The URL can be used to link to this page

Home My WebLink About08-07-08 15056051058 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes ~ ~; County Code Year File Nurnber Po Box 2aosol ~ INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT / \:~~ / ~ ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 558-94-1296 08/11 /2007 07/27/1955 Decedent's last Name Suffix Decedent's First Name MI Bohl-Fabian Louis ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse°s Last Name Suffix Spouse's First Name MI Bohl-Fabian Amy L Spouse's Social Security Number 202-42-1713 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS 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 death after 12-12-82) • 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit 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) (:UFZRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Amy L Bohl-Fabian Firm Name (If Applicable) First line of address 121 South 27th Street Second line of address City or Post Office Camp Hill Correspondent's a-mail address State ZIP Code PA 17011 REGIST'tR lii 'cViLLi.; Ut:~[ OWI'Y l_ ... I oAT[ Fl~~t_D ~~=` _~ .. Nt7 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 PERSON RESPONSIBLE FOR FILING RETURN DA •' _ '1 -_ - - -- - A DRESS - 121 South 27th Street Camp Hill PA 17011 - IG~ATURE OF PREPARER OTHER THAN~REPRESENTATIVE DATE ~, ADDRESS ! ' -- - _- 282 Lowther Street Ste 201 Lemoyne PA 17043 PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 ,_ j :~~ __.J REV-1500 EX 15056052059 Decedent's Name: LOUIS J Bohl-Fabian RECAPITULATION 1. Real estate (Schedule A) . ... ........................................ 1. 2. Stacks 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) 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) .................. ... 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. 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. 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 0 262,291.00 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 ,Q 19. TAX DUE . .........................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 Decedent's Social Security Plumber 558-94-1296 0.00 0.00 0.00 0.00 0.00 0.00 262,291.00 262,291.00 0.00 0.00 0.00 0.00 0.00 262,291.00 0.00 0.00 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number I DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Louis J Bohl-Fabian _ 558-94-1296 -- - - - _- -- - STREET ADDRESS - _ -- - --- - -- 121 South 27th Street _ _ --- -- CITY -- ~ STATE - {ZIP --- - - Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2 Credits/Payments A. Spousal Poverty Credit ___ B. Prior Payments C. Discount 3. Interest/Penalty if applicable D, Interest E. Penalty 0.00 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 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) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 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 [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)]. A sibling 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-1510 EX+ ~g..gF3) ~. il. , . ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Louis Bohl-Fabian FILE NUMBER This srhedule 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. I DESCRIPTION OF PROPERTY ITEM mcwoErHENaMEOrrHErRnNSFEReE.rHEiRReunoNSHiarooECEOeNraNO NUMBER rHEOArEOFrruNSFER nnncHncoavoFrHEOEEOFORREn~ESrnrE DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION urnaaucns~Ei TAXABLE VALUE ~ TIAA-Retirement Plan 262,291.00 100 262,291.00 TOTAL (Also enter on line 7 Recapitulation) $ I 7_62,291.00 (If more space is needed, insert additional sheets of the same size)