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Home My WebLink About02-19-10 (2)--~ REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue councy code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 2 1 0 9 0 5 7 0 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 188123632 04152008 12291918 Decedent's Last Name Suffix Decedent's First Name MI BURR PEARL E (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 IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 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) ® g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust 8. Total Number of Safe De o (Attach Copy of Wilp (Attach Copy of Trust) - - p Slt BOXeS ^ 9. Litigation Proceeds Received ^ 1 p, 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) ( ) ,CiORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ryname Daytime Telephone Number LAURIE J M~WERY 7175746916 r.a Firm Name (If Applicable) First line of address 1 2 1 5 WILL IAMS GRt~~1E RD . Second line of address City or Post Office State ZIP Code MECHANICSBURG FA 17055 Correspondent's a-mail address: c} REGISTER 4!~ ~LLS U SF~NLY `- , _, ~: r ~ -7 3 w..~ ` :' ~ ~y '~v R) - DATE FILED ~ -~-1 ,.~ --, :': i Nl ~-- r'''~ .. .,..~.~ °~~ ~ -_.~ U e penaltie f perj ry, declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it i t e, corre nd te. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. F E SO E FO FILING RETURN D TE Laurie J. Mowery ~ J ~~ A ESS 1215 Willia s Grove Road, Mechanicsburg, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS Side 1 1505607120 1505607 120 J J 1505607220 REV-1500 EX Decedent's Social Security Number Decedent's Name: BURD, PEARL ELIZABETH 1 8 8 1 2 3 6 3 2 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 8 Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Pro e ) P rtY (Schedule E ................ 5. 6 2 8 8 8 0 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 3 2 5 4 8 7 9 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7, 2 7 2 0 2 3 1 3 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 3 6 7 4 5 9 9 6 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ......................................... 9. 4 - __ 8 2 0 4 4 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 3 , 2 1 1 4 0 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11 • 8 0 3 1 8 4 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 3 5 9 4 2 8 1 2 13. Charitable and Governmental 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. 3 5 9 4 2 8 1 2 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 15. 16. Amount of Line 14 taxable at lineal rate x .045 3 5 9, 4 2 8 1 2 16. 1 6, 1 7 4 2 7 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. Tax Due ..................................................................................................................... 19. 1 6, 1 7 4 2 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 0570 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 16,174.27 _ _ _ -- __ Credits/Payments A. Spousal Poverty Credit B. Prior Payments - ___. C. Discount _ _ 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. (4) Check box on Page 2 Line 20 to request arefund -------- --- --- - - -- 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1 6,174.27 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 16,174.27 _. Make Check Payable to: REGISTER OF W/LLS, 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 :.................................................................................. ~ _ ;L x~ b. retain the right to designate who shall use the property transferred or its income :.................................... ~ ~ ~ x' -- ~ I c. retain a reversionary interest; or ..................................... ~--~ L-X ............................................................................. d. receive the promise for life of either payments, benefits or cares ............................. 1 irX 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... _ i ~ _ ~ ~~ x_ i 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? .................................................................................... LX_~ ~ _l .................................. 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)J. 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)]. 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. SCHEDULE E CASH, BANK DEPOSITS, &~MISC. COMMONWEAITHOFPENNSYLVANIA PERSONAL PROPERT i INHERITANCE TAX RETURN ~ 1 G RESIDENT DECEDENT FILE NUMBER ESTATE OF Burd, Pearl Elizabeth 21 - 09 - 0570 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. - __ ____ __ _ _ __ __ __ __ ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 MetLife (Unclaimed property) 4,012.55 2 ~ PNC Checking account 3 ~ Estate of Galyn Burd 54,109.66 4,765.83 I __ ___ _ _ _ __ _ _ ___ _ --- _ _- -- - ---- _ _.__ _- --- __ ___-- -------------- __._ TOTAL (Also enter on Line 5, Recapitulation) 62,888.04 SCHEDULE F COMMONWEALTH OF PENNSYLVANIA ~ JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN j RESIDENT DECEDENT ESTATE OF Burd, Pearl Elizabeth ', FILE NUMBER 21 - 09 - 0570 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 ___.__ -- - - Laurie Mowery 1215 Williams Grove Road Granddaughter A Mechanicsburg, PA 17055 JOIN I LY UWNED PROPERTY: LETTER ITEM NUMBER FOR JOINT DATE MADE EESCRIPTIO . oF PROPERTY Include name o~~inanclal Ins~u~tion and bank account number % OF DATE OF DEATH ' DATE OF DEATH V TENANT JOINT or similar identifying number. Attach deed for jointly-held real DECD S VALUE OF ASSET ALUE OF DECEDENT'S INTEREST _. __ __. 1 A estate. __ . _ _ __ - _ _ . _ _ __ 8~ ~~~ Sovereign Bank CD # 0575137609 i INTERESTI 1 65,097.58 50% I 32,548.79 COMMONW SCHEDULE G EALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Burd, Pearl Elizabeth FILE NUMBER 21 - 09 - 0570 __ . This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY `~0 OF EXCLUSION Include the name of the transferee, their relationship to decedent DATE OF DEATH DECD'S TAXABLE VALUE NUMBER and the date of transfer. Attach a copy of the deed for real estate. VALUE OF ASSET INTEREST j (IF APPLICABLE) 1 ' Wachovia Securities Annuity # 304 720 614 272,023.13 100% 272,023.13 TOTAL (Also enter on line 7, Recapitulation) 272,023.13 SCHEDULE H '' FUf~ERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~w^Q'r~e-~ RESIDENT DECEDENT ~, ~~VV ~„~ ~~I'\~ B. ', ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Ahrens Law Firm, P.C. 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 4. Probate Fees Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees Estimated 402.00 200.00 7. Other Administrative Costs 1 PA Inheritance Tax filing fee 15.00 ___ . _ __ _ _ _ TOTAL (Also enter on line 9, Recapitulation) 4,820.44 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMNHERTANCETAXRETURN~IA LIABILITIES, & LIENS RESIDENT DECEDENT ~ FILE NUMBER ESTATE OF Burd, Pearl Elizabeth '~~ 21 - 09 - 0570 Include unreimbursed medical expenses. _- __--__ ITEM _ _ __ _ ___ _ _ ___ __ _- -__ ___ NUMBER DESCRIPTION AMOUNT 1 Final medical expenses 3,211.40 TOTAL (Also enter on Line 10, Recapitulation) 3,211.40