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HomeMy WebLinkAbout04-03-09REV-1500 IX (06-OS) OFFICIAL USE ONLY PA Department of Revenue County Cotla Vear File Number Bureau oilndividualTaxes INHERITANCE TAX RETURN PO BOX 280801 Harrisburg,PA 1]128-gBD1 RESIDENT DECEDENT 21 08 1135 ENTER DECEDENT INFORMATION BELOW Social Secudty Number Date of Death Date of Birth 204 72 5091 08 13 2008 07 27 1991 Deceden's Las[ Name Suffix Decedent's Rrst Name MI Shearer Brandon E (If Applleable) Enter Surviving Spouse's Informatlon Below Spouse's Lasl Name Suffix Spouse's Rrst 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. Supplemernal Retum D 3. Remainder Retum (date of death prior to 12-13-82) D 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Re[um Required death after 12-12-82) I~ 6. Decedent Died Testate I~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received I~ 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - Thls section must be completed. All Correspondence and Confldentlal Tax Informatlon Should be Directed to: Name Daytime Telephone Number Stephanie Kleinfelter, Esq. rv 717 901 ~ ~ a, ~ Frm Name (If Applicable) Zr Keefer Wood Allen & Raha l, LLP REGIST ((CAS US LY ~ ~ , " a Frst line of address 635 N. 12th Street Second line of address City or Post Office State ZIP Code Lemoyne PA 17043 Correspondern's a-mail address: skleinfelter@keeferwood.com Untler penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the it is [rue, correct and cam plate. D eclaration of the Dreparer other than personal re Dresantative is basetl on all information of w hic h pi See schedule attached N. PA 17043 .~~ ~ t erra 3 ' ~'I ~ ~ •='`^ ~- O - :~ to 7 DATE FILE D of my knowledge and belief, er has any knowledge. ryy// PATE r/4 ~ ,a~ ~ p~ ~r 3r ~.3' z/4 / PLEASE USE ORIGINAL FORM ONLY Side 1 L I o ^o ^I I ^^ ~vu~j Estate of: Brandon E. Shearer Deborah A. Mahady 20 Landvale Street York Haven, PA 17370-908 Administrators Bruce E. Shearer 5023 Inverness Drive Mechanicsburg, PA 17050 204-72-5091 J I o ^o ^ol ^^ Rev-1600 EX Decedent's Social Security Number Decedents Name: Brandon E. Shearer 204 72 5091 RECAPITULATION ~'~~ 1. Real estate (Schedule A) ...................................... ... 1. 3 332.03 2. ................................. Stocks and Bonds (Schedule B) ... z. , ~'~~ 3. Closel Held Co oration, Partnershi or Sole-Pro rietorshi Schedule C Y rP P P P( )~~~ 3. ~~~ 4. ........................ Mortgages & Notes Receivable (Schedule D) ... 4. 0.0~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... ... 6. 0.0~ 6. Joirnly Owned Property (Schedule F) O Separate Billing Requested .... .. 6. 1,622.71 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 1 541 98 (Schedule G) O Separate Billing Requested .... .. 7. , . 8. Total Gross Assets (total Lines t-7) ............................. ... 6. 6,496.72 6,1$4'00 9. P ( ) ................. Funeral Ex enses & Administrative Costs Schedule H ... 9. ~'~~ 10. 9 9 ( ) ... .. ... ... . Debts of Decedent, Mort a e Liabilities, & Liens Schedule I ... 10. 6 184 00 11. Total Deduetlons (total Lines s & 10) ............................. ... 11. , . 312 72 12. 13. 14. Net Value of Estate (Line 8 minus Line 11) ................... Charitable and Governmernal Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............. Net Value SubJect to Tax (Line 12 minus Line 13) ............. ......... ......... ......... . 12. . 13. . 14. ' ~ • ~~ 312'72 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 289 05 0 00 (a)(1.z>x.oo . ts. . 16. Amourn of Line 14 taxable ~ ~~ 0 00 at lineal rate X .045 ~ 16. . 17. Amourn of Line 14 taxable ~ ~~ 00 0 at sibling rate X.12 • 17 . 16. Amourn of Line 14 taxable 23 67 3 55 at collateral rate X .1 s . 1 e . 3 55 19. .......................................... TAX DUE ......... 19, . . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Slde 2 L I L7 ^o ^ol ^^ I o ^o ^ol ^^ J Rev-1500 IX Page 3 rfecedenT's Cmm~lefe Addressc Rle Number 21 08 1135 DECEDENTS NAME Brandon E. Shearer DECEDENTS SOCIAL SECURITY NUMBER 204-72-5091 STREET ADDRESS 5023 Inverness Drive CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 3.55 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 0.00 C. Dixount 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Irterest 0.00 E. Penalty 0.00 Total Interest/Penalty (D+E) (3) 0.00 4. If Llne 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Page 2, Llne 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, ever the difference. This is the TAX DUE. (5) 3.55 A. Ener the inerest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 3.55. 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: 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? ..................... ... ^ 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 "intrust tof' or payable upon death bank account or secudty at his or her death? ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................... ... ~ ^ IF THE ANSWER TO ANV OF THE ABOVE QUESTIONS IS YES, VOU 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. Sect. 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 (O) percent [72 P.S. Sect. 9116(a)(1.1 )(ii)]. The statue 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 parern, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. Sect. 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the deceden's lineal beneficiaries is four and one-half (4.5) percern, except as noted in 72 P.S. Sect. 9116(1.2) [72 P.S. Sec[. 9116(x)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) peroern [72 P.S. Sect. 9116(x)(1.3)]. A sibling 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 -1503 E%t (B-98) SCHEDULE B COMMONW EALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RE510 ENT OECEn ENT ESTATE OF FILE NUMBER Brandon E. Shearer 21 08 1135 All property lolntly-owned with right of survlvorhslp must be disclosed on Sehetlule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 $50 United States of America Series EE Bond 26.74 Issued 07/19/06 Serial No.: L635635891 EE Principal $25.00 Accrued Interest $1.74 2 $50 United States of America Series EE Bond 27.50 Issued 08/02/05 Serial No.: L612463169EE Principal $25.00 Accrued Interest $2.50 3 $50 United States of America Series EE Bond 30.98 Issued 06/06/02 Serial No.: L623640650EE Principal $25.00 Accrued Interest $5.98 4 $50 United States of America Series EE Bond 29.78 Issued 08/06/03 Serial No.: L627977290EE Principal $25.00 Accrued Interest $4.78 5 $50 United States of America Series EE Bond 28.96 Issued 03/23/04 Serial No.: L603902983EE Principal $25.00 Accrued Interest $3.96 6 $50 United States of America Series EE Bond 44.24 Issued 01/03/95 Serial No.: L532801006EE Principal $25.00 Accrued Interest $19.24 7 $50 United States of America Series EE Bond 59.56 Issued 08/26/92 Serial No.: L481182441EE Principal $25.00 Accrued Interest $34.56 Total from continuation Schedule(s) 3,084.27 TOTAL (Also enter on line 2, Recapitulation) 3,332.03 (If more space is needed, insert additional sheets of the same size) Page 2 Estate of: Brandon E. Shearer 21 08 1135 Schedule B -Stocks and Bonds Item Value at Date Number Description of Death 8 Phoenix Funds 3,084.27 204.799 Shares Phoenix Capital Growth Fund-A Fund #53 Account No. 700557157 TOTAL. (Carry forward to main schedule) ...... 3,084.27 REV -1 fi09 EX+IB-98) SCHEDULE F COMMONW EALTH OF PENNSYLVANIA INHERITAN CE TAX RETURN RESIDENT DECEDENT JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Brandon E. Shearer 21 08 1135 If an asset was made lolnt within one year of the decedent's date o} death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME I ADDRESS RELATIONSHIP TO DECEDENT A. Deborah A. Mahady 20 Landvale Street Mother York Haven. PA 17370-908 B. Bruce E. Shearer 5023 Inverness Drive Father Mechanicsburg, PA 17050 c. Steve Shearer ~ ~ Uncle JOINTLY-OWNED PROPERTY: ITEM NUM. LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY. INCLUDE NAME OF FINANCIAL INSTITUTION AND SANK ACCT NUMBER OR SIMILARID ENTIFYING NUMBER. ATTACH GEED FOR JOINTLY-H ELD REAL ESTATE. DATE OF DEATH VAL UE OF ASSET %OF DECD'S INTEREST DATE OF DEATH VALUEOF DECEDENT'S INTEREST 1 A $100 United States of America Series EE Bond 57.12 50.000 28.56 Issued 11/24/04 Serial No.: C797460018EE Principal $50.00 Accrued Interest $7.12 2 A $50 United States of America Series EE Bond 27.00 50.000 13.50 Issued 12/20/05 Serial No.: L614837268EE Principal $25.00 Accrued Interest $2.00 3 A $50 United States of America Series EE Bond 33.26 50.000 16.63 Issued 11/30/00 Serial No.: L589746324EE Principal $25.00 Accrued Interest $8.26 4 A $50 United States of America Series EE Bond 31.58 50.000 15.79 Issued 12/05/01 Serial No.: L617587890EE Principal $25.00 Accrued Interest $6.58 5 B $100 United States of America Series EE Bond 116.76 50.000 58.38 Issued 12/03/92 Total from continuation Schedule(s) 1,489.85 TOTAL (Also erner on line 6, Recapitulation) 1,622.71 (If more space is needed, insert additional sheets of the same size) Page 2 Estate of: Brandon E. Shearer Schedule F -Jointly-Owned Property 21 08 1135 Letter Date % of Date of Death Item for Joint Made Date of Death Decd's Value of Num. Tenant Joint Description of Property Value of Asset Interest Decedent's Interest 5 Serial No.: C362169071EE Principal $50.00 Accrued Interest $66.76 6 C $50 United States of America Series EE Bond Issued 07/28/93 Serial No.: L511695211 EE Principal $25.00 Accrued Interest $22.34 7 A AmeriChoice Teen Club Checking Account Account No. 24739 8 A AmeriChoice Certificate of Deposit Maturity Date: 12/26/08 Account No. 24739 47.34 50.0000 23.67 188.68 50.0000 94.34 2,743.68 50.0000 1,371.84 TOTAL. (Carry forward to main schedule) ...... 1,489.85 REV-151° EXf ili-98) COMMONWEALTH OF PENNSYLVANIA INH ERITANCE TAX RETURN RESID ENT DECED ENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Brandon E. Shearer 21 08 1135 This sc hadula must be campletetl antl tiled if the answer to any of questions 1 through 9 on the reverse side atthe REV-15°° COVER SH EET is yes. ITEM NUM DESCRIPTION OF PROPERTY INCLUDE NAME OFTRANSFERE E, RELATIONSHIP TO DECED ENT& DATE OF TRANSFE R. ATTACH COPYOF GEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSEr °i°OF Dees INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Primerica 1,541.98 IRA 127.542 shares LMP Life Allc 70% A TOTAL (Also enter on line 7, Recapitulation) 1,541.98 (If more space is needed, insert additional sheets of the same size) REV-1511 EXr(10-Oe) COMMONWEALTH Of PENNSYLVANIA INH ERITANCE TAX RETURN RESID ENT DECED ENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Brandon E. Shearer 21 08 1135 Debts of decedent must be reported on Schedule I. A. FUNERAL IXPENSES: 1 William E. Llttle Funeral Homes 2 West Shore Evangelical Free Church -Visitation Services B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Represernative(s) Street Address City Stale _ Zip 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 4. 5. 6. 7 City State _ Zip Relationship of gaimant to Decedent Probate Fees Accountant's Fees Tax Retum Preparers Fees Cumberland County Register of Wills Automation Fee $ 5.00 JCP Fee $10.00 Filing Fees - Inventory & Inheritance Tax Return$30.00 6,004.00 105.00 30.00 45.00 TOTAL (Also erner on line 9, Recapitulation) 6,184.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+(9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INH ERITANCE TAX RETURN RESID ENT DECED ENT ESTATE OF FILE NUMBER Brandon E. Shearer 21 08 1135 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NuMaE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not Llst Trus s OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Deborah A. Mahady Mother 278.50 20 Landvale Street York Haven, PA 17370-908 Bruce E. Shearer Father 10.55 5023 Inverness Drive Mechanicsburg, PA 17050 Steve Shearer Uncle 23.67 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LIN EB 15 TH ROUG H 18, AS APPROPRIATE, ON REV-1500 COVE R SH EET TT NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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)