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Home My WebLink About05-27-15 � ! v<nnsylvania 1505614105 �y '•••,^•,".•"•" sx�m-�aur�t REV-1500 orFicw�use ox�r BureauoflntlividualTaxes CounryCotle Year FIIeNumber PO BOx 280601 INNERITANCE TA7( RETURN {� I IS D �./ Harnsburg, aa tnze-o6o1 RESIDENT DECEDENT L ENTER�ECEOENT INFORMATION BELOW Social Secu�i�y Num�e� Dale o(Death MM��YYVV Da�e of Bitlh MM��YYYY 03132015 07311942 oeceaenfs Last Name Sufix OecetlenCs First Name MI OSTRICHE CAROLINE R (If ApplicaEle)Entar Surviving Spouce i Info�ma�lon Below Spouse's Las1 Name SURix Spouse's First Name MI THIS RETURN MUST BE FILEO IN DIIPLICATE WITH THE REGISTER OF WILLS FILL IN APVROPRIATE OVALS BELOW (� 1.Onginal RaWm O ��Supplamenlal ReWm O 3. Remainder ReNm(da�e ot tleat� ptlar�o 1244EP) p 4.AgriculNre ExempLm(data ot 0 &Fulure Interesl Compmmise(tlate ol 0 6. Fetleral Eslate Tax ReW m Requiretl tleatM1onoraRer]-L2012) deamaXert2-t2A2) O �- ��enl Dietl Tes�ale O 8.�ecetlant MainGinetl e Living Tmst 9. TOGI Numberol Sa�e Deposil9oxes (AtlecM1 copy ot wIIL) (AtlacM1 copy o!�msL) p 1�.Lifigafion Pmceeds Receivetl O 11.Non-Proba�e Transteree Relum O 12 OafartaVEleclion of Spousal Tms�s (SCM1edule F antl G Asse60nly) O 13.BusinassAssats O t¢.Spouu is Sole Beneficiary (No[mstlmolved) CORRESPONDENT- TNIS SEQION MV9T BE COMPLETEO.RlL CORRESPONOENCE ANO CONFIDENTIAL TA%INFORMAiION SNOOLU BE OIRECTEO T0: Name Daytime TelepM1one Number MICHELE NORTHROP 717-776-9233 First Line of Atltlress 38 COUNTRY VIEW ESTATES Second Lina of Atltlress ClryorPostOifce State ZIPCotle NEVJVILLE PA 17241 corresponaenl's email aaeress: XEGISIEfl OF WILLS USE.QNLY FEGISTEROFWILLSUSEONLV � �n J'� � J Il pATEFIIEDMM�DYVYV �= O � �� (] _ � � � . (.l N � OATE FILEO STRMP � _1 > C_'J p PLFJI3E USE ORIGINIIL FORM ONLY � '`� �� Side 1 � �� L ��II�IISOI56I1I41IOSII�II��I��I11� 15�5614105 J � J Lsoselvzos REV-0500 EX(FI) OeceJenfs Social Secunry Number oeceaenrsNama: CAROLINER. OSTRICHE RECAVITULATION 1. Real Es�ate�Scbedule A). . .... . .... ... . .... ........ ... ...... ... ... . .. 1. � 2. 5[ocks antl Bontls(Schetlule 9) .. .... .... . ... .... ........ ........ ..... 2 0 3. Closely Held Gorporation,PaMership or Sole�PmprietorsM1ip(Schedule C) ..... 3. 0 0. Morigages antl Notes Receivable(Schetlule D) ........ .... . ........ ...... 4. � 5. Wsn,Bank oeposits ane Miscenaneous Perwnai Pmperty(Schetlule E). .... .. 5. 1,537.82 6. Joinlly Ownetl Properry(Schetlule F) m Separale Billinq RequesteE .. .... . 6. ��4��8� ). In�er-Vlvos Transfe5&Miscellaneous Non-Pmba�e PmpeNy 0 (Schetlule G) O Separate Billing Reques[ed..... .. ]. e. Tota�Gross nzsets(mtai�ines t mmugn�)... . ... . ... .... . ....... ...... e. 3,009.62 9. Funeral Expenses ana Aaminishativa Cosis(Scnetlule H�. . .... ... . ......... 9. 6,406.58 10. Debts o(DeceDenl, Motlgage LiabiliUes antl Liens(Schetlule p.. .... . ... .... . 10. 5,208.35 ii Total oeaudions Qo1al Lines 9 antl 10).............. ........ .... ... .... 11. 11,616.97 12. Net Value of Esbh(Line 8 minus Line fl) .... . ... ... . ... ..... .......... 12 (8,605$1) 13. CM1arita�leantlGovemmenWlBequeslslSec.9113Tms�storwM1ich � an eleclion to tax M1as not�een matle(Scheaule J) ....... ................. 13. 1A. Na1 Value Sub�ect ta Tax(Line 12 minus Line 13) ................... ..... 14. (8,605.37) TA%LALCUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Artwunt of Line 14 texable at Ne spousal tax rele,or «ansiers untler Sec 9116 (a)ry 2)X.0_ 15. 16. Artwunt of Line iC taxable atlinealate X.0_ 16. Q 1]. Amounto�Linel4�axaCle a�sibling rate X.12 1]. �8. NmountoiLine141axa�le at wllateral rate X.15 1B. 19. TAX DUE ...... .... . .. ....... .. ... . .... . . ........ .. 19. � , 20. FILL IN THE OVAL IF YOU ARE RE�UESTING A REFIIND OF AN OVERPAVMENT O 11n0er p¢nal�les of pepury,I Jxlare 1 M1eve exemimC NIs reWm.Inclu0rn9 accwnpanying scM1etlules anU sUtements,anJ lo IM1e bas�ol my knowl¢d3e a�M belie[ i�Is We,w rec�anE com0lete.DaGaralron of preparer o�M1er IM1an IM penon ec�ns0le lor f�llrg[M1e reW m is baee0 on all In(wma�ion o!wM1icM1 OreOa�e�Ms eny knowleE9e. SIGrp�OF EF ON51 5o R F TORN ON E i"li+r �uo' S�/�l ��S aooaess 38 COUNTRY VIEW ESTATES, NEVVVILLE, PA 17241 SIGNHTURE OF PREPARER OTHERTHAN PERSON RESPONSIBLE FOR FlLING THE RETURN �HTE nooaEss L IIIINIIIIIIIIIIII�I��II��II�I�I�I�I�hIIINIIIIVIIIII S;da2 1505614205 J RE0.t500 E% (FI) Page 3 Flle HumOar DecedenYs Complete Address: oECEOENrs uquE CAROLINE OSTRICHE .____ .—_. _.. .. __ ._ _.. . _—__. . . _. . _ .. sraEErnooaEss� 38 COUNTRV VIEW ESTATES _.._ .. _ ___.. _ .. _ . __. . . – _. . .._ —_ CITV ... r STATE ZIP NEVN/ILLE PA 17241 Tax Payments and Credits: t Tax Due(Page 2.Line 19) (�) 4 2. CretlityPayments A.PnorPaymenis __ . . _ _____ B.Diuount (Seeinsimctions) TotalCredlis(AaB) (2) 3. Inlerwt (J) 4. If Line 2 is greater lhan Line 1 +Line 3,enter Me 0itterenca. This is the OVERPAYMENT. Fill in oval on Page 2,Lirre 2010 request a refund (Q) 5. If Line 1+Line 3 is greater than Line 2,enler the diHerence.This is ihe TAX DUE. (5) � Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. �iddecedenimakeatransferanB. Yes No a. retain the use or inmme of�he pmperry VansterreG........ ......... .............._. ......... ❑ � b. retain ihe rght b tlesignale who shall use Ne propeM1y tronsferteG or its inmme ........__............................_. ❑ � c. re�ain a reversionary mteresl __.... ..... ........._.. ._............ . ................. ........_.. ❑ � G. receivethe0romiseforlifeofeitherpaymenls.benefi�sorcare?...................._........................................._... ❑ � 2. Ii death occurretl after Dec.12,1982,Gitl Gecetlent iransier property wi�hin one year of Cea�h wilhoWreceivingadequaleconsiGeration� ......... .......... ........ . ......... ......... ❑ � 3. �itl tlecedent own an"in trus�fo�or payable-upon-death bank account or security at his or�er Geath?.............. ❑ � 4. Ditl decetlent own an individual retirement acwunt,annuiry or other non-probate Dmpetly,which contains a beneficiary designatbn? ...... __............ .......... ........... .___. ❑ � IF THE ANSWER TO ANY OF THE ABOVE�UESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AN�FILE ITAS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposetl on ihe net value of transfere to or for the use of the surviving spouse is 3 percent�72 P.S.§9116(a)p.1�(i)], For tlates ot dealh on or after Jan. 1, 1995, ihe tax rete imposed on the net value of iransfers to or kr ihe use of the surviving spouse is 0 percent [72 P S.§9116(a)(1.1)(ii)�.The s�aWte does no�exempt a Uansfer�o a surviving spausa from Wx,and�he staN�ory requiremen�s kr disclosura of assets and fJing a tax reWm are slill applicable even if ihe surviving spouse is ihe only beneficiary. Por dates of death on or after July 1.2000: • 7he tax rele imposed on ihe net value of iransfers 6om a deceased child 21 years of age or younger at death to or tor ihe use of a natural parent,an adopirve parent or a step-parent of Ihe chlld is 0 percent[R P5,§9118�a)(12)]. . metaxreteimposedonihenetvalueoftrans�erstoorforiheuseoflhedecedenfslinealheneficiariesis4.5percent,exceptasnotedinDZPS.§9116(a)�i)�. • The lax rate imposed on�he ne�value of iransfers to or for Ihe use of the decetlenPs siblings is 12 percent�72 P.S.§9116�a)(1.3)].A sibling is defined, untler Section 9102,as an mtlividual who has at leasl one parent in common wi�h ihe decedenl,whelher hy blood or atloption. REV-�Sae E%«(o8-v) i ' pennsylvania SCNEDULE E � oevnarnenrorAevervue CASH� BANK DEPOSITS& MISC. �,A�,ce.nx ae*vax PERSONAL PROPERTY xesioerv.occeocrvr ESTATE OF: FILE NUMBER: CAROLINE R. OSTRICHE Incluae the pmce[ds of litiga[ion anE Me tla[e tM1e procee0s were receivee by[he estate. All property)ointly ownetl wk�right of survlvorohip must be Eittlosed an ScheEule F. ITEM VAW E AT DATE NUMBER �ESCRIFRON OF DEATH �- FWGER LAKES HEALTH CARE FEDERAL CREDIT UNION(NY)(Share antl draft account#39309) 1.537.82 TOTAL(Alw enter on Line 5, Recapitulation) S �.53782 If more space is neeGeG,use adtli[ional shee6 of paper af the same size. IlonicH:inking hllps: hhansm�.mmcu IfiIMOi(^�li'umc.up � Ncme Bankin� � � Confact � Logouf � 1 ° Balanres Hlstoy Transfcr Withdraw checks Download SPrtin�s Account History Individual Armunl Inquiry Drak 0000039309 Check Deposi[ Withtlrawal Balanre Date � � Uescription � • Fee ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ 0326/2015 �I:'�1 PAIDDRAFT 839982 8663.63 ATM/ACH DEBIT 075-MET CAS INS CO INS 03/1620�5 562.66 S�OG3.45 PAVMNT ATM/ACH CREDIT061-ARVOTOGDEN MED 03/022015 85�7.00 S1,126.�1 PENsioN ATM WITHDR,4WAL 07J24/02 COOP EFT�5 - OL242015 DOLLAR-GENERAL#8418 VEWVILLE PAUS 81720 8609.11 0214 0 2/1 9201 5 ATM/ACHDEBITO50-WEB:CHASEEPAY 8396.08 5626.35 ATM/ACH DEBIT 048-M ET CAS INS CO INS 02/1]2015 86266 8102239 PAVMNT ATM W ITH DR,4WAL OL15/02 COOP EFf 05 - 02/172�15 SOLLENBERGERS NESSENGERSHIPPENSBURG 594.00 51,085.05 PAUS 0215 ATb1 WITHDRAWAL 02/09/02 COOP ERO� - 02/092055 58.00 St,17905 PSHCI-PHARMACV 7ll53�0700 PAUS 0209 02/062015 - PAI� DRAFT 815.00 81,18].DS 02/0320�5 PAIDDRAFT 83849 5�,202.05 02/032015 =_ PAIDDRAFf 82000 51.24054 ATM/ACH CREDIT 033-ARVOT OGDE V MED 02/022015 851]00 8�,260.54 PENSION ATM W ITH DR4WAL 02/02/02 COOP EFT 0� - 02/02/2015 817 74 474354 PSHCI-PHAR MACV 71753�0700 PAUS 0202 OVU2015 ATM/ACHDEBIT02�-WEB:CHASEEPAV $�00.00 876L2N ATM/ACH DEBIT 0�5-M ET CAS INS CO INS ��/1520�5 862.66 g86L28 PAYMNT C�Copyright 2015 CMS, Inc All righ[s reserved. I ol I 17 1+.7:ig:Ul L Ionic 13ankSn� h I Ips..hh cm��nc.ann'cu:1 C I�367'Il�nnic naP � ` I ! � I Contac[ Logou[ � _..,, .. . Hls:ory Transfcr wl[htlraw Checks Download Set[ings Account Balances Click on an acmun[below to view transac�ons and o[her informazion. Deposit Accounts Account Acrount Type Accoun[No[e YTO lnterest Avail Balance Balance Ilcl<I' r� � y�'.? SHAREACCOUNT � $0.10 30_10 5411J1 �I<C ie��.c�A� f l�'O�i° �C] Dra([AccounC � 50.00 (4399.82) $663.63 L.______"._... Total � ($399.]2) 51,07534 N Bill Pay -uea i�eee�o Parrouz�ius o�uutde C Copyrigh[2015 CMS, Inc All rights reserved. L o( L 1�71Ii,'1:59 AM1I xev-isos ex.(ox-�s� � pennsylvania SCNEDULE F oeeanrmEr�roFaE�ENUE )OINTLY-OWNEDPROPERTY aEs`oRa�,cE.A.a�.�a�, E»,oECEOE�„ ESTATE OF: FILE NUMBE0.: CAROLWE R. OSTRICHE It an asse[beome Jointly ownM wlNin one year of Ne tlecetlein's Gah of death,k must�e rcportetl an Schedule G. SURVIVING JOINT TENAM(5)NAME(5) AD�RE55 RElAT10N5HiP TO�ECEDEM A.MICHELE NORTHROP 38 COUNTRV VIEW ESTATES CHILD NEWVILLE, PA 17241 B. C. IOINTLV OWNED PROPE0.TY: �e.rEa onre oEsea�ar�orvaiaaoaEatt wor w*eoroen.n 1@M FORl01Ni MPDE INCWOEWMEOFFINPNCIPLINSiINiI�NPNOBM'MPROVNiVUMBEROP5IMINP 04ROFDEAiX DECfDEM3 V�WfOF NIIMBEP iENPNi ]OIM IOFNiIfVINGXUMgER.PnPCNpEE0fO0.1011fRYHELO0.EPlE5iR�E. VPWFOfPSSP IMERE4 MCE�fNiSINiERE4 �' A' 06082009 F&MTRUST-AGGOUNTNUMBER34-9W55 2,943.59 50 1471.80 TOTAL(Also en[er on Line 6, RecapiNlation) S ��4��-80 If more space is neeGeQ use adeitional sheets of paper of[he same size. � �d�� -'U}ou�h Alaln}Irt'cL �y � PO Hox GOLLI � r��7� Ch�.�n�brcbnru.lti IT201 CAROLME OSTRICHE Page 2 of 2 � Mamh27,20'IS 0003480755 DAILV BALANCES � �a[e Amount Oate Amount �a�e Nmoun[ — — __ _ 02-27 3,863.68 03-OS - 3,270.50 03-27 2 94371 03-02 376678 03-92 2943.59 �� 03-03 �� 3,70750 03-25 2943.59 INTEREST INFORMATION Annual percentage yield eamed 0 OS% Interest-bearing tlays Za Averege balance fo�APY 53,175 00 Inlerest eamed ��2 OVERDRAFT/RETURNITEMFEES Totalfor Totel this period year-to-date Total Overdraft Fees 50.00 $0 00 Total Returned Item Fees 50.00 50.00 Thank you foi6anking with F 8 M Trust "i`" pennsylvania SCHEDULE H � oeanarmervrornevervue FUNERAL EXPENSES AND wHea�rnrvcera.arrua�+ ADMINISTRATIVECOSTS aesmEnr oeceoenr ESTATE OF F1LE NUMBER CAROLINE R. OSTRICHE DeceEent's aeEts mus[be reported on Schetlule I. I�EM NUMBER DESCWPTION AMOUNT n. FONEAAL EXGENSES: �' EGGER FUNERAL HOME,INQ(Pmfessional services and obiWary) $2,906.58 B. ADMINISTRATIVE COSTS: L PersonalRepresen[abve Commissions: xame(s)of venonai kepresentao�els) . . 5neet NdGress [ity .. .__ __ _.State _ZIP Vear(s)CommissionPaid: _ _ __ ___ _. . �� Attomey kes: 3,SD0 3, Family EHemp[iom(1!tleaaent's aGdress is not the same as daimantY,attach evplanatlon.) Oaimant MICHELE NORTHROP StreetMtlress 38 COUNTRV VIEW ESTATES . __ __—___ — ��ty NEWVILLE Swte . PA Z�p 17241 _. __— — . . . ____ RelationshipofClaimanitoDeceGen[ CHILD(DAUGHTER) _ . . a. vrobah Fres: 5, qcmuntanlFees' 6. Tax ReNm Preparer Fees: ). TOTAL(Also enter on Line 9,RerapiNlation) S 6.406.58 If more space is neeJed,use aAEibonal shee6 of paper of the same slz¢. i , pennsylvania SCHEDULE I � oEVAarnErvraFa[veHue DEBTS OF DECEDENT� �r�xEa�raxceuxxcruarv MORTGAGE LIABILITIES & LIENS aesoex,oeceoen. ESTATE OF FILE NUMBER CAROLINE R. OSTRICHE ReportAebls IncurrcE bythe AeceAent priorm dath Mat remalnM unpaiE at lhe Eate of tleaN,IncluEing unreimbuneE medial expenses. ITEM VAW E AT�Aif NUMBER DESCRIPtION OF DEATH �� MSHERSHEYMEDICALCENTER(ACCOUNTNUMBER21725322) 51.90 MS HERSHEY MEOICAL CENTER�ACCOUNT NUMBER 22075560) 15.00 MSHMC PHYSICIANS GROUP(ACCOUNT NUMBER 2070256) 190A0 MS HERSHEY MEOICAL CENTER(ACCOUNT NUMBER 22185570) 680.71 MS HERSHEY MEDICAL CENTER(ACCOUNT NUMBER R20fi3526) 3,91420 COMCAST 26.65 HOLY SPIRIT HOSPITAL 20A0 CARLISLE REGIONAL MEDICAL CENTER(ACCOUNT NUMBER 1525931) 15.00 CARLISLE REGIONAL MEDICAL CENTER(ACCOUNT NUMBER 1520394) ��a PPL ELECTRIC UTILITIES 34�89 FRIENDSHIP HOSE COMPANY#1 250.00 70TAL(Also en[er on Line S0, Recapitulation) S 5 208.35 If more spare is needed,insert aEGitional sheets of Ihe same size. � pennsylvania SCHEDULE J oevnArnErvroFacvcrvue BENEFICIARIES ixxexnnnce.A.xe,�an aEsmErvr oeceoex. ESTATE OF: FILE NUMBER: CAROLINE R.OSTRICHE REIATIONSHIPTO�ECEDENT AMOUNTORSHARE NOMBER NAME AND ADDRESS OF 4ERSON(5)RKEIVING GROPERIV Do Not Llst Trus[ee(a) OF ESTATE I TA%ABLE DISiNBUTI0N5[Indutle ouMght SDousal tli4ribu[ions antl Imnsfers wEer Seu 9116(a)Q.3).] i. MICHELE NORTHROP,38 COUNTRY VIEW ESTATES,NEWVILLE,PA CHILD 50% (Michele NoMrop is the sole beneficiary of ihe aaount in Schedule E and the join4owner of ihe aaount listed in Schedule F.) 2 DAVID OSTRICHE,PLANTATION,FL CHILD 50% ENTE0.DOLUR AMOUNTS FOR DISTRIBMONS SHOWN ABOVE ON LINES 151H0.00GH I6 OF REV-I500 COVER SHEE[AS AGGROPRIATE. �I NON4A%ABLE DISTRIBUTIONS F. SGOlISAL DISTRIBUTIONS UN�ER SECRON 9113 FOR WHICH AN ELECTION TO TA%IS NOT TAKEN: 1. B. CHARRABIE AND GWERNMENTAL�ISTtIBUTI0N5: 1. TOTAL OF PART 0-ENTER TOTAL NON-TA%ABIE DISTRIBUIIONS ON IINE 13 OF REV1500 COVER SHEEi. S If more space is needctl,use additional shee6 of paper of Ihe same size,