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Home My WebLink About07-24-15 (2) Or"LA) 1505614134 EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 5 0 2 8 1 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 1 3 1 2 0 1 5 0 3 2 1 1 9 3 1 Decedent's Last Name Suffix Decedent's First Name MI C H E S T E R R U T H G (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) Q 7. Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 0 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 5 4 E . MA I N S T City or Post Office State ZIP Code MECHA NI CS BU RG PA 1 7 0 5 5 C, u-, MM Correspondent's e-mail address: dayid@waltersgalloway.com c_ rri n 71 REGISTER D VIII LS USE ONLY REGISTER OF WILLS USE ONLY CJS 7.1 DATE FILED MMDDYYYY p C a -rI -71 C ZE n t-. r-- M DATE FIL'8Q STAMP PLEASE USE ORIGINAL FORM ONLY Side 1 111111 VIII 11111 VIII VIII III')VIII 11111 VIII VIII IIII IN 1505614134 1505614134 1505614234 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: RUTH G. CHESTER RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . .. . . . . 1. 2. Stocks and Bonds(Schedule B) . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 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). . . . . . . 5. 8 0 7 3 8 • 3 2 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 3 4 0 5 , 3 0 (Schedule G) f_1 Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . .. . . . . . . . . . . . . . . 8. 8 4 1 4 3 . 6 2 9. Funeral Expenses and Administrative Costs(Schedule H) .. .. . . . . . . . . . . . . . . 9. 4 3 7 2 9 6 10. Debts of Decedent,Mortgage Liabilities, and Liens(Schedule I) . . . . . . . . . . . . . 10. 4 6 7 0 • 5 2 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . .. . . . . .. .. . . . . 11. 9 0 4 3 . 4 8 12. Net Value of Estate(Line 8 minus Line 11) . .. . . . . . . . . . . . . . . . . . . . .. . . . . 12. 7 5 1 0 0 . 1 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. 7 5 1 0 0 . 1 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 7 5 1 0 0 . 1 4 16. 3 3 7 9 . 5 1 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. 3 3 7 9 . 5 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Under pens ies 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,96rrect and complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knpAleXge. SIG RE OF PERSON NSI RFL RETU � ,DATE ^!�r A DRESS MARGARET E. CHESTER 1675 SAWYER LN. MECHANICSBURG PA 17050 S1 OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN D E z 1J, ADDR S DAVID R GALLOWAY 54 E. MAIN ST. MECHANICSBURG PA 17055 111111111111111111111111111111111111111 IN Side 2 1505614234 1505614234 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: 21 15 0281 DECEDENT'S NAME RUTH G. CHESTER STREET ADDRESS 5225 WILSON LANE, STE 212 CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 3,379.51 2. Credits/Payments A.Prior Payments 3,000.00 B.Discount 150.00 (See instructions.) Total Credits(A+B) (2) 3,150.00 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) 229.51 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 ............. ❑ ❑ 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?.................................................................................................. ❑ 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-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS 8r MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: RUTH G. CHESTER 21 15 0281 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC BANK 4,948.25 CHECKING ACCOUNT(x9539)- Date of Death Balance 2. PNC BANK 14,645.13 CHECKING ACCOUNT(x9766)- Date of Death Balance 3. PNC BANK 56,550.00 SAVINGS ACCOUNT(x8309)-Date of Death Balance 4. PENNSYLVANIA MUNICIPAL RETIREMENT SYSTEM 265.77 PENSION PAYMENTS 5. UNITED HEALTH CARE SVS, INC. 49.70 REFUND 6. RIVERSOURCE 3,000.00 LONG TERM CARE INSURANCE CLAIMS 7. 2003 FORD WINDSTAR 1,000.00 SALE PRICE 8. THRIVENT FINANCIAL 83.88 DIVIDEND ON CONTRACT-LIFE INSURANCE 9. PHILADELPHIA LIFE 195.59 REFUND TOTAL(Also enter on Line 5,Recapitulation) $ 80 738.32 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER RUTH G. CHESTER 21 15 0281 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICABLE) VALUE 1. AMERIPRISE FINANCIAL 3,405.30 100.00 3,405.30 Beneficiary-Children Transferred after death TOTAL (Also enter on Line 7,Recapitulation) $ 3,405.30 If more space is needed,use additional sheets of paper 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 RUTH G. CHESTER 21 15 0281 Decedent's debts must be reported on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS BUHRIG FUNERAL HOME &CREMATORY(Balance after insurance) 631.78 2. TRINITY LUTHERAN CHURCH-FUNERAL MEAL 375.68 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) MARGARET E. CHESTER (waived) 0.00 Street Address 1675 SAWYER LANE City MECHANICSBURG State PA Zip 17055 Years)Commission Paid: NONE 2. Attorney Fees: WALTERS&GALLOWAY, PLLC 2,750.00 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 315.50 5 Accountant Fees: 6. Tax Return Preparer Fees: JOHN KOSTOVICH, CPA-2014 Personal Income Tax Return 300.00 JOHN KOSTOVICH, CPA-2015 Personal Income Tax Return (Reserved) 7. TOTAL(Also enter on Line 9,Recapitulation) $ 4,372.96 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 RUTH G. CHESTER 21 15 0281 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. BETHANY VILLAGE 4,182.20 NURSING HOME 2. MEDICINE SHOPPE 227.85 PHARMACY 3. AT&T MOBILITY 83.29 WIRELESS PHONE 4. PENNSYLVANIA MUNICIPAL RETIREMENT SYSTEM 177.18 RETURN PENSION PAYMENTS TOTAL(Also enter on Line 10,Recapitulation) $ 4,670.52 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: RUTH G. CHESTER 21 15 0281 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. MARGARET E. CHESTER Lineal 50.00 1675 SAWYER LN. MECHANICSBURG, PA 17050 2. KATHRYN A. CHESTER Lineal 50.00 10 PALMER DR. CAMP HILL, PA 17011 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.