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HomeMy WebLinkAbout04-06-10. 1505607121 REV-1500 Ex (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 9 0 0 7 6 7 Harrislwm PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 4 2 6 6 8 2 5 0 7 3 0 2 0 0 9 1 2 1 5 1 9 3 0 Decedent's Last Name Suffuc Decedent's First Name MI SCOTT KENNETH ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Socal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1. Original Retum ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-52) ~ 5. Federal Estate Tax Retum Required ® 6. Decedent Died Testate (Attach Copy of Will) ~ death after 12-12-82) 7. Decedent Maintained a Living Trust Att ~ 8. Total Number of Safe Deposit Boxes 9 Litigation Proceed R i d ( ach Copy of Trust) . s ece ve ~ 10. Spousal Poverty CredR (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 CONFIDENTUU. TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Firm Name (If Applicable) ^ _ a First line of address Second line of address City or Post Office Correspondent's e-mail address: lnder penel6es of perjury, I dedare that I have examined th I is tn~eprred and carriplete. Dedaratbn of preparer oche ilGr~flTl~tE OF PERS~I~t~~NSI~OR FILING SIGNAT{1RE~OF e State ZIP Code REGISTER OII~ I USE ONT~r ~-z ~ Ar ~ 7 ,~ ~ [ - 'tm r `' ~ ,,t - d ' ~ ~ i ` ~ C ~ ~: ~~~ ~ ~J - , ~ m, DATE FILED 'r '` ' CJ '~ ~ wing accompanying sdledules and statements, and to the best of my knowled sonal representa8ve is based aN Infonna8on of w ch preparer has any knm DATE DATE. PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505607121 1505607121 ~~ a~ 7 J ~~ ~ n 1505607221 REV-1500 EX Decedent's Social Security Number oecedenrs Name: KENNETH L. SCOTT 1 9 4 2 6 6 8 2 5 RECAPITULATION 1. Real estate (Schedule A) .................................... .... 1. 9 3 2 7 0, 0 0 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. 2 8 2 4 9 6 , 5 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... 6. . 7. Inter-Vrvos Transfers & Miscellaneous N~Probate Property (Schedule G) .. Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1-7) ........................ ... 8. 3 7 5 7 6 6, 5 0 9. Funeral Expenses & Administrative Costs (Schedule H) ............. ... 9. 4 7 0 7 , 1 7 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (schedule I) ......... ... 10. 3 6 8 5 , 2 $ 11. Total Deductions (total Lines 9 & 10) ..:..................... ... 11. 8 3 9 2 , 4 0 12. Net Value of Estate (Line 8 minus Line 11) ...................... ... 12. 3 6 7 3 7 4 1 0 13. Charitable and GovemmeMal Bequests/Sec 9113 Trusts for which , an election to tax has not been made (Schedule J) , ,, , , , , , , , , , , , , 13, 14. Net Value Subject to Taz (Line 12 minus Line 13) ................ .. 14. 3 s 7 3 7 4 , 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)(t2)x.o _ 0. 0 0 15. 0 0 0 i6. Amount of Line 14 taxable . at lineal rate x .oas 3 6 7 3 7 4. 1 0 is. 1 6 5 3 1. 8 3 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. 1 6 5 3 1. 8 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ _. Side 2 L 1505607221 1505607221 J REY-1Sb0 F~(~Pape 3 Decedent's Complete Address: File Number 21 09 00767 DECEDENTS NAME KENNETH L. SCOTT STREET ADDRESS 108 EAST MAIN STREET CITY NEWBURG STATE ZIP PA 17240 Tax Payments and Credits: 1 • Tax l9ae (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interesi/Penalty ff appliceble D. Interest E. Penalty (1) - 16.531..83 Total Credits (A + g + C) (2) 0.00 Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 +Line 3, enter the d'rfference. This is the OVERPAYMENT. 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (3) 0.00 (4) 0.00 (5) 16.531.83 (5A) (56) 16,531.83 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 : ........................ 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 foriife of eithergaymen<s, 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 foT or payable upon death bank acxount or security at his or her death? ......... ^ ^X 4. Did decedent own an Individual Retirement Account, annuity, or athernon-probate property which containsabeneficiarydesignation? ..... ......... .._..,., ,,,.,.. ,.,.. ...... .............. ^ o 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)j. 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 onl y beneficiary. For dates of death ort or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twentyone 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)j. 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)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent j72 P.S. §9116(a)(1.3)j. 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. REY-1602 EX + (&8B) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FILE NUMBER =NNETH L. SCOTT 21 09 00767 Ag real property owned solely or as a Nnant in common must be reported at hir market value. Fair market value is defined as the dce at which exchanged between a wiping buyer and a willing seller. neither beilg compelled to buy w sell, both having reasonable knowle ge of the re~a~M fa~~a be Rawl OII<tOSM u1hi'h k InIMh..-........a ..... .~~u _e _--__~-- - - ------ -----..... _. --• •••..•a•.. ...wa w uwFwsap on ~Cn80Ule t. ITEM NUMBER DESCRIPTION 1. 1.08.EAST-..MAIN~TREET,_NEW-BURG,_PA, J~OPEWELL TDWNSNIP, CIJMBERLAND- COUNTY DEED BOOK "C" VOL. 16 PG 540 CURRENT ASSESSED VALUE Qo~ ~~~ ~~ VALUE AT DATE OF DEATH 93-971 TO7AL Also enter on line 1, Recapitulation E 93 270.00 (If more space Is needed, insert addpkxlal sheets of the same size) RFsV-1508 El~+ (&98) COMMDNWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FIL ~~ All property lol~N-0wn~ Mdth aM of sur~vivorshfp p ~st bye dKcbs~ed on Schedule F - - - ITEM . NUMBER DESCRIPTION VALUE AT DATE t• CITIZENS BANK GOLD CHECKING# OF DEATH 610079-456-3 _ __ ___ 5,149.01 2• CITZENS BANK CD #6140-691532 29,370.21 3• CITZENS BANK CD # 6252-096580 34,516.15 4• CITZENS BANK IRA 6250-390236 47,262.06 5• ORRSTOWN BANK CHECKING 69410 10,581.16 6• ORRSTOWN BANK SAVINGS 702000405 3, 080.23 7• ORRSTOWN BANK CD# 4000007671 29,122.23 8. ORRSTOWN BANK CD# 40000025612 9,451.52 9• ORRSTOWN BANK CD# 5030067479 8,836.85 10. ORRSTOWN BANK CD# 4000026318 11,102.19 11. ORRSTOWN BANK CD# 4000027104 __ __ 8,000.00 12. _ _ _. __. _ _ _. ORRSTOWN BANK CD# 4000027283 15,489.52 13. ORRSTOWN BANK CD# 4000028635 44,803.37 14• CEHVROLET TRAILBLAZER (kbb.com) - - 10,1 15.00 15. MODEL A. FORD (model A tr~er.com) 12,000.00 16. GIBBON HUMMINGBIRD GUITAR (ebay) 1,499.00 TOTAL (Also enter on line 5, Recapitulation) 5 282 496.50 (If more space is needed, Msert additlonal sheets of the same size) M ` COMMONWEALTH OF PENNSYLVANW INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF L. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Dells of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERALEXP.ENSES:_ __ 1. FOGELSANGER BRICKER FUNERAL HOME B. ADMINISTRATIVE COSTS: ~ • Personal Representative's Commissions Name of Personal RepreserdaUve (s) Street Address Cdy State lap Year(s) Commission Paid: 2. Attorney Fees 3. Famly Exemption: (If decedent's address rs not the same as dalmanYs, attach explanation) Claimant Street Address CUy State Zip Relationship of Claimant to Decedent 4• Probate Fees 389.00 5. Accountants Fees __ __ _. _ _ __ 6• Tax Return Preparer's Fees 7. 2,500.00 TOTAL (Also enter on line 9, Recapitulation) S (If more space is needed, ir-sert additional sheets of the same size) 4 707.17 09 AMOUNT 1,818.17 ~, REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANW DEBTS OF DECEDENT , IN RES DENT DE EDENT N MORTGAGE LIABILITIES, ~ LIENS ESTATE OF FILE NUMBER KENNETH L. SCOTT 21 09' 00767 Report debb inwrred by the dacederrt prior to death which remained unpaid as of the date of death, including unreimbureed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. _ RICHARD HOCKENBERRY (TAX COLLECTOR) - - __ 1,179.40 2. CENTURY LINK (PHONE) 4.97 3• TIMMONS OIL (UTILITY FOR REAL PROPERTY) 1,004.19 4. NEWBURG-HOPEWELL JOINT AUTHORITY (UTILITY) 170.67 5. PENELEC 184.97 6. KUHN COMMUNICATIONS 33.72 7. EMBARQ 49.20 8. REHAB MEDICINE 14.29 9. GEORGE KUNKLE MD 380.82 10. ERIE INSURANCE GROUP (INSURANCE ON ESTATE REAL PROPERTY) 663.00 TOTAL (Also enter on line 10, Recapitulation) I s (K more space is needed, N1sert adddanal sheets of the same size) . `' RFV-(513 Fit (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE J BENEFICIARIES NUMBER I. 1. 2. 3. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ~""' ivrvanlr I u utGEDENT AMOUNT OR SH TAXABLE DISTRIBUTIONS [ndude ou ' ht s I distributions, and transfers under ~ Not List Trustee(s) OF ESTATE seo. st is (a (t. )z JOYCE E._HOLTRY Lineal 2315 HATER ROAD _ _ - - ___ FAYETTEVILLE, PA 17222 1/3 JANET G. WELKER Lineal 14 LLOYD CIRCLE WILMINGTON, DE 19810 1/3 JAYNE L. KELSO Lineal 220 SHLPPENSBURG ROAD SHIPPENSBURG, PA 17257 1/3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIA II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE t B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS COVER TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET s (If more space Is needed, insert addrtronal sheets of the same size)