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Home My WebLink About01-25-08 .-J 15056041169 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO Box 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 01 8'rS& Date of Birth 348-36-1386 12272006 02091944 Decedent's Last Name Suffix Decedent's First Name PAYNE CHARLES (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name PAYNE CAROL Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 487-48-5535 FILL IN APPROPRIATE BOXES BELOW !Xl 1. Original Retum 0 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82) 0 4. Limited Estate 0 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Retum Required death afte r 12 -12 -82) D 6. Decedent Died Testate D 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 0 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death D 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) MI T MI CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ALFRED L WHITCOMB 717-766-9477 Firm Name (If Applicable) REGISTE~ WILLS USe:~LY .~~~ () ~ ': ~:u , -" i -~c: 0 WHITCOMB TAX SERVICE First line of address 43 WEST MAIN STREET ;--"C! J ....._.',-. Second line of address -, \7 '''-',oJ ~) 'PATE FILED City or Post Office State ZIP Code C] MECHANICSBURG PA 17055 Correspondent's e-mail address:AL@WHITCOMBTAX.COM --'{:J.":r> ~..- N 'Jl T, MECHANICSBURG, PA 17055 REPRESENTATIVE MECHANICSBURG, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041169 15056041169 o~ .-J ~~ ....J 15056042160 REV-1500 EX Decedent's Name: CHARLE S T PAYNE RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 1. 2. Stocks and Bonds (Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested. . . . . . . 7. 8. Total Gross Assets (total Lines 1 - 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. Decedent's Social Security Number 348-36-1386 76,551.00 24,163.00 4,150.00 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . . . . . . ., 9. 104,864.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . .. 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . .. 13. 14. Net Value Subjectto 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_ 104, 864 16. Amount of Line 14 taxable at lineal rate x .0 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE ........................................................ 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042160 0.00 104,864.00 104,864.00 0.00 0.00 D 15056042160 ....J 'REV-1500 EX Page 3 Decedent's Complete Address: File Number 2 1 0 7 - 0 2 8 6 DECEDENT'S NAME CHARLES T PAYNE STREETADDRESS 220 WEST MAIN STREET CITY I STATE 1ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 0.00 Total Credits (A + 8 + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty 0.00 TotallnterestlPenalty (0 + E) (3) 4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) 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. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 0 [XI b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . . . .. 0 ~ c. retain a reversionary interest; or ......................................................... 0 ~ d. receive the promise for life of either payments, benefits or care? ................................ 0 ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 0 [XI 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . . .. 0 [X] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [X] 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. 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)1. 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 PS. ~9116(a)(1.1 )Qi)). The statute does not exemot 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 zero (0) percent [72 P.S. ~9116(a)(1.2)1. 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. 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 twelve (12) percent [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. oREV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF CHARLES T PAYNE ESTATE FILE NUMBER 2107-0286 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUEAT DATE OF DEATH 2 3 PA-ZFS-LTPSP PA-ZFS-LTPSP PA-ZFS-LTPSP 25,840 36,176 14,535 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 76,551.00 .REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF CHARLES T PAYNE ESTATE FILE NUMBER 2107-0286 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. ITEM NUMBER 1 2 3 DESCRIPTION VALUEAT DATE OF DEATH 3,198 16,223 4,742 IRA MEMBERS 1ST IRA AMERITRADE ROTH IRA MEMBERS 1ST TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 24,163.00 ~REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF CHARLES T PAYNE ESTATE FILE NUMBER 2107-0286 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINTTENANT(S) NAME A. CAROL PAYNE ADDRESS RELATIONSHIP TO DECEDENT 220 WEST MAIN STREET MECHANICSBURG, PA 17055 SPOUSE B. ERIN K. PAYNE 526 EVERGREEN ROAD NEW BLOOMFIELD, PA 17068 DAUGHTER c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 2005 MEMBERS 1ST 198262-11 2,185 16.6 362.71 B 2005 MEMBERS 1ST 198262-11 2,185 16.6 362.71 2 B 2005 MEMBERS 1ST 198262-05 20,206 16.6 3,354.20 3 B 2005 MEMBERS 1ST 198262-00 424 16.6 70.38 TOTAL (Also enter on line 6, Recapitulation) $ 4,150.00 (If more space is needed, insert additional sheets of the same size) .REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF CHARLES T PAYNE ESTATE FILE NUMBER 2107-0286 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) NUMBER NAMEANDADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)) 1 CAROL K PAYNE 220 WEST MAIN ST, MECHANICSBURG, PA SPOUSE 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 WHICHAN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS (If more space is needed, insert additional sheets of the same size) TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRI BUTIONS ON LINE 13 OF REV-1500 COVER SHEET $