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HomeMy WebLinkAbout10-08-09 (3)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 2 1 PO 60X.280601 ~ O 8 0 6 7 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 159 12 3618 05 14 2008 09 08 1915 Decedent's Last Name Suffix Decedent's First Name FRANTZ PHYLLIS (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI MI FILL IN APPROPRIATE OVALS BELOW ~ ~ 1. Original Return ~ X ~ 2. Supplemental Return C1 3, Remainder Return (date of death _ prior to 12-13-82) 4. Limited Estate `~ 4a. Future Interest Compromise (date of death after 12-12-82) ~_~ 5. Federal Estate Tax Return Required X I 6. Decedent Died Testate (Attach Copy of Will) (1 7 Decedent Maintained a Living Trust i-- (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received I 1 p, Spousal Poverty Credit (date of death ~_ between 12-31-91 and 1-1-95) ~ 11.Election to tax under Sec. 9113(A) ~ _ ~- (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LEONARD TINTNER ESQUIRE 717 236 9377 Firm Name (If Applicable) BOSWELL, TINTNER, PICCOLA First line of address 315 N. FRONT STREET/PO BOX 741 Second line of address City or Post Office HARRISBURG State ZIP Code PA 17108-0741 Correspondent's a-mail address: tV 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. ATU OF RSON RESPONSIB OR FI DATE ~i1'/,~i ~A /I , T-( ROBERT W. FRANTZ 813 A ROAD, MECH NICSBl1RG, PA 17050 SIGNAT E PREPARER O'~ R ESENTATIVE DATE ``~"~ LEONARD TINTNER ESQUIRE /©- ~~-~ ~ N. FRONT STREET/PO BOX 741 ,HARRISBURG, PA 17108-0741 Side 1 REGISTEI~~ILLS U~ONLY ~7 ~~ .~_~ ~' ! ... -, -~ ,.J .r ~y.` p } ... f 1 _ .,~ ~ f _,.~ •_ ~ ~TE FILED '~ ^ - - q ~ : t . `~ L 1505607120 1505607120 J J REV-1500 EX 1505607220 Decedents Name: P H Y L L I S F R A N T Z 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 8~ 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) ~~ Separate Billing Requested............ 7. 8. 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 & 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 0 0 0 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable 2 17.7 2 6 5 16 , at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 17 at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 Q 18 ~ at collateral rate X .15 . 19. Tax Due .................................................................................................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 159 12 3618 81,380.72 81,380.72 16,163.00 16,163.00 65,217.72 65,217.72 0.00 2,934.80 0.00 0.00 2,934.80 Side 2 L 1505607220 1505607220 J REV-1500 EX Page 3 File Number 21-08-0674 Decedent's Complete Address: DECEDENT'S NAME PHYLLIS FRANTZ STREET ADDRESS 813 ACRI ROAD _ _ __ CITY Mechanicsburg _ _-_ _ STATE ZIP PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p, Interest E. Penalty 84.66 Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1) (2) 2,934.80 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 :.................................. [__[ L] c. retain a reversionary interest; or ............................................................................................................... ~ _ ~ ~_ _~ ~- d. receive the promise for life of either payments, benefits or care? ............................................................ ~ ~ [ x] 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?........ [ ~ [x~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. fix] ~~ 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)]. 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-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER RANTZ, PHYLLI 21-08-0674 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 D I I INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Principal Financial Group -annuity payable to 81,380.72 81,380.72 Estate TOTAL (Also enter on Line 7, Recapitulation) 81,380.72 (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 G (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 FRANTZ, PHYLLIS 21-08-0674 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. ~ Attorney's Fees BOSWELL, TINTNER, PICCOLA 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. I Probate Fees 5. I Accountant's Fees 6. ~ Tax Return Preparer's Fees 7. Other Administrative Costs 16,163.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 16,163.00 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 FRANTZ, PHYLLIS 21-08-0674 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Pa. Department of Revenue -taxes due on Pa 41 return on asset 1,404.00 2 U.S. Department of Treasury -taxes due on 1041 return on asset 14,759.00 H-B7 Subtotal 16,163.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FRANTZ, PHYLLIS 21-08-0674 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee a I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116(a)(1.2)] 1 KRISTEN G. EDWARDS Granddaughter 20% of Residue 6140 RANDOLPH COURT HARRISBURG, PA 17111 2 ROBERT W. FRANTZ Son 40% of Residue 813 ACRI ROAD MECHANICSBURG, PA 17050 3 DAVID E. SMITH Grandson 20% of Residue 3584 SOUTH CREEK DRIVE ROCHESTER, MI 48306 4 SUZANNE K. SMITH Granddaughter 20% of Residue 1497 BASS CIRCLE FORT MYERS, FL 33919 Total 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 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) financial Group PPInClpal LITe InSUI'BnCe GOmpany Des Moines, IA 50392-0001 ESTATE OF PHYLLIS C/O ROBERT FRANTZ, 813 ACRI RD MECHANICSBURG, PA B FRANTZ PERSONAL REP. 17050-2231 Death Claim: PHYLLIS B FRANTZ Date of Death Value: Taxable Short Term Interest: Net Benefit Payable: Taxable Gain: Tax Year: 2009 $81,380.72 $2,454.80 $83,835.52 $43,267.33 F111AC•1 K 15554353 07/20/2009 (Detach and Retain for Your Records) $83, 835.52 WVALU .VERIFY THE AUTHENTICITY OF THIS MULTI-TONE SECURITY DOCUMENT.~~ _~ _ CHECK BACKGROUND AREA CHANGES COLOR GRADUALLY FROM TOP TO BOTTOM. ' ` ~~ ~ ~ ANT FRAVG VROTECT~OR -~FEI(TS f, NT,~15;571M~0~ `~ ~ , P~inci~~i Life ins~~ance Company \K 15554353 `. ; Des Mibil~es, ~A' S0~92-0001 . ~ ~ ~ ~ ;' `: ~ 70=2382/779 Gro nci~/` _ Date .07-20-~OD~ p NOT VALID AFTER '180 D.AYS~ CONTRACT NUMBER-8585421 REFERENCE NUMBER 00044678 Amount $********83,835.52* Pay To ESTATE OF PHYLLIS B FRANTZ C/O ROBERT FRANTZ, PERSONAL REP. 813 ACRI RD MECHANICSBURG, PA 17050-2231 •rrrrrrrrrrrrrrrrrrrr. rr'•'•rrrrrr •rrrrrrrrrrrrrr•-•rrrrr ••rrr •rrrrrrr••~ rr~r rrr rrrr •rrrrrr rrrrrr •rrrrr: rtrrrrr •rrrrr ~rrrrrrr ~•Jrrrrr.-rrrrrrrrrrrrrrrrrrrrrrrr EIGHTY-THREE THOUSAND EIGHT HUNDRED THIRTY-FIVE AND 52/100-------- THE NORTHERN TRUST COMPANY, CHICAGO, IL 0710 Authorized Signature(s) PAYABLE THROUGH NORTHERN TRUST BANK/DUPAGE, OAK BROOK, IL I~'~L~555~.35311' ~:07~923828~: 030L5620011' ~.