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Home My WebLink About09-23-15 (2) � . pennsylvania 15D5618403 DEPARTMENTOFREVENI�X�0.3-�4� t REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes Counry Code Year File Number Po Box zsosol INHERITANCE TAX RETURN Harrisburq,PA 17128-0601 RESIDENT DECEDENT 21 15 0 4 6 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 179 14 7928 04 09 2015 04 04 1922 DecedenYs Last Name Suffix DecedenYs First Name MI ROTH ARLENE Z (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return � 2. Supplemental Return � 3. Remainder Return(date of death prior to 12-13-82) � q, Agricultural Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) � 7. 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. 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 T0: Name Daytime Telephone Number IVO V OTTO III 717 243 3341 First Line of Address 10 EAST HIGH STREET Second Line of Address City or Post Office State ZIP Code CARLISLE PA 17013 CorrespondenYs email address: �otto martsonlaw.com � �,; ' .,,,3 REGISTE Fd�qILLSUSEJI�LY �; ��' _.„ _. '' <-y 7 . REGISTER OF WILLS USE ONLY �'' �" `U `� .,, _:_ ,r_, ; 7 DATE FILED MMDDYYYY �' � - rJ ' . � ; __ _ C.J ' _ , ..� � _,. � . .. _::;1 DATE FILED STAMP� "' - �-r� F---� `�'� :� _ W Side 1 ..� I I�II�I III'I�I II IIIII'III III'I IIIII II II�I�II IIIII IIII II) \' � 1505618403 1505618403 � � J 15056b84b1 REV-1500 EX Decedent's Social Security Number DeoedenPs Neme: Roth,Arlene Z. Z 7 9 14 7 9 2 8 RECAPITULATION t. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)..................................................................•------��-• 2. 3. Closely Neld Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages and Notes Receivable(Scheduie D).................................................... 4. 5. Cash,Bartk Deposits and Miscellaneous Personal PropeAy(Schedufe E).......... 5. 2,18 5•0 U 6. Jointty Owned Property(Schedule F) ❑ Separate Biiling Requested............ 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate PropeRy (Scheduie G) ❑ Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7}........................................................ 8. 2,18 5•0� 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 16 7•9 5 10. Debts of Oecedent,Mo�tgage Liabilities and Liens(Schedule!)............................ 10. 11. Totai Deductions(total Lines 9 and 10)................................................................ 11. Z 6 7•9 5 12. Net Value of Estate{Line 8 minus Line 11).......................................................... 12. 2,017•0 5 13. Charitable and Govemmental BequestslSec 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. 2,017-0 5 TAX CALCULATION-SEE INSTRUCTiONS FOR APPLICABLE RATES 15. Amount o(Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.QO 15. 0•0 0 16. Amount of Line 14 taxable at�inea�rate x .oa5 2�017•0 5 16. 9 0•7 7 17. Amount of Line 14 taxable at sibling rate X.12 0•0 0 17• U-U U 18. Amount of Line 14 taxabie at coliaterel rate X.15 U•0 0 18• 0-0 0 19. TAX DUE..........................................................................................................�•---. 19. 9�•77 20. FILL IN THE OVAL IF YOU ARE REQUESTIIJG A REFUND OF API OVERPAYMENT � Under penaitles of perjury,1 deGare 1 have examEned this retum,inGuding aa:ompanying schedules and sWtements,and to the best oi my krrowtedge and belief, it is true,correct and compieie.DeGaration of preparer other than the person responsible for filing ihe retum is based on all fn(ormatian ot wRich preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Allen Z.Roth DA� ( 7i Z I 5 ADDRESS 30 Sh !e Lane,Boilin S rin s,PA 17007 SIGNAT R F PARER O ER THAN REPRESENTATNE IVO V.O�O III �A� � p�3 �� ADDRESS 10 East High Street,Carlisle,PA � (I'II'I I"'�'��I�'I'I I�I1I)I��')��"��Ib�I'�I��"��'I I") Side 2 Z 505618 4 Z1 � REV-1500 EX Page 3 File Number 21-15-0462 Decedent's Complete Address: DECEDENT'S NAME Roth,Arlene Z. STREET ADDRESS 2100 Bent Creek Blvd CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 90.77 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (z) 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 9�.77 Make Check Pa able 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:............................................................................... ❑ ❑ b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ ❑ c. retain a reversionary interest;or............................................................................................................... d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑ ❑ receiving adequate consideration?.................................................................................................................... 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑ 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 January 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 ihe 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 decedenYs 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. Re�-isoa ex+�os-�2► SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OFREVENUE p E RSO NAL P RO P E RTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 Include the proceeds of litigation and the date lhe proceeds were received by the estale. All property jointiy-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Social Security-Payment due decedent at death 2,185.00 TOTAL(Also enter on Line 5, Recapitulation) 2,185.00 (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-1517 EX+�OS-73) pennsylvania SCHEDULE H DEPARTMENT OFREVENUE F U N E RAL EXP E N S E S AN D INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT q, FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid Waived 2. Attorney's Fees Martson Law Offices 152.95 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 167.95 Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Roth,Arlene Z. 21-15-0462 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Register of Wills-Filing fee for Supplemental Inheritance Tax return 15.00 H-67 15.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) RE1l•1b1S IX+(01•10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERRANCE TAX REIURN BENEFICIARIES RESIDENT DECEDENT ESTATE aF FILE NUMBER Roth,Arlene Z. 21-15-0462 RELATIONSHIP TO NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT ({�yords) ($$$j I� TAXABLE DISTRIBUTIONS [include outright spousal distnbutions,and transfers under Sec.8116 a 1.2 1 Constance H.Henry Daughter Schedule G Item 512 Woodcrest Drive 6,Twenty-five Mechanicsburg,PA 17050 percent(25%)of $5 04.2 7 residue 3 Allen Z Roth Son Schedule G Item 30 Sheeley Lane 4,Twenty-five Boiltng Springs,PA 17007 percent(25%)of residue $ 509 .25 6 Dean G.Roth Son Schedule G Item 1820 Artnstrong Avenue 8,Twenty-five Morton,PA 190T0 percent(25%)of $5 04.2 6 residue 8 Willfam B.Roth Son Schedule G Item 10008 Scott Plantation O�ive North 2,Twenty-five Mobile,AL 36695 percent(25�0)of $504.26 residue Total $2,017.0 5 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro �iate. 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 SHE Copyright(c)2010 form soflware only The Lackner Group,inc. Fortn PA-15o0 Schedule J(Rev.01-10)