HomeMy WebLinkAbout08-20-15 EX(03-14)(FI) 1505614134
REV-1 500 OFFICIAL USE O,',P_Y
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 5 0 0 3 2 3
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 8 2 5 2 0 1 4 0 2 2 0 1 9 3 3
Decedent's Last Name Suffix Decedent's First Name MI
R OD G E R S ME R I A M L
(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
Q 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 El6.Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
❑ 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 71 7 697 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
MECHANICSBURG P A 1 7 0 5 5
Correspondent's e-mail address: david(Wwaltersplalloway.com M
r
REGISTit-fR*WILLS U&EDNLY6 CD
REGISTER OF WILLS USE ONLY .�i.7 .._,.� t
DATE FILED MMDDYYYY
(7)
DATE"FILED STANtP r- rn
CJ 1 (n C)
PLEASE USE ORIGINAL FORM ONLY
Side 1
I IIIIII IIID VIII VIII IIID VIII VIII VIII VIII VIII IN IN
1505614134 1505614134
o�
1505614234
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: MERIAM L. RODGERS
RECAPITULATION
1. Real Estate(Schedule A) ... . . . ..... . . .. .. . .. ... .... . . . .... ... . . . .. . 1.
2. Stocks and Bonds(Schedule B) .. . .. . . . .. ...... . 4 3 7 6 2 , 9 4
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. 1 2 7 9 8 • 7 4
6. Jointly Owned Property(Schedule F) E] Separate Billing Requested .. ..... 6.
7. Inter-Vivos Transfers&Miscellaneous N -Probate Property
M
(Schedule G) Separate Billing Requested . .. . ... 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . .. . .. .. .. ....... .. . .. . 8. 5 6 5 6 1 6 8
9. Funeral Expenses and Administrative Costs Schedule H 9. 1 7 9 8 1 1 5
10. Debts of Decedent,Mortgage Liabilities,and Liens Schedule I 10. 5 1 6 . 5 0
11. Total Deductions(total Lines 9 and 10) ..... . .. .. .. . . . .... . . . ........ . 11. 1 8 4 9 7 . 6 5
12. Net Value of Estate(Line 8 minus Line 11) . ........ ... . .... . . . . . ... . . . 12. 3 8 0 6 4 . 0 3
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. 3 8 0 6 4 . 0 3
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 3 8 0 6 4 . 0 3 76. 1 7 1 2 . 8 8
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Lina 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE ..... .. .. . . . .... . . .... . . . . . . .. . ... ..... . . . ..... .. . . . . . 19. 1 7 1 2 . 8 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT QX
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 knowledge.
SIGNATURE OF PERSO��eNe RESPONSIBLE FOR FILING RETURN Q DATE
t
ADDRESS
CHARLES E. RODGERS 6121 FINGLAS DR. COLORADO SPRINGS CO 80923
SI URE EPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DRAT
3 /
ADDRE
DAVID R. &LLOWAY 54 E. MAIN ST. MECHANICSBURG PA 17055
11111111111111111111111111111111111111111111111111111111 IN Side 2
1505614234 1505614234
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 15 00323
DECEDENTS NAME
MERIAM L. RODGERS
STREET ADDRESS
856 BOILING SPRINGS RD.
CITY STATE ZIP
MECHANICSBURG I PA 117055
Tax Payments and Credits:
I. Tax Due(Page 2,Line 19) (1) 1,712.88
2. Credits/Payments
A.Prior Payments 1,741.94
B.Discount
(See instructions.) Total Credits(A+B) (2) 1,741.94
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) 29.06
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 ...................................................................... ❑ N
b. retain the right to designate who shall use the property transferred or its income ❑ 0
c. retain a reversionary interest ................................................................... El ❑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? ....................................................................................... ❑ 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ Q
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑
1F 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-1503 EX+(8-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MERIAM L. RODGERS 21 15 00323
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. JANNEY MONTGOMERY SCOTT 43,762.94
TREASURY ITEMS-HOME LOAN MORTGAGE
DATE OF DEATH VALUE
TOTAL(Also enter on Line 2,Recapitulation) $ 43 762.94
If more space is needed, insert additional sheets of the same size
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
MERIAM L. RODGERS 21 15 00323
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. JANNEY MONTGOMERY SCOTT 129798.74
MONEY MARKET ACCOUNT
DATE OF DEATH VALUE
TOTAL(Also enter on Line 5,Recapitulation) $ 12 798.74
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
MERIAM L. RODGERS 21 15 00323
Decedents debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS BUHRIG FUNERAL HOME&CREMATORY 14,517.47
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) CHARLES E. RODGERS (waived) 0.00
Street Address 6121 FINGLAS DR.
City COLORADO SPRINGS State CO Zlp 80923
Year(s)Commission Paid:
2. Attorney Fees: WALTERS&GALLOWAY, PLLC 1,750.00
3. Family Exemption:(If decedent's address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: REGISTER OF WILLS, CUMBERLAND COUNTY 110.50
5 Accountant Fees: FIDUCIARY RETURN (Estimated) 350.00
6. Tax Return PreparerFees: H &R BLOCK-2014 PERSONAL INCOME TAXES 315.75
7. STATE FARM-SURETY BOND 378.00
8. REGISTER OF WILLS, CUMBERLAND COUNTY-BOND FEE 15.00
9. REGISTER OF WILLS, CUMBERLAND COUNTY-ADDITIONAL PROBATE 115.00
10. JANNEY MONTGOMERY SCOTT-LIQUIDATION OF SECURITIES FEE 429.43
TOTAL(Also enter on Line 9,Recapitulation) S 17 981.15
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
MERIAM L. RODGERS 21 15 00323
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. QUANTUM IMAGING &THERAPEUTIC ASSOCIATES, INC. 516.50
TOTAL(Also enteron Line 10,Recapitulation) $ 516.50
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:
MERIAM L. RODGERS 21 15 00323
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).j
1. CHARLES E. RODGERS Lineal 50.00
6121 FINGLAS DR.
COLORADO SPRINGS, CO 80923
2. DELORIS M. MOYER Lineal 50.00
100 S. WEST ST.,APT. 203
GRATZ, PA 17030
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.