HomeMy WebLinkAbout07-16-09 (2)' 1505607121
REV-1500 ~ Los-o5)
OFFICIAL USE ONLY
PA Department of Revenue
County Code Year
File Number
Bureau of Indmidual Taxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 0 8 1 0 6 6
Harrisbum, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 0 0. 9 2 0 0 8 0 3 1 8 1 9 5 2
Decedent's Last Name Suffix Decedent's First Name MI
F I R S T K E N N E T H B
(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 Retum ~ 2. Supplemental Retum ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required
death after 12-12-82)
0
® 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)
GORRESPVNDtN 1 - i Mis atc i IUn Mus i lit VVMr~t i tu. ALL V VKKt.7rvnUtl'!VC AnU l.Vnt1UCP1 I wL I ~ IntVK111P-1 ivn .~17VULU DC UIKGb 1 CU 1 V:
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)
First line of address
5 4 E A S T M A I N S T R E E T
Second line of address
City or Post Office State
M E C H A N I C S B U R G P A
Correspondent's a-mail address:
RN
ZIP Code
REGISTEI~F WILLS US LY
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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 personal representable ~s based on all information of which preparer has any knowledge.
OF
4J
ur~i~ - J /~ ~~
ADDRESS
CHARLES E F J , 4 921 HIGHLAND ST HARRISBURG PA 17111
SIGNATURE ~ R E N REPRESENTATNE DATA /~~ f
MURREL R.'WALTERS III, 54 E. MAIN ST MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 1505607121 J
J
1505607221
REV-1500 EX Decedent's Social Security Number
Decedent's Name: KENNETH B. FIRST 1 8 7 4 4 9 9 2 9
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1
8 1 8 2 7 1
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. •
1 0 2 5 0 6 • 5 2
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 1 9 8 9 9 5 • 4 5
7. Inter-Vivos Transfers ~ Miscellaneous N -Probate Property
Billi
R
t
d
t
~ S
7
•
.......
ng
eques
e
epara
e
(Schedule G) .
8. Total Gross Assets (total Lines 1-7) ........................... 8. 3 0 9 6 8 4. 6 8
g 1 7 8 1 5. 0 0
P ( ) .............
9. Funeral Ex enses 8 Administrative Costs Schedule H .
...
5 2 4 0 0
9 9 ( ) ............
10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I 10. •
11. Total Deductions (total Lines 9 8 10) ........................... 11. 1 8 3 3 9. 0 0
12. Net Value of Estate (Line 8 minus Line 11) ...................... ... 12. 2 9 1 3 4 5 • 6 8
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .............. .... 13• •
2 9 1 3 4 5 6 8
14. Net Value Subject to Tax (Line 12 minus Line 13) .................. 14. •
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
0 0
0
0
0
0
.
(a)(1.2) x .0 15. .
16. Amount of Line 14 taxable 0 0 0
at lineal rate X 16. •
17. Amount of Line 14 taxable 2 9 4 1 9 1 8 1 3 5 3 0 3 0 2
at sibling rate X .12 1 ~• .
18. Amount of Line 14 taxable
0 0
0
0
0
0
.
at collateral rate X .15 18 .
3 5 3 0 3. 0 2
19. Tax Due ............................................ ....19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505607221 1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 28 1066
DECEDENTS NAME
KENNETH B. FIRST
STREET ADDRESS
CIO GOLDEN LIVING CENTER
46 ERFORD ROAD
CITE( STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
7. 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) 35,303.02
29,000.00
1,450.00
Total Credits (A + B + C) (2) 30,450.00
0.00
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
FIII in oval on Page 2, Line 20 to request a refund.
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(4) 0.00
(5) 4,853.02
(5A)
(5B) 4,853.02
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? ................................................................................. ...... ^ 0
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ... ...... ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................ ...... ^ 0
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 p2 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 childtwenty-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-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
KENNETH B. FIRST 21 28 1066
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
73 SERIES EE SAVINGS BONDS
8,182.71
TOTAL (Also enter on line 2, Recapitulation) ~ S 8,182.71
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (8-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KENNETH B. FIRST 21 28 1066
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be discbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. JOHN HANCOCK 4,423.50
MUTUAL FUND 340.008 SHARES ~ $13.01 PER SHARE
2. H&R BLOCK 290.00
IRA
3. 2004 CHEVROLET CAVALIER AUTOMOBILE 5,500.00
PER KELLEY BLUE BOOK VALUE
4. DEPARTMENT OF DEFENSE 64,931.89
RETIREMENT BENEFITS
5. THRIFT SAVINGS PLAN 21,853.13
6. 2008 FEDERAL INCOME TAX REFUND 5,508.00
TOTAL (Also enter on line 5, Recapitulation) ~ 3
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
ESTATE OF
FILE NUMBER
KENNETH B. FIRST 21 28 1066
Han asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. CHARLES E. FIRST, JR. 4921 HIGHLAND STREET
HARRISBURG, PA 17111
JOINTLY-OWNED PROPERTY:
ADDRESS
,TIONSHIP TO DECEDENT
BROTHER
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET 96 OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1. A. 3/13/08 WACHOVIA 4,720.33 100. 4,720.33
CHECKING
2. A. 3/19/08 WACHOVIA 194,275.12 100. 194,275.12
CHECKING
0.00
TOTAL (Also enter on line 6, Recapitulation) I S 198,995.45
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
KENNETH B. FIRST 21 28 1066
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. SULLIVAN FUNERAL HOME 6,611.00
2. MT. ZION LUTHERAN CHURCH, ENOLA, PA -CEMETERY LOT 1,100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) CHARLES E. FIRST, JR. (RENOUNCED)
Street Address 4921 HIGHLAND STREET
City HARRISBURG State PA Zip 17111
Year(s) Commission Paid:
2, Attorney Fees MURREL R. WALTERS, III, ESQ.
3, Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
4.
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY
5 Accountants Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) I ;
9,625.00
479.00
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
KENNETH B. FIRST 21 28 1066
Report debts incurred by the decedent prior to deatl~ which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CAMP HILL EMERGENCY PHYSICIANS 284.00
MEDICAL
2. HOLY SPIRIT PHYSICIANS 240.00
MEDICAL
TOTAL (Also enter on line 10, Recapitulation) I ;
(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
KENNETH B. FIRST c~ co -~ vvv
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 [indude ou ht sppoousal distributions, and transfers under
Sec. 9116 (~a (1.2)]
1. CHARLES E. FIRST, JR. Sibling 100.00
4921 HIGHLAND STREET
HARRISBURG, PA 17111
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 TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S
(If more space is needed, insert additional sheets of the same size)
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