HomeMy WebLinkAbout04-04-08 (3)
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue '*
~~~a~~~~~~~~ual Taxes . INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code ye6arr/
1- \ 'f)
File Number
1D
Date of Birth
171305714
112 4 2 0 0 7
03281935
Decedent's Last Name
Suffix
Decedent's First Name
Hippensteel
Mar y
MI
J
(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 DUPUCA TE WITH THE
REGISTER OF WILLS
FILL. IN APPROPRIATE OVALS BELOW
[R] 1 Original Return
o 4. limited Estate
[R]
o
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
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 ~OIRECTED TO:
Name Daytime Tele~~ne Number~3 ..:T)
K a r 1 E. R 0 In i n g e r 7 1 7 ~2~ 1 ~ 0 inG'--~
Firm Name (If Applicable) I; 22 P ;g f'cs ~',:i
REGIST~:~ ~~LS USE ONL y[:,.-j I>';
& Ass 0 C l ate s (;:::~~:~ :"I'~=~
.:) -;-1 -:;tiJ
~~.: .....d -".-- ~::,j.)
_.::J N I, '-;,
~ --I -- \':-=:-)
a 'n
co
6 Decedent Died Testate
(Attach Copy of Will)
9. litigation Proceeds Received
o
o
o
o
8 Total Number of Safe Deposit Boxes
R 0 In i n g e r
First line of address
1 5 5
Sou t h
Hanover
Street
Second line of address
City or Post Office
State
ZI P Code
DATE FILED
Car 1 i s 1 e
P A
17013
Correspondent's e-mail address:
Under penalbes of pe8ury, 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 pre parer other than the personal representative is based on all information of which preparer has any knowledge.
:SIG/p;Z:;;?N t~4h:N y -~;r~ Ot?
ADDRESS
11 Mountain Street Mt. Holl Springs
SJ,GN,l F PREPARER OTHER THAN REPRESENTATIVE
AD[)f{ESS - < )Juw 11 l!c /)
15D 0. . J~ SI. la'r )5 e- I ~f}-
PLEASE USE ORiGINAL FORM ONLY
/70(3
Side 1
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15056041125
15056041125
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name Mary J. Hippensteel
RECAPITULA TION
171305714
Real estate (Schedule A)
110000.00
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
3325.78
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.
1 1 3 3 2 5. 7 8
1 7 2 0 3. 2 2
2 2 5 3. 3 4
1 9 4 5 6. 5 6
9 3 8 6 9. 2 2
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 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.
93869.22
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 _ o . 0 0 15 o . 0 0
16. Amount of Line 14 taxable 9 3 8 7 o . 2 1
at lineal rate X 042- 16. 4 2 2 4 . 1 6
17 Amount of Line 14 taxable o . 0 0 o . 0 0
at sibling rate X .12 17.
18 Amount of Line 14 taxable o . 0 0 o. 0 0
at collateral rate X .15 18
19 Tax Due . . . . 19 4 2 2 4 . 1 6
20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
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15056042126
15056042126
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S I~AME
Mary J. Hir:;'pensteel
STREET ADDRESS
File Number
o 0
.~~---
.------ .------
CITY
I STATE
!
I ZIP
!
----
Tax Payments and Credits:
1. Tax Due (F'age 2Line 19) (1)
2. Credits/Payments
A Spousal Poverty Credit
8. Prior Payments
C. Discount
4,224.16
Total Credits (A + 8 + C) (2)
0.00
3. Interest/PE!nalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + 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
4,224.16
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A This is the BALANCE DUE.
(5A)
(58)
4,224.16
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 00
b. retain the right to designate who shall use the property transferred or its income; 0 00
c. retain a reversionary interest; or ............................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? .................................. .. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ..................................................................................... 0 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................... .... 0 00
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 PS 99116 (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.
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 PS. 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 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 PS. 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.
REV-1502 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mary J. Hippensteel 0 0
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real prooertv which is iointlv-owned with rioht of survivorshio must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
110,000.00
2059 Rellim Street, Carlisle, PA
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
110000.00
REV-1503 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Mary J. Hippensteel
FILE NUMBER
o 0
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1504 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
FtESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF
Mary J. Hippensteel
FILE NUMBER
o 0
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instnuctions for the supporting information to be submitted for sole-proprietorships.
ITEM
NUMBER
1.
DESCRIPTION
I
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1505 EX + (6-98)
'*
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
COMMONlWEAL TH OF PENNSYLVANIA
INHI=RITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary J. Hippensteel
FILE NUMBER
o 0
1. Name of Corporation
Address
City
2. Federal Employer 1.0. Number
3. Type of Business
Zip Code
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
State
Product/Service
4.
I STOCK TYPE TOTAL NUMBER OF PAR VALUE NUMBER OF SHARES VALUE OFTHE I
Voting/Non-Voting SHARES OUTSTANDING OWNED BY THE DECEDENT DECEDENrS STOCK
Common $
Preferred $
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes 0 No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? ....................................... 0 Yes 0 No
If yes, provide amount of indebtedness $
7. Was thel.e life insurance payable to the corporation upon the death of the decedent? ............... 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years
if the date of death was prior to 12 -31-82?
DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares
Transfen3e or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? . . . . . . . . . . . . 0 Yes 0 No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? .................................................0 Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? ....................... 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . . . . . .. 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If thE! corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. StatElment of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX .. (9-00)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
Mary J. Hippensteel
FILE NUMBER
o 0
Name of Partnership
Address
Date Business Commenced
Business Reporting Year
City _
State
Zi P Code
2. Federal Employer 1.0. Number
3. Type of Business Product/Service
4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $
5.
PARTNER NAME PERCENT PERCENT BALANCE OF
OF INCOME OF OWNERSHIP CAPITAL ACCOUNT
A.
B.
C
0
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ................................ 0 Yes 0 No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ........ 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 1.2 -31-82?
DYes 0 No If yes, 0 Transfer 0 Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
10. Was them a written partnership agreement in effect at the time of the decedent's death? . . . . . . . 0 Yes 0 No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death? ................. 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? ................................ 0 Yes 0 No
If yes, explain
14 Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
REV-1507 EX + (13-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
Mary J. Hippensteel
FILE NUMBER
o 0
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-15G8 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Mary J. Hippensteel
FILE NUMBER
o 0
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.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,32578
Checking Account M& T Bank
2.
Personal Property
2,000.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3 325.78
REV-1509 EX + (6-98)
*'
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary J. Hippensteel
FilE NUMBER
o 0
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
ADDRESS
RELATIONSHIP TO DECEDENT
A
B
c
JOINTL V-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '!oOF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL EST ATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Mary J. Hippensteel
FILE NUMBER
o 0
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPliCABLE) VALUE
1.
TOTAL (Also enter on line 7 Recapitulation) $
(If more space ~ needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Mary J. Hippensteel
FILE NUMBER
o 0
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
2
3.
4.
FUNERAL EXPENSES
Cumberland Law Journal
The Carlisle Evening Sentinel
Cumberland County Register of Wi lis to open estate
PA Inheritance Tax
75.00
134.06
31000
4,224.16
B.
1.
ADMINISTRATIVE COSTS
Personal Representative's Commissions
Name of Personal Representative (s) Robert L. Hippensteel, Sr.
Social Security Numbe~s)/EIN Number of Personal Representative(s)
Street Address 11 Mountain Street
6,230.00
City Mt. Holly SprinQs
State P A
Zip 17065
Yea~s) Commission Paid: 1
2.
3.
Attorney Fees Karl E. Rominger
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
6,230.00
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
Probate Fees
5.
Accountanfs Fees
6.
Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
17 203.22
REV-1512 EX + (12-03)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary J. Hippensteel
FILE NUMBER
o 0
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
2,129.72
1.
Carlisle Regional Medical Center
2
Walnut Bottom Radiology
14.51
3
Spring Road Family Practice
109 11
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,253.34
'>V~ """. ",*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Marv J. Hiooensteel 0 0
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)]
1. Robert L. Hippensteel, Sr Lineal 23,462.08
Frank B. Hippensteel, Jr. 23,462.08
Brian K. Hippensteel 23,462.08
~Iody Hippensteel-Parson Lineal 23,462.08
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. f\lON- 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 11- 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)
REv-m. EX. ''2-0.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev-1500 Cover Sheet
ESTATE OF FILE NUMBER
Mary J. Hippensteel 0 0
This SChl~dule 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 from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
o Will 0 Intervivos Deed of Trust 0 Other
LIFE ESTATE INTEREST CALCULATION
NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH LIFE ESTATE IS PAYABLE
o Life or o Term of Years
o Life or o Term of Years
o Life or DTerm of Years
o Life or o Term of Years -
o Life or o Term of Years -
Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
1
2. Actuarial factor per appropriate table. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest table rate - 031/2% D 6% 010% OVariable Rate
%
3. Value of life estate (Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
ANNUITY INTEREST CALCULATION
NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH ANNUITY IS PAYABLE
o Life or 0 Term of Years -
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or o Term of Years -
Value of fund from which annuity is payable .......................................... $
2. Check appropriate block below and enter corresponding (number) . . . . . . . . . . . . . . . . . . . . . . . . . . .
Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12)
[J Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other (
3 Amount of payout per period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
4. Aggre!~ate annual payment, Line 2 multiplied by Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Annuity Factor (see instructions)
Interest table rate - 0 3 1/2% 06% 010% 0 Variable Rate %
6. Adjustment Factor (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
NOTE: 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 and 15 through 18.
(If more space is needed, insert additional sheets of the same size)
REV-1644 EX + (3-04) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
INHERITANCE TAX
SCHEDULE L
REMAINDER PREPAYMENT
OR INVASION OF TRUST PRINCIPAL FILE NUMBER 0 0
This schedule is appropriate only for estates of decedents dying on or before December 12, 1982.
This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of
Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal.
II. REMAINDER PREPAYMENT:
A. Election to prepay filed with the Register of Wi lis on
(First Name)
--
(Middle Initial)
B Name(s) of Life Tenant(s)
or Annuitant(s)
(Date)
Date of Birth
Age on date
of election
Term of years income
or annuity is payable
C. Assets: Complete Schedule L-1
1. Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . . $
2. Stocks and Bonds . . . . . . . . . . . . . . . . . . . . . . $
3. Closely Held Stock/Partnership. . . . . . . . . . . . . . . $
4. Mortgages and Notes. . . . . . . . . . . . . . . $
5. Cash/Misc. Personal Property. . . . . . . . . . $
6. Total from Schedule L-1 ........
... $
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . $
2. Unpaid Bequests. . . . . . . . . . . . . . . . . . . . . . $
3. Value of Unincludable Assets . . . . . . . . . . . . . . . . $
4. Total from Schedule L-2
.$
.. $
E. Total Value of trust assets (Line C-6 minus Line D-4). . . . . . . . .
F. Remainder factor (see Table I or Table II in Instruction Booklet) . . .
G. Taxable Remainder value (Line E x Line F)
(Also enter on Line 7, Recapitulation)
.. $
III. INVASION OF CORPUS:
A. Invasion of corpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s)
or Annuitant(s)
Date of Birth
Age on date
corpus
consumed
Term of years income
or annuity is payable
C. Corpus consumed
.... $
D. Remainder factor (see Table I or Table II in Instruction Booklet) . . . . . . . . . . . .
E. Taxable value of corpus consumed (Line C x Line D)
(Also enter on Line 7, Recapitulation)
. . .. $
REV-' 645 EX + (3-84) INHERITANCE TAX
SCHEDULE L-l
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION
INlHERITANCE TAX RETURN 0 0
RESIDENT DECEDENT -ASSETS- FILE NUMBER
I. Estate of Hiooensteel Marv J.
(Last Name) (First Name) (Middle Initial)
II. Item No. Description Value
A. Real Estate (please describe)
Total value of real estate $
(include on Section II, Line C-1 on Schedule L)
B. Stocks and Bonds (please list)
Total value of stocks and bonds $
(include on Section II, Line C-2 on Schedule L)
C. Closely Held Stock/Partnership (attach Schedule C- 1 and/or C-2)
(please list)
Total value of Closely Held/Partnership $
(include on Section II, Line C-3 on Schedule L)
D. Mortgages and Notes (please list)
Total value of Mortgages and Notes $
(include on Section II, Line C-4 on Schedule L)
E. Cash and Miscellaneous Personal Property (please list)
Total value of Cash/Misc. Pers. Property $
{include on Section II Line C-5 on Schedule Ll
III. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $
(If more space is needed, attach additional 8'12 x 11 sheets.)
REV-1646 EX + (3-84) INHERITANCE TAX
*'
SCHEDULE L-2
CONMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION
INHERITANCE TAX RETURN -CREDITS- FILE NUMBER 0 0
RESIDENT DECEDENT
I. Estate of HiDoensteel. Marv J.
(Lost Nome) (First Nome) (Middle Initiol)
II. Item No. Description Amount
A. Unpaid Liabilities Claimed against Original Estate, and payable from assets
reported on Schedule L- 1 (please list)
Total unpaid liabilities $
(include on Section II, Line 0-1 on Schedule L)
B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list)
Total unpaid bequests $
(include on Section II, Line 0-2 on Schedule L)
C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under
"B" above) that are not included for tax purposes or that do not form a part
of the trust.
Computation as follows:
Total unincludable assets $
(include on Section II, Line 0-3 on Schedule L)
III. TOTAL (Also enter on Section II, Line 0-4 on Schedule L) $
(If more space is needed, attach additional 8'/2 x 11 sheets.)
''''~'Mm''*
SCHEDULE M
FUTURE INTEREST COMPROMISE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Check Box 4a on Rev-1500 Cover Sheet
FILE NUMBER
ESTATE OF
Mary J. Hippensteel 0 0
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 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.
D Will D Trust D Other
I. Beneficiaries
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
1.
2.
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 right.
D Unlimited right of withdrawal D Limited right of withdrawal
III. Explanation of Compromise Offer:
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 o 6%, o 3%, o 0% . . . . . . . . . . . . . . . . $
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One o 6%, o 4.5% . . . . . . . . . . . . . , . . . . . . . . $
(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) . . . . . . . . . . . . . . . . . . . . . $
(If more space is needed, insert additional sheets of the same size)
REV-1648 EX (11-9_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX DIVISION (AVAILAEl..E FOR DATES OF DEATH 01/01/92 to 12/31/94)
ESTATE OF I FILE NUMBER
Mary J. Hippensteel 0 0
This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
SCHEDULE N
SPOUSAL POVERTY CREDIT
PART 1- CALCULATION OF GROSS ESTATE
1. 113325.78
2
3
4.
5
6a.
6b
6c.
6d.
. .................. 6
7. 113325.78
8.
................................ 9. 113,325.78
PARTII - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income
Tax Return for decedent and spouse.)
Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19
a. Spouse . ... 1a. 2a. 3a.
b Decedent. 1b. 2b. 3b.
c. Joint ... 1c. 2c. 3c.
d. Tax Exempt Income. 1d 2d. 3d.
e. Other Income not
listed abOVE! . 1e. 2e. 3e.
f. Total.. ..... ....... 11. 21. 31.
1. Taxable Assets total from line 8 (cover sheet) .
2 Insurance, Proceeds on Life of Decedent.
3. Retirement Benefits.
4 Joint Assl~ts with Spouse.
5 PA Lottery Winnings.
6a. Other Nontaxable Assets: List (Attach schedule if necessary) .
6
SUBTOTAL (Lines 6a, b, c, d) .
7.
Total Gross Assets (Add lines 1 thru 6) .
8.
9
Total Actual Liabilities.
Net ValuE! of Estate (Subtract line 8 from line 7) ...
If line 9 is reater than $200 000 STOP The estate is not eligible to claim the credit If not contmue to Part 11
4.
4a.
Average Joint Exemption Income Calculation
Add Joint Exemption Income from above:
(1 f)
+ (2f)
+ (3f)
(+3)
4b. Average Joint Exemption Income ..... ................ ...................
If line 4(b) is greater then $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part III.
PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less.
1.
2. Multiply by credit percentage (see instructions) . ................
3. This is th,e amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 18 of the cover sheet. .
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate. . . ...............
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal
Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet
2.
3.
4.
5
REV-1649 EX + (6-98)
'*
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FilE NUMBER
Mary J. Hippensteel 0 0
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) ofthe 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 Trust (marital, residual A, B, By-pass, Unified Credit, etc)
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 sim-
ilar 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
survivin souse under a Section 9113 A trust or similar arran ement.
Description
Value
Part A Total $
Part B: Enter the descri tion and value of all interests included in Part A for which the Section 9113 A election to tax is bein made.
Description Value
Part B Total $
(If more space is needed, insert additional sheets of the same size)
REV-1500 Discount, Interest and Penalty Worksheet
Discount Ca.lculation
Total Amount Paid within three calendar months of the decedent's date of death:
Discount:
0.00
Interest Table
I Days Delinquent I -~._- ,
Year Balance Due I Interest
this time period this year I this period
Before 1981 I
1982
1983
1984 i
1985
1986
1987
1988 throuQh 1991 I
,
1992 I
1993 throuQh 1994
1995 throuQh 1998
1999 I
2000
2001
,
2002 I
2003 i
2004 I I
,
2005 i
2006 I
2007 I
!
i
I
TOTALS I
Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable amount:
Total Balance Due on January 17, 1996:
Penalty: