HomeMy WebLinkAbout06-29-09 (2)15056051058
REV-1500 ~ (os-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year Fle Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po sox 28060, Z~ ~g o~ 2os
Harrisburg, PA 17,28.0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
09/28/2004 09/26/1980
Dec~ent's Last Name Suffix Decedent's First Name MI
Kichman, III ' III Richard L
(If Applicable) Enter Surviving Spouse': Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Socaal Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Retum p 2. Supplemental Retum Q 3. Remainder Retum (date of death
prior to 12-13-82)
p 4. Limited Estate Q 4a. Future Interest Compromise (date of C~ 5. Federal Estate Tax Retum Required
death after 12-12-82)
~ B. Decedent Died Testate C~ 7. Decedent Maintained a Living Trust _-___-__ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
C~ 9. Litigation Proceeds Received c~ 10. Spousal Poverty Credit (date of death C~ 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
'' Darlene C. Hombaker (717) 648-8569
Firm Name (If Applicable) ---- -----.-- -- ,---------- __ . __..----___-,-,
~
- _ _ _ _ __ __ _.. -_ -_ _
REGISTER OF WILLS USE ONLY ~
RECORDED OFFICE OF
_
First line of address _ _ REGISTER OF WILLS
- __ -_. __ _ 2009 JUNE 29
909 Wentzville Rd CLERK OF
Second line of address -
ORPHANS' COURT
CU~ZBERLAND CO., PA
City or Post Office State ZIP Code ~_ DATE FILED
Enola '' PA ':17025
Correspondent's e-mail address:
_ - --
Underpenalties of perjury, I dec~ane that 1 have examined this r+etum. including accompanying ad~edulea and smtements, and to the best of my Ivrowbdge and beMef,
it is true, coned and complete. Declaration of preparer oU~er than the personal representative is based on aN infarrrretlon of which proparer has arry lvrowledge.
+~~
OF
FOR
a~
ADDRESS
909 Wertzvilie Rd Enola, PA 17025
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
p~eASe use ORItliINiAL Foul oN~Y
Side 1
15056051058 15056051058
J
15056052059
REV 1500 EX
Decedents Social Security Number
Richard L Kichman, III
DeoedenYs Name:
RECAPITULATION
1. Real estate (Schedule A) ............................................. 1. ~ 0.00
2. Stocks and Bonds (Schedule B) ....................................... 2. ;
~...~..e 0.00
..._. ~.._m __ ._.e_.__~ ..._.~. ...~___~. _~..~....._.o.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
p 0.00
4. Mortgages & Notes Receivable (Schedule D) ............................. 4. ~ 0.00
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. ' 63,124.59
6. Jointly Owned Property (Schedule F) C~ Separate Billing Requested ....... 6. 0.00
7.
Inter-VNOS Transfers & Miscellaneous Non-Probate Property ,,.. ~.._ .., .. ~ ...,_.~ _._.._.... _w, ._..~~ ~ ..._...n ,....,~..
(Schedule G) ®Separate Billing Requested....... 7. 0.00
8. Total Gross Assets (total Lines 1-7) .................................... 8. 63,124.59
9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9.
~ ~ ~
~ 7,658.67
~rr.~ ~_. e._.~ _ .~~~ a~ _ _~~.: ~_ ~ . _~ r._r......~~
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ ~
10. 2,186.98
11. Total Deductions (total Lines 9 8 10) ................................... 11. ~ 9,845.65
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 53,278.94
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
~. _
_...w._ _....~_._ ~...~.__n ,~,_....~_ ,_......w_ ._~.w._._
an election to tax has not been made (Schedule J) ........................ 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 53,278.94
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 _ _ _ __ _ _ _ _
(ax1.2) X .0_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 16.
,~.. .. .. . _ ..~._r..7.~.,. ....... ...~,..~.~.~._.,_~.. ....~.~_ ~w~,
17. Amount of Line 14 taxable '.
at sibling rate X .12 53,278.94 ; 17.
...N ~ N _ ~._.. ._.µ..,~_ ._,_k .LL._a~.
18. Amount of Line 14 taxable
at collateral rate X .15
_ __ _. _ _ 18.
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Q
15056052059 Side 2
15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
Richard
STREETADDRESS
821 Wertzville Rd
L Kichman, III
crrY
Enola
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
1,728.97
1206
DECEDENTS SOCIAL SECURITY NUtuBER
_ 176-68-9805
STATE ~p
PA
Total Credits (A + B + C )
17025
(1) 6,393.47
(2) 0.00
Total Interast/Penatty (D + E) (3) 1,728.97
4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
FIII to oval on Page 2, Llne 20 to request a refund. (~)
5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5) 6, 393.47
A. Enter the interest on the tax due.
(~) 1,728.97
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(~) 8,122.44
Make Check Payable to: REGISTER OF WILLS, AGENT
~.
._.
..~r~:~ ~_.. , _ _
.a
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE B
LOCKS
1. ~ decedent make a hansfer and:
a. rein the Yes No
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 irrtenest; or ................
d. receive the promise for life of either payments, benefits or care? ... .......... ^
...................................................................
2. ff death oax~nBd 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 accamt or ............................................................ (~
security at his or her death? ..............
4. Did decedent own an Individual Retirement Account, annuity, or other
non-Probate property which
contains a benefiaary designation? ....................
IF THE ANSVYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
__ ,.
. ._
P . _ , _.
.: h.. ~.,~~ _ _ _~ ..._
For dates of death on or after July 1 1994 and before January 1,1995, the tax rate im
is three 3 Posed on the net value of transfers to or for the use of the surviving spouse
()percent [72 P.S. §9116 (a) (1.1) (i)j.
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 survivi
[72 P.S. §9116 (a) (1.1) (ii)j. The statute does nQ n9 sparse is zero (0) percent
filing a tax return are still applicable even if the survit ~n~ a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of asseth and
g spouse is the only benefiaary.
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)j.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is four and one-half (4.5) pest, 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 sibli s is twehre 12
Section 9102, as an individual who has at least one parent in common with the decade t9whether by bl ~or~edopbans §9116(aK1.3)j. Asibling is defined, under
REV 1508 EX+ (6-98)
SCEIEpVLE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUII~ER
Richard Leroy Kichman, III 2008-01206
Indude the proceeds of btigation and the date the proceeds were r+eoeived by the estate.
Ail property Jointly~wnsd with right of survivorship must bs disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 ' `Personal Savings Account 1,002.92
2 ; Tr~sfer from deceased Mother's Estate 61,491.67
3 Insurance payment from HighMark for Erway Ambulance service bill paid directly to the estate 630.00
TOTAL (Also enter on line 5, Recapitulation) s 63,124.59
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCMEI~VLE M
FUNERAI. EXPENSES Bc
COMMONWEALTH of r~ENNSYLVANIA
INHERITANCE TAX RETURN ADMINISTRATIVE CASTS
RESIDENT DECEDENT
ESTATE OF FlLE NUMBER
Richard Leroy Kichman, III 2008-01206
Dsbts of decedent ewst be roported on Sdbduls L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:_
1 ~ '..Funeral Expenses 5,272.00
'Head Stone Expenses 2,050.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions 0.00
Name of Personal Representative(s)
Soaal Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State ! Zip
Year(s) Commission Paid:
2. Attorney Fees 0.00
3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation) 0.00
Claimant
Street Address
City State ! ,Zip
Relationship of Claimant to Decedent
4. Probate Fees 205.00
5. Accountants Fees 0.00
6. Tax Return Preparer's Fees 0.00
~. News Paper Estate Ad -Patriot News 109.52
s Certified Mail Fees 22.15
TOTAL (Also enter on line 9, Recapitulation) s 7,658.67
(tf more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-08)
pennsylvania SCHEDULE I
DEPARTMENT OP REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Richard Leroy Kichman, III 2008-01206
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 • DCM GMC Credit Card Payment 1,214.46
2 Dept. of Rev. - 2004 PA Tax 169.10
3 West Shore - 2004 Local Tax 173.42
4 Erway Ambulance 630.00
TOTAL (Also enter on Line 10, Recapitulation) $ 2,186.98
If more space is needed, insert addigonal sheets of the same size.
REV-1513 EX+ (11-08)
~ pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Richard Lerov Kichman. III 200&01206
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not ilist Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. ':Anna Hurrell - 32 Cessna Dr. Halifax, PA 17032 Half Sister 10655.79
2. Linda Wade - 3859 N. Sixth St. Harrisburg, PA 17110 `Half Sister 10655.79
3. Christopher R. Kichman -303 Salt Rd. Enola, PA 17025 ' Hof Brother 10655.79
4. -Darlene C. Hombaker -909 Wertzville Rd Enola, PA 17025 'Half Sister 10655.79
5. Richard L Kichman, Jr -1102 Knightbridge Ct. Graham, NC 27253 Half Brother 10655.79
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 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 site.
Il~f VENTORY
REGISTER OF WILLS OF Cumberland
COMMONWEALTH OF PENNSYLVANIA l SS
COUNTY OF )
COUNTY, PENNSYLVANIA
File Number 2008-0120b
Personal Representative(s) of the Estate of Richard Leroy Kichman, III
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
I verify that the statements made in this Inven-
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name)
(Address)
(Telephone)
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
09/28/2004 821 Wertzville Rd Enola, PA 17025 176-b8-9805
FIGURES MUST BE TOTALED
Net Estate Bank Acct after admin., Paymt of outstanding debts, and estate taxes - (Gross value: 63,124.59)
(Attach ad~tional sheets os needed)
45,156.50
TOTAL: ~ 45,156.50
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa C. S § 3301(b))
(Supreme Court LD. No.)
Form RW-09 rev. 10.13.06
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Pd ~35.co
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