HomeMy WebLinkAbout10-16-07 (2)
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15IJ5b041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
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County Code Vear
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 6
1031
Date of Birth
204035675
10022006
07231921
LEAPHART
BETTY
MI
J
Decedent's Last Name
Suffix
Decedent's First Name
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return [!J 2. Supplemental Return
[] 4. Limited Estate D 4a. Future Interest Compromise
(date of death after 12-12-82)
[J 6. Decedent Died Testate D 7. Decedent Maintained e Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
D 9. Litigation Proceeds Received D 10 Spousal Poverty Credit }date of death
. between 12-31-91 and -1-95)
D
D
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JERRY A. WEIGLE ESQUIRE 7175327388
Firm Name (If Applicable)
WEIGLE & ASSOCIATES, P.C.
REGISTER OFWILLS USE:ONL Y.
First line of address
126 EAST KING STREET
Second line of address
('<.,."J
DATE FILED (.)
City or Post Office
SHIPPENSBURG
State
PA
ZIP Code
17257
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. '
SIGNAT OF PERSON RESPO SI LE FOR FILING TURN DATE
Susan Leaphart
Jerry A. Weigle Esquire
Side 1
L
15IJ5bIJ41147
15IJ5bIJ41147
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15056042148
REV-1500 EX
Decedent's Name Betty J. Leaphart
RECAPITULATION
1. Real Estate (Schedule A)...................................................................... .................... 1.
2. Stocks and 80nds (Schedule 8)............................................................................... 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) D Separate 8illing Requested.............
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested.............
8. Total Gross Assets (total Lines 1-7).......................................................................
Decedent's Social Security Number
204035675
6.
7.
10 565 81
10 565 81
8.
9. Funeral Expenses & Administrative Costs (Schedule H)..................... .................... 9.
437.63
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, of
transfers under Sec. 9116
(a)(1.2) X .00 0 0 0
15.
16. Amount of Line 14 taxable
at lineal rate X .045 10,128 18
17. Amount of Line 14 taxable
at sibling rate X .12 0 00
18. Amount of Line 14 taxable
at collateral rate X .15 0 00
16.
19. Tax Due.......... .......... ......... ................... ........... ...... .......... ............................ ....... ....... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
437 63
10,128 18
10,128.18
o 00
455 77
17.
o 00
18.
o 00
455 77
o
15056042148
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Betty J. Leaphart
f----
STREET ADDRESS
620 Charles Street
File Number 21-06-1031
-~~---,--_.----------~----"-~-_._----
-- _.------_._---_.._--'-~--_.-
CITY
STATE
ZIP
Shippensburg
PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 455.77
(2)
Total Credits (A + B + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(3)
(4)
(5)
(5A)
(5B)
Total Interest/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 2 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.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
455.77
455.77
Make Check Payable to: REGISTER OF WILLS, AGENT
I j J
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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? ....... .... .......... .......................... ......... ............ ............ ... ...... ............................. Ii] [J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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?................................................................................................................ ......
Yes
o
o
o
o
o
[]
No
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:iJ
:iJ
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ix]
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 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 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 or for 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-1510 EX+ (6-98)
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SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Leaphart, Betty J.
FILE NUMBER
21-06-1031
This schedule must be completed and filed ~ the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Jackson National Life Insurance Company - 10.565.81 100.000 10.565.81
Annuity Policy No. 0058880950, proceeds
received 7-19-2007. Susan Leaphart, daughter,
sole beneficiary
TOTAL (Also enter on Line 7, Recapitulation) 10.565.81
<If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV.1151 EX+ (12-99)
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Leaphart, Betty J.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-1031
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Weigle & Associates, P.C. 422.63
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. Other Administrative Costs Register of Wills, Cumberland Co., - supplemental 15.00
TOTAL (Also enter on line 9, Recapitulation) 437.63
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
REV 1513 EX. (9 00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Leaphart, Betty J.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions. and transfers
under Sec. 9116(a)(1.2)]
FILE NUMBER
21-06-1031
ESTATE OF
RELATIONSHIP TO
DECEDENT
Do Not List Trustee{sl
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
1
Susan Leaphart
620 Charles Street
Shippensburg, PA 17257
Daughter
100%
10,128.81
Total 10,128.81
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
Jackson National Life Insurance Company@
Insuring your financial future~
--
iii
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Claims Administration
Susan Leaphart
620 Charles St
Shippensburg, P A 17257
Your Independent JNL representative:
JOSEPH BOWDEN
C/O FINANCIAL NETWORK
PO BOX 250
SHIPPENSBURG, PA 17257-0250
July 19, 2007
Representative Phone: (717)530-2618
Deceased: Paul B & Betty J Leaphart
Dear Susan Leaphart:
Thank you for your patience during our processing of this claim.
Your payment has been deposited in a Beneficiary Access Account. You will be receiving additional
information, regarding the particulars of the account, within ten business days.
The Internal Revenue Service (IRS) requires us to report payments made, so we will be sending both
you and the IRS tax form 1099R (for Annuity benefit payments) and form 1099INT (for the interest
amounts over $600.00), in January of next year.
If you have any questions or need additional information, please contact our Service Center toll free
at 888/565-4995,
Sincerely,
tX~ ~dvrU
Laura Prieskorn
Claims Administration
CC:
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Jacksol1 National Life Insurance Company
1 Corporate Way, Lansing, MI 48951
PO Box 24068, Lansing, MI 48909-4068
Toll Free Number: 888/565-4995
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Jackson National Life Insurance Company@
Insuring your financial future:
Claims Administration
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Proceeds Pavable to:
Susan Leaphart
Policy Number:
Claim Number:
0058880950
0700023974
Policv Information:
Policy Benefit:
Loan Payoff:
Premium Due:
$10,565.81
$0.00
$0.00
Beneticiarv Information:
Benefit Paid:
Interest Paid:
Misc Interest Paid:
Premium Refund:
Foreign Withholding:
Federal Withholding:
State Withholding:
Distribution Amount:
$10,565.81
$0.00
$0.00
$0.00
$0.00
$406.58
$0.00
$10,159.23
-.
..
Jacksol) National Life Insurance Company
I Corporate Way, Lansing, MI 48951
PO Box 24068, Lansing, MI 48909-4068
Toll Free Number: 888/565-4995