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HomeMy WebLinkAbout02-02-10 15056041125 REV-1500 Ex (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 0 0 9 0 0 6 6 1 Harrisburg, PA 17128-osol RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 6 1 4 2 5 7 6 0 6 0 5 2 0 0 9 0 3 2 5 1 9 2 6 Decedent's Last Name Suffix Decedent's First Name MI B R A M E L O I S M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ^X 1. Original Return 4. Limited Estate OX 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 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) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CO Name J A N E A D A M S E S Q U I R E Firm Name (If Applicable) First line of address 1 7 W S O U T H S T Second line of address City or Post Office C A R L I S L E Correspondent's a-mail address: AND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED T0: Daytime Telephone Number 7 1 7 2 4 5 8 5 0 8 REGISTER LS USE ~Y y ,~~ '*'1 r~7'! ~"'7 r+'1 "~ .C "1 ~ - ) ;. ~ t C: 't ~ { "3 • ~ if V ~'~s ~-~ ~ C J ZII .~~ --~~, 3 ~ ~`~I r State ZIP Code :. ~- lE FILED P A Under penalties of perjury, M decla at I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it' rrect and complete. ration of preparer other than the personal representa4ve a based on all information of which preparer has any knowledge. IGNA F I LE FOR FILING RETURN DATE 12/23/2009 17L,YV. South St., Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 15056041125 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: LOis M. Brame 1 9 6 1 4 2 5 7 6 RECAPITULATION ...................................... 1. Real estate (Schedule A) • • 1 2. Stocks and Bonds (Schedule B) ............................. ..... 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ................... ..... 4. 1 9 7 2 5 0 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 Nan-Probate Property (Schedule G) U Separate Billing Requested .. ..... 7. 8. Total Gross Assets (total Lines 1-7) ...................... ..... 8. 1 9 7 2 5 0 9. ........... Funeral Expenses & Administrative Costs (Schedule H} g, ..... 4 1 0 5 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ....... ..... 10. 11. Total Deductions (total Lines 9 & 10) ...................... ..... 11. 4 1 0 5 6 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) ........... 14. Net Value Subject to Tax (Line 12 minus Line 13) ........... ..... ..... ..... .. 12. .. 13. .. 14. 1 5 6 2 1 5 4 1 0 1 9 0 9 4 0 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 0 0 0 (a)(1.2) X.0 ~ 15. 16. Amount of Line 14 taxable 1 3 5 1 9 4 6 0 8 4 at lineal rate X .045 1 s 17. Amount of Line 14 taxable 4 0 0 0 4 8 0 at sibling rate X .12 1 ~• 18. Amount of Line 14 taxable 1 5 0 0 0 2 2 5 0 at collateral rate X .15 1 g 8 8 1 4 ......................................... 19. Tax Due .... ...19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 L 15056042126 15056042126 J REV-1500 EX Page 3 Decedent's Comulete Address: File Number 00661 DECEDENTS NAME Lois M. Brame - STREETADDRESS 324 Chestnut St ,apt 1 ---- -- -- - _ CITY STATE ZIP Mt Holl S rin s PA ' 17065 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal PoveRy Credit B. Prior Payments C. Discount (1) $88.14 Total Credits (A + B + C) (2) $0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D +E) (3) $0.00 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) $0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $88.14 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (5B) $88.14 Make Check Payable to.• REGISTER OF WILL S, 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 : ...................................................................... ............. .... transferred or its income; ro ert ll use the h h i t i ht t d ^ X ^ ............ .. p y p o s a gna e w g es b. retain the r o ^ c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care7 ....................................................... 2. If death occurred after December 12,1982, did decedent transfer property within one year of death ^ without receiving adequate consideration? ....................................................................................... ? " ^ ......... or payable upon death bank account or security at his or her death 3. Did decedent own an "intrust for Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 4 . contains a beneficiary designation? .................................................................................................. ^ X^ 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 (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exem t 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 childtwenty-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-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE Lois M. Brame 00661 Include the proceeds of litigation and the date the proceeds were received by the estate. All aroosrtr bintl~howned with right of suryivowhlp must bA discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank, checking account $1,332.50 2. ~ Personal property $640.00 TOTAL (Also enter on line 5, Recapitulation) ~ ; 1, 972.50 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) • SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~ INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Lois M. Brame 00661 Debts of decedent must be reported on Schedule Y. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: ~, Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbers}IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Jane Adams, Esquire $200.00 3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees $75.00 5 Accountant's Fees 6. Tax Return Preparers Fees 7. Register of Wills, filing releases $30.00 8. Rowe's printing $80.56 9. Register of Wills, filing family agreement (estimated) $25.00 TOTAL (Also enter on line 9, Recapitulation) I = 4 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9.00) ' SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER I nis M E3rame 00661 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [nclude out>ig ~ spousal distributions, and transfers under 16 1 . Sec. 91 a) See Attachment Page(s) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Mt. Holly Springs United Methodist Church Food Bank $20.00 Mt. Holly Springs, PA 17065 (food items and canned goods) TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ; 20.00 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent Lois M. Brame 20 09 00661 Decedent's Name Page 1 File Number Schedule J - BeneficiaHes -1 NUMBER NAME AND ADDRESS OF PERSON S RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Llst Trust a AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Karen L. Martin, daughter ( + I/4 of residue) Lineal $80.00 109 N. Baltimore Ave. Mt. Holly Springs, PA 17065 2. Shirley Smith, sister Sibling $40.00 One West Penn St., Apt. 412 Carlisle, Pa 17013 3. Amy Byers, granddaugher Lineal $30.00 222 Hill St. Mt. Holly Springs, PA 17065 4. Heather Byers, granddaughter Lineal $50.00 222 Hill St., Mt. Holly Springs, PA 17065 5. Trudy Byers, granddaughter (+ I/4 of residue) Lineal $45.00 222 Hill St. Mt. Holly Springs, PA 17065 6. Dennis Martin, son (+ I/4 of residue) Lineal $60.00 116 South Side Drive Newville, PA 17241 7. John Jacobs, friend Collateral $150.00 1204 Myerstown Road Gardeners, PA 17324 8. Charles R. Martin, Jr., son (+ I/4 of residue) Lineal 52 I/2 E. Penn St. $165.00 Carlisle, Pa 17013 ~.' .~` da= / ~~°~ ~. J ~~ ob ~' ~' o~ ,~ ~ ~ o~ os „~ -~` Ob ` ,. :o ~" ,~,, - ~~~ ~~ 00 ~''~ 1P' 1 ~,~'oa ~ ~ ~~~ ~~` .~•---= Item #719 ~,~_ /" _ t F- vim" ~. ,a~f ls3p~o~ _ ~ ?1 ~~ ~6 i ~ 4 ~~~~ ~~. ~ ., .~ F ~ ~' .~'~r~. ©t.~.•r~ ~' 5 _# item l~~1 , , ~ . _, , ,,(Tyr.` .• ~- ~ i!s ~~1.1~1 ~f. .. .io • ,A'G'r 'Gr COUNT 10. ACCCIUNT TYPE 950882 CLASSIC CHECKING 00 0 04345M NM I17 13326 LOIS M BRAME 324 CHESTNUT ST AP7 1 MT HOLLY SPGS PA 17065-1224 A f`~`AIIWT CIINMADV STATEMENT PERIOD PAGE JUN.04-.1UL.03,2009 1 OF 2 STONEHEDGE B NG BALAUICE S:8 OTHER JtDDIfIflNS CHECKS PAID OTHE SUB'CRAC71ONS GUR ItiTERESt PD EtQ1 9AI.ANCE N0. AMOUNT N0. AMOUNT N0. AMOUNT 1,863.13 0 0.00 1 260.00 4 1,603. 3 0.00 0.00 A f`(`(1I11J T A (` T T V T T V IP1G ATE TRANSACTION D SCRi T ON S, >ER T' & OT R IONS CNECKS _0 HER SUBTRACTIONS DAILY BA E 06-04-09 BEGINNING BALANCE !1,863.13 06-05-09 HARP NEALTH CARE PREMIUM 168.50 1,694.63 06-08-0 CHECK NUMBER 4475 260.00 Ob-08-04 COMCAST CENTRAL CENTRAL PA 63.38 1,371.25 Ob-29-0 EMBARQ T~l~cow 38.75 1,332.50 07-03-09 CLOSEOUT 1,332.50 0.00 ENDING BALANCE 10.00 GHECK'S PAID SUMMARY 4475 06-08-09 260.0