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Home My WebLink About09-28-09 1505607120 -~ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po 60x.280601 2 1 0 9 0 2 9 1 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 161 48 9287 01 23 2009 03 16 1963 Decedent's Last Name Suffix Decedent's First Name MI KLINE SHEILA A (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 X li 1. Original Return 2. Supplemental Return ~ 1 3. Remainder Return (date of death - prior to 12-13-82) 4. Limited Estate r qa. Future Interest Compromise I. 5. Federal Estate Tax Return Required __ 1--- ~ (date of death after 12-12-82) ~,,'X 6 Decedent Died Testate - ~ ~ Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes ~- (Attach Copy of Will) ~,-- -~ (Attach Copy of Trust) -~ S ousal Povert Credit date of death 9. Litigation Proceeds Received 'i ~ 10' between 12-at 91 and 1-f-s5) 11.Election to tax under ec. 9113 - (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number PATRICIA R. BROWN ESQ. 717 249 6333 Firm Name (If Applicable) SALZMANN HUGHES PC First line of address 354 ALEXANDER SPRING READ, SUITE 1 Second line of address City or Post Office CARLISLE State ZIP Code PA 17015 REGISTER OF WILLS USE ONLY r~,i ~ .a ~. - _ _ ~ ~~' I'T'1 -T~1 " f J . • - : C*J _ . ~ - - _ _ ;, bA~~?F1LED -., „; . ~ h \ • r _.~ _ , cs~ Correspondent's a-mail address: Under penalties of perjury, I declare that 1 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~i~.~J Kathleen A. Kline ~ -?~) -~ 9 ADDRESS 25 Summer Lane, Mechanicsburg, PA 17050 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ` ~~~~^`_ ,, ~"~ .-~/'y~-„~`J Patricia R. Brown Esq. ~ ~~, ADDRESS 354 Alexander Spring Road, Suite 1, Carlisle, PA 17015 Side 1 1505607120 1505607120 ~~~i ~~ 1505607220 REV-1500 EX Decedent's Name: $ h e 1 ~ 8 A. K ~ I n e 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 & 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) L~ Separate Billing Requested . ............ 7. g. Total Gross Assets (total Lines 1-7) ........................................................... ............ 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ............................ ............. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................... ............. 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 .o0 2 3 5 4 7 6 15. 16. Amount of Line 14 taxable 0 0 0 16. at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X 12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 19. Tax Due ....................................................................................................... ............. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 161 48 9287 9,706.43 9,706.43 -_ ___ 6,097,23 1,254,44 7,351.67 2,354.76 2,354.76 0.00 0.00 0.00 0.00 0.00 Side 2 1505607220 1505607220 REV-1500 EX Page 3 File Number 21-09-0291 Decedent's Complete Address: DECEDENT'S NAME Sheila A. Kline ___. STREET ADDRESS 106 S. West Street, Apt. 3 CITY STATE ZIP Carlisle PA ' 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable p. Interest E. Penalty Total InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box 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. (5) 0.00 A. Enter the interest on the tax due. (5A) g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Q , Q Q Make Check Payable to: REGISTER OF WILLS, AGENT -~~ .",.~~ ^» ~ :i,'„ ~~' J M' ,h !lbl+i:.~a,e.`+ ~ ., ...r .a ,l,l:, - ~[{fi,'tt~lvCh.J ~+~r ~'=- „ ,~ oJ~q .~,£ ,Kr 6~?~1~i?r*~-.t "~>r'~',A%' ~1't .~.i'}l'~P~iti~ ~-.r ~.~,~~'<~ .... ~a`~i 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 :.................................... ~ ~ [x d. rece ve the promise ortffe of a ther payments, benefits or care? .............................................................. L 1 ~'. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without _ receiving adequate consideration? ....................................................................................................................... _ ' j x ~, 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... irx 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 11 -- contains abeneficiary designation? .......................................................................... x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. - _ _-. a.~+'f5 i,i e ~ V ~ 1. Y u '11Yti, L ~ 7 i_., ,~ F ",":~fi r t . ~ 4 ,y~ ~?~ til:~:rF~' ~h r ,~~477!*1 i i Y ~ ,~~._•,~.+. .. ~ ~4 •. ~, ~ .~":" +~'~,• '1"~7~., ~'~',~~:-n.~~Yti:}~. ~, , .l.Fi. i. T' S-~~.'~ T 12.'i .S vi+~/Y '~!..:} ,1 i'45. ~7SF~I~N 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)]. A sibling 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 E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kline, Sheila A. 21-09-0291 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survlvorshlp must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Comcast Financial Agency Corporation -refund 35.00 2 District Court 09-2-02 -restitution owed from Jesse D. Reed for an automobile 559.81 accident; Docket No. NT-0000787-08 3 Mancke, Wagner, Spreha 8t McQuillan -balance due for settlement funds owed for 644.19 an automobile accident 4 Members 1st Federal Credit Union -Checking Account 6,401.43 5 2001 Mazda 626 - at book value 1,400.00 6 Commonwealth of Pennsylvania - 2008 rent rebate 650.00 7 United States Treasury - 2008, 1040 income tax refund 16.00 TOTAL (Also enter on Line 5, Recapitulation) I 9,706.43 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV•1151 EX+~12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kline, Sheila A. 21-09-0291 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached 3,892.84 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Kathleen A. Kline Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 25 Summer Lane City Mechanicsburg state PA zip 17050 Year(s) Commission paid 485.00 2. Attorney's Fees SALZMANN HUGHES PC 1,000.00 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 117.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 602.39 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 6,097.23 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kline, Sheila A. 21-09-0291 ITEM NUMBER DESCRIPTION Funeral Expenses 1 Anne Kline -reimbursement for funeral expenses 2 Hoffman-Roth Funeral Home 8~ Crematory, Inc. -cremation and funeral services 3 Kathleen A. Kline -reimbursement for funeral expenses 4 Michael Kline -reimbursement for funeral expenses H-A Subtotal Other Administrative Costs 5 Kathleen A. Kline -reimbursement for automobile services 6 Kathleen A. Kline -reimbursement to the executrix for mileage 7 Salzmann Hughes, P.C. -reimbursement for legal advertising expense paid to the Cumberland Law Journal 8 The Sentinel -Legal -Legal advertising H-B7 Subtotal AMOUNT 405.75 2,375.42 657.47 454.20 3,892.84 93.50 196.10 75.00 237.79 602.39 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-7572 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kline, Sheila A. 21-09-0291 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 National Recovery Agency -balance due for Associated Cardiologists services 25.00 2 NCO Financial Systems, Inc. -balance due for Alexander Springs ER Physcians 57.91 service 3 NCO Financial Systems, Inc. - KGPORT -balance due for Carlisle Regional Medical 73.50 service 4 Philip 8r. Cohen Associates, Ltd. -balance due for Capital One Bank card 760.51 5 PPBL Electric Utilities -final payment 224.10 6 RJM Acquisitions LLCC -balance due on account 113.42 TOTAL (Also enter on Line 10, Recapitulation) I 1,254.44 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+~9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kline, Sheila A. 21-09-02 91 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not Llst Trustee s I. TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers , under Sec. 9116(a)(1.2)] 1 Anne M. Kline Mother Entire Estate 2,354.76 64 Sabal Palm Drive Largo, FL 33770 Total 2,354.76 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)