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Home My WebLink About07-15-15 pan�ylvama 1505614105 J �l�.....e.a.. Ex(m,a„Fl� REV-1500 OFFICIAL USE ONLY eureauoflntlividualTaxes CounryGke Year FkNumber vo aox zaoeoi INHERITANCE TAX RETURN � , I /�� Harrisburg vA v126-0601 RESIDENT DECEDENT �'� �'�. �y '�, � V�� ' ENTER DECEOENT INFORMATION BELOW Social Secun�y Numbe� �a�a el Deat� MM�DYYYY Date of BiM MMODWYY _ _ I 01262015 __ �3/9/1923 .._. �'. Decetlent's Last Name �� Suifu OeceCent's Firs�Name MI — ' � � Bordner _ ._ LVerda .__. .... _ � E '��.. Qf Applicable)Enter Survivinp Spouaa's Infortnetion Below Spouse's Lest Name Suifix Spouse's F rst Nama ..__. ___ MI � .._ . _..._ ._ .. _ .. .. __ . THIS RE7URN MUST BE FILED IN DUPLICATE WRH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW • i.Orginal ReNm p 2.SupplemenWl Rewm O 3. Remainder ReWm(tlate olEeaN pnor lo t3-03A27 p 4.PgnculNre Etemptlon(tla�e ol p 5.Fuwra Interest Compromise(Eate ol p 6. FeEeral Estale Tax Remm Required tleeNonaefle�94-2J12) tleaMahe�12-02�82) p ].OeceEent Oled Tes�ate O B.�eceEant MaintaineC a Living Tmst _ A Total NumDar ol5ale Deposit Boxes (AUacM1 copY of wlll.) (Atdc�coPY ol imsl) � 10.LiGge�iw Prometls ReceiveE O 11.Noo-ProGa�e Trareferea RaNrn p 13. �etarrallElec4on ol Spouul Tmsls (SCM1etlule F anE G Assats Only) O 13.BusinassAwets O �a.Spouse is Sole Benefivary (No tms�InvoNaE) . CORRESPONDENT- TNIS SECiION NI19T BE COMFLETE�.ALL CORRESFONDENCE ANU COHFIDENTIAL iA%INFORMATON SXOVLO BE OIRECTfU T0: Neme Daylime TelepM1one Number �— ."..____— ,. ...__. _ ._ _. . MichaelS.Travis ..... ..... .._. . .... __ .....717-731-9509_._ _ ___ . . First Line of Atltlrass l4ttomeV at Law ...,.... .... ... .... .. . Secontl Line ofAdCress 3904Tnndle_Road ,.__ . . ... . . �� __-- Ci�y or Pasl Oifica Steta ZIP Catle '__ _. __ .. .. . . _. .. Camp WII ...._ ___. ._.. �.. PA 77017_ ..... . CorzeaponEent'e email atltlress: . FEGISTfR OF WILLS USE ONLY RE014ER OF WILLS WE ONIY��° O � I � C ~ � T .� .�„_...... 3C � L � CJ � � � G� 0 m � c� r .> � o Wce65rnw�+ -�+ o �o : o 0 , , 3 _; i PLEASE USE ORIGINA�FORM ONLY r�� Side 1 -:� �� '— '�' r c.� cn o ��II��01 � ��I I�� I�II�II'I�� ' � T� � (^`I� L ��5{,�y'y[(3 1505614105 J ; \ / X �_� � 1505614205 aev-�soo ex(Fi1 oe�aae�rs so��ai se��my N�mee� oe�eeeorsrvame� RECAPITULATION 1 RealEs�atel5dietlule A). . . .. ... . . .. . . . . . . . ........ . . ...... . . ... ... . 1. ..._... ...._ . .. . ..... ... 2 Sbcks and Borus(ScheOule B) . . . .. . . . . . . . . ...... .. . ...... . . .... ... 2 � 3. Closely Hela Coryoratioq PaMers�ip or Sole-Propne�orship(Schetlule C) . . . . . 3. �. d. Motlgages antl Notes Receivable(Schetlule 0)........ ....... . . ...... . . .. C. �� 5. Cash, Bank Deposi�s antl Mlscellaneous Personal Pmpetly(Schetlule E). . . . . .. 5 . 473$Q.40. 6. Joiniry Owned Propetly(Schetlule F) O Separate Billing Reqvested . . . . . . . 6. i. Imervvrvos Iraoslars 5 Miscellenwus Non-Pmba�e Pmperry � � � � � (Schedule G) O Separate Billing Requested.. . . . . . . Z . 8. Total Grosa Aaseta(tolal Lines� [M1rougM1 1). ...... . .. . ....... . . . . ... . . . . 8. � q�380.40 9. Funaral Expenses and Aaminisvative Costs(Sc�etlule H). ...... . . ...... . . . . 9. 106fi4.05 10. Deb6 of Decetlen�, Mortgage Liabill[ies and Liens(Scbetlule I)... . ...... . . . .. 10. �� Z�04 24 n. rovi o.a�cno�s Oo�ai o�es 5 a�a iol_........_ . _..... . . ..._. . . . n. 12768 29 12. Net Value o�ESWh(Line 8 minus Line 11) . . . . . ... . .. ... . . . . . . 12 . .... . ... . .. .. . . 34612.11 _... ...__ ... . . . 13. Chantable antl Governmental Bepueslsl5ec 9113 Tmsls br which an elec�ion[o tax has no�baen made�Schetlula J) . . . . ....... . . . .... . . . . . 13. 14. Ne!Value Subjeq to Taz(LinB 12 minu5 Lin¢ 13) . . . ..... . . . . ...... . . . . .. 16. $46�$.71 TAX CAICULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amoun�ot Line 14 taxable at ine spousal�ax rale,or �ransfers un0er Sec.9116 � � � �� . (a)l12)X.0_ 15. . .__. ......... . �_. . _. .._.. .. . 16. Amoun�of Line 161axable . � auineal ra�e x Aqy 34612.11 . 16� 1557.54 t). AmounlofLine�4laxable .... . .. ...... .. ... ... . . .. .. . . .. ... .. . .. .. atsioling rale %.12 , � 1]. 18. Amounl of Line 141axable . .. . . .. . .. . . .. ... . ..... ... atwl�ateralrate X.15 '� 18 � 19. TAX DUE . .. . . .. . ... ... ...... ....... . . .. . .. .... 19. 1557.54�. 20. FILL IN THE OVAL IF VOII ARE REpUESTING A REFUND OF AN OVERVAYMENT p UnUer penaples o(pe�ury,I aeclate I�ave examinetl I�is reW�q Inclutling acwmpanyin9^.cn¢Uvles an0 sla�emen�s,anU lo��e�esl of my hnoMedge antl�elie( 11 Is Irve,mrrect antl complete.Oecl lion o!preparer ol�er inan�pe person msponu0lo lor fling Ne reWm is�ase0 on al InlonnaDon ol w�kM1 prep3rer nas any Wwwleag SIGNANRE GE ° N H`SV 9L FlLING RENRN O E 7 L �S nooREss SIGNATUREOFP PA�jlR�OfHEftTNANPERSONRESVONSIBLEFpRRLINGTHFRETURN �ATE �� _ . 7- /S iS nooa �� iiiiAumuuiu��4��4��i�i�iiiiiiiiiuiiiiiii S,dez Lsoselvaos J REV-1500 E% (FI) Page 3 Flle XUmM� DecedenYs Complete Address: D G �ENT'S NAME STREEfADDRE55 W I D 'v cro s*arE nr Tax Payments and Credits: � 1. Tas Due(Page 2,Li're 19) (�) +ts� � 2 CreGOyPaymenLs A.Pnor Payments B.Oiswum (SeeinsWctionsJ To�alCredi6(A+B) (2) 3. Interest (3) 4. II Line 2 is grealer ihan Line 1 �Line 3,enter the�iRerence. This is Ne OVERPAYMENT. Pill in oval an Page 1,Line 10 to request a refunE. (4) 5. Ii line 1 +Line 3 is greater than Line 2,enter Me diRerence.This is ihe TA%OUE. (5) �FF� qa Make check payable to: REGISTER OF WILLS,AGENT. . . . . .. , . .,_ . `�,.�,..+ '�"�,.a'�. . �, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deceGent make a Uansler arA: �es No a. re�ain Ue use or inmme of the pmDeM�nsfemG .............. ................. . . ...._ ..._... ❑ � b. relain Ne nghl to Eesignale who s�all use ihe properry transferteG or�Is mmme .. . ...... ....._ ❑ � c. relainareversionaryinlerest ............... .......... .... . _.... .... ❑ � tl. receivelhepmmiselorhfealeitherpaymenls,benefilsorwre� . _... ........._ __. ❑ � 2. If tleath oaurteG aAer Dec.12,1982,tlia deceCenl�ansfer pmperty withm one year ol dealh withoulreceivingadequateconsi7eretion?._ ..._....... ................ ... ......_........._.._ ❑ � 3. DiG CeceGen�own an'in W st fof or payable-upon-0ealh bank aaowt or secudty at his or�er Eealh?......__.... ❑ � 4. DiG Gecetlent pvn an inCividual reliremenl aaoun�,annuiry oro�her non-proba�e property•which Wnlainsabenefkia7tlesignation7 .. ......... .................. .................. . . .......................... ❑ � IF THE ANSWER TOANY OF THE ABOVE QUESTIONS IS YES,YOUYMUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. d�.. ., i 5 "+dse.xY � . ..,•. �I$ ., `42Pht�F.0 i; Y . � ..S For dates of death on or afier July 1, 1994,and before Jan.1, 1995,the tax rate imposed on the net value of iransfers to or for Me use of Me surviving sDouse Is 3 percent[/2 P.S.§9116(a)(1.1)(i)I. For dates of death on or a%er Jan. 1, 1995, the tau rete imposed on ihe net value of irensfers to or for Ne use of Me surviving spouse is 0 percenl [72 P.S.§9116(a)(1.1)(ii�].The staNte dces not exempl a transfer to a suniving sDouse from tax,and ihe statutory requiremenis for disclosure of asuts and fling a�ax retum are still applicabie even if the surv'rving spouse is Me only beneficiary. For aates of death on or aRer July 1,2000: . The tax rate imposed on ihe net value of tronsfers from a Oeceased child 21 years of age or younger at death to or for the use of a naNral parent,an adoD�ive parent or a steµparent of the child is 0 percent p2 P.S.§9116(a)(11)]. . ThetaxateimposedonihenelvalueoftansferstoorfiriheuseofUedecedenYslinealbeneficianesis4.5percent,exceptasnotedin[/2PS.§9176�a�(7)]. • The tax rate imposed on the net value of transfers to or fa the use of the decedenfs siblings is 12 percent[72 P.S.§9116�a�(1.3�J.A sibling is defined, under Section 9102,as an indiviCual who has at least one parent in cammon with Me dece0ent,wheMer by blooG or adopfion. aev-isoe Ex.(ox-is) j�i�pennsyNania SCHEDULE E �i7 oernmmwraFnerexue CASH� BANK DEPOSITS & MISC. '""E"^""cE'"""t'�'"" pERSONALPROPERTY usmexro�cmExr ESTATE OF: FILE NUMBER: InduEe Me OKK�ds of Iltlgation and[he date[he pmceetls were received by Me estate. All propeRy folntly owne0 with riqht of curvlvachip murt be Alsclosed on ScheAuk F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH personal effecisldothing 1. 0.00 Checking aaount M870ank 3538 ' 2 79.54 M8T Checking acaunt 12471Savings fi410 3 22528 SERS refund 4 617.14 Mnuiry,S�ate Farm,1952 contract SPIA payable to es�ate 46458.44 TOTAL(Alw enter on Line 5, RecaDttulation) S 47380.40 If more space Is neeOeG,use aJJiUonal shee6 of Oape�af Me same sixe. REV-1511 E%�(@45) �i�Jpennsylvania SCHEDULE H �,y omumnexrarxEverwe FUNERAL EXPENSES AND �""E"�cET"xa�"" pDMINISTRATIVE CO5T5 RESIOEM DFQOEXI ESTATE OF FILE NUMBER OxeEent'v Eebts murt be reporteE on SNeEule I. REM NUMBE0. DESC0.IPTION AMOIINT A. FUNERAL EXPENSES: � 1. PaAhemore Funeral Home and Cremation Services Inc 3212.81 Rolling Green Cemetery 335.00 e. ADMINIST(1ATIVE COSTS: 1. Personal Represenlative Commissions: ' Name(s)af Personal Represendtive(s) � 2500.00 SCOG.�-.hPLPy, Stree[AtlEress City l`�mn H'll S[ate��ZIP��O�� YeaQs)Commission Paid: �q �. Attomeykes: 4500.00��t) 3. Family Exemp[iore(1(EecetlenPs adEreu is not Ihe same as tlaimanPs,attach e�plana[ion.) Claimant Street A0dres5 Ciry Sta[e_ZIV Relationship of Cbiman[[o DeaEent 4. GfObd[P Fp¢5: 225.50 5. Accoun[ant Fees: 6. Tax 0.eNm Prepara Fees:`t��utOL [JLEp3r2 state and federal returns �' Advehisinq 225.74 TOTAL(Also enter on Line 9,Recapi[ulation) � �0664A5 1I more space Is nee0e0,use aEdiOonal sheets o!paper ot lhe same siie. - 0.EV-ISIi EXi(W-l5) �'i�pennsylvania SCHEDULE I ty� oEvexinwrornevwue DEBTS OF DECEDENT� mneaRexcer�u ar�uw� MORTGAGE LIABILITIES & LIENS aesmerrt o[uoExr ESTATE OF FiLE NUMBER �Ierav-E-Beranc ��,= ee R<port debb incurred by the OeaEen[pdor lo deaN that remainetl unpaiE at the date ot Oeath,including unreimbuned medial ex0ensev. �M VAWE Ai pATE NUMBER DESC0.IPTION ' OFDEATH 1. Bethany Vllage nursing care Mal invoice 1200,13 2 PADepartmentofWelfare,TPLclaimformediwlassistance 904�� TOTAL(Alm en[er on Line 10, Recapi[ulation) s y10424 If more s0ace is neeGeG,insert aCEiOonal shee[s o!tAe same si¢e. RF/-1513 E%+(W-l5) � �pennsylvania SCHEDULE J �i7 oevaamwroFnEvsvue �xxEw,q�r�a�ax BENEFICIARIES nesmexroeceoem ESTRTE OF: FILE NUMBER: RElAT10N5H1VTODECEOENT ORSHA0.E NUMBER NAME AND A�D0.ESS OF FE0.50N(S)RECEIVING PFOiER1V Do Not lirt Trustee(s) OF EAATE I TA%ABLE OISTRIBUTIORS[Intlutle outrigh[s0ousal ClrttlbuUons an0 t2ns�ers unEer Sec 9316(a)p.i).� 1. seelis�ofgrendchiWren/greatgrandchildrenreceiving prandchildren 1/14share greatyrandchildren 1/14 share ENTER DOLtAR AMOUNrS FOR 0[SfRI9UTI0N5 SHOWN ABOVE ON IlNES 15 TNROUGH l8 OF REVd504 COVER SHEE[AS APGROVWATE. �� NON-TPXABIF�ISTRIBUT10N5 A. SPOUS4L DISiRiBMONS UNDER SERION 9113 FOR WHICH AN E�ECfION TO TAX IS NOT TAKEN: 1. 9. CHARRABLEANDGOVERNMENTAlDIS1RI8MON5: 1. TOTAL OF PA0.T II-ENTE0.TOTNL NON-TN%ABLE DIS7R18UilONS ON IINE 13 OF REVd500 COVER SHEET. j If more space is neede�,use aAGitional sheets o!paper of the same size. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ) ESTATE OF VERDA E. BORDNER ) 21-15-337 ) REGISTER OF WILLS Schedule J Supplement- Beneficiaries Name of Decedent: VERDA E BORDNER Date of Death: January 26, 2015 Date Letters Granted: April 22, 2015 Schedule of heirs Namg Address Testate heirs: Michael Chazles D'Mgelo Grandson 1 West Front Street Apartment A, Second Floor Media, PA 19063� Pazent or Guazdian of Great-Granddaughter Sophia Marie D'Rngelo 1 West Front Sffeet Apaztment A, Second Floor Media, PA 19063 Pazent or Guazdiari of Great-Grandson Alec Mick�ael D'Angelo 1 West Front Street Apartment A, Second Floor Media,PA 19063 Anthony Joseph D'Mgelo Grandson 606 Pacinosa Avenue Eastoq PA 18042-� Pazent oc Guazdian of Great-Grandson Anthony Salvador D'Mgelo 606 Pa�cinosa Avenue Easton, PA 18042. Matt Bahoric Grandson 1444 Greenmeadow Drive York,PA 17404 Pazent or Guazdian of Great-Granddaughter Elizabeth Bahoric� 1444 Greenmeadow Drive York, PA 17404 Andrea Bahoric Granddaughter 714 Oakhill Drive Boiling Springs, PA 17007 Mazk Joseph Dusick Grandson 13500 South 183 Drive Goodyear, AZ 85338 Pazent or Guardian of Grea[-Granddaughter Bryony Rose Dusibk 13500 South 183 Drive Goodyeaz, AZ 85338 Megan Shelley Dapp Granddaughter 145 Fineview Road Camp Hill, PA 17011 Pazeut or Guardian of Great-Grandson Chase Michael Dapp 145 Fineview Road Camp Hill,PA 17011 Pazent or Guardian of Great-Granddaughter Brinley Christine Dapp 145 Fineview Road Camp Hill, PA 17011 Douglass Scott Shelley Grandson 405 Candlewyck Road Camp Hill, PA 17011 Date: �/. i S- �� - Michael S. ravis 3904 Trindle Road, Camp Hill, PA 17011 (717) 731-9502 Counsel for Estate