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Home My WebLink About06-07-07 REV -1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT [...~_.~~:~:~~...;..~~~:::.m..:._.......~_...~...._............, FilE NUMBER ~ Original Return 0 2. Supplemental Return o 4. Limited Estate 0 4a. Future Interest Compromise (date of death after 12-12-82) I 0 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach of Will) copy ofTrust) '0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 11.Election to tax under Sec. 9113(1\) (Attach Sch 0) ~J!iiJ:lliiij!Efj]!!ili@lli~(lllliffliik~iklit$til~~i!iII(i!@Fffiltl.(m NAME COMPLETE MAILING ADDRESS Lisa M. Greason - - -- COMMONWEALTH OF FENNSYLVANIA DEPARTMENT OF ~EVENUE DEPT 280601 HARRISBURG. PA 17128-0601 ~ z w o w u w o DECEDENT'S NAME (LAST, I'IRST. AND MIDDLE INITIAL) PECKHOLDT,HELEN I:A~~~F1~;~HO(~MDD. YEAR) ~A~~ ~;~~T; ;M;.DDYEAR) !(iF APPLICABLE) SURVIVING SPOUSESNAME(LAST:F!RSTAND MIDDLE INITIAL) --- 21 06 ___COUNTY CODE YEAR SOCIAL SECURITY NUMBER 0826 _--'"UMBER____ W I- :::s::::!;(/) uO::'<: wo..u IOO uO::-' o..ID 0.. <( 'I- (/)z Ww 0::0 O::z 00 Uo.. FIRM NAME (If applicable) Greason Law Office 121 20 3696 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS - SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes P.O. Box 385 Carlisle, PA 17013 ~ELEPHONE NUMBER I 717/241-3030 ,~+ I Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) I- 0:: <( u W 0:: 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 8~ Administrative Costs (Schedule H) (1) (2) (3) (4) (5) (6) (7) ----,.-- ;..J:~:T_.IJ\~_ 1.1.'::.::: ;j '-,::.-, I I i ~ 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) None None None None 15,492.59 None None (8) '15,492.59 (9) (10) 16,984.96 - -- 8,287.32 (11) 25,272.28 (12) insolvent 13. Charitable and Governmental 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 Line 13) (13) (14) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1 .2) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES x .00 (15) Copyright 2000 form software only The Lackner Group, Inc. z o >= <( I- :J 0.. :;: o U >< <( I- 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. Tax Due x .045 (16) x .12 (17) x .15 (18) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. (19) 20. 0 !Ws;~'~gE~2l:..lT.::.~ii'~iile$ORetoAN~j(miiooE$tl~QiiiReV~$E$liiiNiiiia~1iiiMJFT00:mFIiUig;.~?TI Form REV-1500 EX (Rev. 6-00) /'" . C.'-j / D~cedent's Complete Address: STREET ADDRESS CME LOT 136 - CITY NEWVILLE 1 STATE PA 1.-- - -.- .-- - . - -- -- ---.. - ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8 Prior Payments C Discount (1) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 0.00 Tota/lnterest/Penalty (0 + 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. (3) (4) 0.00 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) 0.00 A. Enter the interest on the tax due. 0.00 Make Check Payable to. REGISTER OF WILLS, AGENT 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................ ........................ .................................. 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; .................... n 15<1 b. retain the right to designate who shall use the property transferred or its income; .......................... n 15<1 c. retain a reversionary interest; n ~ 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 ~ o ~ o ~ 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 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 D~~lar~~:m oLprep~Ler o~~_er t~,,!_n t~~_per:~'?nal!~pr~~_nta~~e i~?sed o~~ j~~m~n -.91_~h~ p~ear~a~~~y~_o~~dg~ __ _. __ SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS D!\TE THE~1jX\CO],;KLI:\ /;. 306 RAYMaN AVENUE SIGN{~ OFP~ii-~~ESPok~~10~'~;;LJ~N ---- - ADDRESS _BOJLI~G~Pf3.INi3S~PA_17.90Z _ t.ii.'l,lC"2 _ ""'DATE - -- - --- - SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Lisa M. Greason un --"1'>'1. /u.'U) .. __I / / ) ADDRESS DATE For dates of death on or after July 1, 1994 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 PS 89116 (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. 39116 (a) (1.1) (i1)]. 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 0% [72 P.S. 39116 (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. 3911 E 1.2) [72 PS 39116 (a) (1 )J. 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. 39116 (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. P.O. Box 385 Carlisle, PA 17013 6/3/c) .~.. ~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PECKHOLDT, HELEN FILE NUMBER 21 - 06 - 0826 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 DESCRIPTION VALUE AT DATE OF DEATH 1,833.21 F & M Checking Account, # 34-10358 2 1991 Redman mobile home, sold through Park Place, List # 1844, Job # 06-23, VIN # 12221620 12,713.43 3 Adams Electric Retirement Summary 171.09 4 F & M Savings Acct, # 08-09894 732.86 5 Goodville Mutual Casualty Co., refund on Home Owners Insurance 42.00 TOTAL (Also enter on Line 5, Recapitulation) 15,492.59 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PECKHOLDT, HELEN !FILENUM-EfE-R 21 - 06 - 0826 Debts of decedent must be reported on Schedule I. -- -..- - ---- ITEM NUMBER I FUNERAL EXPENSES: A. 1- I. Hoffman Roth F~~er~IH;~e - DESCRIPTION AMOUNT 2 Carlisle Memorial - head stone 3 S1. Patrick Catholic Church, payment to priest 4 Flowers, food, cards, postage B. I ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions THERESA CONKLIN Social Security Number(s) / EIN Number of Personal Representative(s): 100 30 5783 Street Address 306 RAYMaN AVENUE City BOILING SPRINGS State PA Zip 17007 2. Year(s) Commission paid Attorney's Fees Greason Law Office 3. Family Exemption (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees to Cumberland County Register of Wills Inheritance Tax Return fee to Register of Wills Inventory filed with Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs The Sentinel - Legal Advertising Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 7,207.10 1,846.00 75.00 300.00 3,500.00 3,500.00 110.00 15.00 15.00 181.86 235.00 16,984.96 Sched.je H Funeral Expenses & Administrative Cos1s continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT - --- --- -- --I ~L~ ;U_M~~: ESTATE OF PECKHOLDT, HELEN 2 1 The Cumberland Law Journal - Legal Advertising 75.00 3 First & Final Account filing fees 50.00 4 Advertising First & Final Accounting 80.00 5 Adjudications for recording and distribution to Register of Wills 30.00 Page 2 of Schedule H SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INrlERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PECKHOLDT, HELEN Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION CITI CARD ACCT # 5424180678346153 2 CHASE MASTERCARD ACCT # 5260 3642 9309 9010 FILE NUMBER 21 - 06 - 0826 AMOUNT 4.206.75 650.20 1,610.07 96.08 19.59 65.86 163.91 34.93 10.66 67.00 30.01 47.90 215.00 ---- -- --- ...--... --- ---.. ..--- ..-- ----- -- -...- ---- ---- TOTAL (Also enter on Line 10, Recapitulation) 8,287.32 3 CAPITAL ONE ACCT # 5291 4923 4968 3850 4 ADAMS ELECTRIC COOPERATIVE, INC. ACCT # 2054113600 5 MCI ACCT # 2CL 12518 6 U-haul for boxes 7 Rental Truck for moving household items to donation 8 Newville Hardware - door handle 9 UPS to mail claims 10 GMCC Homeowners Insurance 11 Sheetz - gas for rental truck 12 Lunch for movers 13 John Walters, Lot Rent ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT PECKHOLDT, HELEN Include unreimbursed medical expenses. ITEM NUMBER 14 DESCRIPTION HCR Manor Care, final medical payment, Patient # 25010 ---- FILE NUMBER 121 - 06 - 0826 1- AMOUNT 1,069.36 Page 2 of Schedule I