HomeMy WebLinkAbout12-18-08 (3)15056041147
REV-1500 Ex (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year Fite Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO 60X.280601 21 0 8 0 5 7 9
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
211588546 01232006 01091979
Decedent's Last Name Suffix Decedent's First Name MI
SIMS DANIEL
(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 IN APPROPRIATE OVALS BELOW
® 1. Original Return ^ 2. Supplemental Retum ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ qa. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
^ 6 Decedent Died Testate ^ ~ Decedent Maintained a Living Trust
(Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
^ 9. Litigation Proceeds Received ^ 1 p, Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
ame Daytime Telephone Number
TERRENCE J. KERWIN 7172384765
Firm Name (If Applicable) ev
REGISTEI~~VILLS U>~ONLY.-. i _
KERWIN & KERWIN L-o c~ s _~;_"%
First line of address ~r--tr~~1 ~ n C7 ' `~ ,~'
2 7 NORTH FRONT STREET; c~i~ ~ - ' i-:-7
Second line of address
City or Post Office
HARRISBURG
Correspondent's a-mail address:
_ _-,
:~;:
~F
FILED t
State ZIP Code D
E
W ,. ~;
PA 17101
Under pena ties 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, rest and complete. Declaje)tion of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
Harold T. Sims
18 Ross Avenue, Apt. B, New Cumberland, PA 17070
SIGNATURE OF P RER HER HAN REPRESENTATIVE DATE
_- Terrence J. Kerwin ~ ~(Q ~
ADDRESS
27 No Front Street, Harrisburg, PA 17101
Side 1
15056041147 15056041147
REV-1500 EX
Decedents Name: $ I M$, D A N I E L
Decedent's Social Security Number
211588546
__
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.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........... ..... 5.
6. Jointly Owned Property (Schedule F) ^ 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.
9. Funeral Expenses & Administrative Costs (Schedule H) .................................. ....... 9.
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) .......................... ...... 10.
11. Total Deductions (total Lines 9 & 10) .............................................................. ........11.
12. Net Value of Estate (Line 8 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 FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 0 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 REQUESTING A REFUND OF AN OVERPAYMENT.
15056042148
5,258.04
5,258.04
7,800.00
7,800.00
-2,541.96
-2,541.96
0.00
Side 2
15056042148 15056042148 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 08 - 0579
Sims, Daniel _
STREET ADDRESS
1007 Bridge Street
CITY
New Cumberland STATE
PA ZIP
17070
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
0.00
0.00
0.00
0.00
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
p. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box 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. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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 :....................................
c. retain a reversionary interest; or ...............................................................................................................~
d. receive the promise for life of either payments, benefits or care? ..............................................................~ [x~j
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .....................................................................................................................0
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 RETUR
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 exemog 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)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF $1111S, Daniel 21 - 08 - 0579
Include the proceeds of litigation and the date the proceeds were received by the estate9111 property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Fidelity Investments 5,258.04
Diocese of Harrisburg 401(K) Plan
Account #57506
TOTAL (Also enter on Line 5, Recapitulation) ~ 5,258.04
., "I~VI~I~I~~N9IA~AMI~~~AEBR9R~p~ ~~
DIOCESE OF HARRISBURG 401K
57506 40
ESTATE OF DA SIMS(BENE)
Ci0 ADELE M SIMS, ADMINISTRATRIX
Ci0 HAROLD T SIMS, ADMINISTRATOR
1007 BRIIlGE 5T
NEW CUMBERLAND, PA 17070
i~~~w~~~~~~~~~~~~~oa~n~~
PAGE 03/06
Paymonl type: Death 8enrtN -non-s
ou
l b
°ne~
uery
Check Number: p
sa
y
C q
00236022970
Check Dote: August 13, 2008
Description Current
Gross $6,572.55
Taxable $6,572.55
FEDERAL TAX $t,3ta.5t
tJor ;
~ERIfV TM1i AUTHENTICITY Of 1'MIS MULTI•TONE SECURITY DOCIIMEN . CHECK BACKBROUNO AREA CHANGES COLOR GRADUALLY F7aOd1 TOP TO BOTTOM.
,, ~~:
` r ~ ~ bIOCES~ Ors HARAISBURG`4>oj1E ,~. ,a ~ , . ,
fides/~>t~ : - 3,,
Fidel
tty..lnyestm~~ts lirstitudional Operations Co.
... ' :.
- •
Check M1Jumber Account Number ;Date of CheEk
oo2ssan97o s7sos Aug 13, Zoos
$"""5,258 Od
Pay to tF-e Otcter of:
ESTATE OF DA SIMSCfSENE)
Ci0 ADELE M SIMS, ADMINISTRATRIX
Ci0 HAROLD T SIMS, ADMINISTRATOR
1007 BRIDGE ST
NEN CUMBERLAND, PA 17070
Deutsche Bank Trust Gompeny D9laware
AUI Lae Srgnattme
u^O 2 3~0 2 29 7OII' t:0 3 i L00 3801: 0'O 59fl 3 Z Ln^
SCFfDULE H
FUNERAL D~ENSES &
COMMONWEALTH OF PENNSYLVANIA ~~ ~~-W 1 ~7
INHERITANCE TA% RETURN
RESIDENT DECEDENT
ESTATE OF Sims, Daniel
Debts of decedent must be reported on Schedule I. __
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION
A. 1 I Parthemore Funeral Home
Rolling Green Cemetery -grave opening, plot transfer
FILE NUMBER
21 - 08 - 0579
AMOUNT
5,931.00
1,785.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 closing costs
64.00
20.00
TOTAL (Also enter on line 9, Recapitulation) 7,800.00
REV-1513 EX+ (8-00) a ~ a
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Sims, Daniel 21 - 08 - 0579 _
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I
• TAXABLE DISTRIBUTIONS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Adele M. Sims Mother .50
1007 Bridge Street
New Cumberland, PA 17070
2 Harold T. Sims ~ Father .50
18 Ross Avenue, Apt. B
New Cumberland, PA 17070
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, o n 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 SHE~T 0.00