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Home My WebLink About07-31-09J REV-1500 Ex (oB-DSO PA Department o! Revenue 15056041114 OFFICIAL USE ONLY County Cotle Year File Number e2 / GB' ~ ,~, -y Bureau W Intlivitlual Taxes Po Box zeoeol INHERITANCE TAX RETURN Nartiabu PA 17129-0801 ---- ENTER DECEDENT INFORMATION BELOW Social Security Number Date of bath 162-22-3658 01232008 Decedent's Last Name Date of Birth 07281929 Suffix Decedents First Name ADAMS (H Applicable) Enter Surviving Spouse's Information Below BETTY Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number MI F MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS [~ 1.Od61rrel Retum ® 2. Supplemental Retum R ~ 3 Q 4. Limited Fatale . emainder Retum (tlate of tleam _ Q 4e. Future Interest Compromise (tlate o! Pnor to 12-13-82) deem slier 12.12.92) ~ 5. Fetlerel Estate Tax Retum Required ® e. Decedent Dbtl Testate (Attach Copy o! Wilq 0 7. Detletlerd Meinteinetl a LNln6 Trust 0 (Attadt Copy of Trust) s. Total Number of Sak Depoa9 Baxee Q 9. Litlpatlon Proceeds Received ~ 10. Spousal Poverty Cretlk (tlate of deem between 12.31-Di antl 1.1.65) ~ 11. Election to fax antler See. 6113(A) CORRESPONDENT-THIS SECTION MUST BE COMPLET Name ED. ALL CORRESPONDENCE AND CONFIDEN TIAL TAX INFORMATION SHOULD BE DIRECTED T0: ROBERT G. FREY Daytime Telephone Number Firrn Nama (If Applicable) 717 2 4 3 5 8 3 8 FREY & TILEY REGISTER OF WILLS USE ONLY First line of address N n o 5 SOUTH HANOVER STREET T O '° 7 D ~' Second line of address S ~ `nom r City or Post Office CARLISLE Correspondent's e-mail address: OF PERSON RESPONSIBLE FOR FILING RETURN ,_ _~ ADDRESS 447 OAK FLAT ROAD, NEWV SIGNA'[pRE OF PRBPAwr:w nruwwirue.~~.... 5 SOUTH ' 15056041114 State ZIP Code PA 17013 :LEY.COM lp etxompan u an sl zonal re ntatNa u based on all IMom PA 17241 3LE, PA 17013 i USE ORIGINAL FORM ONLY Side 1 -~rrn W y1T CJJ~ C~~Q~ ~ ! E'D' ~ ~~ cn O>• my ow een e, Im knaMedo°-__ DATE ~_ DATE 07/16/09 15056041114 ;;.? ~ 4_ c'r~ T, '~ • r C::` C.7 s-~ -ri •, -.~ ~' iT ~- c,^ r~ "i i J J 15056042115 REV-1500 EX BETTY F ADAMS RECAPITULATION Decedent's Social Security Number 162-22-3658 1. Real estate (Schedule A) ...... .................................. ... 1. NONE 2. Stocks and Bonds (Schedule B) ... ................................ 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C ... 2. NONE NO ) .. ... 3. NE 4. Mortgages 8 Notes Receivable (Schedule D) . ....................... . . .. 4. NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... , . , , 5 8. Jointly Owned property (Schedule F) ~Separay Billing Requested ...... 7. Inter-Vivos Transfers 8 Miscella .. 6. NONE neous Non-Probate Property (Schedule G) OSeparate Billing Requested ....... B. Total Grose Assay (total Linea 1-7) ..... . 7. NONE .. . ......................... . 8. 9. Funeral Expenses & Administrative Costs (Schedule H) .................. . 9. NONE 10. Debts of Decadent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. NONE 11. Total DeducUOns (toyl Lines 9 & 10) .......... . ...................... 11. 12. Net Valw of Esyy (Line S minus Line 11) ............ . 13. Charkable and Govemmenyl Begwsta/Sec 9113 Trust' for which 12 an election to tax has net bean made (Schedule J) ....................... 19 TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 14 15. Amount of Lina 14 taxable at the spousal tax ray, or transfers under See. 9118 (a)(1.2) X .0 0 16. Amount of Line 14 taxable 15. et linealrayX.O 45 7000.00 18. 17. Amount of Line 14 taxable at sibling rata X • 12 18. Amount of Llne 14 taxable 17. at collateral rate X . 15 18. 19. TAX DUE .......... . ............................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 7000.00 7000.00 0.00 7000.00 0.00 7000.00 0.00 315.00 0.00 0.00 315.00 L s)de 2 15056042115 15056042115 J REV-1500 EX Pape 3 Decedent's Con DECEDENTS NAME 162-22-3658 Address: File Number DECEDENTS SOCIAL SECURITY NUMBER ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credks/Payments A. Spousal Poverty Credk _ B. Pdor Payments _ C. Discount 3. Interest/Penalty If applicable D. Interest E. Penalty (t) 315.00 Total Credks (A + B + C) (2) 0.00 4. If Line 2 Ls greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.enalty (D + E) (3) D.00 Fill In Duel on page 2, Llns 20 to request s refund. (4) 0.00 5. If Line 1 + Lina 3 Is greeter than Line 2, enter the dNference. This is the TAX DUE. (5) 315.00 A. Enter the Interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 315.00 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: a. retain the use or income of the property transferred; ........ No b. retain the dght to designate who shall use the property transferred or its tnceme : ............... ^ c. rofain a reverolonary interest; or...... ...................... d. receWe the promise for IHe of ekher payments, beneflts or cere9 ............................. 2. If death occurred after December 12, 1982, did decedent transfer property wkh(n one year of death ^ without receiving adequate consideretion9 ................ . 3. Did decedent own an "intrust for' or payable upon death bank account or secudty at his or her death? .. 4. Did decedent own an IndNidual Redrement Account, annuity, or other non-probate properly which X contains a beneficiary destgnation7 ........... ^ .......... X IF THE ANSWER 70 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. §9118 (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 (O) percent [72 P.S. §9118 (a) (1.1) (ii)]. The statute does no_ t 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 adopt(ve parent, or a stepparent of the child is zero (0) percent p2 P.S. §9118(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 fhe decedent, whether by blood or adoption. 217 REV-1509 EX+ (6.85) SCHEDULE E COMMONWEALTH OF PENN9VLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCETAX RETURN PERSONAL PROPERTY RESIOENi OECEOENT .STATE oa the proceeds of Iitlaation anH ~Hn -- --..._ .,~..o.