HomeMy WebLinkAbout09-04-08150560411 7
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TA RETURN g"~D 2
PO 60X.280601 2 1 0 8 J
Harrisburg, PA 17128-0601 RESIDENT DE EDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death D to of Birth
180 58 9071 05 04 2008 09 09 1962
Decedent's Last Name Suffix D cedent's First Name MI
PLAYER AMELA L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Souse's First Name MI
PLAYER OHNNY
Spouse's Social Security Number THIS RETURN M ST BE FILED IN DUPLICATE WITH THE
R GISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X 1. Original Return ~ 2. Supplemental Return
4. Limited Estate _.- 1 qa. Future Interest Compromise
(date of death after 12-12-82)
6 Decedent Died Testate ~ Decedent Maintained a Living Trust
li-- ~ (Attach Copy of Trust)
(Attach Copy of Wilq
9. Litigation Proceeds Received 1 D, Spousal Poverty Credit ((date of death
between 12-31-91 and 1-1-95)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. nLL c~
Name
JERRY A. WEIGLE ESQUIRE
Firm Name (If Applicable)
WEIGLE & ASSOCIATES, P.C.
First line of address
126 EAST KING STREET
Second line of address
City or Post Office
SHIPPENSBURG
~ ! 3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
L TAX INFORMATION SHOULD I
Daytime Telephone Number
717 532 7388
State ZIP Code
PA 17257
TO:
REGISTER OF WILLS USE ONLY
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Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying , chedules 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 based on all information of which preparer has any knowledge.
SI AT RE OF PERSON RESPONSIBLE FOR FILING RETURN ~ ATE ~~
Debra A. Morni gstar `"I/{
ADDRESS
6 ntain Lane, Newburg, P 1724
GNATU OF EPA ~~ HAN~EP ES NTA DATE
Jerry A. Weigle Esquire ~` - ~ ^-~
ADDRES~1 1 - f
126 (/East King Street, Shippensbu , PA 17257
Side 1
1556041147
15056041147
J
J
15D56O421~48
REV-1500 EX Decedent's Social Security Number
1 8 0 5 8 9 0 7 1
~ecedenrsName: Pamela L. Player
REC APITULATION
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.
7,101.97
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 No_n-Probate Property
. (Schedule G) ~ I Separate Billing Requested..... ....... 7.
7,101.97
8. Total Gross Assets (total Lines 1-7) .............................................................. _..... 8.
-_
- -- 7,538.94
9. Funeral Expenses & Administrative Costs (Schedule H) .............................. ....... 9.
5,468.61
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..................... ....... ... 10.
13,007.55
11. Total Deductions (total Lines 9 & 10) .............................._.......................... .._.... . 11.
-5,905.58
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.
-5,905.58
14. Net Value Subject to Tax (Line 12 minus Line 13) .....................................
_
--_ ___ ........ . 14.
TA __ _ _
X COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116 0 0 15. 0 0 0
(a)(1.2) X .00
16 . Amount of Line 14 taxable 0 0 16. 0 0 0
at lineal rate X .045
17 . Amount of Line 14 taxable 0 0 0 17. 0 0 0
at sibling rate X .12
18 . Amount of Line 14 taxable 0 0 0 18. 0 0 0
at collateral rate X .15
19.
0.00
19 . Tax Due ............................................................__............................__........ ....... ...
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
15D56D42148 15D56D42148
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Pamela L. Player _
STREET ADDRESS
Claremont Nursing Home
CITY
Carlisle
File Nur{~ber 21-08-
__ -_
___ __ _ __
__ 'STATE I ZIP
i PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
g. Prior Payments
__ _
C. Discount 0.00
3. InterestlPenalty if applicable
p. Interest
E. Penalty
Total credits (A + B + C)
Total Inte
q. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYN
Check 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 theTAX DUE.
A, Enter the interest on the tax due.
g. Enter the total of Line 5 + 5A. This is theBALANCE DUE
Make Check Payable to: REGISTER
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACI~
(1) 0.00
(2) 0.00
alty (D + E) (3)
(4)
(5) 0.00
(5A)
__ __ __
(5B) Q .
WILLS, AGENT
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 :............................................................................ ~ ' x!
b. retain the right to designate who shall use the property transfer ed or its income :................................ ~ x
d. rece ve the p olmise fortlife of a ther payments, benefits or care ..............:..................................:........ II I x
2. If death occurred after December 12, 1982, did decedent transfer pr perty within one year of death without
receiving adequate consideration? ............................................................._................................................... I ' x I~
3. Did decedent own an "in trust for" or payable upon death bank acco nt or security at his or her death?......... I ~ x ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST CO PLETE 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 im osed 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 o transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exempta transfer to a su iving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving s ouse 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 y ars 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 li eal 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 s blings 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 c mmon with the decedent, whether by blood or adoption.
' Rev-709 EX+16.98)
SCHEDULE
CASH, BANK DEPOSITS, 8~ MISC.
PERSONAL PROPE TY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Player, Pamela L. 21-08-
Include the proceeds of litigation and the date the proceed were received by the estate.
All property jointly-owned with the right of survivorship m st be disclosed on schedule F.
VALUE AT DATE
ITEM DESCRIPTION OF DEATH
NUMBER
1 Disability benefit -final check 800.00
2 The Hartford -refund 45.00
3 U. S. Treasury - 2008 economic stimulus payment 306.00
4 Wal Mart -final pay checks 249.53
5 Wal Mart -vacation pay 05-09-2008 232.83
6 Wal Mart 401(k) Plan 5,468.61
TOTAL (Also en r on Line 5, Recapitulation) 7,101.97
(If more space is needed, additional pages of the sa a size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+(12-99) SCHEDULE
FUNERAL EXPENS S &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN ADMINISTRATIVE C STS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Player, Pamela L. 21-08-
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) ! EIN Number of Personal Representative(s):
Street Address
City State Zi
Year(s) Commission paid
2. Attorney's Fees Weigle & Associates, P.C.
3. Family Exemption: (If decedent's address is not the same as claimant' ,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
7,173.94
350.00
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 15.00
See continuation schedule(s) attached
TOTAL (Also enter o line 9, Recapitulation) 7,538.94
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
' Rev-1502 EX+16-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE
FUNERAL EXPE
continued
Player, Pamela L.
FILE NUMBER
21-08-
NUM ER DESCRIPTION AMOUNT
1 Hoffman-Roth Funeral Home 4,858.94
2 Osiris Holding of PA -monument 2,315.00
Subtotal ~ 7,173.94
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98)
' Rev-1 ~02 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H- 7
OTHER
ADMINISTRATIVE C S1
continued
Player, Pamela L.
FILE NUMBER
21-08-
NUM ER DESCRIPTION AMOUNT
1 Register of Wills, Cumberland County -filing Insolvent A Inheritance Tax Return 15.00
Subtotal I 15.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98)
__ _ _
' Rev-112 EX+(6-98)
SCHEDULE
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES 8~ LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Plaver, Pamela L.
Include unreimbursed medical
ITEM DESCRIPTION
NUMBER
1 Claremont Nursing Home -proceeds of 401(k) Plan
FILE NUMBER
21-08-
VALUE AT DATE
OF DEATH
5,468.61
TOTAL (Also en er on Line 70, Recapitulation) 5,468.61
(If more space is needed, additional pages of the s me size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
' REV-1513 EX+(9-00) !i
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Player, Pamela L.
RELAT
NAME AND ADDRESS OF DE
NUMBER PERSON(S) RECEIVING PROPERTY Do Not
TAXABLE DISTRIBUTIONS [include outright spousal
I. distributions, and transfers
under Sec. 9116(a)(1.2)J
Not relevant as estate is insolve>#t.
FILE NUMBER
21-08-
HIP TO SHARE OF ESTATE AMOUNT OF ESTATE
iNT ,_` (Words) ($$$)
Total
Enter dollar amounts for distributions shown above on lines 15 through 8, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH N ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
v.vv
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS O LINE 13 OF REV-1500 COV
Form PA-1500 Schedule) (Rev. 6-98)
Copyright (c) 2002 form software only The Lackner Group, Inc.