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Home My WebLink About04-20-10 (2) Future Interest Compromise (date of 4a 5. Federal Estate Tax Retum egwre 4. Limited Estate . death after 12-12-82) Decedent Maintained a Living Trust 7 8. Total Number of Safe Deposit Boxes 6. Decedent Died Testate (Attach Copy of Will) . (Attach Copy of Trust) nder Sec. 9113(A) 11 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death ~°° between 12-31-91 and 1-1-95) - . Attach Sc O) ( ULD BE DIRECTED TO: THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHq' CORRESPONDENT - ~ p Da Ime Tele hone Number Name (717) 737-0464 'Lisa Marie Coyne, Esq. Name (If Applicable) Fi _ -rya REGISTER ILLS USE OP~ rm _ K ~ Coyne & Coyne, P.C. lD -s~ ~ ~ ' c e of address t li Fi _ --~ ~, --"' n rs 3901 Market Street _ _ _ _ ~Z . ~ ~ 0 rte` 1"~...~ ?_"~ ~ C Second line of address _ - _ ~ 3 ~Q~n ' ,_ i - f State ZIP Code ;,~ , = O~ FED r~ ~ 3 City or Post Office Camp Hill PA 17011-4227 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Cade Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po sox 28oso1 RESIDENT DECEDENT 21 09 0763 Hanisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death _ __ 187-16-4406 08/04/2009 ....,,.02/18/1921 Suffix Decedent's First Name MI Decedent's Last Name - Dorothy L Winn __ (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name MI Spouse's Last Name __ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 3. Remainder Retyrn (date of death 1. Original Retum ~' 2. Supplemental Retum prior to 12-13-82) R d Correspondent's a-mail address: Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best pf 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. TURE OF PERSON RESPONSIBLE FOR FILING RETURN DATFl i _ '~ / U ,~ 01 ~ 1A~0/i ~ AD ESS Renee J. Wewer, 312 48th Street, Harrisburg, PA 17111 DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 1:1056052059 REV-1500 EX Decedent's Social Security Number Dorothy L Wnn ' 187-16-4406 ..,,. ... _.__.. Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) . ........................................ 1. .... _ __ 1,799.77 2. Stocks and Bonds (Schedule B) .................................. 2. ..... _ _ __ 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 8 Miscellaneous Non-Probate Property .° Separate Billing Requested... ..... 7. (Schedule G) u_. 8 1,799.77 8. Total Gross Assets (total Lines 1-7) ............. .... Wµ ,_µ_,.. " _....., 9. . ... -, .... , ~.mm..~.~ Funeral Expenses 8 Administrative Costs (Schedule H) .. ............. g .... . 15. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .......... ...... 10. 11. Total Deductions (total Lines 9 & 10) ............................. ...... 11. 15.00 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. 1,784.77 tai Be uests/Sec 9113 Trusts for which 13. Chartable and Govemmen q an election to tax has not been made (Schedule J) ........................ 13. 14 1,784.77 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ . • • • • TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. 16. Amount of Line 14 taxable 1,799.77 ' 16. 80.31 at lineal rate X .0 45 _-. .. _ _ -- 17. Amount of Line 14 taxable 17 at sibling rate X .12 18. Amount of Line 14 taxable 18 at collateral rate X .15 - - 80.31 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 ~,~.;:;~ 15056052059 REV-1500 EX Page 3 Flle kumber Decedent's Complete Address: 21 09 .'0763 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Dorothy L Winn 187-16-4406 STREET ADDRESS 208 Fourth Street aTv West Fairview PA 17025 Tax Payments and Credits: 80.31 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InterestlPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Fill in oval on Page 2, Line 20 to request a refund. 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) (5B) 80.31 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROP~tIATE BLOCKS 1. Did decedent make a transfer and: Yes ^ No a. retain the use or income of the property transferred :.......................................................................................... erty transferred or its income ro the ll h :::.......:::::..::..::..:..::..:..::::..:..: p p use o s a t s h o ionary interes rever c. retain a .............................................. nefits or care? t b ^ ........................ e s, d. receive the promise for life of either paymen 2. If death occurred after December 12,1982, did decedent transfer property within one year of death ^ without receiving adequate consideretion7 .............................................................................................................. ^ 3. Did decedent own an "intrust 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. REV-1503 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt~LE B STOCKS & BONDS ESTATE OF Dorothy L. Winn _ .... _ ___ _ ~ ._.:.~ _~_~. _s -.....~......tii.. ~~~at he disrlesad on Schedule F. FILE NUMBER 21-09-0763 (If more space is neeaea, insen awnionai miecw ~~ u~o ~...~ .,.....~ REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy L. Winn ITEM NUMBER A. FUNERAL EXPENSES: 1. B. 1 2. 3. 4. 5. 6. ~. a. s. ~ o. SCNEDI~ILE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-09-0763 Debts of decedent must be reported on Schedule I. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Sodal Security Number(s)IEIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State City Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Filing fee for Supplemental Inheritance Tax Return Zip Zip 15.00 TOTAL (Also enter on line 9, Recapitulation) I $ 15.00 (If more space is needed, insert additional sheets of the same size)