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Home My WebLink About06-03-0815056051047 REV-1500 EX (Oi3-05) ~.~{wIA~ U~E~NLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHER4TANCE TAX RETURN - - Harrisburg, PA 11128-0601 RESIDENT DECEDENT 2 1 0 7 0 1 1 6 1 ENTER DECEDENT INFORMATION BELOW ~ ~~_~ ~~ Social Security Number Date of Death Date of Birth 20 8 42.2656, 1 Z 18 2007 040 -5191 9 Decedent's Last Name Suffix Decedent's First Name MI 0 F F L E Y _ C,_H A R L 0 T'T;E Y (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 INAPPROPRIATE OVALS BELOW ,~ 1. Original Return 2. Supplemental Return '` 3. Remainder Return (date of death prior to 12-13-82) t 4. Limited Estate G 4a. Future Interest Compromise (date of ~;- 5. Federal Estate Tax Return Required death after 12-12-82) :n 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ;w"~~ 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 GONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number K E I T H 0. B R E N N E M__ A N 7 1 7' 6 9 7 ~ 2 8 Firm Name (If Applicable} ___ ~.-~ , . ~ ~ u%c~.... ~; G,~, t~~i 7 .N{ ~ SNELBAKER & BRENNEMAN PC ~ 'r'; - ~ First line of address ; rT C7 ~ ~ ~ ~ ! ~ I r ~` -~ ,~ ~ x ~~ ~ `'~ _r . 44 WEST MAI N STREET ~ ~ ~ ~ Second line of address ~_~ ~~ ~ - - ;, ;~ -r ~ _ ",7 c, ? Gity or Post Office State ZIP Code _ t .. ......... .. ~ ~ '-' M E C H A N I C S B U R G P A 1 7 0 5 5 Correspondent's a-mail address: Under penalties of perjury, I declare that 1 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 knowledgep SIG T E OF PE O ESP SIBL R IL BUR m ~ DATE Executrix cn ~ ~ > C3 _ 108 S. Walnut Street Mechanicsb r P~S.~ _.._~..~_..,_,...~.-.,.~.._._~.._.. SIGNAT E F PREPARER OTHER THAN REPRESENTATIVE DATE AGDRESS 44 W. Main Street, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 ,.-,.~ 15056052048 REV-1500 EX Decedent's Social Security Number Charlotte Y. Offley ' 2 0 8 4 2 2 6 5 6 Decedent s Name: 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, 3 9 7 7 5 6. Jointly Owned Property (Schedule F) c~ Separate Billing Requested .... ... 6. 7. {nter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C.v3 Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) .............. . .................. ... 8. 1 , 3 9 7 7 5 9. Funeral Expenses 8~ Administrative Costs (Schedule H) .................. ... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ~ 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. j , 3 9 7 75 13. Charitable and Governmental eequestslSec 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. j 3 9 7 75 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 • 16. Amount of Line 14 taxable at lineal rate x .o ~5 1, 3 9 7 7 5 16. 6 2 , 9 0 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1g. 19. TAX DUE ...................................................... ... 19. 6 2 90 20. FILL 1N THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 15056052048 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21-07-01161 Charlotte Y. Offley STREET ADDRESS ----- - 355 S. Sporting Hill Road, Apartment 59 CITY STATE zip Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ B. Prior Payments C. Discount (1) 62 90 Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (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 Z, 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. A. Enter the interest on the tax due. (5) (5A) 62.90 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 62.90 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 :.................................................................................... ...... ^ ~] 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)]. 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 j72 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) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNED~ILE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Charlott Y. Offley - 21 ~~ (h?hj 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. (If more space is needed, insert additional sheets of the same size)