HomeMy WebLinkAbout95-00711
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~ PILI NUMIIR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE ~ I
WITH REGIS!_~~ OF_WILLS) COUNTY CODE
I t IIA N' M
Cumberland County Nursing Hare
375 Claremont Drive
Carlisle, PA 17013-BB20
IIIEY.Uoo EX. (17.11'
~~
COMMONWEALTH Of PENNSYLVANIA
DfrAlIIlMfHl Of IIIfYEHUE
DEPT. 710601
HAUIUUIIIO, PI. 11121-0601
N' NAM lA ,I . AN MI
Q5
'11/
YEAR
NUMBER
~
III
lrl
o
Burris Ilelen
SOCIAL SECURITY HUMin
172-32-2022
Il.
1"~;:~;~~0';12~~;';~98
o 2. Supplemenlal Return
COlii'll
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~~12
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u"'....
...",
...
<C
leX I. Original R.lurn
03.
05.
Remainder Relurn
(lor dol.. 01 d.ath prior to 12.13.82)
Federal EUate Tax
Return Required
Tolal Number of Safe Deposit Boxes
o A. Limited ESlale 0 Aa. Fulure Inlerest Compromise
(lor dol.. 01 d.alh aft.r 12.12.821
06. Oecedenl Died Testate 0 7. Decedent Maintained a Living TruU
(Allach co y 01 Will (Allach cop 01 Tru'll
ALL CORRISFONDINCI AND CONPlDINTlAL TAX INFORMATION SHOULD 81 DIRICTED TOI
AM M l MAllI A
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~~
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82
Nornan D. Berlin, Jr.
410 Black Latch Lane
Camp Hill, PA 17011
M
23B-5235 (wed-Fri)
- B" l~n_rt'1~_rJlI'UJr1
717
1. R.ol E,'al.{Sth.dul. A) ( I) ----I10D<>
2. Stack. and Band. (Sch.dul. 8) { 21 none
3. Cla..ly H.ld Stock/Partn...hlp Int.r.'1 (Sch.dul. q (31 none
4. Marlgag.. and Not.. R.c.i.abl. (Sch.dul. D) ( 4) none
92.70
5. Ca.h. Bank D.po.I" & Milc.llan.au. P...anal Prap.rty( 51
(Sea.dul. EI
6. Joinlly Own.d Prap.rty {Sch.dul. fl
7. Tra..f." (Sch.dul. G) (Sch.dul. II
8. Tolal Gran Anels (tala I lines 1.7)
9. Funeral Expensol, Admlnlslrallve COlh, Mlscellaneoul ( 9) _196.99
Exp..... (Sch.dul. HI none
10. D.b", Marlgag. liabllill... li... (Sch.dul. I) (10)
II. T 0101 D.duCllo", (Ialallln.. 9 & 10)
12. N.I Valu. 01 E.lat. (IIn. 8 minu.lln. 111
13. Charltabl. and Gov.rnm.nlal 8.qu.." (Sch.dul. J)
14. N.I Valu. Subj.t1IO Tax (IIn. 12 min..lln. 131
15. Amount of line 141 taxoble 016% role
(Include value, from Schedule K or Schedule M.I
16. Amount of line 14 taKable at 15% role
(Include value I from Schedule K or Schedule M.)
17. Prlnclpal lox due (Add tax from line 15 and from line 16.)
18. Credlll Prior Poymenh Discount
z
o
3
g
...
~
w
'"
none
( 6)
( 7) ----I1Qoe
92.70
( B)
(111~L99
(12) -.Ze.rQ
(131 ._.no!}9
(14) ilQ!:O_
(15)__~____..___x .06 =
(161
)( .15 =
z
o
~
::>
...
~
o
u
g
(17)
Inlerell
+ ----.------- ----------
19. If line 1811 greater than line 17, enler the difference an line 19. This Is the OVERPAYMENT.
aD
20. If line 17 I, grealer Ihon line 18, enler the difference on line 20. Thh I. Ihe TAX DUE.
A. Enter the InlereU on the balance due on line 20A.
B. Enl.r Ih. tolal 01 IIn. 20 and 20A on IIn. 20B. Thl. II Ih. BALANCE DUE.
Make Chick Payabl. '01 Regllt.r of Will., Ag.nt
.. ..81 SURI TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH....
Undor penoltiel of perjury. I declare thai I have 1",:amlned Ikll return, including occomponylno .(hedull" and Ilot.menll, and 10 the bell of my knowledge and beliof.
It I. Irue, correct and compl.le. I declar. Ihal 011 real ..Iale hOI been reported ollrue marke' value. Declaration of preparer other than Ih. personal reprelenlolive i.
bated on alllnformollon of which preparer ho. any "now ledge.
SH1NAtUiir6rPiilSONACX-~~lbRTiiTNQ RffURN AooR1n------.---. DATE
1~'Or-I!:;.~Hr;.~"f-~[m!lNrA1IV[---- -AL~[!P1ack...1i1tclLLanc,-Camp__Jlill,1'1LL701J- 0,,19/25/95
(18)
(19)
Chede here If you are requolllng a refund of your ovorpayment.
120)
(20A)
(2081
~'i-.'.'_'.)'i ...... ...~
i
f'
I
I
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (...) IN THE
APPROPRIATE BLOCKS.
~E~ .~N()
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,
x
x
c. retain a reversionary interest or ....................................................................
x
d. receive the promise for life of either payments, benefits or care~ .......................
2. If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate conslderation~ If death
occurred after December 12, 1982, did decedent transfer property within one year of
deoth without receiving adequate consideration~ .................................................
3. Did decedent own an 'in trust for' bonk account at his or her death~......................
x
X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
...
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2.00
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COMMONWEAUH O' PENNSYLVANIA.
'HHIIIlANer TAX "'UIN
1.S1DINT DICIOI"'
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Plea.. Print or Ttpe
BER
"
ESTATE Of
Helen H. Burris
(An p,operty lalntly-ownad with the Rllhl 0' SUnltvouhlp must b, dllcl...d on Schedule ')
ITEM
NUMBER
DESCRII'TION
VALUE AT
DATE OF DEATH
Cash on Person
1.
2.
personal effects including wear apparel,
costume jewelry
Guest Fund Account at cumberland County
Nursing Home - Patient No. 3129
10.00
3.
BO.70
TOTAL Alia enler on line 5, Reea lIulotlon S 92 . 70
tAI1Qth additional BVlH K 11" ,h"'1 II more spa'lls n..dld.)
.
,
_IV.'1I11t 11111
ITEM
NUMBER
A.
1.
.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
PI.a.. Prlnl or Typ.
E NUMBER
COMMONWEALTH 0' '(NNSYlVANIA
INHUIfANCf YAX lETUJlH
JlUIOINT DfCWIN'
II. Burris
DESCRIPTION
AMOUNT
Funeral Exp.n....
Pre~Paid Funeral Plan
None
1.
B. Admlnl.trallv. Co.11I
2.
3.
4.
C.
1.
2.
3.
4.
S.
6.
7.
8.
Personal Rep,..entative Camml..lan.
Social secu,lty Number of Personal Representative:
Yea, Comml..lon. paid
None
Allo'ney Fe..
None
Family Ex.mptian
Clalmonl
Add,... of Clalmonl al d.c.d.nt'. d.ath
st,..1 Add,...
R.latlon.hlp
None
City
Stat.
Zip Cod.
Pro bal. Fe..
None
MI.c.llan.ou. Exp.n....
Pealer's, Casket Spray
BB.99
R.J. Romberger & Sons - Engraving year of death
on headstone
Register of Wills, Cumberland County, Filing Fee
Tax Return
9B.00
10.00
TOTAL (AI.o .nt., on IIn. 9, R.capltulatlon)
(If more .pac. I. n..d.d, In...t additional .h..I. of .am. .1...)
5 196.99
~ ~.. - "..,' .-. - -
. .
LAST WILL AND TESTAMENT
Ol~
III~Llm 11. lIURRIS
.
I, I11~LEN H. lIURllIS, of 3528 September Drive, Camp
Hill, Cumberland Ceunty, Pennsylvania, being of sound mind, memory
and understanding, do malto, publish and declare this as and for my
Last Will and 'reotament, in the manner and form following, hereby
revolting and maltinn void all rOl'mer Wills or writings in the nature
thereof by me heretofore made.
ITEM I. I direet my Executor hereinafter named to pay all
my juot debto, obligationo and taxes as soon after my decease as
io practicable.
I'l'EM II. I give any automobile which may be owned by me at
my death to my ncphow, Norman D. lIerlin, Jr.
I'l'EH III. All the reot, residue and remainder of my Estate,
l'eal, poroonal and mixed, wherever situate, I give, devise and
bequoath to my II ill tel', Irma M. Burris, 3528 September Drive, Camp
Hill, Pennsylvania.
ITEM IV. In the event my sister Irma predeceases me, I give,
devise and bequeath my entire Estate in equal shares to my sister,
Minerva I. Swovel.in, 3528 September Drive, Camp Hill, Pennsylvania
and my nephew, Norman D. Berlin, Jr., 410 Black Latch Lane, Camp
Hill, Pennsylvania.
ITEM V. If both my sisters, Irma and Minerva, predecease me,
I givD, devise and bequeath my entire Estate to my nephew Norman.
" .
ITEM VI.
If my nephew Norman predeceases me, his Distributive
Share under this Will shall be paid over in equal shares to his wife
Marilyn and their children living at my death.
ITEM VII. I hereby name Norman D. Berlin, Jr. as the Executor
of this my Last Will and Testament, who shall not be required to
give bond in the execution of his duties.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this 4-.:t9..... day of
/)'l "Jd'
, 1972.
"'~v\.-...:H . aLt..,'t...\.~
Helen H. Burris, Testatrix
ATTEST:
Signed, published and declared by the Testatrix, Helen H. Burris,
as and for her Last Will, in the presence of us, who, at her request,
in her presence, and in the presence of each other, have subscribed
our names as witnesses hereto.
~-4~~~
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G)~ /
C/
REV-lS47 EX AFP (12-95w
CO""OHWUltlt or P[NNSYlVANIA
DE:PAAIHrHl Of A[IJ[NlJ{
BUREAU Of IHDIVIDUAl fAN[1
DEPt. 110'01
HARRISIURG, PA .'1'.'0'01
ACN 101
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE 01-09-96
FILE NO.
12-27-94 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAX
PAYHENT TO TItE REOISTER OF WILLS. HAKE CItECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
NORMAN D BERLIN JR
410 BLACK LATCH LN
CAMP HILL PA 17011
REGISTER DF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AMount R..itt.d
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiiWIa;.rilC"Ajip--m-:9s"f"ilcifici--o,;-'iNHiifii'ANcE-YAinfPPiiiiisiif€il:r;-iii.UiwAifcE-ifli-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ISTATI 0,. BURRIS HELEN H FILE NO. 21 95-0711 ACN 101 DATE 01-09-96
TAX RETURN WAS. I X I ACCEPTED AS FILED
RISIRVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISID VALUE OF RETURN BASED ON: ORIGINAL RETURN
I, R..I hht. (Schodul. Al III
I. Stoelk, and londl (Schedul. 8) 12)
S. ClD..ly Hald stock/Partner.hip Int.r..t (Sch.dull C) (S)
~I "Drtg'DII/Not.. Rlcllvabl. (Schedul. DJ (4)
I, C"h/.~ Dapollt./H1Ic. Parlonal Property (Schedull E) IS)
,. Jointly Owned Property lSchedul. F) (6)
7. fran.fara (Schedule 0) (7)
eo Tot.l A...ta
) CItANGED
.00
.00
.00
.00
92.70
.00
.00
181
92.70
APPROVED DEDUCTIONS AND EXEMPTIONS:
.. funaral EKpan.../Ada. Co.t./Hi.c. EMp.n... (Schedula H) (9)
10. Dabt./Hortaaaa Llabl11tl../Llan. (Schedula I) (10) .00
II. Totol Doduotlon. 1111
12. Hat V.lu. of T.M R.turn (12)
11. Charltable/Oovarn..nt.l aaqua.t. (Schedul. J) (15)
14. Hat Valu. Df E.tat. Subj.ct to Tax (14)
NOTE I If.n ......mant w.. is.u.d pr.viDu.ly, lin.. 14, 15 .nd/or 16, 17 and IB
r.fl.ct figur.. that includ. the total of ~ r.turn. a......d to dat..
ASSESSHENT OF TAXI
1&. A.ount of Llna 14 .t Spou..l
16. A.aunt of Lln. 14 taxable .t
17. AMount of Llna 14 taxabla .t
18. Prlnalp.l r.x Dua
196.99
1 qlfl; QQ
104.29-
.00
104.29-
will
r.t.
Lln..l/Cl... A r.t.
Coll.t.r.l/Cl... 8 r.ta
.00
.00
.00
X .03.
X .06.
X .15.
IlBI
US)
1161
U71
.00
.00
.00
.00
TAX CREDITS:
PAYHENT
DATE
RECEIPT
NUHBER
DISCOUNT 101
INTEREST (-I
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
.00
.00
.00
.00
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN fl, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF TItIS FORH FOR INSTRUCTIONS. I
f.i.
I
;J...
. "1
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RESERVATION I E.t.t.. of d.c.dent. dyIng on or b.far. O'c.~.r 12, 19'2 -- If eny future '"t.r..t In the ..t.t. 1. tr8n.f'rred
In po.....lon or enJoy.."t to CI... . (coll.t.r.l) benlflcl.rl.. of thl d.cedent Ift.r the .xp.r.tlon of en)' ..t.t. for
Ilf. or 'or v..r., ~ C~.lth her.by .xpr...ly r...rv.. the rlght to ."r.l.. end ...... trln.,.r Inh.rltenc. TIXI.
It the lew'ul CI... I (coll.tlrll) r.tl on eny .uch futurl lntlrl.t.
PURPOSE OF
NOTICE. To 'ulflll the r.qulrl""''' of SICtion 2140 of the Inhtlrltencl end E.t.tl Till Act, Act Z2 of 1"1. 72 P.S.
SICtion 2140.
PAYMENT. altlCh the top portion 0' thl. Notlc. end .~It with your p.y.ent to the Rlgl.tlr of Will. prInted on the rlVlr.. .Id..
--".... chick or lMln.y order p.yabll tal REGISTER OF HILLS, AGENT
All P'YHnt. rec.lved 1hI11 'Ir.t be ..-Ued to II'IY Inter..t which ..y b. due with ....y r"llnd.r 1PP11ed to the tell.
REflJHD (CRh A r.flA'Ml of I tell cr.dit, whIch .... not requ..t.d on the Tax R.turn, ..y b. r~.tMl bv cOllPI,Una ... "Appllc.Uon
for Rlfund of p.nn.ylvenl. Inh.rltenc. end E.t.t. Tlx" (REV-131S). Applleltlon, Irl IVlllabl. .t the Of'lcI
of thl Rlgl.tlr of Will., any 0' the 2S R.vany. DI.trlct O'flc.., or by c'lllng the .p.el.1 24-hour
'"....rlng .ervlcl nueb.r. for 'or.. ord.rlng. In Penn.ylvenl. 1-100-162-2050, out.ld. Penn.ylvenl. end
within loc.1 H.rrl.burg .r'l (717) 7'7-1094, TOO. (711) 772-2252 (H'lrlng IlPllred Only).
OBJECTIONS I Anv p.rt)' In Int.r..t not ..tl.,I.d with the IPpr.I...ent, .llowlnc. or dl..llowenc. of deductlon., or .....se.nt
of tllC (IncludIng dl.count or I"t.r..t) .. .hown on thl. Natlc. su.t obJ.ct within .llCty (60) dlY, of rlcllpt of
thit HoUc. bYI
--written protl.t to the PA a'Plrtaint of R.vlnue, 10lrd of App..I., D.pt. 211021, Harrl.burg, PA 17121-1021, OR
--.l.ctlon to hlv. the sltt.r d.t.rsl".d .t audit of the account of the plr.on.l r.prl..nt.tlv., OR
--epp..1 to the Drph.n.' Court.
APHIN
ISTRATlYE
CORRECTIONS I
INTEREST.
'Ictuel .rror. dl.coy.rld on thl. .......ent .hould b. Iddr....d In writing tal PA D.p.rtlent 0' R.y~,
.ur..... of Indlvldull T...., ATTN. Po.t A.......nt R.vl... Unit, D.pt. 210601, Il.rrhburg, PA 17121'0601
Phon. (717) 717-6505. S.. P'O' 3 0' thl bookl.t -In.tructlon. for Inh.rltancl ralC R.turn for a A..ldent
n.c.dent.. (REV-1501) for In eMplenetlon 0' .d.lnl.trltlvlly correctable .rror..
If MV t.1C due h p.ld within thr.. (J) celMCIer enth. .fter the d.cedent.. d'lth, . fiv. p.reent (5:U dhcCM'lt of
the t.1l p.ld I. IlloMld.
Int.r..t J. ch.rg.d b.glnnlng with 'Ir.t d.y 0' d.llnquencv, or nln. (9) IOnth. and one (I) d.v 'roe the d.te of
d'lth, to the dlt. 0' ply.ent. r'M" Mhlch bee... d.llnquent b.for. Jenuery I, 19.2 b..r Int.rl.t .t the r.t. of
.Ix (6X) perc.nt p.t ~ c.lcul.t.d at . d.lly r.t. of .000164. All t.... which blc... d.llnquent on end .ft.r
Jenuery I, 1912 will be.r I"t.r..t at . rlt. which will v.rv fro. cIIMCI.r y..r to cII.nd.r VI.r with th.t r.t.
ennounc.d by t~ PA D.p.rtl.nt of A.y.nu.. Th. .ppllclbl. Int.r..t ret.. 'or 191Z through 1996 .r..
DISCOUHH
!!!! Inter." A.t. n.l1y lnt.re.t Factor ~ lnter..t R.t. D_Uy lnt.r..t Factor
1912 ZDX .000541 1917 'X .DD024?
1913 lOX .OODUI 191'-1991 lIX .000301
1,.4 lIX .OOOSOI 1992 'X .000247
1915 ISX .OOOS56 199}-1994 7X .000192
1916 lOX .00027" 1995-1996 'X .000247
--Inter..t I. clleul.t.d .. followlI
INTEREST . BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlc. I..u.d .ft.r the t.. beeDl" d.llnquent will r.fl.ct an Int.r..t c.lculltlon to fl,t.an (15) d.va
beyond the d... 0' the .u......,t. If pIVllant II .ad. .".r the Int.r..t CCIIPUtetlon d.t. .hown on the
HotJe., addltlon.1 Interllt au.t b. calcul.ted.