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Home My WebLink About05-24-07 REV-1500 EX' (8-00) .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z W C w (J w C I!! ~:!511) ua::~ wlLU :z:i9 U IL ID IL <C REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENrs NAME (LAST, FIRST. AND MIDDLE INITIAL) RAYMOND .JASON DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 001. Original Retum D 4. limited Estate D 6. Decedent Died Testate (AllachcopyofW~) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 4a. Future Interest Compromise (daleofdealhalllr 12-12-82) D 7. Decedent Maintained a living Trust (AllachcopyofTrust) D 10. Spousal Poverty Credit (daIIlofdealhbe1ween 12-31-91 and 1-1-95) OFFICIAl. USE ONLY FILE NUMBER 21 -0 6 0 8 1 6 COuii'TY"CoOE -YEAR- - - NUMSER- - SOCIAL SECURITY NUMBER 085-66-5949 THIS RETURN IIUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (dale ofdealh prior1D 12-13-82) D 5. Federal Estate Tax Retum Required !... 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Allach Sch 0) z o ~ :) l- ii: c( (J w a:: z o ~ :) D. 2 o (J ~ 09/0212006 08/28/1966 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ... z W Q Z f II) w a:: a:: 8 NAME MURREL R. WALTERS III ESQUIRE FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS TELEPHONE NUMBER 717-697-4650 54 EAST MAIN STREET MECHANICSBURG 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Groll Assets (total lines 1-7) 9. Funeral Expenses & Administrative Cosls (Schedule H) (9) 10. Debls of Decedent Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total lines 9 & 10) 12. Net V.lue of Estata (Line 8 minus Line 11) 13. Charitable and Govemmental Beques1slSec 9113 Trusls for which an election to tax has not been made (Schedule J) 14. Net V.lue Subject to Tu (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 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 19. Tu Due X _(15) X _(16) X .12 (17) X .15 (18) (19) 20.0 CHECK HERE ,c YOU ARE 'icQUESTING A REFUND OF AN OVERPAYrllENT (8) (11) (12) (13) (14) PA 17055 OFFICIAL~E ONLY o .Tj C:-> - ,~) ["1 6,912.03 co :~ c..n Ui 6,912.03 4,419.00 9,978.44 14,397.44 -7,485.41 -7,485.41 0.00 o d t' C I t Add ece en s ample e ress: STREET ADD~ESS 815 APPLETRI!E LANE CITY I STATE I ZIP MECHANIC.BURG PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( 0 + E) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (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 No a. retain the use or income of the property transferred; ........................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 l&l c. retain a reversionary interest; or ...................................................................................................... 0 l&l d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 00 3. Did decedent own an oin trust for" or payable upon death bank account or security at his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 00 0.00 0.00 0.00 0.00 II IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS MURRE R. WAL TIERS III, ESQUIRE 54I!AST MAIN STREET, MECHANICSBURG PA 17055 ~II -~j~.j 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 exemot 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. REV-1508 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RAYMOND JASON FILE NUMBER 21 06 Indude 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. 0816 ITEM NUMBER DESCRIPTION 1. SOVEREIGN BANK 2. PROGRESSIVE INSURANCE REFUND AUTOMOBILE INSURANCE 3. 2002 FORD FOCUS SALE PRICE 4. 2006 FEDERAL INCOME TAX REFUND 5. S & P AUTO PARTS FINAL PAYCHECK 6. CASH IN WALLET VALUE AT DATE OF DEATH 819.28 44.02 4,000.00 1,486.00 543.73 19.00 TOT At (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6.912.03 REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RAYMOND JASON SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FilE NUMBER 21 06 0816 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME. MECHANICSBURG, PA 2,417.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) WILLIAM H. RAYMOND 350.00 Social Security Numbe~s)IEJN Number of Personal Representative(s) Street Address 4010 SILVER BEACH ROAD City BALLSTON SPA State NY Zip 12020 Yea~s) Commission Paid: 2007 2. Attorney Fees MURREL R. WALTERS III 1,200.00 3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS. CUMBERLAND COUNTY 102.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. TOTAl (Also enter on line 9, Recapitulation) $ 4.419.00 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent RAYMOND JASON Decedent's Name Page 1 21 06 0816 File Number Schedule H - Funeral Expenses & Administrative Costs - 81 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 2. Name of Personal Representative (s) SUE ANN RAYMOND 350.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 4010 SILVER BEACH ROAD City BALLSTON SPA State NY Zip 12020 Yea~s) Commission Paid: 2007 SUBTOTAL SCHEDULE H.B1 350.00 REV-1512 EX + (6-98) . SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RAYMOND JASON FILE NUMBER 21 06 0816 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. CITI FINANCIAL BALANCE DUE ON CAR LOAN TO RELEASE TITLE 3,248.42 2. BALOGH BECKER L TO TARGET NATIONAL BANK 632.91 3. EASTERN ACCOUNT SYSTEM OF CONNECTICUT COMCAST 65.00 4. AFNIINC. VERIZON PENNSYLVANIA 101.17 5. TORRES CREDIT SERVICES, INC. UGIIHBG/GAS 91.50 6. ARROW FINANCIAL SERVICES CAPITAL ONE CRDIT CARD 424.93 7. PPL ELECTRIC 443.96 8. THE BROOK RESIDENTIAL RENT 3,216.50 9. CHASE (BANKONE) CREDIT CARD 1,623.05 10. FIRST PREMIER BANK CREDIT CARD 131.00 TOTAL (Also enteron line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 9,978.44 ~'-"""':* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RAYMOND JASON SCHEDULE J BENEFICIARIES NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] WILLIAM H. RAYMOND 4010 SILVER BEACH ROAD BALLSTON SPA, NY 12020 SUE ANN RAYMOND 4010 SILVER BEACH ROAD BALLSTON SPA, NY 12020 1. 2. FILE NUMBER ?1 06 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FATHER MOTHER 0816 AMOUNT OR SHARE OF ESTATE 50% 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. 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 1. 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)