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Home My WebLink About02-22-07 W l- x: :!II) (J 0:: x: wa.(J zOO (J O::..J !t1D c( REV-15i1'aEX + (6-00~ . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ z w c w (J w c DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 001. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy omust) D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) OFFICIAL USE ONLY -- ..---- ______u.._____ _____n_ _._______.____ ________ o. ____u__ _n_______.______.__ FILE NUMBER 1. L--11kL_fl5-IJ-Q COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 2 0 4 - 3 0 - 6 5 1 5 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death priortc 12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) z o i= <C ..J ::::) ~ a: <C o w a::: z o i= ~ ::::) Q. :E o (J ~ TIMMONS FRANK E. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 11/07/2004 12/16/1910 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W C Z o a. II) w 0:: 0:: o (J NAME SALLY J. WINDER FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS 9974 MOLLY PITCHER HWY TELEPHONE NUMBER 717 532 9476 SHIPPENSBURG 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 (5) (Schedule E) 6. JoinUy Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 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 which 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 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 (8) (11) (12) (13) (14) X _(15) X _(16) X .12 (17) X .15 (18) (19) 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT PA 17257 r ~h ,;to "j" ~.~.".\-:2 .i .~~~ ~_........ "\' r -,": ~;; ~}2 5,506.48 i; . OFFIq!~ USE ONLY ~ c::> -..J -r; j"'Y"'j co N N l -u i :):5 t.;--i .... N Ul 5,506.48 8,457.00 1 ,948.65 10,405.65 -4,899.17 -4,899.17 Decedentls Complete Address: STREET ADDRESS WALNUT BOTTOM ROAD SHIPPENSBURG HEALTH CARE CTR. CITY I STATE T ZIP SHIPPENSBURG PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) Total Interest/Penalty ( D + E) (3) 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) 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. (SA) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 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; ........................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00 c. retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?........ ....... ....... ........ .......... ............ ................ .......... .... ..... ... .... 0 00 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 00 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 pe~ury, I declare that I have examined this return, includinQ 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. SIGNA OF PERS N R PO LE FOR FILING RETURN DATE ~ ADORES 99 MOLLY PITCHER HWY SHIPPENSBURG PA 17257 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. 99116 (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 exemot 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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.150BEX+(1.97) , ~~ '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF TIMMONS. FRANK E. 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. FILE NUMBER ITEM NUMBER 1. DESCRIPTION ORRSTOWN BANK, CHECKING ACCOUNT IN NAME OF DECEDENT, ACCT NO 350702 VALUE AT DATE OF DEATH 5,506.48 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5 506.48 _,.;'B.... . COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF TIMMONS. FRANK E. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FOGELSANGER BRICKER FUNERAL HOME, FUNERAL ACCOUNT 7,743.00 . . B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of PeISOnaI Represenlative (s) Social Security Number(s) I EIN Number of Personal Represenlative(s) Street Address City State Zip Year(s) Commission Paid: 2. AtIomeyFees SALLY J. WINDER, ESQUIRE 625.00 3. FamHy Exemption: (If decedenrs address is not 1he same as claimanfs, allach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. ProbateFees LETTERS TESTAMENTARY, FILING RETURN 84.00 5. Aa:ountanrs Fees 6. Tax Return Prepare!'s Fees 7. ORRSTOWN BANK, LOST SAFE DEPOSIT KEY 5.00 TOTAL (Also enter on line 9, Recapitulation) $ 8457.00 Ilf mOl'P. ~n;:K:P. i~ nP.Aded in~p.rl additional ~heets of the same size\ ORRSTOWNBANK A Tradition oj Excellence Date 6/09/06 Primary Account Enclosures 1...11111.1..1.1.1.111.1.11.1. .1.. .I.I~ I.. .1.1..11.1. .1.1.1..1 Frank E Timmons % Janet E Jones 538 Loudon Road St Thomas PA 17252~9752 WE PUT THE LOW IN LOANS! ASK ABOUT OUR SPECIAL LOW RATE HOME EQUITY LINE TODAY! CALL 1-888-0RRSTOWN ABOUT THIS LIMITED TIME OFFER! CHECKING ACCOUNTS Account Title Frank E Timmons % Janet E Jones Free Checking Account Number Previous Balance Deposits/Credits Checks/Debits Service Fee Interest Paid Current Balance 350702 5,512.48 .00 .00 .00 .00 5,512.48 Check Safekeeping Statement Dates 5/11/06 thru Days In The Statement Period Average Ledger Average Collected Page 1 350702 6/11/06 32 5,512.48 5,512.48 ~.'m.".'.* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TIMMONS. FRANK E. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS I FILE NUMBER Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. SHIPPENSBURG HEALTH CARE CENTER, FINAL CHARGES AMOUNT 693.47 2. PHARMACARE, PHARMACEUTICALS OUTSTANDING ACCOUNT 1,255.18 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1 948.65