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Home My WebLink About10-21-09 -~ REV-1500 EX (06-05) PA Department of Revenue Bur~u of Individual Taxes PO BOX 280601 Harristwrg, PA 17128-0601 15056051058 OFFICIAL USE ONLY County Code Year Fle Number INHERITANCE TAX RETURN ~ Q Q~/- RESIDENT DECEDENT ~ ~' U 1 D -! 0 to _ _ ___ Spouse's Social Security Number FILL IN APPROPRU-TE O~lALS BELOW tt~1 1. Original Return C 4. Limited Estate t,~ z 6. Decedent Died Testate (Attach Copy of Will) t 9. Litigation Proceeds Received Date of Birth _._ 04/11/1919 Decedent's First Name MI __ _. _. :GENEVA R Spouse's First Name MI _. _ _. _ ___ __ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS r.'~.~ 2. Supplemental Return ~:wµs 3. Remainder Return (date of death prior to 12-1362) C~ 4a. Future Interest Compromise (date of ~;~;;~ 5. Federal Estate lax Return Required death after 12-12-82) z~ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) t~9 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 8ECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONflDENTIAI TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number __.._ _ L u c~ ~/~ ~/CL ~. Cr~c.r» 7/ 7-~~(---d~as , _ _ Firm Name (If Applicable) ____ _ _ ___ ___ _ _ _ _ _ _ _. _ REGISTER OF USE ONL ~S .n i First line of address ~ ~~-! / - / ,.._ ; ~~ ~ _ Second line of address........ _ _ , } ~ _ j' ~ ~ . _ _ _ _ _.~ , ! ` ~ 3 DATE D .. , ~ State Ciiy or Post Office _t ZIP Code ` _ ..... __ ._.__.-_ _ G ~--~,~ t~~ P~- ~f"- ~ ~~a ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 aJ ;. t;a~ r'j ~:J 5 .:,`~ r _~ t. ri _. ~, C;.7 ..::~ - r i -?-~ .:. t `t 7 --r'y Correspondents a-mall address: [1~er`~. ~71~ ~~ ~C[/~Q'Je ~m Under penalties of perjury, I dedare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and Relief, it is true, coned and complete. Dedaretion of preparer other than the personal representable is based on all inforrnaUon of which prepares hes any knowledge. J REV 1500 EX Decedent's Name: GENEVA RECAPtTULATiON ~ _.~ 15056052059 R GELSINGER Decedent's Social Security Number _ _ _. .__. 199-07-4998 __ 1. Real estate (Schedule A) ............................................. L 2. Stocks and Bonds (Schedule B) ....................................... 2 ...... ,,... ,. ....,,,..._ 3. Cbsely 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) t ~m.s Separate Billing Requested ....... 6. 7. Inter-Vrvos Transfers & Miscellaneais Non-Probate Property (Schedule G) Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. ''. 45,573.62 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent; Mortgage Liabilities, & Liens (Schedule 1) ................ 10. ' 3,652.65 11. Total Deductions (total Lines 9 & 10) ................................... 11. '; 3,652.65 !. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ! 41,920.97 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ' ~ ' ~ ~~~ an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value SubjecPto Tax (Line 12 minus Line 13) ........................ 14. ', ~~ _ _..~._. 41,920.97 , .~.._.._~_.~.,,._. ~.~ TAX COMPUTATION - 5EE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or . _ transfers under Sec. 9116 _ (ax1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 41,920.97 16, 1,886.44 '. ._.,..r... .... ...____ 17. Amount of Line 14 taxable ..~.......... ~ ., ...... __ ..w....___.. .. at sibling rate X .12 ' ' 17. 18. Amount of Line 14 taxable at collateral rate X .15 ' 18. 19. TAX DUE ......................................................... 19.' __. 1,886.44 __ _ _ 20. FILL IN THE OVA4 IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 45,573.62 15056052059 Side 2 15056052059 REV-1500 EX Page 3 rfp~Qrlpnt'_c Cemnlete Address: Flee Number ..,._...._..~.....__. DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER GENEVA R GELSINGER 199-07-4998 STREETADDRESS 1128 MYERSTOWN ROAD CITY STATE ZIP GARDNERS PA 17324 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments 0. Spousal Poverty Credit B. Prior Payments C. Discount (~) Total Credits (A + B + C) (2) 3. InterestlPenalty 'rf applicable D. Interest E. Penalty Total InterestlPenalty (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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable fo: REGISTER OF WILLS, AGENT 1,886.44 1,886.44 1,886.44 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 Iffe of either payments, benefits or care? ...................................................................... ^ 2. If death oaxlmed after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an 'in Dust for" or payable upon death bank acxount 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 [12 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 172 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+ (6-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCMEpULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER GENEVA R GELSINGER Indude the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 'Checking Acxount-Orrsotwn 245.03 Oki Mutual Llfe Insurance Company -Money Market Program 18,697.80 :Lincoln Benefit Life Company 26,630.79 '' TOTAL (Also enter on line 5, Recapitulation) s 45,573.62 (If more space is needed, insert additional sheets of the same sae) REV-1512 EX+ (12-OB) ~~~ ` Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8c LIENS ESTATE OF FILE NUMBER GENEVA R GELSINGER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimburaed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• ``HOSPICE OF CENTRAL PENNSYLVANIA 2,760.00 WEST SHORE EMS-CARLISLE 892.65 TOTAL (Also enter on Line 10, Recapitulation) I ~ 3,652.65 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ {il-OB) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF FILE NUMBER GENEVA R GELSINGER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. 'Lucinda G Crum,1128 Myerstown Road, GaMners PA 17324 'Daughter 45328.59 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 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.' B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ u more space is neetletl, insert atltlitional sheets of the same size.