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HomeMy WebLinkAbout08-06-09 (2)15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PoBOx2sosol INHERITANCE TAX RETURN Harrisburg, PA m2s-0so1 RESIDENT DECEDENT 21 06 01112 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204-01-8492 ' 06/27/2006 12/22/1919 Decedent's Last Name Suffix Decedent's First Name MI Eppler Mervin A ', (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Eppler Doris R Spouse's Social Security Number _ -. THIS RETURN MUST BE FILED IN DUPLIrtiATE WITH THE _ REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 1• 1. Original Return 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 0 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 ..µ._ 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 TO: Name Daytime Telephone Number Doris R. Eppler, Execut (717;1 519-8705 Firm Name (If Applicable) REGISTER OF WILLS USE ~ n c~ - - , r/ 0 - ~ -.r . ~ i First line of address ' : i..7 ~t-, ~ ~ ~ .~ I ~ 5225 Wilson Lane ~ .. !' ~,,-,^, I _ - _ _ _ ~'- C%~ f _: Second line of address .,. -- `~, ,--. ~ t ~ Apartment 2105 ~ -`~ ~ _ City or Post Office... State ZIP Code DATE-~.ED - - G,? .: ~ __ ,'; _ _ ~ ~ ~ _ ^ Mechanicsburg PA 17055 ' ~ x Correspondent's a-mail address: 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 representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS ' 5225 Wilson ane, Apt. 21 5, Mechanicburg, PA 17055 ___ SIG R RF~1' E H HAN REPRESENTATIVE ~D/ATE/~ 909 North Second St., Harrisburg, PA 17102 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 c 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Mervin A Eppley ', 21)4-01-8492 _.. RECAPITULATION .. w _ .,,, ,,,,,,,,,,.µ„__ _. __._._._._._. 1. Real estate (Schedule A) . .......................................... .. 1. 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. '', 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 237,109.67 6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested...... .. 7. 0.00 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 237,109.67 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 4,075.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. ', 0.00 11. Total Deductions (total Lines 9 8~ 10) ................................. .. 11. ' 4,075.00 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ', 233,034.67 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 233,034.67 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 0 233,034.67 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 0.00 16. '', 0.00 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17 ! 0.00 18. Amount of Line 14 taxable - _. at collateral rate X .15 0.00 18 ', 0.00 19. TAX DUE ....................................................... .. 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT „_;,,, 15056052059 Side 2 L 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: FIIe Number 21 06 '01112 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Mervin A Eppler 204-01-8492 STREET ADDRESS 5225 Wilson Lane, Apt. 2105 CITY Mechanicsburg STATE ZIP PA ~ 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 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 Interest/Penalty (D + E ) 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. 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. (3) (4) (5) (5A) (5B) Make Check Payable fo: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 0.00 0.00 0.00 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? ......................................................................................................... ^ 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 [7;? 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-15U2 EX+ (11-08) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Eppler, Mervin A. 01112 All real property owned solely ar as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is 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-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Eppler, Mervin A. 01112 All property Jolntlyowned with right of survivorship must be disclosed on Schedule f. (If more space is needed, insert additional sheets of the same size) 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 Eppler, Mervin A. 01112 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Eppler, Mervin A. 01112 If an 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 ADDRESS RELATIONSHIP TO DECEDENT A• None B. C. JOINTLY-OWNED PROPERTY: 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 CAF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST t • A. None TOTAL (Also enter on line 6, Recapitulation) I S 0.00 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (8-98j COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Eppler, Mervin A. 01112 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 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1 • None TOTAL (Also enter on line 7 Recapitulation) 5 I 0.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Eppler, Mervin A. 01112 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. B. 1 2. 3. 4. 5. 6. 7. FUNERAL EXPENSES: None -Prepaid city Mechanicsburg State PA _zip 17102 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Paid: None Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Doris R. Eppler street Address 5225 Wilson Lane Apt. 2105 Relationship of Claimant to Decedent SpOUSe Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, I~ecapitulation) $ (If more space is needed, insert additional sheets of the same size) Zip 3,500.00 100.00 200.00 275.00 4,075.00 REV-1513 EX+ (11-08) i' , Pennsylvania SCHEDULE ~ ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Eppler, M ervin A. u~ ~ ~~ 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. Entire estate to Doris R. Eppler, 5225 Wilson Lane, Apt. 2105 Mechanicsburg, PA 17055 Spouse 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 CO~JER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. None 0 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. None 0 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. # 0 If more space is needed, insert additional sheets of the same size.