HomeMy WebLinkAbout02-21-07
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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
06
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DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
Melton, Thomas Arthur Jr.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
259-18-7120
0003
NUMBER
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS '
SOCIAL SECURITY NUMBER
o 1. Original Return
o 4. Limited Estate
[!] 6. Decedent Died Testate (Attach
copy of Wdl)
o 9. Litigation Proceeds Received
[!J 2. Supplemental Return
o
o
o
4a. Future Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a living Trust (Attach
copy of Trust)
10 Spousal PovertY Credit (date of death between
. 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME
John E. Slike, Esq.
FIRM NAME (If applicable)
Said is, Flower & Lindsay
TELEPHONE NUMBER
(717) 737-3405
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
11-03-2005
12-06-1920
COMPLETE MAILING ADDRESS
2109 Market Street
Camp Hill, PA 17011
(1 ) None OFFICI~SE ONL Y
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(2) 12. 3 ~ f6 ~~~ --'
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(3) None co
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(4) None [,: ::TI
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(5) None (.::.)(") :Po
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(6) None i-j :u -
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(7) c.n
None \.0
(8) 0.00
(9) None
(10) None
(11 )
13. Charitable and Govemmental Bequests/Sec 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)
(12)
(13)
(14)
12. Net Value of Estate (Line 8 minus Line 11)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
20.0
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0 423(,,16
i= 16. Amount of Line 14 taxable at lineal rate x .045 (16)
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A. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0
0 18. Amount of Line 14 taxable at collateral rate 0.00 (18)
~ x .15
19. Tax Due (19)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
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3. Closely Held Corporation, Partnership or SoJe-Proprietorship
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)
11. Total Deductions (total Lines 9 & 10)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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None
0.00
0.00
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0.00
0.00
19()M
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00;
Decedent's Complete Address:
STREET ADDRESS
4 Annette Dr.
CITY Enola
I STATE PA
I ZIP 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
t tt (3-. (p rf
Total Credits (A + 8 + C) (2)
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestIPimalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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 the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
,qo. ~1
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;.................................................................................. D ~
b. retain the right to designate who shall use the property transferred or its income;.................................... D ~
c. retain a reversionary interest; or.................................................................................................................. D ~
d. receive the promise for life of either payments, benefits or care?.............................................................. D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?...................................................................................................................... D [!]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... D [!]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?..................................................................................................................... D [!]
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 penaItles of perjury, I declare that I have exalTined this return. including accClll1'llnying schedules and statements, and to the best of my knowledge and belief, it is true, correct and
COI11llele. Declaration of preparer other than the personal representative is based on alllnfonnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Jos h C. Melton
C .Yvt~
OF P RSON RESPONSIBLE FOR FILING RETURN
DATE
33 Augusta Drive
Annville, PA 17003
3-/lJ/o/
ADDRESS
DATE
2109 Market Street
Camp Hill, PA 17011
DATE
fi'!/3! () 7
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
John . II J
ADDRESS
For 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
survi ng 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. ~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 decedenfs 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 decedenfs 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)
.
COMMON\M:ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21-06- 003
ESTATE OF
Melton, Thomas Arthur, Jr.
ITEM
NUMBER
1.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
56 shares Prudential Financial stock at 75.65 per share
VALUE AT DATE
OF DEATH
4,236.4
4,236.40
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
..
REV.1513 EX+ (9-00)
.
SCHEDULE ~
BENEFICIARIES
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Melton, Thomas Arthur Jr.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS ~nclude outright spousal
aistributions and transfers
under Sec. 9116(a)(1.2)]
I.
Arthur L. Melton
103 Iron Master Road
Cherry Hill, NJ 08034
Joseph C. Melton
33 Augusta Dr.
Annville, PA 17003
William C. Melton
1700 Delancey Place
Philadelphia, PA 19103
. RELATIONSHIP TO
DECEDENT
Do Not List Trustee(sl
Son
Son
Son
FILE NUMBER
21-06-0003
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
1/3 of residue
1/3 of residue
1/3 of residue
Total
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnate, on Rev 1500 cover sheet
ll. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Form PA.1500 Schedule J (Rev. 6-98)
tomputershare
LAW OFFICES
SAlOIS FLOWER & UNDSA Y
ATTN: SHELBY L YINGUNG
2109 MARKET SfREET
CAMP HILL PA 17011
Computershare
250 Royall Street
Canton, MA 02021
www.computershare.com
January 25, 2007
Company: PRUDENTIAL FINANCIAL INC
Registration: THOMAS A MELTON JR
Holder Account Number: COOO9011935
Our Reference: PRU/008oo71478/14
Dear Ms.Yingling:
Thank you for contacting Computershare, Prudential's transfer agent. We appreciate the opportunity
to be of service to you.
On November 5,2005, account number Coo09011935 held 56 shares. On that date, the closing price
~~m~~~ - ~
Should you have other account related questions, please call us at 1-800-305-9404 between the
hours of 8:30 AM and 6:00 PM Eastern US time, Monday through Friday. A telecommunications
device for the hearing impaired (TTY/TDD) is also available at 1-800-619-2837.
Sincerely,
Stacey Locke
Shareholder Services Representative
Worldwide
Argentina
Australia
Canada
Channel Islands
France
Germany
Hong Kong
India
Ireland
Italy
New Zealand
Philippines
Russia
Singapore
South Africa
Spain
Switzerland
United Arab Emirates
United Kingdom
United States
.-.
SET DATE RANGE
Start Date:
@ Daily
Eg. Jan 1, 2003
o Weekly
o
Monthly
End Date:
o Dividends Only
First I Prey I Next I Last
PRICES
Open
AvV'
Close Volume Adj Close" 1{,V5
75.60 4,568,200 73.95
72.97 71.10 71.79 2,668,500 70.22
74.75
2-Nov.Q5 71.44
.. Close price adjusted for dividends and splits.
First I Prey I Next I Last
ADownload To Soreadsheet
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