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Home My WebLink About03-31-10-"', REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 15056051058 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year Flle Number 21 ; 10 0~~ , Social Security Number Date of Death Date of Birth 211-24 B926 03/22/2010 07/09/1930 Decedent's Last Name " " Suffix Decedents Fvst Name KAUFFMAN MI __ ' ___ -__ _ .. _ r j ELMER ` 'S' m__. Applicable) Enter Surviving Spouse's Information Below _ _ ~ .._-_ «~ ___ ' r Spouse's Last Name Suffix __ pouse s First Name KAUFFMAN _.... i ... _..... __ ML... .......... ROSE ~! Spouse's Social Security Number _ ...... __ `° 200-54-512 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - - REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum p 2. Supplemental Retum O 3. Remainder Retum (date of death t 4. Limited Estate prior to 12-13-82) C:) 4a. Future Interest Compromise (date of ~,} 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate G'~ 7. Decedent Maintained a Living Trust (Attach Copy of Will) .................. 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death p 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MU9T BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name -- -- -- __ Daytime Telephone Number ROSE KAUFFMAN _......... __ (717) 737-0345 irm Name (If Applicable) _. ~ __ _..,~, oY I - ~ . _ mm.. ~ RE613TER~ WILLS USE ~~~--~ + n First line of address - u } ~-? ._ 24 ESSEX RD r-n , - ',_': --. _ ~_ __ _.__ ~.._._ 1 Second Ilne of address °"" ~- - _._ w - -_. _ _, City or Post Office - "' ~ 3 , "+":? State ZIP Code JLED ~ _ ~ 7 CAMP HILT _ ~ __ .. __ _......... ~ PA 17011 -. ~ W `= •' ~: _, rn Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this realm, InGUtling acwmpanying schedules and statements, and to the beat of my knowledge and belief, it is true, correct and complete. DeGaretgn of preparer other than the personal represematWe is lased on all infonna0on of which preparer has any knowledge. SIGNyiflyRE OF PERSON RESFlffuciwr c cno c„ ,.,.. .,.-_...-.. ROSE KAUFFMAN, EXECUTRIX; 24 ESSEX RD., CAMP HILL, PA 17011 SIGNATURE OF PREPARER OTHER 7HAN REPRESENTATIVE ADDRESS DATE PLEASE USE ORIOtNAL FORM ONLY L. 15056051058 Side 1 15056051058 ~b J 15056052059 REV-1500 EX Decedents Name: ELMER S KAUFFMAN rctagf'ITULATION 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprtetorship (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) Cf Separate Billing Requested ..... .. 6 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property . (Schedule G) O Separete Billing Requested...... .. 7. B. 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. Nat Value of Estate (Line 6 minus Line 11) .............................. 12. 13. Charitable and Governmental Baquests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subisct to Taz (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 0 16. Amount of Lina 14 taxable 15. at lineal rate X .0 17. _ Amount of Line 14 taxable 16 at sibling rate X .12 18. Amount of Line 14 taxable 17 at coflateref rate X .15 18 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social Security Number r ___ ............ .............. .. .. .................. '211-24-6926 467.85 467.8b 467.85 487.85 Q 15056052059 REV-7500 EX Paga 3 Decedent's Com lete Address: Fu um6sr DECEDEN S NAME p 21 10 0~ (J ELMER S KAUFFMAN DECEDENTS SOCIAL 211-24-6926 24 ESSEX RD CAMP HILL I STATE Zip PA 17011 Tax Payments and Credits: _ 1. Tax Due (Page 2 Line 19) 2. Credits/Payments (t) 0.00 A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable Total Credits (A + B + C) (2) D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENTOtai Interest/Penalty (D + E) (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE . (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING " " AN X IN THE APPR 1. Did decedent make a transfer and: OPRI ATE BLOCKS a. retain the use or income of the property trans(erred :................................ b t i Yes ^ No . re a n the right to designate who shall use the property transferred or its Income : .................................... t i ^ ........ c. re a n a reversionary interest; or ............................................. d. receive the promise for life of either payments benefit .•.~~~..~~~..~~~~~~ ~~ ~~~~~~~~~~ 0 , s or care? ................................ ... 2. If death occurred after December 12, 1962, did decedent transfer ro p peAy within one year of death without receiring 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 decedentown an In~widual Retirement A x t ^ : c cun , annuity, ur other non-probate property wh~h contains a beneficiary designation? ..........:............................................................................................................. ^ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 benefidaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. Section 9102 aps andindividuaewho has at least one parent in common with the deceden twhethervby blood oar adoption. ~ §9116(a)(1.3)]. A sibling is defined, under F~V-1508 EX+ (8.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~i ~ CASH, BANK DEPOSITS, 8 MISC. PERSONAL PROPERTY tJTArE vF ELMER S. KAUFFMAN FILE NUMBER 21-10- 0365 Indude the proceeds of litigagon and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship moat be dbciwad on Schedule F. ITCu LUE AT OF DEA 138.00 ~. ~ ~~ r.. 122.85 `~„ 207.00 467.85 (If more space is needed, insert additional sheets of Me same sue) dEV-1513 EX~ (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ELMER S. KAUFFMAN NUMBER 1 ~~ II SCNEOI~ILE J BENEFICIARIES NAME AND ADDRESS OF FILE NUMBER 21-10- D305 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE RECEIVING PROPERTY Do Not Lht Trusba(a) OF ESTATE d dlslnbubons and transfers under