HomeMy WebLinkAbout10-25-07
REV - 1eo-i EX + IMD)
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OFFICiAL USE ONLY
I
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280801
HARRISBURG. PA 17128-0601
FILE NUMBER
21 06 1072
COUNTY CODE YEMl__ _~ _..NUMB[;R..__._
--.- --r SOCIAL SECURITY NUMBER----------
165-26-6194
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
I made (Schedule J)
i 14. Net Value SubJectto Tax (line 12 minus line 13)
-------L -~'___________.___.__._.~____.._.___.._.___________..__.___,__
I SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
I 15.Amount of Line 14 taxable at the spousal tax rate,
I or transfers under Sec. 9116(a)(1.2)
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i 16.Amount of Line 14 taxable at lineal rate
I
I 17.Amount of line 14 taxable at sibling rate
i 18. Amount of Line 14 taxable at collateral rate
119. Tax Due
120.0
....
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I DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL)
I Madeira, Frederick L
, DATE OF DEATH (MM-DD-YEAR) - DATE OF BIRTH (MM-DD-YEAR)------'
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
03/10/2006
05/17/1931
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPUCABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
Madeira, Carolyn G
208-24-0200
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
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1. Original Return
4. Lirnited Estate
4a. Future Interest Compromise (date of death after
12.12.82)
7. Decedent Maintained a Living Trust (Attach
copy of TNst)
10. Spousal Poverty Credit (date of death between
2. Supplemental Return
6. Decedent Died Testate (Attach copy
of Will)
9. Litigation Proceeds Received
.....
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IRM NAME (If applicable)
Ahrens Law Firm, P.C.
I
------1
52 Gettysburg Pike
Mechanicsburg, PA 17055
ELEPHONE NUMBER
717/697-1800
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1 )
(2)
(3)
(4)
(5)
(6)
(7)
None
None
OFFICIAL USE ONLY
3. Closely Held Corporation, Partnership or Sole-Proprietorship
1,092,477.00
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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)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
V"J
None
,-)
None
None
None
1---;
i. (
(8)
1 ;..0~92 ,477.00
(9)
23,758.77
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(10)
11. Total Deductions (total Lines 9 & 10)
(11 )
23,758.77
1,068,718.23
12. Net Value of Estate (Line 8 minus Line 11)
(12)
(13)
(14) 1,068,718.23
1,068,718.23
x .00
(15) 0.00
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x .045
(16)
x .12
(17)
x .15
(18)
(19) 0.00
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
305 Chestnut Ridge Drive
CITY
lSTATE PA
TZIP 17055------
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
0.00
Total Credits (A + 8 + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Totallnterest/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.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(3)
(4)
(5)
(SA)
(58)
0.00
0.00
0.00
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?.....................................................................................................................
Yes No
~ I
o ~
o ~
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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 RESPONSIBLE FOR FILING RETURN ADDRESS DATE
Alfred L. Madeira
ADDRESS
1124 Kennebec Drive
Chambersburg, PA 17201
/0 -' 21/-0 I
~---------- DA TE-----
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Thomas J. A ens
ADDRESS
DATE
.....
52 Gettysburg Pike
Mechanicsburg, PA 17055
/lJ-'ZI(~ 0 I
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 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 0%
[72 P.5. ~9116 (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 0% [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 4.5%, except as noted in 72 P .5. 99116
1.2) [72 P.5. ~9116 (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. ~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.
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SCHEDULE C
CLOSELY-HELD CORPORA liON,
PARTNERSHIP or
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
...."'. ... ....--"..............~......... '1""
~' FILE NUMBER
21 - 06 - 1072
--'~-~----_._~----_...._---_.,-_.-
ESTATE OF Madeira, Frederick L
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corJ)oration/partnership interest of the
decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-propnetorships.
.~----_.- ---.-.--..--------
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
--- -~--------
11,894.00
500 Shares of Keo Homes, Inc. representing a 50% ownership in company.
(See attached valuation calculations)
2
150 Shares of LaOeira, Inc. representing a 50% ownership in company.
(See attached valuation calculations)
1,073,083.00
3
62,500 Member interests in Castle Housing of Pennsylvania L TO.
7,500.00
------------I------------~ __
TOTAL (Also enter on Line 3, Recapitulation)
1,092,477.00
.
SCtEU.E H
FltERAL. EXPENSES &
AIl\IINS1RAlNE COSlS
COMMONWEAl. TH OF PENNSYlVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
ESTATE OF Madeira, Frederick L
FILE NUMBER
21-06-1072
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES:
~_..._-~----- -'-'--"-~---'---'--'---'-'-'-
AMOUNT
_.__._--------_._--------,-,~--~,_._--+-._--~---_._.__.-------'^-'-'-^--
DESCRIPTION
A.
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
State
Zip
Year(s) Commission paid
Attomey's Fees Ahrens Law Firm, P.C.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Carolyn G Madeira
Street Address 305 Chestnut Ridge Drive
City Mechanicsburg State PA Zip 17055
Relationship of Claimant to Decedent Spouse
4. Probate Fees
2.
3.
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1
Estate notices
Total of Continuation Schedule(s)
23,758.77
TOTAL (Also enter on line 9, Recapitulation)
20,000.00
3,500.00
204.77
54.00
.
Schedule H
F\I1eraI Expel s:s &
AamistlativeCoslsconli'lJed
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
L
~UMBER
~~-=--9~-~072 ___ ~__ _____
54.00
ESTATE OF Madeira, Frederick L
2 Register of Wills
Page 2 of Schedule H
REV-1613 EX+ (9-G0) .
COMMONWEAL~HOFPENNSYLVANIA L
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
_ Ju_ _ _ _ ____
I FILE N~1M_a::: ----
RELATIONSHIP TO i AMOUNT OR SHARE
DECEDENT - OF ESTATE
___1-----_ Do Not List Trustee(8) ,____________
ESTATE OF
Madeira, Frederick L
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
.
1
Frederick L. Madeira Marital Trust
305 Chestnut Ridge Drive, Mechanicsburg, PA
Carolyn G. Madeira, spouse, is sole beneficiary
Spouse
Entire Estate
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i Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria e, on Rev 1500 cover sheet
I
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