The URL can be used to link to this page

Home My WebLink About12-21-07 W I- ~ :$11) (,J1Ii:~ wD-(,J zOO (,J1Ii:..J ~al c( REV-1500EX+(~) , '* REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 -0 6 1 07 1 COuN1YCOOE ----vEAA- - - NuMBER- - SOCIAL SECURITY NUMBER 453-24-3496 THIS RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date otdeath prior1ll12-13-B2) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under See. 9113(A) (Attach Sch 0) z o i= ct ...J :J I- 0: ct (.) w a::: z o i= ct I- :J a. ~ o (.) ~ I- (1) i"I'i 0 <.~--) (2) rr1 '. n (3) N ; ~ (4) ~, (5) 17,601.91 - CO N 1-'--) (6) -.I (7) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W C W (.) W C REYNA ROBERT M. DATE OF DEATH (MM-DD-Year) AJKJA ROBERT MOLINA REYNA DATE OF BIRTH (MM-DD-Year) PA 17050 17,601.91 2,334.85 39,294.22 41,629.07 -24,027.16 -24,027.16 11/18/2006 01/21/1925 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [Xl 1. Original Return D 4. Limited Estate [Xl 6. Decedent Died Testate (Attach C<ll>Y otWiIl) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date ot death after 12-12-ll2) D 7. Decedent Maintained a Living Trust (Attach copy oITrust) D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) I- Z W C Z o D- II) W iii: iii: o (,J NAME MURREL R. WALTERS III, ESQUIRE FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS 54 EAST MAIN STREET TELEPHONE NUMBER 717-697-4650 MECHANICSBURG 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) 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) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 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) (8) (11) (12) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 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) 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 2Q.D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o . d t' C I t Add ece en s omp e e ress: STREET ADDRESS 442 WALNUT BOTTOM ROAD CITY I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C) (2) 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) B. Enter the total of Line 5 + 5A. 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 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [&] 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 [&] 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 Retirement Account, 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. Under penalties of pe~ury, 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 information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETUR"N DATE ~~'\ L~,,--- ROBERT M. REYNA I 497 T EW SIGNATURE OF PRE OT. R N / " / /"" / D,SHERMANSDALE SENTATIVE Ii ('_ -- f 2..-.0 ') ADDRESS PA ADDRESS M RREL . WALTERS III, ESQ. 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)l. 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) '*' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF REYNA ROBERT M. FILE NUMBER A/K1A ROBERT MOLINA REYNA 21 06 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. 1071 ITEM NUMBER 1. DESCRIPTION MEMBERS 1ST FEDERAL CREDIT UNION CHECKING & SAVINGS ACCOUNT VALUE AT DATE OF DEATH 4,101.90 2. 1996 CHEVROLET ASTRO VAN SALE PROCEEDS 350.00 3. BANKERS LIFE INSURANCE PROCEEDS FROM LIFE INS. POLICY 8,122.61 4. UNITED AMERICAN PROCEEDS FROM LIFE INS. POLICY 4,842.49 4. MALPEZZI FUNERAL HOME REFUND - OVERPAYMENT OF FUNERAL 184.91 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 17,601.91 RE\1-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF REYNA ROBERT M. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS AJKJA ROBERT MOLINA REYNA Debts of decedent must be reported on Schedule I. FILE NUMBER 21 06 1071 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MALPEZZI FUNERAL HOME - PREPAID 2. CACC BAKED GOODS. AFTER FUNERAL LUNCHEON 36.85 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) ROBERT M. REYNA 910.00 Social Security Number(s)/EIN Number of Personal Representative(s) StreetAddress 497 MOUNTAIN VIEW ROAD City SHERMANSDALE State PA lip 17090 Year(s) Commission Paid: 2007 2. Attorney Fees MURREL R. WALTERS III 1,125.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State lip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS - CUMBERLAND COUNTY 263.00 5. Accountanfs Fees 6. Tax Return Prepare~s Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 2,334.85 (If more space IS needed, insert additional sheets of the same size) . REV-1512 EX + (6-98) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF REYNA ROBERT M. A/KJA ROBERT MOLINA REYNA 21 06 1071 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. BALOGH BECKER L TD SEARS CREDIT CARD 2,683.58 2. CURRIE & HECHT DENTAL 645.00 3. FAIRFIELD GLADE 212.75 4. PHARMERICA MEDICAL 482.62 5. WEST SHORE EMS MEDICAL TRANSPORT 112.50 6. THORNWALD HOME NURSING HOME CARE 23,115.60 7. CHASE CARD SERVICES CREDIT CARD 7,066.89 8. QUEST DIAGNOSTICS MEDICAL 92.00 9. POSTMASTER STAMPS 7.80 10. JACKSON HEWITT TAX RETURN PREPARATION 84.00 11. IRS 2006 FEDERAL TAXES 1,338.00 12. COSTILLA COUNTY TREASURER TAXES 36.98 13. U.S. LAND SERVICES 799.00 14. BANK OF AMERICA CREDIT CARD 2,617.50 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 39,294.22 """"""'... COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER REYNA ROBI=RT M. A1K/A ROBERT MOLINA RI=YNA 21 OR 1071 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. ROBERT MICHAEL REYNA SON ONE-FIFTH 497 MOUNTAIN VIEW ROAD SHERMANSDALE, PA 17090 2. GAYLE GODTLlBSEN DAUGHTER ONE-FIFTH 585 SUNSET RIDGE ROAD WASHOUGAL, WA 98617 3. CATHY LENYO DAUGHTER ONE-FIFTH 4000 BUSH CREEK ROAD, UNIT 13 SNOW MASS, CO 81615 4. WILLIAM REYNA SON ONE-FIFTH 135 TUCKAHOE ROAD DILLS BURG, PA 17090 5. .JAMES REYNA SON ONE-FIFTH 200 AIRY VIEW ROAD SHERMANSDALE, PA 17090 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS 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)