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Home My WebLink About06-28-10Bureau of Individual Taxes Po Box sao5oi Date of Birth MMDDYYYY 06/23!1951 Decedent's First Name Raymond __-____,___ Spouse's Last Name Suffix Spouse's First Name t~' Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH _ _ _ __ __ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return O 2. Supplemental Return O 3. Remainder Retil prior to 12-13-851 O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate l death after 12-12-82) O fi. Decedent Died Testate O 7. Decadent Maintained a Living Trust ~ 8. Total Number of (Attach Copy of 1ArIQ (Attach Copy of Trust) MI E.~._., T 3............... MI_ G Z N OD ~f deaf ~um Requ~ CrJ Deposit Bolted ~? '--~ r-T1 rM.'7i ;,-' r .~ s"S i.•7 ~1. . O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax urhder Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) Name Craig Keefauver (717) 761-1990 DIRECTED TO: fiber tea .LS USEANLY tz ; ~ ~-~ m O .~'7 ~i Correspondent's e-mail address: Undsr penakies of perjury. I declare that I have examined this return, including accompanying schedules and statemerds, and to the best of ri4Y knowledge and belief. K is we, correct and conmplete. Dedaretlon of preparer otlmer than the personal represe~tlve is based on aN information of which preparet~ has any knowledge. SIGNATURE OF PEF~ON RESP_ON,SIB~E~ FlLING RETURN ~ ATE ,~' n ~i~, !/I!/w A' /~ .~` / d~>~-~ c+-~ frc~ huh tid C ra.~,1y ffi lI >+'f~ ~ ~D I / SIGNATURE OF PREPARER OTHE THAN REPRESENTATIVE BATE ADDRESS PLEASE UsE ORIGINAL FORM ONLY Side 1 L 1505610101 150561010 J - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIOti SHOULD @ Daytime Telephone Nt INHERITANCE TAX RETURN w rl~~wc~~T wL~f~CACUT J 1505610101 OFFtCU1L USE ONLY REV-1500`01-10' ~" PA Department of Revenue petxtsylvarHa County Code Year File Numtrer dnMMF.M d N[NfNUS J 1505610105 REV-1500 EX Decedent's Social 5ecwrity Number Decedent's Name: Raymond T. Deli 202-42-6212 RECAPITULATION 00 '' 0 1. Real Estate (Schedule A) ............................................. 1. . 2. Stocks and Bonds (Schedule B) ........ .............. 2. 0• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 ~ 9 9 ( ) ........................... 4. Mort a es and Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ', 4,915.44 6. Jointy Owned Properly (Schedule F) O Separate Billing Requested ....... 6. ' 35,250.00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 16,174.83 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. ' 56,340.27 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10,208.00 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 9,103.17 11. Total Deductions (total Lines 9 and 10) ................................. 11. 19,311.17 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 37,029.10 13. Charitable and Governmental Bequests/Seo 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. ', 0.00 14. Net Valus Sut~ject to Tax (Una 12 minus Line 13) ........................ 14. 37,029.10 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or : transfers under Sec. 9116 _....__..._ ....................................._.........._........_........................................................... _.., 3._...... ....._........._....................................................~ .._........................_....................................._....... (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 37,029.10 16. ~ 1,666.31 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. 1,666.31 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 150561D105 150561010$ REV-1500 EX Page 3 Decedent's Complete Address: Fite Number DECEDENTS NAME Raymond T. Dell STREETADDRESS 301 North Second Street CrrY 'STATE ZIP Wormleysburg PA Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments __ B. Discount 3. Interest 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. (1) 1,666.31 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING C}UESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent nmke a transfer and: Yes No a. retain the use or income of the property transferred :.......................................................................................... ^ b. retain the right to designate who shah use the property transferred or its income :............................................ ^ c. retain a reversionary interest; or ..................:....................................................................................................... ^ d. receive the prornise for life of either payments, benefits or care? ........................................:............................. ^ 2. If oath o«.urred after Dec.12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ x^ 3. Did decedent own an "in trust for" or payable-upon-death bank acxount or security at his or her death? .............. ^ ^Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ~ ^ 1,666.31 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AIS PART OF THE RETURN. For dates ~ 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 thd use of the surviving spouse is 3 percent [T2 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 hurviving 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 disdosure 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 chid 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 rats imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent p2 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-1508 EX+ (5-g8) SCMEDt~LE E COMMONWEALTH of PENNSYLVANIA b/131•~ BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF 'FILE NUMBER Raymond T. Dell Mdude the proceeds of litigation and the date the proceeds were received by the estate. Atl property Jointy-oMmed with right of survivorthlp must be dlecloaed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 ~ Uncashed check from Nationwide trust ', 4,606.14 2; <Mass Mutual checking account 159.30 3 ~ F Misc personal property and clothing 150.00 i '~~ I Y ~ ~e ,xaMU Urmv, a.w.w~newv+.~~,z„ <... ..... .. ._ -. ,.. .w,srrax>.. _ maauaa. ~u mm. i F REV-1509 EX+ (Oi-io) Pennsylvania Y~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ~+CMEd11LE ~ 70INTLY-OWNED PROPERTY " ESTATE OF: FILE HUMBER: Raymond T. Dell If an asset became jointly owned wRhin one year of the decedent's dabs of death, it must be reported on ule G. SURVMNG ]OiNT TENANT(S) NAME(S) ADDRESS RELAtIONSHIP TO DECEDENT A•=Ar~ne Dell ;Manor Care Carlisle I940 Walnut Bottom Rd ;Carlisle, PA 17015 B. C. 70INTLY OWNED PROPERTY: Mother f ITEM NUMBER LETTH! FOR ]DIlfT TENANT GATE MADE ]DINT DESCRIPTION ~ PROPERTY INCLUDE NAME OF FINANCIAL INSTITUnON AND BANK ACCOUNT NUMBER OR SIMILAR 1DENRFYING NUMBER. ATTACH DEED FOR JOINTLY FOLD REAL ESTATE, DATE OF DEATH VALUE OF ASSET ~,' I OF DATE OF DEATH VALUE OF DECEDENTS WIBtEST 1' A' ;11/18/94 ~5irlgle ferrBly home -deed at Cumberland Co Deed book 115 pg 102 70,500.00 510% 35.250.00 . i i -. _ . TOTAL (Also enter on Line 6, Recapitulation) ; 35,250.00 If more space is needed, use additional sheets of paper of fire same size. 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A asa! ba ataatad, k la aaai twyt by the oaatpaat of aai aa~l Y~~wte Raab tray twe ate. ~ het ~ ~1{ne d Steoad ~ ~ ~ aMealY-was (7~ 'cEt18 ti A PION•!A7[A><Ii'PRAI'~>RER for taa~eyhiasi tcamGt trot parposas from amtllar aad briar to ~ A.d t6a acid Ot'attMers ~atary aoraaaat +a~ a~aa q~t t6a~ vrMl wattaat : 4• aY ~ ~ ~ Vrit~ ~+ ~~Orautas ~nrs karewto sat tltale baadt aad sash >1t0~ ~~EALBD MID ~ S1tED Cor~oNwea.TH ol: P~vtrSYI,vANIA ) ~ tyOUrcrst OF CUB } oil ~ ~ ~~,, 1994. baton nay, w ..a rears s nsau, '.'~ ' 4 ~ ) b ~ ~rea°"o...t~tti. obi fie ~ `° '~ wtgSS wFtE~oP. t~i~anat.w.at iy asa+ awa al~I ,~jf '~ ~,I,+,~r, *` ~ 103 ~ta,..lt.~,,,. . ~~ '' ~ ~ r .~. _. ___._ _. __ _T _ __. _ _ _ _ _. _. _ _ _. __ ' FEB-02-2010 09:14 ~OWELLOROUP 7177619107 P.009 .. _ •j,...~. _.. .. , i do Meey- oettiy ~ eke p~ raidoaae aa~ aeapMee pert et8ee addle. at t(Is MMYN~•ate~wd Omlee(~ !~ JOl Naeai 8eeoad 3aaec Nedala~rr0. pA 17043 1~ ~ ~~ ~ ~-' y ~" ~~~ "v•. ~: OOId/OMIMPJ1L.77i Ola li3rINSY1.VM11A ) ~ e, ~+ G ~.~, • 9S. . F.. z ~~ •.. ODUFI'1`Y Olr CiJ1~itLMiD ~ , s ~ N `•~ Zp~ b d+s ReemdeYr Omer at the aid Lbee~y Y Deed paolc Qlwa ^edet ~),aad eed Ibe reel of tlw raid Ocoee, ~ dare above s~111ee. ~, ~~~~ __ _ _ ,_ REV•1510 EX+ (08-09} Pennsylvania SCHEDULE G DEPARTMENT Of REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE Tax RETURN MTSC. NON-PROBATE PROPERTY RESIDENT DECEDENT Raymond T. Dell This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-150p is yes. iTEM DESCRIPTION OF PROPERTY >NUUOE THe NN+E of THE TRU~sR:>rEE, THEIR NEtAT1oNSHiP To DECEDENr Mro DATE OF DEATH 96 Of DECD'S E~(CLUSION TAXABLE NUMBER THE DALE aF TRAHSFE0. ATTACH A COW of THE DEED wR REAL ESTATE. VALUE OF ASSET INTEREST APPtItABIE VALUE __ „~,~w.aw, 1 American Funds 401(k) pl~- paid to beneficiary Arlene Dell (mother) 16,174.83 100:. 16,174.$3 i ~~ i , _._ } TOTAL (Also enter on Line 7, Recapitulation) # 16,174.83 If more space is needed, use additlonal sheets of paper of the same size. __ _ _ , REV-1511 EX+ (10-09) pennsyivania DEPARTMENT Of REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMB R Raymond T. Dell Decedent's debts moat be reported on Schedule i. ITEM NUMBER DESCRIPTION ~ AMOUNT A• FUN~RAL,,,~XPfNSES: 1• _. ___.._...._ ... ........ ..... 'Funeral home invoice 5,385.58 2 Cemetery plot invoice 895.00 B. ADMINISTRATNE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Pald: Z• Attorney Fees: 427.50 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.} 3,500.00 Claimant ArlenB Dell street Address c/o Manor Care Carlisle 940 Walnut Bottom Rd qty Carlisle state PA ZIP 17015 Relationship of gaimant to Decedent mother 4• Probate Fees: S• Accountant Fees: 6• Tex Return Preparer Fees: rv. ,_ ......_ ~....... _... 7. _...,.. _.,._.._.. TOTAL (Also enter on Line 9, Recapitulation) $ 10,208.00 If more space is needed, use additlonal sheets of paper of the same size Estate of: Raymond T. Dell Supplemental Statement regarding Schedule H, Item B(3) Decendent lived with his mother, Arlene Dell, at their home at 301 North Second street, Wormleysburg, Pennsylvania. Due to her age and physical condition, Decedent's rhother is not currently capable of living alone and now resides at Manor Care Carlisle. The homee is in the process of being sold. - _ ` __ REV-1512 EX+ (12-OS) Pennsylvania SCHEQULE I DEVARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8E LIENS RESIDENT DECEDENT TOTAL (Also enter on Une 10, Recapitulation) ; 9,103.17 If more space is needed, insert additional sheets of the same size,