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HomeMy WebLinkAbout07-17-0815056041169 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 280601 INHERITANCE TAX RETURN ~~ Harrisburg,PA17128-Olil)t RESIDENT DECEDENT ~ ~ `~~ ` ~~g ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 167-40-4424 09042007 12061951 Decedent's Last Name PALSON Suffix Decedent's First Name WILLIAM (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE BOXES BELOW ® 1. Original Return 4. Limited Estate ^X 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required MI M MI _ 8. Total Number of Safe Deposit Boxes 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 T0: Name Daytime Telephone Number JACOB PALSON 717-582-2039 r,,, Firm Name (If Applicable) REGISTER~~IILLS US ~NLY - ~- '~~~~ '° ~ ~ ~ ' ; First line of address r m -- r ~ 302 SO CARLISLE STREET ~ ~ ;> y,~o~ -~ , Second line of address ,~ ~ ~ - " ~`~ .~-I ~ f'T7 ^' _~ Y f V , -. City or Post Office State ZIP COde DATE FILED W NEW BLOOMFIELD PA 17068 Correspondent's a-mail address Under penalties of perju de a that I have exam ed this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and I eGaration of arer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P P NSIBL OR FILING RETURN DATE /~ ~6 ADDRESS JA O PALSON, 302 SO CARLISLE ST, NEW BLOOMFIELD, PA 17068 ADDRE ~ ~~ AL ED WHITCOMB, 43 WEST MAIN STREET, MECHANICSBURG, PA 17055 PLEASE USE ORIGINAL FORM ONLY 15056041169 Side 1 15056041169 S 15056042160 REV-1500 EX Decedent's Social Security Number Decedent's Name: WILLIAM M PALSON 167-40-4424 RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ........................................ 2. 3, 0 2 1. 9 0 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. 12 , 7 5 8 . 0 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. 15 , 7 7 9 . 9 0 9. Funeral Ex enses & Administrative Costs Schedule H p ( ) ................ g. ..... 4 , 3 7 8 . 0 0 10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I 9 9 ( ) ........... .... 10. 2 8 2 • 6 2 11. Total Deductions (total Lines 9 & 10) .............................. .... 11. 4 , 6 6 0.62 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 11 , 119.2 8 13. Charitable and Governmental BequestslSec 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. 11 , 119.2 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 15. 16. Amount of Line 14 taxable at lineal rate x .04 5 10 , 819 .2 8 1 g. 4 8 6. 8 7 17. Amount of Line 14 taxable at sibling rate x .12 17. 18. Amount of Line 14 taxable at collateral rate x .15 18. 19. TAX DUE ........................................................ 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042160 15056042160 486.87 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21- 0 7- 0 8 2 8 DECEDENT'S NAME WILLIAM M PALSON STREETADDRESS 82 LINDA DRIVE CITY MECHANICSBURG STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 4 8 6. 8 7 C. Discount 3. Interest/Penalty if applicable D. Interest E. Penally (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box 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) (5) (5A) (56) 486.87 486.87 0.00 Make Check Payable fo: 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 : ........................................ .. ~ 0 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 "intrust 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)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 zero (0) percent [72 P.S. §9116(a)(1.1)(ii)j. 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)j. 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)j. 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-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIAM M PALSON 21-07-0828 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) 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 WILLIAM M PALSON 21-07-0828 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. (It more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WILLIAM M PALSON 21-07-0828 Debts of decedent m ust be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ MYERS FUNERAL HOME 3,048.00 B. 1 2. 3. 4. 5. s. 7. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) StreetAddress 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 StreetAddress City State Relationship of Claimant fo Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees ZIP 130.00 1,200.00 TOTAL (Also enter on line 9, Recapitulation) 15 4 , 3 7 8 . 0 0 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER WILLIAM M PALSON 21-07-0828 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) F7EV-1513 EX+ (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIA M M PALSON Ll-U /-VtSLtS RELATIONSHIPTODECEDENT AMOUNTORSHARE NUMBER NAMEANDADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE [ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2j] 1 JACOB C PALSON SON 100 302 S CARLISLE ST, NEW BLOOMFIELD, PA ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWNABOVE ON LINES 15 THROUGH 1 8, 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 B. CHARITABLE AND GOVERNMENTALDISTRIBUTIONS TOTAL OF PART [I -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) OF ~ .-= WILLIAM M. PALSON ~~, r = -- ;~-. I, WILLIAM M. PALSON, of the Township of Silver Spring, County of CumbiLland ..~ --i .. s :% and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do ~~~ make, publish and declare this my Last Will and Testament, hereby revoking and making void any and aI1 former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United States; or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this will or otherwise. 3. X11 the rest, residue and remainder of my estate, of ~~-hatsoever nature and ~;-hereso~ ~ ~- ~i~uate, I give, devise and bequeath to my son, JACOB CALEB PALSON, absolutely and in :e simple. 4. I nominate, constitute and appoint JACOB C.~I,EB P ~I.SO\, to be the Executor of this my Last Will and Testament. I further direct that :.o bond or other security be required of my personal representati~-e to guarantee faithisl performance of his duties. IN ~~'ITNESS «-HEREOF, I have hereunto set my hand and seal this ~,~ al day of ' .N+~-~ . X003. ~(~~ ~ ~.-, .~'~., d~ ~~'' (SEAL) WILLIAM M. PALSON Signed, sealed, published and declared by the above-named WILLIAM M. PALSON as and for his Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at his request, in his presence and in the presence of each other.