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HomeMy WebLinkAbout08-08-07 REV-1500 EX... (6-00) . . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W C w U w C RAGER CAMREN M. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 07/30/2006 01/14/2000 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) W I- ~ ~en uD::~ w o.u J:OO UD::....I o.aJ 0. c( [X] 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate [Attacn copy 01 Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise [date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attacn copy oITrusf) o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95) OFFICIAL USE ONLY FILE NUMBER W 21 200997 COuNTYCOOE ---vEA~ - - NUMsER-- SOCIAL SECURITY NUMBER 2 0 1 - 7 8 - 5 4 9 2 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 Q.. 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) [Attach Sch 0) I- Z W Cl Z o 0. en W D:: D:: o U THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX.INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS DAVID W. REAGER 2331 MARKET STREET FIRM NAME (If Applicable) REAGER & ADLER P.C. TELEPHONE NUMBER 717-763-1383 CAMP HILL PA 17011 0.00 X _(15) 0.00 0.00 X _(16) 0.00 0.00 X .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 0.00 z o l- e( ...J ::> I- 0.. e( U w 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 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) g. Funeral Expenses & Administrative Costs (Schedule H) (1) (2) (3) (4) (5) (6) (7) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 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) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= e( I- ::> 0.. :E o u >< e( I- 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. Tax Due 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SI.DE AND RECHECK MATH < < )'(f C OFFICIAL USE ONLY .'...... :::>" (.J.....) I i 0.001 I OJ "'"" r<o_~) i en 0'> (8) 0.00 (11) (12) (13) 0.00 (14) 0.00 Oe<!edent's Complete Address: ! STREET ADDRESS I 195 Beaqle Club Road I i I CITY Carlisle I STATE PA I ZIP 17013 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C) (2) 0.00 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. Check box on Page 1 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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 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 00 c. retain a reversionary interest; or ...................................................................................................... 0 00 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 !Xl 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?............................. ......................................... ............... ......... 0 !Xl 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 !Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 00 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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESP?NSIBLE FOR FILING RETURN -IDDRESS c?"7?t rt: 2 ??;/ ,LIt{ via. 1 Y- Df;,TJ ! !tu r) C tll/~{)) !II' /1 DATE Pu- lit/II SIGNATURE OF PRE PARER 0 ADDRESS 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 PS. 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 0% [72 P.S. ~9116 (a) (1.1) (iill. 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. :Oor 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. 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 4,5%, except as noted in 72 P.S. ~9116( 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 12% [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. REV.1508 EX +.(6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF :HAGER. CAMREN M. FilE NUMBER 21 20 Include 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. 0997 ITEM NUMBER 1. DESCRIPTION Decedent was 6 years old at the time of his death. His estate was probated for the sole purpose of obtaining a short certificate so his mother could claim a small life insurance policy on his life. VALUE AT DATE OF DEATH 0.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 ~'.~"H."_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER RAGER r:AMREN M. 21 ?O 0997 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Tammy Ann Rager (mother) Lineal 0.00 195 Beagle Club Road Carlisle, PA 17013 2. Randy Eugene Rager (father) Lineal 0.00 195 Beagle Club Road 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 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) INVENTORY REGISTER OF WILLS OFCUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF } ss File Number 21 20iJU7 0997 Personal Representative(s) of the Estate of RAGER, CAMREN M. deceased, depose( s) and say( s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsy lvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I verify that the statements made in this Inven_} !J2 4- L tory are true and correct. I understand that false state- I ments herein are made subject to the penalties of 18 Pa. c.s. 9 4904 relating to unsworn falsification to authorities. Attorney -- (Name) DAVID W. REAGER (Address) 2331 MARKET STREET (Telephone) 717-763-1383 (Supreme Court J.D. No.) 020~&~ CAMP HILL PA 17011 DATE OF DEATH LAST RESIDENCE 195 Beagle Club Road Carlisle DECEDENT'S SOC. SEC. NO. 7/30/2006 PA 17013 201785492 FIGURES MUST BE TOTALED Decedent was 6 years old at the time of his death. His estate was probated for the sole purpose of obtaining a short certificate so his mother could claim a small life insurance policy on his life. L .~~ ~'~_.J ;;::'"l.' I C!) ell (J', (Attach additional sheets as needed) TOTAL: NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. c.s. J 3301(b)) Form RW-09 rev. 10.13.06 ~v\ REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP Hill. PENNSYLVANIA 17011-4642 717-763-1383 TElEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com THEODORE A. ADLER + DAVID W. REAGER LINUS E. FENIClE THOMAS O. WilLIAMS SUSAN J. SMITH PETER R. WilSON SUSAN H. CONFAIR JOHN H. PIETRZAK RICHARD J. JOYCE + Certified Civil Trial Specialist Writer's E-Mail Address:MZercher@ReagerAdlerPC.com August 6, 2007 Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 RE: Estate ofCamren M. Rager Our file number: 06-688 Dear Sir or Madam: Enclosed please find the Inheritance Tax Return and Inventory for the Estate of Camren M. Rager together with a check in the amount of $30.00 to cover the costs of filing. Kindly return a time-stamped copy in the envelope provided. Thank you for your attention to this matter. Very truly yours, I ,1,__ SJ?{t~cJ,- .~ ~'-.) Monica D. Rhodes Legal Assistant :!---:ld Enclosures j ~::.) --~~ CI1 0-.