The URL can be used to link to this page

Home My WebLink About04-20-07 .-J 15056051047 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisbur ,PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT Suffix MI l: (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW c::::) 1. Original Return c::::) 4. Limited Estate c::::) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::::) 2. Supplemental Return c::::) c::::) c::::) 4a. Future Interest Compromise (date of death after 12-12-82) c::::) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 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 Tele hone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes c::::) 1",) (.n Correspondent's e-mail address: 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 true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU F PERSON RESPONSIB R FILING RETURN DATE fi). . ADDRESS SI:~E ~~~~~THER T~~:~VEO/jK5 Ih / r;; b "' ..::/' DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 -I -.J REV-1500 EX Decedent's Name: RECAPITULATION 15056052048 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 Subjectto 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_ 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 15. 16. 17. 19. TAX DUE. . . . .,. . . .... .. . .. . . . . .. ... ... .. .. . .. . .... . .. . .. ... .. . . . . 19. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052048 Side 2 - 15056052048 --.J REV-t500 EX PFlge 3 Decedent's Complete Address: DECEDENT~ME \-\ u. +h €.. ~ f'<\ \ -\\n _._-------_..._....._--~- ~._-----_._-_._-_.. ------ - ._--_.~----_.._- - --------. STREET ADDRESS '-~~ ~~j. C:S_~~tc.. \J ~_\_\.J t.__~ ~ 0 ~_____~_______________ File Number I-------~--~-- CITY L~ (L~LlL -_._-~------_._._-_.._--~._----_._-----. -~--------- j STATEp ! . Q. Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2). -- --- ------ 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) · ZIP I I '1 D I$" 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (5B) 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 a. retain the use or income of the property transferred; .......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 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 No ~ ~ ~ <rg] ~ ~ 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 PS: 99116 (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. 99116 (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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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. . REV-1513 EX+ (9-00. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee( s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. TODD R KLING 2858 MORNINGS IDE DRIVE $1,000.00 NEPHEW CAMP HILL PA 17011 TRACY HILL $1,000.00 21 MT ROCK RD NIECE NEWVILLE PA 17241 RONALD L KLING JR $1,000.00 2310 NEW YORK AVE NEPHEW CAMP HILL PA 17011 DAVID KLING $1,000.00 NEPHEW 173 W LOUTHER ST #5 CARLISLE PA 17013 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS , DOD. 0 0 1. L ~ ~c--'^ 0'\ ~ ~\le.~ N - S. 'n \ ~~~S b..u-e...., I J ~{~ "'~S ('{\~Cl~\ N\~()d.\~-\- LnlMLc..-n \ ,ClOO. t) (J \-\A~~9 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) REV-l508 EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 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) '5 ~ SA\') I ~~S LlI, 3sf. 7J... TOTAL (Also enter on line 5, Recapitulation) $ q J, 331. 7 J. (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. G.€.AU~ OPf:..-NlIUJ L/7 S. Db .:t. fYI, IV /oS I-~ I (j() . 00 r 7 CJ. DO 3. r/ow Lfs B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _Zip Year(s) Commission 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 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ CAs' ~ 00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 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. UJAt.....nc\.>\ A c... fLu! \ t- c:.. (:\ e.d LfL u:t \ ~ L.(:\ e..d. Uul, -l- L.A fLtl J08- ~D 106'. ~ )'\'3. ~lD d. 3. ~ \~ LD Ue. (2. ,eo m IhJ-5 TOTAL (Also enter on line 10, Recapitulation) $ 6 os.. 7.y (If more space is needed, insert additional sheets of the same size) "W"ACHOVIA TIME DEPOSIT WITHDRAWAL CONFIRMATION Office Name Customer Name(s), Address and Taxpayer ID Number RUTH E SMITH SUSAN KLING 35 EAST GATE DR APT 207 NE CNTRL PA 1 CARLISLE PA Date 04/12/2007 CARLISLE PA 17015 S208242413 CURRENT BALANCE: $11,000.00 + ACCRUED INTEREST: $6.17 Availlnt WD/PenFree: $6.17 - PENALTY AMOUNT: $0.00 - FEDERAL WIHD DUE: $0.00 - WITHDRAWAL FEE: $0.00 - OUTSTANDING PYMT : $0.00 FULL REDEMPTION CD ACCOUNT NUMBER: 247412061757118 PAID TO CUSTOMER: $11,006.17 566594 "W"ACHOVIA TIME DEPOSIT NOT TRANSFERABLE Opening Date Account Number Taxpayer 10 Number This Receipt Acknowledges That TIle DelXlsltor Named Below Has Deposited With This Bank The Sum Of ****************\lOID***** Depositor Name And Address Term Maturity Date Interest Rate Per Annum Annual Percentage Yield Interest Payment Frequency/Period Interest Payment DisposiUon Account to Credit PROD-TYPE: PROMO CD: Issued by WACHOVIA BANK, NA X Authorized Signature X Date 1566594 "WACHOVIA TIME DEPOSIT WITHDRAWAL CONFIRMATION Office Name Customer Name(s), Address and Taxpayer 10 Number RUTH E SMITH SUSAN KLING 35 EAST GATE DR APT 207 NE CNTRL PA 1 CARLISLE PA Date 04/12/2007 CARLISLE PA 17015 S208242413 CURRENT BALANCE: $11,000.00 + ACCRUED INTEREST: $4.03 Avail Int WD/PenFree: $4.03 - PENALTY AMOUNT: $0.00 - FEDERAL WIHD DUE: $0.00 - WITHDRAWAL FEE: $0.00 - OUTSTANDING PYMT : $0.00 FULL REDEMPTION CD ACCOUNT NUMBER: 247412071757120 PAID TO CUSTOMER: $11,004.03 566594 "WACHOVIA TIME DEPOSIT NOT TRANSFERABLE Opening Date Account Number Taxpayer 10 Number This Receipt Acknowledges That The Depositor Named Below Has Deposited With This Bank The SumO! ****************VO I D***** Depositor Name And Address Term Maturity Date Interest Rate Per Annum Arlr!ual PerceptageYield Interest Payment FrequencylPeriod Interest Payment Oi$P(lsition Account to Credit PROD-TYPE: PROMO CD: Issued by WACHOVIA BANK. N.A. X Authorized Signature X Date 1566594 W"ACHOVIA TIME DEPOSIT WITHDRAWAL CONFIRMATION Office Name Customer Name(s), Address and Taxpayer ID Number RUTH E SMITH SUSAN KLING 35 EAST GATE DR APT 207 NE CNTRL PA 1 CARLISLE PA Date 04/12/2007 CARLISLE PA 17015 S208242413 CURRENT BALANCE: $15,000.00 + ACCRUED INTEREST: $8.02 Availlnt WD/PenFree: $8.02 - PENALTY AMOUNT: $0.00 - FEDERAL WIHD DUE: $0.00 - WITHDRAWAL FEE: $0.00 - OUTSTANDING PYMT : $0.00 FULL REDEMPTION CD ACCOUNT NUMBER: 247412091757101 PAID TO CUSTOMER: $15,008.02 566594 W"ACHOVIA DEPOSIT NOT TRANSFERABLE Opening Date Account Number Taxpa)'E!r1D Number This Receipt Acknowledges That The Depositor Named Below Has Deposited With This Bank The Sum Of **~*************\lOJD***** Depositor Name And Address Term Maturity Date Interest Rate Per Annum Annual percentage Yield Interest Payment Frequency/Period Interest Payment D1Spo$itlon Account to Credit PROD-TYPE: PROMO CD: Issued by WACHO\lJA BANK, NA X Authorized Signature X Date 566594 WACHOVIA Deposit Account Close Confirmation (Debit) WACHOVIA BANK, NA Date Customer Name(s) and Address Taxpayer 10 Number 04/12/2007 RUTH SMITH SUSAN KLING S208242413 35 EAST GATE DR APT 207 CARLISLE PA 17015 ACCOUNT NUMBER: 3064980603052 Available Balance $4,320.48 + Accrued Int : $0.02 - Fed W/Hd Due: $0.00 - Admin Fee: $0.00 - Outstanding Db : $0.00 - Closing Fee: $0.00 Paid To Customer: $4,320.50 566596 CUSTOMER COPY