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Home My WebLink About04-20-07 z ~ ~ ::> Q, :E S g .. REV. tllO EX + fI~J . . COMMoNWEALTH OF PENNSYlVANIA DEPARlMENT OF REVENUE DEPT. 2l108O1 HARRISBURG, PA 1712a.oeol REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 06 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 182-22-9906 0711 NUMBER ... Z W ~ Q DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) Shaub, Matilda E THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 6. Decedent Died Testate (Attach copy dWlII) 9. Litigation Proceeds Received 4a. Future Interest Compromise (dete 01 deeth aller 12-12-82) 7. Decedent Maintained a Uving Trust (Attach copy of Trust) 10. Spousal Poverty Credit (dete of dealh between 12 1- 1 1.1. 3. Remainder Return (dale 01 death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Allach Sch 0) 13. Charitable and Govemmental 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 Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 4. Limited Estate .... I~ Sf lEPHONE NUMBER 717/697-1800 z o ~ ~ I 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 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) DATE OF DEATH (MM"[)D-YEAR) DATE OF BIRTH (MM"[)D-YEAR) 52 Gettysburg Pike Mechanicsburg, PA 17055 (1) None (2) 4,555.32 (3) None (4) None (5) None (6) None (7) None OFFICIAL USE ONLY 1'-." f.,":','J' C"....;.:..) -..J ~ 'c~'l ":7:J f'.) a o :2 <:l'J .....~n 07/31/2006 10/07/1926 ~-'>< =-- c., a 4,555.32 (IF APPUCABlE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) l!! ~Ji !l!t. OQ,ID ~ 1. Original Return 2. Supplemental Return (8) (9) 3,469.00 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) 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 (11) (12) (13) (14) 3,469.00 1,086.32 1,086.32 x .00 (15) x .045 (16) - x .12 (17) 1,086.32 x .15 (18) 163.00 19. Tax Due (19) 163.00 copyright - fonn ..-.. only Thslack_ Goo.P. Inc. Fann REV-,... EX _. ....) Oi Decedent's Complete Address: STREET ADDRESS 1051 Country Club Road CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount TSTATE PA F'17011 (1) 163.00 -------~------- 3. InterestlPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 0.00 TotallnterestlPenalty (0 + E) 4. If Line 2 is greater than Lille 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. B. Enter the total of Line 5 + 5A. This Is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (3) 0.00 (4) (5) 163.00 (5A) (5B) 163.00 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;.................................................................................. ~ I b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or................................ ................................. .......... ....................................... d. receive the promise for life of either payments, benefits or care?.............................................................. 2. If death occurred after December 12, 1982, did deCedent transfer property within one year of death without receiving adequate consideration?...................................................................................................................... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~ 4. Did deCedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..................................................................................................................... 0 ~ 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 fllIm*Iea fA perjury. I decIant that I have examined this Altum. lnc:Iuding lICCOInplInylng lIChedulea and statements, and to the best of my knowledge and belief, n is lIue, COfT8Cland complete. Declaration of pI1IpmW other lh8n the I*8On8I Is ba88d on 8M lnfonnatlon of which has any ~. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Ruth Jane Dun ADDRESS 4000 Woodvale Road Harrisburg, PA 17109 7 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Thomas J. Ahrens 7/. C ADDRESS DATE 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 exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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. 52 Gettysburg Pike Mechanicsburg, PA 17055 4-/9-01 . SCHEDULE B STOCKS & BONDS COMMoNWEALTH OF PENNSYLVANIA ~HERrrANCETAXRETURN RESIDENT DECEDENT ESTATE OF Shaub, Matilda E FILE NUMBER 21- 06 - 0711 All property jOlntly-owned with right of survivorship must be disclosed on Schedule F. ITEM 1 DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER I DEATH I 1 Jennison Utility Fund class A 15.92 4,555.00 I I TOTAL (Also enter on I/ne 2, Recapitulation) 4,555.00 . SCI-EDlJ..E H RH:RALEXPENsEs& AI:M\tS1RAnve COS1S COMMONWEALTW OF PENNSYlVANIA INHERITANCE TAX RElURN RESIDENT DECEDENT ESTATE OF Shaub, Matilda E Debts of decedent must be reported on Schedule I. --- "- ---- -- -"~-_.-._-----. ------..__._._----_._---,-,--~-._--- ITEM i NUMBER I FUNERAL EXPENSES: A. I I I I I ! I I FILE NUMBER 21- 06 - 0711 DESCRIPTION AMOUNT B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number ot Personal Representative(s): 2. 3. Street Address City State Zip Year(s) Commission paid Attomey's Fees Ahrens Law Firm, P.C. Family Exemption: (It decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 45.00 City Relationship of Claimant to Decedent State Zip 4. Probate Fees Additional short certificates 24.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 2006 Federal Income tax due 229.00 Total of Continuation SChedule(s) TOTAL (Also enter on line 9, Recapitulation) 3,171.00 3,469.00 # .. . SctIeclM H FtI1eraI EicpeI ~& Am. Mc6IaCostscanlRJed COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shaub, Matilda E 2 2006 State Income tax due FILE NUMBER 21 - 06 - 0711 3 2006 Estate Federal Income Tax due 648.00 4 2006 Estate State Tax due 2,229.00 5 Supplemental Inheritance tax return filing fee 279.00 15.00 Page 2 of Schedule H -t":, ,,;. ,., ~.'; <.((!i." . .~ '. ., ~ ~~~ ..B:'~/~ .k..... '.'. M1tl...... ",. :C\~:' ,'. :~ ", 'j"I~'tt.i ", ',. 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