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Home My WebLink About02-08-10 (2)1505607120 REV-1500 ~( (06-05) ~ OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box.28oso~ INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 9 0 7 6 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 200 24 1738 07 28 2009 08 05 1929 Decedent's Last Name Suffix Decedent's First Name MI BACHMAN DONALD R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 1. Original Return X 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate qa. future interest Compromise ^ 5. Federal Estate Tax Return Required date of death after 12-12-82) X g Decedent Died Testate ~ Decedent Maintained a living Trust (Attach Copy of wii) ^ (Attach Copy of Trust) 1 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 p, Spousal Poverty Cred'R (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 INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JOEL O. SECHRIST ESQ. 717 938 3396 Firm Name (If Applicable) JOEL O. SECHRIST, ATTORNEY First line of address 568 OLD YORK ROAD Second line of address Gity or Post OfFce ETTERS _, . REGISTER OF~L LS USE Oo1' o -' -' ~ r CCU f: .; ~ ~ .. i, ~, ~~ ~ 4! ~~ DATRFILI'D •• - ,C.. State ZIP Code PA 17319 ~~~~ <T? ~~ ." T'l `_;:.J `F~~. '~"ri _.k ,~ Correspondent's a-mail address: S e C h r I S t I a W ae g In a i I. C O m Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. CI4INATI IGG nC DCDCnwi occons,c,o, r rr~n ~„ ~. ~....~.-. ..... _. ADDRESS 14~idge Roa~Etters, RA 17319 R Houseal .~--~'~ Joel O. Sechrist Esq. DATE York Road, Etters, PA 17319 Side 1 1505607120 1505607120 1505607220 REV-1500 EX Decedent's Social Security Number oe~eaer,rs Name: D o n a I d R B a c h rn a n 2 0 0 2 4 17 3 8 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 1, 2 5 8. 5 6 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 1 , 2 5 8 . 5 6 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 8 10) ...................................................................... 11 _ 0 . 0 0 12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 1 , 2 5 8 . 5 6 13. Charitable and Govemmentat Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................................................. 14. 1 , 2 5 8 . 5 6 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 0 . 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 0 . 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 4 1 9. 5 2 17. 18. Amount of Line 14 taxable at collateral rate X .15 8 3 9. 0 4 18. 19. Tax Due ........................................................... .......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 0.00 0.00 50.34 125.86 176.20 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-0764 DECEDENT'S NAME Donald R Bachman STREET ADDRESS Claremont Nursing 8~ Rehab. Center CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 1 76.20 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B+ C) `(2) 3. InteresUPenalty if applicable p, 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. (q) Check box 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) 176.20 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ 7 6.2 0 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 :.................................................................................. ~ x b. retain the right to designate who shall use the property transferred or its income :.................................... x c. retain a reversionary interest; or .................................................................................................................. x d. receive the promise for life of either payments, benefits or care? .............................................................. x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 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 exemat 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)]. 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. Rev-1503 EX+ (6-98) SCHEDULE B STOCKS 8t BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bachman, Donald R 21-09-0764 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 36 shares MetLife stock 1,258.56 TOTAL (Also enter on Line 2, Recapitulation) 1,258.56 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) REV-1513 E7(+ (11A8) COMMNHERITALNCETRX RNETURN ANIA aFSIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Bachman, Donald R NAME AND ADDRESS OF NUMBER PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spou I, distributions, and tray under Sec. 9116(a)(1 1 2 3 4 II. Copyright (c) 2009 form software onty The Lackner Group, Inc. Brian L Bachman 5266 Smith-Stewart Road Girard, OH 44420 Robert S. Bachman 980 Bristol-Champion Town Line Road Warren, OH 44481 Evelyn R Houseal 140 Ridge Road Etters, P~- 17319 Susan Prescott 35 Cedar Drive York Haven, PA 17370 FILE NUMl3tK 21-09-0764 RELATIONSHIP TO SHARE OF ESTATE AMOI DECEDENT (Words) Do Not List Trustee(s) Nephew Nephew Sister Niece one sixth of residue one sixth of residue one third of residue one third of residue I I Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as approp NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS r.,Tw~ nc oeRT ii _ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Form PA-1500 Schedule J (Rev. 11-08) f OF ESTATE ($$$)