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HomeMy WebLinkAbout06-15-1015056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN - _ _ r PO BOX 280601 21 08 ~ 1168 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth __... 022-24-8798 12/23/08 ; ~ 7/5/32 _ _ __ . _ __ . _ _ -_ I - -- - _ ___ __ ~. ` - - - - __ _ _ Decedent's Last Name Suffix Decedents First Name __ ; Gordon _______; ' Catherine ----_- ___ __ __ ;,, H I ___ _ (If Applicable) Enter Surviving Spouse's Information Below Spouse s Last Name Suffix Spouse s First Name MI _.__ ___- I -. - __ Spouse s Social Security Number - - _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ______ ____ _i REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return ~ 2. Supplemental Return Ca 3. Remainder Return (date of death (~ 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) C;;r 9. Litigation Proceeds Received c_7 4a. Future Interest Compromise (date of death after 12-12-82) C~ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) Q 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) pnor to 12-13-82) t'~ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes CD 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 TO: Name Daytime Telephone Number Bradford Dorrance, Esquire - - ---- _- '; (717) 255-8014 '~? _ __ n _ ~' _ - _ -- - Firm Name (If Applicable) __ _._ _ _-_ __ r __ - _-_ I _ _ _ ° REGISTER LS USE O~1LY ~ __ _ _ ~'~, KEEFER WOOD ALLEN & }ZAHAL, LLP __ I ' -u . ` ~~n ~ ' , First line of address --- -- ~ ' ~ U"1 __ ___ _.__ __ __ _ ____ ~ CJ1 ~. r ~ t i - `a~~0 210 Walnut Street - - - _ _ _ __ ~" ~ ~ ~ Second line of address __ - - _- ~. _ _ _ P.0 BOX 11963 ~ I , y t~7 T F L ~ City or Post Office ----__ _____- State ZIP Code - -DA ED __ . E j Harrisburg PA ~ 17108-1963 I Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the pest or my xnowieage anc oeuer, 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 RETUR /~ ~ ~ ,, uAi t Lynn M Toland -a '~-~-•-- ~~l ~~~-" ~ `S~- ~~~ ADDRESS i nn~ ~,...t r~l,,...,,,- cr Mnr}i~ni rclti»ra_ PA 1 7[755 SICiNAIUKt ur rr<trrvccrc vin~r~ inr.~. r.~r ~..-~".,.-.,,.-- ~~ ~~ ~ / `~ Bradford Dorrance, Esquire ADDRESS 210 Walnut St P 0 Box 11963, Harrisburg, PA 17108-1963 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~b J 15056052059 REV-1500 EX Decedent's Social Security Number i Decedent's Name: Gordon, Catherine H. 022-24-8798 ~___.e RECAPITULATION __._ - -- - - - - - 1. Real estate (Schedule A) ............................................. 1. $ 61 ,133.38_ _.._.___.___._____..._.___1! ! 2. Stocks and Bonds (Schedule B) ....................................... 2. ', $ 549.53 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ''._~.~ __._.__._._ ___~___.____._-_- _~ i 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. I ~~.~_.~..__._._.._._.._ .____..____._....___.._._..~ ~ I 5. Cash, Bank Deposits & Miscellaneous Personal Pro ert (Schedule E P Y ) ........ 5• 3, 086.59 __~.._.._...__________._._._ ____..._..._ ..___.__._---_._..j 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 4_ `v~, ~____.__~..____._ _.___._.____.___~' Inter-Vivos Transfers & Miscellaneous Non-Probate Pro ert 7 I . (Schedule G) C~ Separate Billing Requested....... , . 7. ____._,___.__.._. 8. Total Gross Assets (total Lines 1-7) ................................... ! . 8. ! $64, 769.50 `~_.._.____.._______.._____..._.._ 9. Funeral Expenses & Administrative Costs (Schedule H) .................... . 9. Iq$15 , 459.08 _. ~. __ ! j 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... . 10. '', $ 7 , 075.73 _ _ _ _.._____ ____ _ _._~_._~..___.._ ._-, r_ ~ 11. Total Deductions (total Lines 9 & 10) .................................. ',$22,534.81 . 11. ;'~^ .___. y __.. ~ _..~___ ". 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12.', $42, 234.69 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... . 13. `__~_ .________..______.__________...___i 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 1a.'', $42,234.69 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or _ _...__ __ _ -- - _ transfers under Sec. 9116 ~~~^ _~~ ti ~_._. m.~r____.__~_.__.._ _._._.._._-___ _ 16. Amount of Line 14 taxable ~~ at lineal rate X .045 $1, 900.56 ___. _ 16 j$ 1, 900.56 ~_ _~~ ___ ___ - -; 17. Amount of Line 14 taxable I 17. ' at sibling rate X .12 _.__._._~ .__.______._ , _.__.______~_._~___.___.__._._~.______ .___.- 18. Amount of Line 14 taxable I ' 18 ' _ _ ! at collateral rate X .15 .._.__._ • $ 1 , 900.56 19 19. TAX DUE ....................................................... . .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O 15056052059 Side 2 15056052059 REV-1500 EX Page 3 e~___r_-L~.. r+........1.,4e Arirlrncc• File Number ____ __________. r------ ~---- ; of ~~ nR ~! 11 FiR Y.~_._..... -.._.._.....__.__._..__..__.___.._. _. ___......__. _. /GVr.M~.~~a v vv...~......_ __.-- ---- DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Gordon, Catherine .H. 022-24-8798 STREET ADDRESS 29 Southmont Drive CITY Enola STATE PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments _ C. Discount 3. InterestlPenalty if applicable D. Interest E P Halt $ 1,180.85 $ 252.37 (credit) (1) $ 1, 900.56 Total Credits (A+ B + C) (2) $ 1 , 433.22 . e y Total Interest/Penalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 4 . Line 20 to request a refund. (4) Fill in oval on Page 2 , enter the difference. This is the TAX DUE. (5) reater than Line 2 1 + Line 3 is If Li 5 $ 467.34 , g ne . (5A) n the tax due t i t th . eres o n e A. Enter This is the BALANCE DUE. (5B) Enter the total of Line 5 + 5A B $ 467.34 . . Make Check Payable fo: 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 ^ retain the use or income of the property transferred :....................................................................................... a ... . retain the right to designate who shall use the property transferred or its income :......................................... b ... ^ ^ . ^ ^ c. retain a reversionary interest; or ....................................................................................................................... ... ^ ^ d. receive the promise for life of either payments, benefits or care? ................................................................... ... If death occurred after December 12,1982, did decedent transfer property within one year of death 2 . ^ ^ 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 .... Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 4 . ^ ^ 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. .41 . ~:r. 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 exemat 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)(1.3)]. 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-1512 EX+ (12.03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Gordon, Catherine H. 21-08-1168 o.,..,..~ astit~ ~„~~~..o~ h~ the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (It more space Is neeaea, uisen auwuunai mwcw ~~ uic ao~~~~ ~~~..~ ~:. JtflSO<~ Si'1 ~~ ~v '~~ Ch ~ t.7 _ Cq ~ CJ to 7 ~ P ~ LL. 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