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HomeMy WebLinkAbout08-18-09 (2)r J 15056051058 REV-1500 EX (OB-05) OFFICIAL USE ONLY PA Department of Revenue Bu(eau W IndivWual Texas County Code Year File Number Po Box 2&)60t INHERITANCE TAX RETURN Nanisburg, PA 17128A601 RESIDENT DECEDENT 21 09 0434 ENTER DECEDENT INFORMATION BELOW Social Security Number Dato of Death Data of Birth 172-01-7237 04/12/2008 05!15!1916 Decedent's Last Name Suffix Decedent's First Name MI BAIRD DAISY B (If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Suffix Spouse's First Name Ml Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW '• 1. Odginal Return 2. Supplemental Ratum 3. Remainder Return (date of death prior to 12-73-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tex Retum Required death after 12-12-82) 6. Decedent pied Testate 7. Decedent Maintained a Living Trust 8. Total Number of Sefe Deposit Boxes (Attach Copy of Will) (ABech Copy of Trust) 9. Litlgation Proceeds Receivetl t0. Spousal Poverty Credit (dace of death 11. Election to tax under Sec. 9173(A) between 12.31.91 antl 1-t-95) (Attach Sch. O) CORRESPONDENT - TNIS SECTION NUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATNIN SHOULD SE DIRECTED 70: Name Daytime Telephone Number CYNTHIA Y KOSTELAC N {717) 903-845fp ° c, c O .~ Firm Name (If Applicable) REGfSTER OR-'Vdli~ USE ON~ !T_~ G7 '- ~ r m -- ~~~' cri ~ ~ First line of atldress 3 , 520 FAIRWAY DR c w ~T T = rjC Second line of address - =.j N a ca Gty Or Poet OtfiCe State ZIP Code DATE FILED CAMP HILL PA 17011 Correspondent's a-mail address: Under penalties or perjury, l daUere that 1 here examined this return, including axompanying sMeduks antl sretemenls, and to the Dest of my knc It is true, mmect and complete. Declaration of preperer other Nan the personal representative is based on all 7nfomlalion of whk:h preparer has a SIn~RiTOP PERSON RESPONSYBLE FOR f11fINCaRETURN A ~„ _ (DATE .o Cl _'' i-i~ ~'~i `! J C.! r ', ~'r? _,:.- r_y <__~ ; ~ '.. :''r l -~ __~ ADORES , SIGNATURE QE,PREPARER TktER TFjgN FjEP NTATXfE DATE I.._ 1 505605 1 058 Side t 15056051058 15056052059 REV-1500 EX Decedent's Social Secudty Number DAISY B BAIRD 172-O1-7237 Decedem's Name: RECAPITULATION 1. Real estate (Schedule A) ........... . ................................ . 1. 156,000.00 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. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ...... .. 5. 2,430,00 8. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. 682.00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested...... .. 7. 6. Total Gross Asseta (total Lines 1-7) ................................:. _._ _.... .. 8. 159,112.00 9. Funeral Expenses 8 Administrative Costs (Schedule H) ................... .. 9. 10,443.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 3,343.00 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 13,785.00 12. Nat Value of F~tate (Line 8 minus Line 11) ............................ .. 12. 145,326.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .... . ................. .. 13. 14. Nat Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 145,326.00 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal taz rate, or transfers under Sec. 9116 18. Amount of Line 14 taxable at Pineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line l4 taxable 145,326.00 t8 21,799.00 at collateral rate X .15 21,799.00 19. ....................................................... TAX DUE 19, .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Stde2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 os 0434 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER DAISY _ B BAIRD __ _ 172-01-7237 STREETADDRESS -- --~-- 22 CIRCLE DR CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line t9) (1) 21,799.00 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. piscount --- Total Credits (A+ B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest __ _ E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. Thls Is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line i + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 21,799.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 21,799.00 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: Yes No a. retain the use or income of the Property transfemed :.................................................................................... ...... ^ b. retain the right to designate who shalt use the property transferred or'ds 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 progeny within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in Wet for" or payable upon death bank account or security at his w 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 Jufy 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. REV-ISUZ FX+ (iJ ~OBi ~' Pennsylvania SCHEDULE A UF.PANiMENT OF HFVENDk. iNNERirnNCE rnx REruRN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER DAISY B BAIRD 21-09-0434 All real property owned solely or 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 Mat is jointly-owned with right of survivorship must ha disclosed on Schedule F. Attach a copy of [he settlement sheet if the property has been sold. r ' ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' SINGLE FAMILY RESIDENCE 22 CIRCLE DR CAMP HILL PA 17011 CUMBERLAND COUNTY CENSUS TRACT 25420-102.2 MAP REF ADC 3117K1 { 156,OD0.00 TOTAL (Also enter on Line 1, Recapitulation.) I; 156,000.00 If more space is needed, insert additional sheets of the same size. REV-1508 EX+ (fi-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~LE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER DAISY B BAIRD 21-09-0434 (Ii more space is needed, insert addhional sheets of the same size) REV-1509 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY DAISY B BAIRD 21-09-0434 It an asset was matle pint within one year of tha decedent's tlate of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RE4ATIONSHIP TO DECEDENT A. CYNTHIA Y KOSTELAC 520 FAIRWAY DR CAMP H4LL PA 17011 NONE 8. C. JOINTLY-0WNED PROPERTY: ITEM NUMBER LETTER FoR .KNNT TENPNT DATE MADE JDINi DESCRIPTION OF PROPERTY INCLUDE NAME Of FINANCIAL INSiiTUiION ANO aM1X gCCWNT NUMBER OR SIMILAR IDENAfY1NG NUMBER. ATTACH DEEP FOR JOINTLY,HELO REAL ESTATE. DAiE OF DEATH VALUE OF RSSET n, GF DECOS INTEREST pATE OG DEATH VALUE OF DECEDENi'91NTEREST ~ ~ A' 02!14/00 SOVEREIGN BANK CHECKING ACCOUNT #571132227 325.00 .50 163.00 A. 02/14/00 PNCBANK CHECKING ACCT#51-0012-8455 1 037 00 50 519 00 , . . . TOTAL (Also enter on line 6, Recapitulation) I S 682.00 pf more space is nestled, insert addtlional sheets of the same size) REV•7611 EX+(1298) SCHED!!4E H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER DAISY B BAIRD 21-09-0434 DeWS of decedent must be reported on Schedule L A. FUNERAL EXPENSES: ~' MYERS HARNER FUNERAL HOME 1903 MARKET ST CAMP HILL PA 17011 2. GRAVE OPENING a. ROYERSFLOWERS a. FUNERAL LUNCHEON B. ADMINISTRATIVE COSTS: 1. Personal Representallve's Commissions Name of Personal Representative(s) Social Security Numberls)IEIN Number of Personal Represenlafive(s) Street Address Ciry ,Slate Year(s) Commission Paid: 2. Attorney fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Sseel Address Clly State Relasonstep of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Re1um Preparer's Fees 7. Zlp Zip TOTAL (Also enter on fine 9, Recapitulation) I $ (If more space is needed, insert atlditional sheets of the same size) 7,745.00 1,200.00 350.00 125.00 500.00 423.00 100.00 10,443.00 REV-151 EXi (72-OP) ~~ Pennsylvania SCHEDULE I UreAR,MF;N, oT RE~~N~t DEBTS OF DECEDENT, ~NneanaNCE rax RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER DAISY B BAIRD 21-09-0434 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 t OMNICARE MEDICATIONS 1,030.00 2. WEST SHORE EMS 624.00 3. UTILITIES 522.00 4. US TREASURY RETURN OF APRIL SOCIAL SECURITY 255.00 5. OFFICE OF PERSONNEL MANAGEMENT RETURN OF APRIL FEDERAL PENSION 912.00 TOTAL (Also enter on Line 30, Recapitulation) $ 3,343.00 1(more space is needed, insert additional sheets of the same size. NEV-1513 EX+ (11-08) ~ `l' pennsylvania W UE~'AUiMfrvi OF r1EVFNUk INHERITANCE iA% RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DAISY B BAIRD 21-09-0434 RELATIONSHIP TO DECEDENT AMOUNT OR SNARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s) OF ESTATE I TAXABLE DI57RIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2),] 1. CYNTHIA Y KOSTELAC 520 FA{RWAY DR CAMP HILL PA 17011 NONE 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON gNES 15 THROUGH 1R OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TA%ABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUT10N5 UNDER SECTION 9113 fOR WHICH AN ELECTION TO TAX (S NOT TAKEN 1. B. CHARITABLE ANO GOVERNMENTAL DISTR16UilONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE pISTRIBUTI0N5 ON LINE 13 OF REV-1500 COVER SHEET. ; SCHEDULE 7 BENEFICIARIES if more space is needed, insert addRional sheets of the same size.