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Home My WebLink About02-22-10 15056041114 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 _ Harrisburg PA 17128-0601 RESIDENT DECEDENT ~ ~~ ~~~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 192-12-4189 05232009 09271920 Decedent's Last Name Suffix Decedent's First Name MI HARKLEROAD MARY H. (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 0 1. Original Retum 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 0 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 0 2. Supplemental Retum 0 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) 0 3. Remainder Return (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) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number PENNIE L. CAVANAUGH, EXECUTRIX Firm Name (If Applicable) First line of address 228 BRIAN DRIVE Second line of address City or Post Office State ZIP Code ENOLA PA 17025 r.a REGISTER O LLS USE ON 0 i7 ~ 'T t l ,;A ~ ~ fV r~~~~C~ r 7 ~ ~-i = r~~ ~ .t- DA ILED N ;,~ ~"} ' '*"i i_; _t :' 7 ~~ ; ..: __.- ~=~ ~,.... ~ L`-1 r._,_- ,. ~_ .: i" .-~1 C ~~,. f"r"l C~'] C'l Correspondent's a-mail address: Under penalties o perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best o my nowledge and be ie , ft is true, correct and corn fete. Declaration of re aver other than the rsonal re resentative is based on all information of which re aver has an knowled e. SI E PERSON R SIBLE FOR FILING R RN DATE NATURE OF PREPAR OTHER THAN REPRESENTATIVE' DATE ADDRESS 401 DORCHESTER AVE. WEST LAWN, PENNSYLVANIA 19609 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041114 15056041114 ~~~ REV-1500 EX t~ecedent's Name: MARY H . HARKLEROAD Decedent's Social Security Number 192-12-4189 RECAPITULATION 1. Real estate (Schedule A) ........................................... 1. On Original Return 2. Stocks and Bonds (Schedule B) ...................................... 2. Ori Original Return 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. Ori Original Return 4. Mortgages & Notes Receivable (Schedule D) ............................ 4. On Original Return 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 2 3 8 • 0 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ........ 6. On Original Return 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ........ 7 Ori Original Return 8. Total Gross Assets (total Lines 1-7) .................................. 8. 2 3 8 . 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) .................... 9. On Original. Return 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. On Original Return 11. Total Deductions (total Lines 9 & 10) ................................. 11. On Original Return 12. Net Value of Estate (Line 8 minus Line 11) ............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 238.00 an election to tax has not been made (Schedule J) ....................... 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... 14. 2 3 8 • 0 0 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 .0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 4 5 2 3 8. 0 0 1 g. 11.0 0 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 • 0 0 18. Amount of Line 14 taxable at collateral rate X , 15 18. 0 . 0 0 19. TAX DUE ...................................................... .19. 1 1 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 15056042115 Side 2 15056042115 15056042115 • REV-1500 EX Page 3 192-12-4189 Decedent's Complete Address: File Number DECEDENT'S NAME MARY H. HARKLEROAD DECEDENTS SOCIAL SECURITY NUMBER 192-12-4189 STREET ADDRESS 10 CHARLOTTE WAY SUITE 204 CITY ENOLA STATE PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + g + C) (2) (1) 11.00 0.00 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) 11.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 11.00 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. 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 is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 217 REV-1508 F,(+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER MARY H. HARKLEROAD 21-09-0608 Include the proceeds of litigation and the date the proceeds were received by the estate. (If more space is needed, insert additional sheets of the same size)