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Home My WebLink About02-08-08 , ,. . j' -.J 15056041125 REV -1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 7 File Number 098 0 Date of Birth 178163403 o 3 1 1 2 005 06131923 Decedent's Last Name Suffix Decedent's First Name BURGER C L A I R MI Y (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI BURGER BEATRICE v Spouse's Social Security Number 16612 614 9 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW IXI 1. Original Retum o 4. Limited Estate o o 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 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes 2. Supplemental Return o o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required D A V I D w REAGER 717 763 1 3 8 3 Firm Name (If Applicable) r- -, REAGER & ADLER, p C -~-- -~-1 REGIS1~ OF WILLS ~~ ONLY,. " F3 \'l ' I' en f I ':1, oJ- DATE"FILED r- I --o.-----J ----.4 :i: First line of address 2 3 3 1 MARKET STREET I 0:> Second line of address .',:U - - City or Post Office State liP Code C AMP H ILL P A 17011 Correspondent's e-mail address:DWREAGER@REAGERADLERPC.COM MECHANICSBURG ADDRESS 2331 MARKET STREET CAMP HILL PLEASE USE ORIGINAL FORM ONLY PA 17011 Side 1 L 15056041125 15056041125 .....J CfJ . , . 1. , . --.J 15056042126 REV-1500 EX Decedent's Name: CLAIR Y. BURGER 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) D Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. 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.O _ 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 2356.08 15. o . 0 0 16. o . 0 0 17. o . 0 0 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 Decedent's Social Security Number 178163403 2972.08 2972.08 616.00 616.00 2356.08 2356.08 o. 0 0 O. 0 0 O. 0 0 O. 0 0 O. 0 0 D 15056042126 --.J REV-1500 EX Page 3 10 t 'I 1 Decedent's Complete Address: I DECEDENT'S NAME ICLAIR Y. BURGER J~- I STREET ADDRESS '113 N. 36TH STREET File Number 21 07 0980 ""- -- CITY CAMP HILL -I STATE I PA ~ . 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 0.00 Total Credits (A + B + C) (2) 0.00 h IJ. : , 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. Fill in oval on Page 2, 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) 0.00 0.00 0.00 A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SA) (5B) 0.00 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; ...................................................................... D IKl b. retain the right to designate who shall use the property transferred or its income; ............................... D IKl c. retain a reversionary interest; or ................................................................................................ D IKl d. receive the promise for life of either payments, benefits or care? ....................................................... D IKl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... D IKl 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... D IKl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. D IKl 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 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 (a) 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 ofthe 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-150' EX,. '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF CLAIR Y. BURGER FILE NUMBER 21 07 0980 All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION CERTEGY, INC. - STOCK 24 SHARES VALUE AT DATE OF DEATH 867.60 2. CHOICEPOINT, INC. - STOCK 16 SHARES 640.00 3. EQUIFAX INC. - STOCK 46 SHARES 1 ,403.46 4. RETAIL CREDIT COMMON STOCK NOW EQUIFAX, INC. - 2 SHARES 61.02 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,972.08 REV-151' ~..(l. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF CLAIR Y. BURGER FILE NUMBER 21 07 0980 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) .' Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees REAGER & ADLER, PC 400.00 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 LETTERS OF ADMINISTRATION - CUMBERLAND COUNTY 30.00 REGISTER OF WILLS 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. SHORT CERTIFICATES - CUMBERLAND COUNTY REGISTER OF WILLS 12.00 8. RENUNCIATION - CUMBERLAND COUNTY REGISTER OF WILLS 5.00 9. JCP & AUTOMATION - CUMBERLAND COUNTY REGISTER OF WILLS 15.00 10. ADVERTISEMENT - CUMBERLAND LAW JOURNAL 75.00 11. ADVERTISEMENT - THE CENTRAL PENN BUSINESS JOURNAL 79.00 TOTAL (Also enter on line 9, Recapitulation) $ 616.00 (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 I. TAXABLE DISTRIBUTIONS [include outJight spousal distributions. and transfers under Sec. 9116 (a) (1.2)] 1. BEATRICE V. BURGER Spousal 2,356.08 113 N. 36TH STREET CAMP HILL, PA 17011 .. 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 CLAIR Y BURGER SCHEDULE J BENEFICIARIES FILE NUMBER 21 07 0980 (If more space is needed, insert additional sheets of the same size) .... ~ ~ ... INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY,PENNSYLVA}ITA COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } SS File Number 21 07 0980 Personal Representative(s) of the Estate of CLAIR Y. BURGER deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the ~ ments herein are made subject to the penalties of 18 Pa. C.S. ~ 4904 relating to unsworn falsification to authorities. ~ Attorney - (Name) DAVID W. REAGER (Address) 2331 MARKET STREET (Telephone) 7177631383 r-.:> c? .:..::> i (~) CO .~\ -, (Supreme diiir~D. No.);a0868'" " '-.:J ') ,:0__ J CAMP HILL', =);'~=-. p)A. 17011) ",__",;:] UJ j");.::--'::' ,...." ..-':......_J ~ DATE OF DEATH LAST RESIDENCE 113 N. 36TH STREET CAMP HILL PA 17011 I FIGURES MUST BE TOTALED I D~Nrs SOC,.SliiC, NO,. 'CD -::" 17'81-63403 .r:- 3/11/2005 Stocks & Bonds CERTEGY, INC. - STOCK 24 SHARES 867.60 CHOICEPOINT, INC. - STOCK 16 SHARES 640.00 EQUIFAX INC. - STOCK 46 SHARES 1,403.46 RETAIL CREDI COMMON STOCK NOW EQUIFAX, INC. - 2 SHARES 61.02 Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable (Attach additional sheets as needed) TOTAL: 2,972.08 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may. at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. ~ 3301 (b)) Form RW-09 rev. 10.13.06 s Continuation of Inventory CLAIR Y. BURGER Decedent Name 21 07 0980 File Number Page 1 Description of Inventory Cash, Bank Deposits, & Misc. Personal Property Real Estate Subtotal $ Grand Total $ 2,972.08