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HomeMy WebLinkAbout10-23-0815056051058 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 ~' 07 1~~~8^ Harrisburg, PA n128-0601 RESIDENT DECEDENT ;, ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth __ _ . . lJ~-12~~211 '' ~Pr~l ,t5,xon"7 ~'CPw>„~~r ~o~ 1q'21 Decedent's Last Name Suffix Decedent's First Name MI WorK, I-~'t7Y~C r ~~~ _ ~I (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Nam<> Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~~~ 2. Supplemental Return - _.. 4. Limited Estate t~w~'s 4a. Future Interest Compromise (date of death after 12-12-82) u 6. Decedent Died Testate ::'":::~ 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) .. 9. Litigation Proceeds Received :: ~"5 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI a~ 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) ~°` CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATI~PF S}iQULD BE DI1t~TED TO- Name Daytime Telephone _, umber~~-. . _, ,_ __. Firm Name (If Applicable) REGISTER OFiM111LLS USE ONLY `I - - 3- ' - ~ ~;~. First line of address _ _ ;i ~.~ -__.; .. ~~'IQ~Y-~-~ S~u(z/'~, ~3ui IGtir)t~ _ _ _' ~ 1 Second line of address Clty or Post Office State ZIP Code __ DATE FILED _.___ _ ~~Gn~.nlUs,b(~r-~~ __ __ ~,A- 1 ~n55 Correspondent's a-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 than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PE N RESPONSIB OR FILI G),RET N ~ DATE ~/ ..,, / ADDRESS ~ / ` 1113 ~~~~~hr~'li~ Drtv'~ ~~~ ~ee..i~u~,; c.Sau; ~~ ~ ~A 17?S~: SIGNATURE OF`PREPARER O HER T AN REPRESENTATIVE ~ DATE `` ~,.. rc . ADDr~S PL SE USE ORIGINAL FORM O LY Side 1 15056051058 15056051058 J REV-1500 EX Honora Work Decedent's Name: RECAPITULATION ~.~.a~.~,- ~.~.~ ~,.~.._...~._.._.~., Decedent's Social Security Number 183-12-2271 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. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. __ . 6. Jointly Owned Property (Schedule F) ~..:~:1 Separate Billing Requested ... .... 6. __ __. __ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) `a:==' Separate Billing Requested.... .... 7. 8. Total Gross Assets (total Lines 1-7) ................................ .... 8. !, 7,933.24 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ................. .... 9. ' 4,861.69 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ .... 10. 300.00 11. Total Deductions (total Lines 9 & 10) ............................... .... 11. ' 5,161.69 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 2,771.55 I 13. Charitable and Governmental Bequests/Sec 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. '; 2,771.55 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_ 2,771.55 ' 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ ', ' 16. ', - d.__.... _.__-.- 17. ....~. _ ._ Amount of Line 14 taxable ' ~. __.. __ . _._ .,..., . __..... _~ __ . I at sibling rate X .12 __~ ', 17. _..._. _ .__,. , ...., . ._.. _ . ..._t. _ ....~-. 18. Amount of Line 14 taxable at collateral rate X .15 18. ' 0.00' 19. TAX DUE ............................ .............................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 CmJ 15056052059 REV-1500 EX Page 3 ne..e.~e.,*~~ (_mm~lptp ~-~ciress~ File Number.. ..... .. _ 21.... 07-. 04998 V ~iVVMV~~~ v vv... r.~-~ - -~---_ __ __ DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Honora Work 183-12-2271 STREET ADDRESS 4603 Chestnut Avenue CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + ice) (2) 3. Interest/Penalty 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. 6. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (56) Make Check Payable to: REGISTER OF WILLS, AGENT o.oo 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 exemg_t 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-1503 EX+ (6-98) ~ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Honora M. Work FILE NUMBER 21-07-0498 nu ~.nnarfv 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-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT _ FILE NUMBER ESTATE OF 21-07-0498 unnnrn M 1A/nrk _ ..___1 ~_~._ :_~....,.a ti., +~e aere,~e„t nrler e~ death which remained unbaid as of the date of death, including unreimbursea mealcal expenses. SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS (If more space is needed, insert additional sheets of the same size) • REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Honora M. Work 21-07-0498 Debts of decedent must be reported on Schedule I. ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1. Neil Funeral Home 299.13 2. Brothers Restaurant, Funeral Luncheon 559.56 g. 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 Zip Year(s) Commission Paid: 2. Attorney Fees 400.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant John T. Work street Address 4603 Chestnut Avenue, Camp Hill, PA 17011 city Camp Hill state PA .zip 17011 Relationship of Claimant to Decedent Husband 4. Probate Fees 73.00 5. Accountant's fees 6. Tax Retum Preparer's Fees ~. Register of Wills -Filing Fee 30.00 TOTAL (Also enter on line 9, Recapitulation) $ 4,861.69 (If more space is needed, insert additional sheets of the same size)