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HomeMy WebLinkAbout01-05-10- ~ 1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county Code near File Number - Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.28oso~ 2 1 0 9 0 3 18 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 206 32 3940 03 13 2009 08 04 1941 Decedent's Last Name Suffix Decedent's First Name MI SMITH JILL K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BEfILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 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-t32) g. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ], 8. Total Number of Safe Deposit Boxes L-~ (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 1 D, Spousal Poverty Credit ((date of death ~ 11. Election to tax under Sec. 9113(A) ^ between 12-31-91 and i-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 WM. D. SCHRACK III 717 432 9733 R, Firm Name (If Applicable) SCHRACK & LINSENBACH First line of address 124 W. HARRISBURG Second line of address ST., P.O. BOX 310 City or Post Office DILLSBURG C7 REGISTER ~ 'lLLS USB.ONLY r - i _ v n x~ Wi - ~ . t ,.~~ ~ cn ~•~ _ <~ -v ~"~ c~ -n ~ ~_~ --i N ~. :~ DATE FILED ~p State ZIP Code PA 17019-0310 ~_? ;._.~ c:`~ '~ T ~' r-:'1 c~ _f..r 555 Blanchester Road, Harrisburg, PA 17112 SIGNATURE OF PR~PAREJrIKHER THASI REPRESENTATIVE DATE Wm. D. Schrack III ~a , ~ f, ADDRESS ' Schrack 8~ Linsenbach PC 124 West Harrisburg Street, PO Box 310, Dillsburg, PA 17019-0310 Side 1 1505607120 1505607120 J Correspondent'se-mail address: SChracklaW@COmCaSt.net 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. J 1505607220 REV-1500 EX Decedent's Social Security Number Decedents Name: J I I I K. Smith 2 0 6 3 2 3 9 4 0 RECAPITULATION 1. Real Estate (Schedule A) ...................................................................................... 1. 2. Stocks and Bonds (Schedule B) .............................._..........................._.............. 2. 5 9, 6 8 0. 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .............................__....................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6 , 1 1 5 . 0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7. g. Total Gross Assets (total Lines 1-7) ............................._,...........................__..... 8. 6 5, 7 9 5. 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ............................._................................... 11. 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) ..................... .................... ..... 14. 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 .00 0 . 0 0 15. 16. Amount of Line 14 taxable 16 at lineal rate X .045 0 0 0 . 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ............................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 12,218.00 89,973.00 102,191.00 -36,396.00 -36,396.00 0.00 0.00 0.00 0.00 0.00 Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-0318 DECEDENT'S NAME Jill K. Smith STREET ADDRESS 2100 Bent Creek Boulevard CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 3. Total Credits (A + B + C) InteresUPenalty if applicable (2) 0.00 __ p. Interest E. Penalty Total Interest/Penalty {D + E) (3) 4. if Line 2 is greater than Line 1 + Line 3, enter the difference. This is th~VERPAYMENT. - (q) -- - Check box on Page 2 Line 20 to request arefund --- ---- , 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (56) ~ . ~ Q 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 :................................ n ^ c. retain a reversionary interest; or .............................._............................_............................._................ tr~J ^ 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 Jufy 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 statutedoes not exemota 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)J. 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) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Jill K. 21-09-0318 Ail property Jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 Franklin Templeton Investments -Account 59,546.00 #129-12911798869 (proceeds of redemption) 2 9 Redemption of bond in estate of decedent's father 134.00 TOTAL (Also enter on Line 2, Recapitulation) 59,680.00 (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-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Smith, Jill K. 21-09-0318 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly owned with the right of survivorship must be disclosed on schedule F. Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) (If more space is neetletl, atltllnonal pages or me same slze~ REV-1151 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF I FILE NUMBER Smith, Jill K. 21-09-0318 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTSe Personal Representative's Commissions Name(s) of Personal Representative(s) Maria F. Friel street Address 555 Blanchester Road city Harrisburg State PA zip 17112 Year(s) Commission paid 2, Attorney's Fees Schrack & Linsenbach 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. I Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,523.00 3,100.00 7,500.00 95.00 TOTAL (Also enter on line 9, Recapitulation) I 12,218.00 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 Smith, Jill K. 21-09-0318 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses Auer Cremation Services 1,523.00 H-A Subtotal 1,523.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1572 EX+ (12.08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Smith, Jill K. 21-09-0318 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Hospital telephone service -unpaid bill 104.00 2 ~ Internal Revenue Service - 2003 tax liability 3 ~ Internal Revenue Service - 2004 tax liability 4 ~ ROBC The Bridges at Bent Creek -balance due for repair of room damage 5 ~ ROBC The Bridges at Bent Creek -balance for room and board 57,792.00 19,561.00 5,093.00 7,423.00 TOTAL (Also enter on Line 10, Recapitulation) I 89,973.00 (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+ (~ 7-08) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Jill K. 21-09-0318 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE ~ AMOUNT OF ESTATE Do Not List Trustees ( /~/ords) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. ~116(a)(1.2)J PA I 3 ~ Total Enter dollar amounts for distributions shown above on fines 15 through 18 on Rev 15 00 cover sheet, as app ropriate, III 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 SHEE~ O.QO Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 1 i-08) REV-485 EX (1-07) SAFE DEPOSIT . BOX INVENTORY PA Department of Revenue 48500041046 PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death County Code Year File Number 2 0 6 3 2 3 9 4 0 0 3 1 3 2 0 0 9 !2 1 0 9 0 0 3 1 8 Decedent's Last Name Suffix First Name MI S M I T H J I L L K © ADDRESS OF DECEDENT STREET: CITY: STATE: ZIP CODE: 2100 P.~echani c sbur NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME: ~dl~7 D SCf~iA(~. III Attorn~-at-Law .- - - 1---__ - - - - - - STREETADDRESS: -- -- - - - CITY: ---- STATE: -- -- ZIP CODE: 124 W. Iiarrisbur St. P.O. Box 310 Dillsbur PA 17019-0310: NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. NAME: RELATIONSHIP: li9ARIA F. FRIF,L -- - _- Adrtinistratr~~ _- STREETADDRESS: CITY: STATE: ZIP CODE: b55 -.Blanchester-woad -_ - - -_ - - Ilarr?sburo, - -PA- - ---_17112___ b. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: c. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: PNC B~~, N.A. - ---- ---- ---- STREET ADDRESS: CITY: STATE: ZIP CODE: 312 Bri a Street P1ew Gta7berland PA 1707 NAME OF PER ON M G LAST ENTRY DATE AND TIME OF LAST ENTRY DATE OF CONTRACT TO RENT BOX • NUMB OF BOX ~! 1 TI~TL~NDER WHICH BO REGISTERED NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. NAME: b. NAME: _~IILL~. _SCII1~- -- - _- - - - - - _ -- --- - - - --- STREET ADDRESS: STREET ADDRESS: - 21.0 0 -Ben>~ _ _L`r-eQk Paul euard - -- - _ - -- - - - -- -- ---- - CITY: STATE: ZIP CODE: CITY: STATE: ZIP CODE: I.lechanicsburg, PA 17050 ® NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY I'-M. D. SCf-IP~AQ~ III At torne for WAS A WILL IN THE BOX? ^ YES ~ NO If yes, a. Date of will: b. Name and address of personal representative, if named in the will NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: - - - - - - -- c. Name and address of attorney, if any NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: 48500041046 48500041046 J SCHRACK ;eT LINSENBACH LAW OFFICES 124 W. HARRISBURG ST. P.O. BOX 310 D~LLSBURG, PA 17019-0310 PHONE (717) 432-9733 FAX (717) 432-1053 January 4, 2010 Register of Wills Cumberland County Court House One Courthouse Square Carlisle, PA 17013 Re: D/D: File #: Dear Register: Attorneys WM. D. SCHRACK III BRIAN C. LINSENBACH The Estate of Jill K. Smith March 13, 2009 21-09-0318 o ~ -, , ~_r _ae~ - ,~ -_ ~w , ~ P '~~ i ~ -`~ ;c J ~ -; ... J~ ~J ~~ C.~ _ _= J ~ ~ ~ ~ - . You wih find enclosed herewith the original and one copy of "Inheritance Tax Return - Resident Decedent", Form REV-1500, submitted on behalf of the Administrator of the above- notedEstate. Also enclosed is our check to cover the filing fee, along with a third signature page stamped "COPY", which I ask that you time stamp and return to me in the envelope provided. Please include the Official Revenue Receipt when returning the time stamped "face page". Thank you for your attention to this request. Sincerel , .-- Wm. D. Schrack III SCHRACK &LINSENBACH WDS/jsg enc. 0 O ~~ ~~ ~^ v, a 4 j xA N ~~ ~' ~ '" ~, ~ ..- ~~ ~' J ~' --~' ~~ ~ ~~ ~~` ~o~ ~.. ~ ~ ~_ .~. ~ -~ 1 --~- ,~_ ~~ d .._r ~ b Z -~ r ~r . SAFE DEPOSIT BOX INVENTORY Page _ °f _ _ REV-485 EX INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 ITEM NO. ITEM DESCRIPTION (6 Mint Proof sets: 1962, 1968, 1969, 1970 Uncirculated Mint sets:- 1963,_ 1964, _,1965, _19682), 1969 (2), 1970 _(~ U.S. Mint Special sets: .1961, 1966, 1967 Buffalo Nickels: 1937 (2) _ Mor Dollars: 18990, 19020 Barber Quarter: 18920 Standing Liberty Quarter: 1930 Barber Nickels: 1897 (2) __ Nickels: 1940s_(3), 1943s, 1947s (2 194 s 1 6, 1960 1965 Churchill Carmterative MEd 1 Pennies: 1960 and 1961 (uncirculated)_(3 rolls) _ Pennies: (1 roll/junk) _ _. ___ I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS CORRECT AND COMPLETE TO E BEST OF MY KNOWLEDGE AND BELIEF. PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: SIGNATURE SIGNATURE PRINT NAM Wbi. D. I I I __ _ - ---. _- _ PRINT NAME AND CHECK APPROPRIATE BOX BELOW: PRINT TITLE Attorney for Administratrix DATE 5/14/2009 - -- -_-_ CHECK APPROPRIATE BOX: ^Executor(trix) ^Administrator(trix) ^ Estate Representative ^ Joint owner of safe deposit box NU I t: Attach aaaltional 8'h" x 11" sheet(s) if necessary or use duplicates The Department Is authorized by law, 42 U.S.C. X405 ~c~1,2~~C,_ [ ~ ~~~~°-~-k° Sxaat Sec>Jh~y ~~ ~+;~° A