Loading...
HomeMy WebLinkAbout01-16-07 EV-1500 EX (6-00) REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER -2r1- - 4-6- COUNTY CODE YEAR -+-G~--- TluMBER I-- Z W C W o w c DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-YEAR) November 4, 2006 January 4, 1940 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- :.::~(/l uD:::':: WO-U J:oo uD::-' O-lll 0- ct Q 1. Original Return D 4. Limited Estate [1} 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) o 2 Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy oITrust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) I- Z W Q Z o 0- (/l W D:: D:: o U :r....~;~ -- NAME COMPLETE MAILING ADDRESS Gre or J. Katshir FIRM NAME (If Applicable) 900 Market street Lemoyne PA 17043 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (1) (2) (3) (4) (5) .$..3A~34.D...-1.E 0.---,11 \,,"-~ ~:-'(~;s\ 0' (6) <f? ,.::- s::- -0 -","iI'" .-- z o !;;: ..J ::::J !:: D.. <( o w 0::: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (7) $ 3 0 , 6 8 5 . 2 1 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) (8) $ 3 77, G.:2 5. 3 9 (9) $4554 _ 22 (10) $1 4 g? _ R 0 (11) $6047.02 (12) $370,978.37 (13) 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) (14) $ 370 , 9 7 R _ ~ 7 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I-- ::::> D.. ~ o o >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0_ (15) x .0 A5. (16) $16,694.02 x .12 (17) x .15 (18) (19) $16.694.02 16. Amount of Line 14 taxable at lineal rate $370,978.37 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT REV-150B EX + (1-97) ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 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. ,Joan E Noll FILE NUMBER 21-06-1038 ITEM NUMBER 1. 2 3 4 5 6 VALUE AT DATE DESCRIPTION OF DEATH Wayne Bank - checking account $3541.90 Commerce Bank - Certificate of Deposit $101,261.78 Commerce Bank - Certificate of Deposit $230,000.00 Commerce Bank - Savings account $3192.74 Commerce Bank - Checking account $1890.48 Toyota Camry ($11,750 sale price - $5296.72 payoff) $6453.28 TOTAL (Also enter on line 5, Recapitulation) $346, 340. 1 8 (If more space is needed, insert additional sheets of the same size) REV-151O EX .(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Joan E wall SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER ?1-06-1038 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. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE \ NUMBER 1. Mainstay Investments IRA ~26,832.79 100 $26,832.79 2 New York Life IRA $3852.42 100 $3852.42 TOTAL (Also enter on line 7, Recapitulation) $~n: _ hRC; '/1, (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) . j....; "~l~;:~.. ':~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Joan E Wall FILE NUMBER 21-06-1038 Debts of decedent must be reported on Schedule I. ITEM NUMBER A DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Auer Memorial Ibme $3019.60 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State ~ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Gregory J. Katshir, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) $1000.00 Claimant Street Address City State ~ Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills, Cumberland County $368.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Advertising (Patriot News91.62, Cumberland Law Journal $75.00) $166.62 TOTAL (Also enter on line 9, Recapitulation) $ 4554 22 (If more space is needed, insert additional sheets of the same size) REV 1512EX'll.971 *. .<'''.. I . d"~ . - ",i!- _ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF J ();:In F. t-4o 1 1 FILE NUMBER :n 06 1038 Include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION AMOUNT Discover 4 PrirneMed $819.50 $144.85 $358.51 $15.79 $11.67 $5.68 2 GM Card 3 Wayne Highlands Blue-Cross/Blue Shield 5 Pinnacle leal th 6 Northeast Rehab 7 Blue Cross $136.80 TOTAL (Also enter on line 10, Recapitulation) $ 1492.80 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00. COMMONW~ALT~ OF P~NNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF .,. n;:> n R 101;-,1 1 FILE NUMBER ")1 nc 1 n 0 RELATIONSHIP TO DECEDENt AMOUNT OR SHARE Do Not ListTrustee(s) OF ESTATE NUMBER I 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Christine Ridd 3 Charisma Drive Camp lill PA 17011 daughter 50% 2 Scott Hall 2420 Dickenson Avenue Camp Hill PA 17011 son 50% 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 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, insert additional sheets of the same size) me Iff m.emembrrc~ I17T'1:..."'t '.'.)( , 201 Terrace Heights, ~~lu ~ JOAN E. HOLL of Honesdale !:n the COlJ,nty of Wayne and State af Pennsylvania.) being of sOl~nd mind, memory and understanding do 7nake and publish this liZ,y last Will and Testament, hereby revoking and making void all former T.f/ills by me at any time heretofore made. ,1\ttn Jfftrst, ~ direct that my funeral be conducted in a manner corresponding with my estate and situation in life and that all my just debts and funeral e.rpen- ses be fl.dly paid nnd satisfied. as soon as conveniently lnay be afler Iny decease. J\un to such f'stale as it has pleased God to entrust to rne, I rlisposl:' of fhe same as follows, viz; AND SECOND, I give, devise, and bequeath all the rest, residue and remainder of my Estate of whatsoever nature and wheresoever situate to my beloved husband, GERALD J. HOLL. AND THIRD, Provided, however, should my husband, ~~~~LD J. HOLL, predecease me, die as a result of a common accident or disaster with me, or for any reason fails to survive me for a period of thirty (30) days, then and in that event, I give, devise, and bequeath all the rest, residue, and remainder of my Estate, be it re~lr personal or mixed, of whatsoever nature and wheresoever situate, to my surviving children, share and share alike, except for that property which may be the subject of a Memorandum of Distribution of Personal Property placed with my Will and signed by me indicating my desires with respect to certain items which shall be regarded. AND FOURTH, I give, devise, and bequeath the share which I own in the Honesdale Country Cl ub to my son, SCOTT uq~__ H011. Ann I hereby nominate, constitute and appoint my husband, GERALD J. HaLL Executor of this my Last Will and Testament. In the event he is unwilling or unable to serve, I nominate, constitute and appoint my ~XNlXXXXX~~~~~~~~H~~~~. daughter, CHRISTINE B. HaLL Executrix of this my Last Will and Testament. ----.;3Ju ;Iliiht~s~ .h,erenf. ,;3J JOAN E. HaLL the Testat r ix .. have to this, my Will written on one 8 heet of paper, set my Ii and and sea,l, thl:S day of Sep-t-effil3er .11. D. One Thonsand Nine lllmdred and Eighty-Eight (1988). jOA~' .:E.:....HOLL.... .............. .....;...:....:....... ...... '" ... .........~? / Siffned, scaled, pu.blishpd a.nd declared by the above named JOAN E. HOLL as and for her last W'ill and Testament, in the presence of UJ~, who have hereunto subscribed onr names at her reqlJ..est as Witnesses thereto, in the presence of the said Testat rix , and of each otlln. ,/' "" ....:...........:.....':.."J..................... <llnoitiI AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF WAYNE We, Alfred J. Howell, Esquire and Shirley M. Gill, f/n/a Shirley M. Mason, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as her Last Will, that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses and that to the best of our knowledge, the Testator was at the time eighteen (18) or more years of mind ~nd under no constraint or undue . '. ' " . --_._" __-1 Address: SWORN or affirmed to and subscribed to before me by r-\ \ {{ (d .3 \-b\...~c,-l CV\ , and3hII~\ 1'-\ l',\\ (~(~c,3\1I!l>.,\ANI1kWitnessesl I I (-I.~.'\..., this \ ~'\' t' day of 1\)(\\) Q,p l 'JJ( ,2 0 O~~. I .._j;t ~ t (\1"'k klSl. .Gl /l ~/ Notary Public 1- NOTA~~~~A~:-.-~.W-l I ,PAMELA SrARK. Notary PubliC I !'1r!i,esC1ale Boro, Wayne County l!~~_~l)~~~~:.SIP~' ~X)J.I:.=S _ ::~~~ 27, 2010 .