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HomeMy WebLinkAbout03-09-09 (2) 15056041125 REV-1500 Ex 0 ( 6-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of IndNidual Taxes Po Box zaosol County Code Year File Number INHERITANCE TAX RETURN Harrtsbum PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 0 0 2 0 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 7 6 3 4 9 2 6 9 1 2 1 9 2 0 0 7 0 2 1 6 1 9 4 4 Decedent's Last Name Suffer Decedent's First Name MI K u n k l e m a n C h a r l o t t e A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Secudty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death 4. Limited Estate ~ pdor to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required © 6 Deced t Di d death after 12-12-82) . en e Testate ~ (Attach Copy of Will) 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes A 9. Litigation Proceeds Received ~ ( ttach Copy of Trust) 10. Spousal Poverty Credit (date of death ~ 17. 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 Telephone Number H A n t h o n y A d a m s Finn Name (If Applicable) First line of address 4 9 W e s t. O r a n g e Second line of address S u i t e 3 City or Post Office S h i p p e n s b u r g S t r e e t State ZIP Code P A 1 7 2 5 7 fER OF WILLS USE O C7 0 O ~' ;,~ ~ ~ ~ ~ -.>~ ~ rn I _v~ tD J i a t+AT` -VE FILES ~ J ~ ~ ~> o Correspondent's a-mail address: htadamslaw(o~embargmail.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the hest of my kno it is We, coned and complete. Declaregon of preparer other than the personal represenfahve is based on all information of which preparer has any S~(JAATURE OF PfrRSON ~SRONSIBLE FOR FJt{NG RETU N4 - ., , C "~I , -J -{ 7 Side 1 15056041125 15056041125 --~~fi~ J 15056092126 REV-1500 EX Decedent's Social Security Number oecedertrs Name: Charlotte A. Kunkleman 1 7 6 3 4 9 2 6 4 RECAPITULATION 1. Real estate (Schedule A) , , , , , .. , ... 1 2. Stocks and Bands (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 8 Miscellaneous Personal Property (Schedule E) ....... 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 9. Funeral Expenses 8 Administrative Costs (Schedule H) ................ 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............ 10. 11. Total Deductions (total Lines 9 8 10) ........................... 11. 12. Net Value of Estate (Line 8 minus Line 11) , , . , , . . .......... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ..... ... 12. an election to tax has not been made (Schedule J) ........... ..... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........... ..... .. ta. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLIC ABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .045 1 1 8 2 9 0, 1 5 17. Amount of Line 14 taxable i s at sibling rate X .12 0 0 0 17 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18 19. Tax Due ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 0, 0 0 1 2 1 4 2 6- 5 9 1 2 1 4 2 6, 5 9 3 1 3 6, 4 9 3 1 3 6, 4 4 1 1 8 2 9 0, 1 5 1 1 8 2 9 0- 1 5 0, 0 0 5 3 2 3, 0 6 0, 0 0 0, 0 0 5 3 2 3, 0 6 15056042126 J REV-7500 EX Page 3 Decede+~t's Complete Address: tte A. Kunkle_m_an_ ADDRESS cirY Tax Payments and Credits: 1 Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ B. Pdor Payments C. Discount File Number 21 08 00020 STATE ZIP -- PA 117257 (1) 5 323.06 3. Interest/Penalty ifapplicable D. Interest E. Penalty Total Credits (A + g + C) (2) 0.00 4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT Total InteresVPenalty (D +E) (3) Fill in oval on Page 2, Line 20 to request a refund. 0.00 (4) 0.00 5. If Line 1 +Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) 5 323.06 (5A) B. Enter the total of Line 5 * 5A. This is the BALANCE DUE. (58) 5 323.06 Make Check Payable to REGISTER OF WILLS, AGENT ,r~ ,: .. , .. 4t, .: :: ~t~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; Yes No b. retain the dght !o designate who shall use the property transferred or its income; ~ ^ c. retainareversionaryinterest;or ................ ~~~~~~~~~~~~~~~~~~~~~""""" ................................................................................ ~ 0 d. receive the promise for life of either payments, benefits or care? ................ . . .. ................................... If death occurred after December 12, 1982, did decedent transfer progeny within one year of death without receiving adequate consideration? .............. ........................................ 3. Did decedent own an "intrust for' or payable upon death bank account or secudty 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? ................ ^ ............................................................................. ^ X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ._ :4.., 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 p2 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 [/2 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 (O) 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 tour and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) p2 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 p2 P.S. §9116(a)(1.3)]. Asibling is defned, 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 * (6-99) COMMONWEALTH OF PENNSYLVANIA INHERn-ANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Indude the proceeds of litigation All property joinUyowned with ri ITEM NUMBER DES ~ M&T Bank Account # 21000001216573 2. Orrstown Bank Checking Account # 103000713 3. Orrstown Bank Certificate of Deposit Account # 40000935 4. F&M Trust Company Checking Account # 33-57198 5. Security Benefit Life Account#2030016497 Qf more space is date ~ (Also enter on line 5, Recapitulation) I S of We same size) VALUE AT DATE OF DEATH 1,337.66 26, 246.04 73,644.00 1,315.87 18,883.02 REV-1511 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule 1. ITEM NUMBER A DESCRIPTION FUNERAL EXPENSES: 1. AMOUNT B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) ---~- Sodal Secudry Number(s)IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AttomeyFees H. Anthony Adams 3. Family Exemption: (If decedents address is not the same as daimanYs, attach explanation) 2, 000.00 Claimant Street Address City State Zip Relationship o(Claimant to Decedent 4. Probate Fees 348.00 5, Accountants Fees 6• Tax Retum Preparefs Fees 7. York Hospital (last illness) 8. Well Span Medical Group (last illness) 356.27 9. Quantum Inaging 95.40 10. West Shore EMS 7,85 11. Jatman Enterprises 131.67 12. Recorder of Deeds (Estate Mortgage) 143.25 54.00 more space is needed, insert additicnal sheets of the TOTAL (Also enter on line 9, Recapitulation) I g 1 REV-1513 EX * (9-001 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE) BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [inclutle outd~ht spousal disfdbu6ons, and transfers under Ser.. 9178 r~ r~ m1 1. Guy Kunkleman 34 Kunkleman Lane Shippensburg, PA 17257 2. Brian Kunkleman 495 Private Oak Lane Shippensburg, PA 17257 3. David Kunkleman 42 Kunkleman Lane Shippensburg, PA 17257 ~~~ ~ ~R uvILAK AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 II. NON-TAXARI F nrcromi ~T~~.~~. Do Not List Lineal A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OFPART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is same REV- E OF ESTATE