HomeMy WebLinkAbout04-10-07
--.-J
15056041147
REV.1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
.
County Code
INHERITANCE TAX RETURN 21
RESIDENT DECEDENT
OFFICIAL USE ONLY
Year
File Number
06
-0926
Date of Birth
208426400_
09292006
10121953
Decedent's Last Name
GRIFFIE
Suffix
Decedent's First Name
DARYL
MI
R
(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
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1m 1. Original Return 0 2. Supplemental Return
0 4. Limited Estate 0 4a. Future Interest Compromise
(date of death after 12-12-82)
0 6. Decedent Died Testate " 0 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10 Spousal Poverty Credit (date of death
. between 12-31-91 and 1-1-95)
o
o
3. Remainder Return (date of death
prior to 12-13-82)
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)
~ORRESPONDENT _ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
B~ADLEY L. GRIFFIE 7172435551
Firm Name (If Applicable)
GRIFFIE & ASSOCIATES
( )
(.- ...c~-="
REGISTER OF:.Wl\-LS USE1>~L Y
,.~ .,-'--
First line of address
200 NORTH HANOVER STREET
C.J
\..'/
-r"
Second line of address
_.;..:,~
r:-?
,.-
-,.
0)
DATE FILED
City or Post Office
CARLISLE
State
PA
ZIP Code
17013
C d t' "I dd' b g r iff i e@griffielaw.com
orrespon en s e-mal a ress:
Under penalties 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 trUll, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. '
IG I,tRE OF P~RSON RESP SIBLE R i;ILlNG RETURN DATE
Virginia L. Giordano
If
()7
1324 Georgetown Circle, Carlisle, PA 17013
SIGN F PRE PARER OTHER THAN REPRESENTATIVE
Bradley L. Griffie
DATE
07
17013
Side 1
L
15056041147
15056041147
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w
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15056042148
REV-1500 EX
Decedent's Name:
GRIFFIE, DARYL R
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)................
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 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 (tptal 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, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
19. Tax Due..................................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
Decedent's Social Security Number
208426400
5.
9,076.68
9,076.68
11,540.58
14,544.28
26,084.86
-17,008.18
-17,008.18
16.
17.
18.
o . 0 0
D
15056042148
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 06 - -0926
DECEDENT'S NAME
Griffie, Daryl R
STREET ADDRESS
27 Eastwood Drive
CITY I STATE IZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
0.00
Total Credits (A + 8 + C)
(2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE.
(3) 0.00
(4)
(5) 0.00
(5A)
(58) 0.00
TotallnteresUPenalty (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.
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;.................................................................................. 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 deced,ent 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.
For dates of death on or afte~ 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 P.S. ~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 .5. ~9116 1.2) [72 P .5. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for 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.
..
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Griffie, Daryl R
FILE NUMBER
21 - 06 --0926
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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 2001 Mecury Marques 6,225.00
2 Contibution to Funeral expense from White Circle Club 200.00
3 Contribution to Funeral expense from Fraternal Order of Eagles 500.00
4 Members 1 st Federal Credit Union Savings 260.68
Account No. 33065-00
5 State Auto Insurance Companies 239.00
Auto insurance refund
6 2006 Federal Income Tax Refund 1,652.00
.
I
TOTAL (Also enter on Line 5, Recapitulation) 9,076.68
*'
SCHEDlJll: H
FUNERAL EXPENSES &
ADMNSlRATIVE COS1S
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TM RETURN
RESIDENT DECEDENT
ESTATE OF Griffie, Daryl R
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 - 06 - -0926
ITEM DESCRIPTION AMOUNT
NUMBER FUNERAL EXPENSES:
A. 1 Ewing Brothers Funeral Home 7,769.35
2 Cumberland Valley Memorial Gardens (Plaque) 2,065.00
3 Cumberland Valley Memorial Gardens (opening/closing) 1,150.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
t
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees : 0.00
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 146.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 The Sentinel - Ad 137.03
TOTAL (Also enter on line 9, Recapitulation)
11,540.58
.
Schedule H
Funeral Expenses &
Administrative Costs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Griffie, Daryl R
I FILE NUMBER
21 - 06 - -0926
2
The Cumberland Law Journal
75.00
3
The Clean Up Sh?p - car clean-up for sale
125.00
4
The Sentinel - thank you ad
73.20
Page 2 of Schedule H
.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Griffie, Daryl R
FILE NUMBER
21 - 06 - -0926
Include unreimbursed medical expenses.
ITEM DESCRIPTION
NUMBER AMOUNT
1 Members 1st Federal Credit Union 5,867.78
Auto Loan No. 33065-11
2 Masland Associates, Inc. 161.00
3 Members 1 st Visa account 2,057.20
No. 4121 449998330653
4 Yellow Breeches EMS, Inc. 100.00
5 Carlisle Regional Medical Center 3,700.00
6 Members 1 st Federal Credit Union 1,500.00
Personal Loan No. 33065-10
7 Cingular Wireless * 153.30
8 Yellow Breeches EMS Inc. * 100.00
9 Masland Associates, Inc. * 100.00
10 Lancaster HMA Physicians Management Central Pennsylvania * 100.00
11 A TM Withdrawals * 505.00
t
TOTAL (Also enter on Line 10, Recapitulation) 14,544.28
.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Griffie, Daryl R
FILE NUMBER
21 - 06 --0926
Include unreimbursed medical expenses.
ITEM
NUMBER
12
DESCRIPTION
AMOUNT
Members 1 st Visa account *
200.00
* CHECKS I WITHDRAWALS PROCESSED POST-DEATH
Page 2 of Schedule I
REV-1513 EX+ (9-00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Griffie, Daryl R
I FILE NUMBER
21 - 06 - -0926
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS [include outright sr,ousal
. distributions, and ransfers
under Sec. 9116 (a) (1.2)]
1 Alison R. Parker daughter 100%
9006 Hayden Drive
Shreveport, LA 71106
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS
NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00