Loading...
HomeMy WebLinkAbout04-01-091505607121 REV-1500 Ex (os-05) OFFICIAL USE ONLY PA Departrnent of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 1 0 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 2 3 0 4 9 1 0 0 1 0 1 2 0 0 9 0 2 2 6 1 9 2 8 Decedent's Last Name Suffix Decedent's First Name MI B O W M A N D O R I S S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Sulfur Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate © 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust ~ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) State ZIP Code CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number M U R R E L R W A L T E R S I I I 7 1 7 6 9 7 4 6 5 0 Firm Name (If Applicable) First line of address 5 4 E A S T M A I N S T R E E T Second line of address City or Post Office M E C H A N I C S B U R G Correspondent's e-mail address: 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) REGISTER OF WILLS USE ONLY rv Q -.-~ i ~ ~ ~~ ~ lei. _ _ { •, ~ . , F r'1 ~ -: e ' 7 t - -. ~ ~~ - r , ~: ~ rr ...~ a ~ ~ ~ (".. f..._. ~ FILED ~` _i ~ - -a ~ a- ~`_ t P A 1 7 0 5 5 ~ cn "'' ~-f-; Under penalties of perjury, I dedare that I have examined this return, including accompanying schedules and statements, and to the hest of my knowledge and belief, it is true, correct and complete. Dedaratan of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE ERSON.R SIBLE FOR FILI RETURN DATE ~-) z~ je4 ADDRESS LARRY B SIGNATURE I ADDRESS ' MURREL R CARRIAGE WAY F REPRESENTATIVE 54 E MAIN ST MECHANI PLEASE USE ORIGINAL FORM ONLY Side 1 ANCH BURG L 1505607121 1505607121 / ~lr~d 5 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 os o102 DECEDENTS NAME DORIS S. BOWMAN STREET ADDRESS 107 E. LOCUST STREET CITY MECHANICSBURG STATE PA ZIP 17055 Tax Payments and Credits: ~~ Tax Due (Page 2 Line 19) (1) 10.174.48 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 508.72 Total Credits (A + B + C) (2) 508.72 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E ) 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. 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. (3) 0.00 (4) 0.00 (5) 9.665.76 (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 9.665.76 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 : ...................................................................... ^ Q 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? ....................................................................................... ^ Q 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? .................................................................................................. ^ 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 exemot 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-0ne 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) p2 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. sssssss~ 1505607221 REV-1500 EX Decedent's Social Security Number Decedents Name: D O R I S S• BOWMAN 1 9 2 3 0 4 9 1 0 RECAPITULATION 1. Real estate (Schedule A) 1. 1 2 4 0 0 0. 0 0 ........................................ 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 8 Miscellaneous Personal Property (Schedule E) .... ... 5. 1 0 6 1 9 3. 1 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers 8 Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1-7) ........................ ... 8. 2 3 0 1 9 3. 1 4 9. Funeral Ex enses ~ Administrative Costs Schedule H P ( ) ............. 9. ... 3 3 4 1 • 0 0 10. Debts of Decedent, Mort a e Liabilities, 8~ Liens Schedule I 9 9 ( ) ......... 10, ... 7 5 2. 4 9 11. Total Deductions (total Lines 9 8 10) ........................ ... 11. 4 0 9 3. 4 9 12. Net Value of Estate (Line 8 minus Line 11) ...................... ... 12. 2 2 6 0 9 9 . 6 5 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. 2 2 6 0 9 9 • 6 5 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.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .045 2 2 6 0 9 9. 6 5 16. 1 0 1 7 4. 4 8 17. Amount of Line 14 taxable 0 0 0 0 0 0 at sibling rate X .12 17. . 18. Amount of Line 14 taxable 0 0 0 ll t t l X 1 0 0 0 . a era co a rate . 5 18. . 19. Tax Due ............................................. ...19. 1 0 1 7 4. 4 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505607221 1505607221 REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER BORIS S. BOWMAN 21 09 0102 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 wiling seller, neither being compelled to buy or sell, both having reasonable krrowledge of the relevant fads. Real proaerhr which is ioiMN-owned with riots of surv'rvorshio must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 107 E. LOCUST STREET 124,000.00 MECHANICSBURG, PA 17055 (assessed value $98,430 x county common level ratio 1.26) TOTAL (Also enter on line 1 (If more space Ls needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E BANK DEPOSITS, ~ MISC. CASH COMMONWEALTH OF PENNSYLVANIA , INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER DORIS S. BOWMAN 21 09 0102 Indude the proceeds of litigation and the date the procxeds were received by the estate. All property joirrtly~owned with right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. AMERIPRISE -POST 1985 27,243.81 #93008043128 9 004 2. AMERIPRISE -POST 1985 8,630.78 #93101846788 2 004 P/O 3. AMERIPRISE ONE FINANCIAL ACCOUNT 16,044.34 #00050043652 2 021 4. SPS ADVANTAGE 22,535.19 #00032097206 0 021 5. WACHOVIA 1,421.12 CERTIFICATE OF DEPOSIT #24-740-211-2085924 6. PNC BANK 12,404.70 CHECKING 7. PNC BANK 4,280.81 SAVINGS 8. 2008 FEDERAL INCOME TAX REFUND 5,090.13 9. CASH 26.29 10. CUMBERLAND GOODWILL FIRE 8~ RESCUE 249.10 REFUND 11. PNC BANK 15.00 REFUND OF SERVICE CHARGE 12. METLIFE 30.34 DIVIDENT 13. METLIFE 645.63 SALE & CLOSING OF ACCOUNT 14. CHURCH OF GOD 2,331.87 REFUND OF DEPOSIT 15. CHURCH OF GOO 113.38 PETTY CASH REFUND 16. U.S. TREASURY 300.00 STIMULUS CHECK TOTAL (Also enter on line 5, Recapitulation) ~ ; (If more space is needed, insert additional sheets of the same s¢e) Continuation of REV-1500 Inheritance Tax Return Resident Decedent DORIS S. BOWMAN 21 09 0102 Decedent's Name Page 1 File Number Schedule E -Cash, Bank Deposits, 8~ Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. CARLISLE REGIONAL MEDICAL CENTER 46.09 REFUND 18. PERSONAL PROPERTY 4,784.56 RECEIVED FROM AUCTION SUBTOTAL SCHEDULE E 4,830.65 GRAND TOTAL SCHEDULE E S 106,193.14 REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER DORIS S. BOWMAN 21 09 0102 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME -FINAL FUNERAL EXPENSE 350.00 2. FUNERAL LUNCHEON -CHUCK IRVIN 170.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) LARRY BOWMAN (RENOUNCED) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees MURREL R. WALTERS, III 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant 4. Street Address City State Zip Relationship of Claimant m Decedent Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY 5 Accountants Fees 6. Tax Return Preparer's Fees 7. 2,500.00 321.00 TOTAL (Also enter on line 9, Recapitulation) I ~ (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER DORIS S. BOWMAN 21 09 0102 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC BANK SERVICE CHARGE 2. IPUBLlC SCHOOL RETIREMENT RETURN OF JANUARY 2009 CHECK 3. (CONTINUING CARE RX MEDICATION 4. (MOBILE XRAY IMAGING MEDICAL TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) s 10.00 463.76 244.18 34.55 REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DORIS S. BOWMAN ~~ na 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 [ndude outright spousal distributans, and transfers under Sec. 9116 (a) (1.2)] 1. LARRY BOWMAN Lineal 54,108.48 4707 CARRIAGE WAY FLOWERY BRANCH, GA 30542 2. BRENDA BOWMAN Lineal 54,108.47 CIO LARRY BOWMAN, 4707 CARRIAGE WAY FLOWERY BRANCH, GA 30542 3, JOANNE BOWMAN Lineal 54,108.47 C/0 LARRY BOWMAN, 4707 CARRIAGE WAY FLOWERY BRANCH, GA 30542 4. MARY BETH BOWMAN Lineal 54,108.47 C/O LARRY BOWMAN, 4707 CARRIAGE WAY FLOWERY BRANCH, GA 30542 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 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 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET s ~1T more space Is neeaea, Insert atltlltlonal sheets of the same size)