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HomeMy WebLinkAbout11-13-09 (2) 1505607121 06 REV'-1500 EX 05 ( - ) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28fl601 County Code Year File Number Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 0 6 1 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 9 0 3 6 0 6 9 0 6 1 3 2 0 0 9 0 7 2 6 1 9 2 0 Decedent's Last Name Suffix Decedent's First Name MI CA S S I D~' T H E L MA V (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 1. Original Return 4. Limited Estate QX 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust 0 (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 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 T0: Name Daytime Telephone Number H ANTHONY ADAMS Firm Name (If Applicable) First line of address 4 9 WEST ORANGE STREET Second line of address S U I T E City or Post Office State S H I P P E N S B UR G PA ZIP Code 1 7 2 5 7 Correspondent's a-mail address: htadamslaw@embargmail.com w Under penalties of perjury, I declare that I have examined this return, including acx:ompanying 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. SIGNATU E OF PER RESPONSIBLE FOR FILING RETURN t' ~TE ADDRESS ~ ~-... .. SIGNATURE F PREP ~ i ~ ~ A~ ADD [ 49 West Orange street, Suite 3 Shippensburg PA_.17257 PLEASE USE ORIGINAL FORM ONLY REGISTERQF WILLS USE+~ILY 4 C ~ ~ " ~ "C7 aC j..~ ~ ;. ~ ~ =' ~~ ~ .., , ' ~'~ •.~ ~ ..O s ^t ~-t ~ ' ' =-~, ~ it~J ' ,.. r .. ~ ~ D FLED ~ - Side 1 1505607121 1505607121 J 1505607221 REV-1500 EX Decedent's Social Security Number Decedents Name: THELMA V. CASSIDY 1 9 9 0 3 6 0 6 9 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. • 2. Stocks and Bonds (Schedule B) .................................. 2. 1 6 0 6 6. 1 9 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages 8~ Notes Receivable (Schedule D) ........................ 4. • 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ....... 5. 8 7 3 0 • 0 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property (Schedule G) ~ S eparate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 2 4 7 9 6, 2 5 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 1 4 4 1 7. 6 8 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. • 11. Total Deductions (total Lines 9 & 10) ........................... 11. 1 4 4 1 7. 6 $ 12. Net Value of Estate (~.ine 8 minus Line 11) ......................... 12. 1 0 3 7 8. 5 7 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. 1 0 3 7 8. 5 7 TAX COMPUTATION - SFE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 3116 (a)(1.2) X.0 0 . 0 0 15. 16. Amount of Line 14 taxable 1 0 3 7 8 5 7 at lineal rate X .045 . 1 s 17. Amount of Line 14 t~~xable 0 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable ' 0 0 0 at collateral rate X . ~5 18 19. Tax Due .............. ........................... .... ...19. 20. FILL IN THE OVAL if YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0. 0 0 4 6 7. 0 4 0. 0 0 0. 0 0 467.04 Side 2 1505607221 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME TH_ELMA V. CASSIDY _ STREET ADDRESS 101 NORTH PRINCE STREE File Number 21 09 00614 APT. 303 CITY STATE ZIP SHIPPENSBURG PA 17257 Tax Payments and Credits: ~• Tax Due (Page 2 Line 19) (1) 467.04 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (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) 467.04 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 467.04 ' Make Check Payable to: REGISTER OF WILLS, AGENT 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; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ ^ Q 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 "intrust for" or payable upon death bank account or security at his or her death? ......... ^ ^ Q Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 ^ 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, +995, 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 ,ransfers 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)]. 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. ti REV-1503 EX + (6-98) ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scHE~u~E s STOCKS & BONDS ESTATE OF FILE NUMBER THELMA V. CASSIDY 21 09 00614 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MAINSTAY HIGH YIELD FUND 15,379.88 2756.250 SHARDS @ 5.58 ACCOUNT # 55795983-7 2. BLACK ROCK PJIONEY MARKET 686.31 ACCOUNT #0009542259 TOTAL (Also enter on line 2, Recapitulation) , ~ 16,066.19 (1f more space is needed, insert additional sheets of the same size) REV-1508 EX ± (8-98) COMMONWEALTH OF PENNSYLVANIA INHFRITANI:F TAX RFTI IRAI SCHEDULE E CASH, BANK DEPOSITS, & MISC. ESTATE OF FILE NUMBER THELMA V. CASSIDY 21 09 00614 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CITIZENS BANK IRA 820.09 PLAN 6186307411 2. MAINSTAY HIGH YIELD IRA 3,843.36 ACCOUNT # 2,~i47-10002526 3. REBATE OF RENTAL AMOUNTS 176.22 4. TRANSFER FROM CHECKING AT CITIZENS TO ESTATE 3,890.39 ACCOUNT# 6100795403 TOTAL (Also enter on line 5, Recapitulation) ~ ~ 8, 730.06 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & {NHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER THELMA V. CASSIDY 21 09 00614 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FOGELSANGER-BRICKER FUNERAL HOME 11,648.17 2. VET'S CANTEEN ASSOCIATION (FUNERAL) 326.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) ARTHUR SHIMKANON street Address 408 KARA WAY City SHIPPENSBURG State PA zip 17257 Year(s) Commission Paid: 2009 2 Attorney Fees H. ANTHONY ADAMS 3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address ~;ty State Zip Relationship of Claimant to Decedent 4. Probate Fees 5 Accountants Fees 6. Tax Return Preparers Fees 7, RT HENRY PHARMACY -LAST ILLNESS 8. VAPOR JET (APARTMENT EXPENSE) 9. EMBARQ 10. PENELEC TOTAL (Also enter on line 9, Recapitulation) ~ 1,100.00 1,100.00 111.00 5.00 72.80 24.55 30.16 14.417.68 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER THELMA V. CASSIDY 21 09 00614 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS {include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. ARTHUR SHIMKANON Lineal 5,189.28 408 KARA WAY SHIPPENSBURG, ?A 17257 2. MARIE LAYBOURN Lineal 5,189.28 . 17577 LARK PARK ROAD BOCA RATON, FL 33487 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET jj, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I ~ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, THELMA V. CASSIDY, being of sound mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking all prior wills and codicils made at any time before by me. FIRST: I direct that all my funeral expenses and just debts be paid as soon as practical after my death. SECOND : I give and bequeath my car and any and al l j ewelr. y of any nature or kind, to my daughter, Marie Laybourn. THIRD: The rest and residue of my estate, be it real, mixed or personal whatsoever and wheresoever situate is to be sold and divided equally between my son, Arthur Shimkanon and my daughter, Marie Laybourn, per stirpes. FOURTH: I nominate, constitute and appoint, my children, Arthur Shimkanon and Marie Laybourn, to be the Executors of this, my Last Will and Testament. IN WITNESS WHEREOF, I, Thelma V. Cassidy, to this my Last Will ~ this ~da of October and Testament, set my hand and ~eal, ~~ y , 1993. ~_ ~) T ~e a V. Cassidy Sworn to and subscribed, declared and published by Thelma V. Cassidy, as her Last Will and Testament, and so done in the presence of we the r•~~ witnesses, who sign at her request, , and in her presence, and in the , ~~' ~~ ~~~ ~' , . hti`. ~'ZC.-L..L%"~~- l.~-~J-"l..li'.Ztc_ r i~ 1~--'"-.-E'~.~C.-t".i~i presence of each other • '~ COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND I, Thelma V. Cassidy, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; and that I signed it willingly; and that I signed it as my free and voluntary act f the purpose therein expressed. T'~ie~a~ V: Cassidy Sworn to and acknowledged, before me, by Thelma V. Cassidy, the Testatrix, ~"c~,s c~~'" day o f Octok~er , 19 9 3 . Notary Public COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND t~0'T~4RC~~. SEAL pA11!!N MARIE SHOOP- Notary Public Shippensburg, Cumberland County. PA My ~;r~~~t*,ai~~a Exptres Feb. 5, 1996 We, H. Anthony Adams and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses, and that to the best of our knowledge and the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. ~ ~. An n ~''--~ <} /;. ;~;~., / f .~c..c..t.vc,~ ~r,L~.c~...r CSC./-~./ S~~aron Coleman Adams Sworn to and subscribed before me by, H. Anthony Adams and Sharon Coleman Adams, the witnesses, this~~~---~s.ay of October, 1993. Notary Pu lic .a w'.r.,.' R~ ARIAL ~~AL' ubtic DAWN NiARIE SHOOP- Naary P Cumberland County, PA Shippsnsburg : , ~, My ~mmissbn Expires Peb• ~,; ' ~~.