HomeMy WebLinkAbout12-07-09 (4)15056051058
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601
Harrisburg, PA 1712a-osol RESIDENT DECEDENT o2 1 ~cac~-7 of - 0~3poo7
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
Decedent's Last Name Suffix Decedent's First Name MI
5 m i j 1.~ ~.c~ t l.l..t ~v\ t
(If' Applicabie) 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 FILE D IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Retum _-_ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate _ _ 4a. Future Interest Compromise (date of __-~ 5. Federal Estate Tax Return Required
death after 12-12-82)
:_ 6. Decedent Died Testate ~,.~ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received °~ 10. Spousal Poverty Credit (date of death =~m.~ 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 T0:
Name Daytime Telephone Number
SI~S~ J . S.~n i J`Z ~
Firm Name (If Applicable) ,, y
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REGISTER LS USE
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First line of address } ~ t
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Second line of address
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City or Post Office State ZIP Code ~E FILED ~
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Correspondent's a-mail address
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Under penalties of ry, I d at I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct an mp e. r ion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE O SO ~ PON J~LE FOR FILING RETURN DATE
ADDRESS 31 [ i /' ~7 1.~ I Y, S ~ ~A., .~ ~ j~{._ /1r ~ "'~ ~'
_ / ~`f O' ~/~V~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
15056051058
Side 1
15056051058
REV-1500 Ex. Page 3 File Number
_._ _ _
Decedent's Complete Address:
DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER
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,
ern F rn, I y 4 ~ ~~ ~ 7~
STREETADDRESS
3 ] ~ . a ~ ~~, s ]-
CITY
C~ STATE
~~ ZIP
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Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. InteresL'Penalty if applicable
D. Interest
E. Penalty
Total InteresUPenalty (D + E) (3)
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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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 Vansferred 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 Vansfer 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? ........ ...... ^
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 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) p2 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 910i!, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
J
15056052059
REV-1500 EX Decedent's Social Security Number
Decedent's Name: ~) i..(.L /4yv~ ~". Sm i1Z ~ ~ ~ ~ ' ~ ~ `~ Lf ~
RECAPITULATION a ~ ~~ ~~ a°._.. _~ __ . _ ~ _ ... _.. ~.
1. Real estate (Schedule A) ............................................. 1.
2. Stocks and Bonds (Schedule B) ....................................... 2. "--'-
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. -'
4. Mortgages 8~ Notes Receivable (Schedule D) ............................. 4. r
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. ~ ~L{
6. Jointly Owned Property (Schedule F) ~ a ~ Separate Billing Requested ....... 6. (~. ~~ l7p ~
7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) ~°s~ Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1-7)...... ... ..... .. ...
8.
G
~ 4 H
9. Funeral Expenses 8 AdminisUative Costs (Schedule H) ..................... 9. ~~ a ~,
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. ~j l7 ~ (, ~ . ~{~
11. Total Deductions (total Lines 9 8 10) ............... . .................. • 11. ~ g (v U
1
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ~,S ~
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.
_ . _. ~,~ ~3
_
_.. e.__ ., ~ ..... __ ,.m.~ _ _.~,... ~a.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of tine 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_ 1 5.
16. Amount of Line l4 taxable
at lineal rate X .0~
16. _
~y 5 !~ ~~
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. ~~ ~~ ~y~
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
15056052059
RE'v- ;, LX-- i;S',
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
FcTATE OF
FILE NUMBER
~ILu~ ~ ~,~ ~ ~- ~ ~~u~
All real property 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, neither being compelled to buy or sell, both having reasonable knowledge of the relevant Fads.
If more space is needed, insert additional sheets of the same size.
REV-1808 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSffS, $ MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
InGude 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.
(tf more space is needed, insert additional sheets of the same size)
REV-1'i09 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANGE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY OWNED PROPERTY
ESTATE OF FILE NUMBER
t,Jc~,~,,,~ F Sr~i~l a( ~~ocx~~
If an asset 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.
.~5~c 3 Sr.I~J
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~~~~
B.
C
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NP.ME OF FINANCIAL INSTITUTION ANO BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % Cf
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
t. A. an~r ~~,~c.-~ 3~ 4 K, a~A, 5,-c~-P h4 ~~
° a5~ v~~ s~~ ~-~ 5; 00
t
a
TOTAL (Also enter on line 6, Recapitulation) `i ~ ~ S f po u 0.00
(If more space is needed, insert additional sheets of the same sae)
CD 7 u e.~
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File No. 01-3635 Parcel ID No. 01-20-1854-125
Z,h1S Indenture, made the 12th day of March, 2001,
Between
BRUCE S. BAZELON and BARBARA A. BAZELON, husband and wife
(hereinafter called the Grantors), of the one part, and
SUSAN J. SMITH, WILLIAM F. SMITH and JOSEPHINE SMITH, husband and wife,
as Joint Tenants with the Right of Survivorship
(hereinafter called the Grantees), of the other part,
W itnesseth, that the said Grantors for and in consideration of the sum of ONE HUNDRED FORTY
SEVEN THOUSAND TWO HUNDRED FIFTY DOLLARS and 00/100 ($147,250.00) lawful money of the
United States of America, unto them well and truly paid by the said Grantees, at or before the sealing and
delivery hereof, the receipt whereof is hereby acknowledged, have granted, bargained and sold, released and
confirmed, and by these presents do grant, bargain and sell, release and confirm unto the said Grantees,
as Joint Tenants, and not as tenants in common, their assigns, the survivor of them and the survivor's personal
representatives and assigns,
ALL THAT CERTAIN tract or piece of land situate in the Borough of Camp Hill,
County of Cumberland and State of Pennsylvania, bounded and described as
follows:
BEGINNING at a point on the eastern side of North Twenty-fourth Street (formerly
Park Avenue) said point being two hundred twenty-three and five one hundredths
(223.05) feet in a northerly direction from the northeast corner of North Twenty-
fourth and Lincoln Streets; thence in a northerly direction along the east side of said
north Twenty-fourth street, ninety (90} feet; thence in an easterly direction by a line
at right angles to said north Twenty-fourth Street, one hundred forty-three and
seven tenths (143.7) feet to a point; thence in a southerly direction parallel with said
North Twenty-fourth Street, ninety (90) feet to a point; thence in a westerly
direction by a line at right angles to said North Twenty-fourth Street, one hundred
forty-three and seven tenths (143.7) feet to a point, the place of BEGINNING.
BEING the northern one half of Lot No. 21 and all of Lot No. 22 on a plan of Lots
Laid out by Charles W. Strayer, said plan being recorded in the Recorder's Office at
Carlisle, Pennsylvania, in Plan Book 1, Page 87, and being improved with a two and
one-half (2 %) story frame dwelling house, known and numbered as 319 North ~
Twenty-fourth Street.
I
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?SS240-60184 ~ ~~~~'~
BEING THE SAME PREMISES WHICH James D. Campbell, Jr. and Shirley A.
Campbell, his wife, dated October 14, 1974 and recorded October 15, 1974 in the Office
of the Recorder of Deeds in and for Cumberland County, Pennsylvania in Record Book
V, Volume 25, Page 164, granted and conveyed unto BRUCE S. BAZELON and
BARBARA BAZELON, husband and wife, grantors herein.
Together Wlth all and singular the buildings and improvements, ways, streets, alleys, driveways,
passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances, whatsoever unto
the hereby granted premises belonging, or in anywise appertaining, and the reversions and remainders, rents,
issues, and profits thereof; and all the estate, right, title, interest, property, claim and demand whatsoever of
them, the said grantors, as well at law as in equity, of, in and to the same.
To have and to hold the said lot or piece of ground described above, with the buildings and
improvements thereon erected, hereditaments and premises hereby granted, or mentioned and intended so to
be, with the appurtenances, unto the said Grantees, their heirs and assigns, to and for the only proper use and
behoof of the said Grantees, their heirs and assigns, forever.
Arld the said Grantors, for themselves and their heirs, executors and administrators, do, by these presents
cove°nant, grant and agree, to and with the said Grantees, their heirs and assigns, that they, the said Grantors,
and their heirs, all and singular the hereditaments and premises herein described and granted, or mentioned and
intended so to be, with the appurtenances, unto the said Grantees, their heirs and assigns, against them, the said
Grantors, and their heirs, and against all and every other person and persons whosoever lawfully claiming or to
clairn the same or any part thereof, by, from or under him, her, it, or any of them, shall and will
Specially Warrant and Defend.
In Witness Whereof, the parties of the first part have hereunto set their hands and seals. Dated the day
and year first above written.
~'~,_ ~, ±;~~ _~ _._ {SEAL}
BRUCE S. BAZELON
~7 ' ~ ~~
~__~ %~_,~ .., ~ ~ i '~ c:%;z'`" {SEAL}
BARBARA A. BAZELON
TS S 240-00184
Sealed and Delivered
IN THE PRESENCE OF:
Commonwealth of Pennsylvania
County of E-I~RERLAI~D : ss
; ~;~~,~~~'ri~,i~
On this the 12th day of March, 2001, before me, a Notary Public for the Commonwealth of
Pennsylvania, residing in the County of CUMBERLAND, the undersigned Officer, personally appeared BRUCE
S. BAZELON and BARBARA A. BAZELON, known to me (or satisfactorily proven) to be the persons whose
names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes
therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~r`OTAF11Al S~At.
S7ACY M. STEitiCI; Notary Pul11iC
?~lummetstown 8oro, G4aphln cou~,ty
M Commission Expires Fsb. 23, 20134
The address of the above-named Grantees is:
319 N. 24TH S/TAR\EET, CAMP HILL, PA
~` _/
n behalf ie Grantees
File' No. 01-3635
Record and return to:
3 iii N . Z~-~'~`^ S~.
Notarp blic
My con~nission expires
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TSS240-00184
REV-1511 EX+ (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE N
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF ' ^ FILE NUMBER
WZ U-l /h,"~ f"'; SM I 1 j-) oZ (z7 i~ f~t7 ~
Debts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
CR-~-i~t7`-d~ V~~ ~~~~ y-evlZC-c--~,~ ~ C~~Z-rlr=l~a,~, C~-AO~ ~ 3~~~
OPC'~-~l i f..Q ~t ~ ('t1 e.vn~ ~`(L IY~ ~ ~2t t.3~" Sl t~,~t~~ C~4R-~~ ~i 1 La-C ~~lt
Mt,~,
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions ~~ r..'~__ ~~ ~~ nn
Name of Personal Repreesentative(s) 5"~"19'~- ~~ SM rho
SVeetAddress 3j ~ ~• 01`-1^ Sr
City _ G~-yrP ~ LrL State _.~ Zip ~ ~ CJ ( 1
Year(s) Commission Paid:
2. ~ Attorney Fees
~a~~ . G~
3• Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation)
Claimant ~i l.Xi ./~j.~ S S1.M j 7"I.-1 ~ ~~ v C
Street Address ~ 1 cl ~c • °2 `"t L (~ ~ j ~L
City C'Afi-~~ ~ ! L \ , State k • ' Zip 1 ~ D I I
Relationship of Claimant to Decedent I-~rsL~G-rr~[j~ CSC fJ VSt.= ~~Zr~S~~~
4• I Probate Fees
5. ~ Acx:ountant's Fees
6. ~ Tax Return Preparer's Fees
7
~ 35 S
TOTAL (Also enter on line 9, Recapitulation) I S ~ ~' ~~ L
(If more space is needed, insert additional streets of the same size)
~ pennsylvania SCHEDULE I
DEPARTMENT Or REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILTTIES & LIEN5
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
W ILLt /~~rv~ F-, SM 1 7~.? 2 (- O'Be~00 7
Resort debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sneers of the same size.
pennsylvania SCHEDULE ~
'~-~ DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(Sj RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
i TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (aj (1.2j.]
1. _
~~~x,t J - 5rv1 l~ _
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
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.