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HomeMy WebLinkAbout07-11-08 (2)- ~ 15056041046 REV-1500 EX (05-04) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN Dept. 280601 Harrisburg, PA 17128-0601 - RESIDENT DECEDENT Z-- ~ ~ ~ ~ Q4" ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth „, - . °_ - ~~ al o~LOoB of oSli 30 Decedent's Last Name Suffix Decedent's First Name MI (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 ~ 1. Original Return Q 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate ~ 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number -ho_RG ~~ A't:l}fZ 1 ET T~- 4 t ~.~-;YZ2 R1 ~ _ ~~ Firm Name (If Applicable) REGISTE~F WILLS~fSE ONLY ' ' a --,-. _~ ~ First line of address by ~ ~ ' -' T. 4 - ' i ~:;. Second line of address - '-, =, _ - City or Post Office State ZIP Code I DATt Correspondent's a-mail address: /L1/tgG-rie*'(-~ ~C+/N.~~'~`b/l,Fc~C/ 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 P RSON RESPONSIBLE R FILING R URN DATE O r A 41/' u.~l D Y ADDRESS ~~/~ ~~ `t ~,r/ ~h [~a c 1 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 J EX Page 15056042047 ens REV-1500 EX Decedent's Social Security Number ~, ' ~ ~ Decedent s Name: RECAPITULATION 1. Real estate (Schedule A): ..:.. ~ ...:................................ .. ~ 1. ! f y ~ ~ : V .Q ~ O ,v - ..~. 2. Stocks and Bonds Schedule B ~ ~~ ~ 0 '~ ~. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. N ~ ±+~ c - 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. i". 5. Cash, Bank De osits & Miscellaneous Personal Pro ert Schedule E P P Y( )...... .. 5. Z ~"' ~` Z ~{ O O " 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ~ r 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. ~ ~ ~ ~ „ ?j ~ , S, 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. / r - 2 2 6 I R ~' i,3 U 9. Funeral Expenses & Administrative Costs (Schedule H) .:................. .. 9. ~"' ~ / 7 , v~0 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) .............. .. 10..""~ S p 3 ~ ~ ~ ~ O 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 6 b ~ ~ 3 ~ Q O 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ~ ~ d ~ g Y ~, 3 O 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which :•. . 0 an election to tax has not been made (Schedule J) ...................... .. 13. , , 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ~ 6 ~ ~ ~ Y . 3~ 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 .0 ~ ~ +~ ~ ~ $ "Y , ~ o 1s. ~ Z o 3 , ~ - ~ 17. Amount of Line 14 taxable at sibling rate X .12 . 17. 18. Amount of Line 14 taxable at collateral rate X .15 • 18. r ' 19. TAX DUE ... ................... .. 19. 1 ~ Z:d ~ . 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O ppDRES`. Due 1 Iditslp gpoue prior .Disc ~teresl ). Inte t, per If Line E li Lit A. E B. Side 2 15056042047 15D56042047 t EX Page 3 ~r~ent's Complete Address: File Number iE NT'S NAME w~•~l~ a~, R. mar; e~-4- - _ _ _ _ _ - - - -_ _ - - 7ADDRESS Y 3 ~ Y_ GGc.e c ~~•t c~ t_ ~r _ - - .' - __ _ --- _. -- _-__7-- - - ___ __ ___ __~ STATE .~~ ZIP ~ ~Q I Payments and Credits: 3x due (Page 2 Line 19) (1) ~. Zo 3. ~` Spousal Poverty Credit _ _-_ Prior Payments .Discount - -_ _ ---- - -- _- --- -- Total Credits (A+ B + C) (2) InteresUPenalty if applicable D. Irterest E. Penalty -" _ Total InteresUPenalty (D + E) (3) 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. (4) 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. D (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) '~ Z b 3 , 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 I 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 fife 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 (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. f REV-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA ~ REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ,~-/~ FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (If more space is needed, insert additional sheets of the same size) ~ rx. 197 ,ne _ 1 - ) :- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT STATE OF SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY 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. C~r„~i-Zyv~~ ~Anl~ c~c~c.~~ Ct~caon't I Z. /ur.~r~~*,..t ~o~..yt~te(c~ ~/vaD~1 ~Zy~oz3~, ~' 3, ~uv TOTAL (Also enter on line 5, Recapitulation) I $ 2~- ~ ~ 3 ~ (If more space is needed, insert additional sheets of the same size) ad ~2 n~T /- ~ ..:X.(1.97) ~,.,~. I,, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS 8r. MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF7HETRANSFEREE,THEIRRELATIONSHIPTODECEDENTANDTHEDATEOFTRANSFER. ATTACHACOPYOFTHEDEEDfOFREALESTATE. DATE OF DEATH VALUE OF ASSET °k OF DECD'S INTEREST EXCLUSION iFAa~icr~e TAXABLE VALUE ,. ~G ~P/w~~f ~~.~ ~26,BY/.do ~~ ~26 Byl.~ ~ 2 , S 12 i4 ~} G ~u/wa ~o~i „~' Z ~~ 03 Z. Sa I Oo ~ 2 } 0 3 2 . TOTAL (Also enter on line 7, Recapitulation) I S ~ ~ ~ ~' ~. 3 ~ (If more space is needed, insert additional sheets of the same size) S0 pEV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. B. 1 2. 3. 4. 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State _ Zip Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant ~~/JJ//ff/r~t'~ /~!~/t~CC4- ----_--------- -- - --- Street Address _ ~~ l Y -. C ~_C ZK ut ~. ~~f /n- - ---- --- City C~~,4 f7~lr State ~/T_Zip _~~~~ Relationship of Claimant to Decedent SO~_ Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) ,~ ~'oo ,$' 3, odo ~ 36Y 7. ~~ REV-~ 512 EX+ (~ p-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDULE 1 DEBTS Of DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. tir more space is needed, insert atltlftional sheets of the same size) TAXES ARE IN ESCROW, FORWARD TO MORTGAGE CO. 'LEASE SAND BOTH COPES OF BILL W/SASE FOR RECEIPT arns~e ro; MARIE HUGER, TREASURER 230 S SPORTING HILL ROAD MECHANICSBURG, PA 17050 :sc: ASSESS.NO -10007582 MAP NO: 10-21-0277-176 4314 CHESTNUT STREET ACRES 250 DEED 0021 81 01 1 30 OAKWOOD PARK LOT2PB15PG60 Residential Building RESIDENTIAL rnx MARIETTA, WILLIAM R Wren 4314 CHESTNUT STREET CAMP HILL PA 17011 ice MARCH $ APRIL: MON i} TUES 9-4:30 ,Duns: WED 8~ THURS 9-12 MAY & JUNE: MON,WED,THURS 9-12 CLOSED FRIDAYS '(717)737-4822' TIUC CULLEGTOR COPY BIII NO: 6740 Control No: 010 -007551 zu11s a~os tmsntt otr HM I Estate Ta1xN Biil Date: 3/01 /2008 Assessed Land Improvement Mineral Tot Valued 27,830 117,43() 0 145 260 COUNTY OF C1111BEALAND, PENNSYLY Diaeo~r~t Rated .00228500 .0022850() 2 } 10 } CpUNT)r R B 63.59 268.3:5 325.28 331.92 365.11 Rates .00018000 .0001800() g } i0 } COONT)r LIB 5.01 21.14 25.63 26.15 28.77 70'YYNSItTP OF MAMPDE]!I Rates .000180001 .0001800() 2 } 1p } MONK. R/B 5.01 21.14 25.63 26.15 28.77 TAX AMOUNT DUE ---> i~.~ i~e4.n ~.e6 - i! paid Oa or altar 3 O1 2008 5 01 2008 7 O1 2008 I! Paid Oa or salosa 4 30 2008 6 30 2008 ~ NOT PAD 1 8E T CLAM BUREAU FOR COLLECTION AND FIL.MKi OF A LE7i AQANST YOUR PROPBITY. ~' SEE REVERSE SIDE OF BILL FOR A BREAIO)01NN OF YOUR COUNTY TAX DOLLARS " Retum Bill with Payment. For a Receipt ,Enclose Self Addressed Stamped Envelope. a~ Citizens Bank 1-800-773-7373 Call Citizens' PhoneBank anytime for account information, current rates and answers to your questions. US002 BR291 WILLIAM R MARIETTA 4314 CHESTNUT ST CAMP HILL PA 17011-4104 Balance Last Statement Circle Gold Summary Account Account Number DEPOSIT BALANCE Checking Circle Gold Checking w/Interest 62 1818-980-9 Circle Gold Money Market 62 1818-984-1 Circle Gold Account Statement © or 4 Beginning June 05, 2008 through July 03, 2008 Contents Summary Page 1 Checking Page 2 Overdraft Line of Credit Page 3 Balance WILLIAM R MARIETTA This Statement Circle Gold Checking w/Interest 621818-980-9 10,299.69 9,460.33 14,544.65 14,563.21 Total Ck (v-J 24,023.54 - LOAN BALANCE Overdraft Line of Credit 621818-980-9 .00 .00 Credit Card" as of 02/14/08 Acct ending in 1753 .00 .00 `A statement containing details of this account will be mailed to you separately. If you have questions about your bnlnnce, ~ Total Loan Balance please refer to your detailed statement when it naives. Coupon book accounts do not receive monthly statements. .00 Monthly combined balance to waive monthly fee is 20,000.00 n Total Relationship Balance Your monthly combined balance this statement period is 24,766.62 24,023.54 o'o^ ~. ~r=y w ~ ~ r ~rn ~ ~ .... ~ O w¢'~x N ti ~ '.~ N -a a. i ~~v ~~~~ c"ac o~ ~~ Q.~a2 n ~~b.~ I'n v, ~O '.~ Al 1 ~oNs~ a~ < -~ °' "'' ~ 3 d$.9 co ~ y ~ 7 ~~~y O G ~ 7 7 4~' 0. ~ ~ O y ~O ~ v~ n~P-' ~ ~ n O a O 7 ~ b A= V'. O f9 u,ao'o cc ~ y ~ a~ 7.y ¢o ruN+' ~y T -, v ~ `< t"' w ~. ~ r;~ a~~~a ~ ro ~ ~ O ~ O d O 7 ~. -, o ~ °a rn ~. ~ ~ ~^~.~ 0 o A'w °+c~'..~ ~ ~ ~ 7 caN°' A+ N ~ ~ d N S ~ ~ y, m 5' ~. `~. a f9 A> ~ (9 G. t.fl n ~ ? O in is d 7 ~'~' `^ ^~w m c~c~ ~ ^•, m a- 0 `~° °~ a E ~, N y ~~,=^ s ~ 7 ~ O ~' ~9~ o.w no o ~ -~ ~ m~ 0 c~n3Q~ v' °' O ~ ~ p.~. ~°.°' S o °.= ~~.c iooN.~ o s ~ n w ~' O N ~. 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N ~ O,a ry is O ~= r ~ ~ ~ 7 w m N O N y h ~ ~ ~ S~' ~ !A O < c.st.w ~c°d~ c ~, c ~ n o. ~ ~ ~ ~', n. °_:w ~ c G ~, r N ~ ~ 7 n K ~ N w m~~ a~ ~ N < S ~ ro ~ c ~ ~ ~ * w O .9 ~ ^~ f. ~ ~~ G' ~ a y -~ ~ ~ ~ J ++ ~ ~ ~y VI ^^~~ w w O ~" ~ ~, r ~~ ~o O '~ ~ ~ `„3 r +~ r '~ ^ ~ ~ r ~ by r~~ yd ~ ~ ~ ~ ~ ~ ~ rte., ~ d d ~ ~ ~ ~ ~G C7 ~ ~ r ~ 9 a 9x N J ~ N ~. .- ~ ~ O 00 =.] ~ w ~ O -F' O cn O ~ N N N ~ ~.1 O ~ N ~ ~ U o u` O u' O ~ 'o pO o ~ ~ ~ W ~ .~-~ w ~ N ~, O ~ w ~a ~' o a` ao l/~ J w ~ W N w N w ~ .P Z N w '~ Q ~ a °` ~ J U ~ r lh N w ;..a °° ~ ~ w ~N ,.- o0 b ~ w W ~ ~ J ~ W w W ~ A ~ ~ w `^ o, o W J N N A ~ N ~ ~ ~ ` ~ N [T~ r~+ ~.. ~ ~ ~ ~ ~ ~~ ~~ ~; ~d ^ N ~ ~ ' z z~ b d ~ rx7 r~ ~ t" z x n-~ tJ~ r ~ N rn ~ J N W V ~ W O Q Vl ~ N ~ r r ~ ~ J w -P ~ ~ ~ O M .A cn -.] cr a o ~ G b A .t+ ~ ~o w U A W O .b -a ~• ~ ~ n O -~ n w ~ 9 w °' ,.' ~ ~ o ~ ~ A ~ ~ C D= A ~ ~' 7 . ~ ~ O C B ' N b ~ "/- / 7 CJ I 1 ~ J ~ ~~ Q N ~ V ~ r ~ r~ _ w .a ~ C r b G (~7 C~9 [D r C 0 ~ ~ O_ ~ o~ .+~ C v ~ Z O rNc N ~ n 9 o ~ CD w -C r. N d O ~ O N O .~ o Q^ r W M O J N ~ O H O of ~ rr n /~ ~~ O ~ ~- G 7 in W ° a Q ~ ~ ~ ~I ~ ~ ~ o- ~ ~ ~ ~ ~• rr~ ° ~ b 0 ~ ~ r WReset Form _...~a INVENTORY REGISTER OE WILLS OF Cumberland COMMONWEALTii OF PENNSYLVANIA ~ SS COUNTY OF C(JUNTY, PENNSYLVANIA File 00045 Personal Representative(s) ofthe Estate of W'lliam R. Marietta deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I verify that the statements made in this Inven- ~~ ~ ~,~~~ l ~ ~ ~~z~ tory are true and correct I understand that false state- ments herein are made subject to the penalties of ~ w.~ ~j ~,~ ~Z 1~~` _ cz2-C~i l8 Pa.C.S. § 4904 relating to unsworn falsification to / authorities. Attorney -- (Name) none (Supreme Caurt LD. No.) (Address) (Telephone] DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO. 2 January 2008 4314 Chestnut Street, Camp Hill, PA (7011 FIGURES MUST BE TOTALED Residential Real Estate, 4314 Chestnut Street, Camp Hill, PA 17011 Checking Account, Citizens Bank Furniture & Household Goods t'~ _ ]= ,. C~ t ~- L - ', \ ~ ~ r 4i ~~ [__ ~~ f. - ___~ • _t ~J. U _ ~ ~a: "7 ~~ LY C=:J _; CU ~-.a (Attach additional sheets as Heeded) TOTAL: $145,300 $24,023 $3,000 $172,323 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such tigures should not be extended into the total of the Inventory. /See 10 Pa. C.S. y~ 3301(t~)) Fo~~m R66'-09 rer. 10.13.06