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HomeMy WebLinkAbout05-04-0915056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~ County Code Year File Numh?r Po Box 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 ~ © ~ ~ D ~ ENTER DECEDENT INFORMATION BELOW Sncial Security Number Date of Death Date of Birth ~7~ io Qay~ ©~/z~oo7 a~~7/9/8 Dr F,dent ti L<~t Name Suffix D~ ~e'~icnts Fir>t Name MI L o N ~ G~ ~ D .4 -~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return ~ 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) SeC ori~igt/ Ael~rtil. N~ ~' ~ 6. Decedent Died Testate O / 8. Total Number of Safe Deposit Boxes 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 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 - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number eN~,e~ES ~ ~~ ~ F~.~s ~• ~ ~~ ~ ~6~ ©aa g Firm Name (If Applicable) ~/ First line of address 6 C ~. O G~ S E R i2 0 .~ .D Second line of address City or Post Office State ~~e ~~N% ~ sBu ~~ ~~ ZIP Code REGISTER OF WILLS I~ONLY r -~ r ~ .: ..r_~ ~ ; _ _,. ' z1 ~ ; ~~ __ _< _ .r~ I _, .. .~ ~~c~r> - - - _~ ~ ~~ E FILED ..' to , ~ 7 oS'5~73~" N Correspondent's a-mail address: C~°$1'11 l°Ids 3 t~ C0111CQSt: l~el. 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 I representative is based on all information of which preparer has any knowledge. SIGNATURE OF P ~ ~~i0t~~ ~ F NG ~, DATE ~[//3~Dg f~// ~ T ADDRESS ~EFYJI~ ~, L,a/1((~ ('J s,/ Gln//u Dhi vo - ~lov ~u~,~/mod /~i~ /707D -- OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS CHj¢~L~Tj ~' ~SH~bZDS ~r 6 C1ou Rd /11 a i bu ~ / 7osS PL SE USE ORIGINAL FORM ONLY Side 1 1505605104? 15056051047 J J 15056052048 REV-1500 EX I/ a Decedent's Name: L ~N G Y ~~J Z • Deced-7ent's Social Securipty Number / / ~ / O ` RECAPITULATION 1 •' ~ ~ 1. Real estate (Schedule A) . ........:................................. .. . 2 5 ~ ~ 4 • 7 ~" 2. Stocks and Bonds (Schedule B) ..................................... .. . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. . O D 4. Mortgages & Notes Receivable (Schedule D) ........................... 4. . . . ~ ~ 5. p P Y )...... Cash, Bank De osits & Miscellaneous Personal Pro ert (Schedule E 5. .. ~ ~ ~ ~O ~ • ~ 3 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. • D ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 • ~ ~ (Schedule G) O Separate Billing Requested..... . ... 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ~ ~ ~ 1 ~o • ~ J 9. Funeral Expenses & Administrative Costs (Schedule H) ............ ........ . 9. -I 9 0 ~ ~ 10. 9 9 ( ) ....... Debts of Decedent, Mort a e Liabilities, & Liens Schedule I ....... 10. .. O O 11. Total Deductions (total Lines 9 & 10) .......................... ....... .. 11. p / q a ~ 12. Net Value of Estate (Line 8 minus Line 11) ..................... ....... .. 12. ;~ Q .Z 7 ~ • r [!O J 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which D ~ an election to tax has not been made (Schedule J) ............... ....... .. 13. • 14. Net Value Subject to Tax (Line 12 minus line 13) ............... ....... .. 14. ~,~ ~ 7 ~' • f7 J TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or , transfers under Sec. 9116 ~ D 15. p d (a)(1.2) X .0 0 16. Amount of Line 14 taxable ~ D ~ 7 g ~ at lineal rate X .0 ~ (~ ~ 16. -I J oC • 5 ,' 17. Amount of Line 14 taxable ~ 0 17 • D p at sibling rate X .12 . 1P~. Amount of Line 14 taxable ~ Q 18 • p Q at collateral rate X .15 . 19. TAX DUE .........................................................19. 20. FILL iN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT q / ~.5-~f O Side 2 15056052048 15056052048 J REV-1500 EX F'age 3 Decedent's Complete Address: File Number ~/ ~ Q 7..~ fr7 O - _ - __ - -_ STREET ADDRESS /~1E5S/.~Y !~/LE.¢GE' /oo /hT, i¢~GE~t/ TrlrvE CITY _ - _ filE~/~/y~~s.~G//pG - -- - - - STATE ~~ ZIP l /70SS Tax Payments and Credits: f 1. Tax Due (Page 2 Line 19) (1) (~ a~ Sry 2. CreditslPayments D A. Spousali Poverty Credit __ B. Prior Payments ~ C. Discount d Total Credits (A + B + C) (2) O 3. Interest/Penalty if applicable D D. Interest - _ __O._ E. Penalty - Total Interest/Penalty (D + E) {3) O 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) O 5. If Line 1 + (Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~~//Z~..S~f A. Enter the interest on the tax due. (5A) g 9.37' B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~~~ p G ~. g$ T 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 :......................................................................................... . ^ 0 b. retain the right to designate who shall use the property transferred or its~incame :........................................... . ^ [~ 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? ............ .. © ^ ~~ 4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which ~ /lt.~ ~ contains a beneficiary designation? ....................... 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 ar 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 isdefined, under Section 9102, as an individual who has at Veast one parent in common with the decedent, whether by blood or adoption. REV-1'.103 EX+ (6-98) -. SCl~IEDtlLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER L-D/11G~ ~~~ Z. ~/ - p 7~ ~ ~g All property jointly-owned with right of survivorship must be disclosed on Schedule F. (It more space is needed, insert additional sheets of the same size) NFS: Historical Prices for NATIONWIDE FIN SVCS -Yahoo! Finance Yahoo! My Yahool Mail More Make Y! My Homepage New User? Sign Up Sign In Help ,~~i~#.../;,,~, F t ~ lS N 4+ ~ Search '. WEB SEARCH 1/19/09 10:42 AM Dow • 0.84% Nasdaq ~ 1.16% Monday, January 19, 2009, 1D:41AM ET - U.S. Markets Closed for Martin Luther King, ]r. 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Fundamental company data provided by Capital IO. Quotes and other information supplied by independent providers identified on the Yahoo! Finance partner page. Ail information provided "as is" for informational purposes only, not intended for trading purposes or advice. Neither Yahoo! nor any of Independent providers Is Ilable for any informational errors, incompleteness, or delays, or for any actions taken in reliance on information contained herein. By accessing the Yahoo! site, you agree not to redistribute the information found therein. 1/19109 10:42 AM http://finance.yahoo.com/q/hp?s=NFS&a=01&b=12&c=2007&d=01&e=12&f=2007&g=d Page 2 of 2 REV-1508 EX . ry ~97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LONG, !/~Ai~ Z. ,Z/-a7_/~~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. R~-(,wr~d e,.t -~cdural ~-rsonaJ i nCpp~ ~,c ~/, boa. Bo '~~ ~11QG~p~ict cSeCU,r1 ~1~e5 ,rtC~. fan. js¢. ba.lnnct = 13,yRG.$~ Jan . 3jsf c•,e~l~t = ~ t-l ro.re~ ~y3.73~ .78 c14y~ = 1,5(~ {per d~e:m X t2 da.ys F-%t ~tb_ = 18',72 T ~a,( c~, o. d, val. = g13, ~"~ 1, q3 ~ 3, S b l . 93 (see va.luu.h'o~ sfu~cn~u,YVt ~.~.~! SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY TOTAL (Also enter on line 5, Recapitulation) I $ 1 S'~ ~ w'n (, 93 WAGHOVIA SECURITIES, LLC National Client Center 401 S. Tryon Street Charlotte, NC 28202 DATE CHECK N0. 03/30/09 007115826 DESCRIPTION DATE AMOUNT 5348-1499-1 B 03/30/09 007115826 ESTATE OF VEDA LONG CHECK ISSUED 13,862.89 TOTAL 13,862.89 Accounts Carried by First Clearing, LLC, Member NYSE/SIPC. PLEASE DETACH BEFORE DEPOSITING WACHOVIA SECURITIES, :LLC 007115826 ssa2~ol2sso National `Client Center 401 S. Tryon Street DATE` AMOUNT Charlotte, NC 28202 5348-1499-1 03/30!09 *$13,862.89 PAY - ~q ONL nxt rwut - s z ~xa C~TSC PAY ^THIRTEEN THOUSAND EIGHT HUNDRED SIXTY-TWO DOLLARS AND EIGHTY-NINE CENTS *"'"*""`"*****"**""'*******"***~****"**"*"«~******~**~*****~*****~~ TO THE ESTATE OF VEDA LONG DAVID LONG, EXECUTOR ORDER CIO CHARLES SHIELD ATTORNEY OF 6 CLOUSER RD MECHANICSBURG, PA 1705"5 WACHOVIA BANK, NA OAKTON, VIRGBNIA 22124 AUTHORIZED SIGNATURE Accounts Carried by First Clearing, LLC, Member NYSElSIPC. THIS CHECK MUST BE CASHED WITHiN l8o DAYS. 1 PRINTED WI?fH BLUE BACKGROUND ON WH{TE .PAPER ,, ,,. r-, r, ,,, ~„ ,., ..- --------- REV-1511 EX+ (10-06) SICNEDt~LE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER 7-- / O~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions f' ~~, ~ Name of Personal Representative(s) ~iry /.~~ L ~~ v Street Address _ _ ______ ____ __ City State Zip Year(s) Com ission Paid:_____ ____ ______ ___ _ _ 2 m l//~a~`l ~s ~- • ~GJ~,~~Cs ~'~ A t F ~~' 75' t'U . t orney ees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation} Claimant /1b'O/Y~ ~~ Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. ,~-dr,~fhe~/ ~n~~ eerf~c~~es ~~, ~ ~• Fee ~ f,~~. o~ w~%/s. Fi~ a o ~j S ~ . TOTAL (Also enter on line 9, Recapitulation) $ 7 q 8` , ~ - n~ ........ .......... ............... ......... _~~...___, _~ ~ .., REV-1513 EX+ (9-00) . S~NEDtidE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 2 /~ O 7r L oN~, Vii} ?-, /~~ 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, antl transfers under 1. Sec. 9116 (a) (1.2)J ~ u TN ~~~ R I SSE d au~ti~cr yam, 7ZS tYl.orSa~ ~anLL, pr. Grass Va.lle~, cA 9S94S .~, ~,A~V I D ~. LoNG Son y y He„Y ~~... ~ New Cu,-,n bzrl and, PA I? o ~ D ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ LAST WILL AND TESTAMENT OF VEDA 1. LONG I, VEDA I. LONG, of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the: same can conveniently be done. ~, All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to be divided as follows: a.) One-half (1/2) to my daughter, RUTH ANN RIESE, der stiroes. b.) One-half (1/2) to my son, DAVID A. LONG, per stirnes. 3 I notinate, constitute and appoint my son, DAVID A. LONG, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter, RUTH ANN RIESE , to be Executrix in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. nIN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ 2 ~ day of c L~,~2 , A.D. 1995. U VEDA I. LO ~~~~~ ~ ~ (SEAL) Signed, sealed, published and declared by the above-named VEDA I. LONG as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the pre<,~ence of each other, have hereunto subscribed our names as witnesses. C~ CHARLES E. SHIELDS, III AZ°I'ORNEY-AT--LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1512-1991) May 1, 2009 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Veda I. Long No. 21-07-0188 Dear Register of Wills: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find enclosed for filing 2 copies of the Supplemental Inheritance Tax Return for the Veda L Long Estate as well as Check No. 1021, in the amount of $15.00 for the filing fee, Check No.1022 in the amount of $1,001.88 for the Inheritance Tax due. Thank you for your kind attention to this matter. Very truly yours, Charles E. Shields, III Attorney-At-Law CES/mjj Enclosures _~ r. LL . ~~ ~:~ ' ~> ~ `.J .J . ~ 'i~l ~ .... - ~ .~- ~ _ li i r~ `-~ t .~- - - _ . ~ 1V