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REV-1500 EX + (6-00)
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OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
II
05
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DECEDENrs NAME (lAST, FIRST, AND MIDDLE INITIAL)
Trout, John H.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
163-07 -6580
1051
NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
4a. Future Interest Compromise (date of daath after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 SpOusal Pove~ Credit (date of death between
. 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
~ 1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach
copy of \/IIi,,)
09. litigation Proceeds Received
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2. Supplemental Return
10-09-2005
01-24-1913
20.0
COMPLETE MAILING ADDRESS
134 Sipe Avenue
Hummelstown, PA 17036
(1 ) None OFFICIAL USE ONL Y
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(2) 2,791.99 e~...,.,
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(3) None c_
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(4) None ~,... i Tl I
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(5) 66,089.83
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(6) None
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(7) 373,806.97 0) ..
(8) 442,688.79
(9) 23,991.61
(10) 11,418.95
(11)
(12)
(13)
(14)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
Copyright 2002 form software only The Lackner Group, Inc.
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
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NAME
Edward P. Seeber, Esq.
FIRM NAME (If applicable)
James, Smith, Dietterick & Connelly
TELEPHONE NUMBER
717/533-3280
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule 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) 0 Separate Billing Requested
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities. & liens (Schedule I)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
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0 .045 (16)
i= 16.Amount of Line 14 taxable at lineal rate 407,278.23 x
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Q. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0 18. Amount of line 14 taxable at collateral rate 0.00 x .15 (18)
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~ 19. Tax Due (19)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus line 11)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
35,410.56
407,278.23
0.00
407,278.23
0.00
18,327.52
0.00
0.00
18,327.52
Form REV-1500 EX (Rev. 6-00;
Decedent's Complete Address:
STREET ADDRESS
325 Wesley Drive
CITY Mechanicsburg
ISTATE PA
I ZIP 1 7055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
18,327.52
17,411.14
916.38
Total Credits (A + B + C) (2)
18,327.52
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
4. If line 2 is greater than line 1 + line 3, enter the difference. This is thEOVERPA YMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
(3)
(4)
(5) 0.00
(5A)
(5B) O~OO
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;............................................................................. [!J 0
b. retain the right to designate who shall use the property transferred or its income;................................ [!J 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
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 penaRies of perjury, I declare that I have examined this retum. 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 infonnation of which praparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR ILlNG RETURN ADDRESS DATE
Linda Hadcock
[!]
[!]
2611 Brian Drive
Parma, OH 44134
I
ADDRESS
DATE
134 Sipe Avenue
Hummelstown, PA 17036
I
Fo d es 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 or the use of the
su . ing spouse is 3% [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%
[72 P.S. !i9116 (a) (1.1) (ii)]. The statutedoes not exemota 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 beneficiaries 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.
Rev-1503 EX+ (6-98)
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SCHEDULE B
STOCKS & BONDS
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Trout, John H.
FILE NUMBER
21-05-1051
ESTATE OF
All property Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 43 shares of Prudential Financial 64.93 2.791.99
TOTAL (Also enter on Line 2, Recapitulation) 2.791.99
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 ScheduleS (Rev. 6-98)
Rev-1508 EX+ (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMON\I\IEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT OECEOENT
Trout, John H.
FILE NUMBER
21-05-1051
ESTATE OF
Include the pl'OC84lds of litigation and the date the pl'OC84lds were received by the estate.
All property jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Appalachian Orthopedics - refund of account
VALUE AT DATE
OF DEATH
154.85
2 Flagship - refund of account
159.31
3 Readers Digest - refund of account
96.66
4 Legg Mason Brokerage Account No. 363-03309 - spouse's ING Annuities;
beneficiary is Estate; valued per statement ending 9/30/05
65.679.01
TOTAL (Also enter on Line 5, Recapitulation)
66.089.83
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleE (Rev. 6-98)
Rev-1510 EX+ 16-98)
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SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEAl.TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Trout, John H.
FILE NUMBER
21-05-1051
ESTATE OF
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET Is yes.
ITEM IIVI.... OF. ,~ ...... T DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST IIF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE.
1 Legg Mason Brokerage Account No. 363-03307 - 26,163.43 100.000 0.00 26,163.43
ING Annuity; beneficiaries are children; valued
per statement ending 9/30/05
2 Legg Mason Brokerage Account No. 363-02911 - 315,981.04 100.000 0.00 315.981.04
titled in the John H. Trout and Elizabeth J. Trout
Living Trust dated 61311996; valued per public
listing
3 Miscellaneous personal property - titled in the 250.00 100.000 0.00 250.00
John H. Trout and Elizabeth J. Trout Living Trust
dated 61311996; valued per Trustee
4 PNC Bank Checking Account No. 5000978853 - 17,247.83 100.000 0.00 17,247.83
titled in the John H. Trout and Elizabeth J. Trout
Living Trust dated 6/311996; valued per letter
dated 10/25/05
5 PNC Bank Checking Account No. 5000978853, 2.05 100.000 0.00 2.05
accrued interest - titled in the John H. Trout and
Elizabeth J. Trout Living Trust dated 6/3/1996;
valued per letter dated 10/25/05
6 PNC Bank Savings Account No. 5000962907 - 14,139.69 100.000 0.00 14,139.69
titled in the John H. Trout and Elizabeth J. Trout
Living Trust dated 6/311996; valued per letter
dated 10125/05
7 PNC Bank Savings Account No. 5000962907, 22.93 100.000 0.00 22.93
accrued interest - titled in the John H. Trout and
Elizabeth J. Trout Living Trust dated 613/1996;
valued per letter dated 10125105
TOTAL (Also enter on Line 7, Recapitulation) 373,806.97
(If more space Is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV.1151 EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Trout, John H.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-1051
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 16,059.61
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s} I EIN Number of Personal Representative(s}:
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees James, Smith, Dietterick & Connelly 7,500.00
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 202.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 230.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 23,991.61
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleH (Rev. 6-98)
Rey-1502 EX+ (6-98)
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SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Trout, John H.
FilE NUMBER
21-05-1051
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Family airtravel and hotel expense for funeral
4.755.50
2
Malpezzi Funeral Home - funeral bill
8.494.11
3
Weaver Memorials - headstone
2.810.00
Subtotal
16.059.61
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1S02 EX+ (6-88)
.
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TPJ. RETURN
RESIDENT DECEDENT
Trout, John H.
FILE NUMBER
21-05-1051
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
James, Smith, Dletterick & Connelly, LLP - reservation for estate/trust
administration closing costs
200.00
2
Register of Wills, Cumberland County - filing fee for Inventory and Return
30.00
Subtotal
230.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Trout, John H.
FilE NUMBER
21-05-1051
Include unrelmbursed medical expense..
ITEM
NUMBER DESCRIPTION
1 Alert Pharmacy - unreimbursed prescription drug bill
VALUE AT DATE
OF DEATH
332.89
2 Bethany Village - unreimbursed nursing home bill
9,838.40
3 Central Penn Mgt - unreimbursed medical bill
22.61
4 Conner Rich - unreimbursed medical bill
17.56
5 Conner Rich - unreimbursed medical bill
17.56
6 Cumberland Crossings - telephone, laundry, and personal care expenses
699.10
7 IBM - insurance premium
11.00
8 Messiah Village - unreimbursed nursing home bill
80.00
9 Othopedic Instiute of Pennsylvania - unreimbursed medical bill
212.87
10 Philhaven - unreimbursed medical bill
36.00
11 West Shore EMS - unreimbursed ambulance bill
150.96
TOTAL (Also enter on Line 10, Recapitulation)
11,418.95
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 Schedule I (Rev. 6-98)
.
REV-1513 EX+ (9..00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Trout, John H.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions). and transfers
under Sec. ~116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trusteets)
FILE NUMBER
21-05-1051
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
I.
1
Linda M. Hadcock
2611 Brian Drive
Parma,OH 44134
Daughter
1/3 of Residue
135,759.41
2
Nancy B. Ozsogomonian
1150 Lombard Street
San Francisco, CA 94109
Daughter
1/3 of Residue
135,759.41
3
Robert J. Trout
1270 Nahale Court
Lahaina, HI 96761
Son
1/3 of Residue
135,759.41
Total 407,278.23
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 ScheduleJ (Rev. 6-98)