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HomeMy WebLinkAbout01-23-0915056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~1r`~~ ~} ~~~ PO BOX 280601 V UUl Harrisburg. PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death 200-32-9741 04/25/2008 Decedent's Last Name Baron Date of Birth 01 /01 /1943 Suffix Decedent's First Name Kathleen (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum MI A MI :~. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of ;i. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust Et. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 1'I . 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 Lisa K Baron (610) 937-4080., Firm Name (If Applicable) REGISTER OF`jA(ICC~ USE Ot~ :"7 ..r', F~ N _ First line of address ' _~ ~ ~ ~ ~ ~ % j 2759 N Charlotte Street ,\ - ~ ~,~~'=~ -ta _~ _;c- Second line of address ~ ~ ~ ~::s =~ N -..t City or Post Office State ZIP Code DATE FILED Gilbertsville PA 19525 Correspondent's a-mail address: I lo~trG~t Ca) (~~ (~CQ ~ I - ~-~-'1 _- `, ~ . :'-T t _i i r~ ':"r - . . -_ _ .~ ;:.,_, i--- -~z Under penakies of perjury, I declare that 1 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 PER O `RESPONSJ~LE,FjOR FILIN~G'RETURN DAT lam" f~- ~~//FF''°°~1~~~6`"''~rp ~ i 1 ~ ~ ~~~_ ADDRESS ~ / ~ ~ I ~'1r~ ~~l u r~ ~Ll~l~ +~~ ~ ~~' ~~,v-~ ~ Vl ~ ~~~ ~ ~ ~~ /~1 ~~ ~ _~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~4X V J 15056052059 REV-1500 EX Decedent's Social Security Number Kathleen A Baron 200-32-9741 Decedent's Name: RECAPITULATION 188,000.00 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) 2, 46,593.33 ....................................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 9 9 ( ) ............................. 4. Mort a es 8~ Notes Receivable Schedule D 4• 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested .... ... 6. 13,696.12 7. Inter-~vos Transfers 8~ Miscellaneous Non-Probate Property 472 00 10 (Schedule G) Separate Billing Requested..... ... 7. . , 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 258,761.45 9. Funeral Expenses & Administrative Costs (Schedule H) ................. .... 9. 12,585.77 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) ............ .... 10. 2,250.25 11. Total Deductions (total Lines 9 8~ 10) ............................... .... 11. 14,836.02 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 243,925.43 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 750 00 an election to tax has not been made (Schedule J) .................... .... 13. . 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. 243,175.43 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 00 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 243,175.43 16, 10, 942.89 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. 10,942.89 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 ~___J_.~af.. l~...a...l..~w Adilrec•~• File Number VV VVMV••r ....,....r•--- - -------- DECEDENTS NAME DECEDEIVT'S SOCIAL SECURITY NUMBER Kathleen A Baron 200-32-9741 STREET ADDRESS 228 N 23rd Street CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A S I Po a Credit pousa v rty B. Prior Payments 4, 500.00 C. Discount 236.84 Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest _ _- E. Penalty Total InteresUPenalty (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. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 10,942.89 4, 736.84 0.00 6,206.05 6,206.05 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? ...... ........ ^ 0 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 exempt 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 isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 i X+ (11-08; Pennsylvania fii DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Kathleen A Baron 21 08-0684 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Roar n~~narrv chat is ieintiv-owned with right of survivorship must be disclosed ~m Schedule F. If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathleen A Baron 21 08-0684 All property jolnUy-otivned with rlgh! of su-vivomhip must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~~ Prudential Common Stock 0038-71197 2,433.33 2 EE Treasury Savings Bond 4715109 4,536.00 3 EE Treasury Savings Bond 4715110 4, 536.00 4 EE Treasury Savings Bond 471511 4, 536.00 5 EE Treasury Savings Bond 471512 4, 536.00 6 EE Treasury Savings Bond 5097389 8,672.00 7 EE Treasury Savings Bond 5097390 8,672.00 8 EE Treasury Savings Bond 5097391 8,672.00 TOTAL (Also enter on fine 2, Recapitulation) + S 46,593.33 (It more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY __ ESTATE OF FILE NUMBER Kathleen A Baron 21 08-0684 tf an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Lisa K Baron 2759 N Charlotte Street Daughter Gilbertsville, PA 19525 B' Mark A Baron 1449 Devon Road I Son Camp Hill, PA 17011 C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE of DEATH VALUE OF DECEDENT'S INTEREST ~' A' 02/01/92 EE Treasury Bond 2557704 11,912.00 50% 5,956.00 2 B 02/01/92 EE Treasury Bond 2557705 11,912.00 50% 5,956.00 3 A Members' First Savings 17326 00 210.83 50% 105.42 4 A Members's First Money Management 17326 05 285.57 50% 142.79 5 q Commerce Checking 0002252443 3,071.81 50% 1,535.91 TOTAL (Also enter on line 6, Recapitulation) I S 13,696.12 (If more space is needed, insert additional sheets of the same size} REV-1510 EX+ (6-98) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathleen A Baron 21 08-0684 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH ACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET '% OF DECD'S INTEREST EXCLUSION pF APPLICABLE) TAXABLE VALUE ~ ~ Members' First Individual Retirement Account 10,472.00 100 10,472.00 TOTAL (Also enter on line 7 Recapitulation) 3 I 10,472.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDt~LE N FUNERAL EXPENSES & ADMtNtSTRATIVE COSTS ESTATE OF FILE NUMBER Kathleen A Baron 21 08-0684 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Myers-Harner Funeral Home Camp Hili, PA 17011 3,549.00 2 Soloist 75.00 3 Royer's Florist 3015 Gettysburg Rd. Camp Hill, PA 17011 132.50 a Siiverfake Florist Stowe, OH 148.70 5 Funeral Refteshments 3,500.00 s Cemetery 1, 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 1, 970.59 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 214.00 5. Accountant's Fees 315.99 6. Tax Return Preparer's Fees ~. Administrative (Property Maintenance) 1,2t~.t)0 a Broker Fees 279 99 TOTAL (Also enter on line 9, Recapitulation) I $ 12, 585.77 (If more space is needed, insert additional sheets of fhe same size) REV-:512 EX+ (12-JB` ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathleen A Baron 21 08-0684 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• Capital One Credit Card 5291-4926-3136-4714 28.75 2 Citi Credit Card 5466-1602-5937-4088 88.75 3 Citi Business Platinum Card 5082 290(? 57021591 86.04 4 Discover Credit Card 376.53 5 Home Depot Credit Card 6035-3200-9126-2640 20.68 6 Kohl's Credit Card 035-8054-105 19.97 7 Military Star Credit Card 6019-4434-0017-1623 77.93 8 Cardiology Consultants PH 317.27 9 Crozer Keystone Health System 108.32 10 HAN-Emergency Physicians 43.02 11 AT8~T Phone 16.73 12 verizon 50.23 13 IRS Federal Tax 2003 558.00 14 IRS Federal Tax 2004 343.00 15 Crozer Keystone 115.03 TOTAL (Also enter on Line 10, Recapitulation) I $ 2,250.25 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) pennsytvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathleen A Baron 21 08-0684 RELATIONSHIP TC~ DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1. Lisa K Baron Daughter One-half 2759 N Charlotte Street Gllbertsville, PA 19525 2 Mark A Baron Son One-half 449 Devon Road Camp Hill, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LCNES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTCONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Salvation Army Furniture and Household Goods 500.00 2 Goodwill Household Items and Clothing 250.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 750.00 If more space is needed, insert additional sheets of the same size.