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HomeMy WebLinkAbout04-27-1015056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN y~ ~ /.~ ~! ~ PO BOX 280601 ~ ! V Y Harrisburg, PA 17128-0601 RESIDENT DECEDENT Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS __ _ __ FILL IN APPROPRIATE OVALS BELOW ~;~°;~~ 1. Original Return ~N~ 2. Supplemental Return "~"~`~ 3. Remainder Return (date of death x`M':~°~ 4. Limited Estate ...:`:... 6. Decedent Died Testate (Attach Copy of Will) ,....::... 9. Litigation Proceeds Received 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) prior to 12-13-82) `;~ 5. Federal Estate Tax Return 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 Teleph~ Number __... _ _._. __ .. _ .... __ .. ~' -~ 'STEPHANIE E. CHERTOK 717 249 1 ~ ( ) ~ ~„ , r ;. ~ Firm Name (If Applicable) : _ _ _ ~_r ~ ~-' ~-~...~..... `.~?__..... :QIVtt'tS USLY REGI TEES . ~ , ~ .. t . --a- r-n tU 1 , .. C.l..) „r.e < : _, ~ r 1 ...~~. First line of address ,~:."~ ~--~ ~~~~ -~ ` , ; `~. .... _ ~ 61 W. LOUTHER STREET ~ , ~ ~ d Second line of address -~"' .._. '' <y 2 ___. _ City or Post Office State ZIP Code DATE FILED CARLISLE ' PA 17013-2936 Correspondent's a-mail address: Under 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. SIGN T E OF PERSON SPONSI .FOR FILING RETURN DATE ADDRESS ~ ~ ~ ~U ~~ `/~~` ~. SIGNA~UR6 OF~P.jtl3P ER OZHER THAN REPRESENTATIVE DATE ~ 2.'71/b PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number HELEN M PEACH '.180-20-1778 Decedent's Name: _..,.~.._...,,,.,.~.,,,,,_„_,~,~,..,~..,,,..,~.,, ,~.,_,~.,,,m,..~.,~,,.~.,,,mw,,,~.,,,.~.~.~.... ~, ...._~..~..w.,.~,~..w.._._„,_.,..~.....~..~,.w...~ RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 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 8 Miscellaneous Personal Property (Schedule E) ........ 5. 4,601.45 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 281 91 372 (Schedule G) ~ Separate Billing Requested........ . , 8. Total Gross Assets (total Lines 1-7) .................................... 8. 376,883.36 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. ' 5,550.16 !, 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. ': 482.57 11. Total Deductions (total Lines 9 & 10) ................................... 11. 6,032.73 '; 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 370, 850.63 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. ! 370,850.63 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 45 370,850.63: 16, ! 16,688.28 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. '! 19. TAX DUE ......................................................... 19.? 16,688.28 4 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number..,.. rlar_arilpnt'c Cmm~letp Address: I x= _ .~~..._.~_._.....m.~_ _ _.. __ ..._ DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER HELEN M PEACH 180-20-1778 STREET ADDRESS 31 ABBEY COURT CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 16,688.28 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 878.30 Total Credits (A + B + C) (2) 878.30 3. InterestlPenalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 15,809.98 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 15,809.98 Make Check Payable fo: 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 :.......................................................................................... ^x ^ 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? ........................................................................................................................ ^ 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-1508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN M. PEACH 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. M&T BANK- CHECKING ACCOUNT N0.865133 4,495.11 ~ 'war.HnvlA RANK- ACCOUNT NO. 1010187826691 106.34 TOTAL (Also enter on line 5, Recapitulation) a 4,601.45 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09j Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND .............. : INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN M. PEACH This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME of THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE ~~ ASSETS OFTHE HELEN M. PEACH LIVING TRUST ~ REAL ESTATE KNOWN AS 31 ABBEY COURT, CARLISLE, PA 17013- 143,000.00 100 143,000.00 2 BEDROOM, 2 BATH RANCH STYLE TOWNHOME . 2 HOUSEHOLD FURNISHINGS 600.00 i 100:. 600.00 3 ' VANGUARD GNMA FUND 59,034.08 100. 59,034.08 4 SMITH BARNEY ACCOUNT 165,147.83 ! 100 165,147.83 5 .2005 FORD FOCUS AUTOMOBILE- SOLD AT PRIVATE SALE 4,500.00' 100' 4,500.00 TOTAL (Also enter on Line 7, Recapitulation) $ I 372,281.91 If more space is needed, use additional sheets of paper of the same size. REV-1Sll EX+ (1G-09i enns lvania P Y SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN M. PEACH Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: i' ST. PAUL'S CHURCH- FOOD AFTER SERVICE, ETC. 168.50 2. HOLLINGER FUNERAL HOME 3,731.66 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 1, 500.00 2. Attorney Fees: 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 Preparer Fees: ~~ JONES ACCOUNTING- PREPARATION OF FINAL INCOME TAX RETURNS 150.00 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 5,550.16 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (1Z-08; y~• pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN M. PEACH Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' GENTRY LINK- FINAL PHONE BILL 25.16 2. OFFICE MAX- COPIES OF DEATH CERTIFICATE 0.76 3. MET-ED- FINAL ELECTRIC BILL - 97.93 4. HILTON LOCKS- CHANGE LOCKS ON REALTY 30.74 5. SOUTH MIDDLETON TWP. AUTHORITY- WATER & SEWER FOR FIRST QUARTER AT 2010 101.00 6. WILLIAM BOLDOSSER (FOR THE VILLAS)- ASSOC. FEE FOR FEB 2010 101.00 7. WILLIAM BOLDOSSER (FOR THE VILLAS)- SUPPLEMENTAL FEE FOR SNOW REMOVAL 09-10 113.00 8. U.S. POSTAL SERVICE- MAILING OF DEATH CERTIFICATES 12.98 TOTAL (Also enter on Line 10, Recapitulation) $ 482.57 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) ~ pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN ESTATE OF: FILE NUMBER: HELEN M. PEACH 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).] _ _ _ _ _ 1. ' KATHY TATS _ _ _ DAUGHTER ONE-HALF '612 FORGE ROAD CARLISLE, PA 17013 2. .MARLIN R. TATE SON-IN-LAW ONE-HALF 612 FORGE ROAD CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: If more space is needed, use additional sheets of paper of the same size.