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Home My WebLink About04-09-07 (3) J 15056051058 REV-15 00 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ck() ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 570-32-5223 10/12/2006 06/01/1915 Decedent's Last Name Suffix Decedent's First Name Mellon MI - Helen A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Compromise (date of death after 12-12-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) - 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Shirley M. Ryan Firm Name (If Applicable) (954).554-2319 REGISTER OF WILLS USE ONLY.... First line of address RF(:ORI )FD OFFICE OF 2740 NE 6th Street I;I?cls'1?R OIL' Wu.1,S Second line of address 2007 APR 09 c;l,i?RK OF ORY1 JANS COURT City or Post Office Ct-IMBI:R 1ANI 'll COURT, PA State ZIP Code DATE FILED Pompano Beach FL 33062 Correspondent's e-mail address: Under p alties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tr correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG T OF P RSO ESP SIBLE FOR FILING RETURN DATE RE SS SIGNAT PREPARETHER THAN REPRESENTA-iVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 15056051058 1 15056051058 L. ~ 15056052059 REV-1500 EX Decedent's Name: Helen A Mellon RECAPITULATION 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O 45 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 Decedent's Social Security Number 570-32-5223 2,780.00 2,780.00 782.00 782.00 1,998.00 1,998.00 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 15. 16. 89.91 17. 18. 89.91 15056052059 .-J t~ . age Decedent's Complete Address: , II r DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Helen A Mellon 570-32-5223 STREET ADDRESS Bethany Village 5225 Wilson Lane CITY I STATE I ZIP Mechanicsburg PA 17055 REV 1500 EX P 3 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 89.91 Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5) (SA) (5B) 89.91 0.00 89.91 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. 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 [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i] c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [i] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [i] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [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 zero (0) percent [72 PS. ~9116 (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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 PS. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is twelve (12) percent [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. If} REV-1508 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Helen A. Mellon FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 2006 Federallncorne Tax Returned 2,780.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,780.00 !fJ .4Initril1ttBtri GImIBl1Q 19b~1 ~ &i~""'l"MI.!.it;':\, ~~~\ . 't. Il:i ~ ~ f#? "(" ft---O _'. ~+~N)} <',....~~#" 03 30 07 28 AUSTIN, TEXAS 2307 85 2307 85731561 aQ090700 130 OMELL ATLANTATAX R'EiFUND I I I II I I I II I II I I I I II I I I I I I I I I I I II I I "..iJ.H.III,.l,.UI.. I 1,,1 I II SHIRLEY RYAN 2740 NE 6TH ST POMPANO BEACH FL 33062-4929 K523t741,583 4.39 INTEREST 1:000000 5 ~al: as 7l ~ Sb ~ 3dl. 0 ~o :107 Check No. 12/06 61 $***2780*00 REGIONAl DlSBURSlNO OFFICER ~ REV-1512 EX+ (12-ll3) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Helen A. Mellon FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2006 PA Income Tax 782.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 782.00 JJt SUSAN M. PLUTA 7 HOLLY DRIVE NEW CUMBERLAND, PA 17070 60-184/313 4279 d -Qrl~!l- ___,----------~ $ ~ I ' DD ~:_. r.;lI,~,".,..M~ ____ ,V)olllln L!J ;~:-':::'~"i"'oO COMMEFH::E BA,~~/H 4700(IONEST " R, . HARRISBUR,~,"PA 17H)9 "'8" ,"j',,' ~UnCAn"{\L ~~ { "', ' F;:~~~~):~~,~'~tro~~B7 _ill' ~ 27qTh -p~ M' ~ ....~.--" 1587 ,- SHIRLEY RYAN 2740 NE 6TH ST POMPANO BEACH FL 33062 dl'~ cJ.1~ 01 Date 63-9122/2670 82 d ~ ~ ~$~'1f'b-O ,. ~~UU7r~A~~'ft'~ ~ ~!~. Dollar' OJ ~ . AMTRUST BANK .. fli.isiott 01 QIli. s..........,.. 1 , ~'""tl~-~ ~~C:;'2~ ~ I~O; b ~g~~ q:-~:rtoa 20007 2 2 7~'. ...-~ Sa'? ..- . .. 'c~au:~~~_SAFETVGREENWGN CClarkf: Aml!'r"katl ~