HomeMy WebLinkAbout04-0588COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21 04 5~
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
WARNER, JAN L.
~ 202-42-6556
,,Z, DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
u.io THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
~ 09/27/2003 I 08/02/1962
'" REGISTER OF WILLS
IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
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[] 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 death afler
12-12-82)
[] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach
of Will) copy of Trust)
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between
12-31-91 and 1-1-95)
~HI$ SECTION MuST BE COMPLY-1 ~'ui AL~CoRRESPONDENCE AND cONFiDENTIAL TAX iNFORMATiON SHOULD BE DIRECTED TO
',lAME
Edward L. Schorpp, Esquire [COMPLETE MAILING ADDRESS
:IRM NAME (If applicable)
Martson DeardorffWilliams & Otto [ Ten East High Street
'ELEPHONENUMBER /Carlisle, PA 17013
717/243-3341
9.
[] 5. Federal Estate Tax Return Required
0 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
OFFiCIAl. USE ONJ Y
C'
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
None
None
None
None
606.00
5,500.00
None
3,129.18
5,328.24
Net Value of Estate (Line 8 minus Line 11 )
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject toTax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
(8)
(11)
(12)
6,106.00
8,457.42
insolvent
(13)
(14)
x .00
16.Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. []
(15)
x .045 (16)
x .12 (17)
x .15 (18)
(19)
m . :: , ~~>'~ESuRE TOANswER ALE QUE HECK MATH<< :
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
JSTI~EET ADDRESS
CITY CARLISLE
STATE PA ZIP
49 MARILYN DRIVE
17013
Tax Payments and Credits:
1. Tax Due (Page I Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C) (2)
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. (4)
Check box on Page I 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. (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 to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
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.
preparer other than the pemonal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
Gladys M. Warner
SIGNATURE O~'PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS DATE
115 Cavalry Road l--
Carlisle, PA 17013
ADDRESS DATE
SIGNATURE OF PREPARER OTHER THAN REPRE~
ADDRESS
DATE
Edward L. Schorpp,
Ten East High Street
Carlisle, PA 17013
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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
WARNER, JAN L.
21 - 04 -
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
NUMBER DESCRIPTION VALUE AT DATE OF
DEATH
1
2
Orrstown Bank, checking account
1990 Isuzu Trooper, poor condition, actual sale price
TOTAL (Aisc enter on Line 5, Recapitulation)
106.00
500.00
606.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF WARJ~ER, .lAN L. FILE NUMBER
21 - 04 -
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 Oladys M. Warner Mother
115 Cavalry Road
CARLISLE, PA 17013
JOINTLY OWNED PROPERTY
DESCRIPTION OF PROPERTY
% OF DATE OF DEATH
ITEM LETTEF; DATE Include name of financial institution and bank account number DATE OF DEATH DECD'S VALUE OF
NUMBER FORTENANTJOINT JOINTMADE estate.er similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'S INTERES';
1 A 12/23/1999 1976 Atlantic mobile home (value is proceeds from 11,000.00 50% 5,500.00
insurance paid as result of destruction of home by fire)
TOTAL (Also enter on line 6, Recapitulation) 5,500.00
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
WARNER, JAN L. FILE NUMBER
21 - 04 -
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1
2
FUNERAL EXPENSES:
Hoffman-Roth Funeral Home, Carlisle, PA
Funeral Flowers
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Gladys M. Warner
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address l 1.5 Cavalry Road
City Carlisle State PA Zip 17013
Year(s) Commission paid
Attorney's Fees MattSOla Deardorff Williams & Otto (estimated)
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
State ~ Zip
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
York Waste Disposal, removal of fire debris
Register of Wills, filing fee, inheritance tax return
TOTAL (Also enter on line 9, Recapitulation)
1,790.00
40.00
300.00
700.00
289.18
10.00
3,129.18
COMMONWEALTH OF PENNSYLVANIA
~NHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
ESTATE OF
WARNER, JAN L. FILE NUMBER
21 - 04 -
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
i Gladys M. Warner, reimbursement due for funds advanced for utilities, insurance, vehicle repairs and 5,328.24
other miscellaneous expenses prior to death
TOTAL (Also enter on Line 10, Recapitulation)
5,328.24
REV-1513 EX+ (9-00) ~
SCHEDULE J
COUMONWEA~T, OF ~E.~S~VAN,A BEN EFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
WARNER, JAN L. FILE NUMBER
21 - 04 -
I
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT
[30 Not LI~t Tru~f~(s~ OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 None due to insolvent estate
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
EDWARD L SCHORPP ESQ
HARTSON ETAL
10 E HIGH ST
CARLISLE PA 17015
COMMONWEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTICE OF ZNHERZTANCE TAX
APPRAZSEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTZONS AND ASSESSMENT OF TAX
REV-15ii? EX AFP COZ-OS)
DATE 08-$O-ZOOq
ESTATE OF WARNER JAN L
DATE OF DEATH 09-27-2005
FILE NUHBER Z ,1~.- 0588
COUNTY cU~.~_.'R LAN~ :~ ~:~
ACN 10~'
AeoUn.l: Ree/.1:.1:~ :
HAKE CHECK PAYAB~ AND
REGISTER 0F H~LLS
CUHBERLAND CG~:' COURT ~0USE :~*'~
CARLISLE, PA ;:' 1701~
CUT ALONG THZS LZNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX
ESTATE OF WARNER JAN L FILE NO. 21 0q-0588 ACM 101 DATE 08-50-200~
TAX RETURN NAS: ( ) ACCEPTED AS F/LED (X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1)
2. S~ocks and Bonds (Schedule
5. Closely Held Stock/Partnership Zniorost (Schedule C) CS)
q. Mor~cgagos/No~os Receivable (Schedule D)
5. Cash/Bank Deposi~cs/Mis¢. Personal Proper~y (Schedule E) (5)
6. Jointly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Asse~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adc. Cos~s/Hlsc. Expenses (Schedule H) (9)
10. Deb~s/Hor~gage Liabili~es/L/ens (Schedule T) (10)
11. To~al Deduc~ ions
12. Ne~ Value of Tax Re~:urn
15.
Char/~able/Governeen~al Bequests; Non-elec*ed 9115 Trusts (Schedule J)
Ne~ Value of Es~a~e Subjec~ ~o Tax
00
O0
O0
O0
606 O0
5/500.00
O0
(8)
5,129.18
.00
NOTE: To insure proper
cred/~ ~o your account,
sube/~ ~he upper, por~ion
of ~h/s fore w/ih your
~ax payeen~.
NOTE:
6,106.00
ZF PAID AFTER DATE IND/CATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
REVERSE SIDE OF THIS FORM
DATE
NUMBER
DISCOUNT
INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 09-1q-ZOOq
AT THE RATES APPLICABLE AS OUTLINED ON THE
19. Princ/pel Tax Due
TAX CREDZTS:
PAYMENT RECEIPT
ASSESSMENT OF TAX:
15. Aeoun~ of L/nm lq a~ Spousal re~e (1.~)
16. Aeoun~ of L/nm lq ~axable a~ L/neal/Cless A ra~e (16)
17. Aeoun~ of L/nm lq a~ S/bl/ng ra~e (17).
18. Aeoun~ of L/nm lq ~axeble a~ Colla:~era1/Class B ra~e (18)
.00 x O0 = .00
2,976.82 x Off5= 155.96
.00 x 12 : .00
.00 x 15 = .00
(19)= 155.96
AMOUNT PAZD
TOTAL TAX CREDZT I .00
BALANCE OF TAX DUEl 155.96
ZNTEREST AND PEN. 1.16
TOTAL DUE 155.12
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS RE~U~RED.
~F TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE S/DE OF TH~S FORM FOR ZNSTRUCT~ONS.)
Zf an assessment was issued previously, 1/nes 1~, 15 and/or 16, 17, 18 and 19 w111
reflect figures that lnclude the total of ALL returns assessed to date.
(11) ~. 129.18
(~2) 2,976.82
(x$) . O0
(lq) 2,976.82
RESERVATION:
PURPOSE OF
NOTICE:
PAYHENT:
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby axpressZy reserves the right to appraise and assess transfer Znheritanca Taxes
at the laaful Class 8 (collateral) rata on any such futura interest.
To fulfill the requirements of Section ZlqO of the /nheritenca and Estate Tax Act, Act 25 of ZOO0. (72 P.S.
Section 91q0).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF NILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, say be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications ara available at the Office
of the F.agistar of Nills, any of the 23 Revenue District Offices, or by calllng the special 2~-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-~7-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (&O) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans" Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-la01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (5Z) discount of
the tax paid is allowed.
The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid bafara January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest Js charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes ehich became delinquent before January l, 1982 bear interest at the rate of
six (6X) percent per annum calculated at a daily rata of .00016q. All taxes ahich became delinquent on and after
January l, i982 wii! bear interest at a rate which mill vary from calendar year to calendar year with that rata
announced by tho PA Department of Revenue. The applicable interest rates for 198Z through 2004 ara:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ ZOZ . OO05q. 8 ~'8-1991 I1Z .O00'~Ol ~ 92 .0002q7
1983 162 .000fi38 1992 92 . O00Zq7 2002 62 . O0016~.
198q 112 .000301 1993-199q 72 .000192 2003 52 .000137
1985 132 .000356 1995-1998 97. .0002~7 2004 42 .000110
1986 lOZ . O00ZTq 1999 72 .000192
1987 lOX . O00Z7q ZOO0 72 .000192
--Xntarest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUI{BER OF DAYS DELTNQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ail1 reflect an interest caZculation to fifteen (15) days
beyond tho date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calcutatad.
REV-1470 EX (6-88)
COMMONWE. ALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28060'1
INHERITANCETAX
EXPLANATION
OFCHANGES
DECEDENT'S NAME
Jan L Warner
REVIEWED BY Deborah Washington
'EM EXPLANATION OF CHANGES
The deduction claimed for reimbursement has been disallowed. No evidence of a written
contract of indebtedness between decedent and claimant was submitted.
Row Page I