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HomeMy WebLinkAbout12-31-0915056041125 ~' REV-1500 EX (06-05) PA Department Of Revenue OFFICIAL USE ONLY Bureau of Ind(vidualTaxes INHERITANCE TAX RETURN County Cate Year File Numt~er Po Box 280601 ~ 9 Hanisburg, PA 17128.0601 RESIDENT DECEDENT o~ ~ ~ ~-1 ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 8 5 0 2 7 0 2 0 7 3 0 2 0 0 9 0 5 0 1 1 9 2 5 Decedent's Last Name Suffix Decedent's First Name MI S M I T H E S T H E R L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Socal Security Number FILL IN APPROPRIATE OVALS BELOW O 1.Original Relum 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust ~ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFO' Name Daytime Te S C O T T W M O R R I S O N E S Q 7 1 7 Firm Name (If Applicable) ~-- „~,,, First line of address 6 W E S T M A I N S T R E E T Second line of address P O B O X 2 3 2 City or Post Office N E W B L O O M F I E L D Correspondents e-mail address: State ZIP Code P A 1 7 0 6 8 .A IVN St1WLU Ct UIKtV 1 tU 1 V: ibne Number ~ ,,.~ 2 2 ~ 0 0 t ~tj~.LS USE @t111.Y ry._I _~ ~ -'h ~. r- ~ ~~ _ `~~~ ~C~..~ ,~; ~~ -,~, --1 ' ~ ~ rya FILED ~ -x~ ~"`; ~ *'t ~-~ c"3 s :,~ '"7 •~c?°? 7 ~.~/ F"~) _:r..i '~ t rrl ?4„_~ `c~ Under penaltles of perjury, I dedare that I have examined ihb return, induding accompanying schedules and statements, and to the best of~my knowledge and belief, it is true, conect and complete. Dedaratan of preparer other th the personal representative is based on all infomlation of which preparer has any knowledge. S1G A URE OF RSON SPO $LE FILI URN DATE ADDRESS 1562 Nel+o~ille Rd Carlisle PA ,7013 REPRESENTATIVE P. O. Box 232 New Bloomfield PLEASE USE ORIGINAL FORM ONLY MI 3. Remainder Retum (date of death prior to 1 ~2-13-82) 5. Federal !*+state Tax Retum Required 8. Total Nurtlber of Safe Deposit Boxes 11. Election do tax under Sec. 9113(A) (Attach Sch. O) 068 Side 1 L 15056041125 150560411125 ....-~ 15056042126 REV-1500 EX Decedents SoGal Security Number ~ecedenYsName: Esther L. Smith 1 8 8 5 0 2 7 0 2 RECAPITULATION 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 & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank De osits & Miscellaneous Personal Pro , , , , , , , 7 4 0 8 2 p party (Schedule E) 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested ....... 6. 2 6 7 5 3 2 7. Inter-Vivos Transfers & Miscellaneous ~Pn~bate Property '7 3 4 0 4 6 1 (Schedule G) Separate Billing Requested ....... 7. 8. Total Grose Assets (total Lines 1-7) ........................... 8. 7 6 8 2 0 7 5 9. Funeral Expenses & Administrative Costs (Schedule H) ............... . 9. 7 9 1 5 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens Schedule I) 10. ~ 0 2 2 8 11. Total Deductions {total Lines 9 & 10) ........................... 11. 8 6 1 7 2 8 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 6 8 2 0 3 4 7 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. 6 8 2 0 3 4 7 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax1.2) X.0 _ 15. 16. Amount of Line 14 taxable at lineal rate X .045 6 8 2 0 3 4 7 1fi 3 0 6 9 1 6 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 Side 2 L 15056042126 3 0 6 9 1 6 15056042126 REV-15Gb EX Page 3 Decedent's Complete Address: { DECEDENTS NAME Esther L. Smith File Number ADDRESS 1562 Nevwille Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: ~. Tax Due {Page 2 Line 19) 2. Credits/Payments A, Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 3,069.1 E Total Credits (A + B + C) (2) O.OC Total InteresUPenalry (D + E) (3) O.Ot 4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII in oval on Page 2, Line 20 to request a refund. (4) O.OC 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,069.1 E A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (5B) 3,069.1 E Make Check Payable fo: 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 : ..................................................................... i i . ^ ^ ncome; .............................. ts b. retain the right to designate who shall use the property transferred or ^ c, retain a reversionary interest; or ............................................................................................... . ^ 0 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 or payable upon death bank account or security at his or her death? ........ intrust for 3. Did decedent own an . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficary 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 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 [T2 P.S. §9116 (a) (1,1) (ii)]. The statute des 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 appligble even ff 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) perceht, 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 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-1508 EX + (6-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE Esther L. Smith Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-0vmed with right of survhrorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Blue Cross refund 740.8 TOTAL (Also enter on line 5, (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (g-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN ESTATE OF riG~.numo~ec Esther L. Smith ff an asset was made joint within one year of the decedent's date of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ~ ADDRESS (RELATIONSHIP TO DECEDENT A. Charles K. Smith 11562 Newville Road Carlisle, PA 17013 C JOINTLY-OWNED PROPERTY: 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. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. ' DATE OF DEATH VALUE OF ASSET ' 96 OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTERES 1. A. ComerStone Federal Credit Union Account #24765-01 25.08 50. 12.54 2. A ComerStone Federal Credit Union Account #24765-07 5,325.5 50. 2,662.7E TOTAL (Also enter on line 6, Recapitulations S 2 675.3 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVO5 TRANSFERS ~ MISC. NON-PROBATE PROPERTY Esther L. Smith This schedule must be completed and filedrf the answer fo any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY i~uo~n~r~EaFrr~rau+s~t~~.TMaart~una+s~narooec~rrrnrao TME°"~°Fr~s~R"n'a""co~'ovn~v~oFORruxesrnr~. DATE OF DEATH VALUE OF ASSET %OFDEC~'S INTERES EXCLUSION nF~~i TAXABLE VALUE 1. New York Life Non Qualified Annuity #58279726 27,474.83 100. 27,474.8: 2. New York Life IRA Annuity #58279766 1,696.02 100. 1,696.0 3. New York Life Non Qualified Annuity#74701925 10,501.77 100. 10,501.71 4. New York Lice Non Qualified Annuity #53688994 33,731.99 100. 33,731.9 TOTAL (Also enter on line 7 Recapitulation¢ ~ ~ 73.404.61 (If more space is needed, insert addifional sheets of the same size) REV-1511 EX+(12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS FILE Esther L. Smith Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 • 3,400.0( B. ADMINISTRATIVE COSTS: 1, Personal Representative's Commissions Name of Personal Representative (s) Sodal Security Numtrer(s)IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees Scott W. Morrison 3. Family F~cemption: (If decedents address Is not the same as daimant's, attach explanation) Claimant Charles K. Smith Street Address 1562 Newville Road Citir Carlisle State PA Zip 17013 Relationship of Claimant t0 Decedent son 4• Probate Fees 5 ~ Accountant's Fees 6. I Tax Return Preparers Fees 7. ~ Cumberland County Register of Wills filing fee 1,000.0( 3,500.0( 15.0( TOTAL (Also enter on line 9; RecapituMation) 15 (If more space is needed, insert additional sheets of the same srze) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER Esther L. Smith Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreilmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Lifeline 19 9° 2. ICredit card 3. Blue Cross 4. ~Retumed retirement payment 15.0C 370.41 296.9 TOTAL (Also enter on line 1Q, Recapitulation) I s (If more space is needed, insert additlonal sheets of the same size) CORNERSTONE p O, Box 1 181, 5 East Gate Drive, Carlisle, PA 170 l 5 Federal Credit Union Telephone (7 t 7) 249- 166 I FAX (717) 249-8208 Memher founded -Service based vwvw.cornerstonefcu.coop August 10, 2009 To Whom It May Concern: As of July 30,2009, the balance in account 24765-01 was $25.08. ThE: balance in 24765- 07 was $5;3,25.55. Sincerely;' Lindsey Miller Member Service Rep Comerstana federal Credit Union AUG 1 Q 2019 ~0 Box t 181 alt to riv ar ...e. - 1~H1~ . YOUR SAVINGS FEDEEtALLY INSURED TO AT LEAST $ I OO,000 BY THE NATIONAL CREDIT UN~ON ADMINISTRATION NEW YORK LIFE INSURANCE AND ANNUITY CORPORATION 51 MADISON AVENUE NEW YORK, NEW YORK 10010 I~~~III~~~III~~~~~~il~l~l~l~l~~~l~~ll~~l~l~l~~~ll~~~~l~ll~~i~l CHARLES K SMITH 1562 NEWVILLE RD CARLISLE PA 17013 POLICY NUMBER 58279726 DECEASED SMITH ESTHER L. CLAIM NUMBER 177460 DATE 08/28/2009 PAYEE CHARLES K SMITH TOTAL AMOUNT 1562 NEWVILLE RD DUE PAYEE 27,474.83 CARLISLE PA TAXABLE GAIN 104.59 FEDERAL TAX WITHHELD 0.00 STATE TAX WITHHELD 0.00 PAYMENT AMOUNT 27,474.83 IF YOU HAVE ANY QUESTIONS OR REQUIRE FURTHER ASSISTANCE,', PLEASE CONTACT OUR VARIABLE PRODUCT SERVICE CENTER AT 1-800-598-2019 THE SETTLEMENT AMT WAS CREDITED TO THE CONTINUED INTERES1f ACGOUNT. YOUR ACCOUNT STARTER KIT WILL BE DELIVERED BY OUR AGENT SHORTLY. NEW YORK LIFE INSURANCE AND ANNUITY CORPORATION 51 MADISON AVENUE NEW YORK, NEW YORK 10010 I~~~III~~~III~~~~~~II~I~1~1~1~~~1~~11~~1~1~1~~~11~~~~1~11~~1~1 CHARLES K SMITH 1562 NEWVILLE RD CARLISLE PA 17013 POLICY NUMBER 58279766 DECEASED SMITH ESTHER L. CLAIM NUMBER 177460 DATE 08/28/2009 PAYEE CHARLES K SMITH TOTAL AMOUNT 1562 NEWVILLE RD DUE PAYEE 1,696.02 CARLISLE PA TAXABLE GAIN 1,696.02 FEDERAL TAX WITHHELD 0.00 STATE TAX WITHHELD 0.00 PAYMENT AMOUNT 1,696.02 IF YOU HAVE ANY QUESTIONS OR REQUIRE FURTHER ASSISTANCE, PLEASE CONTACT OUR VARIABLE PRODUCT SERVICE CENTER AT 1-800-598-2019 THE SETTLEMENT AMT WAS CREDITED TO THE CONTINUED INTERESI~ ACCOUNT. YOUR ACCOUNT STARTER KIT WILL BE DELIVERED BY OUR AGENT SHORTLY. NEW YORK LIFE INSURANCE AND L ANNUITY CORPORATION BOX 6916 CLEVELAND OH 44101-6916 I„~IU.~,111.~~.~II~I~I~I,I~~~I„II,~I~I,I~~~II„„I,II.~I~i CHARLES K SMITH 1562 NEWVILLE ROAD CARLISLE, PA ],7015-9489 EXPLANATION OF BENEFITS PLEASE DETACH AND SAVE FOR YOUR RECORDS 0780 CHECK NO: 0003129094 SEPTEMBER 09, 2009 PAYEE: CHARLES K SMITH OWNER: ESTHER L SMITH POLICY NUMBER: 74701925 TRANSACTION: DEATH CLAIM PAYwIENT TO BENEFICIARY PLEASE FIND YOUR ENCLOSED CHECK. DETAILS ARE AS FOLLOWS: GROSS PAYMENT AMOUNT: FEDERAL TAX WITHHELD: STATE TAX WITHHELD: 510,501.77 AMOUNT OF CHECK: 0.00 0.00 10,501.77 NOTE - DO NOT USE CHECK AS A MEANS OF CHANGING YDUR ADDRESS. BE SURE TO LET US KNOW IF WE CAN BE OF FURTHER ASSISTANCE TO YOU. ANNUITY SERVICE MANAGER NEW YORK LIFE INSURANCE AND ANNUITY CORPORATION BOX 6916 CLEVELAND OH 44101-1916 I~~~III~~~III~~~„~il~l~l~l~l~~~l~~ll~~l~l~l~~~ll~~~~l~ll~~l~l CHARLES SMITH b562 NEWVILLE ROAD CARLISLE, PA 17015-9489 EXPLANATION OF BENEFITS PLEASE DETACH AND SAVE FOR YOUR RECORDS 0780 CHECK NO: 0003128770 SEPTEMBER 08, 2009 PAYEE: CHARLES SMITH POLICY NUMBER: 53888994 TRANSACTION: DEATH CLAIM PAI~MENT TO BENEFICIARY WE ARE PLEASED TO ENCLOSE YOUR CHECK. DETAILS ARE AS FOLLOWS: PORTION PAYABLE TO BENEFICIARY: 533,596.69 MISCELLANEOUS INTEREST PAID: 135.30 FEDERAL TAX WITHHELD: 0.00 STATE TAX WITHHELD: 0.00 AMOUNT OF CHECK: 33,731.99 52,201.45 IS TAXABLE TO THE PAYEE BE SURE TO LET US KNOW IF WE CAN BE OF FURTHER ASSISTANCE TO YOU. ANNUITY SERVICE MANAGER