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Home My WebLink About06-01-09 15056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes OFFICU\L USE ONLY County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN ' Hanisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 1042 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth __ : 09/10/2008 ! 02/23/1915 Decedent's Last Name Suffix Decedent's First Name MI MacCaffray Catharine E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI 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 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) '~`~ 6. Decedent Died Testate € 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) w.:= 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 TO: Name __ Daytime Telephone Number John Oszustowicz ' (717) 243-7437 Firm Name (If Applicable) REGISTER OF WILLS USE ONE1C,~ Law Office of John C OsZ,US~}'oW I GZ , - - : `' __ . ~ _ --, .~~ First line of address _. _ D ~ , ,. ~ 104 SHanover St ~ ; `~: "`~ , _- l Second line of address _ "- ~ ._ -_} ~ ~~ _=~; _.„. - : , City or Post Office _ . State ZIP Code _ DATE ~1ft.ED - -~ .. _ _ _ ~ _> Carlisle _ PA ' 17013 ~ 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, it is true, correct and complete. DeGaration of preparer other than the personal representative is based on all information of which prepan3r has any knowledge. FOR FILING RETURN DATE ~~L~~~ -- 104 S1Hanover St, Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number Catharine E MacCaffray ' !: Decedent s Name. ~.._~._.m....~._...__.~ __..~__.___ _.. _.~...__._..._ _ _ _ ._. _ ___ __,._.__ RECAPRULATION __ __ 1. Real estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 46,044.06 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. i 267,639.78 6. Jointly Owned Properly (Schedule F) ~.~ Separate Billing Requested .... ... 8. ', 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Properly (Schedule G) ~'"°~ Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 313,683.84', 9. Funerai Expenses 8~ Administrative Costs (Schedule H) .................. ... 9. 21,404.62 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 443.00 ', 11. Total Deductions (total Lines 9 8~ 10) ......... . ...................... ... 11. 21,847.62 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ! 291,836.22 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. I 291,836.22 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATESy _ _._..w~~~~~ ~~~~~"~"-M.._____.__..__.___,.,..~~ ""__.__"......_..____.__." 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 __ _ 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 ! ' 17. 18. Amount of Line 14 taxable 291 836 22 ; 43 775 43 , . at collateral rate X .15 18. , . 19. TAX DUE ...................................................... ...19. 43,775.43 '' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Comulete Address: Flle Number _ 21 _. . _ _ ..._.x -. 08 1042 __ DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Catharine E MacCaffray 175-10-6058 STREET ADDRESS 770 S Hanover St _ CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 28,000.00 C. Discount 1,473.64 Total Credits (A + B + C) (2) 3. InteresNPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (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. A. Enter the interest on the tax due. (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 43,775.43 29,473.64 14,301.79 14,301.79 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 inoome 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 oaurred 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 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 or for the use of the surviving spouse is zero (0) percent p2 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 decedents 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-1503 EX+ (6-98) SCNEpuLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MacCaffray, Catharine E 21-08-1042 eu n~n~nrfv Inintlv.ewned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (8-98) SCNEDt~LE E CASH BANK DEPOSITS 8c MISC. COMMONWEALTH OF PENNSYLVANIA , INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MacCaffray, Catharine E 21-08-1042 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 American Home Bank Acct#110892 168,761.04 2 Escrow account of John C Oszustowicz 4,363.23 3 F&M Trust Checking Acct # 34-01324 66,352.63 4 F&M Trust Checking Acct # 70-66635 5 721.63 5 Chapel Pointe PCA 74.08 6 Genworth Long Term Care reimbursement 840.00 7 Commonwealth of PA retirement pay -September 2008 399.15 8 Chapel Pointe Retirement Community refund 4,602.00 9 2008 PA tax refund 4.00 10 Refund from Belvedere Medical Center 22.02 11 Miscellaneous personal property 16,500.00 TOTAL (Also enter on line 5, Recapitulation) S I 267,639.78 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCNEDI~LE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MacCaffray, Catharine E 21-08-1042 Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT a. FUNERAL EXPENSES: t' Hoffman-Roth Funeral Home 8,784.84 2 Chapel Pointe -luncheon 601.02 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.00 Name of Personal Representative(s) Social Security Number(s)lEIN Number of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 9,410.00 3. Fatuity Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Street Address City State ,tip Relationship of Claimant to Decedent 4. Probate Fees 356.00 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Filing fees 35.00 s Legal Advertising (The Sentinel $102.76, Cumb Co Law Journal $75) 177.76 s Ibis Appraisal Services 540.00 1o Storage at Rovegno Properties (15 months @ $100/month) 1,500.00 TOTAL (Also enter on line 9, Recapitulation) ~ $ 21,404.62 (If more space is needed, insert additional sheets of the same size) REV-15]2 EX+ (]2-08) ~i Pennsylvania SCHEDULE I ' DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER MacCaffray, Catharine E 21-08-1042 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. RFV-1513 EX+ {11-08) ~ pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MacCaffray, Catharine E 21-08-1042 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. Catharine E Bishop 7800 Dassett Ct #303, Annandale, VA 22003 niece 1 /3 2 J Michael Bishop 66 Johnstone Dr., San Francisco CA 94131 nephew 1/3 3 Stephen G Bishop 3301 Stoneybrook Dr., Champaign IL 61822 nephew 1/3 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 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. 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. > ~~~ t~