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Home My WebLink About02-20-08 ---1 REV -1500 EX (06-05) P}I, Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 1505604115.8 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year 21 07 File Number 0197 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 007-07-2487 02192007 10291921 Decedent's Last Name Suffix Decedent's First Name JONES VELMA MI A (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 BOXES BELOW [K] 1. Original Return D 4. Limited Estate o 6. Decedent Died Testate (Attach Copy of Will) o 9. Litigation Proceeds Received ~ 8. Total Number of Safe Deposit Boxes 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 o 7. 010. Future Interest Compromise (date of death after 12-12-82) Decedent Maintained a Living Trust (Attach Copy of Trust) o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required o 2. 04a. Supplemental Return RICHARD C. SNELBAKER 717-697-8528 44 WEST MAIN STREET t::::: REGIS~ OF WILLS UgONL Y CZ. g ~, j -0 OJ , --r: N o ~ -'.. Firm Name (If Applicable) SNELBAKER & BRENNEMAN, P.C. First line of address Second line of address City or Post Office State ZIP Code }; CfJ --1 ~TE FILED (..0 P.O. BOX 318 MECHANICSBURG PA 17055 Correspondent's e-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. 9202 CHAPMAN OAK COURT, PALM DATE ADDRESS RICHARD C. SNELBAKER 44 WEST MAIN ST., MECHANICSBURG,PA PLEASE USE ORIGINAL FORM ONLY 17055 Side 1 L 15056041158 6M46473.000 15056041158 ---1 n-N \: ~ ---I 15056042159 REV-1500 EX Decedent's Name:J 0 N E S RECAPITULATION 1. Real estate (Schedule A) 2. Stocks and Bonds (Schedule B) . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested 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). . . . 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) . 14. Net Value Subject to Tax (Line 12 minus Line 13) Decedent's Social Security Number 007-07-2487 VELMA A . 1. 0.00 0.00 0.00 . 2. . 3. . 4. 0.00 . 5. 38320.04 0.00 . 6. . 7. 0.00 38320.04 10520.29 . 8. . 9. 10. 1505.63 12025.92 11. 12. 26294.12 0.00 26294.12 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 .0D- 0 . 00 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 26294.12 0.00 0.00 19. TAX DUE . . . . . . 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042159 6M4648 2.000 15. 0.00 16 1183.24 17. 0.00 18. 0.00 19. 1183.24 W 15056042159 ---I REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME JONES STREET ADDRESS File Number 0197 VELMA A CUMBERLAND COUNTY CITY MECHANICSBURG STATE 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 0.00 0.00 Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnteresUPenalty (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) 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) 1183.24 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 1183.24 0.00 0.00 0.00 1183.24 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes o o o o o o o No [K] 00 00 00 00 [K] [K] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. F or 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. 139116 (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. 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. F or 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 use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 139116(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. 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. 6M4671 1.000 REV-1508 EX + (6-98) COMMONWEAL TH OF PENNSYl VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Velma A. Jones FILE NUMBER 21 07 0197 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Citizens Bank savings account, #6140167876 22,799.90 2 Citizens Bank checking account, #6100703959 15,394.14 3 Delbrook Manor refund security deposit on apartment 126.00 TOTAL (Also enter on line 5, Recapitulation) $ 38,320.04 3W46AD 1.000 (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 ESTATE OF Velma A. Jones SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 07 0197 ITEM NUMBER A. FUNERAL EXPENSES: 1. Myers Funeral Home, Inc. funeral services B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: Debts of decedent must be reported on Schedule I. DESCRIPTION State Zip 2. Attorney Fees Snelbaker & Brenneman, P.C. Claimant 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Street Address City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 State Zip 1-800-Got-Junk removal of trash from apartment 2 FedEx overnight postage fees Total from continuation schedules 7W46AG 1.000 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ AMOUNT 7,075.00 2,000.00 83.00 443.00 51.50 867.79 10,520.29 Estate of: Velma A. Jones 007-07-2487 Schedule H Part 7 (Page 2) 3 PPL Electric electric service 325.31 4 Register of Wills filing fee for Inheritance Tax return 15.00 5 Verizon phone service 27.48 6 Reserve for filing fees, accountant fees, and other miscellaneous costs associated with the administration of the decedent's estate 500.00 Total (Carry forward to main schedule) 867.79 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Velma A. Jones SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 07 0197 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRiPTION VALUE AT DATE OF DEATH 1. Comcast cable TV service 76.69 2 Community Life Transport ambulance services 325.00 3 Delbrook Manor apartment rent for March 2007 600.00 4 PPL Electric electric service 395.45 5 Verizon phone service 51.33 6 West Shore EMS ambulance service 57.16 3W46AH 2.000 TOTAL (Also enter on line 10. Recapitulation) $ (if more space is needed, insert additional sheets of the same size) 1,505.63 REV-1'513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Velma A. Jones SCHEDULE J BENEFICIARIES FILE NUMBER 21 07 0197 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1 Lee A. Jones 9202 Chapman Oak Court Palm Beach Gardens, FL 33410 All of Residue: 26,294.12 Son 26,294.12 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 3W46AI 1.000 (If more space IS needed, Insert additional sheets of the same size)