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Home My WebLink About09-25-08 (2)15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 2~ 08 .00718 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 198-22-9134 ` 08/21/2007 ' 09/26/1915 Decedent's Last Name Suffix Decedent's First Name MI Burkholder 'Gertrude G (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 INAPPROPRIATE OVALS BELOW 1. Original Return 2. Supplemental Return _ 3. Remainder Retum (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 _ 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) CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Duane P. Stone ' (717) 432-2089 Firm Name (If Applicable) - - r,.~ REGISTER OF 117IfjLS USE ONL~ , Law Ofcs of Duane Stone ` C? ~ , First line of address _ _ __ --~ r~°1 - `-~ "O 8 N. Baltimore Street f`:. i ~ crt ; .. Second line of address _ _ , ! - --' ~ '-: P O Box 696 -- i `~' : ~ . . : ~ .,, DATE ~.Ed • • __ City or Post Office State ZIP Code _ - _ - _ C~.S Dillsburg ' PA ! 17019 ~` Correspondent's a-mail address: Duane@StOneatlaw.COm Under penalties of perjury, 1 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. SI N RE OF PERSON ESPONSIBL O ILING TU N DATE SI NA U F PREPARER O'Fli IA EPRESENTATIVE DATE ADDRES~ , ~ 4 ~J . J~pr ~ S f ~ // .slJG1 I" S J ~/ ,/ ~ ~ G ~ / PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Genf ude G Bu~khOlder 198-22-9134 .. RECAPITULATION , _. 1. Real estate (Schedule A) ............................................ . L ' 0.00 2. Stocks and Bonds (Schedule B) ...................................... . 2.' 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. ' 0.00 4. Mortgages & Notes Receivable (Schedule D) ............................ . 4. +++++ 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . 5. 22,757.95 6. Jointly Owned Property (Schedule F) Separate Billing Requested ...... . 6. ! 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested....... . 7. ' 0.00 8. Total Gross Assets (total Lines 1-7) .................................... 8. ' 22,757.95 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. ' 2,114.00 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ................ 10. I 0.00 11. Total Deductions (total Lines 9 & 10) ................................... 11. 0.00 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 20,643.95 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ' 20,643.95 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. ' 0.00 16. Amount of Line 14 taxable at lineal rate X .0 45 ' 928.98 16. ' 928.98 17. Amount of Line 14 taxable at sibling rate X .12 ', 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 18. 0.00 19. TAX DUE ......................................................... 19. 928.98 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 t~pr_priPnt'c Cc~mnlete Address: File Number_ 20 08 '00718 __ DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Gertrude G Burkholder 198-22-9134 STREET ADDRESS 66 West Main Street CITY Newville STATE PA ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments _ C. Discount (1) Total Credits (A + B + C) (2) 3. lnterestlPenalty if applicable D. Interest E. Penalty 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 928.98 0.00 0.00 0.00 928.98 0.00 928.98 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 "intrust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 0 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 exemot 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-1502 EX+ {6-98) ~ SCifEDU1.E A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) . scNE~u~E s COMMONWEALTH OP PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (Ir more space is needed, insert additional sheets of the same size) REV-1504 EX+ {6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT E-CNEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 Schedule C-1 or C-2 (induding all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole•proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV-1505 EX+ t8-98) ~ SCI~EDULE C-1 CLOSELY HELQ CORPORATE COMMONWEALTH dF PENNSYLVANIA INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 1. Name of Corporation None State of Incorporation Address City 2. Federal Employer I.D. Number 3. Type of Business 4. Provide al! rights and restrictions pretaining to each class of stock. 5. Was the decedent empioyed by the Corporation? ................................ ^ Yes ^ No If yes, Position Annual Salary S Time Devoted to Business 6. Was the Corporation indebted to the decedent? ................................. ^ Yes ^ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes ^ No If yes, Gash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Gonsideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....^ Yes ^ No if yes, provide a copy of the agreement. 10. Was the decedent's stock sold? .. . ............................................... ^ Yes ^ Na If yes; provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? ................... ^ Yes ^ No {f yes. provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ............. ^ Yes ^ No !f yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • ~ •- • - ~ ~ A. Detailed calculations used in the valuation of the decedents stock. B. Complete copies of financal statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete addressles and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. Date of Incorporation State Zip Code Total Number of Shareholders Product/Service Business Reporting Year S70CK TYPE VotinglNon•Voting TOTAL NUMBER OF SHARES OUTSTANDING pAR VALUE NUMBER OF SHARES OWNED BY THE DECEDENT VALUE OF THE DECEDENT'S STOCK Common $ Preferred $ (If more space is needed, insert additional sheets of the same size) REV-1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-Z PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 1. Name of Partnership None Date Business Commenced Address City _ 2. Federal Employer I.D. Number 3. Type of Business Product/Service Business Reporting Year State Zip Code 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. PARTNER NAME PERCENT OF INCOME PERCENT OF OWNERSHIP.. BALANCE OF CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................. ^ Yes ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and(or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ...... ^ Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? ....................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .................................... ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • •- • - ~ ~ A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market values. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-15D7 EX~ (6-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MQttTGAGES & NOTES INHERITANCE TR7C RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 All properly jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSIT5, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. (ir more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA 1p~NTLY OWNED PROPERTY INHERITANGE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A' None B. C. JOINTLY-OWNED PROPERTY: ITEM tJUMBER L'eTTER FOR .JOINT TENANT: DATE MADE JOINT: DESCRIPTION OF PROPEP.TY (fJCLUGE NAMEvF FI~AhJCIAL EPJSTITUT,CN A4JC SANK ACGOUtiT N'vMBER OR SiMflr.R IDENTIr"Y'IhJG NUMBER. ATTAGII DEED FOR JOINTLY-FIELD REr.L ESTAT'e. DATE OF DEATH VALUE GFASSET °.%~ OF GECD~S INTEREST DATE GF DEAT'r, VALUE OF CEGEGENT'S INTEREST 1. A. None TOTAL (Also enter on line 6, Recapitulation) I $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-~s~a Ex+ts-sa} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C INTER-VNOS TRANSFERS & MISC, NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 This schedule 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE ~ None TOTAL (Also enter on line 7 Recapitulation) $ (If more space is needed, insert additional sheets of the same size) o.oa REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' None 0.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Zip Zip TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 2,oa0.o0 114.00 2,114.00 REV-1512 EX+(12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDI~LE J BENEFICIARIES ESTATE OF FILE NUMBER Gertrude G. Burkholder 2008-00718 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 Larry Burkholder Son 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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 I $ (If more space is needed, insert additional sheets of the same size)