Loading...
HomeMy WebLinkAbout01-31-08 (2)15056051047 REV-1500 EX (08-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~. County Code Year File Number PO BOX 280801 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ r D ~ 6 ~ ~ `~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedent's Last Name Suffix Decedent's First Name MI ~" /~ c K 5 a vi /~ d S a z~ l 1 d ry) (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) v 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number S ~ i/ 1J ~ /~ -T ~~ ~ A- V ~_ ~ 7 i ~ s 3 ~- 4~ ~ ~ i Firm Name (If Applicable) REGISTER OF WILLS USE ONLY ..._.~.~,.L,_,.~ vrri~,r, yr REGISTER OF WILLS First line of address 2008 JAN 31 PM ,~y CLERK OF ~ ~ ~ I ~M ~ ~ ~ V ORPH.-DNS' COURT Second line of address CUI~ERLAND CO., P.~ City or Post Office State ZIP Code I DATE FILED S/~~~~~P~n/5au~~ ~/~ r ~~s~ Correspondent's a-mail address Under penalties of perjury, I declare that I have examined this return, 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. SIGNATU OF PE/RSON RESPONSIBLE FOR FILING RETURN DATE llil-fi9~/Lfk.~- ~19/~r~-Ge~2 ~/.~_li /Oc~ ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J v V ~ ~.-- J REV-1500 EX Decedent's Name: RECAPITULATION 15056052048 1. Real estate (Schedule A) . ............................................ 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (.Ssf~edate-~..... 3. 4. Mortgages 8 Notes Receivable (Schede+ems ............................. 4. Decedent's Social Security Number ~5y ~~{~5`"qs: 79 ~~ ~ . / ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. ,~ `~ y ? O ~ 3 6. Jointly Owned Property (F,eFretfnter~) p Separate Billing Requested ....... 6. l~ 3 ~ ~'~ Q 7 7. Inter-Vivos Transfers & Mis~cellan'e'o~us Non-Probate Property S~.,e4II e~ ( j- p Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. ~ ~• ~ >~ ! ~ ~ . ~ L( 9. Funeral Expenses & Administrative Costs (Schedule H ..................... 9. / ~j (p S!q . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........0 ...... 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. j Q ~ 5 9 , 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. l '~ .3 ' ~ ~, ~ . ~ ;cam 13. Charitable and Governmental Bequests/Sec 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. ~ 3 3 ~ co 7 . l~ h 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 15. 16. Amount of Line 14 taxable / at lineal rate X .0 ~ ~ ~ ~ y- ~ ~ •' ~ ~ 16. b ®O S • 9 / 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 • 18. 19. TAX DUE ......................................................... 19. ~ ' r%J d .S • 9 ~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O r~ 1 ``~C ~~ \ \ Side 2 15056052048 15056052048 J REV-1500 EX Page 3 Decedent's Complete Address: File Number ca~~-d8 ~0~~7 ~oscz~~/~~ /1~r,2 ~ ~.1 ~~=k5 o Yl STREETADDRESS CITY Sh~`r~r~~ti~s 6c~ ~y Total Credits (A + B + C) (2) 3 Qp` ~~i' 7~.s ~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 300. •~ 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E ) 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. 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) ZIP (5B) ..~7 G S. ~ 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 :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ [v] c. retain a reversionary interest; or .................................................................................................................... ...... ^ 0 d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ 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 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 zero (0) 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 of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98) ~, SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~aS~i'z Z~~G~ ~~~ ~'. ~~C ~SGyt ~~- a~ ' vo2 7 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX ~ (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER o sue. -z ~ / /a. Yy1~ ~' ~~ c {~ Sv-~.-, ~/= ~ - c~ ~ 7 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, ~-^/"Sfo,w.1 ~~,rc.l; ~cc~,.~ c~~ 3voo ~{~2 ~oa.a7 3 , ~n S cc- }^ cc ~c ~= ~ 17 ~ vu GC ~ LC.C. / ~ Z cc. ~ . vvt e c~ S ti / l'4. . ' ~~• © ~- LG k C' ~Q ~ 12t ~ o~ ~i't7 P~rfY (o Sys /,Z ~p a y~~-95'9 TOTAL (Also enter on line 5, Recapitulation) I S S~ 9?6 .~ y3 (If more space is needed, insert additional sheets of the same size) REV-1509 EX ~ (1-97) SCHEDULEF COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME I ADDRESS RELATIONSHIP TO DECEDENT 56i,'/~/'~~iS6ccr~ ~ . ~72~7 D~~~ ~~~~ B C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. ~/"!" 5~"c/w~.~t / u ~t ~: Cc. CCt~ ~ ~ '3vPC~,~"? ? .5 O ~ ~, 3 7 50 ~S`:~.~. / ~ .~. L' O~ f' SzZc„r>rt ~ a vt V (~ ~ C~ ~ ~ ~ r f Sc.1 ~ 7 2'? ~ ~ 3 ~~' / ~G ~ . ~j TOTAL (Also enter on line 6, Recapitulation) I $ ~ j 3 ~' $, cT ~ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) ,' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ~~ l~ S cr _ Z ~' llcL /~1 ~ F o~ C~ c:~ S ~ a ~ -G ~- s o ~t '7 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~/oui v~ s _ ____ C~ S /l~ ~- _._-. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2~ ~ Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5~ Accountant's Fees 6. Tax Return Preparer's Fees ~. ~ c crcc~~ .1~H v2Srrn ~h-t ~~~ S `1L//,/~ (o ,.JU CiU 330, vc> 6 8;~~-- TOTAL (Also enter on line 9, Recapitulation) I $ / b~ ~ S ~! , ~ 8' (If more space is needed, insert additional sheets of the same size) L REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER 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 outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Z Sa.n arm ~ ~ ~~~~~r `i:Y Ycu~-'~r~ 3 / /, ~. ~ D ~Ll ~ ~ ~ / E .S'~r i c~ ~ 1 Sh, ~~~~ ~~s h~ r~ ~~ . ~ ~,~~-7 3 ~3y~~ «~ s ~~ ~t ~z vL: . ~ ~ ~ ter, ~~~ ~ ~ -~ . ~ s ~;- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 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) n~~~~ i ~n yr vv~~w C11I~9BERLAND COUNTY PENNSYLVANIA V LII 1 11 IV/'1 t L VI GRANT OP=zzTTERS No . PA No . 21- 08- 0027 Estate Of : ROSAZELLA M JACKSON IFrrst, Middle, Lasil Late Of: SOUTHAMPTON TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No : 159-24-8595 WHEREAS, on the 8th day of January 2008 an instrument dated January 19th 1989 was admitted to probate as the last will of ROSAZELLA M JACKSON (First, Middle, Lastl late of SOUTHAMPTON TOWNSH/P, CUMBERLAND County, who died on the 18th day of November 2007 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: THOMAS W JACKSON and DONNA L SCHENK and SANDRA J WEA VER who have duly qualified as EXECUTOR(R/XI and have agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 8th day of January 2008. I r ~. ~~ y ~, Register o r!s i r t r eputy ~`i **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE AND FILE N0. 21 BUREAU OF INDIVIDUAL TAXES DEPT. 280601 ACN 08102011 HARRISBURG, PA 171za-0601 TAXPAYER RESPONSE DATE 01-18-2008 REV-1543 EX I1FP (09-00) TYPE OF ACCOUNT EST. OF ROSAZELLA M JACKSON ^ SAVINGS S.S. N0. 159-24-8595 ® CHECKING DATE OF DEATH 11-18-2007 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: SANDY WEAVER REGISTER OF WILLS 325 WHITMER RD CUMBERLAND CO COURT HOUSE SHIPPENSBURG PA 17257 CARLISLE, PA 17013 ORRSTOWN BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth cf Pennsylvania. Questions may be answered by calling C717) 787-6327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I have reported above are true, correct and omplete to the pest of my knowledge and belief. HOME C7~7 ~-S"3:~-`~~~'/ ~/,~ ~ ~j~(/..c,L,~~: z W 0 R K C ) ~f ~2 ~ ~a TAXPAYER IGNATURE TELEPHONE NUMBER DAT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D DEPT. 280601 TAXPAYER RESPONSE HARRISBURG, PA 17128-D601 REV-1543 EX 11FP (09-001 FILE N0. 21 ACN 08102010 DATE 01-18-2008 SANDY WEAVER 325 WHITMER RD SHIPPENSBURG PA 17257 TYPE OF ACCOUNT EST. OF ROSAZELLA M JACKSON ^ SAVINGS $.$. N0. 159-24-8595 ® CHECKING DATE OF DEATH 11-18-2007 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ORRSTOWN BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a point owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. 0uestions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS TOTAL (Enter on Line 5 of Tax Computation) 8 Under penalties of perjury, I declare that the facts I have reported above are true, correct and co lete to the best of my knowledge and belief. HOME C ~/°~ ) 7 ~ ~,2,~ffi`u~ z~ ~~ WORK C ) /' TAXPAYER SIG ATU E TELEPHONE NUM ER DA t ~ ~~sTOwN B~ A Tradition of Excellence January 17, 2008 To: Dan Baer From: Traci Shaffer Orrstown Bank Customer Service Center PO BOX 250 Shippensburg, Pa 17257 Re: Estate of Rosazella M Jackson Date of death November 18, 2007 IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK CHECKING ACCOUNT Account # Title of Account Date opened Principle Accrued Interest 103000577 Rosazella M Jackson 10/05/98 5048.25 0.12 Sandra J Weaver SA VIIVGS ACCO UNT Account # Title of Account Date opened Principle Accrued Interest 33450 Rosazella M Jackson 12/19/94 3726.08 1.75 Sandra J Weaver 903000422 Rosazella M Jackson 02/02/00 200.00 .07 CERTIFICATE OF DEPOSIT Account # Title of Account Date Opened Principle Accrued Interest XXXXXX P.O. Box 250 •Shippensburg, PA 17257 • 717.530.3530 • 717.532.4143 fax ORRSTOWN FINANCIAL ADVISORS ~" A Tradition of Excellence Account: 50 00 0307 0.05 ROSAZELLA M JACKSON INVESTMENT HOLDINGS AS OF 11/18/07 (DOD) Cusp No• Security Name Shares /Par DOD Value DOD Price Accrued Income 3~a280101 FED TOTAL RETURN BD 945.1730 $10.080.27 $10.67 $25.78 ~i0934N625 FED MONEY MKT-PRI 51,791.6000 $51,791.60 1.00 $124.87 922u3? 836 VG ST JNVESTGRD ADM 566.8250 $6,053 69 $10.68 $14.91 80002994 US SVGS HH 07-01-12 11,500.0000 $11,500.00 100.00 $175.00 TOTALS 579.425.5fi $340.56 bAT~~ 12/10l200~ a CHARLENE L. FEUCHTENB TRUST OPERATIONS OFFII