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Home My WebLink About04-20-10 (2)' 1505607121 REV-'I 5O0 Ex (os-os) OFFICIAL USE ONLY PA Department of Revenue County Code Year Fie Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box 280601 2 1 1 0 0 1 1 ], Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 2 2 2 4 1 7 2 0 1 2 3 2 0 1 0 1 D 2 5 1 9 2 7 Decedents Last Name Suffer Decedents First Name MI BUR R E L L L O R E N A (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 Q 1.Original Return 4. Limited Estate QX 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum 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) 3. Remainder Retum (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 M U R R E L W A L T E R S I I I E S Q ? 1? 6 9 7 4 6 5 0 Firm Name (If Applicable) First line of address 5 4 E A S T M A I N S T R E E T Second line of address City or Post Office M E C R A N I C S B U R G Correspondent's e-mail address: mwaiters54Cci2verizon.net State ZtP Code ~ P A 1 7 0 5 5 REGISTER OF WILLS USE ONLY ~ ev ~ C~ ~ tai a ~ .'~O ~ ,~ _E --~- ~ ~, ' ~ Q ,,~ ~ Dq'T~ D ~ _~ ~ ~ __~ _.~ „~, ,.:::, ~t ~ w ti~ .~ ~..~`:i ~,...,r t ~ µ~;` (~t~„~ e t" r-.. =~ ~._..~ -:.;.~ Under penaltles of perjury, i declare that I have examined this return, induding accompanying schedules and statements, and to the hest of my knowledge and belief, ~ is true, coned and complete. Declaration of preparer other than the personal repraseMathe is tensed on all informatlon of which pn~parer has any knowledge. SIGNATURE OF PER N RESPONSIBLE FILING RETURN /l (o O ADDRESS 2723 L R AD, R ROCKBRIDGE OH 43149 SIGNA ~F P ~E THER THAN REPRESENTATNE ~~ q ~ ~ ( ~ S4 EASTIMAIN STREET, MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505607121 ],505607121 150567221 REV-1500 EX Decedent's Name: LORENA BURRELL Decedent's Social Security Number L 6 2 2 2 4 1 7 2 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 1 4 8 7 3 6. 6 4 2. Stocks and Bonds Schedule B 2. ~ • 0 ~ 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. 7 0 7 1 0 . 0 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. • 8. Total Gross Assets (total Lines 1-7) ........................... 8. 2 1 9 4 4 6. 6 4 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ................ 9. 1 4 2 0 6 . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 1 0 4 2 2 . 5 4 11. Total Deductions (total Lines 9 8 10) ........................... 11. 2 4 6 2 8. 5 4 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 1 9 4 8 1 8 . 1 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. 14. 1 9 4 8 1 8 , 1 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. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 1 9 4 8 1 8. 1 0 16. 8 7 6 6. 8 1 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. 8 7 6 6. 8 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 1505607221 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 10 0111 DECEDENT'S NAME LORENA BURRELL STREETADDRESS 420 EAST WINDING HILL ROAD CITY MECHANICSBURG STATE ZIP PA 17055 Tax Payments and Credits: ~~ Tax Due (Page 2 Line 19) (1) 8,766.81 2. Credits/Payments A, Spousal Poverty Credit B, Prior Payments C. Discount 438.34 Total Credits (A + B + C) (2) 438.34 3. Interest/Penalty if applicable D. Interest E. Penalty 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) 8,328.47 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 8,328.47 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 : ...................................................................... ^ Q b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3, Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q 4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. ^ 0 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-1502 EX + (6-98) ' ~ SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LORENA BURRELL 21 10 0111 All 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. Real propertv which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 420 EAST WINDING HILL ROAD 148,736.64 MECHANICSBURG, PA 17055 NET SALE PRICE TOTAL (Also enter on line 1, Recapitulation} ~ $ 148,736.64 (If more space is needed, insert additional sheets of the same size) 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 LORENA BURRELL 21 10 0111 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1993 BUICK 500.00 NET SALE PRICE 2. ERIE INSURANCE 308.00 REFUND -CAR 3. TERMINEX 45.96 REFUND 4. DISH NETWORK 47.83 REFUND 5. VERIZON 11.99 REFUND 6. ERIE INSURANCE 31.00 REFUND -HOME 7. PP&L 325.00 ENERGY CREDIT REBATE 8. FEDERAL INCOME TAX - 2009 587.00 REFUND 9. PA PROPERTY TAX (PA-1000) 250.00 REFUND 10. METRO BANK 2,773,22 CHECKING 11. AMERIPRISE ANNUITY 65,830.00 50% TO SON BRIAN E. BURRELL 50% TO SON JEFFREY S. BURRELL TOTAL (Also enter on line 5, Recapitulation) I $ 70 (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 LORENA BURRELL 21 10 0111 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME, MECHANICSBURG, PA 17055 8,977.50 2. ROMBERGER MEMORIALS, TOMBSTONE ENGRAVING 110.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) BRIAN E. BURRELL (RENOUNCED) Street Address 27234 MILLER ROAD City ROCKBRIDGE State OH Zip 43149 Year(s) Commission Paid: 2, Attorney Fees MURREL R. WALTERS, III, ESQUIRE 4,725.00 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS, CUMBERLAND COUNTY 393.50 5 Accountant's Fees 6. Tax Return Preparers Fees 7 TOTAL (Also enter on line 9, Recapitulation) I $ 14,206.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) ' ~ . COMMONWEALTH OF PENNSYLVANIA SCHEDULE 1 DEBTS OF DECEDENT, LORENA BURRELL 21 10 0111 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ERIE INSURANCE 324.00 CAR 2. CUMBERLAND COUNTY LANDFILL 233.98 REFUSE 3. PP&L 492.59 ELECTRIC 4. AMERICAN EXPRESS 124.52 5. VERIZON 45.30 6. UPPER ALLEN TOWNSHIP 112.00 SEWER 8. TRASH HAULING 304.34 9. FED EX -SIGNED HOUSE SALES AGREEMENT 24.99 OVERNIGHT RETURN OF HOUSE SALE DOCUMENTS 10. US BANK VISA 8,483.82 11. PA STATE INCOME TAX 277.00 (PA-40) - 2009 TOTAL (Also enter on line 10, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) • - SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LORENA BURRELL Z1 1 U 0111 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 spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1. BRIAN E. BURRELL Lineal 97,409.05 27234 MILLER ROAD ROCKBRIDGE, OH 43149 2. JEFFREY S. BURRELL Lineal 97,409.05 CMR 415, BOX 3036 APO, AE 09114 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) ~~ Ind .~~~ ~ ~ c~ ~~ ~a