HomeMy WebLinkAbout03-13-09 (2)J 1505607121
REV-1500 EX (a6-05>
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 8 7 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
0 8 1 1 2 0 0 8 0 6 1 1 1 9 2 7
Decedent's Last Name
J O H N S O N
Suffix Decedent's First Name
C H A R L E S
MI
A
(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 X
^ 2. Supplemental Return
^ 3. Remainder Return (date of death
^
4. Limited Estate ^ prior to 12-13-82)
4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required
^X 6. Decedent Died Testate ^
(Attach Copy of Will) death after 12-12-82)
7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
9. Litigation Proceeds Received ^ (Attach Copy of Trust)
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
N
ame :
Daytime Telephone Number
R O G E R M M O R G E N T H A L E S Q 7 1 7 3 4 c~4 0 1
Firm Name (If Applicable) r- 0 `n
_ - -
S M I G E L A N D E R - -..-
S O N & S A C K S REGISTeR .~ WILLS US> oNLY ~ f `:
First line of address ~ ' -r ~ -
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4 4 3 1 N O R T H F R O N T S T R E E T r._
Second line of address - " ~ -`
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3 R D F L O O R ~~ ;~ ~
,
17 --i c~
City or Post Office ~
State ZIP Code i _________ _ DATE FILED I
------- -- -----
-
H A R R I S B U R G -
P A 1 7 1 1 0
Correspondent's a-mail address: RMORGENTHAL(a~SASLLP.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 all information of which preparer has any knowledge.
SIGNA PERS RIPON LEAF0~2 FILING RETURN
// ,~ /I J ~ I _ L~ DATE ;
ADDRESS ~ ~
4431 NO TH FRONT ST, 3 D FLOOR HARRISBURG
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505607121
PA 17110
DATE
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RE`1-150o EX Page 3
~ Decedent's Complete Address:
File Number
21 08 0871
DECEDENT'S NAME
CHARLES A. JO_H_N_SO__N__ _
-- ----
- _-- -_ - -
STREETADDRESS
1 146 NEWVILLE ROAD
CITY
CARLISLE
--- -- -
T - -- __ _ ._ ._ __ __ _ - -
STATE ~ ZIP
PA j 17015
Tax Payments and Credits:
1 Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
1,828.23
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter (he difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 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.
(3)
0.00
0.00
(4) 0.00
(5) 1 828.23
(5A)
(5B)
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 : ................................. ^ O
...............................
b. retain the right to designate who shall use the property transferred or its income; ............
............. ......
^
...... Q
c. retain a reversionary interest; or .......................................................................................... ...... ^ Q
d. receive the promise for life of either payments, benefits or care? ................................................
... ^
o
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?
..................................................................................
.... ^ ^
X
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .... .... ^ Q
4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................._. _ n ~X1
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 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)].
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,
1,828.23
REV-1508 EX + (6-98)
1
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
CHARLES A. JOHNSON 21 08 0871
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. GREAT WEST LIFE & ANNUITY POLICY #920321A 43,642.33
TOTAL (Also enter on line 5, Recapitulation) I $ 43 64~ 33
(If more space is needed, insert additional sheets of the same size)
RE`/-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
CHARLES A. JOHNSON 21 08 0871
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B
2
3
4
5
6
7
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) ROGER M. MORGENTHAL, ESQUIRE
SireetAddress 4431 N. FRONT ST., 3RD FLOOR
City HARRISBURG State PA Zip 17110
Year(s) Commission Paid:
Attorney Fees SMIGEL, ANDERSON & SACKS, LLP (additional since original return)
Family Exernption: (Ii decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY
Accountant's Fees
Tax Return Preparer's Fees
0.00
3,000.00
15.00
TOTAL (Also enter on line 9, Recapitulation) I $ 3 0 ] 5 00
(If more space is needed, insert additional sheets of the same size)
RE'/-1513 EX . (g-pp
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CHARLES A. JOHNSON
SCHEDULE)
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. CHARLES W..fOHNSON
1146 NEWVILLE ROAD
CARLISLE, PA 17013
2. JAMES A. JOHNSON
1162 DOUBLING GAP ROAD
NEWVILLE PA 17241
FILE NUMBER
2] 08 0871
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
Lineal
20,313.67
20,313.66
I 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.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET I $
(If more space Is needed, Insert addltlonal sheets of the same size)
AMOUNT OR SHARE
OF ESTATE
R
Great-W®st
LIFE d ANNUITY INSURANCE CC3MRANY
December 3, 2008
Simgef, Anderson & Sacks
Attn: Roger Morgenthal
4431 North Front St 3rd Floor
Harrisburg, PA 17110-1778
Policy Number: 920321A
Annuitant: Charles A Johnson
Dear Mr. Morgenthal:
8515 East Orchard RoaU
Greernrvvod'dillage, Co 80111
(303) 737-3000
Mal ling Address: PO Box 1700, Denver, CO 80201
www. t~reaNre~.com
This is in response to your request for information. We can commute the remaining
payments owed on this policy and issue a lump sum payment of $43,642.33 to the
Estate of Charles A Johnson. This amount is based on a next payment date of
September 2, 2008.
In order to receive this lump sum payment, please complete and sign the enclosed
Agreement and Release form and send it to us along with the forms already sent to
you.
If you have any questions please contact our Customer Service Center at
1-877-495-4472 and a representative will be happy to assist you.
Sincerely,
j~ c ~ ---
Marielle Loef
Individual Customer Services
Enclosures}
Administrative Services Office
Phone: 1-877-495-4472 Fax: 1-888-588-3888