HomeMy WebLinkAbout06-11-08REV-7 500 EX + (8-00)
COMMONWEALTH OF
REV-1500
OFFICIAL USE ONLY
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 ' - ° a ° ° ' °
-
000NTVCDDE YEAR ~~ NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
H
Z STAMBAUGH, FRANCES V. 2 0 4- 0 1- 2 3 5 4
W DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
V 12/15/2007 02/26/1916
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
~ ~ 1.Original Retum ~ 2. Supplemental Retum ~ 3. RemainderRetum (date or death prior to r2-f~-sz)
a
w a ~
~ 4. Limited Estate
~ 4a. Future Interest Compromise (date of death alter fz-t2-a2)
~ 5. Federal Estate Tax Retum Required
0
~ a m
X~ 6. Decedent Died Testate (Aaach copy or wII)
~ 7. Decedent Maintained a Living Trust (Altacn copy of Trust)
_ 8. Total Number of Safe Deposit Boxes
a
9. Litigation Proceeds Received
~ 1 O. Sp0US81 POVerty Cfedlt (date of death between 12-31-91 and 1-1-95)
~ 11, Election to tax under Sec. 9113(A) (Attach sch o)
r ?HiS SECTION MUST BE COMPLETED. AL.L CORRESPONDENCE AN D CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TOs '
Z
w NAME COMPLETE MAILING ADDRESS
°z MURREL R. WALTERS III 54 EAST MAIN STREET
y FIRM NAME (If Applicable)
w
p TELEPHONE NUMBER ~ f,,.
~ 717-697-4650 MECHANICSBURG ='= CJ PA ~ 7055
1. Real Estate (Schedule A) (1) , ~47~ICIAL ~SE ON4Y-'
=
r
,~~
~
2. Stocks and Bonds (Schedule Bj (2) ? `--
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ,. ~ ~;
4. Mortgages & Notes Receivable (Schedule D) (4) -~~ `~ ' -
`J "y °-~
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 3,900.54
(Schedule E) ~
Z
~ 6. Jointly Owned Property (Schedule F) (6)
~
Q ~~ Separate Billing Requested
J
~
7. loiter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
H
a
Q
U
W
(:>chedule G or L)
8. Total Gross Assets (total Lines 1-7) (8) 3,900.54
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1,760.56
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 240,303.18
11. Total Deductions (total Lines 9 & 10) (11) 242,063.74
12. Net Value of Estate (Line 8 minus Line 11) (12} -238,163.20
13. C:haritabie antl Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Met Value Subject to Tax (Line 12 minus Line 13) (14) -238,163.20
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z 15. Amount of Line 14 taxable at the spousal tax
~ rate, or transfers under Sec. 9116 {a){1.2) 0.00 X (15) 0.00
H
Fa.. 16. Amount of Line 14 taxable at lineal rate 0.00 X (16) 0.00
17. Amount of Line 14 taxable at sibling rate 0.00 X 12 (17) 0.00
~
V 18. ,4mount of Line 14 taxable at collateral rate 0.00 X .15 (18) 0.00
Q 19.'iax Due (19) 0.00
H ^
~
BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SID E AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
GOLDEN LIVING CENTER
46 ERFOR!D ROAD
CITY STATE ZIP
CAMP HILL PA 17071
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3
4
Total Credits (A + B + C) (2)
lnteresUPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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 lihe interest on the tax due.
(3)
(4)
(5)
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56)
Make Check Payable fo: REGISTER OF WILLS, AGENT
o.oo
0.00
0.00
0.00
0.00
0.00
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? ............................................................................................... ^ 0
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ................. ^ Q
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUF,~STIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury,l declare that have amin this ret 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 t n the rson C>pre ntative i sed on all information of which preparer has any knowledge.
SIGNATURE OF PERS PO L F I G RETURN DATE
G ~~ ~~
ADDRESS MURREL R. ALTERS, 111
54 EAST MAIN STREET, MECHANICSBURG PA 17055
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
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 3%
[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 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute sloes 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 stepparE:nt 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 beneficiaries 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 decedents siblings is 12% [72 P.S. §9116(aj(1.3)]. 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-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
STAMBAUGH FRANCES V. 21 08 0010
Include the proceeds of litigation and the date the proceeds were received by the estate.
All proaenv jointly-owned with rioht of survivorshia must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
PNC BANK
CHECKING
2. (GOLDEN LIVING PERSONAL ACCOUNT
REFUND
3,85$.50
45.04
TOTAL (Also enter on line 5, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
STAMBAUGH. FRANCES V. 21 08 0010
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. GINGRICH MEMORIALS -TOMBSTONE ENGRAVING 125.00
2. CHURCH OF GOD -MEAL 75.00
3. MALPEZZI FUNERAL HOME -PREPAID
B. ADMINISTRATIVE COSTS:
~. Personal Representative's Commissions
Name of Personal Representative (s) MURREL R. WALTERS, 111
Social Security Number(s)/EIN Number of Personal Representative(s)
SVeetAddress 54 EAST MAIN STREET
195.03
City MECHANICSBURG State PA Zip 17055
Year(s) Commission Paid: 2008
2. Attorney Fees MURREL R. WALTERS, I11 900.00
3, Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY 79.00
5 Accountant's Fees
6. Tax Retum Preparers Fees
7. THE PATRIOT NEWS -OBITUARY NOTICE 231.13
S. THE SENTINEL -OBITUARY NOTICE 155.40
TOTAL (Also enter on line 9, Recapitulation). ~ $ 1,760.56
(If more space is needed, insert additional sheets of the same size)
REV-1512 E;{ + (6-98)
SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
IN REST DAENTED cEDENTRN MORTGAGE LIABILITIES, & LIENS
ESTATE OF' FILE NUMBER
STAMBAUGH FRANCES V. 21 08 0010
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE
P.O. BOX 8486
HARRISBURG, PA 17105
2. GOLDEN LIVING CENTER
RESIDENTAL CARE
240,193.32
109.86
TOTAL (Also enter on line 10, Recapitulation) I $ 240,303.18
(If more space is needed, insert additional sheets of the same size)
RcV-1513 EX + (q-nn~
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF
STAMBAUGH FRANCES V. 21 08 0010
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. GEORGIA M. KABERLE Lineal
610 ROBERT STREET
MECHANICSBURG, PA 17055
2. MABLE L. REIFSNYDER Lineal
11670 WAVERLY MEADOWS
HOLLAND, MICHIGAN 49424
3. GERALDINE K. SWINCHOCK Lineal
602 PINTAIL (FAIRFIELD)
ETTERS, PA 17319
4. JOYCE A. ZRNCIC Lineal
261 SALEM CHURCH ROAD
MECHANICSBURG, PA 17055
FNTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
Ij, NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
E3. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space is needed, insert additional sheets of the same size)