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Home My WebLink About11-13-07 :....J 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue '* County Code Year Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisbu ,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~~ File Number ~ 4a. Future Interest Compromise (date of death after 12-12-82) ~ 7. Decedent Maintained a living Trust (Attach Copy of Trust) ~ 10. Spousal Poverty Credit (date 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 COMPLE-TED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Decedent's Last Name Suffix OIl Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix OIl Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Retum ~ ~ 2. Supplemental Return 3. Remainder. Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required ~ ~ 8. Total Number of Safe Deposit Boxes 4. limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will) 9. litigation Proceeds Received ~ o r"'- '-7:0 i~JQ MI [J MI o ~-.> = c;;::> --J ~ ~"""- (:.:J c:..t.::: w -rJ ~ W Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this retum, 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 infonnation of which preparer has any knowledge. SIGN URE OF PERSON RES ONSI FOR FILING RETURN DATE DATE ADDRESS ..., " PLEASE USE ORIGINAL FORM ONLY Side 1 L "'. 15056051047 15056051047 .-J ~ ...J REV-1500 EX Decedent's Name: RECAPITULATION 15[)56[)52[)48 1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. 3. 4. /5. 6. 7. 8. V 9. 10. 11. 12. L 13. 14. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. Mortgages & Notes Receivable (Schedule D) . '. . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. Jointly Owned Property (Schedule F) C=> Separate Billing Requested . . . . . .. 6. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C=> Separate Billing Requested.. . . . . .. 7. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 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 Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X. 12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Decedent's Social Security Number 15. 16. 17. 18. 20. FILL IN THE OVAUF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 'Q.'Y ~L 15[)56[)52[)48 " " Side 2 c:::) 15[)56[)52[)48 ...J REV-1500 EX Page 3 File Number D~cede'nt's Complete Address: DECEDENT'S NAME \J\" "-I J rL...t ~ . eX. fYL ~ A-L/ STREET AD~ ---ra I. I . 6.;:^":1 J..)" lOa r fJ::S ~1 J..t.. ' CITY STATEpA ZIP /7055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) Cot.! ~ I ~ ft,O..oO Total Credits (A + 8 + C ) (2) {po.oo J,u... ~~ I 3. Interest/Penalty if applicable D. Interest E. Penalty ------ Total Interest/Penalty ( 0 + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) 4. I '-I (5A) (58) LJ. IL( 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. 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. retai~ the use or income Qf the property transferred;...........................n............................................................. D IXI b. retain the right to designate who shall use the property transferred or its income; ............................................ D [jI c. retain a reversionary interest; or.........................................:A.............................................................................. D [] d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 1982, did 'decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D ~ 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 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 be~eficiary. 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 of transfers to or for the use of the 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~1513 EX+ (9-00. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROpERTY Do Not List Trustee(S) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. 2 ~. <.( , 19"16 (P. ~ ~ ~ ~ ~ .~ AMOUNT OR SHARE OF ESTATE :lc2.:l'. Efl & ;;;t.;2 fo . ~ \$~f.:1.~ .d-;l.lD . ~~ $ d.~~' ~R' .:;l~fo .88' . fJa..,. " ql.{O AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n 1. NON.TAXABLE DISTRIBUTIONS: A. SpOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 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) REV-~511 EX+ (10-06)W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER A. FUNERAL EXPENSES: 1. DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions Name of Personal Representative(s) .f~cr6.S9 Street Address City State_Zip Year(s) Commission Paid: 2. Attorney Fees ~/O(!)- tJ CJ 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. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7<fti:s-? .__u:"., . 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. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH ~. ~~~~~~ ~ ~IJ.Q. ~o..cd~ loooc;>"S- ~ n - ~ ~5~q~q ~ "6 cL..o:tn ~~CU- $ ;J..blf. cp $tq 5fo, I L/ I TOTAL (Also enter on line 5, Recapitulation) $ eJ.:l ~ {.o 4 (If more space is needed, insert additional sheets of the same size) CDMMONWEALiH C. "ENNSYLVANlA DEPARTMENT OF REVENUE BUREA') OF INDiviDUAL TAXES DEF- 280601 HA~~IS8uRG. PA 17' 28.060' RE\'.1 162 EX(1 ~ .96) .t,~ ~ - RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. (; l> 008564 DUNN SUSAN L 262 COUNTRY CLUB DRIVE TELFORD, PA 18969 ACN ASSESSMENT CONTROL NUMBER AMOUNT -- _n.. - 'of-oj . .. i- .. I .- j ESTATE INFORMATION: SSN: 172-01.4691 i I FILE NUMBER: 2107-0780 I i DECEDENT NAME: MYERS MILDRED L I I DATE OF PAYMENT: 08/20/2007 I i I FOSTMARK DATE: 08/14/2007 I I COUNTY: CUMBERLAND I DATE OF DEATH: OS/25/2007 I I TOTAL AMOUNT PAID: $60.00 REMARKS: ~"'~' - ... .... .- CHECK# 7611 INITIALS: JA , SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH : REGISTER OF WILLS T AXPA YER 101 $ 60 00 -, ..i . ." ,. " 2007 ~~!J'l 13 P;; 3: 44, r. f"'! rrw nc - I '.a tI= == 8='-- u:S ell: w ~ - ~ - ~ -=- - - - - - - ""::"- '"':::'- -- - -,.. ~ - == - :::.:- -::- - _. - - :=:: ...::. - - '"':::'- - - ~ =--- " o .I:l0> ;:3(0 -0> OCX) 2:-"- ....<( mea.. en :;l \ ~ ,... Oc ('r) rr) , ('0 o ,... t iiia =s Z.. :J ;~CI ~... i?-. W ar: