HomeMy WebLinkAbout11-26-08•
1505607121
--J REV-1500 Ex (06-05) .~-,
PA Department of Revenue County Code Year File Number
E3ureau of Individual Taxes INHERITANCE TAX RETURN 2• ~ 0 g p 1 1 3
Po eox 2aosol RESIDENT DECEDENT
Harrisbu , PA 17128-0601
ENTER DECEDENT INFORMATION BELOD to of Death Date of Birth
Social Security Number
p 7 1 9 2 0 0 5 1 2 1 9 1 9 0 2
1 8 1 3 2 3 6 6 8 MI
Suffix Decedent's First Name
Decedent's Last Name [y A R G A R E T L
P O L L O C K
MI
(If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name
Spouse's Last Name
Spouse's Social Security Number
THIS RET~[R{~,GiSTER QF IWILLS ATE WITH THE
FILL IN APPROPRIATE OVALS BELOW ^ 2 Supplemental Return ^ 3. Remainder Return (date of death
a 1. Original Return prior to 12-13-82)
^ ^ 5. Federal Estate Tax Retum Required
4. Limited Estate 4a. Future Interest Compromise (date of
death after 12-12-82) 8, Total Number of Safe Deposit Boxes
6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust) ^ •I 1. Election to tax under Sec. 9113(A)
^ 10. S ousal Poverty Credit (date of death (Attach Sch. O)
9. Litigation Proceeds Received ^ between 12-31-91 and 1-1-95)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIADaytimle TelephoOne NumUberBE DIRECTED T0:
Name 7 1 7 2 2 8 ~-? 1 5 1
K N U P P E S 4~ `~~
R O B E R T L- ~~ -
Firm Name (If Applicable) I REGISlIlR b ~~ UNLY ~-
K N U P F' L A W O F F I C E S, L L C ~ ~~?
__. •
J_ .
First line of address
p 0 B O X 6 3 0
Second line of address
4 0 7 N O R T H F R O N T
City or Post Office
H A R R I S B U R G
S T L
State ZIP Code
P A 1 7 1 0 8
~. °r+
;i _.
~~ F ,
_.,J--1 .-r ..- ...
DATE FILED ~'~___~
Correspondent's a-mail address: a and
Under penalties ondecom ~IeteeCDecla atlon of preparer other than the pe o~nal e~proesentative is based on aU nfotn ation~~of which prepasrer has an kn~owled9e•
it is true, rwrrecl a ~ __,...~~o~ c.caSFt.`It we RETURN ~t ~ t'1
ADDRESS HARRISBURG PA 17108
PO BOX 630 DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121
1505607121
J
~y
1505607221
J
REV-1500 EX
MARGARET L. POLLOCK
RECAPITULATION 1
......................... 2.
...
.....
1. Real estate (Schedu e
2. Stocks and Bonds (Schedule B) • • • • • • • • ' ' ' ' ' ' • • • • • 3
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . • •
... a.
4. Mortgages 8 Notes Receivable (Schedule D) • • ~ • • ' 5.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) •
rr--tt 6.
Schedule F) 1_J Separate Billing Requested ...... .
6. Jointly Owned Property ( 7.
7. Inter-Vivos Transfers & Miscetlaneous N~];PS pate Bileng Requested ..
(Schedule G) u
,,: ~ 1_71 ... ........................ 8.
8. Total Gross AssQW ~~~•~• -°~_- 9.
...
g. Funeral Expenses & Administrative Costs (Schedule H) • • • • • • • • ' •
.. 10.
1p. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule 1)
....................
11. Total Deductions (total Lines 9 & 10) 12
12. Net Value of Estate (Line 8 minus Line 11) • • • • • • • ' • ' ' ' ' • • • ~ • •
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13
an election to tax has not been made (Schedule J)
14,
_ , o ...cm~a Line 13)
Decedents Social 5ecuriry Number
1 8 1 3 2 3 6 6 8
3 8 1 1. 5 3
3 8 1 1. 5 3
1 5 1 8 4 2~ 7 2
1 5 1 8 4 2. 7 2
- 1 4 8 0 3 1. 1 9
- 1 9 8 0 3 119
14. Net Value SudJect iv ~ ow ~~~~•- •- -
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or 0 ~ 0 0
transfers under Sec. 9116
(a}(12} x.o _ 0 ~ 0 0
1g. Amount of Line 14 taxable
at lineal rate X •0 - 0 • 0 0
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. Tax Due
15.
1s.
17.
18.
19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Slde 2
0. 0 0
0. 0 0
0. 0 0
0. 0 0
1505607221
J
1 1505607221
File Number
REV-1500 EX Rage 3 21 08 0113
Decedent's Complete Address:
STREET ADDRESS
100 Fairway Drive
Manor Care Health Services _._ sTATE ZIP I
- - PA 17011
CITY
Cam Hill
Tax Payments and Credits: (1) 0.00
1. Tax Due (Page 2 Line 19)
2, Creditslpayments
A. Spousal Poverty Credit
B. Prior Payments 0.00
C. Discount Total Credits (A + B + G) (2)
3. InteresUPenalty if applicable
D. Interest 0.00
E. Penalty Total InteresUPenaity (D + E.) (3)
(4) 0.00
4. If Line 2 is greatFill in ovial on Page 2, Liner20 toirequest a eifund.e OVERPAYMENT.
(5) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5A)
A. Enter the interest on the tax due. (5B) 0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN 'THE APPROPRIATE BoLOCKS
1. Did decedent make a transfer and: . []
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 deal:h ^
without receiving adequate consideration? ...................... .
3. Did decedent own an Ind v duaORetirementlAccount annuity oao her non-probate prolperty wFi chath? ......::; ^
4. Did decedent own a •,•„•,,.......
.... .
contains a beneficiary designation ..............
THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
IF
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 impo fe to a surveving spouse fromrtax, and the statutory hequireme ns fo d sclosure o0f)assrecets and
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a t
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
Fa 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 paren , 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)]. g ( ) rcent 1 P.S. 9116 a 1 3 A siblin is defined, under
The tax rate imposed on the net value of transfe ne anent in commonhvrith to he decedenltnwhetheeby bloodo adop~ gyn. § ()( )) 9
Section 9102, as an individual who has at Least p
RE\/-1508 EX +~t6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
OF
Include the
AN property
ITEM
NUMBER -
~, M&T Bank
Buffalo, NY 14240
of litigation and the date the
med wdh right of survivon
DESCRIPTION
Beds were received by the estate.
must be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
3,811.53
TOTAL (Also enter on line 5, Recapitulation) 5
SCHEDULE E
SH BANK DEPOSITS, & MISC.
CA ,
PERSONAL PROPERTY
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX ~ (10-06)
SCHEDULE H
FUNERAL EXPENSES &
COMMtN ERETANCE TTAX RETURNANIA ADMINISTRATIVE COSTS
:STATE OF 21 iDl3 U7 ~ s
Nar aret L. Pollock
Debts of decedent must be reported on Schedule 1. -
AMOUNT
ITEM DESCRIPTION
NUMBER
A FUNERAL EXPENSES:
~ W. Orville Kimmel Funeral Home, 2001 Market St., Harrisburg, PA 1710
Paid by a Funeral Trust
B ADMINISTRATIVE COSTS:
Personal Representative's Commissions 190.00
~• Robert L Knupp, Esquire
Name of Personal Representative (s)
stree-Aadress 407 North Front Street PO Box 630 17108
Harrisbur State PA1 zip _
City
Year(s) Commission Paid:
800.00
2 Attorney Fees Knupp Law Offices, LLC
3 Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
~----
SVeetAddress Zip _
State
City
Relationship of Claimant to Decedent ~ QO
Probate Fees Cumberland County Register of Wills
4.
Accountants Fees I
5.
6. Tax Return Preparers Fees
23.47
Reimbursement for Expense for obtaining EIN 26-6210115 from IRS (on line) 75.00
7. 142.66
g, Advertising Cumberland Law Journal 4.10
g. Advertising The Sentinel 150,523.49
10. Robert L. Knupp, Postage
11. Claim of Pennsylvania Department of Public Welfare
TOTAL (Also enter on line 9, Recapitulation) I S 15
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00) ~
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT FILE NUMBER
ESTATE OF 21 08 0113
Ma aret L. Pollock RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(ppSoo} RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS ~Seo 9116 aj (1S2)]~I distributions, and transfers under
0.30
Collateral
1, R. D. Babbit, Jr.
62 Smith Road
Denville, NJ 07834
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
ji, NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0.35
1. Camp Hill United Methodist Church
417 S. 22nd St.
Camp Hill, PA 17011 0.35
2. Fifth Street United Methodist Church
clo Central PA Conference of The United Methodist Church
PO Sox 2053, Mechanicsburg, PA 17055-2053
TOTAL OF PART 11-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)
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