HomeMy WebLinkAbout05-25-10 (2)1505607121
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 1 0 0 2 1 6
Harrisburg PA 17128-0601 RESIDENT DECEDENT _
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 9 2 3 0 1 3 9 6 0 2 2 8 2 0 1 0 0 9 2 0 1 9 3 8
Decedent's Last Name Suffix Decedent's Firs t Name MI
M C C A U S L I N C A L V I N A
(If Applicable) Enter Surviving Spouse's Information Below
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
0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 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 ANU GUNFIUtN I IAL I Ax mrvrcmAi wn anvuw ne uirct~ i cv i v:
Name Daytime Telephone Number
M U R R E L R W A L T E R S I I I 7 1 7 6 9 7 4 6 5 0
Firm Name (If Applicable)
REGISTER OF WILLS ONLY
First line of address
5 4 E A S T M A I N S T R E E T
Second line of address
City or Post Office State
M E C H A N I C S B U R G P A
Correspondent's a-mail address: mwalters54(a7verizon.net
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ZIP Code _ -- _-~_. _- ~ '~ ~ ~~
1 7 0 5 5 ~"~
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.
SIGNATUR OF SON RESPONSIBLE FOR FILIN RETURN DATE
~ ~ ~-~
ADDRE
90 GLACIER L E ~ NEW BLOOMFIELD PA 17068
SIGNATURE OF PRF A O E A EPRESENTATIVE ~j--DA~ dr l c~
ADDRESS
54 E- M N S BEET MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 1505607121
1505607221
REV-1500 EX Decedent's Social Security Number
~ecedent'sName: CALVIN A• MCCAUSLIN 1 9 2 3 0 1 3 9 6
RECAPITULATION
0 0 0
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.
8 4 8 5 . 3 6
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... .. 6•
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .... .. 7.
8. Total Gross Assets (total Lines 1-7) ........................ ... 8. 8 4 8 5 • 3 6
..........
9. Funeral Expenses & Administrative Costs (Schedule H)
...... 9. 3 5 5 0 . 1 4
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... ...... 10. 8 6 2 . 4 6
11. Total Deductions (total Lines 9 & 10) ..................... ...... 11. 4 4 1 2 . 6 0
12. Net Value of Estate (Line 8 minus Line 11) ................... ...... 12. 4 0 7 2 • 7 6
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. 4 0 7 2 7 6
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 _ 0 0 0 15.
16. Amount of Line 14 taxable
4 0 7 2
7
6
at lineal rate X .045 16
17. Amount of Line 14 taxable
0
0
0
at sibling rate X .12 17.
18. Amount of Line 14 taxable
0
0
0
at collateral rate X .15 18.
19. Tax Due ............... ........................ .. ..... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0. 0 0
1 8 3. 2 7
0. 0 0
0. 0 0
1 8 3. 2 7
Side 2
1505607221 1505607221
REV-1500 EX Page 3
f~pr_Pdpnt's Complete Address:
File Number
21 10 0216
DECEDENT'S NAME
CALVIN A. MCCAUSLIN
STREET ADDRESS
349 MAPLE LANE
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
~. Tax Due (Page 2 Line 19) (1)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 9.16
183.27
Total Credits (A + B + C) (2) 9.16
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (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. (5B)
Make Check Payable fo: REGISTER OF WILLS, AGENT
0.00
0.00
174.11
174.11
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 : .................................................................
i
i ..... ^ ^
X
ncome; ..........................
ts
b. retain the right to designate who shall use the property transferred or .....
^
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? ..................................................................................
"
" ..... ^
^
0
or payable upon death bank account or security at his or her death? ....
in trust for
3. Did decedent own an .....
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 F ILE 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 race 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
CALVIN A. MCCAUSLIN 21 10 0216
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. FULTON BANK
CHECKING ACCOUNT
2. 1997 CHEVROLET PICK UP TRUCK
NET SALE PRICE
3. HARTFORD
AUTO INSURANCE REFUND
4. ALLSTATE
MOBILE HOME INSURANCE REFUND
5. 1987 FLEETWOOD MOBILE HOME
NET SALE PRICE
588.76
1,300.00
53.60
43.00
6,500.00
TOTAL (Also enter on line 5, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8r
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CALVIN A. MCCAUSLIN 21 10 0216
Debts of decedent must be reported on Schedule I„
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS FUNERAL HOME - MECHANICSBURG, PA 634.50
2. ROLLING GREEN CEMETARY, CAMP HILL, PA -CRYPT OPENING & MARKER 655.00
3. FIRST CHURCH OF GOD -FUNERAL RECEPTION 383.14
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) JEFFREY A. MCCAUSLIN (RENOUNCED)
Street Address 90 GLACIER LANE
City NEW BLOOMFIELD State PA Zip 17068
Year(s) Commission Paid:
2 Attorney Fees MURREL R. WALTERS, III 1,500.00
3, Family Exemption. (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4
5.
6.
7
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees REGISTER OF WILLS -CUMBERLAND COUNTY
Accountant's Fees
Tax Return Preparers Fees
TERRY & JAN KIMBALL -MOBILE HOME APPRAISAL
127.50
250.00
TOTAL (Also enter on line 9, Recapitulation) I $ 3,550.14
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
CALVIN A. MCCAUSLIN 21 10 0216
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. UGI 143.41
NATURAL GAS
2. PPL 171.22
ELECTRIC
3. VERIZON 85.38
TELEPHONE
4. PENNY DAVIS, TAX COLLECTOR 60.35
PROPERTY TAX, MOBILE HOME
5. COUNTRY MANOR 402.10
LOT RENT -APRIL
TOTAL (Also enter on line 10, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CALVIN A. MCCAUSLIN 21 10 0216
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. JEFFREY A. MCCAUSLIN Lineal 649.77
90 GLACIER LANE
NEW BLOOMFIELD, PA 17068
2. CAROLE E. HILL Lineal 649.77
1090 MATAMORES ROAD
HALIFAX, PA 17032
3. JO-ANN CLIMER Lineal 649.77
2 CUMBERLAND DRIVE
CARLISLE, PA 17013
4. DANIEL L. MCCAUSLIN Lineal 649.77
90 SALEM CHURCH ROAD, LOT 522
MECHANICSBURG, PA 17050
5. BRIAN C. MCCAUSLIN Lineal 649.77
1250 N. BRASSIE DRIVE
WINTER SPRINGS, FL 32708
6. AMANDA TRUMAN Lineal 649.77
451 VALLEY STREET
MARYSVILLE, PA 17053
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)