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Home My WebLink About01-05-10J 1505607121 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 2 1 0 7 0 7 2 0 Hamsburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 1 1 6 4 7 7 4 0 2 0 1 2 0 0 7 1 1 1 4 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI KEL SO J R CARL (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI K E L S O BETTY L Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ^X 1. Original Return ~ 2. Supplemental Return ~ 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) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 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 ~ 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 H ANTHONY A DAMS 71 7 532 x;270 Firm Name (If Applicable) o REGIS ~1MLLS U ONLY ~ -'-° First line of address 49 WEST ORANGE STREET Second line of address S U I T E 3 City or Post Office SHI PPENSBURG State ZIP Code v .w ~ ~...,.. = -~ J ... ,X~ C.11 . ~ J ~ % c7 E - _ a,,~ ~~a } l._./ ~f'~ ti, ~ i _..-% C DATE FILED Cr.:y P A 1 7 2 5 7 correspondent's a-mail address: htadamslaw(c~embargmail.com 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 s based on all information of which preparer has any knowledge. IGNATU~ OON RESPONSIBLE FOR FILING RETURN DATE b ADDRESS 906 MUD LEVEL ROAD SHIPPENSBURG PA 17257 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 49 WEST ORA_ NGE STREET, SUITE 3 SHIPPENSBURG PA 17257 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505607121 1505607121 1505607221 REV-1500 EX Decedent's Social Security Number Decedent's Name: CARL KELSO, JR 2 0 1 1 6 4 7 7 4 RECAPITULATION 1. Real estate (Schedule A) ...................................... .. 1. 2 480 0 0 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 Deposits & Miscellaneous Personal Property (Schedule E) ..... .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ..... .. 7. • 8. Total Gross Assets (total Lines 1-7) ......................... .. 8. 2 4 $ 0 • 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. 2 4 8 0 • 0 0 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. 2 4 $ 0 • 0 0 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.oo 2 4 8 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable 0 0 0 0 0 0 at lineal rate x .0 1s . 17. Amount of Line 14 taxable 0 0 0 0 0 0 at sibling rate X .12 17. • 18. Amount of Line 14 taxable 0 0 0 0 0 0 at collateral rate X .15 . 1 g . 0 0 0 19. Tax Due ............... .......................... ..... ..19. . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505607221 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 07 0720 DECEDENTS NAME CARL KELSO, JR STREET ADDRESS 906 MUD LEVEL ROAD CITY SHIPPENSBURG STATE PA ZIP 17257 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 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. (1) 0.00 Total Credits (A + B + C) (2) 0.00 Total InteresUPenaity (D + E) (3) 0.00 (4) 0.00 (5) 0.00 (5A) (5B) 0.00 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; ............................... ^ ^X 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? ....................................................................................... ^ ^X 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 p2 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~ne 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. RSV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER CARL KELSO, JR 21 07 0720 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. T.B. WOODS COMMON STOCK 2,480.00 100 SHARES TOTAL (Also enter on line 2, Recapitulation) 15 (If more space is needed, insert additional sheets of the same s¢e) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER CARL KELSO JR 21 07 0720 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. BETTY L. KELSO Spousal 906 MUD LEVEL ROAD 100% SHIPPENSBURG, PA 17257 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I ~ (If more space is needed, insert additional sheets of the same size) t--_ USA FIRST-CLASS fOREV F r' U c ti S" a ti-- ~ ~ O 'C rn Y ~ ~ ~ ~ U <~ ti ~ ~ (n to ~ ~ p a~~'U ~ ~ r L ~ ~ U t6 L ~ O ~±1~ N Q- L L-.~ ~ O (a d? ~ ~ ~ N "~ to ~ ~ ~ in ~ ° '~ V ~ ° c i oc C~LL'U ~ ~U n ~ . A F y -~ ~~` '~d~0 ~ w a z ~ o ~€Z ~£ Nd a ~- ~~~~' Q!OZ g ~ ~ x ~, z ~ ~; F Z 11 ~ .,i ~ t4 I ._ )~ V J~ ' a .. .. _. ~ x W 3 ~ i J_. W . ~ a M ..... "' x ,~. , ,~,yM !~7 .~.. .,,~. M :~ ;i .'+t l.! ~iy ~i i?4 ~ r ~~} !!;! !~ nod t_~_t •i"~ t 3 -~