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Home My WebLink About11-13-07 REV-15DO EX + (6-00) ~ ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 -0 7 0 1 1 9 COUNTYCOoE ---YEA~ - - NUMsER- - DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL) I- Z W C W U W C DERR MABELLE ECKELS DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER 1 74- 2 0 - 2 095 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W l- x: ~(/) (.) 0:: x: w:5(.) :t o::g (.) ll.lD ll. <( 11/16/2006 05/15/1907 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL) 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 o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) [Xl 1. Original Return o 4. Limited Estate [Xl 6. Decedent Died Testate (Attach copy of 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 (Attach copy ofTrust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) .'.THIS'SECTION MUSTSE bOf.llPLETED.'ALLCORRESPONbENCE)~NO'CONFIDENTiAL lAX tNFoRMATloN'SHOULDBE DIRECTED'tO:. . . NAME COMPLETE MAILING ADDRESS MURREL R. WALTERS III, ESQUIRE FIRM NAME (If Applicable) I- Z w C Z o ll. (/) w 0:: 0:: o (.) 54 EAST MAIN STREET PA 17055 z o ~ ..J ::> !:: D- oe:( U W 0:: z o i= oe:( I- ::> D- :E o u ~ I- TELEPHONE NUMBER 717-697-4650 MECHANICSBURG (8) (11) (12) (13) (14) OFFICIAL USE ONLY -) <') 6,634.52 c: (6) ..~ -... (7) 6,634.52 C~) 1..,:-.' (9) (10) 2,302.78 167,560.64 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X_(15) X _(16) X .12 (17) X .15 (18) (19) 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) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 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) (1) (2) (3) (4) (5) 16. Amount of Line 14 taxable at lineal rate 169,863.42 -163,228.90 -163,228.90 0.00 )":::::\~\{:,: Qt 17. Amount of Line 14 taxable at sibling rate 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT i'> >8E,SURE"tQ,jltftSSWERAu:rOUE$TJONScONREVERSE,S1DE AND RECflECKMATH . < <: "'~' 18. Amount of Line 14 taxable at collateral rate 19. Tax Due Decedent's Complete Address: STREET ADDRESS 375 CLAREMONT DRIVE CITY 1 STATE TZIP CARLISLE PA 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 ) o 00 Total Credits (A + B + C) (2) 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. (SA) 8. 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 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; ........................................................................... D 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ D 00 c. retain a reversionary interest; or ...................................................................................................... D 00 d. receive the promise for life of either payments, benefits or care? ............................................................. D 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................. ..... ..................... .............. ......... D 00 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ................. D 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............................................................................................. ......... D IXl 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 retum, including accompanying schedules and statements, and to the best of my knowiedge 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 PER~ON RESP ISLE FOR FILING RETURN DA ~ //tc'v7 PA 17055 DAT (( !,,/cr7 ADDRESS ADDRESS MURREL R. WALTERS III 54 EAST MAIN STREET, MECHANICSBURG PA 17055 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. 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 0% [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 0% [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 4.5%, 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 12% [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-1508 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF DERR MABELLE ECKELS FILE NUMBER 21 07 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. 0119 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 6,634.52 CITIZENS BANK CHECKING ACCOUNT TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 6,634.52 REV-1511 EX + (12-99) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF DERR MABELLE ECKELS FILE NUMBER 21 07 0119 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1. MALPEZZI FUNERAL HOME 958.78 EXCESS EXPENSES OVER PREPAID ARRANGEMENTS B, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) MICHAEL .J. MALPEZZI 500.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 8 MARKET PLAZA WAY City MECHANICSBURG State PA Zip 17055 Year(s) Commission Paid: 2007 2, Attomey Fees MURREL R. WALTERS III, ESQUIRE 750.00 3, Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4, Probate Fees REGISTER OF WILLS - CUMBERLAND COUNTY 94.00 5, Accountant's Fees 6, Tax Retum Preparer's Fees 7, TOTAL (Also enter on line 9, Recapitulation) $ 2,302.78 (If more space is needed, insert additional sheets of the same size) REV-151'2 EX + (6-98) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DERR MABELLE ECKELS FILE NUMBER 21 07 0119 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. DEPARTMENT OF WELFARE 163,241.25 2. CLAREMONT NURSING AND REHABILITATION CENTER RESIDENTIAL CARE 4,105.07 3. MOBILE X.RAY IMAGING, INC. MEDICAL 39.29 4. WEST SHORE EMS MEDICAL 175.03 TOTAL (Also enter on line 10, Recapitulation) $ 167,560.64 (If more space is needed, insert additional sheets of the same size) 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. FLORENCE CYPHER NONE 10% 1849 FISHER ROAD MECHANICSBURG, PA 17055 2. BETTY SHEARER NONE 10% 15 SILVER SPRING ROAD MECHANICSBURG, PA 17055 3. WILLIAM L. DERR SON 40% 617 COUNTRY CLUB DRIVE BLOOMSBURG, PA 17815 4. JAN K. DERR SON 40% 3451 BRIARGATE COURT FAIRFAX, VA 22033 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 $ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DERR MABELLE ECKELS SCHEDULE J BENEFICIARIES FILE NUMBER 21 07 0119 (If more space is needed, insert additional sheets of the same size)