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Home My WebLink About03-17-09 (3)J 15056051058 REV-1500 EX (os-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po sox zsosol INHERITANCE TAX RETURN Harrisburg, PA 171213.0601 RESIDENT DECEDENT 21 ~ 1220 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Data of Birth Name Suffix Decedent's First Name MI DORSEY lRENE C (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 INAPPROPRIATE 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. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number VIRGINIA W. ARTER Firm Name (If Applicable) First line of address 1 HUNTER LANE Second line of address City or Post Office CAMP HILL State ZIP Code PA 17011-2402 n <~ REGISTER ( FAf ILLS ~ " ~ t USE~ILY , -; + ZJ ~~ ' `~ ~ ~ .~ c - . _. i ry ~~ N ;-, ~ `~ DATE FILED Correspondent's e-mail address: patcafnphill@msn.COm Under penalties of perjury, I deGare that I have examined this return, induding accompanying schedules and sffitements, 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 SI URE OF PERSON R~S~ONSIBLE FOR FILING RETURN preparer has any knowledge. • 'J, . 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS - PLEA8E USE ORIGINAL FORM ONLY 1 505605 1 058 Side 1 L 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~RENE C DORSEY 164-42-3947 RECAPITULATION 1. Real estate (Schedule A) ......... .................................. .. 1. 31, 000.00 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. 8,579.71 6. Jointly Owned Property (Schedule F) Separate Billing Requested ... 6 ... 7, Inter-Vivos Transfers 8 MisceAaneous Non-Probate Property . . (Schedule G) Separate Billing Requested....... . 7. 33,996.83 8. Total Gross Assets {total Lines 1-7) ... ................................ . 8. 73,576.54 9. Funeral Expenses & Administrative Costs (Schedule H) . .... . ..... g . . ... . . . . , . 10,292.13 10. Debts of Decedent, Mortgage Liabilities, $ Liens (Schedule I) ..... 10 .......... . . 1,117.98 11. Total Deductions (total Lines 9 & 10) .... .......................... . ... . 11. 11,41Q.11 12. Net Value of Estate (Line 8 minus Line 11) . . .......... . ................ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which . 12. 62,166.43 an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value SubJect to Tax (Line 12 minus Line 13) .......... . .. . . . ........ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14. 62,166.43 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable 15. at lineal rate x .0 45 62,166.43 1g 2 794 49 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable 17 at collateral rate X .15 . _ 19. TAX DUE .........................................................19. 2,794.49 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: FIle Number 21 08 1220 IRENE C DORSEY STRFFrannRCec DECEDENTS SOCIAL SECURITY ~ 1 HUNTER LANE cITY CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit _ 6. Prior Payments C. Discount 3. Interest/Penalty ifapplicable D. Interaest E. Penalty (3) (4) (5) 2, 794.49 (5A) {~) 2,784.48 STATE PA 21P 17011-2402 (1) _ 2,794.49 Total Credits (A + B + C) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal InterestlPenalty (D + E ) FIII in oval on Page 2, Llne 20 to request a refund. 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, Make Check Payable fo: REG/STER OF W-LLS, AGENT #~LEASE ANSWER THE fOLLOWiNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1 Dld 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 : ..................................... ....... c. retain a reversionary interest; or ................................................................................................................... ... . d. receive the promise for life of either payments, benefits or care? .................................. .......................... .. . .... ff 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 able ......... Pay upon death bank account or security at his ~ Fret death? ...... ...... .. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ...... contains a beneficiary designation? ....................... 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 kax 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) (i~]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets anc 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, ar adoptive panertt, or a stepparent of the citNd is zeta (0) percent [72 P.S. §911ti(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 it 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 wl~h the decedent, whether by blood or adoption. REV-1502 EX+ (11-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE IRENE C. DORSEY FILE NUMBER 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 willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relP~anr fa~r~ Real orooerty that .e ;.,~~ti.,_.,....,ea ...:.~ __~. _~ _ . . REV-1508 EX+ (698) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF IRENE C. DORSEY °ILE NUMBER 21-08-1220 Indude the proceeds of litigation and the date the proceeds were received by the estate. AN property iointiv-owned Wlth rinht et eunAvnre6iw w.n~ 1.~ a:__~___~ __ w_~_..._._ _ SCNEpuLE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY - -~--- ~- ..___,.,,, „~,,,,,. a~uiuunn: :eats u: me carne s¢e) REV-1510 EX+(6.98} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpULE G INTER-VNOS TRANSFERS & MISC. NON-PR08ATE PROPERTY w~n~c yr IRENE C. DORSEY FILE NUMBER 21-08-1220 This schedule must be comoletad and fllori s rtia ~.,~,.,....,, .._.. _, __ __... ... _......... ..~ ..w Dania aictl~ REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE5IDENT DECEDENT SCNEpVLE H FUNERAL EXPENSES & ADMINISTRATNE COSTS C.71AIG Vt IRENE C. DORSEY ITEM _ NUMBER A. FUNERAL EXPENSES: #' RICHARDSON FUNERAL HOME FILE NUMBER 21-08-1220 Debts of decedent must be reported on Schedule L 3,846.53 B. ADMINISTRATIVE COSTS: #. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)lEIN 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• Accountant's Fees 6. Tax Return Preparer's Fees ~• HOUSE REPAIRS IN PREPARATION FOR SALE 8 SALE OF HOUSE-SETTLEMENT CHARGES s UTILITY BILLS ~ o DEPT OF TRANSPORTATION -REPLACE TITLE TO AUTOMOBILE Zip _ Zip 105.00 4,530.99 1,400.38 386.73 22.50 TOTAL (Also enter on line 9 Recapitulation) I $ 10 292 13 (I# more space Is Headed, Insert addltlonal sheets of the same size) REV-1512 EX+ f12-OS) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER IRENE C. DORSEY 21-08-1220 Report debts incurred by the decedeirt prior to death that remained unpaid at the date of death, including unreimbursed medical exuenses. IT more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN IPT ~Tr w RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES IRENE C. DORSEY NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [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-OS-1220 ILATIONSHIP 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. 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 If more space is needed, insert additional sheets of the same size. $ A. Settlement Statement 6. T e of Loan U.S. Department of Housing and Urban Development 1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number OMB A roust No. 2502-0265 ex Tres 11/30/2009 FINAI 4. VA 5. Conv.lns s orm I . CA09251553 7. Loan Number 8. Mortgage Insurance Case Number s m a e o plve you a s s amen o ac ua a amen os s. moun a pa a C. NOTE: Items marked "(p.o.e.)" were paitl outside the closing; they are ahown here for information y e se amen gen area own. WARNING: It is a crime to knowingly make false statements to the United States on thi t he tals. conviction I ae a a : ; o °ae~a° ; TitleEx S t ~~o s Or can y other siml lar f r , , ; 8 nclude a fine and im risonment. For details see: TItIe 76 U. S. Code Section 1007 and Section 7010. D. NAME OF BORROWER: The Barbara E. Cullen Revocable Trust dated 1!17/08 press ettlement System Printed 02/09/2009 at 10:50 SPA ADDRESS: 1244 Cornet{ Avenue Drexel Hiii Pa 19026 E. NAME OF SELLER: Virginia W. Arter, Executrix under the will f I ADDRESS: o rene C. Dorsey, deceased F. NAME OF LENDER: ADDRESS: ` G. PROPERTY ADDRESS: 6157 Wheeler Street, Philadelphia, PA 19142 H. SETTLEMENT AGENT: Chase Abstract Company Phone 215-331-6550 F PLACE OF SETTLEMENT: I CCTTt c~rr~,r ... ~.- , ax 215-624-3032 9118 Frankford Avenue Phitadel hie, PA 19114 1 1 1 1 .+~., ureter ~ervlce U1I16/09to02/10/09 1 514. Water Rn~riinr,• n, g~oc 21 ss oza.s6 603. CASH TO SELLER 27 28: SUBSTITUTE FORM 1099 SELLER STATEMENT: The Information contained herein Ic important tax information and 1s being fumiahed to the Internal Revenue Service. 1! u are required to file a return, a negligence penalty or other sanction will be impocod on you (f this Item is r transaction. and the IRS delenninss that II has not been reported. The Contract Sales Price tlescribed on line 401 above eonstitutese helrGrosabProepsgtla of this SELLER INSTRUCTIONS: It this real estate was your prinUpal residence, file Form 2119, Sale or Exchanp a of Prtncfpal Resldenca, /or any gain, with your Income tax return: for other transactions, complete the applicable parts of Form 4797, Form 6252 antl/or Schetlule D (Form 1040). Vou are required by law to provide the Settlement Apent with your correct taxpayer Identification number. If you do not proNde your correct taxpayer Identifiption number, ypu may bs subject to civil or criminal penal(les Imposed bylaw. Under penalties of psrlury, 1 certify that the number ahown on this statement is my correct taxpayer itlenlifiCetion number. _ TIN: / SELLER(S) SIGNATURE(S): SELLER(S) NEW MAILING ADDRESS: Vy' vIJ.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: CA09251553 SETTLEMENT STATEMENT TitleEx ress Settlement Svsi L. SETTLEMENT cueor_~e e 11 1C 11 11 1108. 1109. 1110. 1111. 1112. 1113. 1200. 1201. 1202. 1203. 1204. 1205. 1300. 1301. 1302. 1303 to D ,,,,,,, , ,...,- , ,..,...., , o, , ,e„~~~~~ ,...,., FINAL PAGE = ~inted 02/09/2009 at 10:50 SPS PAID FROM PAID FROM BORROWER'S SELLER'S FUNDS AT FUNDS AT SETTLEMENT SETTLEMENT 427 I have carefully reNSwetl the HUD-1 Settlement Statement antl to the best of my knowledge and belie!, pit is'a true and accurst statement of ell receipts 1 858.75 4 477.96 and disbursements matle on my account in this transaction. I further certify that I have receivetl a copy of the HUD-1 Settlement Statement. Na r ~ • ~ • r un er wi rene o se ece se Y. accordance with this statement. The HUD-1 Ssttlemenl Statement which I have preparstl Is a true and accurate account of this trensactlon. 1 have caused or will cause funds to ba disbursed e WARNING: It is a crime to knowingly make /also statements to the UNtetl States on this or any other similar Corm, penalfles upon conviction un include a fine and imprisonment. For details tee: Title t8 U. S. Coos Section 1001 snd Sactlon 1010. ~~it,~ ~ o. IRE~E C• DURSEY j' IRENE C• DORSE Y Count of p , of 6157 Wheeler Street, in the Cin~ of Philadelphia l;- ; Y hiladelphia and State of Pennsylvarda, bein o and memory do hereby make, publish and declare this to f sound and dls osin P T? mind be mY Last Will and Testament. ~; r ~~ ~I' `~ FIRST: I hereby revoke any and all former Wills and by me. Codicils heretofore made _ SECOND: I direct that m of my just debts, including the eXY Executor, appointed hereunder expenses as soon as shall PenSeS ofmy last illness 'pay and discharge all forei be Practicable. I 'funeral and administration gn or other estate, transfer ' further direct that any and atI federal, state, including interest and ' inheritance, succession, legacy and similar taxes, included in m Penalties thereon, if any, imposed upon an Y gross estate under the provisions of Y Pro ert hereunder or by any codicil hereto or o P Y inquired to be such ro the any such ~ law, and whether P perty, shall be ~Se, or upon an Passing and shall not be equitabl aid out ofmy resid Y person with respect to any Y prorated or char ~'Y estate as an expense of administration ged against the gifts provided herein. THIRD: I give, devise, and be property, Whether real queath all of the rest, residue and remainder of m wheresoever si 'Personal or mixed, of whatsoever kind tuated, of which I shall die seized or and nature and Y which I shall have an funeral and Y Power of appointment, re Possessed, and all property over administration expenses and mining after the mother, Virginia W, Amer who taxes; absolute) Payment ofmy debts, County of C ~ presently resiaes at l H Y and forever to my dear, kind wnberland and State of Pennsylvania, enter Lane, Town of C ~p Hill, FOURTH: I do hereb Virginia W flrter Y nominate, constitute and a Executor of 'Presently residing at 1 H PPoint my dearest mother ~s W~ll• In the event of her deathtor eas gnation serve in said ca ' ~P Hill, Pennsylvania, as father, pa Pacity as Executor, I hereby nominate, constitute and ere or refusal to trick H. Arter, presently residin of Cumberland and State of pe 8 at I Hunter Lane To appoint my step- nnsylvania, as Successor Executorn of Came Hill' Count under this Will, Y T r- `' r ~ ` ~ gt 3r: C ~..e ~ ~ in anc Or OIt2t"'~' '-Y~Idt'~~ "• r - . , iwisdiction of ant ' `~-''~'``~:` ~ -~l?~~~ •~~- faithful perforrmance of her or his duties. indiE ideal na~~ herein ttr the ~~ J'.~-~ ,~. ,,. -, L_ .~' /~\{j- r \ ;' Wltnes C ~ ~,..,.: ,~ e_~.(~ro f ~~ ~ ,,,, ~~ ,~~~ . s 9 Ir r-,~ ~_ ~ ,• c,~ t ~~ `7 y ~ R j: c ~. IN WITNESS WHEREpF, l ha~~e set my hand and October 2007, seal this : -~~'-h. ~y ~ ~_ da~~ of IRENE C. DORSEY The foregoing consisting of 2 (moo was signed and executed by the abo eaneam d Testatrixes was signed Page, the original of which published and declazed b pnor to the execution thereof, our presence and herein Y said Testatrix as her L other subscribed our namesnas we thereu ~ Will and Testament, in Pon, at her request, and in the presence of each witnesses this day of Ocr~ha,.'007 `a, t. ~" r~~. _~