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Home My WebLink About03-30-07 .. REV. 1l5OC1 EX"ttl-OO) I!! :.=oCU) Uii!:.= W&g :Z:a:... UlLlD ~ *' COMMONWEALlli OF PENNSYLVANIA DEPARTMENT OF R;VENUE DEPT. 280601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT IE I!! w U w c DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INmAl) Stetler, Lloyd M OFFICIAL USE ONLY FILE NUMBER 21 07 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 209-12-5754 03\3 NUMBER ntlS RETURN MUST BE FILED IN DUPUCATE W1nt ntE REGISTER OF WILLS SOCIAL SECURITY NUMBER 1. Original Return o 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 01 Trust) 10. Spousal Poverty Credn (date of death between o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposn Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 4. Limned Estate 6. Decedent Died Testate (Attach copy of Will) 9. Lnigation Proceeds Received ME .n IE Eric D. Patrick II!! IRM NAME (If applicable) 82 Patrick / Fugett Associates ElEPHONE NUMBER 717~aT (:899 '7(,3 1Vl t 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) z o 5 j:! ~ U iii! 3. Closely Held Corporation, Partnership or Sole-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) 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) ryFFICIAl USE Y ~- C-:i "~ --.J DATE OF DEAnt (MM-DD-YEAR) DATE OF BIRTlt (MM-DD-YEAR) 240 South 18th Street Camp Hill, PA 17011 (1) None (2) None (3) None (4) None (5) 3,249.43 (6) None (7) None (9) (10) 3,070.00 4,121.12 :;OJ c.) CI :>--00 11/29/2005 03/27/1925 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) 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 c....:> co (8) 3,249.43 (11 ) 7,191.12 (12) insolvent (13) (14) 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) or transfers under Sec. 9116(a)(1.2) z 0.00 .045 (16) 0 16. Amount of Line 14 taxable at lineal rate x ~ ::) lL 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) ~ U S 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) 19. Tax Due (19) 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-(0) Decedent's Complete Address: STREET ADDRESS 209R Four Seasons Lane CITY I STATE pa I ZIP 17025 Enola Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount Total Credits (A + 8 + C) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1) (2) 0.00 (3) 0.00 (4) (5) 0.00 (5A) (58) 0.00 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 I 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 penalties of p9ljury. I declare that I have examined this retum, 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 knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Kennet L. Stetler 4976 Spring Road Sherrnans Dale, pa 17090 ADDRESS ADDRESS 240 South 18th Street Camp Hill, PA 17011 -s 21 01 DA 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. ~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 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. ~9116 (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. ~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 decedent's 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. . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stetler, Lloyd M FILE NUMBER 21 - 07 - 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. ITEM . VALUE AT DATE NUMBER DESCRIPTION. OF DEATH . 1 Commerce Bank Checking: 512018425 -260.27 . ,.. 2 Dodge Caravan 1,400.00 3 Personal Property 980.70 4 Social Security Check 1,129.00 TOTAL (Also enter on Line 5, Recapitulation) 3,249.43 . SCHEDULEH FUNERAL. EXPENSES & ~ISTRATIVE COSTS COMMONWEAL 1H OF PENNSYLVANIA INHERITANCE TAX RElU~ RESIDENT DECEDENT ESTATE OF Stetler, Lloyd M Debts of decedent must be reported on Schedule I. FILE NUMBER 21 - 07 - ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 See attached 2,970.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees Patrick / Fugett Associates -- Eric D. Patrick 100.00 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 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 1 Commerce Bank Checking: 51201B425 -260.27 TOTAL (Also enter on line 9, Recapitulation) 3,070.00 . SchedUe H FlIBCII Expenses & M.IiIM.4NeCostsconlDJed COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF Stetler, Lloyd M [FILE NUMBER 21 - 07 - 10 2 Dodge Caravan 1,400.00 3 Personal Property 980.70 4 Social Security Check 1,129.00 - .~ ., .' . l Page 2 of Schedule H .' . *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Stetler, Lloyd M FILE NUMBER 21 - 07 - Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 CreditOne credit card: 4447961111141681 625.64 2 First National Bank credit card: 4447961111141681 447.50 3 Orchard Bank credit card: 5440455018367394 1,257.87 4 Shell credit card: 73-586-2901-7 1,445.09 5 Comcast: 29547 195131-03-6 6.01 6 Pealers 151.53 7 PPL: 18980-83103 102.66 8 Sherwin - Williams 42.62 9 Verizon: 717728132173519Y 42.20 TOTAL (Also enter on Line 10, Recapitulation) 4,121.12 '1'.......... cc:~ UJ () <( f- := ~I) :~ () lL 0... 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