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Home My WebLink About07-21-08 15056041103 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 ~ Q ~~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ I o ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 195-16-4563 06232007 02111922 Decedent's Last Name CROSSLEY Suffix Decedent's First Name JOHN (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 MI J MI FILL IN APPROPRIATE BOXES BELOW 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 ^ 6 Decedent Died Testate ^ 7 death after 12-12-82) Decedent Maintained a Livin Trust 8 T l N t b f S f D i . . g . o um er o a a e epos t 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 TO: Name Daytime Telephone Number GARY J• CROSSLEY, EXECUTQR 717-697-7174 Firm Name (If Applicable) First line of address 556 ALLENVIEW DRIVE Second line of address City or Post Office MECHANICSBURG State ZIP Code PA 17055 REGISTER OF WILLS USE ONLY n(~ 3 V ~7 7 ~ '~_~ . G_. r~-- .~ . z ~ fU - ~d n ~ - D~rF~ED z, `-~ .a _ t~1 acs Correspondent's e-mail address: ~ C~~SSI E'~W t~~ rl Zit ~ ~ ,_ _. . ,_ 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 lete. De aration preparer of r than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P N RES NSI FOR FIL RETURN DATE ADDRESS OFJjREP~ER OTHER THAN REPRESENTATIVE DATE ADDRESS 120 NORTHGATE DRIVE, CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041103 7W46471.000 15056041103 J 15056042104 REV-1500 EX Decedent's Social Security Number Decedent's Name: JOHN J. CROSSLEY 195-16-4563 RECAPITULATION 1. Real estate (Schedule A) 1. D , D D 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 i3< Miscellaneous Personal Property (Schedule E) . 5. 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. 9. Funeral Expenses & Administrative Costs (Schedule H) . g. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). 10. 11. Total Deductions (total Lines 9 8 10) . 11. 12. Net Value of Estate (Line 8 minus Line 11) 12 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. 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 rateX .045 5833.52 17. Amount of Line 14 taxable 16. 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 15056042104 7 W4648 1.000 15056042104 D•00 O.OD O.OD 8345.00 0.00 0.00 8345.00 2347.68 163.80 2511.48 5833.52 0.00 5833.52 262.51 262.51 REV-1500 EX Page 3 Decedent's Complete Address File Number DECEDENTS NAME JOHN J• CROSSLEY STREET ADDRESS C/0 GARY J• CROSSLEY, EXECUTOR 556 ALLENVIEW DRIVE CITY STATE ZIP MECHANICSBURG PA 17 55 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 14 2 5 0.0 0 C. Discount 13.13 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 262.51 Total Credits (A + 6 + C) (2) 14 2 6 3.13 Total InteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. F111 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. (3) (4) 1400D • 62 (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 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; ^ 0 b. retain the right to designate who shall use the property transferred or its income; ^ c. retain a reversionary interest; or . ^ X 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? X 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. 539116 (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 use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~116(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. 116(1.2) [72 P.S. 538116(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. SyA116(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. 7w4671 1.000 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA SCHEDULE E INHERITANCE TAX RETURN CASH, BANK DEPOSITS, 8c MISC. RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF John J. Crossley FILE NUMBER 195-16-4563 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 NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1 Household goods, furnishings and apparel 2 Automobile 2,095.00 6,300.00 TOTAL Also enter on line 5, Reca itulation $ 8 , 3 4 5 . 0 0 7W46AD 1.000 (If more space is needed, insert additional sheets of the same size) REV-1511 E.;(+(10-x) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT CJ~NIt Vh John J. Crossley SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 195-16-4563 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT 1. Pathemore Funeral Home & Cremation Services, Inc. - cremation services and death certificates 1336.94 B• ADMINISTRATIVE COSTS: t • Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: z~ Attorney Fees 590.00 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 5. Accountant's Fees 6• Tax Return Preparer's Fees 295.00 7. Postage 8. Mileage to administer the estate - 229.4 miles x .485/mile 14.48 111.26 TOTAL (Also enter on line 9, Recapitulation) $ 2 34 7.68 ~wasnc 1.ooo (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12_p31 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF John J. Crossle SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, incl ding unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Utilies - water, sewer, electric, and trash TOTAL (Also enter on line 10, Recap ~wasnH 1.000 (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 8361 g0 163.80 w _ ~;~: J~ 1 ua~~.nffd'.;^ -~ f~ ~~ ~ 1 ~ , ,~,~ ~fwoylmvq pag~ ~./f !:~ r~ ~ `` ~ ~ oi~ouXvP.y ~ !~\ - ~~ ~ 2 '~"^ ~ ~ ~~ .~ ~IS'~p~'I ti^oNS ~ +~ 1 ~ µ ~• ~ ~~ ~~ ~. ~ w~ a~P~v~ ;~ ~~~ ~ ~ ~~ . ~. ~.,~ ~ yrx ~~ ~' ;~ ~~ ~ ~ ~~: 1 ` ., ~ ~r~ j. .~ _ ~ ~ ~ ~" ~ ~ 3 . ~ t ~ ' r } t ~ '~ a; :~ ..~/ ~ '~ ~~ '^~ ~ ~ ~ ~ .! ~ ~ ~ ~ Q ~ ~ d d T \ ~ i A ~ ~ ;,~ ~ .~ 1 ~ ~ ~ ..__ ~