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Home My WebLink About06-29-07 (2) REV ...'ex. (utI w .. lll:~~ ldl1.8 :Z:~..J UI1.IlI 11. cc . OFFICIAL USE ONLY I REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 06 COUNTY CODE YEAR SOCIAL SECURITY NUMBER COMMONWEAl. TH OF PENNSYLVANIA DEPARThlENT OF REVENUE DEPT. 280601 HARRISBURG, PA 171211-0801 0711 NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Shaub, Matilda E 182-22-9906 .. z W Q W ld Q THIS RETURN MUST BE FILED IN DUPUCATE WITH THE DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 07/31/2006 10/07/1926 REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) 1. Original Return 2. Supplemental Return 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 o 11. Election to tax under Sec. 9113(A) (Attach Soh 0) 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy 01 Trust) 10. Spousal Poverty Credit (date of death between 1 - ... IIIZ Ww lli:Q lli:z 00 UI1. 6. Decedent Died Testate (Attach copy 01 Will) 9. Litigation Proceeds Received IRM NAME (II applicable) Ahrens Law Firm, P.C. 52 Gettysburg Pike Mechanicsburg, PA 17055 ElEPHONE NUMBER 717/697-1800 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1 ) None _.~- (2) None (3) None (4) None (5) None (6) None ~_._._. (7) 48,424.35 OFFICIAL USE ONLY r-.;:l = = --.l c...... c:: z ~J.J ~rl C) f~ ,-=-;'1 (.') C) "r--l -q (".') rn ("") C:-'O . .:u J~i~~ ...I'l .., ::rJ 'u)-, JOO C_) -n ,.- :J3 z o ~ ::> .. it ~ lli: 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) (9) 565.00 N \D -0 ::c N ::...;;, W "-.-( -48,424.35 (8) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11 ) 565.00 47,859.35 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Govemmental Bequests/Sec 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) 47,859.35 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) x .00 (15) z o S ::> 11. ~ 8 a x .045 (16) 16.Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate 47,859.35 x .15 (18) 7,178.90 19. Tax Due (19) 7,178.90 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS I STATE . .-----1 ZIP - CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 6. Prior Payments C. Discount (1) 7,178.90 Total Credits (A + 6 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + 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. A. Enter the interest on the tax due. 6. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (56) 0.00 7,178.90 7,178.90 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: a. retain the use or income of the property transferred;.................................................................................. 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?............................................................................................................... ....... 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?..................................................................................................................... y~ I o ~ o ~ ~ 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 penanies of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, n is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS ..-~----"----DATE-._..._- ~th Jane Dn .r b I 4000 Woodvale Road SIGN:T~F~61l~o~~liu",~..~\'IAA""() ADDRESS HCirrisblll"..Q,--PA ..J1109 ~-_._----- (;; J Z5 ",,/)1 DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Thomas J. hrens DATE ADDRESS 52 Gettysburg Pike Mechanicsburg, PA 17055 04 ZC:, -- 07 For dates of death 0 r 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 Yo [72 P.S. 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 0% [72 P.S. 99116 (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 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. 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 4.5%, 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 or for the use of the decedent's siblings is 12% [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. *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ITEM NUMBER lRI~LE NUMBER Shaub, Matilda E 21 - 06 - 0711 ---------. ---~-~-~---~ This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. Include the nam~~~;:::,'~~re~~ ~:~:~~:ShiP to decedent ----~-~:ATE OF DEATH i D~C~S i EXCLUSION r~AXABLE VAL~- and the date of transfer. Attach a copy of the deed for real estate. VALUE OF ASSET i INTEREST i (IF APPLICABLE) I i I 1------- AIG Annuity # A0200328 48,424.351 100% 48,424.35 I ESTATE OF 1 48,424.35 TOTAL (Also enter on line 7, Recapitulation) *' 1- SCtEDlI.E H FlIERALEXPENSES & AlJPtWtSTRA11VE COS1S COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER--~---------- 21 - 06 - 0711 ESTATE OF Shaub, Matilda E Debts of decedent must be reported on Schedule I. ITEM i NUMBER! FUNERAL EXPENSES: ! A. ! DESCRIPTION AMOUNT i ._--1----- 1. i ADMINISTRATIVE COSTS: I \ Personal Representative's Commissions I Social Security Number(s) I EIN Number of Personal Representative(s): I i 1 I Street Address \ B. 2. 3. City State Zip Year(s) Commission paid Attorney's Fees Ahrens Law Firm, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 500.00 State Zip City Relationship of Claimant to Decedent 50.00 4. Probate Fees Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Supplemental Inheritance Tax return fee 15.00 _L___ TOTAL (Also enter on line 9, Recapitulation) 565.00 f' (~, lJ-J c) CC - U-- ' o C-' L,LJ Ci 0-:: c: C) ~~~! r- e'? N ~, ~ .f ,j.' .J ...." .,5 r" f;' j '~ ::c 0- -6' 1-_ c1::. a:: u_ =)~- OC~~o c.-'" ~cn~ ffiz ~<(. U::c- 0_"> 0: ~~, O=~ o nn:;o ~S~ tf.l cr' (;i' ~O ~ ft -'""I ~[~ ......n~ .......0:::= 85m wq n o ~ o ~ tf.l (I) .. ,~ r:.';'l! . 1 ...~ , I ,. f I I t I'.'~ , " r . J . C1\ N :;z: :::> "J r-- = = c-.J , , ,. f . I lit ~,' .4tJ': ' r-, ( , >- :xJ :::0 - en OJ C :::0 Q - \. " .... ....... ...... ." s: ~ .. ...~~~ () 0 ,- ::r (D ~' 1 ~ ~ ti _.'< L () tf.l lC 1tf.l cr'!' g" ~ ~ ... '""I ~ '""I"'" "r ".., , .. .- ", - - == - - - - ,.'~ - - - ..- .. - - - - - - - - .. - - - - - - - ~.,;yj (.... C Z .. ", ", f/IIA ,. ", ", ", ", ,. ", ", .- ~ I'\) 'J ~. -- f\) C) o ....... ~- ~ - :r )> ;0 :::r - (/i CD C -n ~ ....... ~ 1ft