HomeMy WebLinkAbout09-03-09 (2)15056041125
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN ~ ~ ~~
Harrisburg PA 17128-0601 RESIDENT DECEDENT l QC~Co~o
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 7 4 2 0 6 6 2 6 0 1 1 1 2 0 0 9 1 1 2 7 1 9 2 8
Decedent's Last Name Suffix Decedent's First Name MI
L A N D I S C H E S T E R V
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
N O N E
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
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)
0 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 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 ^ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
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Name Daytime Telephone Number
C H A R L E S J D E H A R T I I I 7 1 7 2 3 2 x 6 6 1
Firm Name (If Applicable)
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1 -DATE FILED
C A L D W E L L & K E A R N S
First line of address
3 6 3 1 N O R T H F R O N T S T R E S T
Second line of address
City or Post Office State
H A R R I S B U R G P A
Correspondent's a-mail address:
ZIP Code L
1 7 1 1 0
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.
RE OF
FLING RETURN
u
DA
ADDRESS J !/ ~ ~
113 LAUREL DRIVE ENOLA PA 17025
SIGNATURE OF P EPARER OTHER THAN REPRESENTATIVE D TE
3631 NORTH FRONT STREET HARRISBURG PA 17110
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041125 15056041125
REV-1500 EX
15056042126
Decedent's Social Security Number
Decedent's Name: CHESTER V. LANDIS 1 7 4 2 0 6 6 2 6
RECAPITULATION
1. Real estate (Schedule A) ...................................... .. 1.
2. Stocks and Bonds (Schedule B) ................................ .. 2.
2 9
7
1 6,
4
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. 1 9 3 9 0 5 1
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6•
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ..... .. 7.
8. Total Gross Assets (total Lines 1-7) ......................... .. 8. 4 9 1 0 6, 9 3
9. Funeral Expenses & Administrative Costs (Schedule H) .. ..... ....... .. 9. 1 6 5 4 9 • 7 2
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ... ....... .. 10. 3 0 9 7 • 0 4
11. Total Deductions (total Lines 9& 10)
.............
.....
.......
..11. 1 9 6 4 6• 7 6
12. Net Value of Estate (Line 8 minus Line 11) ........... ..... ....... .. 12. 2 9 4 6 0 , 1 7
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. 2 9 4 6 0 1 7
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 0 0 15. 0• 0 0
16. Amount of Line 14 taxable
at lineal rate X .0 _ 0. 0 O 16 O. 0 0
17. Amount of Line 14 taxable 1 5 0 0 0 0 0 1 8 0 0 0 0
at sibling rate X .12 17. .
18. Amount of Line 14 taxable 1 4 4 6 0 1 7 2 1 6 9 0 3
at collateral rate X .15 18.
19. Tax Due .................................. ..... ....... ..19. 3 9 6 9. 0 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
15056042126
15056042126
REV-i 500 EX Pege 3
Decedent's Complete Address:
File Number
0 0
DECEDENT'S NAME
CHESTER V. LANDIS _
STREET ADDRESS
5225 WILSON LANE
CITY
MECHANICSBURG STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. I nterest
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.
(1) 3,969.03
0.00
0.00
0.00
(5) 3,969.03
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3,969.03
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 : ................................................................. ..... ^ ^X
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
CHESTER V. LANDIS 0 0
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 orooertv which is iointlvowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 1
(If more space is needed, insert additional sheets of the same size)
REV~1503 EX fi (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
CHESTER V. LANDIS 0 0
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. 1,743.116 shares -Susquehanna Bancshares Inc. - $13.00 per share -Date-of-death
value
2. 23.215161 shares - PNC Bank, $46.75 per share -Date-of-death value
3. 138 shares -Banco Santanter SA, $9.45 per share -Date-of-death value
4. 153 shares -Prudential Financial Inc., $30.50 per share -Date-of-death value
TOTAL (Also enter on line 2, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
22,660.51
1,085.31
1,304.10
4,666.50
29.716.42
REV•1508 EX+-(6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHESTER V. LANDIS 0 0
Include 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. PNC Checking Accounts:
(See attached statement)
(a) Checking Account #5003147537 -Date-of-death value 2,165.70
(b) Certificate of Deposit #5004414887 -Date-of-death value I 11,685.09
2. 1998 Lincoln Town Car -Mileage 85,500 -Proceeds -Private sale 4,975.00
3. 5 Violins -Gross sale price 477.00
4. Remaining Personal Property - No value -Nursing home 0.00
5. State Farm -Auto Insurance Refund 87.72
TOTAL (Also enter on line 5, Recapitulation) I $ 19,390.51
(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
CHESTER V. LANDIS 0 0
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
A. None
B
C
JOINTLY-OWNED PROPERTY:
RELATIONSHIP TO DECEDENT
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 OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A.
TOTAL (Also enter on line 6, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX~ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
CHESTER V. LANDIS 0 0
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
iNauoErHENaMEOFTHETaaNSFEREE,THEiaREUrioNSHiPTOOecEOENTnNO
rHEOnrEOrranNSFER nrrncHncoPVOFTr+EOEEOroRaEn~esTnTE
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
EXCLUSION
pFnPPUCne~E~
TAXABLE
VALUE
1. None
TOTAL (Also enter on line 7 Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+x(12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CHESTER V. LANDIS 0 0
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. J. Geigle Funeral Services 8,897.97
B. ADMINISTRATIVE COSTS:
~ Personal Representative's Commissions
Name of Personal Representative (s) Aretta Landis-Perdigao 2,500.00
Social Security Number(s)IEIN Number of Personal Representative(s)
Street Address 113 Laurel Drive
city Enola State F'A zip 17025
Year(s) Commission Paid:
2 Attorney Fees Caldwell & Kearns 4,000.00
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 Decedent
4. Probate Fees Register of Wills 250.00
5 Accountant's Fees
6. Tax Return Preparer's Fees
7. Cumberland Law Journal -Legal advertising 75.00
8. Carlisle Sentinel -Legal advertising 174.58
9. BSSF Inc. -Tax Preparation (2008) 300.00
10. Violin Makers -Violin Appraisal 15.00
11. Engle-Rissinger -Auto Repair for Sale 322.17
12. Miscellaneous -Postage and certified mail 15.00
TOTAL (Also enter on line 9, Recapitulation) I $ 16.549.7
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
CHESTER V. LANDIS 0 0
Report debts incurred 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. Bethany Village -Final nursing home expenses 2,821.51
2. IWest Shore EMS -Unreimbursed medical
3. ILA EMS -Unreimbursed medical
4. ~ Bonnie Miller, Tax Collector -Personal tax
5. Hampden Physician -Unreimbursed medical
TOTAL (Also enter on line 10, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
114.76
55.00
9.80
95.97
REV 1513 EX+(6.00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
CHESTE R V. LANDIS 0 0
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. Aretta Landis-Perdigao Sibling 15,000.00
113 Laurel Drive
Enola, PA 17025
2. Samuel Wayne Landis Collateral
159 Windy Hill Road 9.09% residuary
Duncannon, PA 17020
3. Timothy Alan Landis Collateral
1752 Landis Road 9.09% residuary
Dauphin, PA 17018
4. Sherrie Ann Knapp Klase Collateral
1551 Dell's Lane 9.09% residuary
Dauphin, PA 17018
5. Pastor Michael Gene Knapp Collateral
210 McKelvey Road 9.09% residuary
Dauphin, PA 17018
6. David Elwood Row Collateral
Miller Road 9.09% residuary
Elizabethville, PA 17023
7. Judy Louise Sheesly Swisher Collateral
8 Flagler Lane, Apt. 101 9.09% residuary
Holly Hill, FL 32117
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS 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 $
(It more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
CHESTER V. LANDIS
Decedent's Name Page 1
Schedule J -Beneficiaries - 1
File Number
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS (include outright spousal distributions)
8. Donna Suzette Landis Murphy Collateral
579 Dartmouth Street 9.09% residuary
Harrisburg, PA 17109
9. David Andrew Landis Collateral
3368 Green Ridge Court 9.09% residuary
Dacula, GA 33019
10. Diann Louise Knapp Collateral
1551 Clark's Valley Road 9.09% residuary
Dauphin, PA 17018
11. John Antonio Perdigao Collateral
113 Laurel Drive 9.09% residuary
Enola, PA 17025
12. James Allen Row Collateral
2843 Armstrong Valley Road 9.09% residuary
Halifax, PA 17032
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