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HomeMy WebLinkAbout12-02-09 (2) 1505607121 REV-1500 Ex (~5) PA DepaMlent of Revenue County Code Year File Number Bureau ~ kldlvdual Taxes INHERITANCE TAX RETURN Po Box 21106(11 2 1 0 9 0 0 3 2 1 H PA 1712&0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death Date of Birth 2 0 5 0 9 9 9 4 5 0 3 D 2 2 0 0 9 D 3 2 3 1 9 2 0 Decedent's Last Name Suffix Decedent's First Name MI H E S S A N N A R (If Applicable) Eller Surviving 8pouse's Information Below Spouse's Last Name Suffix Spouse's F'ust Name Spouse's Social Security Nu^:~~: FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI © 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ 4. Limked Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Retum Required death after 12-12-82) 0 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Braces (Attach Capy 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 MlFORMATIOII SftOl1LD BE DIRECTED Td: Name Daytime Telephone Number D A V I D H R A D C L I F F E S Q 7 1 7 2 3 6 9 3 1 8 Firm Name (If Applicable) REGISTER OF NfILLS USE ONLY R A D C L I F F L A W O F F I C E P C o First line of address ~ .`moo .x ;E C=~ . 1 0 1 1 M U M M A R O A D Second line of address S U I T E 2 0 1 City orPost Office L E M O Y N E Crxreapondenrs e-mail address: DHRADt~IX.NETCOIi Under penalties of perjury, I declare that I have examined this return, indu R is true, correct and complete. Dedara6on of preparer other than the pen PEf;40N RESPONS ' _' ~~.,.,, ~ ~ -. t :7 t ~ ;~ }~-~3 N ~'tn7~ ~ ~ State ZIP Code ~ D ti ~ '~y> -~ '-- "`:~ °y~i _.. '.'n P A 1 7 0 4 3 =~~ ~• ~ ~~~'~;~ _ end statements, and b the best of my knowkjdge and belief, all infamalion of which preparer has any knowledge. DATE it-3e_oq ADDRESS 1172 FAIRWAY CLUB LANE ~1 ESTES PARK CO 80517 Side 1 15056D7121 1505607121 PLEASE USE ORIGINAL FORM ONLY f ~ • 1505607221 REV-1500 EX pecedenNs Social Security Number 2 0 5 0 9 9 9 4 5 oscaasM'sName: ANNA R• HESS RECAPITULATION 1. Real estate (Schedule A) ................................... ..... 1 • 3 3 4 , 7 8 2. stocks and Bonds (ScMdule B) ............................. ..... 2. 3. Goaely Held Corporation, Partnerehlp or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) • • • • • • • • • • • • • • • • • • ~ • • • • • 4• • 2 2 1 0 6 6. 2 5 5. Cash, Bank Deposits 6 Miscellaneous Peraorrel Property (Schedule E) .. ..... 5. 8. Jointly Owned Properly (Schedule F) ^ Separate Biling Requested .. ..... 8• • 7. inter-Vlvos Transfers 3 Miacetlaneous NSQ;Probate Property 7 (Schedule G) L( separate Billing Requested .. ..... . 8 2 2 1 4 0 1. 0 3 8. Total Gross Assets (total Lines 1-7) ....... ...... . 9 1 0 5 5 7 , 6 6 9. Funerel Expemua & Administretive Coate (Schedule H) .......... .... . . . ...... 10. Debts of Decedent, Mortgage Liabilities, R liens (Schedule I) ..... .10. 1 0 3 9 0 , 1 4 11. Total Deductions (total Lines 9 & 10) ..................... ..... . 11. 2 D 9 4 7. 8 0 12. Nat Valw of Estate (Line 8 minus Line 11) ................... ..... . 12. 2 0 0 4 5 3 , 2 3 13. Charitebb Bind Governmental BequeatslSec 9113 Truata for which an elsdion to tax has not been made (Schedule J) ........... ..... . 13. 14. Nat Value Subject to Tax (Lure 12 minus Line 13) ...... , 14. 2 O 0 4 5 3. 2 3 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sac. 9118 0 0 0 15 D. 0 0 . . 18. Amount of Line 14 taxable 2 0 0 4 5 3. 2 3 16 9 0 2 0. 4 0 al lineal rele X •045 • 17. Amount of Line 14 taxable 0 0 0 17 0 • 0 0 at abling rate X .12 18, Amount of Line 14laxeble 0. 0 0 1 g 0. 0 0 al collateral rete X .15 , 9 0 2 0. 4 0 19. Tax Dw , 1 g. 20. FILL 1N THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 L 1505607221 1505607221 REV-1600 EX. Papi 3 w__~ J~.~Yw Aw...w~w1s SaleR!!!• File Number 21 09 00321 YVMQMaua v vv.. q..~~ • ~~~• ---_ DECEDENTS NAME ANNA R. HESS ______- - -- STREETADDRESS 100 MT ALLEN DRIVE ._____ - - __._..__-_-• an ~ srnre Z1p MECHANICSBt1RG PA 17055 Tax Payments and Ctredi~: 1. Tax Due (Page 2 Line 19) (1} 9,020,40 2. CredildPaymenta A. Spousal Poverty Credit B. Prtar Payments 8,000.00 C. Diacasrt 421.04 Total Credits { A +B +C) (2) 8,421.04 3. InteresUPerrally it applicable D. Interest E~ Penefty Total intereatlPenalty (D+E) (3) 0.00 4. H Line 2 is greater Oran Una 1 + Line 3, errthr the difference. This is the OVERPAYMENT. FlII in ovN on Page 2, Llns 20 to request a rotund. l4) 0.00 5. if Line 1 + Line 3 is greeter then tine 2, enter the dNterenoe. This is the TAX DUE. (5) 599.36 A, Enter the Interest on Ore tax due. (5A) B. Enter tits total of Une 5 +5A. This b the BALANCE DUE. (5B) 599.38 Make Check Payable fo: REGISTER OF W/LLS, AGENT .. ,.: , .: ,.;;r , .. , ,:. ,,, . .~ PLEASE ANSWER THE FOLLOWING gUE8TKNIS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deoederd make a Nerrsfer and: Yes No a. retain the use a income of the property tr~sferred : ........................................................... erly treneferred a its income : ro nete who shall use Ore th i ht t d l ........... ..... . .................... p p e r g o es g b. relakr c. r~afn a reverakxrary Interest: or .......... ................................................................... .... . ........... d. receive Ore promise (or Nfe of eiOter paymerrts, berreTits a care? ............................................ ........... If daaOr aorxared after December 12,1982, dkt decedent transfer propeAy widrin one year of death 2 . wrilroul receiving adepuate oonaideretion? ............................................................................ ' ' ........... a peyaae upon deatr bank account a aeardty at hb a her death? in toot for 3. Did decedent own an ........ . L! 4. Old decadent awn an lndNAdual Retirement Account, annuity, or other non-probate properly whNOr contains a txirraflciery dealgneOon? ....................................................................................... .......... . ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 1.4 YES, YOU MUST COMPLETE SCHEDULE 0 AND FILE IT AS PART OF THE RETURN. •. ; For dales of dea0r on a alter July 1,1994 and before January 1,1995, the toot rate imposed on the net value of transfere to or for the use of the surviving spouse is three (3).per6ent ]T2 P.S: $gi~iii ;:; i ~ :.; :.:: For dates of deaO- on a after January 1,1895, fire tax rate Imposed on the net value of transfers to a for the use of the suMving spouse is zero {0) percent p2 P.S. §9118 (a) (1.1) (IIU. The atahde a transfer a a surviving spouse Nom loot, and the statutory requirements for disdo~re of assets end badg a tax Tatum are etin appttcaae even K the aravivkrg spouse la the any berreficlery. Fa dates of deMh on a althr JrAy 1,2000: The tax rate imposed on the net value of transfers from a deceased chNd twenty~are years of age a younger at death to odor the use of a natural parent an adoptlve parent or a srent a Ore child is zero (0) peroent (12 P.S.1R118(aN1.2)i. The tax rah Imposed on the net value of transfers to or fa Ore use of the decedents lineal berreOdaries b four and one-fielf (A.~ peroent e~epl as noted In 72 P.S. §9118(1.2} (72 P.S. §9118(aK1)]. The tax rate Imposed on the rret value of trmrsfers to afar the use of the deoedenl'a aNOOnga is twelve (12} percent (72 P.S. §9110(aK1.3)]. A sibNng is defined, urrder Section 9102, ere an in~viduai who has of lest one parent in crommon wOh the decedent, whether by flood a adoption. REV-1403 EX+(8~8) . scHe~u~e s COhMAONVUEAITM o>: PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ANNA R HE55 21 09 00321 AN prouahi lolnlyownsd vr)NI rtpht of eunNo»hlp snrN be dNebted on Bdiedule F, (N mare space fs needed, ineert eddMianel ahee~ otFe aeme dze) REV-1608 EX F (~8) . coM iR~irnNCe°rAZ ~~~iANw SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY All owMd wNh trt of wro nant M dbelosW on BchMuN F. REM VALUE AT DATE w iuaca DESCRIPTION OF DEATH 2. CITIZENS BANK ACCT N0.8203203924 80,218.99 3. C{TIZENS BANK ACCT N0.6700778851 88,221.92 4. 2008 PA INCOME TAX REFUND 52.00 5. 2008 FEDERAL INCOME TAX REFUND 214.00 8. GENWORTH LTC INS 50.00 7. PSERS 43.55 8. METLIFE INSURANCE POLICY # 117847076 (THIS IS A NON TAXABLE ITEM AND ONLY LISTED FOR INFORMATIONAL PURPOSE) TOTAL (Also enter on Bne 5, RecepitulaliWl) ~ ; needed, lnawt addlUond duNa oflhe same rtrs) REV-1611 EX+(10-08~ COMMONWEALTH OF PENNSYLVANIA MHERITANCE TAX RETURN SCHEDULE M FUNERAL EXPENSES & ADMII~gSTRATNE COSTS ANNA R. HESS 21 09 00321 Debte of dwwdeat mmd a nPorbd on 8chadule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. GINGRK;H MEMORIALS 135.00 B. 1 ADMINISTRATIVE COSTS: Pet80nal RBpR138fMB1IY8'8 CAITlrttlesldtm Name of P&sonal Repreeentatlre (s) $treel Addross Clry Stem rP Year(s) Commteebn Paid: p Albmsyfees RADCLIFF LAW OFFICE, P.G. 3, Femlry Exemptlon: (H decadence address k not the wne ~ delmenta, etmdl explenalal) (~elmeM Street AddNiss Cny stem Zip Retatlonshp otClalmanttoOecedent 4. I Probate Fees 5. Aoooumm~ca Feee 6. Tax tietum Preparefa fees 7. CITQENS BANK (OPEN SAFE DEPOSIT BOX) 8. FILING FEES -INVENTORY & PA1500 9. LEC3AL ADVERTISING -CUMBERLAND LAW JOURNAL 10. LEGAL ADVERTISING -THE SENTINEL 11. EXECUTOR'S EXPENSES 12, CHECK PRINTING FEE -ESTATE ACCT 8,500.00 352.00 150.00 30.00 75.00 145.06 1,153.61 16.139 TOTAL (Also etderon Iine 9. RecapNulatiorl) I S (Itmore apace m REV-1512 EX + (12-03~ COMMONWEALTH OF PENNSYLVANIA IrylERITANCE TAX RETURN SCHEDULEI DEBTS OF DECEDENT, MORT(3AQIE LIABILITIES, & LIENS ANNA R. HESS 21 09 00321 Report debts incurrod try the deeedsnt prior to death which nmNnsd unpsld as of the date of death, fndudinQ unreknbuned medical expenses. ITEM VALUE AT DATE NUA~ER DESCRIPTION OF DEATH 1. MESSIAH VILLAGE 282.16 2. 2009 FEDERAL ESTIMATED TAX 3. ICITI MASTERCARD 4. IO/S CHECK #2455 PAYABLE TO MELODY BARKER 5. IO/S CHECK #2458 PAYABLE TO MARJORIE SMITH (CAREGIVER) 6. IO/S CHECK #2481 PAYABLE TO MESSIAH VILLAGE TOTAL (fUso enter on Ifne 10, Recapitulation) I S (II more spelx Is needed, Insert eddgiand sheela of the same size) 645.00 40.77 172.71 1,805.00 7,464.50 REV-181,3 EKy~ lo'~. ' ' ~ ~ SCHEDULE J COMMDNVJEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESn)ENTDECEDENT ESTATE OF FILE NUMBER 21 09 00321 ANNA R. HESS RELATIONSHIP TO DECEDENT AMOUNT ORSHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not Lkt Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS (hdudetpouisldisbRutlons,endvens6arsun~ I . Sec. 9118 ( (1. 1 1. FREDERICK M HESS Lineal 88,817.75 1172 FAIRWAY CLUB LANE #1 ESTES PARK, CO 80517 Lineal 66,817.74 2. .MELODY H. BARKER 288 BREWSTER ROAD BRISTOL, CT 08010 Lineal 86,817.74 3. SYLVIA H. GRIER 9635 PARKWOOD DRIVE BETHESDA, MD 20814 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES 15 THROUGH 19, AS APPROPRIATE, ON ~. NCMI-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS N07 BEING MADE 1 B. CHARTABLE AND GOVEt~IMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 5 -' 1!f mOre eFace N needed, Insect addi5onal sheets of the sane Nze)