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Home My WebLink About06-11-10' 150561U145 REV-1500 ~``°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~~ PO BOX 280601 / ~/,, / Harrisbur PA 17128-0601 RESIDENT DECEDENT ( (,(~' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 093-05-6915 07012008 12191928 Decedent's Last Name Suffix Decedent's First Name MI Burdick William H (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 BOXES BELOW 0 1. Original Return 0 4. Limited Estate 0 6. Decedent Died Testate (Attach Copy of Will) 0 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 0 2. Supplemental Return 0 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 0 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 0 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Robert G. Frey 7172435838 First line of address 5 South Hanover Street Second line of address City or Post Office State ZIP Code Carlisle PA 17013 REGISTEf~F WILLS US LY C "" ~-T C~ ~ :~.. ~ C... ~- .;.~ °'~ -Q C ~ _ ~ ~ ~ ~~~ ~~~ ~ ~ ~. ~~~~ ~ ., .. ~ ~ ,:. 'i'E FILED •• _ .• L~ Correspondent's a-mail address: r f rey@ f reyt i 1 ey . c om 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 ADDRESS 197 Big Spring Terrace, Newville, PA 17241 SIG RE OF E R O HE AN EPRESENTATIVE DATE G ~o io ADDRESS 5 South Hanover Stre Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610145 1505610145 J REV-1500 EX Decedents Name: W 1111 dm H B u r d i c k 1505610245 Decedent's Social Security Number 093-05-6915 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. NONE 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ...... 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested ........ 6. NONE 7. Inter-~vos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ........ 7. NONE 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 32131.00 32131.00 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. NONE 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. NONE 11. Total Deductions (total Lines 9 and 10) ............................... 11. 0 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................. 12. 3 2131.0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... . 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... . 14. 3 2131.0 0 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 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .0 4 5 3 2131.0 0 1 g. 14 4 5. 9 0 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X , 15 18. 0 . 0 0 19. TAX DUE ....................................................... 19. 1445.90 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 1505610245 1505610245 J REV-1500 EX Page 3 File Number 093-05-6915 nwwwrl~r~+~~+ ~+...,n.,lefn Ae~lrlrecc• 21-08-00761 ~~~~~.~.._ . _ ----r---- - -°-- - - - DECEDENT'S NAME William H Burdick STREET ADDRESS 3286 S rin Road CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (1) 1445.90 Total Credits (A + B) (2) _ 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) (4) 0.00 (5) 1445.90 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: f d Yes ^ No 0 : ............................................................................. erre a. retain the use or income of the property trans 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 ? i ^ ................................................................................................. on without receiving adequate considerat 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 ^ 0 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. R~-1508 ~`+ c6_98' SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMO ERITANCETAx RETURNANIA PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER William H Burdick 21-08-00761 Include the proceeds of litigation and the date the proceeds were received by the estate. (If more space is needed, insert additional sheets of the same size)