HomeMy WebLinkAbout08-21-091505607121
08
05
REV-1500 Ex
(
-
) OFFICIAL USE ONLY
PA Department of Revenue
County Code Year
File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box 28oso1 2 1 0 8 1 1 2 4
Hanisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 7 1 2 8 5 5 6 2 1 1 0 4 2 0 0 8 0 6 2 6 1 9 1 8
Decedent's Last Name Suffix Decedent's First Name MI
L E B O H E L E N V
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
^X 1. Original Retum
4. Limited Estate
^X 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Retum
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust ~
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
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
M E C R A N I C S B U R G
State ZIP Code
P A 1 7 0 5 5
REGISTER OF WILLS U$EUNLY
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Correspondent's a-mail address:
Under penalties of perjury, I declare that I have examined this return, induding accompanying schedules and statements, and to the hest of my knowledge and belief,
it is true, correct and complete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN~lfj RE Oj~ PERSON RESPONSIBLF~ FOF~I~ING RETURN ~ DATE
ADDRESS
P•0- B X 3 2 W- MAIN ST• NEW BLOOMFIELD PA 17068
SIGNATUR O RE O R THAN REPRESENTATNE DATE G
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ADDRES -
54 E ST AIN STREET MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505607121 1505607121 J
15D5607221
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: HELEN V• L E B O 1 7 1 2 8 5 5 6 2
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 8 Notes Receivable (Schedule D) ...................... .. 4.
4 1 6 4 6 6. 6 6
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ..... .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6•
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) ~ Separate Billing Requested ..... .. 7.
8. Total Gross Assets (total Lines 1-7) ......................... .. 8. 4 1 6 4 6 6. 6 6
9. Funeral Expenses 8 Administrative Costs (Schedule H) ................ 9. 8 2 8 5. 0 0
10. Debts of Decedent, Mort a e Liabilities, 8 Liens Schedule I 10. 9
9 9 ( ) ............ 1 6 1. 6 6
11. Total Deductions (total Lines 9 & 10) ........................... 11. 1 7 4 4 6 . 6 6
12. Net Value of Estate (Line 8 minus Line 11) .... ............ .. ..... .. 12. 3 9 9 D 2 0 . 0 0
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. 3 9 9 0 2 0 . 0 0
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.o _ O. D D 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate x .0_ 0. 0 0 16. 0. 0 0
17. Amount of Line 14 taxable
D
D
D
D
D
D
at sibling rate X .12 17. .
18. Amount of Line 14 taxable 3 9 9 0 2 0 0 0 5 9 8 5 3 0 0
at collateral rate X .15 18. .
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
5 9 8 5 3. 0 0
Side 2
L 1505607221 1505607221
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 08 1124
DECEDENTS NAME
HELEN V. LEBO
STREET ADDRESS
MESSIAH VILLAGE
100 MT. ALLEN DRIVE
CITY STATE ZIP
MECHANICSBURG PA 17050
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 59,853.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 56,000.00
C. Discount
Total Credits (A + B + C) (2) 56,000.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total InteresUPenalty (D + E )
4. If lane 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) 0.00
(4)
0.00
(5)
(5A)
(5B)
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 : ................................................................ ...... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^
c. retain a reversionary interest; or .......................................................................................... ...... ^ ^X
d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................. ...... ^ ^X
3. Did decedent own an "in trust for• or payable upon death bank account or security at his or her death? ... ...... ^ Q
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................................................................ ...... ^ ^X
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
[T2 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-0ne 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) peroent (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-1508 EX + (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, ~ MISC.
P
COMMONWEALTH OF
ENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HELEN V. LEBO 21 OS 1124
InGude 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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MESSIAH VILLAGE 12,025.00
HOUSING REFUND
2. AMERIPRISE 113.81
MUTUAL FUND 25.956 SHARES @ 4.380
3. AMERIPRISE 15,206.06
ANNUITY
4. AMERIPRISE 14,768.02
ANNUITY
5. AMERIPRISE 69,434.75
ANNUITY
6. AMERIPRISE 39,720.90
ANNUITY
7. AMERIPRISE 41,734.79
ANNUITY
8. AMERIPRISE 101,931.00
BROKERAGE ACCOUNT
9. PNC 12,000.00
CHECKING
10. PNC 15,000.00
MONEY MARKET
11. PNC 94,000.00
CERTIFICATES OF DEPOSIT (2)
12. HIGHMARK 135.33
REFUND
13. 2008 FEDERAL INCOME TAX REFUND 397.00
TOTAL (Also enter on line 5, Recapitulation) I S
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES Se
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HELEN V. LEBO 21 08 1124
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. BOYER FUNERAL HOME 3,146.00
2. NEW BLOOMFIELD CEMETERY -GRAVE OPENING 150.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) ANDREW W. McNEILLIE (RENOUNCED)
Street Address 235 W. MAIN ST., P.O. BOX 233
City NEW BLOOMFIELD State PA Zip 17068
Year(s) Commission Paid:
2. Attorney Fees MURREL R. WALTERS, III, ESQUIRE 4,500.00
3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY 471.00
5 Accountants Fees
6. Tax Return Preparers Fees
7. VITAL RECORDS -DEATH CERTIFICATES 18.00
TOTAL (Also enter on line 9, Recapitulation) I ~
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS
RESIDENT DECEDENT ~
ESTATE OF FILE NUMBER
HELEN V. LEBO 21 08 1124
Report debts incuned by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ALERT PHARMACY SERVICES, INC. 2,705.38
MEDICAL
2. MESSIAH VILLAGE 6,204.28
RESIDENTIAL CARE
3. (PENNSYLVANIA INCOME TAX I 252.00
TOTAL (Also enter on line 10, Recapitulation) I ;
(If more space is needed, insert addrbonal sheets of the same size)
REV-1513 EX + (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
uc~ c~i v ~ cnn 71 OR 1 ~ 7d
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 [nclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. ANDREW W. McNEILLIE Collateral 199,510.00
235 W. MAIN ST., P.O. BOX 233
NEW BLOOMFIELD, PA 17068
2. VIRGINIA McNEILLIE Collateral 199,510.00
235 W. MAIN ST., P.O. BOX 233
NEW BLOOMFIELD, PA 17068
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 TAX IS NOT BEING MADE
1.
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)