HomeMy WebLinkAbout02-14-08 (2)
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OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 08
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
171-28-7007
COMMONWEAL Tli OF PENNSYlVNlIA
DEPARTMENT OF REVENUE
DEPT. 2eoeo1
HARRISBURG. PA 17128-0801
0028
NUMBER
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ECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Stone, Roy Harold
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
11/18/2007
06/22/1914
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
Stone, Jean E.
204-01-2043
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
~ 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
1. Original Return 0
I! 0 4. Limited Estate 181
:.:~~
fdD.8 181 6. Decedent Died Testate (Attach copy ISI
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(JD.III of Will)
~ 0 9. LitigationPr~sR~ed 0
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2. Supplemental Return
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 between
19 9
--~~~-~~~~--'-' -~--- _ ___m.~_... ~-----~ _ -- --- _ -- - .:~--~- -~--'----~' -- _..-~-., ----=:~- .' '." " ~>>. ., , :i:, ~ .
ME
Thomas J. Ahrens
IRM NAME (If applicable)
Ahrens Law Firm, P .C.
COMPLETE MAILING ADDRESS
52 Gettysburg Pike
Mechanicsburg, PA 17055
(1 ) None
(2) 49,556.48
(3) None
(4) None
(5) None
(6) None
(7) 616,599.80
(8)
(9) 26,798.66
(10) 198.00
666,156.28
ELEPHONE NUMBER
717/697-1800
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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. Jointly Owned Property (Schedule F)
o 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)
~":OE:PAL USE @
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(11 )
26,996.66
639,159.62
12. Net Value of Estate (Line 8 minus Line 11)
(12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
639,159.62
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, 134,769.38 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 504,390.24 .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
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lL 17. Amount of Line 14 taxable at sibling rate x .12 (17)
s
0
(J
~ 18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
0.00
22,697.56
22.697.56
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Form REV-1500 EX (Rev. 6-(0)
Copyright 2000 form software only The Lackner Group, Inc.
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.
Decedent's Complete Address:
STREET ADDRESS
7 N. Railroad Avenue
CITY
I STATE PA
JZIP 17055
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
1,134.88
Total Credits (A + B + C)
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty (D + E)
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
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.
Make Check Payable to: REGISTER OF WILLS, AGENT
(1) 22,697.56
(2)
1,134.88
(3) 0.00
(4)
(5) 21,562.68
(5A)
(5B) 21,562.68
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
y~ I
1. Did decedent make a transfer and:
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;....................................
c. retain a reversionary interest; or........................... ...................... ....................... ..... ....................... ....... .......
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?.....................................................................................................................
D
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~
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D
D
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 perjury. 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 aU infonnalion of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Jeaa E. Stoat
7 N. Railroad Avenue
Mechanicsburg, PA 17055
ADDRESS
DATE
2-11-1/1
DATE
ADDRESS
DATE
'-
.----
52 Gettysburg Pike
Mechanicsburg, PA 17055
.z-- 11/0/
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% [12 P.S. ~9116 (a) (1.1) (i}J.
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) (iin. The statute does not exemDt 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 .5. ~9116
1.2) [12 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% [12 P .5. ~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.
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Stone, Roy Harold
~L~ ~UMBER
21 - 08 - 0028
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
I DESCRIPTION
I Dryfus Premier State Muni BdFd PA-Class A
I
UNIT VALUE
VALUE AT DATE OF
DEATH
15.89
49,556.48
TOTAL (Also enter on line 2, Recapitulation)
49,556.48
.
SCHEDULE G ~ l_
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
I FILE NUMBER
Stone, Roy Harold . 21 - 08 - 0028
This schedule must be completed and flied If the answer to any of questions 1 through 4 on page 2 Is yes.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ITEM
NUMBER
DESCRIPTION OF PROPERTY
Indude the name of the transferee, their relationship to decedent
and the date of transfer. Attach a copy of the deed for real estate.
1
7 N. Railroad Avenue property in the Roy Harold Stone:
Living Trust dated November 2, 1999 .
DATE OF DEATH I
VALUE OF ASSET I
%OF
DECO'S
INTEREST
EXCLUSION
(IF APPLICABLE)
84.912.00
84,912.001 100%
,
i
I
i
!
i
18.507.401 100%
I
I
i
11,904.011 100%
I
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!
!
379,074.431 100%
i
20,000.001 100%
f
19,978.861
50%
2
17 E. Strawberry Avenue property in the Roy Harold
Stone Living Trust dated November 2, 1999
f
I
i
i
I
I
671.991
I
38,720.131
100%
100%
3
PNC Bank CD # 31600213634 in the Roy Harold
Stone Living Trust dated November 2, 1999
I
52,820.411 100%
I
I
TAXABLE VALUE
18,507.40
11,904.01
379,074.43
20,000.00
9,989.43
671.99
38,720.13
52,820.41
TOTAL (Also enter on line 7, Recapitulation)
616,599.80
4
USB Financial Services, Inc. investment account
# AH 00084 38 in the Roy Harold Stone Living Trust
dated 11/2/1999
5
Thrivent Annuity Contract # LC3347849, spouse is the :
beneficiary ,
6
AIG Sun America Annuity # A634050528D, spouse is
the beneficiary
7
Citizens Bank IRA # 6140-169704, spouse is the
beneficiary
8
Citizens Bank Checking account # 610070-686-9 in thei,
Roy Harold Stone Living Trust dated November 2,
1999
9
Citizens Bank Money Market account # 620116-689-4 i
in the Roy Harold Stone Living Trust dated Novenber
2, 1999
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SCtEDlI.E H
RN:RAL EXPENSES &
AIlVNSTRA11VE COSTS
COMMONWEALTH OF PENNSYWANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Stone, Roy Harold
Debts of decedent must be reported on Schedule I.
ITEM !
NUMBER I FUNERAL EXPENSES:
I
A. 1! Funeral Home
I
FILE NUMBER
21 - 08 - 0028
DESCRIPTION
AMOUNT
6,025.00
2
Funeral luncheon
259.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
State
Zip
2.
Year(s) Commission paid
Attorney's Fees Ahrens Law Firm, P.C.
16,650.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Jean E. Stone
Street Address 7 N. Railroad Avenue
City Mechanicsburg
Relationship of Claimant to Decedent
3,500.00
State P A
Spouse
Zip
17055
132.00
4.
Probate Fees
Register of Wills
5. Accountant's Fees
6. Tax Return Prepare(s Fees
7. Other Administrative Costs
1
Estate notices
217.66
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
15.00
26,798.66
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Stone, Roy Harold
2 PA Inheritance Tax filing fee
SchecUe H
FtnIaI Elcpensss &
Amnshc4NeCosisconli'uJd
_I
~~E NUMBER
21 - 08 - 0028
I
I
I
I
I
I
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I
15.00
Page 2 of Schedule H
'*
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX REnJRN
RESIDENT DECEDENT
ESTATE OF Stone, Roy Harold
I FILE NUMBER
21 - 08 - 0028
Include unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Quantium Imaging 198.00
TOTAL (Also enter on Line 10, Recapitulation) 198.00
REV.1513 EX. (9-00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stone, Roy Harold
I FILE NUMBER
21 - 08 - 0028
! RELATIONSHIP TO I
; AMOUNT OR SHARE
I i
NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT i OF ESTATE
I Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
i
i
1 I Jean E Stone Spouse 30,661.42
I
i 7 N. Railroad Avenue, Mechanicsburg, PA 17055
;
i
2 I Roy Harold Stone Beneficiary Trust Trust 608,498.20
I 7 N. Railroad Avenue, Mechanicsburg, PA 17055
I
I
!
I
I
!
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;
r
I
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;
I
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria e, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
REV.1514 EX+ (9.00)
.
SCI-EDll.EK J
LFE ESTAlE, AtftJTY
& 1ERNI CERTAIN
(Check Box 4 on Rev-1500 CouerSheel)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
21 - 08 - 0028
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found
in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
o Will ~ Intervivos Deed of Trust 0 Other
ESTATE OF
Stone, Roy Harold
NAME(S) OF
LIFE TENANT(S)
G
TERM OF YEARS LIFE ESTATE IS
Jean E. Stone
09/27/1915
NEAREST A EAT
DATE OF DEATH PAYABLE
92 ~ Life or o Term of Years
o Life or o Term of Years
o Life or o Term of Years
o Life or o Term of Years
DATE OF BIRTH
1. Value of fund from which life estate is payable
$
608,498.20
.17109
2. Actuarial factor per appropriate table
Interesttable rate - 031/2% 06% D 10% D Variable Ratt
Value of life estate (Line 1 multiplied by Line 2)
5.2%
$
104.107.96
._--~
o Life or
o Life or
o Life or
o Life or
TERM OF YEARS ANNUITY IS
PAYABLE
o Term of Years
o Term of Years
o Term of Years
o Term of Years
NAME(S) OF
ANNUITANTS
NEAREST AGE AT
DATE OF BIRTH DATE OF DEATH
1. Value of fund from which annuity is payable
$
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - 0 Weekly (52) 0 Hi-weekly (26) 0 Monthly (12) 0 Quarterly (4)
o Semi-annually (2) 0 Annually (1) 0 Other
3. Amount of payout per period
4. Aggregate annual payment. Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interesttable rate - 031/2% 06% 010% 0 Variable Rat<<
6. Adjustment Factor (see instructions)
0.00
7. Value of annuity - If using 31/2%,6%,10% or if variable rate and period payout is at end of period,
calculation is: Line 4 x Line 5 x line 6
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3
HOlE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of
this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16, 17 and 18.
REV.1647 EX+ (9-00)
.
SCI-EDULE M
FlITl.R:... ~TCCM=ROMSE
(Check Box4a on Rev-1500 CowrSheel)
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stone, Roy Harold
I FILE NUMBER
21 - 08 - 0028
This schedule Is appropriate only for Estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and 11
enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return
o Will 181 Trust 0 Other
I. Beneficiaries
NAME OF BENEFICIARY
1. Jean E. Stone
2. Rickie J. Cook
3.
4.
5.
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9
months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
exercises such withdrawal ri~.
U Unlimited right of withdrawal 181 Limited right of withdrawal
III. Explanation of Compromise Offer:
Spouse will withdraw $104,107.96 for her future needs, balance will go to the daughter upon the death of the
spouse.
RELATIONSHIP
Spouse
Daughter
----
DATE OF BIRTH
09/27/1915
04/18/1945
ta:ro
NEARESTBRTH:lAY
92
63
Cl
IV. Summary of Compromise Offer:
1 . Amount of Future Interest:
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet)
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 0 6% 0 3% 181 0%
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
06% 1814.5%
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet)
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet)
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1)
608,498.20
104,107.96
504.390.24
608,498.20
.
~~~9113(A)
(SPOUSAl.. DIS1RBJT1ONS)
COMMONWEAllli OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I FILE NUMBER
21 - 08 - 0028
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Roy Harold Stone Beneficiary Trust Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
Stone, Roy Harold
If a trust or similar arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have
such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable
transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement.
The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal
to the total value of the trust or similar arrangement.
Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement.
1
DESCRIPTION
7 N. Railroad Avenue, Mechanicsburg
VALUE
84,912.00
2
17 E. Strawberry Avenue, Mechanicsburg
18,507.40
3
PNC Bank CD # 31600213634
11,904.01
4
USB Financial Services, Inc. account # AH 00084 38
379,074.43
5
Citizens Bank Money Market account # 620116-689-4
52,820.41
6
3,118.721 shares of Dryfus Premier Muni BdFd PA-Class A
49,556.48
Total of Continuation Schedule(s)
Part A Total
11,723.47
608,498.20
Part B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made.
DESCRIPTION VALUE
1 7 N. Railroad Avenue, Mechanicsburg 84,912.00
2
17 E. Strawberry Avenue, Mechanicsburg
18,507.40
3
PNC Bank CD # 31600213634
11,904.01
4
USB Financial Services, Inc. account # AH 00084 38
379,074.43
5
Items # 5, 6 and 7 I
Part B Tot;Il
(If more space is needed, insert additional sheets of the same size)
114,100.36
608,498.20
.
SCI-EDlI..E 0
8..ECTION IN:ERSEC. 9113(A)
(SPOUSAL CIS1RBJT1ONS)
conIi1ued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stone, Roy Harold
FILE NUMBER
21 - 08 - 0028
Part A, Continued:
Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement.
7
DESCRIPTION
Balance of Citizens Bank checking account # 610070-686-9 after estate
deductions/expenses
VALUE
11,723.47
Page 2 of Schedule 0 Part A
ESTATE OF
5
6
7
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
Part B continued
Stone, Roy Harold
FILE NUMBER 21-08-0028
Citizens Bank Money Market account # 620116-689-4
All shares of Dryfus Premier Muni BdFd PA-Class A
Balance of Citizens Bank checking account
52,820.41
49,556.48
11,723.47
Ahrens Law Firm, P .C.
I"~ "<<ii Gettysburg Pike ]i i;#
:i ~chanicsburg, PA 1705i- ..
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