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HomeMy WebLinkAbout09-01-15 Pennsylvania 1505618403 _.J DEVAftTMENTOFftEVENX(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 15 0708 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06 01 2015 09 15 1924 Decedent's Last Name Suffix Decedent's First Name MI ROMBERG,ER R . LOUISE (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 Q1. Original Return Q 2. Supplemental Return r] 3. Remainder Return(date of death prior to 12-13-82) EJ4, Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Requ(red death on or after 7-1-2012) death after 12-12-82) a7. Decedent Died Testate 8. Decedent Maintained a Living Trust ], 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. DeferraltElectiori of Spousal Trusts (Schedule F and G Assets Only) Q.. 13. Business Assets Q 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT•THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name' Daytime Telephone Number VICKY ANN TRIMMER 717 724 9821 First Line of Address 635 N 12TH ST SUITE 101 Second Line of Address City or Post Office State ZIP Code LEMOYNE PA 17043 Correspondent's email address: vtrimmer(ai_)dzmmlaw.com REGISTER OF WILLS USE ONLY w REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY C_rl � CJS r-rl 2 !� DATE FILEb-S-15A � C-) �1 C-) Cil cn Side 1 11111111111111111 11111 Illli 1111111111 11111 11111111111111 IN �;�. 1505618403 1505618403 1505618411 REV-1500 EX Decedent's Social Security Number Decedent's Name: Romberger, R. Louise RECAPITULATION 1. Real Estate(Schedule A)............____.............. ...... ....... 2. Stocks and Bonds(Schedule B)....... ............. ..................................... 2. 55 ,268 - 05 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages and Notes Receivable(Schedule D)........ ...........7............ ............. 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)......._ 5. 16,787 - 24 6. Jointly Owned Property(Schedule F) r_1 separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (schedule G) ❑ Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines I through 7)........................................................ 8, 72 ,055 - 29 9. Funeral Expenses and Administrative Costs(Schedule H)....... ......... .................. 9. 4 ,728 - 56 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 6 ,790 - 15 11, Total Deductions(total Lines 9 and 10).... ....... ...... ...........__........ 11 ,518 - 71 12. Net Value of Estate(Line 8 minus Line 11)...... .......... ........................................ 12. 60 -, 536 - 58 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J).................. ...........I........... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 60,536 - 58 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.00 15. 0 . 00 16. Amount of Line 14 taxable at.lineal rate X .045 60,536 - 58 16. 2,724 - 15 17- Amount of Line 14 taxable at sibling rate X.12 0 . 00 17, 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE............................... ........................ ......... ........... .............._1............ 19. 2-,724 . 15 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 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 PF PERSON RESPONSIBLE FOR FILING RETURN Lois A. DeHart DATE ADDRESt 1159 Kuhn Road, Boiling Springs, PA 17007 SIGNATUEO PREPAR 0=THHAN REPRESENTATIVE Vicky Ann Trimmer DATE ADDRESS 635 N. 12th St., Suite 101, Lemoyne, PA 17043 11111 Side 2 1505618411 1505618411 REv-1ouoExPage 3 File Number 214S-D7U8 Decedent's Complete Address: DECEDENT'S NAME Romberger, R. Louise STREETADDRESS 20 N. 12th St., Room 118 CITY Lemoyne STATE PA ZIP 17043 Tax and ' 1` Tax Due(Page 2,Line 1g) (1) 2,724.15 2. A. Prior Payments | B. Discount 13$.21 Total Credits(* +8) C0 136.21 � 3, Interest uY u� KLine 2isgreater than Line 1 +Line 3.enter the difference. This is the OVERPAYMENT. yq . Check box nnPage z.Line eou,request a,efunu & |fLine 1 ~Line 3isgreater than Line u.enter the difference. This iathe TAX DUE. (5) 2,587.94 Make Check Payable to: REGISTER OF WILLSAGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN 'X" IN THE APPROPRIATE BLOCKS 1. Did decedent make etransfer and: Yes No a. retain the use mincome v/the property transferred;.... ...... ............—................ —'—' ...........___ b. retain the right to designate who shall use the property transferred or its income;.................................. c retain areversionary interest;vr.-------............................ ........ .......................—............. ' d. receive the promise for life of either payments,benefits or care?... .......... ............................................ u. If death occurred after Dec. 12, 1982. did decedent transfer property within one year ovdeath without receiving adequate oonoidemUuo?—.......... —.... ................................................ ............ ................. ..... n n. Did decedent own an"in trust foe' or payable upon death bank account or security at his or her death?....... 1:1 n * D�d000�en�nwnoo|nui,|�ua|mhmman�ocooum annuity,or� ' ' containsbeneficiary designation?......... ................................................ ......... .......... ................................ �l�� �J�� IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE GAND FILE nAaPART OFTHE RETURN. . rmdates of death on or after July 1.1894and before Jan.1.1995.the tax rate imposed vnthe net value of transfers too,for the use of the surviving spouse isnpercent p2P&O9110$V(11)(i)). For dates of death ono,after January 1.1SSo.the tax rate imposed onmenetva|ueufhansfemmorfo,theuaenfthamvm*|ngvpvumaiaOpoomm (72p.S,O3116(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 ofdeath onorafter July 1.2Uo0: ^ The tax rate imposed unthe net value of transfers from a deceased child 21years vfage myounger gdeath mmfor the use oxunatural parent,an adoptive parent,ur*step-parent ufthe child iaOpercent(72P.8.§9116(o)(12)|. ° The tax rate imposed unthe net value of transfers morfor the use ufthe decedent's lineal beneficiaries is*5percent,except ounoted inp2P,8.hB110(a)(1D . The tax rate imposed onthonetvo|uauftranefesmo,fo,theuuooftdsiblings iu12percent[72P.S.@S118V4(1.x)). Asibling iodefined, 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+(08.12) SCHEDULE B Pennsylvania STOCKS & BONDS DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Romberger, R. Louise 21-15-0708 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 Edward Jones-744.26 Money Market Investment Shares 744.26 2 Edward Jones-265.479 Baird FDS Inc Mutual Fund 2,575.15 3 Edward Jones-783.797 Bridge Bldr Tr Mutual Fund 7,986.89 4 Edward Jones-309.486 Bridge Bldr Tr Large Cap Val Mutual 3,107.24 Fund 5 Edward Jones-372.381 Dodge&Cox income Fd Mutual 5,138.86 Fund 6 Edward Jones-97.867 Strategic Funds Inc Mutual Fund 1,532.60 7 Edward Jones-592.436 Franklin Invs Secs Tr Mutual Fund 5,977.68 8 Edward Jones-177.413 John Hancock FDS III Mutual Fund 2,045.57 9 Edward Jones-131.1 JP Morgan Tr I Mutual Fund 131.10 10 Edward Jones-236.324 JP Morgan Tr[if Mutual Fund 2,575.93 11 Edward Jones-326.633 Lord Abbett Invt Tr Mutual Fund 3,602.76 12 Edward Jones-141.457 Massachusetts Invs Growth Stk 3,670.81 Mutual Fund 13 Edward Jones-550.427 Metropolitan West Fds Mutual Fund 5,988.65 14 Edward Jones-373.371 Price T Rowe High Yield FD Inc 2,587.46 Total of Continuation Schedule See attached page TOTAL(Also enter on Line 2, Recapitulation) 55,268.05 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.08-12) Rev-1503 EX+(08-12) SCHEDULE B -_.� Y ry „.;. penes Ivania STOCKS & BONDS DEPARTMENT OF REVENUE INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Romberger, R. Louise 21-15-0708 ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 15 Edward Jones-353.22 Rowe T Price Intl FDS inc Mutual 2,988.24 Fund 16 Edward Jones -Accrued Interest on Mutual Funds 2.05 17 Series EE Savings Bond-M6247041 2,306.40' 18 Series EE Savings Bond -M6247042 2,306.40 TOTAL(Also enter on Line 2, Recapitulation) 55,268.05 Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule B(Rev.08-12) Rev-11508EX+(08-112) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF IFILE NUMBER Romberger, R. Louise 21-15-0708 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I PNC Bank-Checking Account#5140053713, 14,101.45 2 PNC Bank -Savings Account#5130104732 2,685.77 3 PNC Bank-Accrued Interest 0.02 TOTAL(Also enter on Line 5,Recapitulation) 16,787.24 (if more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12) REV-1511 EX+(08.13) Wr,... SCHEDULE H s b Pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERIRESIDENT EDENAX TURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Romberger, R. Louise 21-15-0708 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 2,788.06 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Persona(Representative(s) Street Address City State Zio Year(s)Commission Paid 2. Attorney's Fees Daley Zucker Meilton & Miner, LLC 1,625.00 3. Family Exemption: (if decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 245.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 70.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 4,728.56 Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1504 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Romberger, R. Louise 21-15-0708 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Funeral -Myers&Harner Funeral &Cremation 454.88 2 Funeral -Guy Eckert St.John's Cemetery-fee for opening grave 950.00 3 Funeral-Clothing for burial 21.99 4 Funeral-Stauffers-flowers 111.27 5 Funeral-Funeral luncheon 914.64 6 Funeral-Miscellaneous items 35.28 7 Funeral-Patricia Putz, harpist 150.00 8 Funeral-R..J. Romberger&Sons Monuments-engrave date on stone 150.00, H-A 2,788.06 Other Administrative Costs 9 Edward Jones -Fee for date of death statement 50.00 10 Vital Statistics-Birth Certificate for Ken 20.00 H-B7 70.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form FA-1500 Schedule H(Rev.6-98) Rev-1612 EX+(12-12) SCHEDULE I pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Romberger, R. Louise I 21-15-0708 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 Essex House-Final Rent 2,042.60 2 Holy Spirit Hospital 225.00 3 Hospice of Central Pennsylvania 4,500.00 4 Manor Care Services 20.00 5 Verizon 2.55 TOTAL(Also enter on Line 10, Recapitulation) 6,790.15 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-12) REV-1513 EX+(01.10) `t pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES p INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Romberger, R. Louise 21-15-0708 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) 0 of List Trusted s I+ TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Lois A. DeHart Daughter 50% 30,268.29 1159 Kuhn Road Boiling Springs, PA 17.007 ° 2 Kenneth L. Romberger Son 50% 30,268.29 P.O. Box 1185 Twain Harte, CA 95383 . r Total 60,536.58 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as appupdate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)