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HomeMy WebLinkAbout02-20-09 (3) 15056051058 06-05 REV-1500 Ex ( ) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN County Code Year File Number Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 00701 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 213-52-8646 06/11 /2008 01/14/1949 Decedent's Last Name Suffix Decedent's First Name MI Dillow Roger ~ (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 tN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW • 1. Original Retum 2. Supplemental Retum 3. Remainder Retum (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Compromise (date of 5. Federal Estate Tax Retum Required death after 12-12-82) • 6. Decedent Died Testate (Attach Copy of Will) 7. 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 CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephof5ij Number c~.a Tiffany Burket ~-c~ (717) 880-537~~ -, Firm Name (If Applicable) ~ sr ~-, ry-t ' , y ~ r ~ - y sue. - ~4;3•i'r- ~ - j~ 3 7 (~ ! ~ +.l First line of address _ ~ C- r r r 170 Charles Drive ~:~, ~ _ -` Second line of address ~ , ~ _, City or Post Office State ZIP Code "' ` ' "' Windsor PA 17366 Correspondent's a-mail address: wldflowers94i~yahOO.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. SIGNATURE OF PERSON( RESPQN$IBLE FOR FILING RETURN ADDRESS .~, rr l70 .{tnr pS DY ~~i`~~Isnr'~ Pfd l73t:t: SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 J 15056052059 REV-1500 EX Decedent's Name: Rig@I' L DIIIOW 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, & Liens (Schedule I) ............... . 10. 11. Total Deductions (total Lines 9 8 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, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 727.56 18 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Social Security Number 213-52-8646 0.00 0.00 0.00 0.00 3,811.00 0.00 0.00 3,810.97 3,083.41 0.00 3,083.41 727.59 0.00 727.56 109.13 109.13 15056052059 Side 2 L 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 08 00701 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Roger L Dillow 213-52-8646 STREET ADDRESS 520 Reno St Apt #2 CITY STATE zlp New Cumberland PA 17070 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 109.13 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 109.13 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 109.13 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 : ................................... ......... ^ 0 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? ................................................................................................................ ........ ^ 0 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 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+ I6-98) ~ SCHEDULE E COMMONUVEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Roger L. Dillow 2008-00701 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUEAT DATE OF DEATH 1 Checking Acct- Integrity Bank 3345 Market St. Camp Hill Pa 17011 Acct #203009537 10.97 2 1998 Ford Ranger 4x2 Regular Cab XLT Pickup Truck-Automatic 2,500.00 3 Clothing-Men's work shirts, jeans, tee shirts, socks, shoes boots one men's suit , , 200.00 4 Household Goods/Furnishings-Kitchen Table, 3 table chairs, 4 lamps, metal desk, bed table crock pot , , none cilvnnuorn vonnnm nleonnr 0 500.00 5 Books & CD's 100.00 6 Tools-shovels, saw horses, power saws 8 drills, concrete trowels painting supplies shop vac ladder , , , 500.00 TOTAL (Also enter on line 5, Recapitulation) S ~ 3,810.97 ~`i1 pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES ESTATE OF FILE NUMBER Roger L. Dillow 2008-00701 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER ~ NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees} OF ESTATE I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1. I Suann Dillow-45 Royal Court at Waterford, York , PA 17402 Ex-Wife 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE, II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET.1 ~~ =~ .~....:- S I- ~ ILL A1'~ D TESTAMENT _ ~` ,~ pE -' = _ ROGER L. DILLOW ~_~ ~ 4 ~} L.~'~. I. ~OGER L. DILLOW, of Stewartstown, York County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situated, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto Suann F. Dillow, absolutely, provided she survives me for a period of thirty (30) days. ITEM 3: Should Suann F. Dillow predecease me or fail to survive me for a period of thirty (3U) days, or should we die simultaneously, Ithen give, devise and bequeath my entire residuary estate unto Tiffany B. Dillow, absolutely. ITEM 4: I direct my Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing WITNE, ~i 1 ~~ J / ~ , ~-~! ROGER L. DILLOW „_~ rte. ~'=.- _-ti_ "per::- or sate, on any- property required to bz included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my Estate to whom such property is or may be transferred or to whom any benefit accrues. ITEIVI 5: 1 appoint Tiffany B. Dillow as Executor of this my Last Will and Testament. ITEM 6: I direct that my Executor or her successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 2v w~ day of ~~~/'VCI r`'1 2001. ,. "4-a -j ~ J~( ~t~-' GER L. DILLOW The preceding instrument, consisting of this and one other typewritten page was on the day and date thereof signed, sealed, published and declared by ROGER L. DILLOW the Testator herein named as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto. I ~ ` n ~ `j / ~._~_: ~~t~e, ROGER L. DILLOW, ~ ~ ~ ~ ~on~.c1 G-- ,and ----~~? ~ - ~`I ~b~ ~-- ,the Testator and the witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament, and that he signed willingly, and that he executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Will as witnesses, and that to the best of their knowledge, the Testator was at the time eighteen years of age or older, of sound mind, and under no constraint or undue influence. ,~ /--, Rt3GEIC L. liILLV~t SWORN TO AND SUBSCRIBED BEFORE ME THIS ~~ DAY OF ~bfv~ /' 2001. f ~~- SEAL ~ ) NOTARY PUBLIC Naia.rial Seal ~~ici<i L. Bcue, Nciary Pu'~!i; Dover Boro, Ycrk Ccuni~ My Commission Expires ©ct. ?3, _:;°?;> ~t^nmhnr Ponnc•.ilv:~n~a ~~~~~.;,~,....__..`..:.._.=... _ _. WILLS CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA No . 2008- 00701 PA No . 21- 08- 0701 Estate Of: ROGER L D/LLOW lrnst, Midtlle, Lastl a/k/a : ROGER LAFAYETTE DILLOW Late Of : NEW CUMBERLAND BOROUGH CUMBERLAND COUNTY Deceased Social Security No: 213-52-8646 WHEREAS, on the 1st day of July 2008 an instrument dated February 20th 2001 was admitted to probate as the last will of ROGER L DILLOW (First, Midd/e, Lastl a/k/a ROGERLAFAYETTEDILLOW 1 a to of NEW CUMBERLAND BOROUGH, CUMBERLAND County, who died on the 11th day of June 2008 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: TIFFANY BURKET who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, aI1 of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 1st day of July 2008. tom. ~~.,~, I ~,~_ ~ (~'~~` k--- ~ ~~ ~ ~Llv:~~%h~ `fig/ster' ofof d Depu-fy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA EARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 1st day of July, Two Thousand and Eight, Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of ROGER L DILLOW late of NEW CUMBERLAND BOROUGH IFnsg Midd/e, Las/1 a/k/a ROGERLAFAYETTEDILLOW in said county, deceased, to TIFFANYBURKET (First, Middle, Last) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 1st day of July Two Thousand and Eight. File No. PA File No. Date of Death S. s. # 2008- 00701 21- 08- 0701 6/11/2008 213-52-8646 Register Of Wils ' le NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL