HomeMy WebLinkAbout07-14-0815056051047
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes ~. County Code Year File Number
Po Box zsosol INHERITANCE TAX RETURN Z , ~,~ . _~ ,, _ ~
Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT `-~ ~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
~q~ 073~~9 08a7Zd~~ 0~19191~'
Decedent's Last Name Suffix Decedent's First Name MI
~voS~ Mks Ly7>L~ V
(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
~ 1. Original Return
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
O 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 TO:
Name Daytime Telephone Numbed
Firm Name (If Applicable)
REGIStEia'O~A'VILLSttfSE ONLY-,
First line of address
~a3 13~~~N CvU~7'
Second line of address
City or Post Office
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Correspondent's a-mail address:
,~ ~ .C" ~ ... _ i
,; -
y~ ~ ~
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CJl
.r`"
State ZIP Code I DATE FILED
!~R ~7os~4~ao
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, orrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG AT RE OF PERSON R SP NSI E FOR FILING RETURN ATE
SIGNATURE OF PREPARER OTHER THAN
DATE
ADDRESS
15056051047
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051047
15056U52U48
REV-1500 EX
Decedentr'fs Soc/i-al Securit?y N/u~mbper[~
Decedent's Name: L.~~~I ~' ~•. ~d Us C., f ~ 1 V ~ J t7'S 6 -J
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.
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6.
7. inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1-7) .......... ........................ 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9
~ ~ z~ ~. ~ ~~y. g ~
/~ a
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10.
11. Total Deductions (total Lines 9 & 10) ................................. .. 11. $ (p
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12 t ¢ ! ~ L~- j . ~''j '~
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. ~ j ' 1 ~l ~ ( . ~ ~.,
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_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0~ ~ l /~ ` 4 ~ . [~ Z
16.
,~
~ Q J .
17. Amount of Line 14 taxable j
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 • 18. •
19. TAX DUE ....................................................... ..19. Sj ~ a 1 . 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
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~~~
Side 2
15056052048 Z5D56052D48
REV-1506 EX Page 3
Decedent's Complete Address:
File Number
STREET A QRESS
~3 ,~ rr~N «u~~
~~c ~~Nic'SbUr~j~ ~~
CITY
cf v ~fvcvArdr ~ ~o~s ~
STATE ~~ ~1P D~D ' ~~
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPeralty if applicable
D. Interest
E. Penalty
(11 ~_S~ CEO (~ ~S
Total Credits { A + g + C) (2}
Total InteresUPenalty (D + E )
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.
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.
(3)
(4)
a. DD
Q. do
(5} ~ 5 ao ! a 35
(5A)
s0 ~
(5B) ~ S , (? Ca (. ~~~
Make Check Payable to: REGISTER OF W-LLS, 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? ........ ...... ^ [l/r
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 [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 + (t-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF / FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Pcr' -"bdA•'A- f /~/'O P N ~"~' + J`'E'e ~t1A~~'~ m c~,AJ`'~ ,~ . Q 29
~ 33S
• ~,qN ~ J~CeocL u ~s RNd C' ~5 h vN L-~~}-N~
(~~,~ %~~ 1 fir ~ f I ~r~N~r-~cou.~.~s ~ I I 1 357.5 a•
~ ~~ ~i~~ l C~~9sh o N t~{~-Nd ~ 559.39
~' ~ ~ ~1 ~ ~~ fi mP~ 2 .fir ~~,~>~ ~~1~~ ti,
TOTAL (Also enter on line 5, Recapitulation) I $ ~ j '~, ~ S!~
(If more space is needed, insert additional sheets of the same size)
Attachment 1 to Schedule E
Personal Property of Lydia V. Foose
It should be noted that Lydia V. Foose (who passed away at the age of 89 on
August 7, 2007) lived most of her last years in a small one-bedroom, HUD
supported apartment (at Bethany Towers, 335 Wesley Drive,
Mechanicsburg, PA 17055). (She lived the last two weeks of her life in
"skilled nursing" at Cumberland Crossings Retirement Community in
Carlisle). As such, she only had a very limited number of property items, all
of which were well used and of no value or very limited value.
The following is a list of Lydia V. Foose's property items at the time of her
death:
1. Kitchen table and four chairs, 26 years old: Estimated value $ 60.00
2. Bedroom bureau and chest, 68 years old: Estimated value $ 100.00
3. TV, 19 inch, approximately 10 years old: Estimated value $ 50.00
4. Wedding band and engagement ring (several very small
diamond chips), 68 years old, well used: Estimated value $ 50.00
5. Cedar chest, 68 years old, well used, chipped finshed,
Estimated value $ 50.00
b. White ("Rotary" model) sewing machine from the late 1930s,
well worn, motor is defective: Estimated value $ 25.00
7. Single bed with steel support frame, 10+ years old,
donated to the Salvation Army, no receipt: Estimated value $ 0.0
8. Originally unfinished pine multi-drawer chest, hand painted,
over 25 years old, well used, donated to the Salvation
Army, no receipt: Estimated value $ 0.0
9. Old bureau used for storage, old surface removed and
refinished, old Foose family item, donated to the Salvation
Army, no receipt: Estimated value $ 0.0
10. Old sofa and matching chair, over 50 years old, out of
fashion "wagon wheel" end wood design, donated to the
Salvation Army, no receipt: Estimated value $ 0.0
11. End table, matching Item 7 above, stained, Salvation
Army rejected item, put in trash: Estimated value $ 0.0
12. Credenza, to store items, donated to the Salvation
Army, no receipt: Estimated value $ 0.0
13. Two old floor lamps, one over 25 years old, the other
over 10 years old: Estimated value $ 0.0
2
Attachment 1 to Schedule E
Personal Property of Lydia V. Foose
(continued)
14. Two table lamps, both over 40 years old: Estimated value $ 0.0
15. Set of various dishes, cups, etc., all over 40 years old,
much used, donated to Salvation Army, no receipt:
Estimated value $ 0.0
16. Set of various "silverware" (stainless steel),
all over 40 years old, much used: Estimated value $ 0.0
17. Various pots and pans, at least 25 years old, much used,
donated to Salvation Army, no receipt: Estimated value $ 0.0
18. Old wooden-based ironing board, over 50 years old:
Estimated value $ 0.0
19. Small amount of personal clothes, most much used,
donated to Salvation Army, no receipt: Estimated value $ 0.0
20. Several towels, sheets, well used, donated to
Salvation Army, no receipt: Estimated value $ 0.0
21. Several costume jewelry items, pins: Estimated value $ 0.0
22. Personal photographs and pictures: Estimated value $ 0.0
Total estimated value: $ 335.00
9N~ ~ ,C3~tix' , /~'~~'i~ ~5~.
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~~ 19-~ j lv 9 ~ A l ~- ! 9 (~ 10~ - o~ 64- ~P `r,~ ~, 7a _ ~ s-
m°~~`l ~,~~a•f j~er•f ~ asp ~i~9 ~4~
n
~~t~~;~•T~ cA~-t a~~ ~~~si~~. f -, # ~a r15" ~ 34- ~ ~ 4' ~ ~ I S~$'~~ . ~~ `~ ~ 1+~t~.~
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REV-1511 EX+ (10-06)
~'~ `~ SCHEDI~LE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF ~
~
~ 1 f ,~v~
FIL ~ ;DER
~
r
~~
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
,. FUNERAL EXPENSES:
'j~e~~~4 a ~l ruNerA-! ~ r~~C~.NS~~ 5
~(
~
~ `~'75.S5`
P~9
rp X11 ~
~-NGJ~des ieu~ ~ivd C'fiArrs~ e,~
~
.
~'X,Qp,V S c',S f}Nd °t~uM b s~trl ,vim C «~~ ~~-
Ch~~es~
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City _ State _ Zip
Years} Commission Paid:
2. Attorney Fees ~ ~ ~~.,,` ~ ~
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 ~ ~) $~ ~ 4
5. Accountant's Fees
6. Tax Return Preparer's Fees
7
TOTAL (Also enter on lime 9, Recapitulation) I $ a ~Jg~ ~ 9
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
' SCNED~ILE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~ ~ (,. ~ ~ ~ FILE NUMBER
y ®os~ ~ro~~- c.~~~~s
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
(.vRr~ ~-_ 'CUo 5 ~
X03 ~ ~~~ N ~~~ f' ~o N (9 O ~o
~i(ec ~ a-~v r cs b~ ~~; ~A- ~7~-~ a ' 4~~ ~-e~
Vic-frrr ~- ~~ 1~~~c~ ~D °,~
I<It fyJPA~~W 4
~~ /rld0`7- ~ ~ ~
~ rN~S
~~1~ Ny P
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II 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 $
(If more space is needed, insert additional sheets of the same size)