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Home My WebLink About06-24-10J 1505610101 REV-1500 Ex(ol_lo, OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ~` A„M`~~ " County Code Year File Number PO Box z8o6o1 ~ INHERITANCE TAX RETURN Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ~ ~ ' C=~ C>C~(G'~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 173-38-5027 10/06/2009 07/30/1948 Decedent's Last Name Suffix Decedent's First Name MI CALAMAN RAYMOND E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name N91 Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) Q 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 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 T0: Name Daytime Telephone Number STEPHANIE E. CHERTOK (717) 249-1177 First line of address 61 W LOUTHER STREET Second line of address City or Post Office CARLISLE State ZIP Code PA 17013 REGISTER 6'F WILLS USE C~9`( _t~ -r~ ~~ - 'r t .~`~ -,-, '~`f - - : s:: - --1~ DACE FILED "- w r{ ~._ ~ 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 bes± of my knowledge and belief. it is true, coj{ect and complete. eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIC,,NATUR OF PERSO PON I ~ R FILING R URN ~ DATE ~ ~r ~ 3 ~~ ~~~ . fiUUK 5 /~ /t SIGNAT~/ E OF ~ RER OTHER THAN REPRESENT TIVE ~ DATE AD9RESS ~ PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 150567,0101 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: 173-38-5027 RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. ' 5,162.26 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property {Schedule G) O Separate Billing Requested..... ... 7. 8. Tatal Gross Assets (total Lines 1 through 7) .......................... ... 8. 5,162.26 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 3,462.31 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ... ....... ... 10. 6,770.94 i1. Total Deductions (total Lines 9 and 10) .............................. ... 11. 10,233.25 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 0.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... ... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. ', 0.00 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 taxable at lineal rate X .0 ~ 16. 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. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610],05 REV-1500 EX Page 3 File Number Decedent's Complete Address: '`~ ~ Q~ ~%~'~~~~' Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 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) 0.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPR{ATE 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? ...................................................................... L_J X 2. 1f death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. C_) ~~ 3. Did decedent own an "in trust for" or payabie-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 Jufy 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 ar for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(x)(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. §9118(x)(1)]. The tax rate imposed on the net value or` transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(x)(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) ~ scNEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND E. CALAMAN 210900960 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. METRO BANK- ACCOUNT N0. 6799 1,812.70 2. NORTHWESTERN HUMAN SERVICES- FINAL PAYCHECK 200.40 3. CASH- MONIES HELD BY EXECUTRIX BUT OWNED BY DECEDENT 1,618.08 4. HOUSEHOLD FURNISHINGS-ALL EXTREMELY OLD (NO ANTIQUES) 239.60 5. NORTHWESTERN HUMAN SERVICES- RETURN OF SECURITY DEPOSIT 506.00 6. HARTFORD INS. (AARP) REFUND OF AUTO INSURANCE 85.56 7. I.R.S. -REFUND FOR 2009 RETURN 517.00 8. PA DEPT. OF REVENUE -REFUND FOR 2009 RETURN 157.00 9. 2009 HYUNDAI SONATA -SURRENDERED TO LIENHOLDER; MEMBERS 1ST- LOAN PAYOFF AT $16,661.97 EXCEEDED F.M.V. 0.00 10. COMCAST CABLE REFUND 25 92 TOTAL (Also enter on line 5, Recapitulation) $ 5,162.26 (If more space is needed, insert additional sheets of the same size) i pennsylvania SCHEDULE G DEFARTMErJT of REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND E. CALAMAN This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY I INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELAAONSHIF TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTP.TE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXC! USION ('F AFFLiCABLEj TAXABLE VA''~.UE -. SMITH BANEY IRA- ACCOUNT N0.73H-600454-18 32,290.54 100 THIS ACCOUNT BECAME THE PROPERTY OF BENEFICIARY JO DEE HOOVER, DECEDENT'S NIECE. ANY INHERITANCE TAX ' LIABILITY WOULD HAVE TO BE PAID BY HER, INASMUCH AS THE ESTATE IS INSOLVENT. I i i I i i I JO DEE HOOVER ~ 105 E. SPRINGVILLE ROAD ~ i I I , BOILING SPRINGS, PA 17007 i I i i TOTAL (Also enter on Line 7, Recapitulation) $ ( 0.00 If more space is needed, use additional sheets of paper of the same size. ~~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ES7A'TE OF FILE NUMBER RAYMOND E. CALAMAN 2109000960 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT a. FUNERAL EXPENSES: 1' HOFFMAN-ROTH FUNERAL HOME-CREMATION 1,757.00 2. HOFFMAN-ROTH FUNERAL HOME- 8 DEATH CERTIFICATES 48.00 B. ADMINISTRATIVE COSTS: i. Personal Representative Commissions: Names} of Personal Representative(s) Street Address City ___ State ZIP Year(s) Commission Paid: Z. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant __ __ Street Address City __ __ State ZIP Relationship of Claimant to Decedent _ _ _ 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: ~ CUMBERLAND LAW JOURNAL- ADVERTISEMENT OF ESTATE s. PATRIOT NEWS C0.-ADVERTISEMENT OF ESTATE 9. TAMY WIMER- HAULING OF TRASH FROM DECEDENT'S APARTMENT ~o. FREYSINGER-MAZDA HYUNDAI- RE-KEYING OF IGNITION AND DOORS (ORIGINAL KEYS TAKEN FROM APARTMENT) ~ i. OFFICE SUPPLIES/POSTAGE FOR EXECUTRIX TO OPERATE ESTATE 500.00 107.00 45.00 75.00 194.73 85.00 641.06 9.52 TOTAL (Also enter on Line 4, Recapitulation) $ 3,462.31 If more space is needed, use additional sheets of paper of the same size. .~~ :Sim =X+ (12~~~;,8} i pennsylvania SCHEDULE I oEFaarMENr or rye/ENUE DEBTS OF DECEDENT, INHERITANCE Tnx RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND E. CALAMAN 210900960 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RAYMOND E. CALAMAN 210900960 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1~ NONE- DEBTS EXCEED ASSETS II ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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. ( $ If more space is needed, use additional sheets of paper of the same size.