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HomeMy WebLinkAbout06-07-10 15056051047 REV-150 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2s06o1 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT a- i ~ O ~ ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth l ~~~46~~7 ~3~~~0~© 07~~ t~~b Decedent's Last Name Suffix Decedent's First Name MI I TT N ~ ~ ~ D I'\( ~c G (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Soaal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust Q, 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 ~ h ~ ~ 1 ~- ~ ~ fi~ n e r (~ Q ~'gq ~ ~ ~~' Firm Name (If Applicabie) _ REGISTER OF WILLS USE ONLY First line of address ~~~..~ IDD~ IDt~~s~ R~ C~ ~CI~ ~ ~:_~ ~~ ~ Second line of address ~ ~ ~ ,, A~~ ~ " ~ .. ~ `b ~ y~ ~~ `~~ ~~ City or Post Office State ZIP Code ILED ~,; -r,,,,it ~ a ~ ~ ~ i ~~ ~ ~ ~;; ~~ a7 , ~ ~ ~, Correspondent's a-mail address: Under penalties of pery'ury, I declare that I have examine~'fhis 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. SI URE OF PERSP9A1 RFRAe1N_ ~ GnR_cu ~nirz ocr~ Boni _ ___ ~ It~ SIGNATUf2E OF PREPARER OTHER THAN DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ~)'Yl J 1505610105 REV 1500 EX Decedent's Social Security Number Decedent's Name: ~ r ~ ~ ~ a O ~ ~ ~~ RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. J~ D ~C 2. Stocks and Bonds (Schedule B) ....................................... 2. ~ Q ~~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ~ (~ 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. ~~ N~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. ~ ©N 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. n / Q ~ }-- 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 03 LJ' 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. (~ ~ ~ D 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. ~ ~ l 11. Total Deductions (total Lines 9 and 10) ................................. 11. l ~ ~ 3 '"7 12. Net Value of Estate (Line 8 minus Line 11) .......... .................... 12. a i 9 ~ ~ 13. Charitable and Governmental Be uests/S 9113 T t f q ec rus s or which 14. an election to tax has not been made (Schedule J) ........................ Net Value Subject to Tax (Line 12 minus Line 13) ........................ 13. 14. (~ a ~ g TAX CALCULATION -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 tax ble ~ at lineal rate X .0 ~ ~ ~ ~ ~ 16. ~ g 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. ~ 0 a 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610105 1505610105 J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME ~c~ ~ Q ~r o ji n ~ ~T; ~ci P ~ , r STREET ADDRESS ~~~~+~y m~~~~-S _ 7~~ ~. ) ~' (v)c'~ ~~ oac~ ~ ~~~ CITY M~~h ~ ~ c ~ rc STATE Pf~ ZIP i'7OSo Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) (,} g' Q' _/ 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest (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) G~'~ 9 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APP ROPRIATE 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 Dec. 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 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 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 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) I scN~~u~E ~ COMMONWEALTH OF PENNSYLVANIA ~ CA5H, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN ~ RESIDENT DECEDENT +~ PERSONAL PROPERTY .- __--_ _ _ __ I _ _ _ _-, EST: _ .. ~tLE h;::.:_~. _ ~dYIC~ j ~~ Include t~~ rv--_--_-_~-_ -_~1:.:__.:__ __~ ~L~ J..t.. 4L- .._~~~_J~ ~..~..- ----:.._J 1.... ~L- --i-~- All R~~;:_,J __ .. rtEM __ _ VALUE, :...... _ NUMBER DESCRIPTION OF DEATH ~ - ~ ~ Q ~ ~ cc,r ~ M on e~ ~1/1a-r ~~~ (~ 12 s~2 o i o ,~.. ~ ~ 5 ~ ~ ~ ; ~, C Ci. S h O r> h a r~ (~ 3lZSl Z o I o~ ~, 3 I . ~ l .T l Z-P t7 i~~ K ~h e C~ ~ n f~-C.C~ ~"~ 3 f Z.s Z 5 c~ ~ /ate ~o) 3 3 S L s co r Wc~ ~ 3 - , d 7~ ~ i ~~e.S a~- K e (I ~~ 131 ~ e aoo I~ v ~.. ~ ~ e (~ ~ o ~ Z© ~0 1 ©`~' ~ ~' Refund -~'om Covn+ry 1~1'l~adocvs Rss~sl-ed l...iv~n~ Cy f~~~) 3pg ~. Red-uncl from T3r~d~es a~ `!3en+ ere~el~ ~4~wio~ /~ ~3 1 Refund -from rn~~care (~l~zo/o~ 23 g t~ e -~-u ~d ~-om 1-I-~c~ h mo-r k I-leaa~I-G~ I~ 5~ ra n ce Z ~ TOTS _ , ' • 1• r n (If more space is needGU, IfisCii auuiuuiiai aiiww ~i uiG ~afnc sict;~ 35 X99 Edna C. Bittner Country Medows Apt 3084 4905 E Trindle Rd Mechanicsburg, PA 17050-3662 Page > 1 of 1 t. 1~an~ard ~~ Re port: for. 03/25/2010 Client Services: 800-662-2739 Total report value. $28,953.41 (Total report value includes any accrued dividends.) Edna C: Bittner =Individual Account .:Account value summary ~ Name Fund & Account ~ Date Price Per' I Accrued ~ Number Opened ~ Shares j Share E Value* Dividends Prime Money Mkt Fund i 0030-09948280200 ' 05/03/2001 ' 28,953.210 $1.00' $28,953.21 $0.20 __ Totals $28,953 21 -- - $0.20 'Doesn't include accrued dividends. _ __ _._ ,_.._.. _.. _ ____ ____ _ ~__ _ _ ______ _^ _ _..~ _ 1688332099 04/19/2010 15:19:10 Citizens Bank REV-1511 EX+ (10-09) r- _ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF >- FILE NUMBER Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. 1= v ~ P rc~l b ~ re c.--tz~ r ~~ 3 3 ~' ~ ~ Yl 151~i(' Gfi..Y1 ~ ~ v S L C. 3. (_~n-era < <Re-ire h 2~~ 5 rn e n-~-5 21 5 d B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP Z• Attorney Fees: 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 4. 5 City State Relationship of Claimant to Decedent Probate Fees: Cv m ~ Q ~ ~ ~.~ ~ C(~ v ~ ~ ~ I , ~~ Accountant Fees: 6• ~ Tax Return Preparer Fees: 7 ZIP (~ TOTAL (Also enter on Line 9, Recapitulation) ~ $ ~~ 2Q If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) `~ pennsytvan~a DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES Ec LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unretmbursed medical expenses. If more space is needed, insert additional sheets of the same size.