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HomeMy WebLinkAbout04-16-09 (2)1505607121 ~OC~ ~~" REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Coun Code Year File Number Bureau of Individual Taxes tY PO BOX 280601 INHERITANCE TAX RETURN ~e,~ GG Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 lI"1 6~`, ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 6 4 2 5 1 9 0 0 7 2 4 2 0 0 8 0 9 0 5 1 9 2 0 Decedent's Last Name LEI SHMAN Suffix Decedent's First Name S A R A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name 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) MI MI 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) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARK A MA T EYA ESQ UI RE 717 241 6500 Firm Name (If Applicable) REGISTER OF WILLS U SE ONLY MATEYA LA W F I R M First line of address r`a PO BOX 1 2 7 <~~ ~ _--, ~~~~~-; Second line of address -~~ ~ _~~ ~ _ _ -, ~ i'- - ~ i-' A . ` . ~ t ,' a i = ~ ~ - City or Post Office State ZEP Code _DA~Fi~ED _' CT3 -, `~" 1'~ ,-, /-7 'i'~ ~ i,~ B O I L I N G S P R I N G S P A 1 7 0 0 7 ~ :~~~ ~r ~ _ ~ _ v _ Correspondent's a-mail address: MAM@ MATEYALAW.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: SIGNATURE O ERSO NSIBLE FOR FILING RETURN DATE ADDRESS 108 S ORANGE STREET CARLISLE PA 17013 SIGNATURE OF PREPA}2ER OT~iER T}~1,AN REPRESENTATIVE DATE ADDRESS PO BOX 127 BOILING SPRINGS PA 17007 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 1505607221 REV-1500 EX Decedent's Social Security Number Decedents Name: SARA LEISHMAN 1 8 6 4 2 5 1 9 0 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 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. 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) ........ 10. 11. Total Deductions (total Lines 9 & 10) ......................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ....................... 12. 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. 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 0 0 15. 16. Amount of Line 14 taxable 1 0 9 0 9 1 6 at lineal rate X .045 . 1s. 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 6 2 9 2, 3 8 1 6 8 9 6, 1 2 2 3 1 8 8, 5 0 9 0 6 7, 7 0 3 2 1 1, 6 4 1 2 2 7 9, 3 4 1 0 9 0 9, 1 6 1 0 9 0 9, 1 6 0. 0 0 4 9 0. 9 1 0. 0 0 0. 0 0 4 9 0. 9 1 Side 2 1505607221 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 0 0 DECEDENT'S NAME SARA LEISHMAN STREET ADDRESS 503 "B" S VVEST STREET CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1 Tax Due (Page 2 Line 19) (1) 490.91 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InteresUPanalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 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) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 490.91 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 490.91 Make Check Payable to.' REG/STER OF W/LLS, 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 : ................................................................ ...... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ X^ c. retain a reversionary interest; or .......................................................................................... ...... ^ X^ 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 "intrust 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? ............................................................................................ ...... ^ 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)]. 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. REV-1508 EX + (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER SARA LEISHMAN 21 0 0 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MONUMENTAL LIFE INSURANCE 6,292.38 PRE-PAID POLICY FOR FUNERAL EXPENSES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT TOTAL (Also enter on line 5, Recapitulation) I $ 6,292.38 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER SARA LEISHMAN 21 0 0 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. JANE L. BLACK 108 S ORANGE STREET DAUGHTER CARLISLE, PA 17013 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 1. A. PNC BANK 3,072.01 50. 1,536.01 CHECKING ACCOUNT NO. XX-XXXX-0235 2. A PNC BANK 30,720.21 50. 15,360.11 MONEY MARKET ACCOUNT NO. XX-XXXX-1576 TOTAL (Also enter on line 6, Recapitulation) ( $ 16, 896.12 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Debts of decedent must be reported on Schedule 1. DESCRIPTION ESTATE OF FILE NUMBER SARA LEISHMAN 21 0 0 ITEM NUMBER A. 1. 2 3 4 5 6 7 B 2. 3. 4. SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS FUNERAL EXPENSES: HOFFMAN ROTH FUNERAL HOME MIFFLINTOWN MARBLE -MEMORIAL MARKER WAYNE NOSS FLORIST -FLOWERS FOR FUNERAL FIRST PRESBYTERIAN FAITH CIRCLE -AFTER FUNERAL MEAL HONORARIUM FOR JANITORIAL SERVICES FOR CHURCH BUDDY WHEAT -PASTORAL SERVICE FOR FUNERAL ARTHUR THOMPSON -ORGANIST FOR FUNERAL SERVICE -DONATION ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City State _ Year(s) Commission Paid: Attorney Fees MATEYA LAW FIRM Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees 5 Accountants Fees 6. Tax Return Preparers Fees 7. DAVE SCHEIBLEY -CLEANING AND FURNITURE DISPOSAL 125.00 TOTAL (Also enter on line 9, Recapitulation) I $ 9.067.70 Zip AMOUNT 6,907.74 565.00 69.96 200.00 50.00 200.00 200.00 750.00 Zip (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER SARA LEISHMAN 21 0 0 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. CELTIC ASSISTED LIVING 466.65 PERSONAL CARE SERVICES 2. HIGH MARK BLUE SHIELD 286.90 HEALTHCARE INSURANCE PREMIUM 3. MED STAFFERS 441.25 PERSONAL CARE SERVICES 4. PP & L 139.57 ELECTRIC SERVICES FOR RESIDENCE 5. FIRST PRESBYTERIAN CHURCH 600.00 DECEDENT'S MONTHLY PLEDGE 6. MED STAFFERS 28.50 PERSONAL CARE SERVICES 7. CELTIC ASSISTED LIVING SERVICES 420.50 PERSONAL CARE SERVICES 8. ELWOOD GARDENS 622.00 APARTMENT RENT -FINAL 9. EMBARQ 66.70 TELEPHONE SERVICE AT APARTMENT FINAL BILL 10. PP&L 139.57 ELECTRIC SERVICE AT APARTMENT FINAL BILL TOTAL (Also enter on line 10, Recapitulation) I $ 3,211.64 (lf more space is needed, insert additional sheets of the same size) REV-1513 EX + (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SARA LEISHMAN 21 0 0 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 [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. MARTHA LEISHMAN Lineal 3,636.38 1742 "U" STREET NW APT 201 WASHINGTON, DC 20009 2. RUTH PIECHALAK Lineal 3,636.38 PO BOX 622 EAST AURORA, NY 14052 3. JANE BLACK Lineal 3,636.40 108 S ORANGE S T REET CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET Il. 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 I I -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size)