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Home My WebLink About04-06-09 ~~~~ ~ 1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.2aosol Harrisburg, PA 17128-0601 2 1 0 6 1 0 7 2 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1652b6194 03102006 05171931 Decedent's Last Name Suffix Decedent's First Name MI MADEIRA FREDERICK L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suftix Spouse's First Name MI MADEIRA CAR~LYN G 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 ^ 4. Limited Estate ^ 6 Decedent Died Testate (Attach Copy of Will) ^ 9. Litigation Proceeds Received ® 2. Supplemental Return ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 10 Spousal Poverty Credil (date of death between 12-31-91 and 1-1-95) THOMAS J. AHRENS Firm Name (If Applicable) AHRENS LAW FIRM, P.C. First line of address 52 GETTYSBURG PIKE Second line of 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) N >~ :NTIAL TAX INFORM HOULD IRECIEp ; - Daytime Telep~i umber~r. s= ~-i ~~;a . 7 1 7 6 9 7 ~v ~~ ~~ !v /-}~ w r ` • ~ - ~/ REGISTER USE ONLY C ~ ~~ ~ _ ~ ~- ~~ -- t City or Post Office MECHANICSBURG State 21P Code PA 17055 DATE FILED Correspondent'se-maiiaddress: judd@ahrenslawfirm.com Under penalties of pery'ury, 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. Alfred L. Madeira 1124 Kennebec Drive, Chambersburg, PA 17201 .3-a~-o SIGNATURE REPy~tER OTHER THAN REPRESENTATIVE DATE ~ //~// Thomas J. Ahrens ~ - .3 J~ D ADDRESS j 52 Gettysburg Pike, Mechanicsburg, PA 17055 Side 1 1505607120 1505607120 1505607220 REV-1500 EX Decedent's Social Security Number DecedeM~sName: MADEIRA, FREDERICK L 1 6 5 2 6 6 1 9 4 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 1 1 0 4 8 8 6 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 1 1 0 4 8 8 6 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. - 1 9 0 0 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 1 9 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 1 1 0 2 9 8 6 13. Charitable and Governmental BequestslSec 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, 1 1 0 2 9 8 6 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 .o0 1 1 0 2 9 8 6 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ..................................................................................................................... 19. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505607220 1505607220 J REV-1500 EX Page 3 File Number 21 - 06 - 1072 Decedent's Complete Address: A Madeira, Frederick L __ __ ____ _ _ STREET ADDRESS 305 Chestnut Ridge Drive CITY ~ STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. (1) 0.00 (2) 0.00 (3) 0.00 (4) (5> 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Q , Q Q 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 :.................................... ~ Ox c. retain a reversionary interest; or .................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? .............................................................. j~ ^x 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?......... ^ x^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ^ 0 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 stilt 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}J. 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. SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAK RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Madeira, Frederick L 21 - 06 - 1072 All property jointty-owned with right of survivorship must lte disclosed on Schedule F. ITEMi DESCRIPTION NUMBER UNIT VALUE VALUE AT DATE OF 1 DEATH 1 ' 466 shares of Realty Income Corporation Common Stock 23.71 11, 048.86 TOTAL (Also enter on line 2, Recapitulation) ~ 11,048.$6 ~ SCFEDULE H FUI~iAL ~VSES ~ COMMONWEALTH OF PENNSYLVANIA /~~y~~~~~-~p/~•~ w~/~ //~+y~~~~ INHERITANCE TAX RETURN F~L~Ir~1~-71 IW I IYG VW 1~7 RESIDENT DECEDENT ESTATE OF Madeira, Frederick L Debts of decedent must be reported on Schedule I. ITEM I DESCRIPTION NUMBER ~ FUNERAL EXPENSES: _!__ A. B. 1. 2 i 3. i 4. 5. i 6. 7. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions AMOUNT Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid j Attorney's Fees Family Exemption: (If 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 Accountant's Fees lax Return Preparer's Fees Other Administrative Costs Short Certificate FILE NUMBER 21 - 06 - 1072 4.00 TOTAL (Also enter on line 9, Recapitulation) 19.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Sc~~edt~le H /~~,~,.,Fineral E~er~ses & Ji~,~ i ^ ~.~OM~ ~.~711V R~CIJ FILE NUMBER ESTATE OF Madeira, Frederick L 21 - 06 - 1072 2 ;Inheritance tax filing fee 15.00 Page 2 of Schedule H REV-161 ~ EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Madeira, Frederick L NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. ~ITAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers i under Sec. 9116 (a) (1.2)] 1 ;Frederick L. Madeira Marital Trust, 305 Chestnut Ridge Drive, Mechanicsburg, PA II. RELATIONSHIP TO DECEDENT Do Not Llat Trustee(s) Trust for Spouse i - __ 'I FIDE NUMBER -'-- ~ 21 - 06 - 1072 T SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) 100% I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 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 0.00 ~~ ~ ,~ ~+f '~~ nrnr('+Tr^r ~. '~ 1 ; ~~;,', , APR - I ~',~ 3~ ~ ~ ~ ..g ~~ E ~~ ~.~HAId`S ':~l1RT ,~ r_~rl ~ ~ .~ E ~ , ,,, ,r~ ~~ ~~ k t I~ l ;~ ~ I -x e•i ~, 1 tr ~~ ~ I £~ t~'al .j '~~ ,~ '~ ~- i ~, `~ ~ ~~ '~ f 3 .,..., '- n n _, P~-~ _,_- _ - bA w ~~ 3 ~~ ~ U --a~ ' ~ 0 U ~ ~' p' M r-r rn ~ O r, O ~ ~ .--~ 3~ o~ o ~~a, ~, ~ a~ o ,~ v .~ U •~ ~ ~ :~ p~UOU