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Home My WebLink About04-15-10 (2) J 1505607121 REV-1500 Ex (06-05) OFFICIAL USE ONLY PA DepaMlent of Revenue Bureau otindividual Taxes County Code Year File Number POBOx21i0601 INHERITANCE TAX RETURN 2 1 0 9 0 4 5 5 HanisMrm PA 17128.0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 2 3 1 8 3 8 9 8 0 2 0 2 2 0 0 9 0 3 0 7 1 9 2 1 Decedent's Last Name MACKI N Suffix Decedents First Name MARY MI P pf Applicable) Errter Surviving 3pouse's Inforrnatton Below Spouse's Last Name Suffoc Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® 1.Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required I~ 8. Decedent Died Testate (Attach Copy of Wiil) ~ death after 12-12-82) 7. Decederrt Maintained a Living TrusE ~ 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ (Attach Copy of Trust) 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 TO N ame : Daytime Telephone Number H ANTHONY A DAMS 71 7 ~32 X270 Firm Name (If Applicable) First line of address 4 9 WEST ORANGE Serbnd Tine of address SUITE 3 City or Post Office S H I P P E N S B U R G STREET state zlP code L PA 1 7 2 5 7 Correspondents e-mail address: htadamslaw(dtembargmail.com ~ )'.~ i U NLY ~~• { - f" ; ~~~ ~ ~ r, .1. j c7 Q~~, 'e C-' c::~ ~J ` 3 - -~'rl ~ N .. _ ` ; m $ ~•~ ~ ; c DATE FILED Under penaltles of perjury, I r~dare drat I have examkled this nstum, inc9udd'eg aorompanying sdredules and stems, and m the best of my knowledge arx it is bue, correct and canplete• Ded~are6on of prepares otl>ar than the personal representatHe 'rs based on of klWrma>gn of which SIGNAT PERSOIIrytE DNSIBL FQR FILING RETURN PrePerer has any krowledge 1// f DATE ADOaes.~ ' ----~ 4 ~1 Side 1 L 1505607121 0 1505607121 J .• J 1505607221 REV-1500 EX Decedent's Social Security Number OecedeM'sName: MARY P. MACKIN 0 2 3 1 8 3 8 9 8 RECAPITULATION 1. Real estate (schedule A) ................................... ..... 1. 2 5 8 6 5 2, 0 0 2. Stocks and Bonds (Schedule B) . . . .......................... ..... 2. 2 3 6 8 0 , 0 0 3. Cbsely Held Corporation, Partnership orSole-Proprietorship (Schedule C) . .... 3. 4. Mortgages & Notes Receivable (Schedule D) .................... .... 4. , 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ... .... 5. 4 1 0 0 4 5 , 4 3 6. Jointly Owned property (Schedule F) ^ Separate Billing Requested .. s. . 7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property (Schedule G) ~ .... Separate Billing Requested ... .... 7. 8. Total Gross Assets (total Lines 1-7) , , , , , , .. , _ • • . , ......... .... s. 6 9 2 3 7 7,4 3 9. Funeral Expenses 8 Administrative Costs (Schedule H) , , , , , , , , , , , , , , , g_ ] 6 2 5 , 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .. , , .. , , , , , • 10. 3 3 6 2 3 , 0 5 11. Total Deductions (total Lines 9 & 10) ....................... .... 11. 4 1 2 4 8 , 0 5 12. Net Value of Estate (Line s minus Line 11) ...................... ... 12. 6 5 1 1 2 9 3 $ 13. Charitable and Governmental eequests/Sec 9113 Trusts for which , an election to tax has not been made (Schedule J) , , , , , , . , , . , 1g 14. Nst Value Sub)aet to Tax (line 12 minus Line 13) ............... ... 14, s 5 1 1 2 9 , 3 $ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 1s. Amount of Line 14 taxable at lineal rate X .045 6 5 1 1 2 9, 3 8 1s. 2 9 3 0 0, 8 2 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17, 0 0 0 18. Amount of Line 14 taxable , at collateral rate X .15 0 0 0 18 0. 0 0 19. Tax Due .............................................. ..19. 2 9 3 0 0. 8 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ side z L 1505607221 1505607221 REV-1500 EX Page 3 Decedent's Complete Address: 21 N09~0455 P E CITY CAMP HILL STATE PA Tax Payments and Credits: 1• Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPen 'rf Total Credits (A + g + C ) sky applicable D. Interest 575 26 E. Penalty 4. If Line 2 is greater than tine 1 + Line 3, enter the difference. This is the OVERPAYMENT Total InteresUPenalty (D + E ) FIII 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. A. Enter the interest on the tax due. ZIP 17011 (1) 29 300.82 (2) 0.00 (3) 575.26 (4) 0.00 (5) 29 876.08 (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 29 876.08 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: a. retain the use w income of the property transferred; Yes No b. retain the right to designate who shall use the property transferred or its income' c. retain a reversions interest; or ~ ............................... ry ~ ................................................................................................ d. receive the promise for life of either payments, benefits or care? .............. 2. If death occurred after December 12,1982, did decedent transfer ......................................... without receivin Property vnthin one year of death g 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 ..••.... ~ ^ O contains a benefidary designation? ............................. ..................................................................... ^ QX 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 far 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 (O) percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even ff 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 (ll) percent p2 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 benefldaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) (/2 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 cxxnmon with the decedent, whether by blood or adoption. REV-1502 EX + (~86) ` ' COMMONWEALTH OF PENNSYLVANW INHERRANCE TAX RETURN _ RESIDENT DECEDENT All real properly owned aoky or a a bnaM In common moat be reported exchanged trelween a wlFing (Nryer and a wNNng sefier, neither tJP.UM ITEM NUMBER SCHEDULE A REAL ESTATE market value. Fair market value is defined a5 the price at Which property would be elled to twy or SeN, both havkg reasonable knowledge of the relevant facts. DESCRIPTION VALUE 2052080 X COMMON LR 1.26 VALUE AT DATE OF DEATH TOTAL (Also enter on line (If more space is needed. insert addfibnal sheep of the same sme) REV-1508 EX + (6-98) SCHEDULE E + COMMONWEALTH OF PENNSYWANIA CASH, BANK DEPOSITS, & MISC. tN R S DENT D EDENTRN PERSONAL PROPERTY FILE NUMBER MARY P. MACKIN 21 09 0455 All pro ~ i wly~ right (survivonih be di~cfosed on Sehsduk F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. WACHOVIA MONEY MARKET #31138897 220.000.00 2. ~WACHOVIA CHECKING ACCOUNT#31138907 3. ~FIDELITY1st2BE-639163 4. ~DWS#9972291471 5. IT. ROWE PRICE GNMA# 5001199698-8 6. IT. ROWE PRICE EQUITY#5001199702-6 7. ~PNC INVESTMENTS #OWN182245428 8. ~PSECU #0016 9. ~AIG # F5212428 10. ~AIG # F5212430 25,000.00 12,629.00 17,000.00 5,524.17 6,259.55 71,261.71 3,992.00 32,564.00 15,815.00 TOTAL (Also enter on line 5 Recapitulation) I ; (If moos space ~ ruuu~, insert additbnal sheets of the same etas) REV-1511 EX+(70-08) COh6NONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE Del#e of decedent must be reported on ScheduN I. ITEM NUMBER A. 1. B. 1 FUNERAL EXPENSES: MYERS-HORWERS CAMP HILL, PA ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commission Paid: State Zip 2. Athomey Fees 3. Family Exemption: (If decedents address is not the same as daimanYs, attach explanation) Claimant Street Address Cdy State Zip Relationship of Claimant to Decedent 4• Probate Fees AMOUNT 6, 000.00 1,500.00 35.00 5. Accountant's Fees 6• Tax Retum Preparer's Fees 7• I VITAL RECORDS (DEATH CERTIFICATE) DESCRIPTION 90.00 TOTAL (Also enter on line 9, Recapitulation) I S (If more space a needed, insert additlonal sheets of the same size) REV-1512 EX + (1°2-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANw DEBTS OF DECEDENT, IN RES DENT DE EDENTRN MORTGAGE LIABILITIES, & LIENS MARY P. MACKIN 21 09 0455 Report debts Incurred by fhe decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. CPM 635.00 2. PP&L 373.18 3. UGI 389.75 4. JERRY SWEETEN LAWN CARE ON ESTATE PROPERTY 1,684 34 5. COMCAST 171.13 6. PAWC UTILITY 225.08 7. HAMPDEN TOWNSHIP SEWER AND TRASH 577.30 8. AMICA HOMEOWNERS INSURANCE 1,036.41 9. WEST SHORE ANESTHESIA (LAST ILLNESS) 78 84 10. ZLOTAFF, GILBERT 8~ GOLD (LAST ILLNESS) 30.74 11. LUNG ASTHANA ASSOC (LAST ILLNESS) 41.90 12. DA MACKIN ADVANCE ON PLUMBING REPAIR 144.01 13. RESTONE CARES (LAST ILLNESS DEDUCTIBLE) 500.00 14. JASON 8 JOES LAWNCARE 53.00 15. ENVIROMENT HELATH CONSULT 9MOLD IN ESTATE REAL PROPERTY) 750.00 TOTAL (Also enter on line 10, Rec~itulation) ~ s (If more space b needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent MARY P. MACKIN 21 09 0455 Decedents Name Page 1 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. 1-800-GOT-JUNK 582.00 REMOVAL OF ITEMS FROM ESTATE REAL PROPERTY 17. DA MACKIN 81.13 ADVANCE ON REMOVAL OF ITEMS FROM THE REAL PROPERTY 18. REAL ESTATE TAXES ON ESTATE REAL PROPERTY 2,210.93 19. JIM BROWN SNOW REMOVAL AT ESTATE PROPERTY 20. PA. DEPARTMENT OF T RANSPORTATION DUPLICATE TITLE 21. M. LANGHMAN TAXES ON REAL ESTATE 22. HERTZ A CRETE MOLD REMEDIATION 23 RESTORECARE -mold remidiation to sell estate real property SUBTOTAL SCHEDULE I GRAND TOTAL SCHEWLE I S 80.00 22.50 555.04 4,400.77 19,000.00 REV-1513 EX + (g..p(~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY P. MACKIN 21 09 0455 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 pndude ht sppoousal distribudons, and Vansfers under Sec. 9116 (a (12)I 1. CHARLES P. MACKIN, JR. Lineal 2734 LOGAN STREET 1/3 CAMP HILL, PA 17011 2. TIMOTHY P. MACKIN Lineal 60 KENTON ROAD 1/3 CHAGRIN FALL, OH 44022 3. PATRICIA J. WILCOX Lineal 718 REGESTER AVENUE 1/3 BALTIMORE, MD 21212 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 II. NON-TAXABLE DISTRI IONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 SHEET TOTAL OFPART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I ; (K nrore space Is needed, Insert addltronal sheets of the same size)