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Home My WebLink About05-09-08 (2) .....I 15056041147 REV -1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes ,~. PO BOX.280601 ~ Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY . County Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 8 File Number 00191 Date of Birth 02142008 04031923 Decedent's Last Name SuffIX Decedent's First Name GRIM JUNE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name SuffIX Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 181 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82) 0 4. Limited Estate 0 4a. Future Interest Compromise 0 5. Federal Estate Tax Return Required (date of death after 12-12-82) 0 6. Decedent Died Testate 0 7. Decedent Maintained a Uving Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of WiD) (Attach Copy of Trust) 0 9. litigatiOn Proceeds Received 0 10 Spousal Poverty Credit ~date of death 0 11. Election to tax under Sec. 9113(A) . between 12-31-91 and -1-95) (Attach Sch. 0) MI M MI 20RRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number JAMES M ROBINSON 7172459688 Finn Name (If Applicable) TURO LAW OFFICES REGISTER OF WILLS USE ONLY ~ <<:::) c;:::) c:::c> :x > -< I \0 First line of address (") ~O ::""":0 w-o ;"1 . (") :n~r- r- Zm ~;: en ~ C.:.) 00 D 28 SOUTH PITT STREET Second line of address City or Post Office CARLISLE State PA ZIP Code 17013 ;: :0 :0-1 )> ~ ::r: Cif w (..) Correspondent's &-mail address: j rob ins 0 n @ t u r 01 a 1f . com Under penalties of perjury, I declare that I have examined this return, including accompanY.ing schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Decla . n of preparer other than the personal representative is based on all information of which preparer has any knoWledge. SIGNATUR OF PERSO RE NSI OR FILING RETURN DATE Marlet E. Grim Je1 v'I ~ 7 Zt:70g- James M Robinson 671/o? , Side 1 L 15056041147 15056041147 ~ ADDITIONAL Personal Representatives Grim, June Marie SS# 193-18-7017 2/14/2008 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. Co - An M \~ l's"'t{'AlO r PA 17013 ......I 1505&042148 REV-1500 EX Decedent's Name: GRIM, JUNE MARIE RECAPITULATION 1. Real Estate (Schedule A).......................................................................................... 1. 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. 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. 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/See 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. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2)X~ 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 478,827.93 16. 17. 18. 19. Tax Due............. ....... ................... .......... ............... ........................ ......... .................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505&042148 Decedent's Social Security Number 509,002.14 509,002.14 27,995.53 2,178.68 30,174.21 478,827.93 478,827.93 21,547.26 21,547.26 D 1505&042148 ~ REV-1500 EX Page 3 Decedent's Complete Address: ., NAME Grim, June Marie STREET ADDRESS 1000 Claremont Drive File Number 21 - 08 - 00191 Carlisle ]stATE PA IZIP . 17013 CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 21,547.26 1,077.36 3. InterestlPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 1,077.36 TotallnterestlPenalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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 + SA. This is the BALANCE DUE. (3) 0.00 (4) (5) 20,469.90 (SA) (5B) 20,469.90 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No o [!] o [i] o [!] o [!] o ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ D [!] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?...... ........................ .................. ............................ ....................... ................... 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. 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?............................................................... ......... ............................................... 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 .5. ~9116 (a) (1.1) (ii)]. The statute does not exemot 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)]. 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 E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Grim, June Marie ~UMBER 21 - 08 - 00191 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Smith Barney Acct. No. 504-44261 507,025.64 2 Charles Schwab Acct. No. 1383-9007 2.39 3 F & M Trust Irrevocable Burial Fund #02-11483 1,974.11 TOTAL (Also enter on Line 5, Recapitulation) 509,002.14 . SCtEU..EH R.N:RALEXPENSES& AI:WNS1RATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Grim, June Marie Debts of decedent must be reported on Schedule I. FILE NUMBER 21 - 08 - 00191 ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Austin H. Eberly Funeral Home, Inc. 9,021.70 B. I ADMINISTRA TlVE COSTS: 1. I Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees Turo Law Offices 15,270.07 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 Register of Wills 511.00 Cumberland Law Journal 75.00 The Sentinel - Legal 166.60 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Family Travel Expenses to Funeral - Airfare, Lodging, Rental Car 2,951.16 TOTAL (Also enter on line 9, Recapitulation) 27,995.53 . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABiliTIES, & LIENS COMMONWEAlni OF PENNSYLVANIA NiERlTANCE TAX RETURN RESI:lENf DECEDeNT ESTATE OF Grim, June Marie I ] FILE NUMBER 21 - 08 - 00191 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Philip D. Carey, MD 27.02 2 Carfisle HMA Physician Management 12.37 3 Cummings Associates, P.C. 135.00 4 Carfisle Ear Nose & Throat Associates 90.21 5 Blue Mountain Anesthesia Associates 16.60 6 Harrisburg Gastroenterology, Ltd. 10.51 7 West Shore EMS - Carlisle 84.68 8 Special Event Emergency Medical Services, Inc. 768.55 9 Special Event EMS (Dillsburg) 490.34 10 Nephrology Associates of Central P A 297.86 11 Joseph P. Cardinale, D.O. 245.54 TOTAL (Also enter on Line 10. Recapitulation) 2,178.68 .. REV-1113 EX+ (9.00) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Grim, June Marie I FILE NUMBER 21 ~ 08 - 00191 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not u. TrutItee(s) I. TAXABLE DISTRIBUTIONS [include outright sr,ousal CiistributionSg and ransfers under Sec. 116 (a) (1.2)] 1 Martet E. Grim Son Entire Estate 478,827.93 4533 Darcelle Drive Union City, CA 94587 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