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HomeMy WebLinkAbout02-02-091505607120 --J REV-1500 EX (OS-05) OFFICIAL USE ONLY PA Department of Revenue county code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.2sosol 21 0 8 0 6 3 7 Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 175 03 1413 04 23 2008 07 07 1918 Decedent's Last Name Suffix Decedent's First Name MI WALTERS MARY G (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 ~ 1 2. Supplemental Return ^ 3. Remainder Return (date of death 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ~"=~ 6 Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death ^ 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 TO: Name Daytime Telephone Number FOREST N MYERS 717 532 9046 Firm Name (If Applicable) LAW OFFICE FOREST N MYERS First line of address 137 PARK PLACE WEST Second line of address City or Post Office SHIPPENSBURG State ZIP Code REGISTER OF WILLS USE ONLY CJ r.~ a ~-~ C O `O _: r=~m ' ~~ :'`° tV _ :t I~D ~ _._ ~= .. i C"> - - tV .. r..r ~ r PA 17257-9212 Correspondent'se-mail address: fnmyers@embargmail.com 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. SIGNATUR F PERSON RESPONSIBLE FOR FILING RETURN DATE Jt 1~~>< i•>,.t_> a, ~ .. `~`~yi. ,~.. ~.._.-»~Stacy Lee Lynch ADDRESS ~s,~ ~ 3+ t _ i- f N' 43 Peach Orchard Road, Newville, PA 17241 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Forest N Myers ADDRESS 137 Park Place West, Shippensburg, PA 17257-9212 Side 1 1505607120 1505607120 J, , _I 1505607220 REV-1500 EX oe~edencs Name: M a ry G W A LT E R S Decedent's Social Security Number '.175 03 1413 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. 2 7 , 419.9 7 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~ Separate Billing Requested ............. l G h d S 7, 7 0 9 6 . 2 8 r ) c e u e ( g. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 3 4, 5 1 6. 2 5 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 1 2 , 5 0 0 . 3 1 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 2 8 5 O 0 11. Total Deductions (total Lines 9 & 10) ..................................................................... . 11. 12 , 7 8 5.31 12• Net Value of Estate (Line 8 minus Line 11) ............................................................ . 12. 2 1 , 7 3 O 9 4 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. 2 1 , 7 3 0 9 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15. 0 0 0 (a)(1.2) x .o0 16. Amount of Line 14 taxable at lineal rate X .045 21 , 7 3 0. 9 4 16. 9 7 7. 8 9 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 collateral rate X .15 O 0 0 18• O O O 19. Tax Due .................................................................................................................... . 19. 9 7 7 8 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. a Side 2 155607220 155607220 REV-1500 EX Page 3 rlnr•_PrilPnt'S Complete Address: File Number 21-08-0637 DECEDENT'S NAME M a r y G W A L T E R S ___ __ ____ STREET ADDRESS 4 5 C a r I a D r ___ ____ CITY Shippensburg STATE PA ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 0.00 Total Credits (A + B + C) (1) 977.89 0.00 977.89 977.89 Total InteresUPenalty (D + E) 4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. (2) (3) (4) (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 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 :.................................................................................. ~j ^x 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? ....................................................................................................................... ^ x^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ C~ 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 betore 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 exemat 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)]. 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. Rsv-1508 EX+(6-98) ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF (FILE NUMBER WALTERS, Mary G 21-08-0637 Include the proceeds of litigation end the date the proceeds were received by the estate. All property Jolntlyowned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Coins - in safe deposit box 1,370.04 2 FB~M Trust -checking *6765 11,236.75 3 Orrstown Bank""0216 -checking 3,201.40 Accrued interest on Item 3 through date of death 0.38 4 Orrstown Bank *8459 -checking 10.473.50 Accrued interest on Item 4 through date of death 8.32 5 IRS -Stimulus check 600.00 6 PA Dept of Treasury -Annuitant payment 529.58 TOTAL (Also enter on Line 5, Recapitulation) ~ 27,419.97 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1610 EX+ (8-88) SCHEDULE G r INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~' IFILE NUMBER WALTERS, Mary G 21-08-0637 This schedule must be completed and filed if the 2nswer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPE TY INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP O DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEE FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET i OF DECD•s INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 MONY -annuity "2919 7,096.28 7,096.28 TOTAL (Also enter on Line 7, Recapitulation) I 7,096.28 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (12.99) ` ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WALTERS, Mary G 21-08-0637 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached 10,448.00 B. ADMINISTRATIVE C05TS: 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 Law Office Forest N Myers 1,725.81 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 155.00 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 171.50 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 12,500.31 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER WALTERS, Mary G 21-08-0637 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Fogelsonger-Bricker Funeral Home -funeral bill 9,635.00 2 Shull-Koontr Memorials - footstone 813.00 fl-A Subtotal 10,448.00 Probate Fees 3 Register of Wills; Cumberland County -probate costslfees; Petition 90.00 4 Register of Wilts; Cumberland County -probate costs/fees; filing Will 15.00 5 Register of Wills; Cumberland County -probate costslfees; Short Certificates 20.00 6 Register of Wills; Cumberland County -probate costs/fees; JCP i4 Auto fee 15.00 7 Register of Wills; Cumberland County -probate costs/fees; filing Inheritance Tax 15.00 Return Fi-Ba Subtotal 155.00 Other Administrative Costs 8 Cumberland Law Journal -advertise estate 75.00 9 News-Chronicle -advertise estate 96.50 Fi-B7 Subtotal 171.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (8-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSriVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER WALTERS, Mary G 21-08-0637 Include unrelmburaed medical eXpensea. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (g-00) ' SCHEDULE J COMMNFIER TANCE TAX RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER WALTERS, Mary G 21-08-0637 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE W d AMOUNT OF ESTATE ($$$) NUMBER PERSON(S) RECEIVING PROPERTY Do Not Llet Trustee s ( s) or I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Nicole D. (Lynch) Boothe Granddaughter One-half of the 10,865.47 5 Barry Circle residue Shippensburg, PA 17257 Tasha R. Lynch Granddaughter One-half of the 10,865.47 45 Carla Drive residue Shippensburg, PA 17257 Total 21,730.94 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r 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 SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)