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Home My WebLink About05-29-08 (2)15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 7 0 0 4 6 9 ENTER DECEDENT INFORMATION BELOW Socia{ Security Number Date of Death Date of Birth 2 0 5 1 2 7 9 7 7 0 5 0 2 2 0 0 7 0 5 1 8 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI B O U S T AN N L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's 1=first Name Ml Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Wilt) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number KEITH 0. B R E N N E M A N 7 1 7 6 9 7 8 5 2 8 Firm Name (If Applicable) S N E L B A K E R & B R E N N E M A N First fine of address 4 4 WEST MAIN S T R E E T Second line of address City or Post Office M E C H A N I C S B U R G Correspondent's a-mail address: State ZIP Code REGISTER OF WILLS USE ONLY } s t'~ _,~~ ;: , ~ y -~, - _ ~ OPTf FIL _ , --... ~-, P A 170 55 =j F _, - -. 0 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. SI 1VVAT E OF P "RSO~PONSIi~ FOR FILING RETURN DATE ADDRESS 290 Center Road, Newville, PA 17241 SIGNATIJ P PARER OTHER THAN REPRESENTATIVE DATE ADORES+S 44 West Main Street, Mechanicsburg, PA 17055 PLEASE USE ORIG{NAL FORM ONLY 15056051047 Side 1 15056051047 J 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: 2 0 5 1 2 7 9 7 7 RECAPITULATION 1. Real estate (Schedule A) ........................................... .. 1. 2. Stocks and Bonds (Schedule 8) ..................................... .. :?. 2 5 , 5 1 7 .5 2 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C} ... .. :i. 4. Mortgages & Notes Receivable (Schedule D} .............. . ............ .. 4•. • 5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ...... .. 5. • 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7, 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 2 5 , 5 1 7 •5 2 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule f) ............. .. . 10. • 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 12. Net Value of Estate (Line 8 minus line 11 } ........................... ... 12. 2 5 , 5 1 7 .5 2 f 3. 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. 2 5 , 5 1 7 •5 2 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 .0_ . 15. • 16. Amount of Line 14 taxable at lineal rate x .0 45 1 6, 8 4 1. 5 6 16. 7 5 7 •8 7 17. Amount of Line 14 taxable at sibling rate X .12 • 17. 18. Amount of Line 14 taxable at collateral rate X .15 8, 6 7 5 • 9 6 1s. 1, 3 0 1 •3 9 19. TAX DUE ...................................................... ... 19. 2, 0 5 9 .2 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 15056052048 15056052048 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21-07-00469 DECEDENT'S NAME ANN L. BOUST ____ __ STREET ADDRESS - __-210__Bi~_ S.pri~ ~~- ____- ------------ CITY ~ STATE I ZIP Newville PA ' 17241 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit ____ _-__ __-_ _- - -._. B. Prior Payments G. Discount __.__- _-_~- ----_.__-_--__-_ - Total Credits (A + B + C } 3. Interest/Penalty if applicable D. Interest 48.80 E P 1 _____ (~) 2,059.26 (2) ena ty 48.80 -"-_"-- - - " Total InterestlPenalty (D + 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) 2.108.06 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 2 ,108.06 Make Check Payable fo: 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 :.................................................................................... ...... ^ [~ 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? .................................................................................................................. ...... ^ 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 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 zero (0) percent [72 P.S. §9116 (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 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)J. 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)J. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98) SCNEDt~LE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER . Boust 21-07-004 All property jointly-owned with right of survivorship must be disclosed on Schedule F. SUPPLEMENTAL INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS File Number Charles M. Boust 21-07-00469 Personal Representative(s) of the Estate of Ann L. Boust deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and al] of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a mem/ orandum at the en~d('of this inventory. I verify that the statements made in this Inven- ~N~~/lJt'~' ~ ~ / tory are true and correct. I understand that false state- , ments herein are made subject to the penalties of by Keith 0. Brenneman, his attorney 18 Pa.C,S. § 4904 relating to unsworn falsification to authorities. Attorney -- (Name) Keith 0. Brenneman (Supreme Court LD. No.) 47077 (Address) 44 W Main Street Mechanicsburg , PA 17055 (Telephone) 717-697-8528 DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO. May 2, 2007 Newville, Cumberland County, Pennsylvania 205-12-7977 FIGURES MUST BE TOTALED p>~ Izcnnrer.Tv Exelon Corporation, 332 shares of common stock at $76.86 per share $25,517.52 ~..~ ~~ `_ ~ ; `~ -- _ z~ _ ~~?; ' ,--; - ; - _` :~ _i^ fU . Lcy - - , J ~ ^Cz _ ~ ~` - --- _ _ 'i J -V _ O (Attach additional sheets as needed) TOTAL: $25,517.52 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 2D Pa. C.S. § 3301(bJ) Form R W-04 rev. 10.13.06