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HomeMy WebLinkAbout03-09-10REV-15 0 0 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 _ Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 15056051047 C;3FfiIt:,`5~~. t1 SF: €.€NL.:'~ INHERITANCE TAX RETURN County Code Year RESIDENT DECEDENT ~„ ~ (~ Date of Birth ~a9S0~~/~~ ~ i I t2do~ Decedent's Last Name Suffix F ; s e. n ~. o ~ e, ~' TZ z (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number 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 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 Will) (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 Number C ~ ~ 1. L. i s e. ~ '~ cn w ~ ~` 1 ~ ?I ? ~7` 3 67 Firm Name (If Applicable) First line of address ~ ~ .~ - ~ ~r "t-:3 Second line of address ,r ..7„ ~-"t I ., ", , Wti ,` v7'7 Ca i r i . r ~. -~ ~,,,,r i , City or Post Office State ZIP Code ~~ r ,. „aaa. ' M~c~•~n ~ CSS v ~ P~ 17d S"0 ~~ .''T~" ~ ` ' c~.::.,~ L""t Correspondent s e-mail address: d? r ~ n~ T ~ ~ m ~ S~ n nder penalties of perjury, 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. ~. _~..~.,.........,~.~ ~...~, .......... -,,.w.~~.~ SIGNATURE OF PERSON~SPON~IBLE R FILING RETURN -~~~~~~~ ...__,..,... DATE _..W._. _. _....~ ~ ~. u . ~.,~ , , ,..a...., ~.~. ~., ~. ...,... ~- ``^^11 ADDRESS ~. e.-. ~.~~,<.~d~. _ _. _~ _...~ .~~~.. ~.~ I, s<'~. .~ y ~ 7 s Pon ~ ...M_ ~_ ..._ ...w ~~.. _~ ...~~.... ...,~ow -____.w~..wM~ ._~.,.._.,.w_.,_~~,.,.~ ....~`~ _~..~'?~~n riGS~ v ~ .___~.... P~ _..L~7o~SD o ,,~.a_~Q'~ I to SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 ~~~z~~cy Decedent's First Name ~~n~r Spouse's First Name File Number 12s3 MI F MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER Of WILLS 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~ - r ~ Q RECAPITULATION m~..~.~ti-..._.~...w._ ~ ...~,~ -.~...~,.-.~ ~ I ~ 4 1. Real estate (Schedule A) . ............................................ 1. ~ ~ ,2~ O d 0 . O Q 2. Stocks and Bonds (Schedule B) ....................................... 2. Q 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 & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10 11. Total Deductions (total Lines 9 & 10) ................................... 11 12. Net Value of Estate (Line 8 minus Line 11) 13. ......................... Charitable and Governmental Bequests/Sec 9113 Trusts for which ..... 12. an election to tax has not been made (Schedule J) ................... ..... 13. 14. Net Value Subject 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 (a)(1.2) X .0 15. 16. Amount of Line 14 taxable at lineal rate X .0 - . 16. 17. Amount of Line 14 taxable at sibling rate X .12 . 17 18. Amount of Line 14 taxable at collateral rate X .15 _ ... 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 ~, 15056052048 c? C7 • 0 • • Q • • 15056052048 J ~. ~. 7,Sn7.i ~ ©• Q 115,so7.1 ~ J~9,gl~3.q.3 1 78, I X5.2 0 CSg~ G 6 ~. a~ REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME File Number _- ---- ~~i~n ---F ~ ~ Se n ~, ~ we~r LET STREET ADDRESS ~ --- -_ - -- CITY ! ~~G~1 G.~n ~ C. S ~ ~~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _-- B. Prior Payments C. Discount STATE T ZIP __ ------- ~~ ~ 1 ~~SO (1) 3. Interest/Penalty if applicable D. Interest E. Penalty _ - Total Interest/Penalty (D + E ) 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. 5. If Line 1 + Line 3 is greater thar: Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A This is the BALANCE DUE. Total Credits (A + B + C) (2) (3) (4) (5) - d (5A) ~ (5B) 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? ................ n ~ 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)J. 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. REV-1502 EX+ (11-08) ~ pennsylvan~a DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ca;w;t ur _ FILE NUMBER All real property owned sol Iy ~r as a tenant ; n ~~„~,,,~„ ,,,,,,t ue reportea ai ra;r 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. Real property that is iointly-owned with rieht of cnrvlvnreh~....,.~~~ w...,:__~___., __ .,_~_,__._ _ -- - -----, ,,,.,..,. ,...,.,~,,,~~u~ ~~~,.~~~ ~~ ui~ JQIIIC JILL. DEED A ~ der! ei,; 1 tie..~.~i~iE~~ ~~.. ~ ~.~ ~ ~ ~ L ;.~ ~!~Y~~~~~rr~ent ~Lil i.iwC...i6J91~J f ~~t~i ~'t~ ~ ~~i ~~'1'~ ~.~, ~i~~rf~i~:~- ~r--- -- THIS INDENTURE, made this ~ 1 day of l%-~ ~ ~ ~~ ~" , 2009, among CORY L. EISENHOWER, Administrator for ESTATE of HENRY F. EISENHOWER, III (hereinafter re- ferred to as "Grantor") AND KEITH A. EISENHOWER, married man, {hereinafter referred to as "Grantee"). WITNESSETH, that Grantor, in consideration of One Hundred Seven Thousand Dollars ($107,000.00) lawful money of the United States of America, the receipt and sufficiency of which hereby are acknowledged, do hereby grant, release and convey unto Grantee and the heirs, executors, administrators, legal representatives, successors and assigns of Grantee forever, ALL THAT CERTAIN piece, parcel and tract of land, situate in the township of Lower Paxton, County of Dauphin, Commonwealth of Pennsylvania, more particularly bounded and described as follows, to wit: BEGINNING at a point on the westerly line of Ford Avenue, which point is three hundred forty feet South of the southwesterly corner of Arminda Street and Ford Avenue; thence along the westerly line of Ford Avenue, South ten degrees fifteen minutes West seventy feet to a point; thence North seventy-nine degrees forty-five minutes West one hundred forty- four feet to a point in the center line of twenty feet wide public alley; thence along the same North two degrees thirty-seven minutes West seventy-five feet to a point; thence South seventy-nine degrees forty-five minutes East one hundred sixty feet to a point, the place of BEGINNING. BEING known as premises 1408 Ford Avenue. SUBJECT to certain Building Restrictions as of record. Main ' e I 1 a e# Kennedy Appraisals 170 Sloop Road Shermans Dale, Pa 7090 717-582-8528 December 29, 2009 Keith Eisenhower Re: Property: 1408 Ford Ave Harrisburg, Pa 17109-5616 Borrower: N/A File No.: EIN9001 Opinion of Value: $ 112,000 Effective Date: December 19, 2009 In accordance with your request, we have appraised the above referenced property. The report of that appraisal is attached. The purpose of the appraisal is to develop an opinion of market value for the property described in this appraisal report, as improved, in unencumbered fee simple title of ownership. This report is based on a physical analysis of the site and improvements, a locational analysis of the neighborhood and city, and an economic analysis of the market for properties such as the subject. The appraisal was developed and the report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice. The opinion of value reported above is as of the stated effective date and is contingent upon the certification and limiting conditions attached. It has been a pleasure to assist you. Please do not hesitate to contact me or any of my staff'rf we can be of additional service to you. Sincerely, .r+ ~~~~~ ~ Melissa H Kennedy License or Certification #: Assistant to the PA Res App State: PA E~ires: June 30, 2011 kennedyappraisals@comcrit. net REV-1508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ~~~ r F. F ~ e.n~~w~cr j~ 2 Y ! zs,3 ~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH .. ~ ~~Ve,re~ n e~~,~ ~c ~ ~ S3 9G z .~- 3 S v ~e~~ ~~ S~v~er-e;, ~ Ir1un c..r ~ kc~` >~~ ~~ Z o! 1 9,S') 7 S" c~ S ~ 1 S I c~ 5. ~6 ~ .. ~ ~' __ ~ cis ~• ~v- ~, A ~ ~ 397a 19 zS7 7 2 j s~ . 2, $ S T n rv~, ~~} er1 I ~ ~~ ~'~ ~ G,1 Q,1G e. ~ 5 e ~ C ~c~e F~.~r~ ~3~ ~'G, n c ~ ~ ~ t ~s ~`L~n /~cc, ~ J ~- 8 ~ - lU~ 06-4 yS ~ 2 Y 7 .~_____ G'o~r~ Se~-le.,~e.~~' - v. ~ C~,se ~o: o70z - o~~ ~ ~ ~ - Zc~$ w-1i~.,it. ~S l~ . d 0 TOTAL (Also enter on line 5, Recapitulation) $ I ~ s"~ "1 ~ I (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) ~ pennsylvan~a DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ITEM NUMBER A. 1. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS 1 h~we~ ~ Decedent's debts must be reported on Schedule I. DESCRIPTION FILE NUMBER FUNERAL EXPENSES: I`'I a1 P 22Z ~ wv n e.~.~ 1~-~ ~ ~.. ~ ~r-~~c~~ -~^ ~~ Se~v~ < <S G~.s ~ke~-) ~ AMOUNT GG oz ~ Kd B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) C~ r _ L, t~~Sen~,~ w~~ yS~-b'7 Street Address ~ ~ ~ ~ f~~y1 Lc` ~ ~ 1 ~ ~~ City ! t ~. 1 /~ ~ ~ State I'~7 ZIP) J Sa Year(s) Commission Paid: 2 c7 f (~ z• Attorney Fees: '7 Q ~ ~ 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: 5• Accountant Fees: 6• Tax Return PreparerFees: 7. TOTAL (Also enter on Line 9, Recapitulation) I $ ~ Z G ~ , Z 7 If more space is needed, use additional sheets of paper of the same size. ~ REV-1512 EX+ (12-d8) ~ pennsylvan~a SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER r F, L,s~e.~ ~,~~ ~ zl~~- 12.s'3 Report debts inc rred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH ~. S , l~ ver r~- ~ ` ~ e,~ a n ~ /~ 03x6 ! ~ ~ 2 z.S7 G 2 . G ~ ~G s~,~-~ ,C ~. ~~c~- ~ o z ~ - 9 ~ ~3 - G N ~ t o y.~" l 1 9 3 z 3 . k e i3w, ~ N~-; o n ~,~ Ass oc,- ~..~- ~r. I ~ c~~- ~ 9 Z ~ Sc~ H G 9 ~ , ~ 2 F~ G I , ~ 7 y. )~{~I S ; r~~ l~~s~~~-w1 ~u~~ 333 ~-I1S~ 3 ~$~ ~ 35~ S- s~~~ e~ _ ~~.!`w1 ~~~ ~/1 S J n4~C{~ I~CC,~~ 3 9 7 C - 2 ~ 3 0 ). 2 ~ 3 ~ Z 1zz,r -._7 1~or~..~-~ Cyr v r~,,~-i ~ F /~ ~i~~ ~, l~cc,~- ~ ~tSk~( 2Fs`~S 1~7.~G C~ r1C;ct,s ~ ~ ~~. ~c.~~- ~ Oq S3 z 2 ~So'Yg -- ~ ~ - f ~ Y ~ z Ve,~ ~ z ~~ t~.>>`~c~ ~e s ~cc,~- ~ c~? z~ ~ ~~ I ~u ~ ~ l kl Ss" , ~~ S~~ere, ~ ~~~ k Gam,, ~~~ a ys zq 3 G 3 G I S~'` 1. o r ~ t ~~ ~~ F'~x E~ ~, ~~~w~ w~,~ ~cc,~~ 1.~ ~9~~oto,~~ 359 y~ ~ ' z _ ~cc,~- L ~ S ,, ~- ~~~- CX Oo~o82z9 SG - $1 Q~ t ~ ~R - - - - k~ ~'~ L , 07 - f -~ ~ ~- -~s ~~ o~r~u~ s~ ~ ~~ ~~ ~ r 2~P . TOTAL (Also enter on Line 10, Recapitulation) I $ / 6 gig ~ 3 ~ R3 If more space is needed, insert additional sheets of the same size. IRS D~~~~ R O~,~EESERVICE Y CINCINNATI OH 45999-0023 HENRY F EISENHOWER III ESTATE CORY L EISENHOWER ADM 4475 PANZA DR MECHANICSBURG, PA 17050 Date of this notice: 12-18-2008 Employer Identification Number: 26-6689946 Form: SS-4 Number of this notice: CP 575 B For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN). We assi ed EIN 26-6689946. This EIN will identif gn you a licant, Y Your estate or trust. If you are not the Pp please contact the individual who is handling the estate or trust for you. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 1041 04/15/2009 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year), see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. (IRS USE ONLY) 575B 12-18-2008 EISE B 9999999999 SS-4 I1~ORTANT REMINDERS: * Keep a copy of this notice in our one time and the IRS will not be able tongeneraterasduplicateocice fs issued only opy for you. * Use this EIN and your name exactl as the a your federal tax forms. y y PPear at the top of this notice on all * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Thank you for your cooperation. Keep this part for your records. CP 575 B (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please correct any errors in your name or address. CP 575 B 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 12-18-2008 (~ j7 ) 7~~ ~~i ` -' EMPLOYER IDENTIFICATION NUMBER: 26-6689946 V'e-~ 1 ~ FORM : SS - 4 NOBOD INTERNAL REVENUE SERVICE HENRY F EISENHOWER III ESTATE CINCINNATI OH 45999-0023 ~i~i~~i~~~~~~~n~~~u~i~u~~n~~~nni~~~u~~~~i~i~~ 4475 PANZAENHOWER ADM MECHANICSBURG, PA 17050 J I~ ~~ ~~~~ ~ C~~~ . ~~~ ~~ ~~~~.