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HomeMy WebLinkAbout07-17-09 15056051047 REV-1500 EX (06-05) OFFI(:IAL USE ONLY PA Department of Revenue ° County Code Year File Number Bureau of Individual Taxes PO BOX 280601 ~, :raw s INHERITANCE TAX RETURN / / CEDENT Z" ~ Q Harrisburg, PA 17128-0601 rLL RESIDENT DE ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~oz ~z /~7 0/ z-~'~oq D~'/~ /;~/9 Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW IIIIIIII~ 1. Original Return O 2. Supplemental Return O :S. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O Ei. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ FS. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 1'I . Election to tax under Sec. 9113(A) bet~.veen 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 Firm Name (If Applicable) /~ ~{~ REGISTER _ ILLS USFL_ LY ` ! ., First line of address tr --"~ ~ -~ i - ~_~ ~/ ~ t/ ~ ~ ~~ ~" ~ ~ C~ ` i t ~----i Second line of address rl t ~ Q ~ -~ ~ ~ _ ~-f - -~ --g .a © t -'. C it P t Offi St t ZIP C d ATE FILED CTl y or os ce a e o e D w ` -- Correspondent's a-mail address Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statement ., 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. SIGNAT OF PERSO RESPONSIBLE OR FILI G RE URN ATE /T ADDRE IGNATUREI~i P ARER OTHEBiT31AN REPRESENTATIVE DA-E / ADDR PLEASE USE ORIGINAL FORM ON Side 1 15056051047 15056051047 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) . .......................................... .. 1. i ~ ~ ~tI V ©~ . 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 Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. Q /U / / l~ ~~ • 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. _ • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ?i,3 / (p ~ ~ . 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ~~ Z~~ . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. /~j 2~Q . 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ~-/~J ~Q / . 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. ?i/~ ~ ~ . 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_ 15. 16. Amount of Line 14 table at lineal rate X .0 ~1' ~ ~~ 0 ~ . 16. ~ ~ . 17. Amount of Line 14 taxable at sibling rate X .12 17. • 18. Amount of Line 14 taxable at collateral rate X .15 • 18. • 19. TAX DUE ......................................................... 19. ~ ~ ~3 • 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 15056052048 O REV-1500 EX Page 3 File Number ~.~ ~9°-Q~( Z' Decedent's Complete Address: DECEDENT'S NAME STREETADDRESS ~~~ ~~ ~~ CITI' / ~ ~ ', STAT ' ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 9~ ~ ~~ 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount " ' ~~ Total Credits (A + d + C) (2) ~~T~~ 3. InteresUPenalty 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. A. Enter the interest on the tax due. (5) ~~~ (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 2 ~9 Make Check Payable fo: 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? ................................................................................................................. ....... ^ 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 [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-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~-,~~ :~/,/ ~ ~~,~?~' l /- O~-©/lam All real property ned 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. (If more space is needed, insert additional sheets of the same size) REV450B EX * (i-971 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY .~- FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH ,. p~~ ~ .,~~ /~o~~~~~j 4~c J'~j~Ge©t~.~Titf , ~ % .3~©~ = 83y3 33, / ~-o ~~ ~i~ r~~~ S`~~_ ~~ ~ g3 ~~ r ~. ~ .~c~~ ~.~k /) 3i~ 3~/~3~3~-~L ,,- //, ,~ z Z- 3) 3 Sao 3~ z-o~s j //~© ~, ~7/ ~f ~ 3 fog ~ `~/~/y9 3 30 ~ ~~,, oe ~ ~~3~0-0 39/fro ~g~g r~,o~~-' ~.> ~,~c c~S'7^ ice/ d r. /r~J~C ~~~~.vm (~~Q ; ~s~'~ 3ao TOTAL (Also enter on line 5, Recapit<Jiation) , $ ~~~ ~~~ (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 FILE NUMBER Debts of decedent must be reported on Schedule I. NUM ER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Zr JQc~rv~ ~7Rc-.~.~/'l',c-.~t~~,c-r1 -- Flora // ~. ~ P~ ~ ~- g. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative(s) _ - -------------- Street Address --- - - - --- City State Zip _ -- -_ Year(s) Commission Paid: __ --- -------- - 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant _ _ - --- _ -- Street Address ------ - - - - - ----- - -- City State Zip --_-_ -__ Relationship of Claimant to/Deceadent ~y /~ Q ~ - --. --- - - - 4. Probate Fees --~c-~is~.~-"/~ ®f~G(//I-G-S~ ~!'/Ke~'~~'W~ ~~~~y ~~~~ ~~ ~ 5. Accountant's Fees .J~ ~ ~ f ~ ,n ~ 6. Tax Return Preparer's Fees , ~~~I~~/y(TO~j ~~f ("~(,~QJ~'~g ~`~~ ~~~ ~~ ~ TOTAL (Also enter on line 9, Recapitulation) $ ~~v~ ~i~0 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ J 2-/- /~9 -/~~/Z 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)] ~7~70 z, ~1~.~i~ ;C ~. ,mil©o~<- ~0~./ 'p o/ ~ f 3~a .S.~l~~ ~f~"~k ~iR ~ . ' /~,c'Gh~n/i~ s ~34`r~~a', /~/Q /~D~p ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ FILE NUMBER (If more space is needed, insert additional sheets of the same size) ~~.~t 3~t11 ttn~ C~TP~f~zmrnt OF EVELYN C. MOORS I, EVELYN C. MOORS, of the Borough of New Cumberland, Cumber- land County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking and making void any and all wills pre- viously made by me. I. I direct that all my just debts and funeral expenses, includin my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as apart of the expense of the administration of my estate. II. I devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate to my husband, MICHAEL J. MOORS, provided he survives me by thirty (30) days. III. Should my husband, MICHAEL J. MOORS, predecease me or die on or before the thirtieth (30th) day following my death, I devise and bequeath all the rest, residue and remainder of my estate to my issue per stirpes living on the thirty-first (31st) day following my death. IV. I nominate, constitute and appoint my husband, MICHAEL J. MOORS, Executor of this, my Last Will and Testament. Should my husband, MICHAEL J. MOORS, fail to qualify or cease to act as such, I appoint my daughter, JOANN C. WORLEY, Executrix of this, my Last Will and Testament. IN WITNESS WHEREOF, Z have hereunto set my hand and seal 1 i, this ~ day of }- 4~1~ 1 1976. ~ ~~ ~,c:.G4°~,.,i ~tcc-e 1-~- (SEAL) elyn C. Moore ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, EVELYN C. MOORS, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. I r elyn C. Moore Sworn or affirmed to and acknowledged before me, b/y EVELYN C. MOORS, the Testatrix, this •~f~ day of /~ pwSY-. 1976. ~` '~ / Notary ublic My Commission Expires: AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) We, .-.~.•Ai~ ~± L~h~~ri/ and /d~j~P I L. l~~/vsA( the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the pur- poses therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time 18 or more years of age of sound mind and under no constraint or undue influence. ~~ ~.~~Q~ ~ Z ~ , Sworn or affirmed to and subscribed to before me by ..._---~ Ta„I ~ rnro./ and r /~ ~~ witnesses, this ! ~ day of .c~us T 1976. .-7 / 7 / L ''Notary Pu is My Conanisaion Expires: ,3~~ . ~~ y~~. P~ 3~~u , rte`' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-96) NO. CD 01 1500 WORLEY JOANN C 403 7TH STREET NEW CUMBERLAND, PA 17070 fold ESTATE INFORMATION: SSN: 202-52-1297 FILE NUMBER: 2109-01 12 DECEDENT NAME: MOORE EVELYN C DATE OF PAYMENT: 07/20/2009 POSTMARK DATE: 07/16/2009 COUNTY: CUMBERLAND DATE OF DEATH: 01 /25/2009 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5219.00 TOTAL AMOUNT PAID: 5219.00 CHECK# 1013 INITIALS: JN SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Register of Wills Cumberland County One Courthouse Sq Carlisle, PA 17013-3387 Ref. Estate of Evelyn C. Moore File No.: 2009-00112 Enclosed are the follaving Checks: 1. Filing Fee $15.00 Check No.: / Dated to 2. REV-1500 Balance Due $219.00 Check No.: Dated ~p Please acknowledge Receipt of same and return rising the enclosed self address/stamped envelope. Date: oann C. WorlE~y, Executrix W ~ v o ~, o cn ~~rn ~ z c~ V7 So• ~ ~'cD o 00 Jf~ •Z d.. CC oID~ ~ •00 f~ ^~ QWI -O •d ~]- ~ o o (!7 E J~2 • O ~ o ~ U ~ 3 W Z M ~ - o r ~^ U ' ` C p h N O O O W "~ ti Z h J ~ N 1~. { t ~' ~ •..~ '? ~: ~ ~ ~,~ ~G~ ~ ~ ~ r Q1 r-I w w 3~~ r U -_ ~r_ ~ J , ~. `~:r.~< ~ --, w~.__ U~~ ,- CC O U m G ~ ~ U M o U~] ~ O U ~ a ~ ~ ~ O ~ .~ N ~ ~ ~ .~ c U ~ U ~-~I U V ~~ Y~ V~ ~-_