HomeMy WebLinkAbout04-25-07
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15D5601.l1041:.
REV-1500 EX (05-04)
PA Department of Revenue '*
Bureau of Individual Taxes
Dept. 280601
Harrisburg, PA 17128-<l601
ENTER DECEDj:NT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(If Applicable) Enter Surviving Spouse's Info'1'lation 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
_ 1. Original Return,
C)
2. Supplemental Retum
C)
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
C 4. L,~iteq.eEs"tate <::) 4a. Future Interest Compromise (date of
,; I death after 12-12-82)
C) 6. Decedent Died Testate C) 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
<:z:) 9. Litigation Proceeds Received C) 10. Spousal Poverty Credit (date of death C) 11. Election to tax under Sec. 9113(A)
, between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
C)
8. Total Number of Safe Deposit Boxes
w
Side 1
L
15056041046
15056041046
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15056042047
REV-1500 EX
Decedent's Social Security Number
Decedent's Name:
;{ I q ~t 906(g
RECAPITULATION
11 Total Deductions (total Lines 9 & 10).
11.
0.00
O.(){)
0.00
() .0 ()
~1/d.jS-
6.tJ(.J
() .0 a
~11;(.3S-
is tt>*' ^. qa
D.()D
g f> ~ :!.93
:5? '7 -s;o ~-(,C(:C A 5~
6.00
D.D D
1. Real estate (Schedule A).
........ 1.
2. Stocks and Bonds (Schedule B) . .
.. . .. .. .. .. 2.
3. Closely Held Corporation, Partnership or Soie-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) c:::> Separate Billing Requested 6
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> 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.
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)
. 12.
. 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) XO_
.
15.
.
16. Amount of Line 14 taxable
at lineal rate X.O
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
.
16.
.
.
17.
.
.
19. TAX DUE.
tPC}
it (/~
gll~.13
(; II a L 9:3
lftJt>o,~
.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A R
..
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15056042047
.!J.::Ju~b042047
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REV1500 EX ,.,age 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME G.. IJ
-rreeL e Yh, I~-L{T I EE-~
STREET ADDRESS
I {)} ;{L p( ; (lC e 0+-
fJlJt- I ~1
CITY
STATE P
ZIP
/
Tax Payments and Credit
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
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 0
b. retain the right to designate who shall use the property transferred or its income:. .. .... 0 0
c. retain a reversionary interest; or. .......................... ....................... .... ...... .... ... 0 0
d. receive the promise for life of either payments, benefits or care? ..... ...................... ........ ............. ............ 0 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ...... .................. .. . . . ...... ...... 0 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. 0 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . .. ...... .............. 0 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.
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. S9116 (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. S9116 (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 PS. s9116(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. S9116(1.2) [72 P.S. s9116(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. s9116(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.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF ~NDIVIDUAL TAXES
DEPT. 28D60l
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 06-0665
06143014
08-2.5-2006
REV-1545 EX AFP (09-00)
EST. OF GRACE M BUTLER
S.S. NO. 219-28-9698
DATE OF DEATH 04-22-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[X] CERTIF.
BRENDA L LAUER
285 ROBIN ANN CT
HELLAM PA 17406
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, P~ 17013
.-....)
FUL TON BANK has provided the Department with the information listed below which ha,s 'oe,,!n usetFfn
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial insti 1;ution,="ii'ttach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax 'Laws of the CIJmmonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW J( J( J( SEE REVERSE SIDE FOR FILING AND PAYMENTfNSTRUCrioNS
Account No. 512-0208539 Date 10-19-2005 To insure proper credit to your a~~'i;un1:, two
Established (2) copies of this notice must accompany your
payment to the Register of Wills. MakE! check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
1,052.34
50.000
526.17
.045
23.68
TAXPAYER RESPONSE
NOTE: If tax payments are made within three
(3) months of the decedent's date IJf dElath,
you may deduct a 5% discount of the ta.. due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death..
Tax
x
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to {Jbtain
a discount or avoid interest, or you may check box "A" and return this notice to the RegistE!r of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
TAXPAYER SIGNATURE
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280(,01
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 06 - 0665
06143013
08-25-2006
REV-1543 EX AFP [09-00)
EST. OF GRACE M BUTLER
S.S. NO. 219-28-9698
DATE OF DEATH 04-22-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[X] CERTIF.
BRENDA L LAUER
285 ROBIN ANN CT
HELLAM PA 17406
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT ~OUSE
CAR LI S L E , P Ac:'_V 0 13c-.-~
FUL TON BANK has provided the Department with the information listed below which has been used 1l"i
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/bSneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, at~ch a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Taxl~ws of the;t"mmonwealth
of Pennsylvania. Questions may be answered by calling [717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 512-0128499 Date 10-19-2005
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
1,060.01
50.000
530.01
.045
23.85
TAXPAYER RESPONSE
To insure proper credit to your account, two
[2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
[3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine [9) months after the date of death.
Tax
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date EstaDllshed
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
x
If you indicate a different tax rate, please state your
relationship to decedent:
x
PART
~
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
TAXPAYER SIGNATURE
DATE
REV.l508 EX. (l-!ln
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
TEOF
(5R.ace
YY\" J5Lf.T/e~ j
FILE NUMBER
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
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
~ ." 1/1, f)60 ;'
rtJO
I
C!.JJ S.
f/~j
I 'd*~-(C; I-
tf ;1l1 S . 3~)
.
.
TOTAL (Also enter on line 5, Recapitulation) $
REV-1511 EX+ (12-99)
~~
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
ftlt.cu.e m ~I/€~
ITEM
NUMBER
A.
B.
1
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1.
FUNERAL EXPENSES:
rtU7er~) t-Ivm~/ h-C));f;C-5
e~i.-e.r
~': Y-er-VV}€ni- Re c ~t-a..c/~
tV -fJ aJ ( P1 ~ /h::Jp 6...J e.. I
p -e dJ5' JX213 '(! ~ ' pO t-/C-e ~
{ij er-:ft >' .,.
J2 e~ '--f'h (] er-fr://; e a ie.5
-.c:- ~ u) -e l-S
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) -:Be e~tZ.... L - L q t< e t::..-
Social Security Number(s)/EIN Number of Personal Representative(s) / ;ry - V~ r- ..16 70
Street Address OZ 2'".::;- J(}:;jJ//J /2 /? J .
~ ~ 1711/1. '- 4=
City j? t\. State ~ Zip (? V O~
Year(s) ommission Paid: ~
2.
Attorney Fees
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
7. .::z::n he/i-K<.n:::'f' ~ 0/1 ;!- CD jd 1/7 Fe h-
(j,;'l/.[I- kM-5 ~ -'5Aod- Ce/f;-A'cz<:I~.5 -,& 5
S"....? Aori- -:krm5 ...:r;Jr 51/1 0 r-P-
&;fa.U.e.- .-e 6f-el\/'~ /0 5-C
r/~Lr /J1Q.,-t<er
.-;;- f2.. S N e?
6. Tax Return Preparer's Fees
AMOUNT
:$ '1/ '-tIDe:> .
~.SV .
1/ t? ,dB I
) 0 .s~ ,
~'6'
""."
C1t:'>
ifP~
Do
cOC
o~
/dS-.
B D ~
I 7'';<' l' /Q
t:J()
<t~?/ ~!J
~5 00
~S-. Co
..-1 ~7 c:--' D ()
o /J .
5- f y, 00
/ ,)^ O~
c:....
TOTAL (Also enter on line 9, Recapitulation) $ }? /1 ;;? . 23
r
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