HomeMy WebLinkAbout10-22-09 (3)15056041114
-" REV-1500 EX (06-a5) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280801
Harrisburg, PA 17128-0801 RESIDENT DECEDENT ~ b ~ (~ ZZZ
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
Decedent's Last Name
Suffix Decedent's First Name
KURTZ
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Social Security Number
FILL INAPPROPRIATE OVALS BELOW
(]x 1.Original Return ~ 2. Supplemental Return
0 4. Limited Estate 0 4a. Future Interest Compromise (date of
death after 12-12-82)
8. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFI
Name
0 3. Remainder Return (date of death
prior to 12-13-82~
0 5. Federal Estate Tdx Return Required
8. Total Number of Safe Deposit Boxes
0 11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
DENTUIL TAX INFORMATION SHOU4D BE DIRECTED T0:
Daytime Telephone Number
ROBERT G. FREY 717-243-5~$ ~`'
Firm Name (If Applicable)
REGISTER S USE OI~Y
-ri -h
FREY & TILEY i
~;-' ._..~ <:~} ,.
First line of address ~, `- i ~ i tv
~-t r t1
--~ +~
_'~..i I`J
l1~ ~'\ .4.~
5 SOUTH HANOVER STREET ' ~"" c:~ -v ~ .~
Second line of address
~ ~~ ~ w. -~-
~-~
.. {`~ ~ _ ~`t`1
City or Post Office State ZIP C
d
CIP
DATE F LED
o
e
CARLISLE PA 17013
Correspondent's a-mail address: RFREY@ FREYTILEY . COM
nder penaltles o pe ury, declare that I ave examm is return, in u ng accompanying schedules an statements, and to the est o my kn ge and be ie , it is
true, correct and complete. Declaration of preparer other than the personal representative is based on all informaNen of Wni~n ~ro„~ro~ time ~,,,, ~.,~.,~~,...,
SIGNATURE
FOR FILING RETURN
G~ 2 ( r}
ADDRESS
37.5 SH WOOD DR E, CARLISLE, PA 17015
SIGNATU PREPA ROT ER T R SENTATNE DATE
ADDRESS .. /
5 SOUTH HANOVER STREET, RLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 15056041114
KENNETH
Spouse's First Name
MI
L
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
15056041114 J
J
REV-1500 EX
15056042115
Decedent's Social Security Number
Decedents Name: KENNETH L KURTZ
RECAPITULATION
1. Real estate (Schedule A) ....................................... . . . . 1. 13 0 0 0 0.0 0
2. Stocks and Bonds (Schedule B) ...................................... 2. NONE
3. Closely Heid Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. NONE
4. Mortgages & Notes Receivable (Schedule D) ............................ 4. NONE
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ....... , 5. 2 6 9 2 9 . 0 0
6.
7. Jointly Owned Property (Schedule F) Separate Billing Requested ........
Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) OSeparate Billing Requested ........ 6. NONE
~. NONE
8. Total Gross Assets (total Lines 1-7) .................................. 8. 15 6 92 9 . 0 0
9. Funeral Expenses 23< Administrative Costs (Schedule H) .................. . . 9. 1710 2 . 0 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) ............... 10. 12 9 91.0 0
11. Total Deductions (total Lines 9 & 10) ................... . . . . . . . . . . . . . . 11 3 O O 9 3 . 0 0
12.
13. Net Value of Estate (Line 8 minus Line 11) ........................... . . 12.
Charitable and Governmental Bequests/Sec 9113 Tr
t
f 12 6 8 3 6 . 0 0
us
s
or which
an election to tax has not been made (Schedule J) ..:..
.................. 18
0.00
14. Net Value Subiect to Tax (Line 12 minus Line 13) . 14 12 6 8 3 6 0 0
TAX COMPUTATION
SEE INS
-
TRUCTIONS 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
16.
Amount of Line 14 taxable 15. 0. 0 0
at lineal rate X .0 4 5
17.
Amount of Line 14 16, 0.0 0
18. taxable at sibling rate X• 12 12 6 8 3 6. 0 0
Amount of Line 14 taxable 1 ~, 15 2 2 0. 0 0
at collateral rate X , 15 18. 0.0 0
19. TAX DUE ....................................................... 19. 15220.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 15056042115 15056042115
J
~_
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21-09-0222
DECEDENTS NAME
ADDRESS
E ROAD
CITY
DECEDENTS SOCIAL SECURITY NUMBER
STATE
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
10000.00
500.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(1) 15220 00
Total Credits (A + B + C) (2) .10500 00
Total InteresUPenalty'(D + E) (3) 0 00
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) 0 00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4720 00
A. Enter the interest on the tax due. (5A)
B. Enter thetotal of Line 5 + 5A. This is the BALANCE DUE. (5B) 4720 00
Make Check Payable to: REGISTER OF WILLS, AGENT
_ : .T
_. ~_
~.~..:
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
Ye
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 ...................................................... I-I
J
L ^
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 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 [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 decedents 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)j.
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)]. Asibling
is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
_ __-r __._.__
REV-1502 EX+ (11-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE A
REAL ESTATE
FILE NUMBER
Kenneth L Kurtz 21-09-0222
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as tlne price at which properly
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy ar sell, both having reasonable knowledge of the relevant ran.
•• •••-•- -r••-•• ~~ ~~ccucu, nwcn auuiuvnai Sn6e[S OT In@ Sart1@ sIZ@.
s~~
REV-1508 EX+(6-98) SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONN/EALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Kenneth L Kurtz 21-09-0222
•~Include the, proceeds of litigation and the date the proceeds were received by the estate.
'-` OF DEATH
1
2 Capital Blue Cross Refund
M&T Bank checking account 000002672024102 316
3
Tax prorations from HUD-1 settlement statement 815
4
2008 Chevrolet, actual sales price 1,097
5
Insurance refund 12,000
6
Miscellaneous personal property sold to Larry's Trading Company 316
7
Hazard insurance refund 75
8
Shipley Oil refund 122
9
Real estate tax rebate 323
10 M&T Savings account 015004200904230 250
11 Income tax refund
9,865
1,750
TOTAL (Also enter on line 5, Recapitulation) $ 26,929
flf more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-05)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8
~DMINISTRATNE COSTS
ESTATE OF
FILE NUMBER
Kenneth L Kurtz
Debts of decedent must be re orted on Schedule I.
ITF6A
A.
1.
2.
3.
4.
e.
1
FUNERAL EXPENSES: r+muurv I
Cocklin Funeral Home
9, 796
Memorial Lunch
179
The Sentinel, Thank you Notice
175
Family headstone
1,132
City State zip
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
Year(s) Commission Paid:
2• Attorney Fees
3• Family Exemption: (K decedents address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4• Probate Fees
5• Accountant's Fees
6• Tax Return Preparers Fees
7. Expenses in connection with real estate sold
e. Final Medici Bill to Alexander Springs Emergency Phys.
9. Automobile insurance
TOTAL {Also enter on line 9 Recapitulation) ~ ~S
(If more space Is needed, insert additional sheets of the same size)
500
257
3, 991
889
183
17.1
B!
REV-1512 EX+ (12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS
is ~ ATE of FILE NUMBER
Kenneth L Kurtz
RBnat dahh IncuRarl by fha duwaiinn~ ..d... ~., ae.~w u.~a .__._i__~ ..---~~ _..~ _ ~_._ _.. .. .. _
Expenses in connection with Real Estate Sold
Met Ed
Waste Management
Peerless Insurance Co.
Met Ed
Robert Cairns, Tax Collector
Peerless Insurance
Cleaning expenses
South Middleton Township Authority
Peerless Insurance
Embarq
Met Ed
Embarq
Peerless Insurance
Met Ed
Embarq
Peerless Insurance
Calaman's Lawn Service
Met Ed
Settlement Costs from HUD-1 Settlement Statement
School Tax
Final Water and Sewer
Met Ed
Embbarq
Total Expenses of Real Estate Sold
59
47
69
60
273
69
93
101
69
37
32
35
69
29
34
69
32
21
1,660
967
111
13
22
3.991
..~--~;
A. Settlement Statement U.S. Department of Houainy
and Urban Development OMB Approval No. 2502-0265
(expires 11/30!2009)
B. Type of Loan
1.^ FHA 2.0 RHS 3.®Conv. Unins.
l.^ VA 5.0 Conv. Ins. 6. File Number
T-22551 7. Loan Number 8. Mortgage Insurance Case Number
C. Note: This farts is famished to give you a stabment of actual settlement cosh. Amounb paid to and by the settlement agent are shown. Items
marked'(p.o.a)' were paid oubide the dosing; they are shown here for infortnatlon purposes and are not inducted in the totals.
D. Name and Address of Borrower
The South Middleton School District E. Name and Address of Seller
The Estate of Kenneth L Kurtz F. Name and Address of Lender
G. Properly Lotxtlon
18 Forge Road
Boiling Springs, PA 17007 H. Settlement Agent
Stlxk and Leader
South Middleton Township Place of Seldement
221 W. Philadelphia Street
Susquehanna Commerce Center East
York, PA 17401 I. Settlement Date
07!09/09
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales rice 130000.00 401. Contract sales rice 130,000.00
102. Personal ro 402. Personal
103. Settlement cha to borrower line 1400 2 266.38 403.
104. 404.
105. 405.
Ad ustments for items Id seller in advance Ad ustments for Items d b seller In advance
106. Ci /town faxes 07/09 to 12!31 18.79 408. /tovnt taxes 07!09 to 12/31 18.79
107. Coun taxes 07/09 to 12/31 712.68 407. Coun taxes 07109 tD 12!31 112.68
108. School taxes 07!09 tD 06/30 965.58 408. SchoolteXes 07/09 to 06/30 965.58
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT. DUE FROM BORROWER 133,363.43 420. GROSS AMOUNT DUE TO SELLER 131,097.05
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER 500. REDUCTK)NS IN AMOUNT TO SELLER
201. Depositor earnest money 1500.00 501. Excess Deposit (see instructlons) 1500.00
202. Prindpal amount of new loan(s) 502. Settlement drargea to seller (line 1400) 1 660,p0
203. Existlng loan(s) taken subJect to 503. ExisWg loan(s) taken subject to
204. 504, Payoff of first morf0age loan 4,046.52
M 8 T Bank
205. 505. Payoff of second mortgage loan
206. 506.2009.10 School Tax 987.22
207. 507. Fatal Water/Sewer Big 111.08
208. 508.
209. 509.
Ad ustments for Items un Id salter Ad uatments for ksms un id b seller
210. Cf /town taxes to 510. CI /town taxes to
211. Coon taxes to 511. Coun taxes to
212. Scholl taxes to 512. School taxes to
213. 513.
214. 514.
215. 515:
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY /FOR BORROWER 1500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 8304.82
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower line 120 133,363.43 601. Gross amount due to seller line 420 131,097.05
302. Less amounb aid b/for borrower line 220 1500.00 602. Less reduction amount due to seller line 520 8 304.82
303. CASH FROM BORROWER 131 863.43 803. CASH TO SELLER 122,792.23
:Il&4TITlJTE FORM 7098 SELLER $TATFJAENT: Tha lnfarrtrtlan con Wned harem Is irrporlant tax brtarrlstlan and la bNnp Nmishad to Ole m4mal Revenue SerNOa r you ale required t Ills a realm, a na9lipanw
~ty or otnar anclbn w91 be arposed an you r Mb Item N rsgtNroO b be r'aporlad and the IRS dNemWws Mat h has not ban nponed. Ths CanbaU Sales Price daaatW an LJns 107 above cans0lula dre
,roes Proaads d dss trenactlan.
:FLIER INSTRl1CTgN3: To dalartNne I/you hsve to repot Me eels a ezoMn9a of your primry rW Wno an your lax rMUm, sea the Schedule D (Form 7040) Instructlw. I/ iM real state ws sat yav pnmry
asidenca, conWate dre approhla park d Form 4787, Fann 8252, end /ar Stlledule D (Farm 1010).
rau are repaired by law to provide the attlemenl spent wah your mrreCl tagtaayw IdenlMntlon number. p you do nd praNN Your aprW IawQays Idenafludan number. you nolY be subject W dNl a afminal
zeal tla Imposed by law. UrMer partalUas U parkuy, t aedN mat tna number shown a, a9a Malattenl la my rnmsa taxpayer IaeMMptlan mortar.
The Petals or lCanrNN ~. l(ratz
frxm HI Ir11 !'1/ARl mf HanrlhM4 dZnF ~
,MENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT PAGE T
,ETTLEMENT CHARGES: File Number. T-22551 PAID FROM PAID FROM
OTAL SALES/BROKER'S COMMISSION based on prlu S -
- BORROWER'S
FUNDS AT SELLER'S
FUNDS AT
Division of commission Ifne 700 as follows: SETTLEMENT SETTLEMENT
.1. $ to
702. S to
703. Commission aid at Settlement
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN P.O.C.
801. Loan Od nation Fee %
802. Loan Discount %
803. reisal Fee to
804. Credit R to
805. Lendefsins ectlon Fee to
806. M .Ins. liptlon Fee to
807. Assum don Fee to
808.
809.
810.
811.
812.
813.
814.
815.
900. REMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest from to S /d
902. Insurance Premium to
903. Hazard Insurance Premium. . to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. S / mo.
1002. Insurance mo. S ! mo.
1003. Ci ro taxes mo. S ! mo.
1004. Coon Taxes mo. S / mo.
1005. Sfiool faxes mo: S / mo.
1006. mo. S / mo.
1007. mo. S / mo.
1008. ate Reserve for Hazard/Flood Ins C /Coon Pro Taxes, Sdtod Taxes & a e Ins
1100. TITLE CHARGES
1101. Settlement or dosin fee to
1102. Abstractor tltle search to
1103. Title examination to
1104. Title insurance binder to
1105. Document re aretlon to
1106. Nota fees to Stodrand Leader 5.00 10.00
1107. Attome s fees to Fre 8 Tile 350.00
indudes above Item No:
1108. Title insurance to Stock and Leader t for Chip o Title ~ 907.88
indudes above item No: REISSUE RATE
1109. Lender's coven e
1110. Ownel's coves a 130 000.00 -907.88
111 L
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin fees Deed S 38.50 a S ~ Releases S 38.50
1202. Ci /coon !slam Deed S 1,300.00 S 1,300.00
1203. State tax/stam s Deed S 1 300.00 a 5 1300.00
1204.
1205. UPI Certiflrgtion 10.00
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve To
1302. Pest ins ctlon to
1303. Tax Certification Robert C. Calms 5,00
1304.
1305.
1306.
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES enter on lines 103 and 502 Sectlons J and K 2,266.38 1,660.00
rmw omsaary lawaaed tM HUD•7 Saltlement Smtenant fo dls bari p my glowladps erM balie4 b b a bus end aaurate sbterront d VI lemipb and Nsbpaenwlb made on my aaount a by me in tllls
rsnascllan. I furl erury bw w repiw0 a c plOf UD~1 Sememenl Slelerrlenl. A
1'M dalelan 8 sv Tha 6b1e w1~//eM L. Kunz
he HU 1 0 m! Sts snl Ma 'h I haw g aerad la a We antl acarata aCmlall of this baneactlon. I hew aueed p Wllybse~a funds b W dbbulaed in attnrNncs vAb, Nla abtMgnt.
Stock and p Dab TQQIJIJJJ--1gIgT-Q
NARNING: la a abrr to lo,oaingly aka false sblarcnb b Uts United Sbtaa on fhb p any albs slMler fpnv Penaltlea upon canNWOn an Induda a floe p Irtpnwnmanl Fp dstNla sae: T10e 18 U.S. Code
ieWOn 100 and Sacvon t010.
form HU0.1 (3/861 ref Handbook 4305.2