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Home My WebLink About11-18-09-~ REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code veer Fiie Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 80X.280601 2 1 0 7 0 9 1 3 Harrisburg, PA ~~~28-DSO RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 207059793 06302007 07161919 Decedent's Last Name Suffix Decedent's First Name MI BURD GALYN L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name BURD PEARL MI E Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death prior to 12-13.82) ^ 4. Limited Estate ~ qa, Future Interest Compromise ^ 5. Federal Estate Tax Retum Required (date or death arter 12-iz-sz) 6 Decedent Died Testate ~ Decedent Maintained a Living Trust 8. Total Number Of Sate Deposit Boxes ® (Attach Copy of VVIII) ^ (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. be~eeniz~~ si edit (d; t9e5~f death ^ 11. Election to tax under Sec. 9113(A) 1 (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST 13E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAT O SHOULD BE DIRECTED TO: ame Daytime Telephone Number N LAURIE J MaWERY 7 1 7 5 7 491 6 d --; n ~.o Firm Name (If Applicable) First line of address 1215 WILLIAMS GROVE RD. Second line of address City or Pont Office MECHANICSBURG REGISTER ~~~ -' C13 ~~~, c~ c~ C.,+ ~ -£3'~' :r> DATE FILED State ZIP Code PA 17055 ..., r , ~. ~LY i_ ? 4? ... ~ , r. _.. ~` _' ' _ ~-~ ~- `--~ Ct3 Correspondent's e-mail address: Under Wattles of perjury, I dectare that I have examined this velum, including accompanying schedules and statements, and to the befit of my knowledge and belief, it)a ir~txxred and complete. DeGajration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Laurie J. Mowery 1215 Williams f;rove Rd., Mechanicsburg, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS Side 1 1505607120 1505607120 J '~ C!J C C 1505607220 REV-1500 EX Decedents Name: B U R D, G A L Y N L RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......................................... 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 8 10) ...................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. 14. Net Value Subject to lax (Line 12 minus Line 13) ................................................. 14. 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 .o0 4 6 8 8 8 3 15. 1ti. Amount of Line 14 taxable at lineal rate X •045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL iF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 207059793 4,765.83 4,765.83 77.00 77.00 4,688.83 4,688.83 0.00 0.00 Side 2 L 1505607220 1505607220 REV-1500 EX Page 3 File Number 21 - 07 - 0913 Decedent's Complete Address: Burd, Galyn L ________ ___ _____ _ _ STREET ADDRESS 442 Walnut Bottom Road CITY - --- ------- -STATE -! ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments _ C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable p, Interest E. Penalty _ _ Total Interest/Penalty (D + E) (3) 0.0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A, Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Q , Q Q 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 :.................................... ^j rx c. retain a reversionary interest; or .................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ~ ^x 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?......... ^ x^ 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 Juy 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 p2 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 p2 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 [72 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. ~ SCHEDULE E CASH, BANK DEPOSITS, & MISG. COMAIONWEALTN OF PENN8YLV/1NIA ~ PERSONAL PROPERTY INMERRANCE TAX RETURN RESIDENT DECEDENT i FILE NUMBER ESTATE OF Burd, Galyn L - _ 21 - 07 - 0913 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must tae disclosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 Mettife 4,765.83 TOTAL (Also enter on Line 5, Recapitulation) ~ 4,765.83 SCFFDULF H Fl~L EXPENSES & COMMONWEALTH OF PBJNSYLVANIA pA /~/~ INHERITANCE TAX RETURN ~STf V1~ ~IW~ RESIDENT DECEDENT ESTATE OF Surd, Galyn L Debts of decedent must be reported on Schedule I. _- ITEM i NUMBER I FUNERAL EXPENSES: DESCRIPTION A. B. 1 2. 3. a. 5. 6. 7. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions FILE NUMBER 21 -07-0913 AMOUNT Soaal Security Number(s) i EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees 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 Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Inheritance tax filing fee 62.00 15.00 TOTAL (Also enter on sine 9, Recapitulation) 77.00 REV-1613 tJC+ (g.go) SCHEDULE) COM NHER TANCE TAX RETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF Burd, Galyn L FILE NUMBER 21 -07-0913 NUMBER ~ NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY i RELATIONSHIP TO DECEDENT Do Not Ust Truttee(a) SHARE OF E6TATE (Words) AMOUNT OF ESTATE ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers ~ under Sec. X116 (a) (1.2)] 1 ~ Pearl E. Burd ', Spouse 442 Walnut Bottom Road Carlisle, PA 17013 ! I I I I i I Enter dollar amounts for distributions shown above on lines 15 through 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS i I TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00