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HomeMy WebLinkAbout12-07-09 (4) 5056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN nt77 al -p-1 tI `~ ~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~-~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedent's Last Name Suffix Decedent's First Name MI ~' rn I T~-~ J^aS~ n,~, ~~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name. MI 5 vet i ~-? 1,~ l Lu,'~y,^___ !. Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE t'~ S (~ ~~~fy 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 a_~,, 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 CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ns '- s~s~'I1~a ~ SP"~ 1 j l f ~ 1 Y _ S ~~p ~ 3 S _ 4'"~ '. T ,~ Firm Name (If Applicable) _ _ _ _. ~SE OI~ REGISTER ) ~ -. ~1 ~ C 9 _ , .•~ _. _~ t ~ m ~ ~ First line of address ~~ ~ "'V C ~--+ 31 9 ti~ , a ~ ~ S r _ c-,~ a ~;' - Second line of address ""~ C.a r ~ r '~ '~~ C~ (a,) E117 .~3 Clty Or Post Office State ZIP Code DATE FILED c ~ i~ LL ~~- ~ ~ ~' Correspondent's a-mail address: Under penalties of ry, 1 dedare that I have examined this return, including arxompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct an mplet ration of preparer other than the persona! representative is based on all information of which preparer has any knowledge. SIGNATURE OF RS R PO LE FOR FILING RETURN DATE ~ ~ ~ . 7 CJ ADDRESS ~~~ S -- SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 REV-1500 EX Page 3 1'1~rorlon+~C f~AMt1IP_tP_ A[I[~PQSS: File Number _ _ _ DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER JosLY~l~~t: r~i;, IY~F ~~~ v7 STREET ADDRESS ~~ ~ ,~ , a ~ r~ S ,- CITY ~ ~~ ~ ~ ` ~ ST l'~ ZIP l`~pfl Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E ) 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. 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) (5A) (56) 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 :...................................... ...... ^ ^ 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 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 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)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 15056052059 REV-1500 EX Decedent's Social Security Number Decedents Name• ~ ~ _ ~'~'~ __~ _._... )~'~' .. ._ ~._ .r. __ .. ~ m _ .. ._ ~.. ~~j- RECAPITULATION 1. Real estate (Schedule Aj .......................................... ... 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. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 6. Jointly Owned Property (Schedule F) ."~ ~= Separate Billing Requested .... ... 6. ~'( (~ Ll -1 3 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) > :~: Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ~ p L{ 4 3 9. Funeral Expenses & AdminisVative Costs (Schedule H) .................. ... 9. ~] I (cJ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ~-j -~ -~ 5 ~ 11. Total Deductions (total Lines 9 8 10) ................................ ... 11. ~4 g 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 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) ........ ..... .. .~.me. ._., .,._ ,.. ... 14. _~. __ Jf (/ ~ ~. _ __~ . ~..m.._m, .._~ - ,_~..,~..m. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or _ b transfers under Sec. 9116 (a)(1.2) X .0_ 15. ~~II1 ~ - ~S' Y! (, StN'V) VInS ~ 16. Amount of Line 14 taxable at lineal rate X .0 `I s 16. I J ~ ~ f!~ 17. Amount of Line 14 taxable at sibling rate X .12 17. 1 S. Amount of Line 14 taxable at collateral rate X .15 18. . .. 19 T 4 ~ ~ 3 19. ...................... ............ TAX DUE ................ .... . , 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 RF`d- jil pennsylvania SCHEDULE A ~ DEPARTMENT OP REVENUE REAL ESTATE 1NNERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~-- FILE NUMBER All real orocerty owned solely ar as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property If more space is needed, insert additional sheets or me same size. REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointy-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1509 E:X+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt~LE F JOINTLY OWNED PROPERTY tSfAIE OF FILE NUMBER ~aSt;t~l~~~ S~I~ ~~- ~~ r! 7( If an asset was made joint wlthln 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. ~~{ t,l.t ~) -~. Srv~ I~ B c. SvS~ ~' . ~nnt ill JOINTLY-OWNED PROPERTY: 3 1 ~ I~ . 02 K ~. ST- C ~.r~ N-t t ~ P~ r -~ n ( 3i~ ,~/. ,~yf1, Sr- r~ spa, ~~~ ~~ ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACN DEED FOR JOINTLY-HELb REAL ESTATE DATE OF DEATH % OF DECD'S DATE OF DEATH VALUE OF ~. A/ ~~ ~ . ~ -~ ~ A ~ VALID OF ASSET INTEREST DECEDENTS INTEREST ~ I L~ I L~-tc.El3ig Lc-t ~ t .Sr Cnti„~p tP~.~, ~sot~ov 33~ ~3 ~~ ~ a A ? ao~o Pal t, CIS-~-~~ ~ ~C, Az.~r-. S t YvuS r 8 - L ~Lnr,-c~ 5 p°~lo ~3 o a-a 3 f'J r,~ anp~ M~:2S 0412-sr sMn ~u~ s ~CC..r`, r y!G ~j ~ 35 n Sb~o { `2 g. 4'~ ~! 3 ~~ ~° ~`+~`M'at~2.s. {'~iQ-sr^~n~~~-e45 ~ccraC~~sa ~~1G3.'-/1 S`o~o 1a3~. -~l ~ ~ P d~ooU ^~ ~-tl 6°r Mt-S fi-2. Sr CI ~ Skvr 1-f4 ~y~l . 5 3 S v~ aon~ , 7 ~ ~ ~' '1997 cl 5 l 44'~ 72~ yo7~, C~+~{2,~/ ~~ Svo o So~v 750 TOTAL {Also enter on line 6, Recapitulation) I ; ~ ~ 4 ~? 3 D.00 (If more space Is needed, Insert addltlonal sheets of the same sae) ~ 7 u v q~ / h File No. 01-3635 Parcel ID No. 01-20-1854-125 This 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, Witnesseth, 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. i BEING the northern one half of Lot No. 21 and all of Lot No. 22 on a plan of Lots j 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 hvo and one-half (2 %2) story frame dwelling house, known and numbered as 319 North Twenty-fourth Street. TSS24GC0184 ~ ~, ~ ~'.j.~ 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 prcper use and behoof of the said Grantees, their heirs and assigns, forever. And the said Grantors, for themselves and their heirs, executors and administrators, do, by these presents, covenant, 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 claim 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. ;~'~;~-~ ~,F'~Jr~_~_. _ {SEAL} BRUCE S. BAZELON ~ ,~ ~~ ~;~/ !-~ ~ `> ~.~~~~ "~ {SEAL} BARBARA A. BAZELON TSS240-00184 ~ ~ ~ - :~ ~.~ Sealed and Delivered IN THE PRESENCE OF: Commonwealth of Pennsylvania County of 1~D : ss .;rr~~~%ti~r"Z 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 3. 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. l _ ,I~~ ~ ~' ~~_~_ ~~t)TAlilAt. W~L ~ Nota~p blic STAGY M. STEld;,E, Noiary puiTlk My co~nission expires liumme;stown 8oro, i~:aphin Catn~ty M Commission Expires Feb. 73, ZA34 The address of the above-named Grantees is: ~~ ' f ,' ~~, a ~.. A ~:. ' 319 N. 24TH STREET, CAMP HILL, PA ., ,9 ~is~ .. ~ ,~. n ehalf e Grantees ; ~,,: File No. 01-3635 Record and return to: f~-~ i~ ~ ~,` ~~ r_ N . ~. _`~ __ ~ ::~- - c~ c-1 TSS24G001 °4 RE1;!STERED y _-~.r. ~~a;.~ .. ., ' i ~ ~ ~. , _.i1R;r1=. _ .rrlli~'Y Fr_r,~r1.i' .. .,~,tr r~s~.r~.a;~er1 -.l'rr; iF;$rr'~ ~~{11- ~':I(r~r' Yj_v.` ,r;' L -` .3,} ~. _ .n;; ~ ~ QED iE~B - ~~?iT _ ''r'ef` i{iit ;;Qr:+;(:~H -- ~'±`~f1 - " ~ ~ -- -r ,_ ~,1,~~ `?L ~'. Iry _ j J- _'. ~ ~+1 f. tr! f j ' _ REV-f5f1 EX+(10-06) SCNEDVLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE QF FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT a. FUNERAL EXPENSES: 1. C 2~m~T nn- ~ /{U-•1 ~ ~- +~ [~ ~ c L..-3 ~ C,t`P-i t ~~ c n-,~ s ~,~ ~ 3 a '7 3 CiA~~ ,~~ i ~ a 2.r~~e ~ ~i---~ ~ ~ ~3r~ S; t Prz~.c ,5 I Li~.+~ S FuI.~rY1-~r1. M ~7rL B. ADMINISTRATIVE COSTS: 7. Personal Representative's Commissions Name of Personal Representative(s) SlJ 5/~y 7' Snn ~~`-1-1 ~ I c~ U Street Address 3/~~ ~ ~-(`~ f c~ Uf'~"~51 Ciry ` ~'W~ r~i L L Sq~ ~~ Zp I ? o t I Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the dame as daimant's, attach explanation) Claimant W I L-t-t ,~ ~ . S r~ tTt~ s Pa V S~ 3 S' o 0 Street Address .3 ~ ~ N •• ~ Wpm S Ciry Cn-~,•P IT- u . (-•~ I '7~tt State ~~ Zip I '? o t t Relationship of Claimant to Decedent SPoV S L 4. Probate Fees ~ oZ~{ C 5. Accountant's Fees 6. ~ Tax Return Preparer's Fees 7 TOTAL (Also enter on line 9, Recapitulation) I S ~ l l `( (Ii more space is needed, insert additional sheets of the same size) REV-i~i2 E.r.... i12-G2.3': ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE pF FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, indudinq unreimbursed medical expanses. If more space is needed, insert additions! sheets of the same size. ~.~•,f-psis __<:+ (Il-o~;) ` i pennsylvania SCHEDULE ] AERARTMENT OF RFVF. fJ UE BENEFICIARIES INHERITANCE TAX RETURN RESTDEN? DECEDENT ESTATE OF FILE NUMBER NUME~ER NAME AND ADDRESS OF PERSONS; RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under Sec. 9116 {a) (1.2).] 1. ~~(l.t-t IZW~ ~ S ~ i'r'k.t SPDV~`' ~(~6 [O (~C.,,tJ J^~ s~ ~ `~ ~,GG~ 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 I5 N07 TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS i. TQTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 7/ l.r If more space is needed, insert additional sheets of the same size.