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HomeMy WebLinkAbout12-10-0815056051047 ' REV-1500 EX (06-05) L~FFICIAL USE C3NLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PoBOx2sosol INHERITANCE TAX RETURN _ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ ~J ~ t ~ F~ ENTER DECEDENT INFORMATION BELOW :>ocial Security Number Date of Death Date of Birth t 80 ~6 r< S8'7 ©`~ 09 2008 I o 07 1 4~8 Decedent's Last Name Suffix Decedent's First Name MI KltAtN~~ MS C-~o2G-1 AlrWuq ~ (Ilf Applicable) Enter Surviving Spouse's Information Below Spouse//'s~~Last Name Suffix Spouse's First Name MI i'f ;spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1=ILL IN APPROPRIATE OVALS BELOW 1~ 1. Original Return 2. Supplemental Return C.' 3. Remainder Return (date of death prior to 12-13-82) f`~ 4. Limited Estate 4a. Future Interest Compromise (date of i~7 5. Federal Estate Tax Return Required death after 12-12-82) e~ 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) t1 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death C 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 T0: Name Daytime Telephone Number CSQ (71(?~fZIEIN ''~O~ERT ~ ~j 1 7 Zy9 (~'S73 ~ , Firm Name (If Applicable) ~----- taECISTER ~~ ~vlLtwS t1~t LY o~3fZt,E~rv 3ffQ.~c -. Sc1{.~F~ . r--, ~ ~ ~ n ` First line of address ~.-~ : 1 ~ tJ SST So v-r tt S-r ~ ~ ~ - t - ..~ . ~ ; Second line of address _ ~ , ;,.'. -. -p I ' ~ J, i ~. - ~ l "' ' City or Post Office State ZIP Code - ----- C A(zLt Si.~ ~ fl i ~o t 3 y .~ 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. SIG N RESPONSIBLE FOR FILING RETURN DATE 2 ~ oar ADDRESS ~. ~~ ~ ~,`s~ ~~ ~^~`~ / SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J REV-1500 E)C Page 3 File Number Decedent's Complete Address: STREET G RESS~ ~~o MM~r~R - _Sv i~ _ 3~ 1 - i c~ ~~ ~~~ St- CITY ea~rl•.s~ c STATE r-y~ 'ZIP 'Z Q' Tax Payments and Credits: S 1. Tax Due (Page 2 Line 19) (1) .3I 2. Credits/Payments A. Spousal Poverty Credit __ B. Prior Payments C. Discount ~16 -- - Total Credits (A + B + C) (2) 31 3. Intere:stlPenalty if applicable D. Interest E. Penalty _ __ - - Total InterestlPenalty (D + E) (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Eni:er the total of Line 5 + 5A. This is the BALANCE DUE. (56) 3 1 `~ Make Check Payable to: REGISTER OF WILLS, AGENT 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 : ..................................... ....... ^ Q 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. x;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 tart 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. J 1,5056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 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. (Schedule E) rsonal Pro ert P ll it & Mi D 5 ~ ~ QJ 4 ` 5. ...... y p aneous e epos s sce Cash, Bank .. . 6. Jointly Owned Property (Schedule F) C~ Separate Billing Requested ..... .. 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ' y D3. 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ~ ~ Q 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) ............. ... 10. 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. '70 O• 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ', Q 3 ~ ` 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. ~ 0 3 y 1 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 tax le y ~ ? ~ 3 16 ~, ~~ at lineal rate X .0 • . . 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. 3 ~ • ~~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15~56052~48 15~56~52~48 REV-1511 EX+ (10-06) F' SCHEDULE H t:OMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE: OF Q,Q~'~ FILE NUMBER .ltow~~c. ~ - ~.C"0.w~ Q?~' Debts of decedent must be reported on Schedule L ITEtd NUME'~ER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: 2. Attorney Fees ~ ~~ 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. Fi 6. Street Address City State Relationship of Claimant to Decedent Probate Fees 's Accountants Fees Tax Return Preparer's Fees State Zip Zip ~~ S~ TOTAL (Also enter on line 9, Recapitulation) I $ ~~~ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (g-00) ~ f . _ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTAIEE OF FILE NUMBER c- ~..r.,~ .~ ci . .. t,~.,` e o r~ ~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUME3ER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ((~~ ~S~ ~ .AA ~~~~~,,S~V~ T/'-7 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON RE V-1500 COVER SHEET lII 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) OCAL REGISTRAR'S CERTIFICATION.OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fce file ti:r5 certificate. x(+.00 _P_1.4~61707 C~ertifiiatiot) Number This is to certify that the information here given is correctly copied frolrt an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ti G~Zat Lf !U ~~ ~- `I_~_ _ /`Local Registrar Date Issued •H105-143 REV 11/2(!06 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PERMANEMkN CERTIFICATE OF DEATH BUCK INK (See Instructions and examples on reverse) STATE FILE NUMBER °u+ i3 0 0 1. Name d 9,(~rat midda. kest suAa) 2. Sax 3. Sorial Secunry Number 4. Data d Deem (alonth, day. year) (~06 )c>.nh~-- ~s,~, Georgianna K. Kramer female 180 -56 - 1587 Se tember 9 2008 5. Aga (last &rlMelr) Ulidel 1 year UrMer 1 day 6. Date d Bidh (Ma4h, day, year) 7.8inhplace (City and sere a laeign muntry) 6a. Place of Deem (Check Day onel alarahe oeye Iloas k4keNa Hospnal: Dthef. 49 Yra. Oct. 7, 1958 Dauphin Co., PA ^Inpanenl ^ER/Outpatient ^DOA ~I Nursug Home ^Resitlance pgner. Spenly: Bb. County d DeaM &. CNy, Boro, Twp. al Dean Bd. Fedliry Name III nd insltluXOn, give street and nunber) 9. Waa Dacedea d Hispanic Origin? .L-l No ^Yas -' t0. Rxe: Nnerican Iran. &rk, While, etc. /C C ' e (S0a'`'' Lancaster Columbia Susquehanna Val 1 ey Nursing Home ,~> gi M ~na white 11. Decedent's Usual ton xo d won d ais ~ most d Be. Do not slate reti 12. Was Decedent ever in the 73. Decedent's Educatim (SpedN Doty Nghest grads Cortip ktad) 14. M6ntal Status: Warned, Never Monied, 15. Surviving Spo use (Ii wife, gNe maiden name) Knd a Work Kotl d Bustiess / mtlusby U.S. Armed Forces? Elementary /Secondary (0-12) College (1d or 5f) Wdowed, Divorcetl (Speayy) none none ^YK Q^~ unkn wn Never Married n a • 76. Decerlenl's MadigAddres. IStreet, ciy I town. elate. rip wde) 745 Choi cki es Hi 11 Road oecedam'a Da Deaaaed Adud Rasitlaice 17a Sale PA Live in 5 17c. ^ Yea. Dewaea laved m Twp. Columbia P A 17512 ,m C«mN Lancaster T°w'°''~Y ,7d. ^ No.DacadaitlrvedwnNn Col umbi a , Adunl limes d Dity l eaa f 6. Fama'a Name jFxst, midde, oat suA'a) 19. Mogrer's Name (First mode. maiden numeme) Harold Kramer (late) Janet L. Henry 20a. Infpmraa's Nuns (Type / Prrmtl 20b. Intomtant's Maaing Address (Brest c41' /Town, stale, zip coda) Harold Kramer 413 Sample Brldge Road, Eno1a, PA 17025 21a Metlpd d Deposition ~,Crertetion ^ Donation 216. Date d Disposiaon (Monet, day; yeerl 21c Place d Doposison (Nance d cemetex aemasxy a oma place) 21d. Location ICiry I own, state, zip code) _ ^ B~^" '"^'°"a"'°'^~°'° ~Waa~OOnidonAWhon:a0,.A( Se t 10 2008 p Evans Cremation Service Leola PA 17540 ^ Omer ~ Spea : M MedcM Examiner/CaoneR L'fYea ^No . f s ~ 22a Signor "vnerU Service a perean as such) 22b. t}cense Number 22c. Name antl Address d Facility ,/ e r d unera ome , nc . . ~ ,,~/ 011596-L P 0 Box 231, 519 Walnut Street Columbia PA 17512 gems 23a<aNy 23a Ta die d ny knvwle0pa, deem oalureU at the time, date an0 pbce staled. (Signature and ti0e) 23b. Lkarwe Number 23c. Date Signed (Month day, Year) ciaan is not rv~Nade at ~ ro , „ _ 1 caWy cause d tlaalh. ~~ ~(~ ~/ w Items 24-26 mim I» cmplded by person 21. Thna d m 25. lYate P Dead (Noah, day. year) 26. Was Case Rekm to Med~ Examna / Coroner la a Reason Omer men Cremation a Donation? ,' xda pronounces deem. Jl Aa. 0 ^Yas Np CAUSE OF DEATH (See instruotlons artd examples) r Approxenare kderval: Pan II: Eller otMr 2e. Did Tahaao Use CmOibae m Dead,? nom 27. Pen I: Eder tlK dyfina evens-dbesces, iijuriea, aoompGCaliora-Iha! dtifu'dY ausep the dnM. W NDT enter terminal evens such as cartiac erred, r Onset k Deam but not h ma ~ref~^9 undedyog ease given o Pan I. ^ Yes ^ PraMdy nepaatay arrest, or venuiadar flhntialbn wimad showky me etbbgy. lial Day ar ease an each toe. r r ^ No ~lkdoiaxn IMMEDUTE CAUSE IFawl dcease a i coriddwn rasaarg n ) _f a. r p riA~ i ~ 29. n Femek: ~.[~ k'hre o (a as a cauequence aQ: i P' Nor gagnaa wMM patl year ^ Pregmnl M time d deem Sequmtiapy Yd axxaions, n ant, D. i badrp b the Cause fisted m ana a t SE Due b (a as a caraequerce d): 8 NDE NG ^ Nd pregrunt ba pregnant within 42 days Eaer ie U RLYI CAU r m"' usTmB o' ~ ~ e d~ wni m8d l ~ am re n a v e g ai Oue to (a as a mnsequeraw d): ~ r ^ Dra9ront. bn pre~aM 43 days ro t year d. r before tleam ^ Unluawn H prepnea wimp die past year 30a. Was an Autpsy 300. Were Autopsy FNtlngs 31. Maurer d Deem 32a Date d Injury (Noah, day. Year) 32b. Oexrbe How ~Y Oavrred 32c. Place d Niury: Home, Farm, Sreet Factory, Penomwd! Aveaade Poor o Cargldon a Cave d DeaM? ~NaN~ ^ HonicMe Otike Baking, etc (SpeaNl ^ Yen -71s7 t, No ^ Yea ~.] No ^ AttHeru ^ Panes Mrveslige6on ~' TYne d Injury 32e. Injury at Wodc? 321. h TrenaporWtion Mjury (SDeafl') /O ^ P d tru ^ Do 32g. Locatlan of kyury (Street, dry I town, state) , [ ^ Sadde ^ Could Not Oe Detemdnad ^ Yes ^ No ver perator a ec n M Omer - SpeaYy: ~ 33a Cenilla (check ady one) 33b. a and Titre d Cedner + • Certllybp pDyelcW (Physiam cennymg auae d deem wean emtlwr phyddan hoe pmnatnced aam and axnpleled nem 23) Toth bestdmy krawledgs, deem aCUrrstl tlw totM ause(e)end msmer as stskd_~______..______________________ • Pronaatcing ana annying phyeklen (Physiden hour proinurc rg deem and ceedYO9 to ease a deem) tl ^ 33c. L r 33tl. Date Signed (Moral, day, year) ________ __________ Toth beetd mY knowretl{p,dNm acumtlat dre fMie,dab. end pWce, arM dw lQ the uvee(s)and manners state C / ~ ~ • MadcY Exsminer I oroner On the bash d examinnon urd / or 0rwstl9stbn, in my opinort deem occurred at tM Hme, tlale, and plop, ell due to tlw cause(s) and menrwr u stated_ ^ s11 Y 34 Nang and Address of Pars/op•Who Completed Cause d Oeam (Item 271 Type / Pdnl G ~ ~ N to Fded IMOnm 36 da ea +f .~7Y. F/-S~. Gf ~f umber / ~ ~ 35. s Sgreture arq Dlddd , y. Y . A Diaposiaon PertnN No. 239970 1VI~cT I~a~k ACCOUNT N0. ACCOUNT TYPE 9511.99692 M8T CLASSIC CHECKING W/INTEREST 00 0 04319M NM 017 43539 GEORGIANNA K KRAMER CUMBERLAND & PERRY COUNTIES MHMR 16 W HIGH ST STE 301 CARLISLE PA 17013-2919 INTEREST EARNED FOR STATEMENT PERIOD 0.05 INTEREST F'AID YEAR TO DATE 0.53 A(`f`f1111JT CIIMMARV STATEMENT PERIOD PAGE AUG.29-SEP.26,2008 1 OF 1 HIGH STREET-CARLISLE BEGINNIING BALANCE: DEPOSITS 8 OTHER ADDITIONS CHECKS PAID -0THER SUBTRACTIONS CURRENT INTEREST PD ENDING BALANCE N0. AMOUN7 N0. AMOUNT N0. AMOUNT 1,4x03.35 0 0.00 0 0.00 0 0.00 0.06 1,403.41 A('f'f111NT AC'TTVTTY POSTING DATE- TRANSACTION DESCRIPTION DEPOSITSINTEREST & OTHER ADDITIONS CHECKS 8 OTHER SUBTRACTIONS DAILY BALANCE 08-29-08 BEGINNING BALANCE 51,403.35 09-26-08 INTEREST PAYMENT 0.06 1,403.41 ENDING BALANCE 51,403.41 ~~~ ANNUAL PERCENTAGE YIELD EARNED = 0.04 % ~~ (~ 3' GOOD NEWS! EFFECTIVE SEPTEMBER 12, 2008, IF YOU DEPOSIT CHECKS WITH ROUTING NUMBERS STARTING WITH 0110, 0111, 0112, 0113, 0114, 0115, 0116, 0117, 0118, 0119, 0211, 2110, 2111, 2112, 2113, 2114, 2115, 2116, 2117, 2118, 2119 OR 2211, FUNDS FROM THOSE DEPOSITS WZLL BE AVAILABLE FOR WITHDRAWAL SOONER. FUNDS FROM THESE CHECKS WILL NOW BE AVAILABLE ON THE SECOND BUSINESS DAY AFTER THE DAY OF YOUR DEPOSIT. LOGBA (61071