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HomeMy WebLinkAbout06-11-09 (2)1505607121 REV-1500 Ex Cos-os) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2801iot INHERITANCE TAX RETURN 2 1 0 8 1 0 4 4 Harrisbum_, PA 17128-0801_ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 9 0 3 2 0 0 8 0 3 2 7 1 9 2 0 Decedent's Last Name Suffix Decedent's First Name MI D O B B S M A R Y K (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 ^X 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 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 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 M U R R E L R- W A L T E R S I I I 7 1 7 6 9 7 4 6 5 0 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY r.,~ First line of address ~ ~ ~.~ 5 4 E A S T M A I N S T R E E T ~ ~ r~ ~ `~"~ .: ~.~, Second line of address -.. ~:'~ `~~ ..~ ~• -,, . ~ ~ r'r.,t , `r -~ ~ ~yw~ ~ C.' City or Post Office State ZIP Code LED ~' ~ 'r- _rr M E C H A N I C S B U R G P A 1 7 0 5 5 d---rr! t[? ' <'i 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. Declaration of preparer other thap the pe~opal representative a based on all information of which preparer has any knowledge. SIGNATURE OF PERSO~SPONSIBLE/~OR FILINGtBl~`T11RN~V/ /) r)ATF , I . ADDRESS - 18 E - KELLER ~T,{ZEE~7' ~ MECHANICSBURG PA 17055. SIGNATURE OF PREPARE ER R ENTATIVE DATE / lC 54 EAST MAIN STREET ~ MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J 1505607221 REV-1500 EX Decedents Social Security Number Decedents Name: MARY K- D O B B S RECAPITULATION 1. Real estate (Schedule A) ........................................ 1 2. Stocks and Bonds (Schedule 8) .................................. 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. 9 9 ( ) ........................ Mort a es & Notes Receivable Schedule D 4. 4 8 0 0 0• 0 0 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 N n-Probate Property arate Billin Re uested l ~ S S h d G 7 ....... g q ep ( c e u e ) . 8. Total Gross Assets (total Lines 1-7) ........................... 8. 4 8 0 0 0• 0 0 9. Funeral Expenses i3<Administrative Costs (Schedule H) 9. 6 2 1 6 • 0 0 ................ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 1 1 • 0 0 11. Total Deductions (total Lines 9 & 10) ........................... 11. 6 2 2 7. 0 0 12. Net Value of Estate (Line 8 minus Line 11) .................. ....... 12. 4 1 7 7 3 . 0 0 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. 4 1 7 7 3 . 0 0 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.o _ 0. 0 D 15. 0. 0 0 16. Amount of Line 14 taxable 4 1 7 7 3 0 0 1 8 7 9 7 9 at lineal rate X .045 16. 17. Amount of Line 14 taxable 0 0 0 0 0 0 . at sibling rate X .12 17, . 18. Amount of Line 14 taxable 0 0 0 0 0 0 . at collateral rate X .15 1 g. . 19. Tax Due ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE D OF AN OVERPAYMENT 1 8 7 9. 7 9 Side 2 L 1505607221 1505607221 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 08 loan DECEDENTS NAME MARY K. DOBBS STREET ADDRESS 203 S. WASHINGTON STREET CITY MECHANICSBURG STATE PA ZIP 17055 Tax Payments and Credits: 1• Tax Due (Page 2 Line 19) (1) 1,879.79 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + g + C) (2) 0.00 3. InteresUPenalty 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) 1,879.79 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 1,879.79 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; ............................... ^ 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? ....................................................................................... ^ 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? .................................................................................................. ^ 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 p2 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-1507 EX + (8-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY K. DOBBS 21 08 1044 All property jointJyowned with the right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH FRANKIE L. HENSEL 18 E. KELLER STREET MECHANICSBURG, PA 17055 48,000.00 TOTAL (Also enter on line (If more space is needed, insert addfional sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERfrANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARY K. DOBBS 21 08 1044 Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME 4,727.00 2. ROLLING GREEN CEMETERY -GRAVE OPENING 225.00 3. FAMILY MEAL 375.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) FRANKIE L. HENSEL (RENOUNCED) Street Address City State Zip Year(s) Commission Paid: p, Attorney Fees MURREL R. WALTERS, III, ESQUIRE 3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. I Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY 5. I Acx;ountanYs Fees 6. I Tax Return Preparer's Fees 7 750.00 139.00 TOTAL (Also enter on line 9, Recapitulation) I ; (If more space s 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 8 LIENS RESIDENT DECEDENT ~ ATE OF FILE NUMBER MARY K. DOBBS 21 08 1044 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 BOROUGH OF MECHANICSBURG PERSONAL TAX TOTAL (Also enter on line 10, Recapitulation) 11.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY K. DOBBS 21 08 1044 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 pndude outright sppoousal distributions, and transfers under Sec. 9116 (a) (12)] 1. FRANKIE L. HENSEL Lineal 13,924.33 18 E. KELLER STREET MECHANICSBURG, PA 17055 2. CYNTHIA K. LARKIN Lineal 13,924.33 209 S. YORK STREET MECHANICSBURG, PA 17055 3, JAMES R. DOBBS, JR. Lineal 13,924.33 1330 WALNUT BOTTOM ROAD SHIPPENSBURG, PA 17257 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET s (It more space is needed, insert additional sheets of the same size)