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Home My WebLink About08-31-09J 15056051058 REV-1500 Ex (Q6-05) OFFICL4L USE ONLY PA Department of Revenue Bureau of Individual Taxes County Cade Year Fife Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ ~?~ ~~,, 1~ ENTER DECEDENT INFORMATION BELOW Social Securiiy Number Date of Death Date of Birth 184-12-2453 02/27/2009 07/29/1922 Decedent's Last Name Suffix Decedent's First Name MI Bair Betty C (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 fN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW • 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prlorto i2-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 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) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONflDENTUIL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Richard C Bair (717) 238-5683 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY ~~? ~, ~ .:, c i _ ~' ~ ~ First line of address ~_ ~ tr. 907 North Front Street ' - t- r? ~~ ; -=~T~~ G) Second line of address - ,; ,` --- .. ~ J~1 ~~ _~ City Or Post Office State ZIP Code DATE ~YL~~ Harrisburg PA 17102-3419 -T' tv +~ Correspondent's a-mail address: 2bairS1~COmcast.net Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, k is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU$[ Z~h~EF;8QN~$!?QNSIBj'E FOR•51LING RETURN neTc 907 N Front St. Harrisburg, PA 17102 _ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J REV-1500 EX 15056052059 Decedent's Name: B@~/ Ci Belt' 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 & Notes Receivable (Schedule D) ........................ ..... 4. 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 Non-Probate Property (Schedule G) Separate Billing Requested... ..... 7. 8. Total Gross Assets (total Lmes 1-7) ............................... ..... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ................ ..... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule t) ........... ..... 10. 11. Total Deductions (total Lines 9 8 10) .............................. ..... 11. 12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. 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. 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_ 0.00 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 5,759.5$ 18. 1 T. Amount of Line 14 taxable at sibling rate X .12 0.00 17 18. Amount of Line 14 taxable at collateral rate X .15 0.00 1 g 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 Decedent's Social Security Number 184-12-2453 0.00 2,391.93 0.00 0.00 3,507.17 0.00 0.00 5,899.10 139.52 0.00 139.52 5,759.58 0.00 5,759.58 0.00 259.1 S 0.00 0.00 259.18 15056052059 REV-1500 EX Page 3 Flle Number Decedent's Complete Address: DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Betty-_-_-- C -Bair -- --_- 184-12-2453 STREET ADDRESS - - - - -- - - -- _- --- 203 S. 2nd Street Apt. B - ------- __ ---- - CITY -~- - -- -- ---- l STATE ZIP Wormleysburg ~ PA 17043 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount InteresUPenaltyIf applicable D. Interest E. Penalty 0.00 0.00 0.00 0.00 Total Credits (A + B + C) (2) ----- _--- Totaf InteresUPenalty (D + E ) 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. 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. Eller the total of Line 5 + 5A, This is the BALANCE DUE. (1) 0.00 (3) (~) (5) (~) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 259.18 0.00 0.00 259.18 0.00 259.18 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a Uansfer and: Yes No a. retain the use or income of the properly 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 Refirement Account, annuity, or other non-probate property which contains a benef~iary 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 no; 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 benefidary. For dates of death on or after Juty 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 benefidaries 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 decedents 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 c~nmon with the decedent, whether by blood or adoption. REV-1503 EX+ (6-96) SCNEp1~LE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty C Bair All propeRy JolMifaowned with right of survivorshfp must be dlacbsed on 5chsduk F. (If more space is needed, insert additlonal sheets of the same size) REV-1508 EX+ (8.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpt~LE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Betty C Bair Indude the proceeds of Ntigation and the date the proceeds were received by the estate. All property jointly-oMmed with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Betty C Bair Debts of decedent must be reported on 3cheduk I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' Pre-paid 0.00 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 CttY State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address Cih' State Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Postage, stationary, printing, etc. s Notary fees Zip Zp TOTAL (Also enter on line 9, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) 0.00 0.00 92.00 0.00 0.00 7.52 40.00 139.52 REV-1513 EX+ (11-08) Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Betty C B air RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustce(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Edward H Bair, ~3~ ltJ aut, 57" #a0~{ ~~JO, NY Son 1100.00 8R5o1 2 Richard C Bair, 907 N Front St Harrisburg, PA 17102 Son 1100.00 3 Wilnita Shipe ao3 S a^'DSTHPT~ ~~ c>`YSQ~~6, ~ Daughter 1100.00 i t ~0~l3 4 Kenneth H Bair, 857 Old Cutler Rd Virginia Beach, VA 23454 Son 1100.00 5 Joetta Maddox, 203 S 2nd St Apt A Wormleysburg, PA 17043 Daughter 1100.00 5500.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1$ OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. 0 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 0 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ U If more space is needed, insert additional sheets of the same size. ~~\ c ~\~~ c~ 6 ~ ~~f _ -~ M~ ~~~ ~ ~~~ G ( Q M~ ...... O~ M '~ N O N ~ N "" s. C%] Q ;~ ~ a ~ o on ~w~ ~z~~ ~~~ ~~ ,~~ ~-~ ~l \~ O +~~ ~` 0 -~