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HomeMy WebLinkAbout04-13-0915056051058 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 21 08 0814 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 04/05/2008 04/23/1924 Decedent's Last Name Suffix Decedent's First Name MI __ __ ....Hall Valda J _; _ _ _ __ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name., MI Spause's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~'~!~ 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS °'~ 2. Supplemental Return fir. 3. Remainder Return (date of death prior to 12-13-82) ~~"~.m? 4. Limited Estate ~ 4a. Future Interest Compromise (date of t".~°"s 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) ,..._s 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 !:John M. Eakin (717) 766-3172 ___ __ .. -_ _ Firm Name (If Applicable) REGIgT>ER OF WILLS~E ONLY , : ~ t '~ ~. , _ __ rt ~~ ~ t a? __ ~ : C? ~ First line of address , , y ~.- ~, f ` ' Market Square Building -, w ,~~; ' = ~" -~> ~ Second line of address __. _ _ _ _ _ - ~ --~ ~ ~ .-,p ~ , -. <, ~ --r-t ;~. -- --~ _ , . _ _ __ _ , * r _ , ~ ~ ...City or Post Office _ State Mechanicsburg PA ZIP Code ATE FILED ~ ,;r~ ___. _~ :17055 Correspondent's a-mail address: 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, .t is tn~e_ cnrcect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN(~URE ADDRESS 1822 Willow Road, Camp Hill, PA 17011 SIGNA OF PRE R QTHER THAN REPRESENTATIVE DATE~~ L re Building, Mechanicsburg, PA 17055 PLEASE USE ONLY Side 1 15056051058 15056051058 FOR FILING RETURN r- 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION ...__ ~.,__. ,._..~..~a_..~_,~...wm.._..Mw..~..,~,.,. .. 1. Real estate (Schedule A) ............................................. 1 2. Stocks and Bonds (Schedule B) 2. 8,400.00 ....................................... 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) ~ m~ Separate Billing Requested ....... 6. ' 546.13 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~`~ Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) ..................... . .............. 8. ' 8,946.13 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 1,106.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 125,161.04 11. Total Deductions (total Lines 9 & 10) .......................... ....... .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ..................... ....... .. 12. 13. Charitable and Governmental BequestsJSec 9113 Trusts for which an election to lax has not been made (Schedule J) ............... ....... .. 13. 14. Net Vatue Subject to Tax (Line 12 minus Line 13) .............. ~ _ ........ ~ _~.. .. 14. ~.-.....~._~. .~~.-~ ~e_..~_e _...~~ . ~~. ,_..~ ~.~_n.~. ~...~ . ~,.~ ~.._.~-..~.~....,.~w~...._~.._~.~-,..-.~_.~.~._.~. 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 .0_ 0.00 ' 15. _~ .. 16. . _ Amount of Line 14 taxable _ 0 00 ' at lineal rate X .0 _ . 16. 17. Amount of Line 14 taxable 0 00 ' at sibling rate X .12 ___ _..~. _ v.. ...... .... . : __ .~___ 17. _..~._ __ ~._. 18. Amount of Line 14 taxable 0 00 at collateral rate X .15 . 18 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 126,267.04 -117,320.91 ', -117,320.91 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number, 21 f 08 0814 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Valda J Hall 201-18-5107 STREET ADDRESS Claremont Nursing Home 1000 Claremont Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 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 "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 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)J. 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 feast one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+(6-98) ~, SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER V. Janet Hall 21-08-0814 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ~u nwre space is neeaea, insert aaalnonal sheets of the same size) Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 04j2008 Page 1 of 1 Total Price Total Value Totai Interest YTl7 Interest $2,500.00 $8,400.00 $5,900.00 $164.00 Bonds: 1-5 of 5 Serial Series Denown Issue Next Final Issue Interest Interest Value Note # pate Accrual Maturity Price sate NA EE $1,000 03/1986 09/2008.` 03/2016` $500 00 $1,180 00 4.00% $1,680.00 NA EE $1,000 03/1986 09/2008 03/2016 $500 00 $1180 00 4.00% $1680.00 NA EE $1,,000. 03/1986. 09/2008 0,3/201,6 ¢ $500 00 $1,180.00 4.00% $ 1,680 00 NA EE $1,000 03/19,86, 09/2008 03/2016 $500.OOA $1,.180.00 4.00% , , $1,680.00 NA' EE $1,000 03/1986,, 09/2008 0312016 $500.OOg $1,180.00 4. 00% __ __ $1,680.00 Totals for 5 Bonds $2,500.00: $5,900.00 . $8,400.00 Notes NI -Not Issued NE ;Not eligible for payment P5 Includes 3 month interest penalty MA .Matured and not earnin interest http://www.treasurydirect.govIBCISBCPrice 52 /S ~~ nn4 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEOENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER V. Janet Hall 21 ~~~$-fk'~i`~ If an asset was made Joint within one year of the decedent's date of death, ft must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Tina D. Deibler 1882 Willow Road Camp Hill, PA 17011 Daughter B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET ~ of DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~ ~ A' 05~01I89 Members First Federal Credit Union, Account 9000-00 1,035.86 50 517.93 2• A 05101/89 Members First Federal Credit Union Account 9000-11 56.41 50 28.20 TOTAL (Also enter on line 6, Recapitulation) f b 546.13 (If mare space is needed, insert additional sheets of the same size) FEB-04-~U09 02~ 5~f Nf1 f1>rc113 1ST 1NSUt~ANS (l ~ ly~hl fti ~~ ulivi MEMBER51" PfiULiKAL C:KEU17' UN1UN PRIMARY OWNER: Ciarence Hall SAVINGS ACCU tr+ T: Account Number/3uffx L7ate Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal anti Accrued Interest Name of Joint Owner Date Joint Ownership Established Nams of Joint Owner Date Joint Ownership Established ~iEC,,,~CI_ G A~C~JUNT: Account Number/.3uffix Date Account Estt~blished Principal Balance at Date of Death Accrued Interest to Date Qf Death Total Principal anti Accrued Interest Name of Joint Owner Date Joint Ownen.hip Established aoao-ao 12/08/1968 $1,035.75 $.11 $1,035.86 Tina Deibler 12/03/1997 Janet Hall 05!22/1989 seas-~I ~ 02/25/2006 $58.41 ~.aa $56.41 Tina Deibler & Janet Hall 02/25/2006 E BERS 1sr FEDERAL CREDIT UNION anielle A. Klrne Insurance Services Specialist February 4, 2008 Estate of: JANET HALi_ Date of Death: D44/DSt3008 Social Security Number: 201-18-5107 5(H)0 Lvuisr 1.?rive: I!<.). [3c~x 4U Mcchartir,,bur};, hcnnsylv~nia 17+155 (»tul} 2tt;3-232?i www.lncmhcl~lst.c~r~; FEf~-~}-~2®0~3 WE[7 BE: 18PM IQ: Pcarr= : ~ REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER V. Janet Hall ~~ ~~$'~~~`~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRfPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 500.00 Name of Personal Representative(s) Tlna D. Deibler Social Security Number(s)IEIN Number of Personal Representative(s) 209-50-9682 Street Address 1882 Willow Road City Camp Hill .State PA zip 17011 Year(s) Commission Paid: 2009 2. Attorney Fees 500.00 3. 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 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees t. Register of Wills -Filing Fee 91.00 15.00 TOTAL (Also enter on line 9, Recapitulation) I $ 1,106.00 (If more space is needed, insert additional sheets of the same size) RE'/-1512 EX+ (12-03) i~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBT5 OF DECEDENT, wHERITANCE TAx RENRN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER V. Janet Hall 21-08-0814 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1.513 EX+ (11-OS} pennsytvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER !JI_na _r)kly V. Janet Hall " ' " " " - ' RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONS} RECEIVING PROPERTY po Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2115 (a) (1.2),] 1. None ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. 8. 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.