HomeMy WebLinkAbout06-17-08REV-1500 EX + (g-pp)
COMMONWEALTH OF REV 15 0 0 OFFICIAL USE ONLY
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1 - O s 0 3 4 0
COUNN CODE YEAR ~~ NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z EARLEY EVELYN M. AKA EVELYN EARLEY
W DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 7HIS RETURN MUST BE FILED IN DUPLICA7E WRH THE
REGISTER OF WILLS
V 03/15/2008 03/26/1924
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
w
F X^ 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death priorto 12-13-82)
Q
~ a Y
~ 4. Limited Estate
~ 4a. Future Interest Compromise (date of death after 12-12-s2)
~ 5. Federal Estate Tax Retum Required
v
~ a m
0 6. Decedent Died Testate (Attach copy of will)
~ 7. Decedent Maintained a Living Trust lAUacn copy of trust)
_ 8. Total Number of Safe Deposit Boxes
a
a
~ 9. Litigation Proceeds Received
~ 10. Spousal Poverty Credit (date of dean t,etween ~ z-31-st and t-t-ss)
~ 11. Election to tax under Sec. 9113(A) (Attach sch o)
~, THIS SECTION: MUST BE COMPtETED. ALL C(1RRESPOMDENCE'AN D CONFIDENTIAL TAX INFQRMATION SHOULD BE DIRECTED TO:
Z
w NAME COMPLETE MAILING ADDR ESS
°z MURREL R. WALTERS III ESQ.
ti FIRM NAME (If Applicable)
~ 54 EAST MAIN STREET
o TELEPHONE NUMBER
~ 717-697-4650 MECHANICSBURG, PA 17055
1. Real Estate (Schedule A)
(1) OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2)
ti~
3. Closely Held Corporation, Partnership orSole-Proprietorship (3) t. ~, ~ ~;~ -
? ~
4. Mortgages & Notes Receivable (Schedule D} (4) '
5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) 82,189.02 ' ~_7~r-
(Schedule E) ~ ~ "•~ ,I
Z
O
6. Jointly Owned Property (Schedule F)
(6)
5,157.16:
~- - ,-~,.
::~ - r , `-
Q ~ Separate Billing Requested _ t_~ ~
~ ..
J
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) _
~
t--
a
Q
U
W
(Schedule G or L) G~
8. Total Gross Assets (total Lines 1-7) (8) 87,346.18
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 12,639.22
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 230.40
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental BequestslSec 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)
(11) 12,869.62
(1P) 74,478.56
(13)
(14) 74,476.56
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
t-
~ 16. Amount of Line 14 taxable at lineal rate 74,476.56 X .045 {16) 3,351.45
d 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00
0 18. Amount of Line 14 taxable at collateral rate 0.00 X .15 (18) 0.00
Q 19. Tax Due (19) 3,351.45
> > BE SURE'TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
139 APPALACHIAN DRIVE
CITY STATE ZIP
CARLISLE PA 17015
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 167.57
(1) 3,351.45
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total InterestlPenalty (D + E )
4. 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 fs greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
167.57
(3) 0.00
(4) 0.00
(5) 3,183.88
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (58) 3,183.88
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 property transferred : ........................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ ^X
c. retain a reversionary interest; or ...................................................................................................... ^ 0
d. receive the promise for life of either payments, benefits or care? ............................................................. ^ ^X
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... ^ ^X
3. Did decedent own an "in trust 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? ....................................................................................................... ~ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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.
SIGNATURE OF PERSON RESPON~I6LE FOR FILING RETURN _ DATE'
u/~ , /~~
AUUKt55 ROBERT EARL , 601'77, NEW KINGSTOWN, PAV17072
JOHN A. EARL , 111, 155 WILLOW MILL PARK ROAD, MECHANICSBURG PA 17050
SIGNATURE~~P ~TH HAN REPRESENTATIVE ~ 11/~
HUUKtJ~ ~Mt~RRpL R. WALTERS, 111, ESQ.
54 AST MAIN STREET, MECHANICSBURG PA 17055
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)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 0% [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 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 decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. Asibling 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-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
.EARLEY. EVELYN M.. AKA EVELYN EARLEY 21 08 0340
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2007 FEDERAL 7AX REFUND 153.00
2. FEDERAL TAX REBATE 300.00
3. PHOENIX 73,935.64
MUTUAL FUND
4. PHOENIX 7,072.21
1 RA
BENEFICIARY ROBERT E. EARLEY
5. 8 DAY JEROMES 8~ DARROW CLOCK 400.00
NOT FUNCTIONING
6. PEERS 328.17
PRORATED PAYMENT AND INSURANCE PREMIUM ASSISTANCE
TOTAL (Also enter on line 5, Recapitulation) I $ 82,189.02
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE
EARLEY. EVELYN M.. AKA EVELYN EARLEY 21 08 0 40 _
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
ADDRESS
TIONSHIP TO DECEDENT
SURVIVING JOINT TENANT(S) NAME
A. ROBERT E. EARLEY
B
C
JOINTLY•OWNED PROPERTY:
BOX T7
NEW KINGSTOWN, PA 17072
SON
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTERESI
1. A. 7/23/90 MST BANK 6,281.42 50. 3,140.71
CHECKING ACCOUNT
2. A. 12/16!83 MST BANK 4,032.90 50. 2,016.45
SAVINGS ACCOUNT
TOTAL (Also enter on line 6, Recapitulation) I $ 5,157.16
(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
EARLEY. EVELYN M.. AKA EVELYN EARLEY 7 08 0340
Debts of decedent must be reported on Schedule [.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 9,197.22
2. CARLISLE MEMORIAL SERVICES, INC. 200.00
TOMBSTONE ENGRAVING
8
2.
3.
4.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) ROBERT E. EARLEY AND JOHN A. EARLEY, III
Social Security Number(s)/EIN Number of Personal Representative(s) (RENOUNCED)
Street Address
City State Zip
Year(s) Commission Paid:
Attorney Fees MURREL R. WALTERS, III, ESQ.
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
Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY
5 ! Accountants Fees
6.
7
Tax Return Preparers Fees
2,975.00
267.00
TOTAL (Also enter on fine 9, Recapitulation) I $
12,639.22
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98}
SCHEDULE i
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
IN R SI DENTEDE EDENTRN MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
EARLEY. EVELYN M.. AKA EVELYN EARLEY 21 08 0340
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MASTERCARD 22.04
2. VERIZON 18.36
TELEPHONE
3. SUBURBAN PROPANE 170.00
FUEL
4. DR. PERNA 10.00
OFFICE VISIT CO-PAY
5. SPIRIT PHYSICIANS 10.00
OFFICE VISIT CO-PAY
TOTAL (Also enter on line 10, Recapitulation) I $ 230 40
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (g-nm
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LORI FV F\/FI Vnl AA OK~ F\/FI VNI F~RI FV ~~ nu n~~n
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. ROBERT E. EARLEY Lineal 24,825.52
BOX 77
NEW KINGSTOWN, PA 17072
2. JOHN A. EARLEY, 111 Lineal 24,825.52
155 WILLOW MILL PARK ROAD
MECHANICSBURG, PA 17050
3. PEGGY A. NAILOR Lineal 24,825.52
11 HOOVER ROAD
CARLISLE, PA 17015
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART I[ -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)