HomeMy WebLinkAbout05-17-10 (2)REV-1500 EX (6-00)
Rev-1500 c: ;::I~ ~::. : ;. ::,3r,;< ,.
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE .........................
FILE NUMBER ..........................................................
DEPT. 280601
HARRI INHERITANCE TAX RETURN
SBURG, PA 17128-0601 - ,2009 W1 ~ 29
RESIDENT DECEDENT County Code Year Number
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I-
z
w ZEIGLER, WILLIAM N. 195-16-2619
~
W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH
w 11 /20/2009 10/30/1923 REGISTER OF WILLS
~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
~, x 1. Original Return 2. Supplemental Return 3. Remainder Return (date ofdeatn
L o 0 4. Limited Estate 4a. Future Interest Comprise (dace or deem after ~z-~2-az> 5. Federal Estate Tax Return Required
U am 6. Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a Living Trust (Attacn a copyot trust) 0 8. Total Number of Safe Deposit Boxes
Q
9. Litigation Proceeds Received 10. Spousal Poverty Credit (dace or death between cz-3c-sc and i-c-ss> D
11. Election to tax under Sec. 9113(A)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
IR 175 BUSTLETON PIKE
~°~, FIRM NAME (If Applicable) FEASTERVILLE, P A 19053
o R R I A
U TELEPHONE NUMBER
1 - _ / - 4 1
1. Real Estate (Schedule A) (1) $0.00 OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2) $1 1,851.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
$0.00 ~ ~
~ ~ ,~, _~..~ .
"
z
4. Mortgages & Notes Receivable (Schedule D) (4)
$0.00 ,~
~ i=-r- ~--~:
t '~ ~-~•~''''~ ~ ! ~~.:Y ~ > '
Q 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5) $198,476.47 r } ~ c~~ -- r°~` F 1 ='1
~ 6. Jointly Owned Property (Schedule F) (6) $Q,QQ + Y~~
C~ ~~
~ 0 Separate Billing Requested ~
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'
~ _
i:J r -" ~, ~ 1
.... _...~
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Q
7. Inter-Vivos Transfers & Misc. Non-Probate Pro ert 7
p v (> $31,035.00:
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t~
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....-~ ................................
.
U (Schedule G or L) c.~ ~....
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8. Total Gross Assets (total Lines 1-7)
(s) .ws
$241,362.47
9. Funeral Expenses & Administrative Costs (Schedule H) (9) $6,878.84
10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) $1,336.00
11. Total Deductions (total Lines 9 & 10) (11) $8.214.84
12. Net Value of Estate (Line 8 minus Line 11) (12) $233,147.63
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) $0.00
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $233,147.63
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 taxable at the spousal tax
Z rate, or transfers under Sec. 9116 (a)(1.2~ x .0 (15) $0.00
0
Q
X
16. Amount of line 14 taxable at lineal rate $233,147':63 X .045
(16>
$10,491.64
~ a 17. Amount of line 14 taxable at sibling rate x .12 (17) $0.00
p 18. Amount of line 14 taxable at collateral rate x .15 (18) $0.00
U
1s. Tax Due (19) $10,491.64
20.~ • .- • ~ - ~ • ~ • -•.
> > ~E ~Rlt~~ R ~ % ~ ~ _
Decedent's Complete Address:
iTREET ADDRESS
324 LISBURN ROAD
%IN STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) $10.491.64
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments -qua snn nn
C. Discount ~a~~ nn
Total Credits (A + B + C) (2) ~
97.5 M
3. Interest/Penalty if applicable ~
D. Interest 08/20/10
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.
Check box on Page 1 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)
$516.64
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) $516.64
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; X
b. retain the right to designate who shall use the property transferred or its income; X
c. retain a revisionary interest; or X
d. receive the promise for life of either payments, benefits or care? X
2. If death occurred after December 12, 1982, did decedent transfer property within on year of death
without receiving adequate consideration? X
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? 0 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.
under penait~es 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 the information of which preparer has any knowledge.
SIGN~_J~~~IJRE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
~~~KC~~ ~~/~-} ~~k=r~ / O~ ,DAC/ vE- , W I [.l~1 ., ~~ /~j o 0 3 - S~ /~3- .
~~ -- -
a~siv }fit yr rrc V I I1ER I NAN REPRESENTATIVE DATE
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A RESS
I ?S'' ~~'~'c.~-~ rt/ Prl~-, F~-ST~.- v ~ LL-~- , P~E~- . /gos3 - ( c,L s-6
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 3% [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 0% [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 0% [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 4.5%, 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 12% [72 P.S. §9116(a)(1.3)]. A sibling 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-1502EX = (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF ZEIGLER, WILLIAM N. FILE NUMBER ;21-09-1129
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 property which is jointly-owned with right of
survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
N/A
TOTAL (Also enter on line 1, Recapitulation) $0.00
(If more space is needed, insert additional sheets of the same size)
' REV-1503EX = (1-97) (I) I I
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF ZEIGLER, WILLIAM N.
FILE NUMBER 21-09-1129
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
AMERIPRISE BROKERAGE ACCT#153414958001
2. PRUDENTIAL STOCK - 24 SHARES
VALUE AT DATE
OF DEATH
$10,638.00
$1,213.00
TOTAL (Also enter on line 2, Recapitulation) I $11,851.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (1-97)(1)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF ZEIGLER, WILLIAM N.
FILE NUMBER 21-09-1129
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on
Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
MEMBERS FIRST CREDIT t1NlON -ACCT.#318777 $1'.91,102.00
checking $6,764 -Savings -$51049: -Money Management $40,358.- Cert -$44,518 - Cert: -$48,413
2. 1997 OLDSMOBILE - MOD.88 $1,200.00
3. 'US SAVINGS BONDS $4,800.00
4, PNC CHECKING ACCOUNT - #5140110335 $1,374.47
TOTAL (Also enter on line 5, Recapitulation) $198,476.47
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ I1_97~(~I I I
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
ESTATE OF
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
RELATIONSHIP TO DECEDENT
SURVIVING JOINT TENANT(S) NAME
A.
B.
I C
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number or similar identifying number.
Attach deed for jointly-held real estate.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A.
TOTAL (Also enter on line 6, Recapitulation)I $0.00
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF ZIEGLER, WILLIAM N.
FILE NUMBER 21-09-1129
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET 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
1.
PRUDENTIAL ANNUITY - E0222673 $22,635.00 100.0% $22,635.00
2. PRUDENTIAL MUTUAL FUND -IRA #3800523924 $8,400.00 100.0% $8,400.00
TOTAL (Also enter on line 7, Recapitulation)I $31,035.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+(~-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF ZEIGLER, WILLIAM N.
FILE NUMBER 21-09-1129
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
1. MUSSELMAN FUNERAL HOME
s. GRAVE STONE
a. MINISTER
DESCRIPTION
s.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
Clty State Zip
Year(s) Commission Paid:
2~ Attorney Fees -BRUCE S. ALLEN, ESQUIRE
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant N/A
Street Address
Clty State zip
Relationship of Claimant to Decedent
a. Probate Fees REGISTER OF WILLS -CUMBERLAND. COUNTY
s. Accountant's Fees INCOME TAX PREPARATION
6. Tax Return Preparer's Fees
'~ WILLIAM MANSFIELD -ESTATE ADVERTISING
8. MISC.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
$4,283.00
$450.00
$200.00
$925..00
$364.00
$150.00
$306.84
$200.00
$6,878.84
1 REV-1512 EX+ (t-97)(1)
ESTATE OF ZEIGLER, WILLIAM N.
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES. & LIENS
FILE NUMBER 21-09-1129
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1.
UTILITIES $86:00
2. PHARMACY $207.00
3. LIFELINE PHONE SYSTEM $116.00
4. MISC. $250.00
5. US TREASURY'- .1040 - 2009. $677.00
TOTAL (Also enter on line 10, Recapitulation) ~ $1,336.00
REV-1513 EX + (9-00))
SCHEDULE J
BENEFICIARIES
ESTATE OF ZEIGLER, WILLIAM N. FILE NUMBER 21-09-1129
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116 (a) (1.2)J
MtCHAE'L ZEIGLER SON 100%
1014 PARKSICE QRIVE, WILMING~'ON, DE 1:9803
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV -1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. 'N/A
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
N/A
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $0.00
(If more space is needed, insert additional sheets of the same size)