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HomeMy WebLinkAbout05-13-10 15056041046 05 04 REV-1500 EX ( - ) PA De a tm nt f Re ~~ ~~ ~~ p r e o venue Bureau of Individual Taxes Count Code Year v File Number Dept. 280601 Harrisburg, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT ,~ {''~ ~`-~ y' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 0 1 1 8 3 4 0 3 0 2 1 6. 2 0 1 0 0 9 1 2 1 9 2 6 Decedent's Last Name Suffix Decedent's First Name MI B e a r J e a n n e E, (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal EstatE: Tax Return Required death after 12-12-82) 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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: Name Daytime Telephone Number A n t h o n y L. D e L u c a E s q. 7 1 7 2 5 8 6 8 4 4 Firm Name (If A licable) Pp First line of address 1 1 3 F r o n t Second line of address P O B o x 3 5 8 City or Post Office S t r e e t B o i l i n g S p r i n g s Correspondent's a-mail address State ZIP Code P A 1 7 0 0 7 REGISTER OF WILLS USE ONLY t ~ ~ P ~ _ I °M~. -~ ~ ~ I k rV 1 ~-~~ "" "` 7 1 ~ ,~ ~'~ (3~ = ~ " ~ " I ' ~ r e~~ ~:-=~ .~ .FILED ~ ~~~''~ ."~ ~ ~. .~ 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE n ~ ~~ ADDRESS ~~~ ~ ~ ~ , • ~ ~ SIGNATURE OF PREPAR OTH R THAN REPRESENTATIVE DA ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 i~ ~5 JA 15056042047 REV-1500 EX Decedent's Social Security Number _ _. ~.. ..:. _ _, ~ ~... _..- 2 , ~ 1 1 _8 3 _4 ~ - 3 Decedent's Name: RECAPITULATION . 1. Real estate (Schedule A) . ............................................ 1. 0 . 0 0 2 0 ' 0 0 2. Stocks and Bonds (Schedule B) . 0 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. , :.z. ~ 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. ~ 0 • 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 4 6 ~ 3 5 2 . 7 5 6. Jointly Owned Property (Schedule F) C Separate Billing Requested ....... 6. 2 3 ~ 0 6 2 y 2 4 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 0 0 (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 6 9, 4 1 4, 9 9 9. Funeral Expenses & Administrative Costs (Schedule H) ................ ..... 9. 1 3 ~ 0 7 7 . 3 4 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........... ..... 10. 1 4 7 ~ 9 9 11. Total Deductions (total Lines 9 8~ 10) .............................. ..... 11. 1 3 , 2 2 5 . 3 3 12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. 5 6 ~ 1 8 9 ~ 6 6 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 0 , 0 0 an election to tax has not been made (Schedule J) ................... ..... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................... ..... 14. 5 6 , 1 £d 9 • 6 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_ 15. 16. Amount of Line 14 taxable at lineal rate x .04 5 5 6 ,1 8 9 ,, 6 6 16. 2 5 2 8 .~ 5 3 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 15056042047 15056042047 O J REV-1500 EX Page 3 Decedent's Complete Address: File Number Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) $ 2 , 5 2 8 . 5 8 2. Credits/Payments - 0 - A. Spousal Poverty Credit B. Prior Payments _ p _ _- --- --- C. Discount $1 2 6. 4 9 Total Credits (A + B + C) (2) 1 2 6 . 4 3 3. Interest/Penalty if applicable D. Interest - 0 - E. Penalty _ __ -0-_ _ Total Interest/Penalty (D + E) (3) - 0 - 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) _ 2 , 4 0 ~.1 0 A. Enter the interest on the tax due. (5A) - 0 - B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 2 4 0 ?~ 1 0 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;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-1502 EX+ (6-98) SCNEDVLE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jeanne E. Bear 21 -1 0-01 85 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. REV-1503 EX+ (6-98) SCI~IEDVLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jeanne E. Bear 21 -1 0-01 85 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of fhe same size) REV-1504 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDVLE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Jeanne E. Bear 21 -1 0-0185 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (1-97) ~~ SCI~IEDIJLE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Jeanne E. Bear 21 -1 0-01 85 All property jointly-owned with right of survivorship must be disclosed on Schedule F. iii more space is needed, insert additional sheets of the same size) ,REV-1508 EX + (1.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Jeanne E. Bear FILE NUMBER 21 -1 0-01 85 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. Checking account, #741337, at M&T Bank $ 2,104.33 2. Savings account, #15004220532839, at M&T Bank 40,912.24 3. REfund of Capital Blue Cross Premium 177.70 4. Refund from Chapel Pointe at Carlisle Nursing 3,158.48 Facility TOTAL (Also enter on line 5, Recapitulation;) I $ 4 6 , 3 5 2. 7 5 (If more space is needed, insert additional sheets of the same size) REV•1509 EX+ (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jeanne E . Bear FILE NU ~ ~ R 1 0 - 01 8 5 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Kathy B. Homan 486 West Old York Road Daughter Carlisle, PA 17015 g, Linda K. Palmer C JOINTLY-OWNED PROPERTY; 580 Dellville Dam Road Shermansdale, PA 17090 Daughter 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. /14/ 6 Apex II Variable Annuity $23,069.77 50$ $11,534.8 #E05013~5 2. B /14/ 6 Apex II Variable Annuity $23,054.71 50$ 11,527.3 #E0501335 TOTAL (Also enter on line 6, Recapitulation) a 2 3 , 0 6 2. 2 4 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF FILE NUMBER Jeanne E. Bear 21 -1 0-01 85 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. NONE -0- SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY TOTAL (Also enter on line 7, Recapitulation) $ - 0 - (If more space is needed, insert additional sheets of the same size) ° REV-1511 EX+ (12-99) ..~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT __ SCI~IEDVLE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Jeanne E,, „Bear 21 -1 0-01 85 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ Hollinger Funeral Home & Crematory, Inc. $9,842.34 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 City State Zip Year(s) Commission Paid: 2. Attorney Fees Anthony L. DeLuca, Esquire 2, 400, 00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 1 5 7. 5 0 5. Accountant's Fees 3 0 0. 0 0 6. Tax Return Preparer's Fees ~. Legal Advertising - Cumberland Law Journal 75.00 8. Legal Advertising - The Sentinel 272.50 9. Filing Fees for Inventory and Inheritance Tax 30.00 TOTAL (Also enter on line 9, Recapitulation) ~ $1 3 , 0 7 7 . 3 4 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDI~ILE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Jeanne E. Bear 21 -1 0-01 85 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jeanne E. Bear FILE NUMBER 21 -1 0-0185 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Kathy B. Homan Daughter 50$ 486 West Old York Road Carlisle, PA 17015 Linda K. Palmer Daughter 50$ 580 Delville Dam Road Shermansdale, PA 17090 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 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. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -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)