The URL can be used to link to this page

Home My WebLink About06-11-0815056041147 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 sox.2soso~ 21 0 8 (fj,~ 7 Harrisburg, PA ~~~2s-oso~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Deatfi Date of Birth 412 48 7824 04 17 2008 10 27 1917 Decedent's Last Name Suffix Decedent's First Name MI GRAY RACHEL H (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 DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW XD 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ~ qa, Future Interest Compromise ~ 5. Federal Estate Tax Retum Required (dale of death after 12-12-52) g. Decedent Died Testate ~ ~ Decedent Maintained a Living Trust (Attach Copy or Will) (Attach Copy of Trust) 0 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. spousal Povarri Credit~(date of deaU, ~ 11, Election to tax under Sec. 9113(A) between t2-31-xr1 and -1-95) (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDWARD P. SEEBER 717 533 3280 Firm Name (ff li bl App ca e) JAMES, SMITH, DIETTERICK & First line of address SUITE C-400, 555 GETTYSBURG Second line of address City or Post Office MECHANICSBURG State ZIP Code PA 17055 REGISTER J~j WILLS USI~NLY ~~ -. --. -i. ~ :a: µ ~, , i ? --- ~ - ~ n -=' ` - D ED ~ r- tx~ :-~~ ~_ i;"-7 ~, v i c_ ~ ."r~ ,' "t'r CorrespondenNs a-mail address: 8 p 8 ~1 s d C. C O m 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. ADDRESS 229 Winding Way, Camp Hill, PA 17011 Ray Smallen SIGNATURE O RE RER OTHER THAN REPRESENTATIVE DATE Edward P. Seeber ~ ~~ ~ ADDR S ite 204, 5020 Ritter Road, Mechanicsburg, PA 17055 Side 1 L 15056041147 15056041147 J 15056042148 REV-1500 EX Decedent's Social Security Number o~a~~t's Name: R a c h e I H. Gray 412 4 8 7 8 2 4 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 De sits & Miscellaneous Personal Pro e po p rty (Schedule E) ................ 5. 3 , 2 4 4 . 0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7. Inter-Vvos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7, 11 , 3 7 5 . 6 0 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 14 , 619.6 0 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......................................... 9. 15 , 16 9 . 5 0 10. Debts of Decedent, Mortgage Liabilities, i3< Liens (Schedule I) ................................ 10. 9 2 7 . 5 0 11. Total Deductions (total Lines 9 8 10) ...................................................................... 11. 1 6, 0 9 7. 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. - 1 , 4 7 7 . 4 0 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. - 1 , 4 7 7 . 4 0 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 .00 0 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 0. 0 0 16• 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0, 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 0. 0 0 19. Tax Due ..................................................................................................................... 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 15056042148 15056042148 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08- DECEDENT'S NAME Rachel H. Gray STREET ADDRESS 940 Walnut Bottom Road CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B, Prior Payments C. Discount 3. InteresUPenalty if applicable p. Interest E. Penalty 0.00 Total Credits (A + B + C) (1) 0.00 (2) 0.00 Total InteresUPenalty (D + 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 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (3) (4) (5) 0.00 (5A) (56) 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 .................................................................................................................. x d. receive the promise for life of either payments, benefits or care? .............................................................. ~ O 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?......... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ^x ^ 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)]. 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 disGosure 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. Rev-7508 EX+ (688) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Gray, Rachel H. 21-08- ...-~--- ...- ~• ^--_- ~...~a-~~~ ~ _,... ,~ ~o vu.- u,v y,weeua wu~n recervea oy Ine es[ate. All Property jolndyowned with the rlgM of wrvNorshlp must be dlselosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Blue Cross Blue Shield -insurance premium refund 120.93 2 Commerce Bank Checking Account No. 537061418 -valued per statement 2,473.07 3 Commonwealth of Pennsylvania -rent rebate 650.00 TOTAL (Also enter on Line 5, Recapitulation) I 3,244.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-88) SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gray, Rachel H. 21-08- This schedule must be completed and filed N the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DEB INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Regions Bank IRA No. 3381781548 -beneficiary 672.26 100.000 0.00 672.26 is son, Ray Smallen; valued per amount received 2 Prepaid funeral account 10,703.34 100.000 0.00 10,703.34 TOTAL (Also enter on Line 7, Recapitulation) 11,375.60 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PI~1500 Schedule G (Rev. 6-98) REV-7151 EX+(72-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Gray, Rachel H. 21-08- Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER AMOUNT A FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) ! EIN Number of Personal Representative(s): Street Address Clty State Zip Year(s) Commission paid 14,041.50 2. Attorneys Fees James, Smith, Dietterick ~ Connelly, LLP 1,000.00 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 53.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 75.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 15,169.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rsv-1502 FJ(+ (0.98) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-A FUNERAL EXPENSES continued ESTATE OF FILE NUMBER Gray, Rachel H. 21-08- Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-7502 EX+ (5.9g) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAx RENRN continued RESIDENT DECEDENT ESTATE OF Rachel H. FILE NUMBER 21-08- Copyright (c) 2002 form software only The Lackner Group, Inc. Form PI~r1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (8.88) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA MHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gray, Rachel H. 21-08- Include unnelmbumed medical expenses. tIr more space Is neeoeD, aDDiUOnal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PI~1500 Schedule I (Rev. 6-98) REV•1513 EX+ (9-00) SCHEDULE J cDM IN ERITANCE T~ REIT RN ANIA BENEFICIARIES U RESIDENT DECEDENT ESTATE OF I FILE NUMBER Gray, Rachel H. 21-08- NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not Llst Tres s I~ TAXABLE DISTRIBUTIONS [include outright spousal di trib ti d t f s ons, an u rans ers under Sec. 9116(a)(1.2)] 1 Ray Smallen Son IRA 8- residue 229 Winding Way Camp Hill, PA 17011 Total Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri ate, on Rev 1500 cove r 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)