00 � Current Stmt Balance 4,214.53 ~ = _----_--____-__-----____--__----___---_-_-__--___--___-__----------_-_--- = = Activity in oate order - nate Description Amount Balance = 9/18 oox DEBIT weMQ 300'00- 3.095,53 " 9/24 xxS0[ SEC SSA TREA6 310 1.589.00 4,684-53 = 903I7]601] 09/24/14 ^ zo # TRACE #-03I7360I8223706 9/26 DDA DEBIT MEMO 300.00- 4,384.53 ^--- I0/06 CHECK # ]l27 170.00- 4.214'53 � --------____--_-_-_--___----_---_---__---__-_---__-____------_-----_--_---__-- Checks in Serial Number order Date [heck No. Amount 18/06 , 3I27 170.00 *Indicates Skip in [heck mumber _________________________________________________________________________ HAzEN ER LAW Estate Planning • Elder Law • Special Needs Planning 2000 Linglestown Road m: (717)540-4332 Suite 202 FAx: (717)540-4313 Harrisburg,PA 17110 www.HazenElderLaw.com June 10, 2015 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of George Howard Ebner File No.: 21-15 Social Security No.: 192-30-1775 Date of Death: 9/26/2014 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 my office in the enclosed self-addressed envelope. Also enclosed is a certified death certificate for the decedent 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, Corinne Eggers Woodhouse Paralegal Enclosures cc: George Ebner ,SES POSTq �A ®PITNEY BOWES 021P $001.664 0000561449 JUN 10 2015 MAILED FROM ZIP CODE 17110 1 Hazen Elder Law 2000 Linglestown Road Suite 202 Harrisburg, PA 17110 TO: Register of Wills Cumberland County Court of Common Pleas One Courthouse Square Carlisle, PA 17013 i .: