HomeMy WebLinkAbout01-23-09 (2)1505607121
REV-1500 EX (D6-D5,
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN r' 1 0 7 0 5 5 7
Harrisburg PA 1?128-0601 RESIDENT DECEDENT
.ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 4 9 0 1 4 1 3 6 0 5 2 5 2 0 0 7 0 7 3 0 1 9 1 7
Decedent's Last Name Suffix Decedent's First Name MI
S U T H E R L I N D O R O T H Y G
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Narrre
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
FILL IN APPROPRIATE OVALS BELOW
1. Original Return 0 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Gopy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-3i-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
D A V I D H R A
D C
L I F F E S Q r.3
3 6 `~ 3 1 ~
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7 1 7~
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Firm Name (If Applicable) REGISTER O~~LS US~NLY
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R A D C L I F F L A W O F F I C E P C _~._ .~~ _
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First line of address ,
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1 0 1 1 M U M M A R O A D ~~ ~ _
Second line of address f
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S T E 2 0 1 '~
City or Post Office State ZIP Code DATE FILED
L E M O Y N E P A 1 7 0 4 3
Correspondent's a-mail address: DHRAD~IX.NETCOM.COM
Under penalties of perjury, {declare that I have examined this return, incfudmg 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.
SIGN-T~RE O PER ON Rf~ SPONSIBLE FOR FILING RETURN ~_/- DATE
ADDRESS
505 EAST GOVERNMENT AVENUE NORFOLK VA 23503
SIGNA~11,IiE OF PREPARER O1rHER ~H EPRESENTATiVE DATE /
ADDRESS
1011 MUMMA RD, STE 201 LEMOYNE PA 17043
PLEASE USE ORIGINAL FORM ONLY
Side 1
15D5607121 1505607121
REV-1500 EX
Decedent's S ocial Securi ty Number
Decedent's Name: DOROTHY G• SUTHERLIN 1 4 9 0 1 4 1 3 6
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 4 3 6 5 . 9 2
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. 6 4 3 6 5, 9 2
9. Funeral Expenses & Administrative Costs (Schedule H) ............. ... 9. 1 9 4 5 . 0 0
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .......... .. 10.
11. Total Deductions (total Lines 9 & 10) ....................... .. 1 t. 1 9 4 5 • 0 0
12. Net Value of Estate (Line 8 minus Line 11) ....................... .. 12. 6 2 4 2 0 . 9 2
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. 6 2 4 2 0 . 9 2
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 .o _ 0 0 0 15. 0. 0 D
16. Amount of Line 14 taxable
at lineal rate X .045 6 2 4 2 0 9 2 16. 2 8 0 8. 9 4
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collatera- rate X .15 0 0 0 18 0. 0 0
19. Tax Due ............. ......................... .. ..... .. 19. 2 8 0 8. 9 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505607221
1!505607221 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 07 t:t557
DECEDENT'S NAME
DOROTHY G. SUTHERLIN
STREET ADDRESS
109 EGE DRIVE
CITY STATE
CARLISLE PA
ZIP _ _.
17013 1
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 2,808.94
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0.00
3. InteresUPenalty if applicable
D. Interest 0.00
E. Penalty
Total InteresUPenalty (D + E) (3) 0.00
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) 0.00
5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2,808.94
Enter the interest on the tax due.
A (5A)
.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 2, 808.94
Make Check Payable fo: 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; ......................... ...... X
c. retain a reversionary interest; or ......................................................................................... ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................ ...... ^ 0
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? ... ...... ^ Q
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 F ILE IT AS PA RT 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 sun~iving 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) percenl, 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.
REV-1508 EX + (6-98)'
COMMONWEALTH OF PENNSYLVANIA
fNHER1TANCE TAX RETURN
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
DOROTHY G. SUTHERLIN 2'1 07 0557
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. RSI BANK -ACCT #01250252971 32,422.58
2. IRSI BANK -ACCT #01250253328 I 31,943.34
TOTAL (Also enter on line fi, Recapitulation) I $ 64, 365.92
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+(10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DOROTHY G. SUTHERLIN 2'I 07 0557
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B.
1
2
3
4.
5.
6.
7.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State _
Year(s) Commission Paid:
AttomeyFees RADCLIFF LAW OFFICE, P.C.
Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
Ciry State
Relationship of Claimant to Decedent
Probate Fees
Accountants Fees
Tax Retum Preparers Fees
FILING FEE
Zip
Zip
1, 930.00
15.00
TOTAL (Also enter on line 9, Recapitulation} I ~ 1, 945.00
(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
ESTATE OF
FILE NUMBER
DOROTH Y G. SUTHERLIN L~I ui u55i _
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
i TAXABLE DISTRIBUTIONS [inciude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. RANDOLPH GROSS Lineal 20,806.97
1849 LINDENHALL DRIVE
LOVELAND, OH 45140
2. NANCY WALSH Lineal 20,806.97
10 NASH ROAD
ACTON, MA 01720
3. KARL W. GROSS Lineal 6,935.66
6710 ROBINSON LANE
SALINE, MI 48176
4. MARTHA E. GROSS Lineal 6,935.66
505 EAST GOVERNMENT AVENUE
NORFOLK, VA 23503
5. JULIA SYMBORSKI Lineal 6,935.66
5610 MONROE PLACE, APT H
NORFOLK, VA 23508
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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 GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size}
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