HomeMy WebLinkAbout03-17-09C 15056051058
REV-1500 EX (os-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PoBOx2sosol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 1220
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
11 /19/2008 08/21 /1951
Decedent's Last Name Suffix Decedent's First Name MI
DORSEY IRENE C
(If Appflt:able) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Seauity 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 6. 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 T0:
Name
Daytime Telephone Number
VIRGINIA W
ARTER
. (717) 737-8791
,
Firm Name (if Applicable) ~
,,,
~
C?
~,
REGIF WILLS~E ONLX:? ._;-
O ~ ~ r~ i
First line of address ;
r~-
,
1 HUNTER LANE ,^ i
_
t.: ;i
~~~ "~ -- ~~%
Second line of address -. .-.
%;~ >
-? -n ~
:~
_
~
_.. _A7
City or Post Office State ZIP Code DATE FILE -,
CAMP HILL PA 17011-2402
Correspondent's e-mail address: patcamphlll~mSn.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 alt information of which preparer has any knowledge
OF PERSON RESPONSIBLE FOR FILING RETURN DATE
03/17/09
1 HUNTER LANE ,CAMP HILL , PA. 17011
SIGNATURE OF PREPARER OTHER TNAN REPRESENTATIVE
ADDRESS
DATE
PLEASE U8E ORIGINAL FORM ONLY
15056051058 Side 1
L 15056051058
J 15056052059
REV-1500 EX
RECAPITULATION
1, Real estate (ScheduleA) ......................................... .... 1. 31,000.00
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) .............. . .... . . . . . . . ... 4.
5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) .... .... 5. 8,579.71
6. Jointly Owned Property (Schedule F) Separate Billing Requested ... .... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested.... ... , 7. 0.00
8. Total Gross Assets (total Lines 1-7) ..... . ........................... ... 8. 39,579.71
9. Funeral Expenses & Administrative Costs (Schedule H) .......... . ....... ... 9. 10,292.13
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 1,117.98
11. Total Deductions (total Lines 9 & 10) .............. . .... . .... . . . . .. . . . . . 11. 11,410.11
12. Net Value of Estate (Line 8 minus Line 11} .................... . ...... .. . 12. 28,169.60
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. 28,169.60
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 45 28,169.60 1s. 1,267.63
17, Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateraH rate X .15 , o
19. TAX DUE .........................................................19. 1,267.63
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN O
REV-1500 EX Page 3
Decedent's Complete Address:
IRENE C DORSEY
REETADDRESS
1 HUNTER LANE
clrr
CAMP HILL
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 2,794.49
C. Discount
Flle Number
21 os 1220
DECEDENTS SOCIAL SECURITY
STATE Zlp
PA ~ 17011-2402
(1 ~ 1,267.63
3. InteresUPenal If a liable Total Credits (A + g + C) (2) 2, 794.49
tf' ~ Pp
D. Interest
E. Penalty
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal InteresUPenalty (D + E) (3)
FIII in oval an Page 2, Line 20 to request a refund.
(4) 1, 526.86
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)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (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:
a. retain the use or income of the
Property transferred :.......................................................................................... Yes
^ No
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? ............... .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ^ 0
......
4. Did decedent. own an Individual ReBrement Account, annuity, or other non-probate property which
contains a beneficiary designation? ......................................... . n n
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 .Ypmnr 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)j.
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.
Pennsylvania
DEPARTMENT CF REVENUE
INHERITANCE -AY. RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
IRENE C. DORSEY 21-08-1220
All real property owned solely or as a tenant in common must be reported at fair market value, Fair market value is defined as the price at which property
would be exchanged between a wii;ing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is inlntly-nwend w;tti .~.,ti~ s ...._....___~:_ ____. ~_ ., _ . _
-• ~••~•~ ..rv~.. ~~ ~.ccucu, ui~cn ouwuUndl SNeeTS 0! one same size.
REV 1508 EX+ (8.98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
IRENE C. DORSEY
SCNEDI~LE E
CASH, BANK DEPOSITS, & MISC.
PERSONA! PROPERTY
FILE®
21-08-1220
Indude the proceeds of litigation and the date the proceeds were received by the estate.
Atl INOPenY 1oiMiv-owned with right of survlvn-:I.ix ~..~..- ~.. ase_~___~ __ ~_~_.,..._ _
~....._._ -r°~ ^~ ~~.....+~u, ~„~~~. uva,iwna~ snee[s or me same s¢e)
REV-1510 EX+ (698)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDI~LE 6
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
- -....__.. ---....,.,....,nvsw v, u,o AaIIRt 61Le)
~~~w~~ yr _
IRENE G. DORSEY FILE NUMBER
21-08-1220
This schedule must be completed and find .rtno ~„~~,e~ ~,..,.,..,,~....__.:___ ..~__ _
REV-1511 EX+ (12-99)
SCFIEp1~LE N
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
IRENE C. DORSEY 21-08-1220
Debts of decodent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' RICHARDSON FUNERAL HOME
3,846.53
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative{s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
2. Attorney Fees
3. family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
4. Probate Fees
5. Acx:ountant's Fees
6. Tax Return Preparer's Fees
~. HOUSE REPAIRS IN PREPARATION FOR SALE
a SALE OF HOUSE-SETTLEMENT CHARGES
s UTILITY BILLS
~ o DEPT OF TRANSPORTATION -REPLACE TITLE TO AUTOMOBILE
Zip
.tip
105.00
4, 530.99
1,400.38
386.73
22.50
TOTAL (Also enter on line 9, Recapitulation) I $ 10,292.13
(K more space is needed, Insert additional sheets of the same stze)
REV-1512 EX+ (12-D$}
Pennsylvania
DECARTMEN7 OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
IRENE C. DORSEY 21-08-1220
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
Ir more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (il-DS)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RES[DEN7 DECEDENT
SCHEDULE
BENEFICIARIES
ESTATE OF
IRENE C. DORSEY
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE OISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 2116 (a) (1.2).)
1. VIRGINIA W. ARTER , 1 HUNTER LANE ,CAMP HILL , PA. 17011
FILE NUMBER
21-08-1220
LATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
MOTHER ~ 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I$
If more space is needed, insert additional sheets of the same size,
A. Settlement Statement U.S. Department of Housing and Urban Development o VVVV^'yVy
6. T e of Loan OMB A royal No. 2502-0285 ex fires 11/30/2009 FI_N_ At.
1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number 8. Mortgage Insurant~ Case Number
4. VA 5. Cony. ins. CA09251553
is orm is um s e o give you a s a amen o a ua se men cos s. moun c pa an y e se amen agen are s own.
C. Note: Items marked '(p.o.e.)" were paid outside Me closin®®; they era shown here for information purposes and are not Included In the totals. TitleEXpreSS .Settlement System
WARNING: It is a crime to knowingly make false statements to the United Staten on this or any other similar forth. Penaltioa upon
conviction can Include a fine and Im rlsonment. For details sea: Title 18 U. S. Code SecUOn 1001 and Seceon toto. Printed 02/09/2009 at 10:50 SPS
D. NAME OF BORROWER: The Barbara E. Cullen Revocable Trust dated 1/17/08
ADDRESS: 1244 Cornell Avenue Drexel Hili Pa 19026
E. NAME OF SELLER: Virginia W. Arter, Executrix under the will of Irene C. Dorsey, deceased
ADDRESS:
F. NAME OF LENDER:
ADDRESS:
G. PROPERTY ADDRESS: 6157 Wheeler Street, Philadelphia, PA 19142
H. SETTLEMENT AGENT: Chase Abstract Company, Phone 215-331-6550 Fax 215-624.3032
of nnc r.v nr-~~ .-..'...~ ....- - -
100. GROSS AMOUNT DUE F
31
iC
1C
11
11
11
1
in
51
51
1
1
1
~u I . ~,ross amount due from borrower line 120 33 642.01 601. Gross amount due to seller line 420
302. less amounts paid by/for borrower line 220 17.65 602. Less reduction amount due seller lint
303. CASH FROM BORROWER 33 624.36 603. CASH TO SELLER
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein fs important tax information and is being furnished to the Internal Revenue
Service. I( u are required to file a return, a negligence penalty or other sanction wit) be imposed on you i( (his item is required to be reported
and the IRS delarrnines that it has not teen reported. Tha Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this
transaction.
tax rerun !ifor other tra^saculonsi eoml ®~,e the as >ror~ble nelPal residence, file Form 2119, Sale or ExehanUa of Principal Resftlence, for any gain, with your Income
P pp parts of Form 6797, Form 6252 and/or Schedule D (Form 1040).
Vou are required bylaw to provide the Settlement Agent with your Correct taxpayer idantiflca[ion number. If you do not provide your correct taxpayer
Identifigtlon number, you maybe subject to civil or criminal penalties Imppsetl Dy law.
Under penalties of penury, I certify that fhe number shown on this statement is my correct taxpayer Identification number.
TIN: /__ SELLER(S)SIGNATURE(S):
SELLER(S) NEW MAILING ADDRESS:
17
"~, oU:S_DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
1
11
11
11
111
111
1
1
1
1
File Number: CA09251553 FINAL PAGE 2
TitleEx ress Settlement S stem Printed 02/09/2009 at 10:50 SPS
PAID FROM PAID FROM
,000 = BORROWER'S SELLER'S
FUNDS AT FUNDS AT
SETTLEMENT SETTLEMENT
1
-- -_"'_" ° """ ""` " ^ 1 858.75 4 477.96
I have carefully reNawad the HUD-1 Settlement Statement antl to the beat of my knowletlga antl ballet, tt Is a true and accurate atalement of all receipts
and disbursements made on my account in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement.
' V rV8 e
e, e u er w o re a orse e e
lTs HUD-1 Settlement SUlsmeni which I have prepared is a true antl accurate account or this transaction. 1 have roused or will cause funds to be disbursed
accordance with this smtemenl.
e
WARNING: 11 la a crime to knowingly make 'false statements to the United States on this or any other aimllar loan. Penaltlei upon
conNCtion un Include a fine antl impnsonmsnt. For detau• sae: Title 1 a U. S. Code Section 1001 antl Ssctlon 1010.
~t~,~
~~ ~' E C. DORSE Y
;~ , County of Ph~iladeE hCia DORSEY, of 6157
^. Wheeler Street, in the Cit<- of Philadelphia,
°" and memo P and State of Pennsylvania, being of sound and disposin mi
ry do hereby make, publish and declare this to be m L
g nd
Y ast Will and Testament.
,~ , FIRST: I hereby revoke any a_nd ail former Wills and C
- ti~ by me.
odlcils heretofore made
.__, SECOND: I direct that m
.., of my just debts, including the exY Executor, appointed hereunder
expenses as soon as shall be penses of my last illness 'pay and discharge all
~~ practicable. I ~ funeral and administration
r> foreign or other estate, transfer, inheri f~'ther direct that an
including interest and tance, succession le ac Y and all federal, state,
~'1 Penalties thereon, if an g y and similaz taxes
included in my gross estate under the Y~ Imposed upon at1 '
hereunder or by any codicil hereto or oche lsions of an Y Property required to be
such property, shall be rwise, or uponsanh ~ law' and whether passing
and shall not be equitabpald out of my resid Y Person with respect to any
Y prorated or charged galnst the g ~ provid f administration
ed herein.
THIRD: I give, devise
property, v-'hether real 'and be9ueath all of the rest, residue
personal or mixed, of whatsoever kind and remainder of my
wheresoever situated, of which I s
which I sha1I have an hall die seized or and nature a11d
funeral and Y Power of apP°1n~ent, remalnlnSessed, and all property over
ministration expenses and g after the Payment of m
mother, Virginia W. Arter, who presentIy~s desbat IuHI Y debts,
County of C Y and forever to my deaz, kind
umberIand and State of Penns 1v under Lane, Town of C
Y aria. aznp Hill,
FOURTH: I do hereb
Virginia W. P Y nominate, constitute and a
Amer, resently residin Ppoint m
Executor of this Will. In the event of her ~~ or e~e' Cam Y dearest mother
serve in said ca P H111, Pennsylvania, as
father, Pa P~1h' as Executor, I hereb Slgnation, or failure or refusal to
trick H. Arter Y nominate, constitute and a
of Cwnberland ~ presently residing at 1 Hunter Lane, To Ppoint my step-
and State of PenrlsYlvania, as Successor ExecutorJn of C
~p Hill, County
under this Will,
T
t 1...~ ti1. r.tia ii~~ l"V1lL. ~ul tt` ~~^^~~T e~,~y.~.,~e~ _
7£ £eQili.refi at arL ,};~~ i£ IP an1".~~$dICiIC~n Ot anl- .
faithful IndIL-idual ``` ~~'~= :~''-``
Performance of her or his duties. ~~ herein ~or the
IN WITNESS ~EREOF,1 have set my hand and seal this :..~ h
October 2007.
/'~ E ~_ da~• of
IRENE C. DORSEY
~:
k
r~•
,-
!L"
vJ~ ~ 7 ~ ..._ "~
Tit'': ~ ~"
t f~~_ ~ - ,; -~
~-
,--~
;,
Witness ~~of ~.~ E , ,-,, 1~1 { ~~
"1
~ ' ~ ~_
i
i'
1
W- tnf ess- -~---~ of ~ i ~ ~ ti P-~,~ ~.~ ~ /~`~ :, ~ I
~ ,~, LL f f r; r r~ Ft..i
The foregoing consisting of 2 (two
was signed and executed by the abo eanamedlTe tatrix~riorage, the original of which
was signed, published and declared b p to ~e execution thereof,
our presence and hearin Y said Testatrix as her Last Will and Testament, in
other subscribed our naxnesnas we thereupon, at her request, and in the presence of each
witnesses this day of October 200'7.