HomeMy WebLinkAbout06-19-15 J �so���alyo
REv-��oo EX (01-10)
OFFICIAL USE OPlLY
PA Department of 12evenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INNERITANCE TAX RETURN 2 1 I, 3 0 7, 2 1 9
Harrisbura PA 17128-0601 RESIDENT DECEDEidT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of 9irth MMDDYYY`!
1 0 � 7 2 0 ]� 3 0 4 D 8 1 9 1 9
Decedent's Last Name Suffix DecedenYs First Name MI
0 R N D 0 R F F N 0 R M A N J
(if Applicable�Enter Surviving 5pouse's InformaEion Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLECATE WITH THE
REGISTER OF WILLS
FlLL IN APPROPRIATE OVAlS BELOW
� 1.Original Return Q 2.Supplemental Return � 3.Remainder Return(date of death
priorto 12-13-82}
� 4.Limited Estate � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Return Required
death after 12-12-82}
QX 6.Decedent Died Testate � 7.becedent Maintained a Living Trust _ 8.Total Number of Safe Deposit Boxes
(Attach Copy of Wiil) (Altach Copy of Trust)
� 8.Litigafion Proceeds Received � 10.Spousal Poverty Credit{date of death � 11.Election to tax under Sec.9713(A)
beiween 12-31-91 and 1-1-95) (Attach Sch.Q)
CORRESPQNDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPON6ENCE AND CONFIDENTIAI TAX IN�ORMATtON SHOULD BE DIRECTED T0:
Name Daytirrre Telephone Number
D 0 U G � A S G . M I L L E R 7 1 7 2 4 9 2 3 5 3
REGISTE�F WfLLS USE�LY �
�
C � C_.. �,,� �Ti
First line of address �� -�; = � `�
�,.j ,_, .� , ;`7
I R W I N & M c K N I G H T , P • C • . � ►—, �;
--- � � -r
Second line of address
_ . ;.�
6 � W E S T P 0 M F R E T S T R E E T ' =- � �' '
, ,.,
, ,
, � ,-,
DATE�FIL�D `-
City or Post Qffice State ZIP Code - � — �:>
_ ._:a L� [�1
C A R L T S L E P A 1 7 0 1 3 '
� ,� c,� c�
= � -r r
Correspondent's e-maii address:
Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.DeclaraCbn of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU ERSQN R�SPAQISIBLE F FILI G ETURN G,r'/ f� ���E
v a
�
AD SS
110 ,OAK DR VE CAMP HILL PA 17011
SIGNA F PR ARER ER THAN REPRESENTATIVE DA —
AD ESS
6d WEST POMFRET STREET CARLISLE PA 17013
PLEA5E USE ORIGINAL FQRM ONLY
Side 1
� 15Q561D14t1 1505610140 �
�
�V
�:ononuat�on ot Ktv-�5uv�nReNtern:e Tax Return Resident Decedent
NORMAN J.Ow11DORFF 21 13 01218
Deoedent's Name Pape 2 Fde Number
COff��f011dAlltS
NemB pByUme Telephone Number
D OU G L A S G . M I L L E R 7 4 7 2 4 9 2 3 5 3
FRst I�te af addrass
t R W i N & M c K N I G H T , P . C .
Sacond ifne of address
6 d WE S T P � M F R E T S T R E E T
Cthr or Poat Offlae � �p� .
C A R L I S ! E P A 1 7 0 1 3
Ca�pondeM's a-ma7 add�:
Under pmalles of pe�ey.l der�sthat I l�eve aommhrod U�reben.�du�n e000mpa�qlh�achedu[es aM�+a�r.aad m�e bestof my Imowledpe am!beAef,
�Is tiue�miact end me�pt�.Dedetatlon of pnepeier otlierthan fre p��epr�lYe b baeed on el ii(omielai af�dich pre�srhes any knnwledge.
SIONAIURE oF CE F�t ��i
�--� -�
AODRESS
17 S. HIGN STREET MECHANICSBURG PA 17055
� 1505610240
R�"��� Oecedent's Soaal Security Number
oecedem'sName: NORMAIY J • ORNDORFF
RECAPITULATION
1. Real Estate(Schedule A} ..... ...... . ..... ....... .. � • � 0
. . .. ....... ...... 1.
2. Stocks and Bonds(Schedufe B) . . .. . .... . .... .. . ..... ........ . .... . . . 2. 7 4 4 6 . 0 0
3. Closely Held CorporaGon,Partnership or Sole-Proprietorship(Schedule C) ., ... 3. '
4. Mortgages and Notes Receivable{Schedule D) ......... . .... . .... .. ... . . 4. •
5. Cash,Bank Deposits and Miscellaneous Pensonal Praperty(Schedule E)... ,.. . 5. � • � �
6. JoinHy Owned Property(Schedule F) ❑ Separate Billing Requested ... ... . 6. � • � �
7. Inter-Vivos Transfers&Miscellaneous No -Probate Property O . 0 O
(Schedule G) � Separete Billing Requested . . .... . 7.
8. Total Gross Assets(total Lfnes 1 through 7) .... . . .._ . , .. 8. 7 4 4 6 . 0 0
. . ....... .... .
9. Funeral Expenses and Administrative Costs(Schedule H) ... .. . . .... .. .. .. . 9. 1 � 4 5 . � 0
10. Debts of Decedent,Mortgage Ltabilities,and Liens(Schedule I) ... . ..... .... 10. Q • � �
11. Total Deductions(total Lines 9 and 10) .. . . .. ....... ... .. .. ... .. ...... 11. �, � 4 5 . 0 0
12. Net Value of Estate(Line 8 minus Line 11) .. .. ... ... . .... ..... ........ 12• 6 4 0 1 . 0 0
13. Charitable and Govemmental BequestslSec 9113 Trusts for which
an elecNon to tax has noE been made(Schedule J} ...... . .. .. . ... .. . ... . 13• •
14. Net Value SubJect to Tax(Line 12 minus Line 13) .. . ........ ... ........ 14. 6 4 � Z . � �
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Une 14 taxable
at the spousal tex rate,or
transfa�s under Sec.9116
{a)(1.2)X•0 � � . 0 � 15. � . � �
16. Amount of Line 14 taxable
at iineai rate x.045 6 4 0 1 . 0 0 �s. 2 8 8 . 0 5
17. Amount of Line 14 taxabte
at sibling rate X.12 0 . 0 0 11. 0 . a 0
18. Amount of Line 94 taxable 0 . � 0 18. 0 • 0 �
at collateral rate X.15
19. TAX DUE . .. ..... . ...... . 19. 2 a 8 • � 5
... ... . . ... . ....... . ... . .. .. . .. .... . . .
20. FILL IN THE OVAL IF YOU ARE REQUESTiNG A REFUND OF AN OVERPAYAAENT ❑
Side 2
L 1505610240 1505610240 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 2� 13 01219
DECEDENT'S NAME
NORMAN J. ORNDORFF ___.
STREET ADDRESS
24 CIRCLE DRIVE _ _
��Ty STATE ZIP
CARLISLE PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 288.05
2. CreditslPayments
A.Prior Payments
B.Discount
Total Cretlits(A+B) (2) 0.00
3. Interest
(3) 8.26
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) 296.31
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 ................................................................................................ ❑ �
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ X❑
2. If death occurred after December 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?.................................................................................................. ❑ �
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 stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)j.
• 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(1.2)[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.
xev-i 603 ex+�s-�2�
pennsylvania SCHEDULE B
DEPARTMENT OFREVENUE
INHERITAN(�TAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE I�JMBER
NORMAN J ORNDORFF 21 13 Q1219
Ail property Joi�ly owned vrith right of survtvorship must be disclosed on Schedula F.
ITEM VALUE AT DATE
NUMBER OESCRIPTION OF DEATH
1. 100 SHARES OF PRUDENTIAL FINANCIAL STOCK 7,446.Q0
100 SHARES X$74.46 PER SHARE_$7,446.00
TOTAL(A{so enter on llne 2,Recapitulatlon} $ 7 446.00
1f more space is needed,insart additional sheets of the same size
�--- ._.._.. , _,
pennsylvania SCHEDULE H
OEPARTMENTOF REVENUE FUIdERAL EXPENSES AND
INNERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
NORAAAN J. ORNDORFF 21 13 01219
DocedanFs deb4s must be rapo�ted on ScF�edule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. EBY GRANITE WORKS-TOMBSTONE ENGRAVING 130.00
B. ADMINISTRATIVE COSTS:
1, Personal Representative Commissions:
Name(s)of Personel Representative(s) MARY O. HOFF 200.OU
sc�eetAddress 110 OAK DRIVE
�;�CAMP HILL state PA ZiP 17011
Year(s)Comm�sion Paid:
2. AttomeyFees: IRWIN &McKNIGHT, P.C. 500.00
3, Famity Exemptlon:{If decedenYs address is not the same as daimanfs,etmch explana�on.}
Cleimaat
Street Address
City State ZIP
Refatlonship of Claimant to Deoedent
4. Probate Fees:
5 Accnuntant Fees:
6. Tax Reium Preparer Fees:
7. REGISTER OF WILLS-FILING FEE 15.00
TOTAL(Aiso enter on Line 9,Recapitulation) S 1 045.00
Ii more spaoe is needed,use ad�itional sheets of paper of ihe same s�e.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
NORMAN J.ORNDORFF 21 13 01219
DecedenYs Name Page 1 File Number
Scheduie H -Funeral Expenses�Administrative Costs-B9
ITEM
NUMBER DESCRIPTION AMOUNF
6. ADMINISTRATIVE COSTS;
Personal Representative Commissions:
2• Name{s)of Personal Represenffitive(s) ELIZABETH A. CHEW 200.00
StreetAddress 17 S. HIGH STREET
c�y MECHANICSBURG s�te PA ziP 17055
Year{s)Commission Paid:
Sl1BTOTAL SCHEDULE H-64 200.00
REV•1513 EX+(01-70)
pennsylvania SCHEDULE J
�EPqRTMENT OF REVENUE BENEFECIARiES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE QF: FILE NUMBER:
NORMAN J. ORNDORFF 21 13 01299
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER IdAME AND ADDRESS 4F PERSON(S)RECEIVING PROPERTY Do Not LisE Trustee(s) OF ESTATE
i TAXABLE DISTRIBUTIONS pndude outnght spousal disUibutions and ha�fers under
5ec.91 f6(a)(1.2),)
1, JOHN A. ORNDORFF Lineal 1,280.20
2727 TIBBETTS-WICK ROAD 1/5TH REMAINDER
HUBBARD, OH 44425
2. ELIZABETH A. CHEW Lineai 1,280.20
17 S. HIGH STREET 1I5TH REMAINDER
MECHANICSBl1RG, PA 17055
3. PATRICIA L. NESBIT Lineal 1,280.20
43 WALTON CIRCLE 1/5TH REMAINDER
ICKESBURG, PA 17037-9633 �
4. MARY O. HOFF Lineal 1,280.20
11Q OAK DRIVE 1/5TH REPAAINDER
CAMP HILL, PA 17011
5. YVONNE M. NOWOTARSKI Lineai 1,280.20
193 DECK ROAD 1/5TH REMAINDER
WOMELSDORF, PA 19567
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIAFE.
n, NON-TAXABLE DISTRIBUTIONS;
A,SPQUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1,
B.GHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TQTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, s
If more space is needed,use additional sheets of paper of the same size,
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