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Home My WebLink About12-30-09J 15056041125 REV-1500 EX (06-05) PA Department of Revenue ~~ ~ .~J ~ ~u~, ~ ~ OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 0 0 6 0 0 6 2 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 4 1 2 2 5 8 5 8 0 4 1 6 2 0 0 6 0 3 2 7 1 9 3 0 Decedent's Last Name B O L L E S Suffix Decedent's First Name P A U L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN MI S MI APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Return Required ^X 6. Decedent Died Testate ~ death after 12-12-82) 7. Decedent Maintained a Livin Trust g (Attach Copy of Will) (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death b ~ 11. Election to tax under Sec 9113(A) etween 12-31-91 and 1-1-95) . (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR Name MATION SHOULD BE DIRECTED T0: Daytime Telephone Number W I L L I A M P D O U G L A S 7 1 7 2 4 3 1 7 9 0 Firm Name (If Applicable) D O U G L A S LAW O F F I C E REGISTER OF WILLS US~,,,,QNLY ~ n First line of address , ,~, i i ~- Q ° ~~--r 4 3 W S O U T H S T ~~ ~ - i~- " Second line of address ~ I _ ~ t~ r...._ C 7 _; ~ ~ ~~ W ,-,.~ _... y7 a t...1 ~ ~ City or Post Office ~ '~ ' ~+ State ZIP Code ~ ._,E FILED -- :- I:~' ~ --•• ---~--r~~l C A R L I S L E P A 1 7 0 ,~ 1 3 w ~~/~ ~.,fl> 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 15056041125 J J 15056042126 REV-1500 EX Decedent's Social Security Number decedent's Name: Pau 1 S. B o 11 e s 0 4 1 2 2 5 8 5 8 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 8~ Notes Receivable (Schedule D) . , , , , , , .... . 4. 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ...... , 5. 7 6 0 0 6 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Re uest d 6 q e ....... . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Re uest d q e ....... 7. 8. Total Gross Assets (total Lines 1-7) .... , , , , , .. 8 7 6 0 0 6 ................ . 3 9. Funeral Expenses & Administrative Costs (Schedule H) ... ............. 9. 8 0 5 3 4 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 11. Total Deductions (total Lines 9& 10) ........... 11 8 0 5 3 4 ................ . 0 12. Net Value of Estate (Line 8 minus Line 11) ,, , , , , , , , , , , , , 12 - 4 5 2 7 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 - 4 5 2 7 7 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICA ........ BLE RATES ....... . 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 0 0 15, 0 0 0 16. Amount of Line 14 taxable at lineal rate X .0 0 0 0 16 0 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 O 0 0 18 0 0 0 19. Tax Due ................................................19. 15056042126 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042126 J RED{-1500 EX Page 3 File Number Decedent's Complete Address: 00627 DECEDENT'S NAME Paul S. Bolles STREET ADDRESS _4111 Nursery Road ---------------- CITY York ~ STATE ;ZIP PA ~ 17404 Tax Payments and Credits: ~ ~ Tax Due (Page 2 Line 19) 2. Credits/Payments (1) $0.00 A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable Total Credits (A + B + C) (2) $0.00 D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Total Interest/Penalty (D + E) (3) $0.00 Fill in oval on Page 2, Line 20 to request a refund . (4) $0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE . (5) $0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE . (56) $0.00 Make Check Payable to.• REG/STER OF lil//LL S, 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; ... ^ ........................ ........................................... X b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^ c. retain a reversionary interest; or ....... ^ .............................................. X ........................................... . receive the promise for life of either payments, benefits or care? ..... ^ .................................................. ^ X 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........ ^ ............................................................................... ^ X 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................... ^ ................................................................... ^ X 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)J. 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)]. 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. RE,V-1508 EX,+ (6-98) SCHEDlJLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITSa ac MASC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF Paul S. Bolles FILE NUMBER 00627 Include the proceeds of litigation and the date the proceeds were received by the estate. Ali property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~ ~ F & M Trust Checking account 34-08043 OF DEATH $7,224.40 2~ UCC Home, refund $376.23 TOTAL (Also enter on line 5, Recapitulation) I $ (If more space ~s needed insert add~onal sheets of the same size) 7, 600 63 REVo1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Paul S. Bolles FILE NUMBER 00627 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT ~ • Heffner Funeral $4, 807.40 B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Douglas Law Office 3• Family Exemption: (If decedents address is not the same as claimants, attach explanation) $ ~ , 500.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees $87.00 5. Accountants Fees 6• I Tax Retum Preparers Fees ~• Ucc Memorial Home 8. Misc. credit cards and utility bills $795.00 $864.00 TOTAL (Also enter on line 9, Recapitulation) ~ $ (If more space is needed insert additional sheets of the same size) $, 053 40 REV-1513 EX + (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT C[~TwTe- i.~ SCHEDULE J BENEFICIARIES Paul S. Bolles FILE NUMBER 00627 NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under ~o Not List Trustee(s) OF ESTATE Sec. 9116 (a) (1.2)j 1. Susan Bolles-Martens, daughter co Jenine J. Kerr Lineal 926 Hamilton St., Carlisle, PA 17013 2. Jane Gress, daughter 4111 Nursery Road Lineal Dover, PA 17315 3. Jenine J. Kerr, daughter 926 Hamilton St. Lineal Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEE II. NON-TAXABLE DISTRIBUTIONS: T A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. I 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) ~ ' CHAMBERSBURG BOILING SPRINGS MARION 0022 0017 3146 Y MONT ALTO NEWVILLE SHIPPENSBURG STATEMENT OF ACCOUNTS ~~ WAYNESBORO CARLISLE 34-08043 ~~ STATEMENT PERIOD ~~ FROM THROUGH ....~.~ ~~~~~~~i~i~~~~i~~~i~~~~~~~~~~~i~~~~~~~~ii~~~~~~~~~~~~~~~~~i~~~ 5-15-06 6-13-06 1692 0.6620 AB Ou317~3-DIGIT 170 PAGE l O F 13 1 71 PAUL S BOLLES 1 201 TODD CIRCLE CARLISLE PA 17013-3596 O ENC LOSURES 5 PREVIOUS DEPOSITS/ CHECKS/ STATEMENT BALANCE CREDITS 1 DEBITS SERVICE ENDING 7,219.76 2.08 O FEES BALANCE .00 .00 7,221.84 INTEREST PAID THIS YEAR ACCOUNT/INTEREST INFORMATION 12.66 DATE,` ACTIVITY DESCRIPTION°REFERENCE DEPOSITS/ CHECKS/ CREDITS DEBITS 05-15 BEGINNING BALANCE BALANCE - 06-13 INTEREST CRECIT 7,219.76 06-13 ENDING BALANCE... 2.08 7,221.84 7,221.84 ~"~'~ ANNUAL PERCENTAGE YIELD EARNED DISCLOSURE FROM 5-15-06 THROUGH 6- ~~~ ANNUAL PERCENTAGE YIELD EARNED 13-06 AVERAGE DAILY 'COLLECTED BALANCE -35% INTEREST EARNED 7.219.76 2.08 SERVICE FEE ,BALANCE INFORMATION FROM 5-15-06 THROUGH 6-13-0 AVERAGE LEDGER BALANCE 7,219.76 AVERAGE COLLECTED BALANC MINIMUM LEDGER BALANCE 7,219.76 MINIMUM COLLECTED BAL E 7,219.76 ANCE 7,219.76 `~- ~ ~~ ~~~. RETAIN, FOB Y~3l1R R~OORD~ j ~ ~D &jut~ tin :~#res~ Chambersburg, PA 17201 ,' P REMITTER :~ U R ~-is~s C ~~ s sso H i PAYABLE TO ~ A j '~~~4 ~ 'E -' m ~~ O~'F1.CI~AL C.~i','E Ci~ ; E FOR , i ~' ~ s .. ~. .~ r,~ r i:< ,_ ~` I