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HomeMy WebLinkAbout07-02-09 (2)r~ 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 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~- ~ a .. .........:... ~- ~.. ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedent's Last Name Suffix Decedent's First Name MI ~~ ~- a 4 S ~ 1Z v T 1?- ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ~;.<~~~. ~ Lsos6os1a4~ Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Retum O 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 911 (Attach Sch. r0„~ ~ --ter---- '~!,,., ECl'EPTO: ; ~' ,t ~: ' "' t.,.. ~ ~ ,'"7. ~'~ r > Firm Name (If Applicable) REGISTER O E ONLY ~~'~ ~'~ ~A;~~ ~ ~ ~ '_~~,~ ~~ First line of address ~ l"~? ~~ ~ Second line of address City or Post Office State ZIP Code __ DATE FILED ,/~ Correspondent's a-mail address: ~~~ ~"'~`'-~t~ • } ~ w ~~v Under penalties of pery'ury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, e, correct and complete. DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN OF PERSON RESPONSIBLE,FpR FILING U DATE CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION Name Daytime Telephoi SIGNAT E OF PREPARER OTHER THAN REPRESENTATIVE C ,,QAT .l y o ADD SS ,. PLEKSE USE ORIGINAVFORM ONLY Side 1 15056051047 1505605104? J J REV-1500 EX 15056052048 Decedent's Social Security Number Decedent's Name: ~U 1 ~'_ Z--. G- ~ RECAPITULATION 1. Real estate (Schedule A) . ............................................ 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. • 5. Cash, Bank De sits & Miscellaneous Personal Pro a Schedule E 5. J~ ' d S • U po P rty ( ) ........ t~ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. • 7. Inter-Vvos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) O Separate BiNing Requested........ 7. Q !? O D D r O a 8. Total Gross Assets (total Lines 1-7) .................................... 8. ~ p ~ t~ ~ ~ . O 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. '~ ~ 3 , + ~ / 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. ,~ a ~ . ~ ~' 11. Total Deductions (total Lines 9 & 10) ................................... 11. '7 ~ ~ 3 . 1 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ~ ~ ~ ~' ~ • ~' 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. ~ (~ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 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 _ . U 16. 17. Amount of Line 14 taxable b ~ at sibling rate X .12 • 17. • 18. Amount of Line 14 taxable ~ at collateral rate X .15 18. • 19. TAX DUE ......................................................... 19. ~ d 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056052048 15056052048 t REV-1500 EX Page 3 Decedent's Complete Address: File Number Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty ___ __. _ _ _.... __.. _._._. _ _.__ Total Interest/Penalty (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. (56) Q 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? .............................................................................................................. ^ ^ 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? ........................................................................................................................ Imo' ^ 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)J. 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. Joanne Marino McGreevy Attorney at Law 137 S. West Street Carlisle, PA 17013 717-243-0092 July 2, 2009 PA Department of Revenue Inheritance Tax Returns To Whom It May Concern: I have filed an inheritance tax return in order to apprise the Department of Revenue of the beneficiary's receipt of anon-probate annuity. In addition, the only cash asset of $6875..06 was held in the decedent's sole name. To transfer the amount, a petition for settlement of small estates and a family exemption was also filed. Should you need additional information, please contact me at the above number. S' cerely, Joanne Marino McGreevy TESTA~F\T WI.L.L AND I LAST ' d CountY~ ~: eton Township ~ Cumbezlan Middl yoke any willl TH L• CLOUSE, °f North re U Will and Testament and I, R e my Last 1 declare this to b ~ P ennsYlvania, ~ made by me• neral eXpenses, including viouslY f u or codicil Pre ust debts and I di ct that all my J , , b ~ p~.i d fro= m,.. ITEM I= re ^L ",. ~ _- -,~r:-_ s'^__ ,, ~,~ ___ .e- -- -- a of _ ,. ,_. _: =Y __ --- "- - ecease as part the "~ -- acticabs-e a=ter mY d e as soon as pr c o f my estate. nature and ~ administration e ueath all of my estate of every evise and b q 1 survive me I ITEM II• I d roviding he"shal uate to mY son, Robert E. Clouse, P wherever slt by thirty days. redeCease me or die on or NEB E • Clouse, P ITEM III: Should my son, Robert of the death, I devise and bequeath all following mY James A• before the thirty-eth day d wherever situate to my son, very nature an ~ residue of mY estate of e first day following I er stirpes living on the thirty- or to his issue, P ~ Clouse, ~, death. _ _ _,,se c~+cCL't.oY cf tais my last ~~ my - ~ .w - ~ .- ---.r ~ • ~ - 4 .... ~ I - - - r i will. r his successors shall not be v; I direct that mY executor o ITEM i ful performance of their duties in an ~ iced to give bond for the faith requ and seal tO this my Last Will I jurisdiction. hand ~~ WITNESS ~RECF~ I hereunto set my day of IN dated this ~_ ten on two (2} sheets of paper, ~! and Testament, writ ,. 79• ,, .J ~ ~.,; '" 19 ~ ;,. ~.-!.~_-~..-. ._ (SEAL) -- ' ~"r ~ - r . ~~. - i- Y _. Ruth L. Clouse one (1) other typeWrittei - v JT s L.; -_, .. o T this and wa on the day and - --- : _ - - - - - =--' _- --"2"signature of the testatr sty trix therein named, _- --__ a - -,-died by to the to nest, in her eGC_: ~e~:-~ ~ who at her req ~'"v' of signed, publishea and declared Y ` date there y1i11, in the presence of us, r her Last each other have subscribed our names as as and fo resence of ;; presence, and in the P ;rnesses hereto. ~ _ - _ - - - - - ''~' siding at ~ - - INVENTORY REGISTER OF WILLS OF L" ~~ ~ ~~ ~.~ ~' ~ COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF L' U/~l ~£~ L ~N ,D SS File Number J A. N~- ~ S ~. c.-o ccs ~ , Personal Representative(s) of the Estate of +~ ~ ^ hh L , C ~- a u- S ~- 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. c Attorney -- (Name) (Supreme Court I.D. No.) ~ 7 ~ ~~ (Address) 1 ~ ') .-f~ . ~" y~._ ~~` . ~~-Ir-~.C~.~-C.~ U .~' ~ ~ ~ j~ (Telephone) ~~~ r' ~ x 3 0 © 90~-- DATE OF DEATH LAST RESIDENCE DECEDENTS SOC. SEC. N0. FIGURES MUST BE TOTALED ~ !._. f -s S ~ c C- h"f ~ l/V~ 4- ,,A- C c ~ T. ~' S S / .5 .~ d ~ ~`1 d ~ 'j~ ~i ~' ~ ~, a ~ (Attach additional sheets as needed) TOTAL: 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)) Form RW-09 rev. 10.13.06 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEpVLE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER ~ L C.rL-o u f £- 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) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~ILE 6 INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER ~, v ~' H- L- , C.~Lo r~r ~ This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBE DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION F APPLICABLE TAXABLE VALUE ,. s E, ~ ~, ~' ~ ~ ~~~- c L ~ ~cc' ~. ~ '~ o p ~1'n ~}. w s ~~- ~ ~ c ~ O~~J'' ~ !! ~ ~} L L 1 /!~N ~ !~ NN U 1 ~ ~ ~i n~ ~ l ~D ~O u ~o ,~U~~ 3 ~.o ~~~ TOTAL (Also enter on line 7 Recapitulation) S I (~ (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 ram numacn Debts of decedent must be reported on Schedule L ITEM NUMBER A. 1. B. 1. DESCRIPTION FUNERAL EXPENSES: /'1 l~-R-K~.-~-~ o S ~ ~- I S t~ ~ ~~ ~~ ~~~.~-y r1 ~ ,~ ~ /Z-b ~ n~ I S 7"' ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address _ ____._. _____ Citv Year(s) Commission Paid: 2. ~ Attorney Fees State Zip ft~~0, Od ~ 3 6 . ~- ~ ~~,~~, ~~ ~~ d o l~o~©~ ~~ ~ ~ ~ 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ` ~ ~~ Claimant 0 IS ~L-~2-~ ~ 1., d l~ S -- _ I -- -- 3 ~ Q ~ , o 0 Street Address _~__L.IL -- 12 O ,~v ~ ~o it !'L-r1 -- City C'~ ~- r S ~ ~ State ,~~ Zip ~ ~ Relationship of Claimant to Decedent ~~ 4. Probate Fees C Sc-~G .~? ~ ~L L.-O-~ 5. Accountant's Feed, 6. Tax Return Preparer's Fees t / Ti4~c ~ '(,~--~C TOTAL (Also enter on line 9, Recapitulation) $ ~ I ~ 3 (If more space is needed, insert additional sheets of the same size) 10I2.~ci ~~ REV-1512 EX+ (12-08) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER C~.- v T.~ L-- , c- ~- ° tcS ~ 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 ~. ~M~~`~~~~ U~ ~lM~urL-SSA ~ ~ ~ ~~ ~ ~ ~ ~ o p w r LL ~l /2- ~ ~.~s ~~ a. I-~r, s P ~ r pr ~ ~ ~rz~,M a urc s r n TOTAL (Also enter on Line 10, Recapitulation) ($ ~~. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08} ~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER 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. S ~ /V , '0 f~ /,0 ~ ~ b b~ 2-T ~. L o ~ ~ [ 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. ~~e~