HomeMy WebLinkAbout04-0083 REV-1500
COM~ONWEALT. O" PE.NSVLVA.,A I N H E RITAN C E TAX RETURN
DEPARTMENT OF REVENUE
OEPT. 28o~o~ RESIDENT DECEDENT
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SHEAFFER, Rema M.
DATE OF D~ATH (MM-DO-YEAR) DATE OF BIRTH (MM-DO:yEAR)
10/19/2003 03/04/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( t. AST, FIRST AND MIDDLE INITIAL)
Sheaffer, Meryl H.
[] 1. Original Return [] 2. Supplemental Return
[] 4 Limited Estate [] 4a. Future Interest Compromise (date of death after
12-12-82)
[] 6. Decedent Died Testate (Attach copy [] 7~ Decedent Maintained a Living Trust (Attach
of Will) copy of Trust)
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
193-12-8595
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
] 3. Remainder Return (date of death prior to 12-13-82)
[] 5. Federal Estate Tax Return Required
0 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
12-31-91 and_ 1-1-95)
iTHiS sEcTiON MUST BI=~oMPLETED:ALL cORRESPONDENCE AND CONFIDENTIAL T~ INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Ivo V. Otto III, Esquire
~ i FIRM NAME (If aPplicable)
Martson Deardorff Williams & Otto Ten East High Street
:TELEPHONE NUMBER Carlisle, PA 17013
717/243-3341
1. Real Estate (Schedule A) (1) None
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 4,899.86
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) None
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 7,9 ! 4.74
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(8) 4,899.86
(11) 7,914.74
(12) insolvent
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
c~ 16.Amount of Line 14 taxable at lineal rate x .045 (16)
= 17.Amount of Line 14 taxable at sibling rate x ,12 (17)
O
,~ 18. Amount of Line 14 taxable at collateral rate
,- x .15 (18)
19. Tax Due (19)
20. []
........ >> B~'~-RE~0~'I~I~wER .~.~-~UE~I(~$ 6~I~:~D~-ND-R~HE~K MATH <<
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
· STREET ADDRESS
CITY
122 Lebo Road
Carlisle
STATE ZIP
PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E)
(3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENI (4)
Check box on Page I Line 20 to request a refund
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
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 "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.
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
preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
M. Thomas Sheaffer
SIGNATL
ADDRESS DATE
130 Lebo Road
Carlisle, PA 17013 /-2.~,-O
ADDRESS
DATE
/- ,-/
ADDRESS DATE
Ivo V.
R THAN REPRESENTATIVE
Ten East High Street
Carlisle, PA 17013
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 3% [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 0%
[72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes 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 0% [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 4.5%, 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 12% [72 P.S. §9116 (a) (1.3)]. 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONALPROPERTY
ESTATE OF FILE NUMBER
SHEAFFER, Rema M. 21 - 03 -
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.
ITEM
NUMBER
DESCRIPTION
M&T Bank CD # 31003~10993590
TOTAL (Also enter on Line 5, Recapitulation)
VALUE AT DATE OF
DEATH
4,899.86
4,899.86
SCHEDULE H
FUNERAL EXPENSES &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN ADIVIIN~llVE COSTS
RESIDENT DECEDENT
ESTATE OF
SHEAFFER, Rema M.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
1 Egger Funeral Home, Newville PA
FILE NUMBER
21 - 03 -
AMOUNT
7,904.74
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
State Zip
5. Accountant's Fees
6. Tax Return Preparer's Fees
Other Administrative Costs
Register of Will, filing fee, Inheritance Tax return
10.00
TOTAL (Also enter on line 9, Recapitulation) 7,9]4.74
REV-1513*EX+ (9-00) ~
' SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SHEAFFER, Rema M.
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Merle H. Sheaffer
Green Ridge Village, 210 Big Spring Road
Newville, PA 17041
FILE NUMBER
21 - 03 -
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
Spouse
AMOUNT OR SHARE
OF ESTATE
(insolvent estate)
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
BUREAU OF ZNDZVZDUAL TAXES
ZNHERTTANCE TAX DZVZSZON
DEPT. 280601
HARRZSaURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTZONS AND ASSESSMENT OF TAX
TVO V OTT ]:T'r ESQ '04 r'IAR 12 P1:44
MARTSON ETAL
10 EAST HTGH STREE~is,:h
DATE
ESTATE OF
DATE OF DEATH
FZLE NUHBER
COUNTY
ACN
05-15-2004
SHEAFFER
10-19-2005
21 04-0085
CUMBERLAND
101
Amount Ram i'l:'l:ed
REV-I$~7 EX AFP (01-03)
RENA H
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGZSTER OF WZLLS
CUHBERLAND CO COURT HOUSE
CARLZSLE, PA 17015
CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~
REV-Z547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR
DZSALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX
ESTATE OF SHEAFFER RENA M FZLE NO. 21 04-0083 ACN 101 DATE 03-15-2004
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RES~.~VATZON CONCERNZNG FUTURE ]:NTEREST - SEE REVERSR
APPRAZSED VALUE OF RETURN BASED ON: ORZGZNAL RETURN
1. Real Es~a*a (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
$. CZosaZy Held S~ock/Par~narship Zn~ares~ (Schedule C) ($)
~. Hor~gages/No~es Rece/vable (Schedule D) (~)
5. Cash/Bank Daposi~s/HLsc. Personal Proper~y (Schedule E) ($)
6. Jointly O~nad Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTZONS AND EXEHPTZONS:
9. Funeral Expansas/Adm. Cos~s/Hisc. Expenses (Schedule H) (9)
10. Dab~s/Nor~gaga Liabilities/Liens (Schedule Z) (10)
11. To,al Deductions
12. Na~ Value of Tax Re*urn
15.
1~.
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Na~ Value of Es*a~e Sub,ac* ~o Tax
4~899.86
.00
.00 NOTE: To Lnsure proper
.00 crad~ ~o your account,
.00 subai~ ~he upper portion
.00 of ~hLs form wi~h your
~ax payman~.
.00
(8)
7,914.74
NOTE:
ASSESSHENT OF TAX:
15. Amoun~ of L/ne 1~ a~ Spousal ra~e
16. Aaoun~ of L/ne 1~ ~axabla a~ Lineal/CZass A ra~a
17. Aaoun~ of Line 1~ a~ Sibling ra~a
18. Aaoun~ of L/ne 1~ ~exable a~ Collateral/Class B ra~e
19. Pr/nc/pal Tax Due
TAX CREDZTS:
PAYHENT RECEZPT DZSCOUNT
DATE NUMBER ZNTEREST/PEN PAZD (-)
4,899.86
(is), .00 x O0 = .00
(z6) .00 x 045= .00
(17) . O0 x 12 = . O0
(18) .00 x 15 = .00
(19)= . O0
AHOUNT PAZD
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZDNAL ZNTEREST.
.00
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUZRED.
1F TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.)
Zf an assessment was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 will
re~lect ~lgures that /nclude the total of ~LL returns assessed to date.
.00
(11) 7.91~. 7~.
(12) 3,01~i.. 88-
(13) . O0
(z~) 3,014.88-
RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves tho right to appraise and assess transfer inheritance Taxes
at the lamful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act Z3 of Z000. (TI P.S.
Section 91~0).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NZLLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special lq-hour
answering service for forms ordering: Z-aOO-36Z-Z050; services for taxpayers with special hearing and / or
speaking needs: 1-BO0-4qT-3OgO (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals~ Dept. zalozz, Harrisburg, PA ITIza-IozI, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
PURPOSE OF
NOTICE:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060I, Harrisburg, PA l?lgB-060!
Phone (717) 787-6505. See page 5 of the book[et "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, e five percent (SI) discount of
tho tax paid is allowed.
The ISZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January I8, lg96, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one fl) day from the date of
death, to the date of payment. Taxes which became delinquent before January l, 19az bear interest at the rate of
six (6Z) percent par annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January l, 19az will bear interest at a rate which will vary free calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for I98Z through ZO0~ are:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rate Factor
[~ 20X .0005q8 ~J~'a-1991 llX .00030I'
1983 16Z .OOOq38 1992 92 .0002~7
19Bq llZ .O0030l X993-X99q 7X .OOOXQ2
1985 X3X .000356 1995-X998 9Z .0002q7
X986 102 .00027~ X999 72 .O00Xgz
1987 lOX .O00Z7q ZOO0 7Z .O00lgZ
--Interest is calculated as follows:
Daily
Year Rate Factor
~ 9X .OOOZq7
ZOO2 62 .O0016q
2003 5Z .000137
200~ ~X .000110
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY 'rNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment ts made after the interest computation date shown on the
Notice, additional interest must ba calculated.