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HomeMy WebLinkAbout11-13-09 (2) 1505607121 06 05 REV-1500 Ex - ) ( PA D f OFFICIAL USE ONLY epartment o Revenue Bureau of Individual Taxes County Code Year File Number INHERITANCE TAX RETURN Po sox 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 1 9 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 7 3 4 0 8 9 0 0 2 2 0 2 0 0 9 0 6 2 7 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI A L B E R T D O R O T H Y M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 0 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death pnorto 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) © 6. Decedent Died Testate ~ T. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty CredR (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTU-L TAX INFORMATION !SHOULD BE DIRECTED TO: Name Daytime Telephone'Number M U R R E L R W A L T E R S I I I 7 1 7 f~`9 7 4 5 0 Firm Name (If Applicable) c ~, -~., ;.,., REGISTER LLS USE LILY ;:.; :i _"~'~ First line of address ^!;. cn 5 4 E A S T M A I N S T R E E T c~~~~ ~ . = -. Second line of address ~'~ ~ ~ ~ j ~R`n' --i b .~. ~ ~~ .C` City or Post Office State ZIP Code DATE FILED M E C H A N I C S B U R G P A 1 7 0 5 5 Correspondent's e-mail address: Under penalties ' ry, I dedare that I have examined this return, induding accompanying sdredules and statements, and m the best of my knowledge and belief it is true, and mpiete. Deda n of preparer other than the personal representative Is based on all infomlation of which prepan:r has any knowledge. SIGNATUR~'O ~ RSON,RES~N~BLEpbht/'LIN RETURN _ ~ ~_ ~ DATE /~. ^Z - ~ it w Q ADDRESS ~ ~" 500 ANDE S NT RO MECHANICSBURG PA 17055 SIGNATURE O A ER EPRESENTATIVE ~qT ~ v ADDRESS __ 54 EA T MA N STREET MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J 1505607221 REV-1500 EX Decedent's Social Security Number Decedents Name: DOROTHY M• ALBERT 1 6 7 3 4 0 8 9 0 RECAPITULATION 1. Real estate (Schedule A) 1. 4 4 5 3 7. D 4 ........................................ 2. Stocks and Bonds (Schedule B) .................................. 2• 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 4 2 8 2 . 9 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous N n-Probate Property h S d l G ~] S Billi t R t d 7 ( c e u e ) epara e ng eques e ....... . 8. Total Gross Assets (total Lines 1-7) ........................... 8. 4 8 8 2 0. 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 1 1 7 1 3. 0 7 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............ 10. 3 0 4 8 . 8 6 11. Total Deductions (total Lines 9 ~ 10) ........................... 11. 1 4 7 6 1. 9 3 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 3 4 0 5 8. 0 7 13. Charitable and Governmental BequesWSec 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. 3 4 0 5 8. 0 7 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .045 3 4 0 5 8. 0 7 16. 1 5 3 2. 6 1 17. Amount of Line 14 taxable D 0 0 0 D 0 at sibling rate X .12 17 • 18. Amount of Line 14 taxable O D D 0 O D at collateral rate X .15 . 1 g• . 19. Tax Due .................................. ....... .... ...19. 1 5 3 2. 6 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 1505607221 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 os 0195 DECEDENTS NAME DOROTHY M. ALBERT STREET ADDRESS GOLDEN LIVING CENTER 46 ERFORD ROAD CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 1.532.61 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty 'rf applicable D. Interest E. Penalty Total Interest/Penalty (D + E ) 4. ff 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. 5. ff Line 1 + Line 3 is greater than Line 2, enter the d'rfference. 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. (3) 0.00 (4) 0.00 (5) _ 1.532.61 (5A) (5B) 1.532.61 Make Check Payable fo: 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; ............................... ^ c. retain a reversionary interest; or ................................................................................................ ^ 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? ....................................................................................... ^ Q 3. Did decedent own an 'intrust 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 beneficlary designation? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R A$ 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 zeero (0) percent [72 P.S. §9116 (a) (1.1) (ii)j. 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 beneficlary. 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-0ne years of age or younger at death to or for the use of a natural parent, an adoptive parent, a a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)). The tax rate irrrposed on the net value of transfers to or for the use of the decedent's lineal beneficlaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) (/2 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 ~/2 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. REV-1502 EX + (8-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ES 1 M 1 E INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY M. ALBERT 21 09 0195 All real propeAy owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neitl~er being compelled to buy or sell, both having rezsonable knowledge of the relevant fads. Real orooerty which is ioirKlvowned with riaM of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 364 COFFEETOWN ROAD 44,537.04 MECHANICSBURG, PA 17055 - net sale price TOTAL (Also enter on line 1 (If more space is needed, insert additional sheets of the same size) -~ REV-1508 EX + (B-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER DOROTHY M. ALBERT 21 09 0195 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 1. M&T BANK 4,282.96 CHECKING TOTAL (Also enter on line 5, Recapitulation) ~ ; (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8~ INHERRANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY M. ALBERT 21 09 0195 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. COCKLIN FUNERAL HOME 8,870.07 2. HONORARIUM TO MINISTER 100.00 3, FAMILY MEAL 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Represerrtative (s) ROBERT D. ALBERT (RENOUNCED) Street Address City State Zip Year(s) Commission Paid: 2. A~eY Fees MURREL R. WALTERS, III, ESQUIRE 3, Famiy F~cemption: (If decedent's address is not the same as daimanCs, attach explanation) Claimant Street Address City Spate Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OFWILLS -CUMBERLAND COUNTY 5 AccountanCs Fees 6. Tax Retum Preparer's Fees 7. 2,400.00 143.00 TOTAL (Also enter on line 9, Recapitulation) I ; , , „„ ,,., (If more space s needed, insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANW INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8 LIENS ESTATE OF FILE NUMBER DOROTHY M. ALBERT 21 09 0195 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. DEPARTMENT OF PUBLIC WELFARE 1,319.44 2. WEST SHORE AMBULANCE 849.02 MEDICAL 3. HERITAGE MEDICAL GROUP 135.00 MEDICAL 4. HEALTHCARE EYE CARE GROUP 47.00 MEDICAL 5. GOLDEN LIVING 12.00 HAIR CARE 6. GOLDEN LIVING 586.40 RESIDENTIAL CARE 7. LEWIS FLICKER 100.00 REMOVAL OF RESIDENTIAL DEBRIS TOTAL (Also enter on line 10, Recapitulation) I = (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COA~MAONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY M_ ALBERT 41 09 0195 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 [indude ou ' ht ssppoousal distributions, and transfers under ~ Sec. 9116 ( a (1.2)] 1. ROBERT D. ALBERT Lineal 6,811.63 500 ANDERSONTOWN ROAD MECHANICSBURG, PA 17055 2. RONALD L. ALBERT Lineal 6,811.61 1842 MICHELLE DRIVE YORK, PA 17408 3. BARBARA A. REFFNER Lineal 6,811.61 360 COFFEETOWN ROAD OILLSBURG, PA 17019 4. BARRY R. ALBERT Lineal 6,811.61 203 S. FILEYS ROAD DILLSBURG, PA 17019 5. RICK E. ALBERT Lineal 6,811.61 1481 PHILADELPHIA STREET YORK, PA 17403 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE L B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ; (If more space is needed, insert additional sheets of the same size)