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Home My WebLink About03-13-092505607122 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 D 8 0 7 4 1 Hamsburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 1 L 6 4 6 8? 0 6 1 2 2 0 0 8 1 2 0 4 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI M O N I S M I T H L Y D A J (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 ~ 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 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. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3 Firm Name (If Appllcable) I R W I N & First line of address 6 0 W E S T Second line of address City or Post Office C A R L I S L E State ZIP Code REGISTER OF WILLS USE ONLY ~ o - ~ r` ~ ~~ - ~. ~ ~, -~, _~~ _' -~:_3 `~? --- :J - -. -; -; ~ ; ~ ~ GiAiTE FILED ~ 7 " _,_ i i P A 1 7 0 1 3 ,.- ~ Correspondent's a-mail address: 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. SI r, U~ OF P~~SON fC~SP~BLF~~ R FILING RETURN ~ / TE /~ ~., ~5 SHARON DRIVE SHERMANS DALE PA 17090 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 60 WEST POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505627121 M c K N I G H T P C P O M F R E T S T R E E T Side 1 2505607121 (w`, 1505607221 REV-1500 EX Decedent's Social Security Number decedent's tvame: L Y D A J• M O N I S M I T H 2 0 1 1 6 4 6 8 7 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 arate Billin Requested le G) ^ Se hed S 7 ]+ 2 9 2 8 . 8 9 ..... p g ( c u .. . 8. Total Gross Assets (total Lines 1-7) ......................... .. 8. 1 2 9 2 8. 8 9 9. Funeral Ex enses & Administrative Costs Schedule H P ( ) .............. 9. .. 1 4 5 , ~ 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .......... .. 10. 11. Total Deductions (total Lines 9 & 10) ........................ ... 11. 1 4 5 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ...................... ... 12. 1 2 7 8 3 • 8 9 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. 1 2 7 8 3 . 8 9 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 , ~ Q D 15. O. ~ ~ 16. Amount of Line 14 taxable 1 2 7 8 3 8 9 5 7 5 2 8 at lineal rate X .045 16. . 17. Amount of Line 14 taxable Q ~ Q ~ ~ ~ at sibling rate X .12 17. • 18. Amount of Line 14 taxable ~ ~ ~ ~ ~ ~ at collateral rate X .15 18. • 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 5 7 5. 2 8 Side 2 15M5607221 150567221 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 08 0741 DECEDENT'S NAME LYDA J. MONISMITH ___ STREET ADDRESS 1535 LONGS GAP ROAD CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) Total InterestlPenalty (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. (5) A. Enter the interest on the tax due. (5A) (1) 575.28 0.00 0.00 0.00 575.28 B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 575.28 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 : ................................................................. ..... ^ 0 b. retain the right to designate who shall use the property transferred or its income; .......................... ..... ^ ^ X ^ c, retain a reversionary interest; or ........................................................................................... ..... ^ ^X 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? ................................................................................. " " ...... ^ ^ 0 or payable upon death bank account or security at his or her death? ... intrust for 3. Did decedent own an ...... 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. 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 childtwenty-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-1510 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & COM Wp ERITANCEOTAx RETURNANIA MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER LYDA J. MONISMITH 21 08 0741 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE CF TRANSFER ATTACHACOPYOFTHEDEEDFORREALESTATE. VALUE OF ASSET INTEREST IIFAPPLICABLE) VALUE 1. M&T SECURITIES, INC. 12,928.89 100. 12,928.89 ALLSTATE LIFE INSURANCE COMPANY ANNUITY #GA18439867 TOTAL (Also enter on line 7 Recapitulation) I $ 12,928.89 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LYDA J. MONISMITH 21 08 0741 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip Year(s) Commission Paid: Z Attorney Fees iRWIN & McKNIGHT 3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. I Probate Fees 5 Accountants Fees 6. Tax Return Preparers Fees 7. I REGISTER OF WILLS -FILING FEE TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 130.00 15.00 REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LYDA J. MONISMITH ~~ nQ n~n~ 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 [include ouUight spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. LYNDA K. COLLEGE Lineal 12,783.89 35 SHARON DRIVE REMAINDER SHERMANS DALE, PA 17090 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 TAX IS NOT BEING MADE 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRlBUT10NS 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) Allstate® Allstate Life Insurance Company PO Box 80469 Lincoln NE 68501-0469 li{VUfi`z ii: ViG~',i`~11{i%',1~ Telephone: 1-800-755-5275 Fax: 1-866-628-1006 February 22, 2009 LYDA .J MONISMITH Yaur Representative 1535 LONGS GAP ROAD CARLISLE PA 17013-8658 KIMBERLY J HEAVNER M & T SECURITIES, INC. 100 S SPRING GARDEN ST CARLISLE PA 17013-2552 (7171218-5426 Allstate® Preferred Performance Annuity Statement # GA18439867 ACTIVITY THIS PERIOD: Beginning Account Balance 02/22/08 ................................................ $ 12,813.51 Interest Earned 02/22/08 thru 02/22/09 ................................................. $ 379.47 Withdrawals .....................................................................$ 823.14 Ending Account Balance 02/22/09 ................................................... $ 12,369.84 Net Cash Surrender Value 02/22/09 ................................................. $ 11,813.20 Net Cash Surrender Value 02/22/08 ................................................. $ 12,121.58 f ~J~~Cj.~ ~>~ ACCQUNT VALUE' DETAIL AS OF 02/22/09;::: _.. Current Fund Rate Value 3.00% $ 12,369.84 New effective annual rates for each fund will be determined when the current guarantee expires. If you have any questions concerning your annuity please contact your representative at your financial institution. Systematic Withdrawal Information: If at any time you would like to change the amount of federal taxes being withheld from your systematic withdrawal or elect out of federal withholding, please notify us in writing. Your election will remain in effect until changed by you, and you may revoke any previous withholding election at any time. Under the estimated tax rules, you may be subject to penalties if adequate tax is not withheld. 1 B149VDIW.N01 acaoaoze~aevoiWeiaevoiwoooao 00507