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HomeMy WebLinkAbout01-11-1015056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 21 09 ;00672 GIY 1 LR NC~rCIJC1V 1 IIVrVRMAI IVIV DCLVW Social Security Number Date of Death _.. _. Date of Birth 1 81-30 5 810 07/10/2009 ~ 05/05/1907 ~ I ; , . . ....... .... ......... ...... .. . .. ......... . ... _ Decedent's Last Name Suffix . ~ ... .. ... _ ~. ~ . . ...~...... .... ......... Decedent's First Name MI ... _. ........ ..... .. ~ . ~.. i Ringlaben ~ ~_. ,. ..., ~~ Winifred ~ (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 BE FILED IN DUPLICATE WITH THE .. ~_ ~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Cl~ 1. Original Return C~ 2. Supplemental Return C,~.9 3. Remainder Return (date of death prior to 12-13-82) C~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~~ 5. Federal Estate Tax Return Required death after 12-12-82) C",~::) 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) C:~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death C" ~, 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THiIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number _ _ _ . (. .. _.. I 7 ,,.. .... ....... .... . . 849 David W ,, Rln laben __....., . _; 9... ....._..... ... .... _... .. ~ ~ . 17 697 0 ..... ..... ..... Cirm Al~mn /If A...,Ii...~L.l~,\ State ZIP Code ity or. Post Office ...... _ ... .. ._ .. .. 'i _ .) ,. 1 ~ .,. .~. ;. _. . 1 ~7 ~ ...7 4,."':, e Mechanic s _ _ 50-5201 ~ ~-~, urg.. _. . , PA 170.._ ... .... _ .. Correspondent's a-mail address: dWringlaben@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. SIGN URE OF PERSON SPOAJSIB FOR FILING RETURN ` DAT ADDRESS ~ / ~f ~ / "cam / 7 a ,f-U SIGNATURE OF PREPARER O R THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 r J 15056052059 REV-1500 EX Decedent's Social Security Number Decedents Name: Winifred M Ringlaben ', 181-30-5810 RECAPITULATION ~~~~~~~~-~~-~--~-,_..__,.~..a.-......M.__._._..._....___._.-~~ 1. Real estate (Schedule A) . ............................................ 1. I, 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00 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) t~ Separate Billing Requested........ 7. 0.00 '' ..... ......... m.,,....,,...........,....., 0.00 2,717.63 1,112.52' 0.00 8. Total Gross Assets (total Lines 1-7) .................................... 8. 3,830.15 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. ', 58,775,453.78 ~I ,, ~.. "..~ ,_,." ...... ..." . m,.. ....,.. M, . ",w.. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. 5,877.01 ;, 12. Net Value of Estate Line 8 minus Line 11 ............................. ( > . 12. 'i; _ 2 046.86 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 _-._-._ ~~~ ~."„°~-.......w...~.....~._.,..~.,................W..~.~....~......._~._........~..Y._........._._ 15. Amount of Line 14 taxable at the spousal tax rate, or trans ers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable ,..... ~ .."....,, ..,. M. ". , r ..... ... .. ..... ....~.,. " .,. , ..,. at sibling rate X .12 17. j' 18. Amount of Line 14 taxable ~.. " "..,.. ..,,..,... ...... v ....,,....... , .,... at collateral rate X .15 1 g. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0.00 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: .__..,.. , .,._.,.,. Fllg,~tV..gJn~~~,.. ., ~ .,,,.,. .,..... ~~ 21 ~ 09 ~ ~ 00672 ..~_.....~.__..__ ~. ..,-.,_ .,,M.~„DECEDENT S SOCIAL S DECEDENT'S NAME ECURITY NUMBER Winifred M Ringlaben 181-30-5810 STREET ADDRESS 6114 Charing Cross CITY STATE ZIP Mechanicsburg PA 17050-5201 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0.00 2. CreditslPayments A. Spousal Poverty Credit 6. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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 fo: REGISTER OF WILLS, AGENT w ,. ~ . '~ , _ .'~ F ~,~~~:~~ ~~~ .. ~~ .. ~, ,. , ~~ I., R ~ ,~ . . 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 "intrust 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 (O) 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. REV-1502 EX+ (11-08) ~ pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT -- ESTATE OF FILE NUMBER Winifred M. Ringlaben 00672 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Winifred M. Ringlaben 00672 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1504 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Winifred M. Ringlaben 00672 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) SCNEDtlLE D COMMONwEA~TH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Winifred M. Ringlaben 00672 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASFI, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Winifred M. Ringlaben 0672 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 :Penn Treaty -Return of Unused Long Term Health Care Preimum 370.46 2 Penn Treaty -Long Term Health Care Benefits 1 550.00 3 Cumberland County -Veterans Burial Allowance 100.00 4 PSERS -Final Payment 493.99 5 Misc. Personal Property 200.00 6 Interest Earned on Estate Checking Accounts 3.18 TOTAL (Also enter on line 5, Recapitulation) $ 2,717.63 (If more space is needed, insert additional sheets of the same size) V • REV-1511 EX+ (10-09) ~ Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Winifred M. Ringlaben 00672 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Boyle Funeral Home_ 220.57 2 Ferdinands Resturant -Luncheon 390.20 3 Stewarts Florist -Flowers 498.20 4 Hampton Inn -Family Lodging 455.56 s, Top of the 80's -Family Dinner 223.00 s Miscellanous Supplies 65.25 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00 Claimant David W. Ringlaben Street Address 6114 Charing CrOSs city Mechanicsburg state PA zIP 17050 Relationship of Claimant to Decedent Son 4. Probate Fees: 76.00 5. Accountant Fees: 6. Tax Return Preparer Fees: ~. Postage 25.00 TOTAL (Also enter on Line 9, Recapitulation) $ 5,453.78 If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+ (6-98) SCHEDt~LE F COMMONWEALTH OF PENNSYLVANIA ,JOINTLY OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Winifred M. Ringlaben 00672 If an asset was made joint within 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. David W. Ringlaben 6114 Charing Cross Son Mechanicsburg, PA 17050 B' Elizabeth F. Ringlaben 6114 Charing Cross Daughter-In-Law Mechanicsburg, PA 17050 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 °k OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 05102/09 M&T Checking Account Number 9841240964 3,340.91 33 1,112.52 B 05/02109 M&T Checking Account Number 9841240964 33 TOTAL (Also enter on line 6, Recapitulation) I a 1,112.52 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Winifred M. Ringlaben 00676 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) ~ pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) 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).J 1. None 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 IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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 REV-1514 EX+ (4-09) ~ pennsylvania DEPARTMENT OF REVENUE Bureau of Individual Taxes PO Box z8o6oi Harrisburg PA i~i28-0601 SCHEDVLE K LIFE ESTATE, ANNUITY & TERM CERTAIN (CHECK BOX 4 ON REV-s5oo COVER SHEET) ESTATE OF FILE NUMBER Winifred M. Ringlaben 00672 This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME ©F LIFE TENANT DATE OF $IRTH NEAREST AG1E AT DATE OF DEATH TERM Of YEARS LIFE ESTATE IS PAYABLE None ^ Life or ^ Term of Years ^ Life or ^ Term of Years O Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable .........................................$ 2. Actuarial factor per appropriate table ............................................... . Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) ....................................$ NAME OF LIFE ANNUITANT • DATE OF BIRTH ~ NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ...........................................$ 2. Check appropriate block below and enter corresponding number ................ . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (See instructions.) ................................................ . 7. Value of annuity - If using 3.5, 6, or 10%, or if variable rate and period payout is at end of period, calculation is Line 4 x Line 5 x Line 6 ...........................$ If using variable rate and period payout is at beginning of period, calculation is (Line 4 x Line 5 x Line 6) + Line 3 ...............................................$ NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. If more space is needed, use additional sheets of the same size. 3N ~~. 30 . o~ ~t~3ocx~ ~fI~P)