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HomeMy WebLinkAbout09-04-09J FILL INAPPROPRIATE OVALS BELOW 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN ~ f r\ ~ ,^ ' n , J Harrichurn PA 1719A~(1R01 RESIDENT DECEDENT 1 U K ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 3ya 16 3 1 8~ bG a~~ao~ 03 i o t ~'~l Decedent's Last Name Suffix Decedent's First Name MI ~i (.LI Soli _K~T(fE~~NC ~, (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 +i• 1. Original Retum C7 2. Supplemental Retum O 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate C 4a. Future Interest Compromise (date of (~ 5. Federal Estate Tax Return Required death after 12-12-82) C} 6. Decedent Died Testate Q 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 C.7 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) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number so ~~ ~. ~s ~ ~ ss o N ~~ ~- a~ ~ gq sG Firm Name (If Applicable) ~------~2~ REGISTER OF S USE ONLYp ub First line of address I ~ ~ Y ~ ~cE~wd~ ~ ~ ~. ~.~ .~- Second line of address ' ~ 1 ~ ~ ~ t Off Cit P State ZIP C d DAT~I_ _ y or os ice o e ~. ~e Cf~~c- i s ~ E ~ ~. 1~ o c 3 °' Correspondent's a-mail address: ~ Cj'L1 Vl~r ~ l ~ S O /l l ~ (,(.S ~ 0.-m/' /vtY r -µ r I 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 a ll information of which preparer has any knowledge. DATE .a3 `t f ~ ~~ *._s . 'r~ C '-, X j _~ t , t-, r,; ~~ r ~;{ t- ' r~ _.~w ~` >: r': i C:."l..r~_y s r.t t~ ADDR~SS~ ' // l~i/~°e~vooc~ r- ear,-l.`f~c ~ ~~f SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 1505605104? Side 1 15056051047 15056052048 REV-1500 EX Decedent's Name: Decedent's Social Security Number ~ ~ ~ ~ ~ ~ ~ ~ ~' 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 i~ Notes Receivable (Schedule D} ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. ' ~ ~^ ~" ~ 1 • ~ dam' 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 JJ / 1 1 ~ a" --- 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 3 5~ ~. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. ~ 10 3 . 11. Total Deductions (total Lines 9 ~ 10) .............................. ..... 11. 3 ~' I 0 , ~ ' 12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. ~ Z ~ w ~ . ~ r 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~ an election to tax has not been made (Schedule J) ................... ..... 13. • w 14. Net Value Subject to Tax (Line 12 minus Line 13) ................... ..... 14. 3 ~. 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 to,~able at lineal rate X .0 ~ ~ . 16. l.~ ~ 1 y ~ • ~' ~' 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. (( ~ ~ -f ~ •~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Cl Side 2 L 15056052048 15056052048 REV-1500 EX Page 3 Decedent's Comalete Address: Flle Number DECEDENTS NAME II II ~t. i +~ L~ I~~ i l t t~ Sp-/1 STREET ADDRESS 1 i l ~( ~ ee,~-woo ~~~ CITY /1 ~{ t ; S ~ ~ STATE ~ ~ ZIP ~ ~ O / Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit _ B. Prior Payments C. Discount "~. ~. `~- 3. InterestlPenalty if applicable D. Interest E. Penalty (3) c1) l , ~l ~l d , a ~- Total Credits (A + B + C) (2) ~- ~, ~'~ Total InterestfPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Filt 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. (4) (5, ) 3 ~ y. Z.8" (5A) (56) 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-1508 EX+ (6-98) SCHEDULE Ep COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Katherine L. Hillison 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 Women's wedding ring (na d i c~v~o ~ ~ ~ ~ ~ 2 Man's ring r j p p, 00 3 Checking Account, Members 1st O Q5 ot" -~- ~U~ ~q ~ ~~ g'03 ,g~q 4 Savings Account, Members 1st ~ It l t t, ~t I~ a3 ~ is~ g 1 J 1'rlew~be~ Ist F~d~-~i C",-ell- GCI~,~n 5boo L n ~.; 5 ~ ~ ~n ~~~ yo m~~~,~,,,cs ~b~- I P~ i~s~ ~ ~~t- -~ ~~ g ~~ y TOTAL (Also enter on line 5, Recapitulation) = 135~~ y9=~~~f ~ (If more space is needed, insert additional sheets of the same size) Q N f~ fD 00 000 0o O oo O o U1 (T U1 U1 (71 O O V V W CD CO ~ 0 ~ ~ ~ ~ 0 W ~ 0 0 ~ W N N N N N N N N N N N N N O O O O O O O O O O O O O O O O O O O O O O O O CO CO f0 CD CD (D CO CO t0 CO CD CD ~Cn ~~~ ~~ ~ ~f~ ~ f~ O O O O O O O O O O O O U1 U1 U1 U1 U1 O O V V OD CO CO o~ ~ww o~o°o o woo 0 0 N N N N N N N N N N N N O O O O O O O O O O O O O O O O O O O O O O O O f0 tD Cfl CO CD (fl (fl CO CD CO CD CO ~ D ~ C7 ~ ~ ~ O O ~ ~ O D ~ C7 ~ ~ O ~ ~ O ~ ~ ~ ~ ~ ~ ~ ~ _ ~ ~ o o ~ ~ ~• o o ~ _ ~ ~ o o ~• o o ~ ~ o o ~ o o N ~ mooDD~,~m DDS !TImDDm DD~m DDm DDS a a~~ m~ ~ a ~~ D n a~~ m~ ~~ D a ~~ D ~~ D a m0 ~ mo m0 m m~° mo mo ~cn~o °-o ~cn~o ,moo ao °-o _(n V_ O_ _(n A ON OIIf ON ~ ~ O ~`G ~~ ~ O ~K ~K ~K .. 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A A AAA CD ~ C D N ~ C D c G S it C f I~ S S i s i ~., r 0 0 ~ o ' O W N J ~ 7 = r r O z n J --~ m ~ N i ~ ~ ~ ~ ~ j• O 3 T m C -~ r 3 o D N ~ D A Z J 7 D ~ ] ~ 0 s ~ 0 0 °o o o w N 00 n ~ D ~ n ~ ".~ 7 S1 7 D N pt A ~ V 0 3 ~ v N C n '• f S S f t f U i ~~ cu p ~< O ~ ~ ~' ~ a' N ~ O ~ ~ REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ~~ , I ~t ~~ ~ ~~, (~ ` S ~ ~ FILE NUMBER I~r^` Debts of decodent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address Citf' .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 ~~~ ~. ~ ~ `,~~ S 0/t Street Address ~ ~ ~ `y ~~e~}-~~~ b{` City ~-~~SI~ ~~+t>J State ~~ .Zip ~ ~{~ (~ Relationship of Claimant to Decedent S O (J 4. Probate Fees 5. Aceountant's Fees 6. Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) I $ (It more space is needed, insert additional sheets of the same size) ~~ s"oo. 00 8~~ bo !•oo S~no c~~Kl1 ~~ RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 HILLISON KATHERINE L Estate File No.: 2009-00664 Paid By Remarks: JOEL HILLISON JN ------------------- Fee/Tax Description PETITION LTRS ADM RENUNCIATION SHORT CERTIFICATE JCP FEE AUTOMATION FEE Cash Total Received......... Receipt Date: 7/17/2009 Receipt Time: 14:10:30 Receipt No.: 1057528 Receipt Distribution ----- ------- --------- --- Payment Amount Payee Name 60.00 CUMBERLAND COUNTY GENERAL FUN 5.00 CUMBERLAND COUNTY GENERAL FUN 4.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- $84.00 $84.00 REV-].57.2 EX+ (17.-08) ~ 1 Pennsylvania W DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF ~ct.~~~r~rn~ ~~ ~~~~~ FILE NUMBER oe...... aeti•~ ~~~~~rrsA by rhn deePaent prior to death that remained unsaid at the date of death, including unreimbursed medical expenses, If more space is needed, insert additional sheets of the same size. F~ ~~ . ~~ ~ ~ ~;~~ a~~~ ~~