HomeMy WebLinkAbout12-21-07
REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SHELLENBERGER EVELYN P.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
[XI 1. Original Retum
D 4. Limited Estate
[XI 6. Decedent Died Testate (Attach copy 01 Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum
D 4a. Future Interest Compromise (date 01 death after 12-12.fl2)
D 7. Decedent Maintained a Living Trust (Attach copy oITrusl)
D 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 7
o 4 0 6
03103/2007 02112/1911
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
"'COuNTY"CoiiE ---YEAr;---- - - NuMBER- -
SOCIAL SECURITY NUMBER
2 0 1 - 1 8 - 4 0 9 0
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Retum (date of death prior to 12-13-82)
D 5. Federal Estate Tax Retum Required
~ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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COMPLETE MAILING ADDRESS
NAME
MURREL R. WALTERS III, ESQUIRE
FIRM NAME (II Applicable)
54 EAST MAIN STREET
TELEPHONE NUMBER
717-697-4650
MECHANICSBURG
(1)
(2)
(3)
(4)
(5)
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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. Jointiy Owned Property (Schedule F)
D 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 Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
X _(15)
X _(16)
X .12 (17)
X .15 (18)
(19)
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20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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OFFICJ1IL USE,Or'!LY-';
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(6)
(7)
(9)
(10)
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)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
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65,849.76
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70,436.10
16,018.00
156,624.29
(11)
(12)
(13)
172,642.29
-102,206.19
(14)
-1 02,206.19
0.00
Dec~dent's Complete Address:
STREET ADDRESS
940 WALNUT BOTTOM ROAD
CITY I STATE I ZIP
CARLISLE PA 17013
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)
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. (5A)
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; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2, If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 00
3, Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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ADDRESS
ADDRESS
ALTERS III
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. ~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.S. ~9116 (a) (1.1) (ii)],
The statute does not exemot a transfer toa surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 orfor the use of the decedent's lineal beneficiaries is 4,5%, 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 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.
REV-J503 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
SHELLENBERGER EVELYN P.
FILE NUMBER
21 07
0406
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
4,586.34
12. $50 SERIES E. SAVINGS BONDS
7 - $75 SERIES EE - SAVINGS BONDS
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,586.34
REV-J508 EX + (6-98)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SHELLENBERGER
FILE NUMBER
EVELYN P. 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.
0406
DESCRIPTION
ITEM
NUMBER
1.
MET LIFE INSURANCE POLICY
INSURED WAS SHIRLEY SHELLENBERGER WHO DIED 4/17/2006 WITH
EVELYN SHELLENBERGER AS BENEFICIARY
THRIVENT INVESTMENT MANAGEMENT
2.
3.
THRIVENT INVESTMENT MANAGEMENT
VALUE AT DATE
OF DEATH
8,593.00
12,328.82
44,927.94
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
65,849.76
REV-I511 EX. (1.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
SHELLENBERGER EVELYN P.
FILE NUMBER
21
07
0406
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. RICHARDSON FUNERAL HOME INC. 8,778.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) DENNIS R. SHELLENBERGER 3,522.00
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address P.O. BOX 394
City LEWISBERRY State PA Zip 17339
Year(s) Commission Paid:
2. Attomey Fees MURREL R. WALTERS III, ESQUIRE 3,522.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS - CUMBERLAND COUNTY 196.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 16,018.00
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV!1512 EX + (6-98)
*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SHELLENBERGER EVELYN P.
FILE NUMBER
21
07
0406
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
DEPARTMENT OF PUBLIC WELFARE
156,624.29
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
156,624.29
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SHELLENBER~ER EVELYN P.
SCHEDULE J
BENEFICIARIES
NUMBER
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
PHYLLIS D. SHELLENBERGER
940 WALNUT BOTTOM ROAD
CARLISLE, PA 17013
1.
FILE NUMBER
21 07
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
DAUGHTER
0406
AMOUNT OR SHARE
OF ESTATE
100%
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 $
(If more space is needed, insert additional sheets of the same size)