HomeMy WebLinkAbout01-22-07
Rf,V.1500 EX (6-00)
OFFICIAl USE ONLY
COMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FilE NUMBER
~L
COUNTY CODE
~L 0456___
YEAR NUMBER
D 2. Supplemental Retum D 3. Remainder Retum (date or death prior to 12-13-82)
D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required
D 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credrt (date of death between 12-31.91 and 1-1-95) D 11. Election to tax under See. 9t 13(A) (Attach Sch 0)
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DECEDENl'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Collins Robert
DATE OF DEATH (MM-DD- YEAR) DATE OF BIRTH (MM-DD- YEAR)
4/28/2006 6/28/1923
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Ruth K. Collins
001
201-16-1893
L
SOCIAL SECURITY NUMBER
219-18-3027
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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Original Retum
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
D 9. litigation Proceeds Received
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Tim Holmes, Es
FIRM NAME (If Applicable)
122 S 16th Street
TELEPHONE NUMBER
Camp Hill, PA 17011
717-343-3256
1 Real Estate (Schedule A)
(1)
2. Stocks and Bonds (Schedule B)
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
Z 6. Jointly OlMled Property (Schedule F) (6)
0 o Separate Billing Requested
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~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
::) (Schedule G or L)
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0:: 8. Total Gross Assets (total Lines 1-7)
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0
W 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
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10. Debts of Decedent, Mortgage Liabilrties, & liens (Scf1edule I) (10)
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for lM'iich an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 taxable at the spousal tax 100,717 L(15)
z rate. or transfers under Sec. 9116 (a)(1.2) x .0
0
i= 16. Amount of line 14 taxable at lineal rate 0 x .0 45 (16)
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11. 17. Amount of line 14 taxable at sibling rate x .12 (17)
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0 0
0 18. Amount of line 14 taxable at collateral rate x .15 (18)
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< Tax Due
.... 19. (19)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE At.lD RECHECK MATH < <
N
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103,752
3,035
100,717
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100,717
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3W4645 1000
Decedent's Complete Address:
S1REET ADDRESS
757 Carol Street
CITY I STA1E I ZIP
New Cumberland PA 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
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3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C) (2)
o
o
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Total Interest/Penalty (0 + E) (3)
o
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)
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5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
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A. Enter the interest on the tax due.
(5A)
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8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(58)
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
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 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 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 penalties of perjury. I declare that I have examined this relum, 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 knowfedge.
Yes
No
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SIGNA n.;E OF PERSON~E~ONSJ-E F/ FILING RETIJRN
~~/21/ /1. i ..J/~;/../
757 Carol Street
SIGNA (ZE OF PREPARER OTHER THAN REPRESENTA llVE
'iJ C) Lr -rtU~ I
ADORE. .
POBox 668
DA1E
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(t! r') "']
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New Cumberland, PA 17070
DA1E
Carlisle, PA 17013
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 P.S.!3 9916 (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. 99116 (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 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. 9 9116(a)(l.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. 9 9116(1.2) [72 P.S. 99116(a)(l)].
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. 9 9116(a)(l.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.
3W4646 1000
REV-1503 EX "(&-96)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Robert L. Collins
21 06 0456
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.10 Shares
Met Life
DESCRIPilON
VALUE AT DATE
OF DEATH
53
2 354 Shares
Principal Financial Group, Inc
18,217
3 208 Shares
Prudential Financial
16,465
3W4696 1000
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
34,735
REV-1510 EX + (&-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert L. Collins
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21 06 0456
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 PROPERlY
ITEM It>CllDE TloE NAME OF Tl-E TRANSFEREE. T>EIR RELA TiONSftP TO DECEDENT />KJ DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER Tl-E DATE OFTRANlFER ATTN:HACOPV OF HoE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IIF APPUCABLEl VALUE
1. Principal Financil Annuity 53,071 100.0000 0 53,071
2 Prudential Financial Annuity 15,946 100.0000 0 15,946
TOTAL (Also enter on line 7, Recapitulation) $ 69 017
(If more space is needed, insert additional sheets of the same size)
3W46AF 1000
R,E:V-1511 EX . (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert L. Collins
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 06 0456
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Bowling Green Cemetery 995
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s) - -
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 1,000
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
5. Accountant's Fees 1,000
6. Tax Return Preparer's Fees
7.
1 Grant of letters 40
TOTAL (Also enter on line 9, Recapitulation) $ 3 035
3W46AG 1.000
(If more space is needed, insert additional sheets of the same size)
.REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Robert L Collins
NUMBER
I
J.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Ruth K. Collins
757 Carol Street
New Cumberland, PA J.7070
100% Residue: J.00,7J.7
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Surviving Spouse
FILE NUMBER
21 06 0456
AMOUNT OR SHARE
OF ESTATE
J.00,7J.7
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
3W46A11.000
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11. 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)
$
o
flrincipal We
Insurance Company
July 19, 2006
BOYER & RITTER
PO BOX 668
CARLISLE P A 17013
Re: Robert Lewis Collins
Contract No. 0070123
We received a letter from Ruth Collins regarding the value of the above annuity as of April 28th, 2006,
Robert L Collins date of death. The value as of that day was $53,070.62
If you have questions about this letter a customer service representative can be reached at 1-800-852-
4450, Monday through Friday, 7 a.m., to 7 p.m., CST.
'J\SinCerelY,
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J ,- / I . . GI/'O' ,. l
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I,,)!j.{j!)!__{/(j! C /LlLJ/ ,/'-""
Darlene Wheeler
Annuity Services
(800) - 852-4450
Y our representative
Richard E Cover
A0220-01439
CC: Ruth K Collins
711 High Street, Des Moines, Iowa USA 50392-0001 (515) 247-5111
. ."
.
Prudential ~ Financial
Pruco Life Insurance Company
Annuity Services
PO Box 7960
Philadelphia PA 19]76
(888) 778-2888
www.prudentiaJ.com
Robert L Collins
757 Carol St
New Cumberlnd, PA 170701422
Contract Number: ROS869434
November 21,2006
Dear Mr. Collins:
Thank you for the opportunity to be of service to you.
In reference to your request of the contract value from April 28, 2006, the total coverage was
$15, 946.43.
If YOll have any questions, please contact the Prudential Annuity Service Center at (888)
778-2888. The Service Center is open Monday through Thursday between 8:00 a.m. to 7:00
p.m. and Friday 8:00 a.m. through 6:00 p.m., Eastern time. If you are using a
telecommunications device for the hearing impaired, you may call (800) 654-7637, at the days
and times listed above. One of our Customer Service Associates will be glad to help you.
Thank you for choosing Prudential for your insurance and financial services.
Sincerely,
B~j)~
Brooke Davis
A Prudenlial business
In rccognili~~ ~P~~:;~~[~r ~~~~~' excellence
Corporate Office: 75] Broad Slreet. Newark NJ 07102-3777