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Home My WebLink About06-17-09 (3) 5056051058 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 280601 21 08 0827 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 08/04/2008 ' 09/13/1926 Decedent's Last Name Suffix Decedent's First Name MI Hudson...... 'Catherine T (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 Original Return ~:~? 1 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 5ch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRecTeo lo: Name Daytime Telephone Number 'Thomas A. Archer, Esq. (717) 233-8676 Firm Name (If Applicable) Archer & Archer, P.C. First line of address 2515 North Front Street Second line of address P.O. Box 5056 City or Post Office _ State Harrisburg PA Correspondent's a-mail address: ZIP Code.....,,,, 17110 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the nest or my xnowieoge a~w ueuei, 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. SIGNASLIfJ=~ ~" SON RESP SIBLE FILING RETURN uHi e -- ADDRESS 2515 North Front Street, P.O. Box 5056, Harrisburg, PA 1.7110 _ __ _ ____ _-- - _ DATE SI NATURE OF PREPARER OTH R THAN REPRESENTATIVE --- ADDRESS 6180 Somerset Street, Harrisburg, PA 17111 PLEASE USE ORIGINAL FORM ONLY REGISTER OF~AjIILLS USE ONE - .- Q ~ c:~ .., w , i ~-- _ J a~ ; ~ ~ , ~; K> m 7 _.._ = J c7 =~ CZ ~ t ..s ~ 's pED -"' ' _ H.. ~Y : O ~ .. .> ~ w ; Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedents Name: Catherine T HudSOn RECAPITULATION 1. Real estate (Schedule A) . .......................................... .. L 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. 47,822.86 6. Jointly Owned Property (Schedule F) ~3 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. 47,822.86 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ................... .. 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............. .. 10, 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. j 47,822.86 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. 47,822.86 TAX COMPUTATION -SEE INSTRUCTIONS~~~~~~~~~~~~~ _ e ~~~ ~~~~~~ ~ ~~ °'°' FOR APPLICABLE RATES "" --..._. _. , ..__ _ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 47,822.86 ' 16. '' 2,152.03 17. Amount of Line 14 taxable at sibling rate X .12 ; 17. 18. Amount of Line 14 taxable at collateral rate X .15 ' 18. 19. TAX DUE ....................................................... ..19.' 2,152.03 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1 ide 2 15056052059 REV-1500 EX Page 3 File Number .. Decedent's Complete Address: 21 os o827 ... DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Catherine T Hudson 579-28-8469 -- - - STREETADDRESS 6180 Somerset Street - - - - --- - - - - - - _STATE ZIP CITY Harrisburg PA 17111 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2,152.03 2. CreditslPayments A. Spousal Poverty Credit - - -- B. Prior Payments _ - C. Discount Total Credits (A + B + C) (2) 3. InteresUPenalty 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 2,152.03 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? ...................................................................................................... ........ ^ ^x 3. Did decedent own an "intrust 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 ^ 0 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 [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) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Catherine T. Hudson 08-00827 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. (If more space is needed, insert additional sheets of the same size) TR.~vS~~uCA ®LIFE INSURANCE COMPANY Transamerica Life Insurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 June 2, 2009 Estate of Catherine T Hudson c/o Thomas A Archer 2515 N Front Street PO Box 5056 Harrisburg PA 17110-0056 RE: Annuity Number 007412020 Dear Estate of Catherine T Hudson: Our office has received your request concerning the above listed non- qualified tax deferred annuity. The owner of this annuity is Catherine Hudson. There were no owner changes to this account. Catherine Hudson has been the sole owner since the account was established on September 12, 2002. The value of this annuity as of August 4, 2008 was $47,822.86. The amount of interest that accrued between January 1, 2008 and August 4, 2008 was $829.26. Any additional questions regarding this annuity can be directed to the Annuity Service Center at 1-800-553-5957. A Transamerica Life Insurance Company representative will gladly assist you with any questions you may have regarding this annuity and help you meet your financial goals. Sincerely, Nicholas Hayes Transamerica Life Insurance Company Claims Member of the ~;EGON. Group ~.. 062S0005927528 ~vx~ OlWCnorn E Ma~rN~~g f..J~tO ~N~~~ ~ ~au~i~Z N~~~ ~~ M - : , ~ ~ . ~ ~; u ~ -- ' U.~C' ~' ~ ~__ "") _ ~: ~ L~ ~::~ ~ C ^3 Y U ~ o a~ -" N __ O N ~ ~ N ~ '~ ~ N O ~ = ~U M .~ ~ M - ~ C sM ~ ~ ~ r 0 0 ~ __ UU N~ ~~ oQ c~ c~ = a L L .~ 0 _ ~~Uca UUr-U