HomeMy WebLinkAbout10-03-081
15056041125
REV-1500 EX (06-05)
PA Department of Revenue ~~ j ~~ `/ t'-~ / ~ OFFICIAL USE ONLY
Bureau of Individual Taxes V G f v County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1 O i 0 6 6 8
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
Date of Birth
2 0 8 4 2 5 3 1 4 0 7 0 6 2 0 0 7 1 2 0 5 1 9 5 2
Decedent's Last Name
M E N T Z E R
Suffix Decedent's First Name
J R R U S S E L L
MI
E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
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
4. Limited Estate ~ prior to 12-13-$2)
4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
QX 6. Decedent Died Testate ~ death after 12-12-82)
7. Decedent Maintained a Livin Trust
g 1
(Attach Copy of Will)
9
Liti
ati
P 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
.
g
on
roceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec
9113(A)
b
.
etween 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED
ALL
Name .
CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
W I L L I A M P D O U G Daytime Telephone Number
L A S
Firm Name (If Applicable) ~~.a
D O U G L A S L A W O F - ..}
F I C E REGI3_ fiF~R10F WILLS EfSE ONtY __
First line of address _z7 c'~
T'• r--, `~
.
4 3 W S O U T H S T _._
I
~,_ _
Second line of address ' - "
_..
--
P O B O X 2 6 1 ' ~ ,
..~--{ ..
City or Post Office State ZIP Code ~"' DATE FILE[~N
C A R L I S L E P A 1 7 0 1 3
Correspondent's e-mail address
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 then the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
DATE
ADDRESS
i\~ ~ \ \
SIGNATURE OF PREPARER OTHER TH
ADDRESS
L 15056041125
ENTATIVE
DATE
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041125
J ~~~
,J 15056042126
REV-1500 EX
Decedent's Social Security Number
oecedenYsName: Russell E. Mentzer, Jr. 2 0 8 4 2 5 3 1 4
RECAPITULATION
1. Real estate (Schedule A)
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 & Miscellaneous Personal Property (Schedule E) ... .... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Re
uested 6
q
...
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Se
t
B ....
.
para
e
illing Requested ... .... 7.
8. Total Gross Assets (total Lines 1-7)
........................ ... a.
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)
..................
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ...12.
an election to tax has not been made (Schedule J)
...........
...13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
..............
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ...14.
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .045
~ ~ ~
15
16. Amount of Line 14 taxable .
at lineal rate X .0 _ 0 ~ ~
17. Amount of Line 14 taxable 16.
at sibling rate X .12 0 ~ ~
18. Amount of Line 14 taxable 17.
at collateral rate X..15 Q ~ ~
18.
19. Tax Due
.......................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 15056042126
1 5 1 5 1 3 2
1 5 1 5 1 3 2
1 5 2 9 4 4 4
1 5 2 9 4 4 4
- ~' 4 3 1 2
- 1. 4 3 1 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
15056042126 J
REV-~ 500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Russell E. Mentzer, Jr.
STREET ADDRESS
32 Center St., Lot 16
CITY
Mt. Holly Springs
Tax Payments and Credits:
1 Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit -
B. Prior Payments
C. Discount _
3. InteresUPenalty if applicable
D. Interest
E. Penalty
File Number
0668
STATE ZIP
PA 17065
Total Credits (A +B +C) (2)
$0.00
$0 00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Total InteresUPenalty (D + E) (3) $0 00
Fill in oval on Page 2, Line 20 to request a refund.
(4) $0 00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5) $0 00
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE.
(5B) $0 00
Make Check Payab/e to.~ REG/STER OFW/LLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;
.
......................................................
b Yes No
^
.....
. retain the right to designate who shall use the property transferred or its income; .........................
t
i ...... ^
^
X
c. re
a
n a reversionary interest; or
................................... .
d ...... ^
X
. 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 one year of death ......
without receiving adequate consideration?
.....................................................................
3
D
"
^ ^
X
............
.
id decedent own an
in trust for" or payable upon death bank account or security at his or her death?
4
Di ......
^
....
.
d 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)]. 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-1508 EX + (6-98)
, ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Russell E. Me ntzer, Jr. FILE NUMBER
0668
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survi
hi
ITEM vors
p must be disclosed on Schedule F.
NUMBER
DESCRIPTION VALUE AT DATE
1.
Pennsylvania State Bank, checking and savings account- see attached OF DEATH
$7,315.16
2- Members 1st F.C.U. Checking and Savings account, see statement
$131.99
3. 2000 Chev.Truck w/230,000 miles, estimated value
$1.800.00
4- 2002 Chrysler SW
$5, 000.00
5- 1976 Princess Mobile home (worthless)
$0.00
6. 1982 Chevy pick up (worthless)
$0.00
~- Personal property
$400.00
$- Fraternal Order of Eagles, death benefit
$500.00
9. Pennsylvania State Bank, safe deposit box rental refund
$4.17
TOTAL (Also enter on line 5 Recapitulation) I $
(If more space is needed, insert additional sheets of the same size) 15 151 32
REV-1511 EX + (12_gg~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Russell E. Mentzer, Jr.
ITEM
NUMBER
A
B.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE MUNFILE MUN BER
0668
Debts of decedent must be reported on Schedule I.
FUNERAL EXPENSES:
1. Hoffman Roth Funeral Home
2 Westminster Cemetery
3. Carlisle Memorial Services
4. BIC Kitchen Fund -funeral lunch
DESCRIPTION
ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Russell E. Mentzer, Sr.
Social Security Number(s)IEIN Number of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission Paid:
2. Attorney Fees Douglas Law Office
3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation}
Claimant
Street Address
City
State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills
5• Accountant's Fees
6• Tax Return Preparer's Fees
~ Evening Sentinel, advertising
8. Cumberland Law Journal, advertising
9. Mabel Sattison, tax bill
10. Evening Sentinel, last bill
11. David Cleland, lot rent on mobile home - 13 months
12. Met-Ed, electric bills on mobile home - 12 months @$230
13. Yellow Breeches EMS
14. Leffler Energy, heating oil
15. Register of Wills, filing fees
TOTAL (Also enter on line 9, Recapitulation)
$6, 915.25
$1,355.00
$1,310.00
$100.00
$900.00
$60.00
$166.60
$75.00
$21.32
$48.80
$2,990.00
$392.46
$66.69
$793.32
$100.00
A
lit more space is needed, insert additional sheets of the same size)
AMOUNT
15,294.44
REV-1513 EX + tg_pr~i
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE nF
SCHEDULE J
BENEFICIARIES
Russell E. Mentzer, Jr.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2))
1. Chris Tina Mentzer
c/o Russell Mentzer, Sr.
37 Kenwood Ave., Carlisle, PA 17013
2. Russell E. Mentzer, Sr. and Betty Mentzer
37 Kenwood Ave.
Carlisle, PA 17013
FILE NUMBER
0668
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal ~r~c~~h~-er
Lineal - ~~~~-~ j ~
AMOUNT OR SHARE
OF ESTATE
k ~ S ~, aL v..sz_
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
11. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space Is needed, Insert additional sheets of the same size)