HomeMy WebLinkAbout12-15-09 (2) 1505607120
REV-1500
EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes
PO 60X.280601 INHERITANCE TAX RETURN 2 1 0 9 0 4 0 3
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
379 56 9504 03 14 2009 08 19 1952
Decedent's Last Name Suffix Decedent's First Name MI
EDDY KEVIN M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
EDDY VICKI A
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X^ 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
r g. Decedent Died Testate ~
l (Attach Copy of Will) 7 Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
RALPH H. WRIGHT JR 717 761 4540
Firm Name (If Applicable) tom.,
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JOHNSON , D U F F I E REGISTEI~f=]NILLS U3/~^E"^^'{~ONLY . ~ `: ~
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First line of address t
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3 0 1 MARKET STREET -r
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Second line of address
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P . O . BOX ._.• ti _
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E~TE FILED C~ `"'~~
City or Post Office ~~`
State ZIP Code
LEMOYNE PA 17043
Correspondent's a-mail address:
Under penalties 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.
SIGt~AT ELF P RSON RESPONSIBL OR FILING RETURN DATE
~' .>> ~ (i~ G~(i' Vicki A Eddy l ~ .~. ~
ADDRESS ~ 1
311 Walton Street, Lemoyne, PA 17043
SIGNATURE O REPAR R R N REPRESENTATIVE DATE
~ Ralph H. Wright Jr f ~p,~`J / !~
301 Market Street, Lemoyne, PA 17043
Side 1
1505607120 15056D?120
J
1505607220
REV-1500 EX
Decedent's Social Security Number
Decedents Name: K e v i n M E D D Y 3 7 9 5 6 9 5 0 4
RECAPITULATION
1. Real Estate (Schedule A) .......................................................................................... 1.
5, 9 0 2 8 0
2. Stocks and Bonds Schedule B 2
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4.
5• Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ................ 5.
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 0 0
(Schedule G) ~ Separate Billing Requested ............. 7.
8. Total Gross Assets (total Lines 1-7) ....................................................................... 8, 5, 9 0 2 8 0
5,202.47
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9.
5,195.18
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10.
11. Total Deductions (total Lines 9& 10) ...................................................................... 11. 1 0, 3 9 7 6 5
12. Net Value of Estate Line 8 minus Line 11
( ) .............................................................
12. - 4 , 4 9 4 8 5
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................................................. 13.
14. Net Value Sub'ect to Tax Line 12 minus Line 13
1 ( ) .................................................
14. - 4 , 4 9 4 8 5
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 0 0 0 15. 0 0 0
16. Amount of Line 14 taxable
0 0 0
16
0 0 0
at lineal rate X .045 .
17. Amount of Line 14 taxable
0 0 0
17
0 0 0
at sibling rate X .12 .
18. Amount of Line 14 taxable
0 0 0
at collateral rate X .15 18. 0 . 0 0
19. Tax Due ..................................................................................................................... 19. 0 . 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
1505607220 1505607220 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-09-0403
DECEDENT'S NAME
Kevin M EDDY
STREET ADDRESS
311 Walton Street
CITY
Lemoyne STATE
PA ZIP
17043
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
p. Interest
E. Penalty
0.00
Total Credits (A + B + C)
(1) 0.00
(2> 0.00
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 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.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 0.00
(5A)
(5B) 0.00
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 :.............................................:.................................... ~ a
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? ....................................................................................................................... ^ 0
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? ...................................................................................................................... 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, 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 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.
Rev-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
EDDY, Kevin M
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21-09-0403
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 55.117 shares of AllianceBernstein Growth A Account 21.68 1,194.94
2 194.633 shares of AllianceBernstein Growth B 14.62 2,845.53
Account
3 53.716 shares of T. Rowe Price Equity Index 500 - 34.67 1,862.33
Account No. 5001380816-8
TOTAL (Also enter on Line 2, Recapitulation) I 5,902.80
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1510 FJC+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
EDDY, Kevin M
FILE NUMBER
21-09-0403
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.
ITEM DESCRIPTION OF PRO E DATE OF DEATH % OF DECD'S EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE)
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 T. Rowe Price Trust Co. IRA -Beneficiary: Vicki 0.00
A. Eddy, Surviving Spouse
This is for informational purposes. This is not
taxable due to the Decedent's Age at the time of
Death (56)
TOTAL (Also enter on Line 7, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
TAXABLE
VALUE
0.00
~ o.oo
Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
EDDY, Kevin M
FILE NUMBER
21-09-0403
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name(s) of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Johnson, Duffie
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
Clty State Zip
Relationship of Claimant to Decedent
AMOUNT
4,839.47
300.00
4. Probate Fees
53.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 10.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 5,202.47
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
EDDY, Kevin M 21-09-0403
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Parthemore Funeral Home 4,839.47
H-A Subtotal 4,839.47
Other Administrative Costs
2 Cumberland County Register of Wills Office -Copying costs for Certified Copies
H-B7 Subtotal
10.00
10.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
EDDY, Kevin M 21-09-0403
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Andrews & Patel Associates, Inc. 379.00
2 Camp Hill Emergency Physicians 44.70
3 Cardiovascular Surgical Inst. 146.60
4 Cumberland County Register of Wills Office -Filing Fees for Inheritance Tax and 30.00
Inventory
5 Holy Spirit Hospital Account No. 33938853 1,130.94
6 Holy Spirit Hospital Account No. 34007799 1,607.84
7 Holy Spirit Hospital Account No. 34684118 924.10
8 Quantum Imaging & Therapeutic Association 932.00
TOTAL (Also enter on Line 10, Recapitulation) I 5,195.18
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
•
• REV-1513 EX+ (11-08)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
EDDY, Kevin M
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
Vicki A Eddy
311 Walton Street
Lemoyne, PA 17043
FILE NUMBER
21-09-0403
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
DECEDENT (Words) ($$$)
Do Not List Trustee(s)
Spouse ~ Entire Estate
~ Tota I
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate,
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 0 00
Copyright (c) 2009 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 11-08)