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Home My WebLink About09-10-08 (2)'REV-i500EX~6-00) FILE THIS RETURN WITH: ReV-1500 OFFIUTAL USE ONLY COMMONWEALTH OF PE"NSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN -_.W .v... _ ~, FILE"UMBER ~- . __ Pw 21 _ 2008 0854 DEPT. 280601 RESIDENT DECEDENT COUNTY CODE YEAR NUMBER HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ z KAIN, GRACE A. ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE v W 12-17-2007 11-04-1915 REGISTER OF WILLS ~ (IF APPLICABLE) SURVNING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER w X 1. Original Retum 2. Supplemental Return 3. Remainder Retum car.aa.m,~o,ro,x-,~ x~Y 4. Limited Estate 4a. Future Interest Comprise cdeie oraeatn aee~ ~z-~z-az> 5. Federal Estate Tax Retum Required Waco c~ia m 6. Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a Living Trust ~nnaon a coot or Ttis~) 8. Total Number of Safe Deposit Boxes a 9. Litigation Proceeds Received 10. Spousal Poverty Credit taa~e or aeatn eetwee~ ~z-s~-e~ aoa ~-~-as> D 11. Election to tax under Sec. 9113(A) (mcn sin o~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: F NAME COMPLETE MAILING ADDRESS Z w ANTHONY T. MCBETH 407 NORTH FRONT STREET z CAMERON MANSION p FIRST FLOOR a H W HARRISBURG, PA 1710 1 ~ FIRM NAME (If Applicable) O ~ TELEPHONE NUMBER na 717-238-3686 ~ r ~ ~:J 1. Real Estate (Schedule A) (1) f "il { $0.00 -~~ OFFICI~ISE Off c:~7 2. Stocks and Bonds (Schedule B) (2) $0.00': ) ? ~ ..._. , ~~ , -i ~ `• ~ ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) $0.00 ~ ;=~; "y T c' ~ ~ ~~7 i _ 4. Mortgages & Notes Receivable (Schedule D) (4) $0.00 i J , ".~,_.. i, r .l Z r__- "r 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5) $77,372.00 ~ -- ~ `i ,_ .:") Q 6. Jointly Owned Property (Schedule F) (6) $0.00 '~~ J ~ Separate Billing Requested ~ ' H 7. Inter-Vivos Transfers & Misc. Non-Probate Property (7) $0.00 d a (Schedule G or L) ..........................................................: W 8. Total Gross Assets (total Lines 1-7) (8) $77,372.00 ~ 9. Funeral Expenses & Administrative Costs (Schedule H) (9) $7,988.00 10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) $12,910.00 11. Total Deductions (total Lines 9 & 10) (11) S2o 8 8 00 12. Net Value of Estate (Line 8 minus Line 11) (12) $56,474.00 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) 0 00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $56,474.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES W 15. Amount of line 14 taxable at the spousal tax ~ rate, or transfers under Sec. 9116 (a)(1.2) x (15) $0.00 W ~ Y a U~ 16. Amount of line 14 taxable at lineal rate $56,474.00 x .045 (16) $2,547.00 = a 17. Amount of line 14 taxable at sibling rate x 12 (17) $0.00 V~ U ~ 18. Amount of line 14 taxable at collateral rate x 15 (18) °;0 00 x Q ~ 19. Tax Due H Q 20 (19) $2,547.00 . ~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < decedent's Complete Address: STREET ADDRESS MESSIAH VILLAGE 100 MOUNT ALLEN DRIVE CITY MECHANICSBURG STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty (1) $2,547.00 Total Credits (A + B + C) (2) 0 00 Total Interest/Penalty (D + E) 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 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. Make Check Payable to: REGISTER OF WILLS, AGENT (3) $0.00 (4) (5) $2,547.00 (5A) (56) $2,547.00 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; X b. retain the right to designate who shall use the property transferred or its income; x c. retain a revisionary interest; or X d. receive the promise for life of either payments, benefits or care? X 2. If death occurred after December 12, 1982, did decedent transfer property within on year of death without receiving adequate consideration? B B 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 Under penalties of perjury, I are that I have examine is return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. D laration of greparer her than the personal representative is based on all the information of which preparer has any knowledge. SIGNATU OF P N SIBLE F R ING RETURN DATE ~~ ADDRESS ~~ / SIGN U E OF PRE ARER O H SENTATIVE / DATE - '~~' AD ESS / ~] / / / ~ / For dates of death on or after Jury 1, 1994 and before January 1, 1995, the tax rate (a) (1.1) (i)] on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 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 0% [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 retum 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 0% [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 4.5%, except as noted in 72 P.S. §9116(1.2) p2 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 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in cemmon with the decedent, whether by blood or adoption. ,REV-1508 EX +~(8-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMO NWEALTH OF PENNSYLVAN IA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF KAIN, GRACE A. FILE NUMBER 21-2008-0854 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. CITIZENS BANK GOLD CHECKING ACCOUNT, #610070-381-9 $77,372.00 TOTAL (Also enter on line 5, Recapitulation) ~ $77,372.00 (If more space is needed, insert additional sheets of the same size) REV-t511 EX +,(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF KAIN, GRACE A. FILE NUMBER 21-2008-0854 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MALPEZZI FUNERAL HOME $3,894.00 2. MESSIAH VILLAGE DINING SERVICES (FUNERAL LUNCHEON) $756.00 3. REVEREND CIAMPA $150.00 4. REVEREND EBERSOLE $100.00 B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees: ANTHONY T. MCBETH, ESQUIRE $2,500.00 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 $249.00 5. Accountant's Fees 6. Tax Return Preparer's Fees $105.00 7. Advertising: THE SENTINEL $159.00 CUMBERLAND COUNTY LEGAL JOURNAL $75.00 TOTAL (Also enter on line 9, Recapitulation) ~ $7 988 00 (If more space Is needed, insert addltlonal sheets of the same size) gEV-1512 EX (12.03) SCHEDULEI DEBTS OF DECEDENT, COMMONWEALTH OF PENNSYLVANIA MORTGAGE LIABILITIES, ~ LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (CAIN, GRACE A. FILE NUMBER 21-2008-0854 Record debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses ITEM NUMBER DESCRIPTION AMOUNT 1. MESSIAH VILLAGE $11,580.00 2. ALERT PHARMACY $1,185.00 3. PAUL D. DALBY, D.P.M. $35.00 4. PINNACLE HEALTH SYSTEMS $50.00 5. HOLY SPIRIT HOSPITAL $50.00 6. PHILHAVEN $10.00 TOTAL (Also enter on line 10, Recapitulation) ~ $12,910.00 (If more space is needed, insert additional sheets of the same size) REV 1513 EX + (9-00)) SCHEDULE) COMMNHERITANCECTAXRE URNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF KAIN, GRACE A. FILE RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. W. BARRY KAIN 207 HILLCREST LANE SON 50% ELIZABETHTOWN, PA 17022 2. RAYMOND KAIN 6337 NORTH POWDERHORN ROAD SON 50% MECHANICSBURG, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, 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 GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $0.00 qtr more space Is neeaea, Insert aaaltlonal sheets or the same size)