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HomeMy WebLinkAbout06-07-101 1505610145 REV-1500 ~``°'-'°' Pennsylvania OFFICIAL USE ONLY PA Department of Revenue oea~nn~rrTOFaeveNUe County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ~~ ~ ~ ~' ~ ~ Z Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 03132010 06091912 Decedent's Last Name Suffix Decedent's First Name MI Hess Nancy G (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 BOXES BELOW ® 1. Original Retum ~ 2. Supplemental Retum 0 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Retum Required death after 12-12-82) ® 6. Decedent Died Testate 0 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 0 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 AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Robert G. Frey First line of address 5 South Hanover Street Second line of address City or Post Office State ZIP Code 7172435838 REGISTER OF WILLS USE 3~3Y ~~ ~ ~~ ~ ~~~ v ~~ "'~ ..? ., ~-~~T ~~~ `. ~.,~ :.;~: ~.~ '` . m ~ N ~~ Carlisle PA 17013 c~ Correspondent's a-mail address: r f rey@f reyt i 1 ey . com Under penalties of perjury, I dedare that I have examined this return, induding 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. ~lAN~4TURE OF PERSON ~ FOR„F~L.ING RETURN DATE ADDRESS 307 Avon Drive, Carlisle, PA 17013 SIGNA OF PR ARR ~FiAN ESENTATIVE ~_ DATE 5 South Hanover Street, C rlisle, PA 17013 / PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610145 1505610145 J J REV-1500 EX 1505610245 Decedent's Social Security Number Decedent's Name: Nancy G Hess 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. NONE 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ........ 6. 3 5 9 6 5 7 . 0 0 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ........ ~. NONE 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 3 5 9 6 5 7.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 15 313.0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... . ........ 10. NONE 11. Total Deductions (total Lines 9 and 10) ............................... 11. 15 313.0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................. 12. 3 4 4 3 4 4.0 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 Sublect to Tax (Line 12 minus Line 13) . 14. 3 4 4 3 4 4 . 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 (ax1.2) X .0 0 15. 0. 0 0 16. Amount of Line 14 taxable at linealrateX.o 45 344344.00 16, 15495.48 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. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15495.48 0 L 1505610245 1505610245 J REV-1500 EX Page 3 File Number 174-38-0361 Decedent's Complete Address: DECEDENT'S NAME Nanc G Hess STREET ADDRESS 800 North Hanover Street CITY Carlisle STATE PA ZI P 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 737.88 3. Interest (1) 15495.48 Total Credits (A + B) (2) 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) 15495.48 (4) 0.00 (5) 0.00 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 : ............................................................................. ^ ^X b. retain the right to designate who shall use the property transferred or its income : ................................ ^ ^X c. retain a reversionary interest; or ............................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? .......................................................... ^ ^X 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................. ^ a 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .... ^ ^X 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 Juty 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(ax1)]. • 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(ax1.3)]. 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. 14757.60 REV-1509 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Nancy G Hess If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Asonia Wolf 307 Avon Drive, Carlisle, PA 17013 Daughter B. C. JOINTLY OWNED PROPERTY: 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 ~a of DECEDENT INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 15570 shares of Orbisonia Community Bancorp ($41/share) 1. A. 12/1/74 638,370 50.00% 319,185 2 A 12/1/74 2856 shares of Juniata Valley Financial Corp ($17/share) . 48,552 50.00% 24,276 Community State Bank, Acct 1701895 3. A 11 /3/03 32,391 ° 50.00 /0 16,196 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on Line 6, Recapitulation) I $ 359,657 00 If more space is needed, use additional sheets of paper of the same size. REV-1511 Ex + (10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Nancy G Hess Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral and Burial 13,569 2. Post funeral dinner 444 3. Flowers 535 B. 1. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address State ZIP 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Ciry Year(s) Commission Paid: Street Address 4. 5. 6. 7. City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: ZIP 750 15 TOTAL (Also enter on Line 9, Recapitulation) ~ S 15,313 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Nancv G Hess RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] Asonia Wolf 1 307 Avon Drive, Carlisle, PA 17013 Daughter 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SH EET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 If more space is needed, use additional sheets of paper of the same size. JUVF.OB: Historical Prices forJUNIATA VALLEY FINL -Yahoo! Finance :.1Daily Start Date: . ~:lk~ai~~=~°~ ~ 12 ~ 2p1o Eg. )an 1, 2010 Weekl ~: Y c.......y ..._................ -: :..lw{~ir;;° >:~~;; . 15 :, ~ 2010 ~ y ;' End Date: "'~ 5.....~.....~ ~:.... ..:... ........~.+ Dividends Only First ~ Previous ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close* Mar 15, 2010 17.00 17.00 17.00 17.00 200 17.00 Mar 12, 2010. 17.75 17.75 16.90 17.00 4, 500 17.00 * Close price adjusted for dividends and splits. First ~ Previous ~ Next ~ Last IDOWnIOad to Spreadsheet 4/23/10 3:35 PM Copyright. ©2010 Yahoo! Inc. All rights reserved. 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