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HomeMy WebLinkAbout02-25-101505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year ~ v File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 ~) O ~ ~' Harrisburra, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 7 1 8 2 5 3 0 0 8 1 3 2 0 0 1 0 6 0 8 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name MI M O U N T Z L EE E (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 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of III) (Attach Copy of Trust} 9. Litigation Proceeds Received ~ 10. 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) CORRESPONDENT - THiS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Numbe r R O G E R B I R W I N E S Q U I R E ? 1 7 ~ 4 9 ~, 3 ...x" 5 5.~,~~~~ Firm Name (If Applicable} .. t~ -.. - f , REGIST~ O~LS U NLY t .%`~ .. I R W I N & M c K N I G H T P- C == ~~ n I :--,l. ~ +:~ ~~ . First line of address ~:. ; ~, ~,3 6 0 W E S T P O M F R E T S T R E E T ''~ ~' ~` t~~ ~ ~ ~ Second line of address ..~ = .t" City or Post Office C A R L I S L E Correspondent's a-mail address: State ZiP Code I DATE FILED P A 1 7 0 1 3 Under penalties of penury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ATURE OF P SON RES NSIBLE FOR FILING ETURN DATE y ~v ADD E 480 PLEASANT HALL ROAD CARLISLE PA 17013 SIGNATUR~.t~F REPARER OTHER AN REPRESENTATIVE AT { G j ~ ~v ADDRESS 6~_WEST I~0 FRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J r 'C22L0950S'C 'C22L09505'[ Z eP!S 1N3WAbd213A0 NV d0 CINIld321 d JNI1S311D3213aV1 f1OJl ~I IVAO 3Hl NI lll~ •OZ 0 0 • 0 •66 ................................................ anp xel•gl. 0 0' 0 .g~ 0 0. 0 9i• X a;e~ lea;elloo;e algexe; b ~ aull ~o;unowy •g ~ 0 0. 0 16 0 0. 0 Z 6' X a;ea 6ullgls ;e • - I ~o lunowy L~ algexe; ~,~ aul 0 0' 0 •g~ 0 0. 0 0• X a}ea leaull;e • gl, algexel ~~ aull ~o;unowy ' oaS ~apun saa;sue~~ 9 L 66 ao `ales xe; lesnods ay;;e algexel },~ sup ~o;unowy •gl. S31~12! 318H~tlddV 21Od SNOIlOfl2l1SNI 33S - NOIlV1f1dW0~ X~Il 0 0 • 'C 6 9 9 'tip .................. 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MOUNTZ STREET ADDRESS 480 PLEASANT HALL ROAD CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fili in oval on Page 2, Line 20 to request a refund. (4) 0.00 5 1f Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 . Enter the interest on the tax due A (5A) . . Enter the total of Line 5 + 5A. This is the BALANCE DUE. B (56) 0.00 . 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 : ...................................................................... ^ 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? ....................................................................................... " " ^ ^ 0 or payable upon death bank account or security at his or her death? ......... intrust for 3. Did decedent own an 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 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 far 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-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LEE E. MOUNTZ 21 09 0 Ail real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Reel property which is jointhr-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ONE-FOURTH (1/4) INTEREST IN UNIMPROVED 9.17 ACRES OF MOUNTAIN 4,000.00 GROUND, WITHOUT LEGAL RIGHT-OF-WAY, LOCATED IN PENN TOWNSHIP, CENTRE COUNTY, RECORDED IN DEED BOOK 434, PAGE 1119 VALUE $16,000 TOTAL (Also enter on line 1, Recapitulation) ~ $ 4,000 00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER LEE E. MOUNTZ 21 09 0 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. RONAN FUNERAL HOME 6,411.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Street address c;ty State Zip Year(s) Commission Paid: 2, Attorney Fees IRWIN & McKNIGHT, P.C. 750.00 3. Family Exemption: (lf decedents address is not the same as claimants, attach explanation) 3, 500.00 Claimant MARTHA MOUNTZ Street address 480 PLEASANT HALL ROAD pity CARLISLE State PA Zip 17013 Relationship of Claimant to Decedent SPOUSE 4. Probate Fees 5 Accountants Fees 6. Tax Return Preparers Fees 7. REGISTER OF WILLS -FILING FEE 30.00 TOTAL (Also enter on line 9, Recapitulation) ` $ 10,691 (If more space is needed, insert additional sheets of the same size) 'REV-1513~EX + (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER LEE E. M OUNTZ 21 09 0 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright sppousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. MARTHA MOUNTZ Spousal 480 PLEASANT HALL ROAD REMAINDER CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ fir more space is neeaea, insert aaaltlonal sneers or the same size) ti ~, '' v ~. ~ c o - ~ c c ~. .~ U o ~ -, '~' ~• A ~ m ~'' o . ~~ ~~ ~~ ~~ © ~~ b Ca ~~ ~ ~~ oo~°~, ' ~ m ~.~~ `~ ~~ g ~ ~... 'c. 0 ~~ c9 ~, p ~ ~ i ~ '"~ ~' '~ w-~o ,tea c a o~ ~ ww o r 0 J `~~ ~ ~ o ~. Q