HomeMy WebLinkAbout06-25-0815056041125
REV-1500 EX {06-05}
OFFICIAL USE ONLY
PA Department of Revenue Coun Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN ~
PO BOX 280601 2 1 0 8 0 0 4 9 8
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
0 4 1 4 2 0 0 8 0 7 1 7 1 9 2 2
Der;edent's Last Name Suffix Decedent's First Name M1
T I C H N E L L J A N E T M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 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
C h r i s t o p h e r E R i c e E s q 7 1 7 2 4 3 3 3 4 1
Firm Name (If Applicable)
MAR T S O N L A W O F F I L E S
First line of address
1 0 E A S T H I G H S T R E E T
Second line of address
City or Post Office State ZIP Code
REGISTER OF WILLS USE ONLY
`~_ ~
-.::,~ ~
-_ ~ --
; DATE ,r QED
_ _-_ ! P~
C A R L I S L E P A 1 7 0 1 3 ~~_;
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1 _«. r ,
Correspondent's a-mail address: crice@martsonlaw.com - __j ;:' - ,
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge 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 knowle
SIGNATUrRE-OF/P~RSON RES ON~~ FOR~TURN ~ ' I ,~/~i~ /J D~~~ y/D C;i
ADDRESS ~ T--
401 Grahams Woods Road, Carlisle, PA 17015 1558 Newville Road. Carlisle PA t7nt 5
Side 1
L 15056D41125 15056041125 J
ADDRE;iS
10 EAST HIGH STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
15056042126
REV-1500 EX
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. 1 6 2 9 7 3 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ..... .. 7.
8. Total Gross Assets (total Lines 1-7) ......................... .. 8. 1 6 2 9 7 3 0
9. Funeral Ex enses & Administrative Costs Schedule H
P ( ) .............. 9.
.. 2 7 3 1 1 9
10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I
9 9 ( ) .......... 10,
.. 6 3 3 6 3
11. Total Deductions (total Lines 9 & 10) ......................... .. 11. 3 3 6 4 8 2
12. Net Value of Estate (Line 8 minus Line 11) ....................... .. 12. 1 2 9 3 2 4 8
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................ .. 13.
14. INet Value Subject to Tax (Line 12 minus Line 13) ................ .. 14. 1 2 9 3 2 4 8
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 _ 0 0 0 15. 0 0 0
16. Amount of Line 14 taxable
at lineal rate X •045 1 2 9 3 2. 4 8 16. 5 8 1 9 6
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 1 g 0. 0 0
19.T'ax Due .............................................. ..19. 5 8 1 9 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYM
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 08 00498
DECEDENT'S NAME
7ANET M. TICIINELL
STREET ADDRESS
1000 West South Street
CITY
Carlisle STATE
PA
ZIP
17013
Tax Payments and Credits:
~. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior P+ayments
C. Discount 29.10
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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.
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E) (3)
(4)
(1) 581.96
29.10
0.00
0.00
5. If Line 1 + U_ine 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 552.86
A. Enter the interest on the tax due. (5A)
B. Enter thES total of Line 5 + 5A. This is the BALANCE DUE. (56) 552.86
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; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................
i
d ^
. rece
ve the promise for life of either payments, benefits or care? ....................................................... ^ 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ Q
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? .................................................................................................. ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE I T 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 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 ~m or after July 1, 2000:
The tax rate imposE;d 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)]. 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)
SCHEDULE E
COMMC)NWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JANET M. TICHNELL 21 08 00498
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T Bank, Checking #1084135 14,816.39
QVC, refund
893.66
Capital Blue Cross, premium refund ~ 287.25
U.S. Treasury, stimulus payment
300.00
TOTAL (Also enter on line 5, Recapitulation) I $ 16 297 30
(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
JANET M. TICHNELL 21 08 00498
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
1. Hoffman-Roth Funeral Home, balance due 20.52
Kohls, burial clothing 50.74
Funeral reception 321.68
Carlisle Memorial Service 990.25
B. ADMINISTRATIVE COSTS:
1 Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)lEIN Number of Personal Representative(s)
Street Address
City State Zip
Year{s) Commission Paid:
2. Attorney Fees Martson Law Offices, estimated
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, Cumberland County
5. I Accountant's Fees
6. I Tax Return Preparer's Fees
7. I Register of Wills, filing fee, Inheritance Tax Return
Reserved for additional probate, filing fees, etc.
1,200.00
83.00
15.00
50.00
TOTAL (Also enter on line 9, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX: + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INIHERITANCE TAX RETURN
ESTATE OF
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
JANET M. TICHNELL 21 08 00498
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Millennium Pharmacy Services, account payable 12.00
2 Sarah Todd Home, outstanding check on date of death 33.50
3 Sarah Todd Home, balance due 588.13
TOTAL {Also enter on line 10, Recapitulation) I $ 633.63
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JANET M. TICHNELL 21 08 00498
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
j TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Edward Spertzel Lineal 6,466.24
401 Grahams Woods Road
Carlisle, PA 17015
2. Robert Tichnell Lineal 6,466.24
1558 Newville Road
Carlisle, PA 17015
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
jj. NON-TAXABLE DISTRIBUTIONS:
A.. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. 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)
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in the nresenc^ ~f e3ch other, have hereunto subscriber':- ntt;^ r<~-~:es
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