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Home My WebLink About02-26-0915056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Count Code Year File Number Bureau of Individual Taxes y Po Box zaosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~''-1 08 0877 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 211-07-8426 05/27/2008 01 /25/1911 Decedent's Last Name Suffix Decedent's First Name MI Kois Margaret (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouses 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 Return 3 Remainder Return (date of death pnor to 12-13-82j 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 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 Tricia D. Naylor (717) 243-7437 Firm Name (If Applicable) Law Office of `"~I ~, a ~ , ~~~ Ipy f<1 ~'g rf_:'i2 ry.-',M=_; > 1 5 ~. '}NL.Y First line of address N 104 S. Hanover Street c'> C Q G' .ca -r.' -~ -a i=re Second line of address 'rr ~ !~r'i _ l ~ C ~ L7C3 i %> ~-7 -:'~ N t ,'t-Tl City or Post Office State ZIP Code _ ~ '~ ~`~ Carlisle PA 17013 ` '`-~ rT ~ -~ '-t ~ ~ .,..,. ~ 6'r l i Correspondent's a-mail address: tnaylor@carlislepalaw.com ~' w ~.:, __,.1 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules an d 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 TURE OF PERSON RESPOFOR FILING RETURN DATE ADDRESS 111 Hillsid Drive, Carli PA 17013 SIG OF P ER OT ER AN REPRESENTATIVE DATE E S ~ ~_/ d "l 104 .Hanover Str t, Ca ~ , PA 17013 l PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15U5EiU510`58 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Maf9ar8t KOIS 211-07-8426 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 8 Notes Receivable (Schedule D) q 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5 5,821 88 6. Jointly Owned Property (Schedule F) Separate Billing Requested 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested..... ... 7 8. Total Gross Assets (total Lines 1-7). ..... 8 5,821.88 9. Funeral Expenses & Administrative Costs (Schedule H) 9 1 ,050.00 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) 10 12,850.06 11 Total Deductions (total Lines 9 & 10).. .. _ 11 13,900.06 12. Net Value of Estate (Line B minus Line 11) .... 12 0.00 13. Charitable and Governmental BequestslSec 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 0.00 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 18 19. TAX DUE 19 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 os o877 DECEDENT'S NAME DECECENT'S SOCIAL SECURITY NUMBER Margaret Kois 211-07-8426 STREET ADDRESS 1114 Hillside Drive CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments 750.00 C. Discount Total Credits (A + B + C ; (2) 3 Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty f 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 0.00 750.00 750.00 (5) (5A) (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,_ ...... ..........._. ..... . _.. ..___ _ _ __ L~ J 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?... ....... . __ ....... _ __ L_.J '~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ___, wit out receiving adequate consideration? ...... _ ... _ _.. _ _ _ ... _ _ _ _ _ _ ~_~ LC I -; Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?. _ , x 4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which r-_, -, contains a beneficiary designation? .._. _ _ ___ _ _.._ _ _ _ _ _ . _ _ _ _ t__l ~! 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)j. 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)j. 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(12) [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 ["r'2 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 adootion REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Margaret Kois 21-08-0877 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 (If more space is needed, insert additional sheets of the same size) EV-1511 EX+ (12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Margaret Kois 21-C'8-0877 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: f B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Larry S. Rankin street Address 1114 Hillside Drive city Carlisle .state PA Z;p 17013 Year(s) Commission Paid: 2009 2. Attorney Fees 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed. insert add~t~onai sheets of the same s~zei 300.00 750.00 1,050.00 j ~ Pennsylvania SCHEDULE I ' °EPARTMF"' °F RE~EN~E DEBTS OF DECEDENT, ~ ~"HERITAN~E TAx RETURN MORTGAGE LIABILITIES & LIENS ' RESIDENT DECEDENT ESTATE OF FILE NUMBER Margaret Kois 21-08-0877 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size.