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HomeMy WebLinkAbout04-0123 Ev-150~ EX (6-001 ~ ']" - - -- ~ . ~ COMMONWEALTH OF ~,~ PENNSYLVANIA ,e~~~ DEPARTMENT OF REVENUE ~ ' ~ "~ ,-, -~,,~-~ ~ DEPT. 280601 ' '~ HARRISBURG, PA 17128-0601 Z UJ LU r~ LU REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH IMM-[~D-YEAR) DATE OF BIRTH (MM-DD-YEAR) i (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLEINITIAL) "FIL~E~ i~UMBER ,/' COUNTY CODE YEAR NUMBER ~1. Original Return ['--~ 4. Limited Estate [~6. Decedent Died Testate (Attach copy of Will) E~]9. Litigation Proceeds Received r~2. Supplemental Return [~] 4a. Future Interest Compromise (date of death after 12-12-82) [--~ 7. Decedent Maintained a Living Trust (A~tach copy of Trust) r--] 10. Spousat Poverty Credit (date of death between 12-31-91 and 1-1-95) E~3. Remainder Return (date of death prior to 12-13-82) ~---] 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [~] 11. Election to tax under Sec. 9113(A) (A~eh Sob O) NAME LO,"O ,-',,'"- FIRM NAME (IfApplicable) COMPLETE MAILING ADDRESS ~o~t 0_1q~_¢~6__ P,-,'L~_ ~D 14. 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses &Administrative Costs (Schedule H) 10. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (8) ~'7 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. x ,0_ (15) x .o HS* (16) I ,~' ~o. x .12 (17) x .15 (18) (19) I > > BE SURE TO ANSWER ALL QUESTIONS ON REVER~E' ~.~_NrJ RECH_;CK MATH < < THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER .2.0.3 - Decedent's Complete Address: STREETADDRESS CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount InterestiPenalty if applicable D. Interest E. Penalty ISTATE (1) Total Credits ( A + B + C ) (2) Total InterestJPenalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 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. (3) (4) -(5) A. Enter the interest on the tax due. (5A) <~ B. Enter the total of Line 5 + 5A. mhis is the BALANCE DUE. (5B) [ ~ ~'~O, L~ (¢ 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; ............................................ [] [] 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 of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON ~PONSIBLE FOR FILING RETURN ~~ DATE / ,.,.~ ! SIGNATURE OF PREPARER OTHER THAN R DATE ADDRESS 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 alter 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 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 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 paren 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 a 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 ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the ITEM NUMBER )roceeds of litigation and the date the proceeds were received by the estate. All property jointly*owned ~ the right of suwivorshi 3 must be disc~,,a,,a on ~a,,~,, r DESCRIPTION TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, inserl additional sheets of the same size) VALUE AT DATE OF DEATH REV-15~ EX* (t-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 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. Co JOINTLY-OWNED PROPERTY: Lc i i ~-~ DATE DESCRIPTION OF PRC~r-~i ¥ % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or simila~ identifying number. Attach DATE OF DEATH DECD~J VALUE OF NUMBER TENANT JOINT deed for ~ntly.-held real estaM. VALUE OF ASSET INTEREST DECEDENT'S INTERES1 A TOT~ (A~so e.te,' OD ,~e S, F~pitu~atio~) $ ~'7 '~ ~''z'" (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) '; COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ITEM NUMBER Debts of decedent must be reported on Schedule L DESCRIPTION AMOUNT FUNERAL EXPENSES: ADMINISTRATIVE COSTS: (~o ~,40 Personal Representative's Co~lmissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees (~1~0 ~--~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant (~;:~ ~V'~ ~--- L~ ~X~ Street Address ~ H ~ City ~,-~.£ ~ ~ r,J,d ~ Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Zip StateF~ Zip 1~7 0 ~'~"- TOTAL (Aisc enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) ~ '7S, 20 ~)0~o , o o R~/1512 EX + (I-~?) .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION TOTAL (Also enter on tine 10, Recapitulation) (if more space is needed, insert additional sheets of the same size) AMOUNT /..SZ. oo REV-1513 EX+ (9-00~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 'ESTATE OF NUMBER I 1. II 1. SCHEDULE J BENEFICIARIES FILE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~L~ ~ ~A RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ~UoN ~ TOTAL OF PART I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insed additional sheets of the same size) REV-1513 EX+ (9-00~;~_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FIlE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under AMOUNT OR SHARE OF ESTATE NUMBER I Sec. 9116 (a) (1.2)] RELATIONSHIP TO Do Not List Trustee(s) 1I 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 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 the same size) O. PNCBANK December 4, 2003 Ms. Lovonne Cooper 6021 Cherry Hill Rd. Harrisburg, PA 17111 Estate of Dorothy E Shuman (Deceased) SSN: 203-10-0149 DOD: 11-05-2003 scp Dear Ms. Cooper: In response to your request for Date of Death balances for the customer noted above, our records show the following: Certificate of Deposit Account#21001020859 Established 03-08-1992 DOROTHY E SHUMAN LOVONNE M COOPER DOD balance: $15,062.50 + $37.32 accrued interest /9'0 ~/ :~'.. . Account#21001020867 Established 10-24-1992 DOROTHY E SHUMAN LOVONNE M COOPER DOD balance: $20,000.00 + $13.06 accrued interest 9-~ o/~. v ~ Account~21001020993 Established 07-09-1993 DOROTHY E SHUMAN LOVONNE M COOPER DOD balance: $18,000.00 + $45.94 accrued interest ~' ~ ' ~ ~ ' Account#31100211206 Established 05-31-2001 DOROTHY E SHUMAN LOVONNE M COOPER DOD balance: $21,112.50+$13.88 accrued interest ~ / /~ ,~ Page 1 of 2 Checking Account Account#5140058186 Established 02-01-1975 DOROTHY E SHUMAN ~/~..~ cL,_~ LOVONNE COOPER DOD balance: $5,104.78 + $0.02 accrued interest ~-/6 4', ~t~ Savings Account Accountg5003268734 Established 03-15-2001 DOROTHY E SHUMAN LOVONNE COOPER DOD balance: $34,795.12 + $0.58 accrued interest ~ ~ ~ ~ .5'-, 7,~ Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, Erica L Schlegel PNC Decedent Reporting Firstside Center 500 First Ave, 4th F1 CIF Pittsburgh PA 15219-3128 1-800-762-1775 Member FDIC Page 2 of 2 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE - BUREAU ~(~I= INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: ; PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003542 COOPER LORONNE 6021 CHERRY HILL ROAD HARRISBURG, PA 17111 ........ fold ESTATE INFORMATION: SSN.' 203-10-0149 FILE NUMBER: 2104-01 23 DECEDENT NAME: SHUMAN DOROTHY E DATE OF PAYMENT: POSTMARK DATE: 02/09/2004 00/00/0000 COUNTY: CUM BERLAN D DATE OF DEATH: 11/05/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,830.46 REMARKS: DOROTHY E SHUMAN TOTAL AMOUNT PAID' $1,830.46 SEAL CHECK# 639 INITIALS: AC RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERITANCE TAX DTVTSION BERT, 280601 HARRISBURG, PA 17128-0601 LOVONNE H COOPER 6021 CHERRY HILL RD HBG CONNONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLONANCE OR DISALLOHANCE OF DEDUCTIONS AND ASSESSNENT OF TAX '0~ ~/tR 26 DATE ESTATE OF DATE OF DEATH FILE NUNBER .d~OUNTY 05-19-2004 SHUHAN 11-05-2003 21 04-0123 CUHBERLAND 101 Aeoun( Ramified REV-15iI7 EX AFP (DI-OS) DOROTHY E HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THZS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~-~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF SHUHAN DOROTHY E FILE NO. 21 04-0123 ACN 101 DATE 03-29-2004 TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORZG~NAL RETURN 1. ReaZ Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~nership In~eres~ (Schedule C) (3) q. Hor~gagas/No~as Receivable (Schedule D) (q) 5. Cash/Bank Daposi~s/Hisc. Personal Proper~y (Schedule E) (5) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse~s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. To,al Deductions 12. Na~ Value of Tax Ra~urn 80.00 .00 NOTE: To insure proper .00 credi~ ~o your account, .00 submi~ ~he upper portion .00 of ~his form w~h your ~ax payment. 57/092.85 .00 (8) 15,807.70 688.24 1t. NOTE: ASSESSHENT OF TAX: 15. Amoun~ of Line lq a~ Spousal ra~a 16. Aeoun~ of Line lq iaxabla at Lineal/Class A rate 17. Amount of Line lq at Sibling rata 18. Amouni of Line lq taxable at Collateral/Class B ra~e 19. Principal Tax Due TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) 02-09-2004 CDOO354Z .00 57,172.85 (11) ]A (12) 40,676.91 Chari*able/Govarnmen*al Bequests; Non-elect:ed 9115 Trus*s (Schedule J) (13) Ne'lc Value of Es~a*e Subjac~ '1:o Tax Zf an assessment was issued previously, 11nas 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 40,676.91 ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDITIONAL INTEREST. 18 and 19 will 1,830 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN 91, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) TOTAL TAX CREDIT BALANCE OF TAX DUE XNTEREST AND PEN. TOTAL DUE 1,830.46 ANOUNT PAID (15) .00 X 00 = .00 (16) 40,676.91 x 045 = 1,830.46 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= 1,830.46 RESERVATION: Estates of decedents dying on or before December 1Z, 19BI -- if any future interest in the estate is transferred in possession er enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for Iife or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawfuI Class B (cotIataral) rate on any such future interest. PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of NilIs printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13IS). Applications ara available at the Office of the Register of Nills, any of the 25 Revenue District Offices, or by calling the special Z4-hour ans#aring service for fores ordering: l-BO0-56Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-50Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disaIlowance 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: --mritten protest to the PA Oepartaent of Revenue~ Beard of Appaals~ Dept. ZBIOZi, Harrisburg, PA I7IZB-IOZi, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individua! Taxes, ATTN: Post Assessment Review Unit, Dept. ZB06OI, Harrisburg, PA ITlZB-060l Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident Decadent' (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid eJthin three (53 calendar months after the dacedent's death, a five percent (SI) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged baglnning mith first day of delinquancy, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes whlch became delinquent before January 1, 1982 bear lnterest at the rate of six (6X) percent per annum calculated at a daiZy rate of .000164. A11 taxes which became delinquent on and after January l, 198Z mill bear interest at a rate which will vary frae calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for I98Z through ZOO4 are: Interest DaiIy Interest Daily Interest Daily Year Rate Factor Year Rata Factor Year Rate Factor ~ ZOZ .000548 1988-1991 iix .000301 2001 9Z .000247 1983 16Z .000458 1992 9Z .000Z47 ZOOZ 6Z .000164 1984 11Z .000301 1995-1994 72 .O0019Z ZO0~ 5Z .000137 1985 152 .000556 1995-1996 92 .000247 2004 4Z .000110 1986 10Z .000274 1999 7Z .00019Z 1987 lOX .000274 2000 7Z .00019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINiIUENT X DAILY INTEREST 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 is made after the interest computation date shown on the Notice, additional interest must be calculated.