The URL can be used to link to this page

Home My WebLink About04-12-08~,-,.aoEZ.,.ml I REV-1500 . . COMMONWEALTH OF PENNSYLVANIA ~ INHERITANCE TAX RETURN FILE NUMBER e DEPAFTMENT OF REVENUE RESIDENT DECEDENT '~ 21 ~~ D V'~ I (~ DEPT. 280601 HAaaiseuaG, PA ntza~oso, ' j COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ SOCIAL SECURITY NUMBER Bartholic, Dorothy M. 161-18-5306 - -- - - - m DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) -- p THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W ~! 07/ 10/2007 05/25/ 1918 o __-_ _ -- ~__ . - REGISTER OF WILLS - - -- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) i SOCIAL SECURITY NUMBER --- I - _--- -- - -- - ® 1 Ori i l R t -- --- --- _ _ - -- -~ - . g na e urn ^ 2. Supplemental Return g Remainder Retum (date of death prior to 12-13-a2) a N ~ d ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death 5. Federal Estate Tax Return Re wired after 12-12-82) ^ q U W ~ ~ ~ m I ^ 6. Decedent Died Testate (Attach copy ^ 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes a of Will) copy of Trust) a ^ 9. Litigation Proceeds Received ^ 10. Spousal Povertyy Credit (date of death between ^ 11. Election to tax under Sec. 9113(A) (Attach Sch O) 12-31 91 d 1 1 9 _ -- - an - - 5) _ THIS SECTIQN MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTL4L TAx INFORMATION SHOULd BE DIRECTED TO: ~ AME John J Myers COMPLETE MAILING ADDRESS ~, _ ~ o FIRM NAME (If applicable) ~ a ,Adams & Myers 1416 Lincoln Way -- - -- -- - - - -- White Oak PA 15131 ELEPHONE NUMBER , 412/672-9644 fi ,- - -- --- --- -- -- - - -- 1. Real Estate (Schedule A) (1) Nnne 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 g I 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property F (Schedule G or L) a 8. Total Gross Assets (total Lines 1-7) V z 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) it 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (2) None (3) None (4) None (5) None (6) - - None (~) 6,215.00 (9) 6,521.00 (1 D) 3,080.63 ~i 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) - -. -- - SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES '~, 15. Amount of Line 14 taxable at the spousal tax rate, j or transfers under Sec. 9116(a)(1.2) - - - --- --- - n .~ .,~ ~ -::,i.-1 I.__ ~s ~; __ ,-, - 111 /~ . ~' tip ~ ~ -~ ' '- i _ j _~~ . c. ~ ~ ~ , ; ='~ _. •. v,.y.i-~.vv -. - Ct1 '-f (11) (12) (13) (14) 9,601.63 insolvent x ,00 (15) z 16. Amount of Line 14 taxable at lineal rate x .045 (16) _ - - _- - - ~ 1 ~~ Amount of Line 14 taxable at sibling rate x .12 (1 ~) v ! - - - -- - F ~! 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19• Tax Due (19) - - - 20. ^ • • ra • • - --- » BE SURE TO ANSWER AI.L QUESTK)NS ON REVERSE SIDE AND RECHECK MATH « T Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) w~~ Decedent's Complete Address: STREET ADDRESS 1010 Myers Road CITY STATE PA ZIP 17324 Gardners Tax Payments and Credits: 1~ Tax Due (Page 1 Line 19) (1) 2 Cred'Rs/Payments A Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty rfapplicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is tht~VERPAYMENT. (q) Check box on Page 1 Line 20 to request arefund - -- - 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 0.00 A Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE (5B) 0.~~ 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 properly transferred :.............................................................................................. ^ b• retain the right to designate who sha!! 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 Acxount, 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. ~_~ ray ~a„~w ~~ yequ~y, ~ aeaare mac i nave examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corteCt and complete. Declaratan of preparer other than the personal represerrtative is based on all information of which preparer has any knowledge. SIC~NATUR OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE ~~_ ~ ~ • ~ 1010 Meyers town Road ~/ (}'~" Gardners PA 17324 ~ ~ ~ D 'TUBE OF PERSON RE 'SIB~E FOR FILING RETURN w70RES., rJ,4TF . Harold Bar olic SIGNAT John J DATE AUUKtSS 4 1416 Lincoln Wayy -' White Oak, PA I5131 '-{ y 6 _ _ _ - _ __ _ _ _ _ _ , For dates f de on or after July 1, 1994 and re January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving sp is 3% [72 P.S. §9116 (a) (1.1 ]. 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% p2 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disGosure of assets and filing a tax return are still appligble 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 chikl twenty-0ne 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. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5%, 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 12% [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. SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VNOS TRANSFERS & INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF Bartholic, Dorothy M. FILE NUMBER 21 -07- This schedule must be comolPfad and fi~o~ s *tie ~.,Q..,.,- ~...._.. _~ _..__~____ . ITEM NUMBER - ----- ---- •-•-- .....- a..~•-~• DESCRIPTION OF PROPERTY InGude the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. ~~ p.. ~~ uCSU DATE OF DEATH VALUE OF ASSE Vns i mrvu %OF DECD'S T INTEREST n 4 on a EXCLUSION (IF APPLICABLE e z is es. TAXABLE VALUE ) 1 Century Heritage Federal Credit Union Account #4483 6 215 0 700 Regis Avenue , . 6,215.00 West Mifflin I'A 15122 Registered Dorothy Bartholic POD J. Hazold Bartholic, Son I TOTAL (Also enter on line 7, Recapitulation) 6,215.00 ~ SCHEDULE H COMMDNwEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8 INHERRANCE TAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF I FILE NUMBER Bartholic, Dorothy M. 21 -07- Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A . FUNERAL EXPENSES: 1 Teichart-Gracan Funeral Home -Funeral Service 5,521.00 B . ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 5oaal Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2 Attorney's Fees Adams & Myers 1,000.00 3. Family Exemption: (If decedent's address is not the same as daimanYs, 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 ~• Other Administrative Costs 1 TOTAL (Also enter on line 9, Recapitulation) 6,521.00 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bartholic, Dorothy M. 21-07- Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Millennium Pharmacy Systems, Inc. 104.93 2 United Church of Christ Homes/Thornwald Home -Balance Due 879.18 3 Harold Bartholic -Travel Expenses for Funeral and Burial 225 72 4 Equitable Gas -Balance Due 42.73 5 Visa Account #4630220000003172 -Balance Due 1,828.07 TOTAL (Also enter on Line 10, Recapitulation) I 3 080.63 n w ~ ~ m n ~ ~' n O n aq r• ~ ~ ~ D = m o n ~o D m a ~ °, rn r fD ~ ~ ~ N z ~n~ o ~ ~ ~ ~ ~ ~ D w n ~ Z -~ ~ D ;(1 w -< fA t of ~ _ ~ ' ~ ~~ ~ ~ ,r 1 ¢~ C 7 - ' L ~p ~ ~ ~± ~. R %~ ~ ~ i s ~ , ~ LL fit Y {~~4,' S :.f i . ~ u ' i i ': 1 y ~- ~~. ~ v W ~ ~~ E `~,,~~ `~ d: . ~ ~ ~' 7 ;'' t .~ .* ~°i I°47 . yay ~. ~~ ~f ~, p i~ i~ C~ ,ry ~ :J "'~ :~ ~., A a:a 4rd