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HomeMy WebLinkAbout02-11-10 (2)15056051058 REV-1500 Ex (06-05) OFFICIAL USE ONLY County Code Year File Number PA Department of Revenue RETURN , ~' / ~ U (~ 1 ~ ~ ', Bureau of Individual Taxes INHERITANCE TAX Po Box z8osol RESIDENT DECEDENT Hanisburg, PA 17128-Or~01 ENTER DECEDENT INFORMATION BELOD to of Death ~.. -__ __ Social Security Number _,_ ~, 10/0112009 ___ 202-20-3626 ~ -~ _. _ Suffix Decedent's Last Name Shellenberger - Date of Birth _ 08/23/1927 __ - ~ MI Decedent's First Name M Romaine (If Applicable) Enter Surviving Spouse's Information Be °W Suffix Spouse's First Name __ Spouse's Last Name _ _ _ _ _ _ Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW {~,3 1. Original Retum 4. Limited Estate 6. Decedent Diedf `eNsil~te (Attach COPY r.' 9. Litigation Proceeds Received THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE Daybme Telephone Number __ CORRESPONDENT - _ _._, _. Name _ _ __.. _ (717) 236-0781 .____ IVIaNIn BeSllOre, ESgUlre ,, REGISTER OF WILLS USE ONLY tV ~ Firm Name (If Applicable) - _ ~ ° r~ Law Offices M.Beshore _ _ _ ~ _ _ ._ __ - First line of address - ~~ ~ ~ ~ 130 State Street '`r~- ~ ~ - '"'" _ __ Second line of address _ -- - ~;::~ -. J r.7 ~~ x> ~ P.O. Box 946 State ._.-.._.~ ~. D D .__- _- ZIP Code _ . _, ~ -~ - (.J .. Ci or Post Office _ Pp _... 17108-0946 _ _ ~,. ,Harrisburg _. _ ~, t'~ C~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum 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) MI 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) .. ~ueneuetrnN SHOULD BE DIRECTED TO: "~T ? i ~, ., c :> c ~~~ f :F f -3 C;r' _. : ~ r -- ~r~ MBeShOre@beshorelaW •COm knowledge and belief, CoRespondent's e-mail address: including accompanying schedules and statements, and to the best of my Under penalties of perjury, I declare that I have examined this return, rsonal representative is based on all information of which prepareDATE any knowledge. it is true, coned and complete. Dedaretion of prepareNG RETURNe ~ •- ~ O SIGNATU ~ F PERSON RESPONS LE FOR gDDR Hollow Road New Cumberland, PA 17070 DATE 382 Steige __ • „ „~oer~vnITATIVE 2 '_ ~ ~ I O ,DDRES6 " 130 State Street, P.O. Box 946, H PA 17108-0946 Side 1 15056051058 15056051058 J 15056052059 Decedent's Social Securely Number REV-1500 FJC ~ M Shellenberger 202-20-3626 Romaine Decedent's Name: .._..._._..._.._-°-, RECAPITULATION ....... ', 1. .. . 1. Real estate (Schedule A) ................................... ..... 2. ... _ 2. Stocks and Bonds (Schedule B) ............................... 3. Closely Held CorporaYwn, Partnership or Sole-Propnetorship (Schedule C) .. 3. ... { & Notes Receivable (Schedule D) .......................... 4.~ .. . 4. Mortgages 5 Schedule E) .... 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property ( . .... 3,232.37 I Owned Property (Schedule F) O Separate Billing Requested ... .... 6• _ ' 6. Jointly 7. Inter-Vivos Transfers & Miscellaneous Non-Probaaem er Biing Requested.... C~ Sep .... 7• (Schedule G) 3,232.37 ', ... .... 6. _ , ............... 8. Total Gross Assets (total Lines 1-7) .............. , _ 2,047 14 8 Administrative Costs (Schedule H) ................ .... • _. 9. Funeral Expenses 376.78 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..... • • • • • • • • • • • 10' ~ , _ 2~4" 23.92 11. Total Deductions (total Lines 9 & 10)• • • • • • ........................ 11. .... ..__... . 808.45 ............ 12. Net Value of Estate (Line 8 minus Line 11) ............. ts/Sec 9113 Trusts for which ..... 12. _ __ 13. Charitable and Governmental Beques an election to tax has not been made (Schedule J) .... • • • • • • • • 13 808,45 .,_..,.,~..e c~~hiect to Tax (Line 12 minus Line 13) .................. 14. '', ..... . TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES .......... 15. Amount of Line 14 taxable at the spousal tax rate, or _ ___.____.__--_________._.-_-- transfers under Sec. 9116 15. . (a)(1.2) X .0_ _ _ 16. Amount of Line 14 taxable 808.45 16. at lineal rate X .0 45 14 taxable 17 at sibling rate X .12 1 S. Amount of Line 14 taxable 18. at collateral rate X .15 _ __ ...........19., 19. TAX DUE .............................................. 17 Amount of Une 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 36.38 Q Side 2 15056052059 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Romaine NI STREETADDRESS 1055 Allendale Road, Shellenberger B CITY Mechanicsburg Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credfts/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount ,Number DECEDENTS SOCIAL SECURITY NUMBER 202-20-3626 STATE ZIP PA 17055 (1) 36.38 Total Credits (A + B + C) (2) 0.00 0.00 36.38 0.00 36.38 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Fill in oval on Page 2, 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 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 "intrust 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 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 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 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 isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt~LE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER Romaine M. Shellenberger If an asset was made Jotnt within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Cindy Pontius 382 Steigerwalt Hollow Road Daughter New Cumberland, PA 17070 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ITEM FOR JOINT MADE INCLUDE NAME OF FINANCVLL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLKHELD REAL ESTATE. ___. 1. A• 09105102 Members 1st Financial Credit Union 222084-01 2• A. 09105102 Members 1st Financial Credit Union 222084-02 %OF DATE OF DEATH DATE OF DEATH DECD'S VALUE OF /ALUE OF ASSET INTEREST DECEDENTS INTEREST 5,862.91 50 2,931.46 601.82 50 300.91 TOTAL (Also enter on line 6, Recapitulation) I ; 3,232.37 (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 ADMINISTRATNE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Romaine M. Shellenberger Debts of decedent must be reported on Schedule I. NUM ER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 ~ Hollinger Funeral Home ~ Crematory, Inc. 1,700.52 2. Edible Arrangements (funeral meal) 81.62 3. g. ADMINISTRATIVE COSTS: ~ . Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) _ Street Address City .State Zip Year(s) Commission Paid: 2. AttomeyFees Marvin Beshore, Esquire -Law Office of Marvin Beshore 250.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent 15.00 4. Probate Fees Inheritance Tax Return 5. Accountant's Fees g, Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) ~ 2,047.14 If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIJLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER ESTATE OF Romaine M. Shellenberger _ .. .. _,__. _~__._ ~__.~...~.~..~ b~si~~ ~~~~~~d Ae of she date of death. including unreimbufsed medical expenses. pr more space ~s neeuou, ~~„~„ a,.,,~ .................... _. -•- --- - -- REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN .,eemeur nCeFIIFNT ESTATE OF Romaine M. Shellenberger RELATIONSHIP TO DECEDENT Do Not Llst Trustee(s) NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY I TAXABLE DISTRIBUTIONS [nclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Cindy Pontius, 382 Steigerwalt Hollow Road, New Cumberland PA 17070 Daughter FILE NUMBER AMOUNT OR SH OF ESTATE 100% 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 TAXIS NOT BEING MAD B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 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 s¢e)