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Home My WebLink About10-16-07 -.J 15056051058 REV-1500 EX (06-{)5) PA Department of~ue '* Bureau of Individual Taxes PO BOX 280601 ~ Harrisburg,PA17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year ;/ I OS- File Number ~~ Date of Birth 177-42-1047 07/1312006 04/13/1952 Decedent's last Name Suffix Decedent's First Name MI WHARE DANIEL J (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 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a UvIng Trust (Attach Copy ofTrust) 10. Spousal Poverty Credit (dale of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Wi") 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes MICHAEL J WHARE Firm Name (If Applicable) LAW OFCS of MICHAEL J W (717) 243-3561 C") ,"---~I l -j First line of address .' i c-, 37 E. Pomfret Street Second line of address . , ~: :,-_.) City or Post Office Carlisle State ZIP Code 17013 en .:;' PA Correspondent's e-mail address;J\i~.\rI.nA(( <i)~..\ \. taV'\ Under penalties of perjury, I declare that I have examined this retum. including accompanying schedules and statemenls. and 10 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. SIGN U E OF PERS R ~ONSIB E FOR FILING RETURN DATE rv ...C("'-O ( . SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 -.J .....I 15056052059 REV-1500 EX Decedents Name: DANIEL J WHARE RECAPrrULATION 1. Real estate (Schedule A). .. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .. .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . .. .. . . .. . . . . . . . . . .. . . . . . . . . . . . ... 2. 3. Closely Held Corporation, Partnership or SoIe-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. JoinUy Owned Properly (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-V NOS Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . .. .. .. . . . . . . . . . . . . . . . . . . . .. . . .. 11. 12. Net Value of Estat& (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 Subject to 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, or transfers under See. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate x.o 45 0.00 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at coHateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 177-42-1047 Decedent's Social Security Number 0.00 668.07 0.00 0.00 8,754.32 0.00 0.00 9,422.39 6,699.41 49,586.44 56,285.85 -46,863.46 0.00 -46,863.46 0.00 0.00 15056052059 -.J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDEN1'S NAME DECEDENrS SOCIAL SECURITY NUMBER DANIEL J WHARE 177-42-1047 STREET ADDRESS 1000 Claremont Rd Claremont Nursing and Rehabilitation Center CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CredilslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits (A + B + C ) (2) 0.00 3. InteresUPenalty 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. Fill in avalon Page 2, 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 lax due. (SA) 0.00 0.00 0.00 0.00 0.00 B. Enter the total of Line 5 + SA. 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 ~ b. retain the right to designate who shall use the property transfenred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~ 2. If death occunred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 ~ 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~ 4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 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. 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. ~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 zero (0) percent [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 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. ~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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value oftransfers to orfor the use ofthe decedent's siblings is twelve (12) percent [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-1503 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DEOEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. II ~~AtC4 of DESCRIPTION f'\QU ;'f. 'J:C\ (. \ \aa:\~'3"'1OO ,tJ ~"'.a t VALUE AT DATE OF DEATH ~ ~~.t)1 TOTAL (Also enter on line 2, Recapitulation) $ L, It ~. 0, (If more space is needed, insert additional sheets of the same size) REV-15G8 EX+ (6-98) . * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. An prvperty jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. t:."~~I\~ ~c.cNn'" .... \'&'1 C\"\ .. J.\.Ju\~ \ '* ~M\~ 8.'~~. ~':l TOTAL (Also enter on 6ne 5, ReeapibJlation) $ (If more space is needed. insert additional sheets of the same size) R 1rtl. -Sd. , REV-1511 EX+ (1().()6)* COMMONWEAllH OF PENNSYLVANIA INHERITANCE TAX RElURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINIS1RA11VE COSTS ESTATE OF FILE NUMBER ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: , 1. t.l..~--. _ It.\\.. F~e.'~' ~ l &.I, '\ll..QO ~, 6ur\-. \ 61i\Nai5> ~. , 00.00 3, l,.",.J,w\...l l..">H ~~"'\ .. A~"\""~i'''j J. ,~.O() 4. l_,.1 ~~Jt Sel\+; 1\ , 1 ... J'J..r~ ""'!) 'I. r~~. S" I B. ADMINISTRATIVE COSTS: , 1. Personal Represen1ative's Commissions $&ft)O.O Name of Personal Representative(s) ~ l. \\t-\ \t..(' l. StreetAddl8SS ~~(,~i "Ct~ P\K1l State 1!4.- Zip /7()', City --D..il1 ~ J, \J 1" Year(s) Commission Paid: ~ 7 2. Attorney Fees ;;J. .J \{OO. 0 3. Family Exemption: (If decedenfs addl8SS is not the same as c1aimanfs, attach explanation) Claimant ~ 0.06 Street Addl8SS City SllIte _ Zip Relationship of Claimant 10 Oealdent 4. Probata Fees 'I. I 'S'. c)o 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ <..,.(. qq. &of Debts at dIcedant must be I8pOrted on Schedule 1 o o (If more space is needed, insert additional sheets of the same size) REV-1512 EX+(12'()3) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABIUllES, & UENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ITEM NUMBER 1. Report debts incurred by the decedent prior to death wllich remained unpllid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH DESCRIPTION c.'~rc.1l'\~+ NoIf"~~ ...,J.. Rt~~\:-\....-\~._ Lt,,\.(' IIc.UI.. 1Jtff.~.rk l-Abor~~O"'lf~ :). l. L1. Ph(,r'~r;,A. 4ttjiC\lD. \l., '"5.'"1, ~,O''i. alGI 531). S-O t'1okk '" - R..~ X",. 3; 'f\ j J In c. TOTAL (Also enter on line 10, Recapitulation) $ &.ICI, ~it,. 41../ (If more space is needed, insert additional sheels of the same size)