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ATTORNEYS AT LAW
ARTliUR K. OILS
DIANE M. OILS
1017 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102
PHONE: (717) 233-8743
FAX: (717) 233-2567
August 4, 2005
Cumberland County Register of Wills
ATTN: Glenda Farner Strasbaugh
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
RE: Estate of Mary E. Koppenheffer
No. 21-05-0051
Dear Ms. Strasbaugh:
Enclosed are an original and one copy of an Inheritance Tax Return .0 be filed in
your office in regards to the above-captioned Estate. I have also enclosed a check
in the amount of$15.00 to cover the filing fee of the same.
Also enclosed is a self-addressed, stamped envelope to return a clocked-in copy to \
me.
Thank you for your assistance in this matter.
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPl 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
REV-1500
OFFICIAL USE ONLY
FILE NUMBER
21 05
0051
COUNTYCOOE
NUMBER
YEAR
SOCIAL SECURITY NUMBER
183 - . 07
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Koppenheffer, Mary E.
DATE OF DEATH (MM.DD-YEAR) DATE OF BIRTH (MM.DD.YEAR)
01/16/2005 03/11/1913
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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[Xl 1. Original Retum
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Willi
o 9. Litigation Proceeds Received
9066
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. Supplemental Retum
o 4a. Future Interest Compromise (data ofd..th aft" 12.12-82)
o 7. Decedent Maintained a Living Trust (A_oopyofTrust)
o 10. Spousal Poverty Credit (da.. of death _,2.31.91 and 1.1-95)
o 3. Remainder Retum (dal. of d.ath pnOf to 12.13-82)
o 5. Federal Estate Tax Retum Required
Q 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Anach SchO)
FIRM NAME (If Appl",,~.)
Dils & Dils
Diane M. Dils, Esquire
TELEPHONE NUMBER
3. Closely Held Corporation, Partnership or Sole-Proprietorship
NAME
,. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
14. Net Value Subject to Tax (Line 12 minus Line 13)
COMPLETE MAILING ADDRESS
1017 North Front Street
Harrisburg, PA 17102
(1)
(2)
(3)
(4)
(5)
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4. Mortgages & Notes Receivable (Scheduie D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or l)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11 . Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
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$8,546.82
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$18,,455.33
-($ 9~908.51)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x .0_ (15)
x .0_ (16)
x .12 (17)
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x .15 (18)
(19)
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYME'NT
20.0
Decedent's Complete Address:
STREET ADDRESS
325 loleslev Drive
CITY Mechanicsburg I STATE PA I ZIP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B Prior Payments
C. Discount
(1)
-0-
N, Pr. P D
3. Interest/Penalty if appiicable
D. Interest
E. Penalty
51<
Total Credits (A + 8 + C ) (2)
-0-
Total Interest/Penalty ( D + E ) (3) -0-
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4) -0-
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) -0-
A. Enter the interest on the tax due.
(5A)
-0-
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) -0-
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: Ves
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 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? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................,......,...... ,..,.............................,.,.. ..............................,.... 0
No
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[X)
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that 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 personal representative is based on all information of which preparer has any knowledge.
1017 North Front Street. Harrisburg. PA 17102
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
DATE
July 28. 2005
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [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 beneficlaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [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% [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.
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COMMONWEALTH OF SCHEDULE A
PENNSYLVANIA REAL ESTATE
INHERITANCE TAX REnJRN
RESIDENT DECEDENT I
I
ESTATE OF: FILE~ER:
MARY E. KOPPENHEFFER 121-05-0051
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All a:::tate should be
reported at fair market value which is defined as the price at whic;h property would be exchanged a willing
buyer and a willing seller, neither being compelled to buy or sell, both having reaSonable knowl e of the relevant
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ITEM NUMBER DESCRIPTION VALtATDATEOF
DEATH
I
1. None.
,
,
2.
I
3.
TOTAL (Also enter on line I, Recapitulation) -0-
(If more space is needed, insert additional sheets of same size.)
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COMMONWEALTH OF SCHEDULE B .
PENNSYLVANIA STOCKS AND BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT ,
ESTATE OF:
MARY E. KOPPENHEFFER
FILE ~ER:
p 1-05-0051
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(All property jointly-owned with Right ofSurvivorsbip must be disclosed on Schedule F)
ITEM NUMBER DESCRIPTION VALl. IE AT DATE OF
DEATH
None 0
i
TOTAL (Also enter on line 2, Recapitulation) i 0
. . ,
(If more space IS needed, insert additlonal sheets of same SIZC.)
COMMONWEALTH OF SCHEDULE C
PENNSYLVANIA CLOSELY HELD STOCK
INHERITANCE TAX
RETURN PARTNERSHIP AND PROPRIETORSHI,
RESIDENT DECEDENT .
I
FILE NUMIJER:
~ 1-05-0051
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Schedule C-l or C-2 must e attached for each business interest of the decedent, other than a propri
ESTATE OF:
MARY E. KOPPENHEFFER
ITEM NUMBER
DESCRIPTION
o
'p.
None
TOTAL (Also enter on line 3, Recapitulation) 0
(If more space is needed, insert additional sheets of same size.)
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COMMONWEALnI OF
PENNSYLVANIA
INHERITANCE TAX REruRN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES AND NOTES
RECEIVABLE
ESTATE OF:
~YE.KOPPENHEFFER
FILE Nl~ER:
21-05-0051
(All property jointly-owned with Right ofSurvivorsbip must be disclosed on Schedule F.)
ITEM NUMBER.
DESCRIPTION
VALtlE AT DATE OF
DEAnI
None
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TOTAL (Also enter on line 4, R.ecapitulation) : 0
(If more spICe is needed, insert additional sheets of same size.) !
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COMMONWEALlH OF SCHEDULE E
PENNSYLVANIA CASH, BANK DEPOSITS
INHERITANCE TAX RETURN
RESIDENT DECEDENT AND MISCELLANEOUS
PERSONAL PROPERTY
I
ESTATE OF:
MARY E. KOPPENHEFFER
FILE Nl~ER:
- , - -'121-05-0051
(All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.)
ITEM NUMBER
DESCRImQN'
1.
2.
3.
4.
Checking aqcount - lIalifp: National Bank
Check from Asbury Se1Vi~, .IIlC.
. '"'" " .. .....1
Check from Highma.rk
Check from United States Treasury tax refund
$7,509.61
$616.53
$303.53
$117.15
TOTAL (Also enter on line S, Recapitulation)
$8,546.82
(If more space is needed, insert additional sheets of same size.)
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COMMONWEALTH OF SCHEDULE F !
PENNSYLVANIA ,
INHERITANCE TAX REn1RN JOINTLY-OWNED ,
RESIDENT DECEDENT PROPERTY
ESTATE OF:
MARY E. KOPPENHEFFER
FILE NUMQER:
121-05-0051
If an asset was made joint within one year of the decedent's date of death, it must be reported on Sbhedule G.
I
SURVIVING JOINT
TENANT S NAME
ADDRESS
TIONSHIPTO
ECEDENT
JOINTLY -OWNED PROPERTY
i
ITEM LEITER. DATE DESCRIPTION OF PROPERTY DATE OP DEATH %OF DATE OF
NUMBER FOR MADE Include _ of ftamu:W inttitutlon and VALUE OF DECO'S DEATH
JOINT JOINT blink IICCOlIIlt nlllllber or limilar ASSET INTEREST VALUE OF
TENANT identifyina DUIIIber. Attach docd for DEcEDENT'S
, jointly-bold real... INTEREST
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TOTAL (Also enter on line 6, Recapitulation) I $ -0-
(If more space is needed, insert additional sheets of the same size.)
COMMONWEALTH OF SCHEDULE G
PENNSYLVANIA TRANSFERS
INHERITANCE TAX RETIJRN
RESIDENT DECEDENT ,
ESTATE OF:
MARY E. KOPPENHEFFER
FILE NT TMHER:
21-05-0051
THIS SCHEDULE MUST BE COMP:LETED AND.FILED IF THE ANSWER TO AN V OF THE
QUESTIONS ON THE REVERSE SIDE OF THE COWR SHEET IS YES
ITEM
NUMBER
DESCRIPTION OF 'pROPERTY EXCLUSION
Include name of ~ trailsftree, their .
relationship to decedent, date of
transfer
TOTAL
VALUE OF
ASSET.
DECO
%
INT.
DOLLAR
VALUE OF
DECEDENT'S
INTEREST
..
TOTAL (Also enter on line 7, Recapitulation) -0-
(If more space is needed, insert additional sheets of same size.)
OCOMMONWEALTH OF SCHEDULE H
PENNSYLVANIA
INHERITANCE FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND
TAX RETURN ~CELLANEOUSEXPENSES
RESIDENT
DECEDENT
ESTATE OF: FILE NUMBER:
MARY E. KOPPENHEFFER 21-05-0051
ITEM NUMBER
A. Funeral Expen...:
DESCRIPTION
AMOUNT
$160.00
1.
, .
COMMONWEALTH OF SCHEDULE I !
PENNSYLVANIA DEBTS OF DECEDENT .
INHERITANCE TAX RETURN MORTGAGE LIABR.ITIES &: LIENS i
RESIDENT DECEDENT i
ESTATE OF:
MARY E. KOPPENHEFFER
FILE ~ER:
~ 1-05-0051
I
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Include unreimbursed medical expenses.
ITEM NUMBER DESCRIPTION
OUNT
1. Metro Moo Services
2. East Pennsboro Ambulance Service, Inc.
3. Connor Rich Associates
4. James R. Norton, DPM
5. Commonwealth ofPA, Dept. of Public Welfare
$47.50
$50.00
$62.81
$51.87
$16,906.40
~
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of same size.)
$17,118.58
.
. ..
COMMONWEALTII OF SCHEDULEJ
PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT I
MARY E. KOPPENHEFFER
FILE NUMBER:
i
I
~ 1-05-0051
i
ESTATE OF:
,
ITEM DESCRIPI'ION . RELATIONSHIP AM01 !NT OR SHARE
NUMBER 0 FESTATE
1. Winifred E. Kivler Daught6r 20%
1308 Country Lane
Dauphin, PA 17018
2. Dorothy Daniel Daughter 20%
843 Tourist Park Road
Halifax, P A 17032
Miriam Keefer Daughter 20%
3. 2408 Annstrong Valley Road
Halifax, P A 17032
,
Joanne Shomper Daughter 20%
4. 711 Cypress Drive
Dauphin, PA 17018
Gary Koppenheffer Son 20%
5. 4330 LaVale Street
Clemmons, NC 27012
ITEM NAME AND ADDRESS OF BENEFICIARY AMOl ~ OR SHARE
NUMBER 0 rESTATE
B. Charitable and Governmental Bequests:
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TOTAL CHARITABLE AND OOVllRNMBNTAL BEQUESTS (AI8oenteron line 13. Realpltulation) I -0-
00
(If more space IS needed, insert additional sheets of same Size.)
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