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HomeMy WebLinkAbout97-0958' 15056051047 REV-15 0 0 EX (OS-05) OFFICIAL USE ONLY PA Deparfinent of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 28oso1 INHERITANCE TAX RETURN Harrisburg, PA 17128-OS01 RESIDENT DECEDENT ~ ~ ~ ~ ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~ -~6 ~~ -~a15 v~o~ ~ ~~y ~~~3 ~ X73 Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N lac Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW m 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to ta:K under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Firm Name (If Applicable First line of address Second line of address City or Post Office tate ~ ~ C ~ ~ ti ~ ~5~~ Lt, fL-c~r ~1- ZIP Code REGIST F WILLS US~NLY ~ ~ .. ~ - 3C t'''- ~ .. ...,C -- ~.~ r ~ .~ CJ7 ~ - ~ ~ ~ ~ ^^77-~~~ 'HATE FILED ~~ ~ •`:~ ~ 7 ~ so Correspondent', a-mail address: YY1 L CcpcuJ L0. ~ (~ ~~ Z JN • ~ °L~ ._.~ _t_. ~„ ~,3 r'r-~ i"".,3 ._, ~ Under penalties f erjury, I Clare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tr , correc d com ete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG AT R PE SO RES --BATE ADDRESS SIGNATUR OF PREPARER OTHE THAN REPRESENT IVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J ~" ~~ J 15056052048 REV-1500 EX Decedent's Soc ial Security Number ' l ~ ~a 1 ~ ~ ~ Decedent s Name: V 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. D. 4 . Mortgages & Notes Receivable (Schedule D) ............................. 4. V • 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ........ 5. D . 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. a 9. Funeral Expenses & Administrative Costs (Schedule H) ......... ............ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .... ............ 10. 11. Total Deductions (total Lines 9 & 10) ....................... ............ 11. O 12. Net Value of Estate (Line 8 minus Line 11) .................. ............ 12. ~, 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. ~ , 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 _ . 16. 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 15056052048 • a • O J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDEN ' ~AM~ ~ / S l ' ,~ c, ~ ~/z STREET ADDRESS ~~TM /~'l ~ c ~ t~ ~ cs,l3u r~ 6- STATE~~ ,ZIP / ~ ,1 5--~ Tax Payments and Credits: ~ 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. Interest/Penalty 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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ~ ~ 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 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 ~,~E~t F INHERITANCE TAX ~*~Fj'.P~~~ I~Y•, LLOWANCE OR DISALLOWANCE ~'~`,©~E ',~ ~'~t~,~S AND ASSESSMENT OF TAX ~o ~ a arc ~ a ~~ ~ ~ ~ ~ ~ ~~.ERK ~~~~T pRPHA ~`~ c,~'` , ~A C TERRY WALTERS ~~~,~~- y "` 714 CARRIAGE LANE MECHANICSBURG PA 17050 Pennsylvania , ~3 DEPARTMENT OF REVENUE ' REV-1547 EX AFP (12-09) DATE 12-06-2010 ESTATE OF WALTERS JESSE T DATE OF DEATH 06-09-1995 FILE NUMBER 21 97-0958 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 02-04-2011 (See reverse side under Objections Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE _ ~ R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS ~-~-- _ REV-1547 EX AFP-C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: WALTERS JESSE TFILE N0.:21 97-0958 ACN: 101 _______________ OR DATE: 12-06-2010 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .0 0 NOTE: To ensure proper 2. Stocks and Bonds (Schedule B) C2) ,Q 0 credit to your account, 0 0 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) (3) . of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) •0 0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .0 0 6. Jointly Owned Property (Schedule F) (6) .0 0 7. Transfers (Schedule G) (7) .0 0 8. Total Assets (8) .0 0 APPROV ED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) .0 0 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0 11. Total Deductions (11) .0 0 12. Net Value of Tax Return C12) .0 0 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .0 0 14. Net Value of Estate Subject to Tax (14) .0 0 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) .0 0 X 0 0 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate (16) .~ 0 X 0 6 = .0 0 17. Amount of Line 14 at Sibling rate (17) .0 0 X 0 0 .0 0 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 = .0 0 19. Principal Tax Due (19 )= .0 0 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~._- ~ ~~~