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HomeMy WebLinkAbout10-21-09 (2) -~ REV-1500 1505607120 PA Department of Revenue EX (06-05) OFFICIAL USE ONLY Bureau of Individual Taxes county coda Year File Number PO 80X.280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-061)1 RESIDENT DECEDENT 21 0 9 0 7 8 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 160 48 8181 07 20 2009 09 18 1955 Decedent's Last Name Suffix Decedent's First Name MI MOWERY RANDALL W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW XD 1. Original Retum 4. Limited Estate 8• Decedent Died Testate (Attach Copy of WII) 9. Litigation Proceeds Received Daisy C MOWERY Forest N Myers --• --••~-~~~ ~ - r nw acc r wrv MUST BE COMPLETED. ALL Name FOREST N MYERS Firm Name (If Applicable) LAW OFFICE FOREST N MYERS First line of address 137 PARR PLACE WEST Second line of address City or Post Office SBIPPENSBURG 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) Daytime Telephone Number 717 532 9046 REGISTER OF WILLS USGiIINLY C'? ~ ~J t~ t-..1 ~~ ~ i_ i ~ ~ -'~ r- ~ ~~,, .^ S f ~. . _, _ . .'.~ ~,.~ r -, ~ ,,. Y ~ .. i, 1 ...w ryry State ZIP Code DA D '~ r-1"i PA 17257-9212 ?~ ~ `~~~`' Correspondent'se-mail address: fnmyers@lawofficeforestmyers.com 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, ft 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 ADDRESS 118 S Fayette St, Shippensburg, PA 17257 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVI= ADDRESS 137 Park Place West, S THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum 4a. Future Interest Compromise (date or death after 12-12-82) ^• 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 1 D, Spousal Poverty Credk (date of death ^ between 12-31-91 and i-1-95) burg, PA 17257-9212 Side 1 1505607120 1505b07120 to -?r0- Z+OD`9 DATE 0 - Z.O - ZaOe 9. J 1505607220 REV-1500 EX Decedent's Name: R a n d a I I W M O W E R Y Decedent's Social Security Number RECAPITULATION 160 48 8181 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. 9 5 , 0 5 6 . 9 4 6. Jointly Owned Property (Schedule F Separate Billing Requested ..... 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ........ 6. ~ Separate Billing Requested ..... ........ 7. 8. Total Gross Assets (total Lines 1-7) ............. ................................................... ....... 8. 95, 056.94 9. Funeral Expenses 8 Administrative Costs (Schedule H) .................................. ....... 9. 9, 7 2 8. 3 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......................... ....... 10. 11. Total Deductions (total Lines 9 8 10) ......... ...................................................... ....... 11. 9, 728.35 12. Net Value of Estate (Line 8 minus Line 11) ... ................................................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been mad S ....... 12. 8 5 , 3 2 8 . 5 9 e ( chedule J) ........................................... ...... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ......... .................................. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ...... 14. 8 5 , 3 2 $ . $ 9 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 0 . 0 0 15. 16. Amount of Line 14 taxable ~ 0 ~ at lineal rate X .045 8 5, 3 2 8. 5 9 17. Amount of Line 14 taxable 16. 3 ~ 8 3 9 . 7 9 at sibling rate X .12 0 . 0 0 18. Amount of Line 14 taxable 17. 0 . 0 0 at collateral rate X .15 0 . 0 0 18. 19. Tax Due ............... 0.00 .................................................................................................. 19. .... 3,839.79 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: Fite Number 21-09-0786 Randall W MOWERY 118 S Fayette St CITY Shippensburg STATE ZIP PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 3,839.79 A. Spousal Poverty Credit B. Prior Payments 3,647.80 C. Discount 191.99 3. Interest/Penalty if applicable Total Credits (A + g + C) (2) 3,839.79 D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 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 (4) 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. (5) 0.0 0 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (56) 0 . Make Check Payable to: REGISTER OF WILLS, AGENT __r.~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and a. retain the use or income of the property transferred :............... Yes No ...... b. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest; or .................................. x ................................................................................ o° a 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 x 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?............ .......................................................................................................... ^ a IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. i~TT' .~ 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 theme surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. F ~' Fx=, 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)]. sibfng is definedounder Sectiont9102, as anrindividual who has at least one padrent in aolmmon wthlthe(decepdent,nwhether b§9116 (a) (1.3)]. A y blood or adoption. Rev-7ti08 tJt+ (ti-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMeIONWEgLTH OF PENNSYLVANIA INFIERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MOWERY, Randall W FILE NUMBER 21-09-0786 InGude the proceeds of litigation and the date the proceeds were received by the estate. Ah Property jolntlyowned with the right of survivorship must be disclosed on schedule F. ITEM ' NUMBER DESCRIPTION VALUE AT DATE 1 Orrstown Bank *0289 -Date of Death balance OF DEATH 34,519.24 2 Thrift Savings Plan 52,917.70 3 91 Ford Pick-up Truck 1,550.00 4 98 Ford Pick-up Truck -.good condition 3,550.00 5 98 Pontiac Grand Am -good condition 2,520.00 TOTAL (Also enter on Line 5, Recapitulation) 95,056.94 Copyright (c) 2002 form software only The Lal:kner Group nlneedc.ed, additional pages of the same size) Form PA-1500 Schedule E (Rev. 6-98) REV-7161 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS tSTATE OF MOWERY, Randall W FILE NUMBER vents of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT See continuation schedule(s) attached 5,046.00 B• ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): ~- Street Address Clty State Zip Year(s) Commission paid 2. ~ Attorney's Fees See continuation schedule(s) attached 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 See continuation schedule(s) attached 5• Accountant's Fees 6• Tax Return Preparer's Fees ~• Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. 132.00 3,129.10 1,421.25 Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued MOWERY, Randall W ESTATE OF FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Eby Granite Works -memorial marker 1,148.00 2 Geisel Funeral Home -funeral bill 3,648.00 3 Spring Hill Cemetery -grave opening 250.00 H-A Subtotal 5,046.00 Attornev Fees 4 Law Office Forest Myers -Attorney fees for estate administrati on 1,421.25 H-62 subtotal 1,421.25 Probate Fees 5 Register of Wills -Probate fees to open estate and secure Grant of Letters and Short Certificate s 117.00 6 Register of Wills -filing fee for REV-1500, Inheritance Tax Return 15.00 H-64 subtotal 132.00 Other Administrative Costs 7 Cumberland Law Journal -Advertise estate notice 75.00 8 Embarq -replacement of telephone pole damaged in an accident 2,249.35 9 FedEx -mailing Inheritance Tax Return for filing to Cumberland County Register of Wills 15.00 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 ~~ ~ ~+ ~ ~ yr MOWERY, Randall W FILE NUMBER 21-09-0786 ITEM NUMBER DESCRIPTION 10 Fogelsanger -vehicle insu AMOUNT rance premium 407.00 11 News-Chronicle -Adverti se estate notice 121.25 12 Sollenberger Messenger Service -vehicle transfer 179.50 13 Sollenberger Messenger Service -vehicle transfer 82.00 H-B7 subtotal 3,129.10 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1613 EX+ (g.gg) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MOWERY, Randall W NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ TAXABLE DISTRIBUTIONS (include outright si~c distributions, and tra under Sec. 9116(a)( SCHEDULE J BENEFICIARIES FILE NUMBER 21-09-0786 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT Do Not Llst 7ruate s (Words) ($$$) Daisy C MOWERY Mother 118 S Fayette St Rest, residue Shippensburg, PA 17257 and remainder of net distributable Enter dollar amounts for distributions shown above on lines 5 through 18, as appropnat Ton Rev 1500 cover 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 Copyright (c) 2002 form software only ThP I a~l~.,o r- ~ I~~~ 0 00 N Form PA-1500 Schedule J (Rev. 6-98)