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HomeMy WebLinkAbout11-24-08J REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Tazes PO BOX 280601 Hamshurc. PA 17128-Ofi01 15D56051047 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death r~A~~r~~ Decedent's Last Name Suffix o c h e r (If Applicable) Enter Surviving Spouse's Information Below Date of Birth ~~ DecedenTt's First Name ~''~' MI M a r 1 9 a rlelt ~ E Spouse's Last Name Suffix Spouse's First Name MI ®m~--~rrr~r 1~ Spouse's Social Security Number rr~~ ~~~I..a FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O O 4. Limited Estate O ~ 6. Decedent Died Testate O (Attach Copy of Will) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum O 3. Remainder Return (date of death prior to 12-13-82) 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) 7. Decedent Malntalned a Llving Trust O 8. Total Number of Safe Deposit Bozes (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Tele hone Numtier A n t h o n y D e L u c a E s q 7 1 2 5 8 6 8 4 4 Finn Name (If Applicable) REGISTER OF WILLS USEONLY f 1i 1f I ~ ~ ~ ~ ~! I.I ~ 1 1 ~ ~ 1~~ 1 1 p First line of address n c`~ - P O B o x 3 5 8 ~_ 9n Second line of address ``~ ~ ~ ~ ~- ~~ 1 1 3 F r o n t S t r e e t `?~;~> a City Or Post OfOce State ZIP Code E~'{LED ~ B o i l i S p r i n g s P A 1 7 0~0~ w Side 1 15056051047 15056051047 J Correspondent's e-mail address: Under penalties or perJury, I declare that I have examined this return, Including accompanying schedules and statements, and to the Dest of my knowledge and belief, it is true, corred and wmplete. Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNgjURE OFPERS(2N Fj~SPgfJSIBLE FOR FILING RETURN DATE 7 J REV-1500 EX Decedent's Name: 1. Real estate (Schedule A) ............................................. 1, 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Propdetorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Tansfers & Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested........ 7. 8. Total Gross Assets (totaLLines 1-7) .................................... 8. 9. Funeral Expenses 8 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 (Linea minus Line 11) ......................... ... .. 12. 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. TAX COMPUTATION -SEE INSTRUCTIONS POR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQOESTING AREFUNDOFAN-OVERPAYMENT 15056052048 Decedent's Social Security Number O Side 2 1505652048 15056052048 J tEV-1500 EX Page 3 )ecedent's Complete Address: Flle Number DECEDENT'S NAME Margaret E. Kocher STREET ADDRESS 1 Peach Tree Lane CITY Boiling Springs, STATE ZIP PA 17007 fax Payments and Credits: Tax Due (Page 2 Line t9) (t) $1 , 4 71.5 3 .. Credits/Payments -0- A. Spousal Poverty Credit B. Prior Payments -0- C. Discount _0_ -0- -" Total Credits (A+ g + C) (2) InteresVPenalty if applicable D. Interest - 0 - E. Penalty ~ Total InterestlPenalty (D + E) (3) - 0 - 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. (4) _ 0 _ If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $1 , 4 71.5 3 A. Enter the interest on the tax due. (5A) - 0- B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) $1 , 4 71.5 3 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS i. Did decedent make a transfer and: Yes No a. retain the use or income of the property transfened :................................................................................... ....... ^ b. retain the right to designate who shall use the property transfened or its income :...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ X^ 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? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefciary designation? .................................................................................................................. ...... ^ X^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN or 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 s three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. or 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 ling a tax return are still applicable even if the surviving spouse is the only benefciary. or dates of death on or after July 1, 2000: 'he 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)]. 'he 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 2 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. 'he 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~150l Ex•pstl SCHEDULE E p COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENTD EDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER Margaret E. Kocher InGUde the proceeds of Iltigation and the dale the proceeds were received by the estate. All property JolMtyovmed with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER _ DESCRIPTION OF DEATH Miscellaneous items of personal property. TOTAL (Also enter on line 5, Recapitulation) I ; $1,272.00 (If mare space is needed, insert additional sheets of the same REJ4~9 EA~119II COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN Margaret E. Kocher If an asset was made Joint within one year of the decedent's date of death, it must be reported on Schedule G. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS I RELATIONSHIP TO DECEDENT A. Rogene A. Schmiedel P.O. Box 35 1 Peach Tree Lane Boiling Springs, PA 17007 B. C. JOINTLY-OWNED PROPERTY: Friend ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PRDPERTY Include name offinanGal insliWtion and bank account number a Similar ldentitying number. Aaach deed for joingy-held real estate. DATE OF DEATH VALUE OF ASSET °A OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST t. A. 2/4/0 Checking account, numbered $2,637.27 508 $1,318.64 33-19210, at F&M Trust Boiling Springs, PA 17007 2. B. 2/4/0 Money Management account, number 21,299.81 508 10,649.91 33-19210, at F&M Trust, Boiling Springs, PA 17007 TOTAL (Also enter on line 6 Recapitulation) ( $ 1 1 , 9 6 8 . 5 5 (If more space is needed, insert additional sheets of the same size) - REV-1511 EX+(10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Vh A. 1 Margaret E. Kocher Debts of decedent must be reported on Schedule I. FUNERAL EXPENSES: Gingrich Memorials Grave marker B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip Z~ Attorney Fees Anthony L. DeLuca, Esquire 3. Family Exemption: (It decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Relationship of Claimant to Decedent 4. Prohate Fees 5~ Accountant's Fees 6. Tax Relurn Preparer's Fees ~ Roy D. Gottshall, Auctioneer appraisal of personal property $' Filing Fee - Inheritance Tax $130.00 400.00 65,00 15.00 (If more space is needad h~oH ,dn~e~.,,i ..,....._ _..~- --._ , TOTAL (Also enter on line 9, Recapitulation) I $ Zip NUMBER 610..00 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Margaret E. Kocher Report debts Intoned by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Three Springs Family Practice - Medical $ 135.00 2. Loyal Bible Class - Funeral Luncheon 100.00 3, Robert C. Cairns, Tax Collector 4.90 Personal Taxes 4. South Middleton Township Municipal Authority 99.00 Water and Sewer 5, Schrock Tree Service - Tree Removal 140.00 6. Met-Ed - Eleetric 341.47 TOTAL (Also enter on line 10, Recapitulation) $ I 820.37 (If more space is needed, insert additional sheets of the same size) ~2EV-1913 EX+ (8-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN .RESIDENT DECEDENT Margaret E. Kocher RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ~ Do Nol Llat Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [include ouVight spousal distdbutlons, and transfers under Sec. 9116 (a) (1.2)] 1. Betty Kleinle Friend $500.00 3 Peach Tree Lane Boiling Springs, PA 17007 2 Janet Troupe Friend 500.00 6 Peach Tree Lane Boiling Springs, PA 17007 3 Joan Cole Friend 500.00 2 Peach Tree Lane Boiling Springs, PA 17007 4 Debra Russell Friend 500.00 104 S. Ridge Road Boiling Springs, PA 17007 5 Rogene A, and Barry L. Schmiedel Friends 100$ 1 Peach Tree Lane Boiling Springs, PA 17007 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVEFjNMENTAL DISTRIBUTIONS Ott b i t 1, er n Un>_ e e Me o ist Church $1,000.00 . Yellow Breeches EMS Inc. 500.00 . South Middleton Township ?Fire Department 500.00 TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 2 , 00 0 . 0 0 (If more space Is needed, insert additlonal sheets of the same size)