HomeMy WebLinkAbout01-13-10 (2)1505607121
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
BureauoflndroidualTaxes INHERITANCE TAX RETURN County Code Year File Number
PO 80X 280801 2 1 0 9 0 0 6 3
Harrisburg, PA 17128-0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
3 9 6 1 2 3 6 6 2 0 1 1 5 2 0 D 9 1 1 2 4 1 9 2 4
Decedent's Last Name Suffix Decedent's First Name MI
B O R G E S M A R Y E L L E N
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
G O R G E S W A Y N E H
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return 0 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)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 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
I V O V O T T O I I I, E S Q U I R E 7 1 7 2 4 3 3 3 4 1
Firm Name (If Applicable) - ---- -- -
REGISTE F WILLS US LY
M A R T S O N
First line of address
1 0 E A S T
Second line of address
City or Post Office
C A R L I S L E
L A W O F F I C E S ~ c`~ _-
~; ;; _ ~;
' ~ -C C7
,~>r-
H I G H S T R E E T I
r-;
~.~Ja _ .
State ZIP Code ~__- _-. _ Tf FILED r+°~
_- e~
P A 1 7 0 1 3 ~`
i' ~ 7
r~ .'_~
< ` ' ice?
~; --~
' ---'
t_'c~~
-~
_; 3
- r~ '
c,,'3 E; ~
_~ .~
correspondent's a-mail address: I O T T O a M A R T S O N L A W. C O M
Under penalties of perjury, l declare that 1 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 eny knowledge.
OF PERSON RE9PAAtSIBLE FOR FILING RETURN DATE
ADDRES
63 C LFAX ROAD HAVERTOWN PA 19083
SIGNATU P ARER OT~IER THAN REPRESENTATIVE DATE
10 E HIGH ST CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 1505607121 J
1505607221
REV-1500 EX
Decedent's Social Security Number
oecedent'sName: MARY ELLEN BORGES 3 9 6 1 2 3 6 6 2
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1.
2. Stocks and Bonds (Schedule B)
.................................. 2, 0 . 0 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 2 9 1 5 . 0 0
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 9 2 7 2 • 0 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• •
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 0 0
(Schedule G) ^ Separate Billing Requested ....... 7. •
8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 2 1 8 7• 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.
0. 0 0
0. 0 0
0. 0 0
1 2 1 8 7. 0 0
1 2 1 8 7. 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.0 0 0 D 15.
16. Amount of Line 14 taxable
1 2 1 8 7
0
0
at lineal rate X .045 . 1 s.
17. Amount of Line 14 taxable 0 0 D
at sibling rate X .12 17.
18. Amount of Line 14 taxable
0
0
0
at collateral rate X .15 18.
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0. 0 0
5 4 8. 4 2
0. 0 0
o. 0 0
5 4 8. 4 2
Side 2
1505607221 1505607221 J
REV-1500 EX Page 3
n___.~1....~~~ !`~w~n~nfn ArlflrpCC•
File Number
21 09 0063
LJG~+GUC~~a ~ vv...r..v.............,._.
DECEDENT'S NAME
MARY ELLEN BORGES ~ -----_------ - -- -
STREET ADDRESS
1000 West South Street - - - - -
- - -_
- _ _-- -
- -- STATE ZIP
CITY
Carlisle PA 17013
Tax Payments and Credits:
t. Tax Due (Page 2 Line 19) (1) 548.42
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty ifapplicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
(3) 0.00
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
4
00
0
.
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)
548.42
(5A) 6.69
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) S 5 S . I 1
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 : ...........................................................
.
income;
it
d
f ...........
...
........
^ X
...................
or
s
erre
b. retain the right to designate who shall use the property trans ^
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
^ X
^
wifhout 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 an or after July 1, 1994 and before January 1, 1995, the fax 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 (OJ 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 of death fo or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (O) percent [72 P.S. §9116(a)(1.2)j.
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. Asibling is defined, under
Section 9102, as an individual who has at feast one parent in common with the decedent, whether by blood or adoption.
REV-1507 EX + (6-98)
SCHEDULED
COMMONWEALTH OF PENNSYLVANIA MORTGAGES 8 NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARY ELLEN BORGES 21 09 0063
All property jointlyowned widh the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Note from John K. Rich dated October 21, 1989; additional amount receivable 2,915.00
(Note shown as $60,000.00 on original return)
TOTAL (Also enter on line 4, Recapitulation) ~ $ 2,915.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
MARY ELLEN BORGES 21 09 0063
Include the proceeds of litigation and the date the proceeds were received by the estate.
All propertvioinNv-owned with rioht of survivorshta must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Long Term Care Insurance, benefit 9,272.00
TOTAL (Also enter on line 5, Recapitulation) I S 9,272.00
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARY ELLEN BORGES 21 09 0063
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DI STRIBUTIONS include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
1. Donald W. Rich, III Lineal 4,062.33
63 Colfax Road
Havertown, PA 19083
2. Toni Rich Bonnette Lineal 4,062.34
306 Kings Highway East
Haddenfield, NJ 08033
3. John K. Rich Lineal 4,062.33
17119 Carriage Dale Court
Spring, TX 77379
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
1.
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 fhe same size)