HomeMy WebLinkAbout04-0046REV-I§0~EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z GROSS JULIA A 195-07-0347
t"'t DATE Of DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-OD-YEAR) THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
(,3 04 -']6-2003 04-27-19']4 REGISTER OF VVlLLS
III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
GROSS HENRY
OQ.O
LU
IOO
Q.
I--
Z
ELI
Z
O
D_
LU
O
SOCIAL SECURITY NUMBER
717-09-2267
[] 1. Original Return
[] 4. Limited Estate
[] 6. Decedent Died Testate (Attach copy of Will)
[] 9. Litigation Proceeds Received
[] 2. Supplemental Return
[] 4a. Future Interest Compromise (date of death alter 12-12-82)
[] 7. Decedent Maintained a Living Trust (A~achcep~ of Trot)
[] 10. Spousal PovedyCredit(dateofdaathbatween12.3'i-91 andl-l-95)
] 3, Remainder Return (date of death Fi~ to 12-13-82)
[] 5. Federal Estate Tax Return Required
0 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) (~ach Sch O)
THIS SECTION MUST BE COMPLt: I t=u. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
WILLIAM S. NAGEL CPA 900 WEST MAIN STREET
FIRM NAME (IfApplicable) MOUNT JOY PA 17552
TELEPHONE NUMBER
717 653 8194
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Propristorship (3)
4. Modgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7)
(Schedule G or L)
Total Gross Assets (total Lines 1 - 7)
Funeral Expenses & Administrative Costs (Schedule H)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
Total Deductions (total Unes 9 & 10)
9. (9)
10. (10)
12. Net Vat ue of Estate (Line 8 minus Line 11)
13..Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Ne{ Vat ue Subject to Tax (Line 12 minus Line 13)
NOT APPLICABLE
NOT APPLICABLE
NOT APPLICABLE
NOT APPLICABLE
NOT APPLICABLE
253,172
NOT APPLICABLE
OFFICIAL USE ONLY
(8) 253,172
14,460
NOT APPLICABLE
(11) 32,460
(12) 220,712
(13)
(14)
220,712
SEE INSYAUCTIONS FOR APPUCABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
0 x .o 0 ¢5)
12, 608 x .0 45 (16)
x .12 (17)
x .15 (18)
(19)
20. [] [ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENTI
0.00
567.36
567.36
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
S TF PA42021F. 1
Dec'edent's Complete Address:
ISTREET ADDRESS 162 S. ENOLA DRIVE
CITY ENOLA
I STATEpA
17025
r
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 567.36
Total Credits (A + B + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page '1 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.
A. Enter the interest on the tax due.
(2)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(3)
(4) 0.00
(5) 567.36
(5A)
(5B) 567.36
PLEASE ANSVVER 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 dght 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? .................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or secudty 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 ANSVVER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under pe~ies of perjury, I declare that I have examined this return, including accompanying 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.
S~ATU. Rj~_ F PEFJ$ON I~ESPONSIBLE FOR FILING RETURN
ADDRESS / ~/ , ' -
SII~BATURE OF PREPARER OTHF:~R T~AN REPRESENTATIVE
ADDRESS
1525 OREGON PIKE
SUITE 1801 LANCASTER PA 17601
DATE
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 3%
[72 P.S. §9116 (a) (1.1) (0].
For dates of death on or after Januar)/1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving soouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse/rom tax, and the statutory requirements for disclosure of assets and f~ling a tax retum 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 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, 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 decedenrs siblings is 12% [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.
STF PA42021F.2
REV-'1502 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE A I
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GROSS JULIE A
NI real propaty owned solely or as a [a,~i[ in C~T,i~ must be reported at fair marke~ value. Fair market value is defined as the pdce at which property would be exchanged between a
willing buyer and a willing seller, neither being compelled to buy or sell, b(:~h having reasonable knowledge of the relevant facts. Real propert7 which is jointly-owned with right of survivorship
must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
TOTAL (Also enter on line 1, Recapitulation) $
VALUE AT DATE
OF DEATH
NOT APPLICABLE
STF PA42021F.3 (If more space is needed, insert additional sheets of the same size)
REV,-'1503 EX + (1-97) (I)
COMMONV~'EALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROSS JULIE A
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All property jointly-owned with the right of sun~ivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
TOTAL (Also enter on line 2, Recapitulation) $
VALUE AT DATE
OF DEATH
NOT APPLICABLE
STF PA42021F.4 (If more space is needed, insert additional sheets of the same size)
REV-fl504 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROSS JULIE A
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP or SOLE-PROPRIETORSHIP
FILE NUMBER
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest o~ the decedent, other than a sole-proprietorship.
See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM
NUMBER
1.
DESCRIPTION
TOTAL (Also enter on line 3, Recapitulation) $
VALUE AT DATE
OF DEATH
NOT APPLICABLE
STF PA42021F.5 (If mom space is needed, insert additional sheets of the same size)
REV-'1505 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROSS JULIE A
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
FILE NUMBER
Name of Corporation
Address
City
2. Federal Employer I.D. Number
3. Type of Business
State Zip Code
Product/Service
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common $
Preferred $
Provide all dghts and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? [] Yes [] No
If yes, Position Annual Salary $
6. Was the Corporation indebted to the decedent? [] Yes [] No
If yes, provide amount of indebtedness $
Time Devoted to Business
7. Was there life insurance payable to the corporation upon the death of the decedent? [] Yes [] No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock of this company within one year pdor to death or within two years if the date of death was prior to 12-31-827
[] Yes [] No If yes, [] Transfer [] Sale Number of Shares
Transferee or Purchaser Consideration $ Date
Attach a separate shea for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedenrs death? [] Yes [] No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? [] Yes [] No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? [] Yes [] No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? [] Yes [] No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of oflcers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
STF PA42021F.6
REV:1506 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROSS JULIE A
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
FILE NUMBER
Name of Partnership
Address
City
2. Federal Employer I.D. Number
3. Type of Business
4. Decedent was a [] General
State Zip Code
Date Business Commenced
Business Reporting Year
Product/Service
[] Limited partner. If decedent was a limited partner, provide initial investment $
PERCENT OF PERCENT OF BALANCE OF
PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? [] Yes [] No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? [] Yes
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
[]No
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-827
[] Yes [] No If yes, []Transfer [] Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Date
Attach a separate shee{ for additional transfers and/or sales.
10. Was there a wdtten partnership agreement in effect at the time of the decedent's death? [] Yes [] No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? [] Yes [] No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death? [] Yes [] No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? [] Yes [] No If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? [] Yes [] No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete addressJes and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
STF PA42021F.7
REV-'1507 EX + (1-97) (0
COMMONWF_ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROSS JULIE A
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
FILE NUMBER
All property jointly-owned with the right of survivomhip must be disclosed on Sched__ _,_,!e F.
ITEM
NUMBER DESCRIPTION
1.
TOTAL (Also enter on line 4, Recapitulation) $
VALUE AT DATE
Of DEATH
NOT APPLICABLh;
(If more space is needed, insert additional sheets of the same size)
STF PA42021F.8
REV;1508 EX + (1-97) (I)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RES,OENTDECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
GROSS JULIE A
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of suwivorship must be discl _ _nsed__ on Sched__u!e F.
ITEM
NUMBER
DESCRIPTION
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
STF PA42021F.9
VALUE AT DATE
OF DEATH
SNOT APPLICABL~;
REV'-1509 EX + (1-97)(0
COMMONWEALTH OF PENNSYLVANIA SCHEDULE F
INHERITANCE TAX RETURN JOINTLY-OVVNED PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GROSS JULIE A
If an asse( was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. HENRY GROSS SPOUSE
B. WILLIAM S NAGEL
162 S. ENOLA DRIVE
ENOLA PA 17025
2.~ SCHOOL LANE
MOUNT JOY PA 17552
NEPHEW
JOINTLY-OWNED PROPERTY:
L~ ) ) ~ DATE ~SCRIPTION OF PROPER~ % OF ~TE OF D~TH
ITEM FOR JOINT ~DE I~e ~ of fi~al i~tit~on a~ ba~ a~ nu'nber or simi~r ide~i~ ~b~ DATE OF D~TH DEC~S ~LUE OF
NUMBER TENANT JOINT A~a~ ~ for~i~-~M mai es~te. ~LUE OF ASSET INTEREST DECEDEN¥S INTEREST
1. A. 1959 REAL ESTATE(RESIDENCE) 70,000 50 35,000
2 A o5/2o0o CERTIFICATE OF DEPOSIT 31000174282 80,269 33 26,489
3 B o5/2oo~' CERTIFICARE OF DEPOSIT 31000174282 80,269 33 26,489
4 k 07/2000 CERTIFICATE OF DEPOSIT 31000191767 11,349 33 3,745
5 B 07/2000 CERTIFICATE OF DEPOSIT 31000191767 11,349 33 3,745
6 A [o/2oo~ CERTIFICATE OF DEPOSIT 31400221219 62,898 33 20,756
7 B [o/2oo[ CERTIFICATE OF DEPOSIT 31400221219 62,898 33 20,756
8 A 05/2o0o CERTIFICATE OF DEPOSIT 31800185266 33,409 33 11,024
9 B o5/2ooo CERTIFICATE OF DEPOSIT 31800185266 33,409 33 11,024
10 A o5/2o0o CERTIFICATE OF DEPOSIT 31900186000 80,112 33 26,436
11 B o5/20oo CERTIFICATE OF DEPOSIT 31900186000 80,112 33 26,436
12 A 02/1970 CHECKING ACCOUNT 5140112648 29,053 50 14,526
13 A 06/2002 SAVINGS ACCOUNT 5003624292 40,525 33 13,373
13 B 06/2002: SAVINGS ACCOUNT 5003624292 40,525 33 13,373
14 A 1~/2oo~ NOTE RECEIVABLE 26,631 50 13,316
~L (Also enter on line 6, Recapitulation) $ 2 5 3, 17 2
(If more space is needed, insert additional sheets of the same s~ze)
STF PA42021 F.IO
RE~-1510 EX + (1-97) (I)
SCHEDULE G J
COMMONVVEALT. OF PENNSYLVANIA INTER-VIVOS TRANSFERS &
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISC, NON-PROBATE PROPERTY
E$¥ATE OF FILE NUMBER
GROSS JULIE A
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPER 1 t' % OF
ITEM liXCLU[]E ~'E NflVIE OF T1-E 'i'RANSFEREE, 'I1-EIR RELATIONF~.Ip TO DECEDENT AI~D 'i}E DAlE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER OF TRANSFER ATrACH A COPY OF TFE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE)
1.
TOTAL (Also enter on line7, Recapitulation) $ NOT A??T,TC_ABLI.;
STF PA42021F.11 pace is needed, insert additional sheets of the same size)
REV-1511 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROSS JULIE A
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Det:~s of decedent must be reported on Schedule I.
ITEM
NUMBER
5.
6.
7.
FUNERAL EXPENSES:
SULLIVAN FUNERAL HOME
MONUMENT ENGRAVING
DESCRIPTION
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social SeoJrity Number(s) / ElM Number of Personal Representative(s)
Street Address
Zip
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
State Zip.
7, 964
85
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
SUNDRY MEDICAL EXPENSES
AMOUNT
3,000
500
2,911
TOTAL (Also enter on line 9, R~apitulation) j $ 14 f 4 6 0
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F. 12
RET-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA SCHEDULE J
,..ER,TA.CET*X RETUR. BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GROSS JULIE A
NUMBER
I.
Il.
1.
STF PA42021 F.14
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
NAME ANDADDRESS OF PERSON(S)RECEIVING PROPE~Y
TAxABLEDISTRIBUTIONS[includeoutdghtspousaldistdbutions, andtmns~m
underSec. 9116(a)(1.2)]
HENRY GROSS
162 ENOLA DRIVE
ENOLA PA 17025 SPOUSE
WILLIAM S NAGEL
23~4 SCHOOL LA=NE
MOUNT JOY, PA 17552 NEPHEW
ENTER DOL~RAMOUNTSFORDISTRIBUTIONSSHOWNABOVEONLiNES15THROUGH18, ASAPPROPRi~E
AMOUNT OR SHARE
O¢ ESTATE
AMOUNT APPLICABLE
AMOUNT APPLICABLE
ON REV-1500 COVER SHEE~
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 $
(If more space is needed, insert additional sheets of the same size)
RE[/-1512 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
m
ESTATE OF
GROSS JULIE A
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
Include unreimbumed medical expenses.
ITEM
NUMBER
DESCRIPTION
TOTAL (Also enter on line 10, Recapitulation)
AMOUNT
$ NOT APPLICABL~;
STF PA42021 F. 13 (If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DE?ARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003449
NAGEL WILLIAM S CPA
900 WEST MAIN STREET
MOUNT JOY, PA 17552
........ fold
ESTATE INFORMATION: SSN: 195-07-0347
FILE NUMBER: 2104-0046
DECEDENT NAME: GROSS JULIA A
DATE OF PAYMENT: 01 / 16/2004
POSTMARK DATE: 01/1 4/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 04/16/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $567.36
REMARKS:
TOTAL AMOUNT PAID'
MARYANN NAGEL
C/O WILLIAM S NAGEL CPA
$567.36
SEAL
CHECK//2153
INITIALS: SK
RECEIVED BY:
GLENDA FARNER STRASBAUGH
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
7099 3220 0008 7318 2205
17552
.......... ~ IIIIIIIIIIIIIIIIIII
IIIIIII IIIII II IIIII
"'""'""'""'" ~ ~7
L%TMBF2RLAND COUR~IOUSE
1 COURTHOUSE SQUIRE
CARLISLE, PA 17013-3387
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-O601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 0O4236
NAGEL WILLIAM S CPA
900 WEST MAIN STREET
MOUNT JOY, PA 17552
........ fold
ESTATE INFORMATION: SSN: 195-07-0347
FILE NUMBER: 2104-0046
DECEDENT NAME: GROSS JULIA A
DATE OF PAYMENT: 08/04/2004
POSTMARK DATE: 08/03/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 04/16/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $6,681.50
REMARKS:
CHECK//2848
'SEAL
TOTAL AMOUNT PAID:
$6,681.50
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
ZNHERITANCE TAX DIVTSION
DEPT. Z80601
HARRTSBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-]*Sdi? EX AFP C01-03)
WILLIAM S NAGEL
900 W MAIN ST
MOUNT JOY
PA 17552
DATE 07-19-2004
ESTATE OF GROSS
DATE OF DEATH 04-16-2005
FILE NUHBER 21 04-0046
COUNTY CUMBERLAND
ACN 101
Amount Rem].'l:tmd
JULIA A
HAKE CHECK PAYABLE AND REMIT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRA/SENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GROSS JULIA A FILE NO. 21 04-0046 ACN 101 DATE 07-19-2004
TAX RETURN NAS: ( ) ACCEPTED AS F/LED (X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST ' SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) ($)
4. Hortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Dmposits/Hisc. Personal Property (Schedule E) (S)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7]
8. To,al Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Nisc. Expanses (Schedule H) (9)
10. Dabts/Nortgege Liabilltlms/Liens (Schedule I) (10)
11. Tote! Deductions
12. Nat Value of Tax Return
15.
14.
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Ne~ Value of Estate Subject to Tax
.00
.00
61~826.85
.00
.00 NOTE: To ~nsure proper
.00 credit to your account,
.00 submit the upper port~on
of this form with your
tax payment.
(8)
14,460.00
.00
61,826.83
.460. OO
47,$66.85
. O0
47,566.8:5
NOTE: Z'F an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19
re~lect ~igures that include the total o.F ALL returns a~ed tp date.~o
ASSESSMENT OF TAX: ~ ~ ~
~ ~ ~ ~ 0 .0 0
16. Amount of L~ne 1~ ~axabZe a* Lineal/Class A rate (16) ~,' X ~: ~::~? ~ . O0
Z7. Amoun~ of L2no Z~ .~ S~bZ~ng ,.~o (ZT) ~00 X ~5 ~ .00
18. Amoun~ of Line 1~ ~axablB a~ Collateral/Class B ra~e (18) ~7~6~8~ X ~ - r'~:' ~"'7~105'
,,,,,, ~ - ,,; ',,
0 ' ([;)= =~C'/~' ' [ 05.
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECE/PT DISCOUNT (+) AHOUNT ~ ~ ]
DATE NUNBER INTEREST/PEN PAID (-) ~.,~.~' ~:~
I
01-14-2004 CD00~449 .00 567.$6
567.56
6,537.67
145.85
6,681.50
INTEREST IS CHARGED THROUGH 08-05-2004
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORH
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
ZF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION:
Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate far
life or for years, the Caamoneaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
ROT[CE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NXLLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
far Refund of Pennsylvania Inheritance and Estate Tax" (REV-J515). Applications are available at the Office
of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special Z4-hour
answering service for fores ordering: 1-SO0-56Z-ZOSO; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-5020 (TT only).
Any party in interest not satisfied with the appraisement, a11oHance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object eithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-lOZ1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA OepartJent of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviem Unit, Dept. 280601, Harrisburg, PA 171Z8-0601
Phone (717) 767-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18~ 1996, the first day after the end of the tax amnesty per[od. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated an this notice.
interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January [, [98Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on end after
January 1, 198Z will bear interest at a rate Nhich will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The appZicable interest rates for L98Z through ZOO4 are:
Interest Daily Interest Daily Interest Daily
Year Rata Factor Year Rate Factor Year Rate Factor
~'~ ZOZ .000548 *~'~'~'/6-1991 11Z .000501 ~ 9Z .000Z47
1983 16Z .000438 199Z 9Z .000Z47 200Z 6Z .000164
1984 112 .000501 1993-1994 72 .O0019Z 2003 52 .000157
1985 132 .000556 1995-1998 9Z .000247 2004 42 .000110
1986 lOX .000274 1999 7Z .OO019Z
1987 IOZ .000Z74 ZOO0 7Z .OO019Z
--Interest is calculated as follows:
TNTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY 'rNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
F~EV-1470 EX (6-88~
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 28O6O1
HARRISBURG, PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Julia A. Gross 2104-0046
REVIEWED BY ACN
ANITA MCCULLY 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The value of the real estate has been removed from the schedule since, the property was
F 1
held by husband and wife.
F 2,4,6, The spouse's portion of these joint accounts has been removed from the schedule since
8,10, joint property with a spouse is not taxable.
12,13
&14
F 3,5,7, Changed tax rate from 4.5 percent to 15 percent since a nephew is a collateral
9,11 & beneficiary.
13
ROW Page 1
AU OF INDIVIDUAL
~ZTANCE TAX DIVISION TAXES
DEPT. 2B0601
HARRISBURG, PA 171Z8-0601
NILLIAH S NAGEL
900 N HAIN ST
NOUNT JOY
PA 17552
CONHONNEALTH OF PENNSYLVANIA BEPARTHENT OF REVENUE
NOT/CE OF INHERITANCE TAX
APPRAZSENENT, ALLONANCE OR DZSALLOHANCE
OF DEDUCTIONS AND ASSESSNENT DF TAX
Reco'~: ,, ~- =~ of "-'"' "''
Re!;;i s~ ~:~AT~I5 O7-t~-Zo0~
ESTATE OF GROSS JULIA A
DATE OF BEATH 0~-16-2005
Zl 0 -00 6
COUNTY CUHBERLAND
ACN 101
HAKE CHECK PAYABLE AND RENIT PAYNENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
=x AFP tDI-O3)__N_O.T.~CE OF ZNHERZTANCE TAX APPRAZSEHEN¥'~,-',~i'~.'ON/i,~-(~/= OR
nZ~;ALLONANCE OF BEBUCTZON$ ANB ASSESSHENT OF TAX
ESTATE OF GROSS JULIA A FILE NO. Z1 0~-00~6 ACN 101 BATE 07-19-200~
TAX RETURN HAS: { ) ACCEPTED AS FILED { X) CHANGED SEE ATTACHED NOTICE
RESerVATION CONCERNING FUTURE INTEREST - SEE REVEn~-"
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To i~sure proper
2. S~ocks and So~ds (Schedule D) (2} .00 credl~ ~o your account,
$. Closely Held Stock/Par~n~rship Zn~eres~ (Schedule C) (3) . O0 submi~ ~he upper por~Lon
~. Hor~gages/NoT:es Receivable (Schedule D) (q) .... O0 of ~his for~ ~l~h your
S. Cash/Bank DePost~s/Nisc. Personal Property (Schedule E) (S).. . O0 ~ax paying.
6. Jointly Otmod Propor~y (Schedule F) (6) 61 826.85
7. Transfers (Schedule D) (7) . O0
8. To~a! Asso~s
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expe~ses/Adm. Cos~s/Nisc. Explmses (ScheduZe H) (9} 14,460.00
10. Deb~s/Hor~gage L~abiZi~ios/L~ens (Schedule Z) (10) . O0
11, To,al Deductions
12. Ne~ VaZue of Tax Return (11)
61,826.85
~7,$66.85
INTEREST/PEN PAID (-)
.00
INTEREST IS CHARGED THROUGH 08-05-200q
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORN
ZF PAID AFTER DATE ZNDZCATED~ SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
AHOUNT PAZD
567.:~6
TOTAL TAX CREDIT I 567.56
BALANCE OF TAX DUEI 6,557.67
INTEREST AND PEN. / lq~.8~
TOTAL DUE / 6,681.50
( ZF TOTAL DUE ZS LESS THAN $1~ NO PAYNENT 1S REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY SE DUE
.00 X O0 =
.00 X 045=
· 00 X 12
~,7,$66.85 x 15 ,~
(19)=
19. Print/pal Tax Due
rAx CREBZT$:
DATE NI~BER
'01-I~~200~ CD00$~.q9
(12)
13. Chari~eble/Ooverrmen*al Bequests; Non-e/ec*ed 9115 Trusts (Schedule J) (1S) .00
14. Ne~ Value of Es~e~e SubJoc* ~o Tax (1fi) 47,366.83
NOTE: Zf an assessment was issued previously, lines 1~, 15 and/er 16, Z7, 18 and 19 ~111
r~leet figures that include the total of ALL returns assessed to date.
ASSESSNENT OF TAX:
15. A~oun~ of L/ne 1~ a~ Spousal ra~e (15) .00
16. Amoun~ of Line 1~
17. A~oun~ of Line 1~ a~ S{bling rede (17) .00
18. /moun~ of Line 1~ ~axable a~ Colla~eral/Cless B ra~e (18) 7,105.0~
7,105.0~
Office of Register of Wills
Cumberland County Cou
1 Courthouse Square rt House
Carlisle, PA 17013
h"llh"lll'"'"ll,,ll.,ll,,,ll,ll,,,,,,lll,l,,i,l,,,,ll,i
BUREAU OF INDIVIDUAL TAXES
INHERTTANCE TAX DIVZSTON
DEPT. 280601
HARRISBURG,, PA 17128-0601
NILLIAH S NAGEL
900 N HA~N ST
HOUNT JOY
PA 17552
COHHONNEALTH OF PENNSYLVANIA
BEPARTHENT OF REVENUE
ZNHER'rTANCE TAX
STATEHENT OF ACCOUNT
DATE 09-15-2004
ESTATE OF GROSS
BATE OF BEATH 04-16-2005
FILE NUHBER 21 04-0046
COUNTY CUHBERLAND
ACN 101
Amount:
REV-I&07 EX AFP (01-05)
JULIA A
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper cred/~: ~:o your eccoun~c) subm/~ ~he upper por~c/on of ~his for. wi~:h your ~ax payment.
CUT ALONG TH]:S LTNE ~ RETAZN LONER PORTTON FOR YOUR RECORDS
REV-1607 EX AFP (01-03) .#~ TNHERZTANCE TAX STATEHENT OF ACCOUNT
ESTATE OF GROSS JULIA A FILE NO. 21 04-0046 ACN 101 BATE 09-15-2004
THIS STATEHENT IS PROV/DED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHONN BELO#
IS A SUHNARY OF THE PR/NC/PAL TAX DUE., APPLICAT/ON OF ALL PAYNENTS., THE CURRENT BALANCE:. AND*' IF APPLICABLE*'
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 07-19-2004
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
7,105.05
PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
01-14-2004
08-05-2004
CD005449
CD004236
.00
143,83-
IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
{ IF TOTAL DUE IS LESS THAN $1.'
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR}.,
5~7~:~6
6,6~:;50
TOTAL TAX CREBZT
7,105.03
BALANCE OF TAX BUE .00
INTEREST ANB PEN. .00
TOTAL DUE .00
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )