The URL can be used to link to this page

Home My WebLink About06-30-10 (3) 1505610101 REV-1500 °` t°'-'°' PA Department of Revenue txnrrsylvarrie OFflCiAL USE ONLY Bureau of Individual Taxes °"""'"`"~""""~ County Code Yew _ Fie Numt~er INHERITANCE TAX RETURN Po sox z8o6o1 21 10 0 6 4 6 RESIDENT DECEDENT Hanisbu PA i 128-o6oi ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 494-16-2556 04/04/2010 ' 12/05/1915 __ _ Decedent's Last Name Suffix Decedent's First Name MI Gillespie !Dorothea M (if Applicable) Entw Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's soaal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WRH TH REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Retu (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federel Estate T Return Required death after 12-12-82) O 6. Decadent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of fe Deposit Boxes (Attach Copy of Wil) (Attach Copy of Trust) O 9. Litlgation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax un er Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST 8E COMPLETED. ALL CtntRESPONDENCE AND CONFIDENTU-L TAX INFORMATION SHOULD S DIRECTED TO: Name Daytime Telephone Nu bar Tricia D. Naylor, Esq. (717) 243-7437 RE018TER OF USE ONLY First line of address d 104 S. Hanover Street ~ c... Second line of address ~ ~T ~~ ', ~ ~ d Cit or Post Office State ZIP Code DATE:.. ~` y _ __ ` U --r-r ~L Carlisle PA 17013 ~' - G .... __ ___ ~ .. W Corssportdsnt's small address: tnaylor~Carlislepalaw.COm ~ Under perrekies of perJury, I ded~e that 1 have examined this return, induding aocompanyhrp schedules and staterrrents, and to the best of knowledge and belief, it is hue, onrrect and canplete. Decleretion of preperer other than the personal representative is traced on all infonnatlorr of whbh preparer any krrcrwledge. SIGNATURE OF SON RESPOd616LE FOR FILING RETURN p E AD 17 ny P ' Ave., S ' nsburg, PA 17257 OF R O ESENTATNE / ~ D l./ ~ AD SS 104 S. Hanover S eet, Carl' , PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 150561010/ :~~.. ~, ~ ~ C.:> ~ ., s~ ~ '` ~'-~~ ~- " ~' ~n ~it r REV-1500 EX Decedents Name: Dorothea Mae Decedents Social 494-16-2556 ly Number RECAPITULATION 1. Real Estate (Schedule A) ............................................. L 2. Stocks and Bonds (Schedule B) ....................................... 2. ~~ 3. Closely Hek1 Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. _ __. _ 4. Mortgages end Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ', 121.20 8. Jointly Owned Properly (Schedule F) O Separate Billing Requested ....... 6. ~ 34,018.03 i 7. In6sr-Vivos Tn3r-sfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 8. Total Gross Assets (total Lines 1 through 7) ............................. 7. 8. I~ i ~~ 34,138.23'', 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. __. 4,063.23 '. _ I _, 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. __ I 978.39 ', _ i 11. Total Deductions (total Lines 9 and 10) ................................. 11. i 5,041.62 12. Nst Vales of Estate (Une 8 minus Line 11) .............................. 12. ~i, 29,097.61 13. Charitable and GovemmeMal BequestslSec 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. 28,097.61 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES i 15. Amount of Line 14 taxable ~~ at the spousal tax rate, or ~ transfers under Sec. 9116 _ _.... _ . _ _ i (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable _.~..... _ .. at lineal rate X .o ~ 29,097.61 1B, I, 1,309.39 _ 17. Amount of Line 14 taxable _ _ L_ at sibling rate X .12 17. _. 18. Amount of Line 14 taxable at collateral rate X .15 18. __ . 1s. TAX DUE ......................................................... 1s.' 'L 1,308.39' Z0. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610105 1505610105'I 1505610105 O J T ~ ~ REV-1500 EX Page 3 Fae Number Decedent's Complete Address: EDE NAME Dorothea Mae Gillespie Green Ridge village 210 Big Spring Rd. C Nevwille sTATEPA ~P17241 I Tax Payments and Credits: I'~, 1. Tax Due (Page 2, Line 19) (1) II 1,309.39 2. CreditslPayments i, A. Prior Payments 1,243.92 B. Discount 65.47 I 1,309.39 Total Credits (A + B } (2) 3. Interest (3) I~ 4. If Line 2 is greater than Line 1 + Line 3, enter the diffeerence. This is the OVERPAYMENT. FIN in oval on Page 2, Une 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 1. Did decedent make a transfer and: Yas a. retain the use or income of the Property transferred :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its incxxne : ............................................ ^ c. retain a reversionary interest; or ........................ ^ .................................................................................................. d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. N death occurred after Dec. 12, 1982, did decedent transfer properly 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 aaxxant, annuity or other non-probate properly, which contains a beneficiary designation? ........................................................................................................................ ^ BLOCKS No O a a Q x^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN For dates of 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 the ~se 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 s rviving 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 requiremen for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefiaary. ~ 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 ~ younger at death to or forth use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)J. II • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5, plercent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)J. 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(a)(~.~)]. A sibling is defined, under Section 9102, as an individual who has at feast one parent in common with the decedent, whether by blood or adoption. ~_T REV-1508 EX+ (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~ E CASH, BANK DEPOSRS, ~ MISC. PERSONAL PROPERTY ecrere nc NUMBER Doroiiiea Mae Gillespie 21-10 - O 6 4 6 Include the proceeds of litigation and the date the proceeds were received by the estate. All property ~IMty-oMmed with right or survivo~shtp must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. ..Social Security Payment 121.20 i I TOTAL (Also enter on line 5, Recapitulation) = 121.20 (fl more space is needed, insert additional sheets of the same size) ._ -~ I _. REV-1509 EX+ (Oi-iD) Pennsylvania SCNEpI/LE F DEPARTMENT OF REVENUE ]OINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE' !!FIBER: Dorothea Mae Gillespie 21-10 ~ 0 6 4 6 If an asset Rxcame idMly owned wR hin one rear of the daeede~'s dab of deatfi, it must be reported on k G. SURVMNG JOIKf TENANT(S) NAME(S) ADDRESS RELA ONSHIP TO DECEDENT A• Nellice Gillespie 173 Stony Point Ave. d~ug'h r Shippensburg, PA 17257 I~ i B' Jacqueline Bums-Ritsc;h PO Box 1475 i daugh~ er Buffalo, MO 65622 C. !,I ~I i ~oINnY owNEO IvROI•ERTY: LETTER DATE DESCRIPTION OF PROPERTY 9~ DATE OF DEATH m~ FOR xxNi MADE INCLUDE MANE OF FINANCIAL INSrrrunoN AND BANK ACCWNT NUMBER OR SIMILAR DATE OF DEATH VALUE OF NUMBER TENANT xTINf IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET DECEDENTS INTEREST 1. A. 09l28I03 Osage Valley Bank Certificate of Deposit #30879 2,502.31 0 1,251.15 2. A. 09!28103 Osage Valley Bank Certificate of Deposit #30879 2,502.31 ~0 1,251.15 3. A. 09!28103 :.Osage Valley Bank Certficate of Deposit #30879 2,502.31 0 1,251.15 4. A. 09128/03 Osage Valley Bank Certificate of Deposit #30879 2,502.31 0 1,251.15 5. B. 0388109 Certificate of Deposit #31364 2,544.00 ~0 1,272.00 6. B. 02102/09 Certificate of Deposit #26555 2,567.69 ~0 1,283.85 7. B. 02105/09 Certificate of Deposit #26558 3,081.55 0 1,540.78 8. B. 06115188 749.217 sh Am Century Growth Mutual Fd CUSIP #025083403 17,172.05 0 8,586.03 9. B. 11/15f19 682.92 sh Washington Mutual Investors Fd CUSIP #939330106 17,564.70 ~0 8,782.35 10 A. 11/15/79 306.398 sh Washington Mutual Investors Fd CUSIP #939330106 7,880.56 0 3,940.28 11 A. 11/15/79 Orrstown Bank checking account #103008638 5,070.00 0 2,535.00 12 AB 06115!90 Hawthorn Bank checking account #120900923 3,219.42 ~i ~i3 1,073.14 TOTAL (Also enter on Une 6, Recapitulagon) ; 34,018.03 If more space is needed, use additional sheets of paper of the same size. i ~_ REV-15]1 EX+ (]0-09) SCHEDULE H Pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RES1DENi DECEDENT s e p ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' The Amos Family Funeral Home 1,843.23 2. Johnson County Chapel 1,295.00 3. Flowers - Nellice Gillespie i 360.00 B. ADMINISTRATIVE COSTS: I 1. Personal Representative Commissions: Name(s) of Personal Representative(s) _ _ _ ___ ~, Street Address City State ZIP _ Year(s) Commission Paid: ~ 2. Attorney Fees: 550.00 3. Family Exemption: ([f decedent's address is not the same as claimant's, attach explanation,) I Claimant Street Address _ __ ~, qty State _ ZIP _ i Relationship of gafmant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: ~• Inherit~ce Tax Return filing fee ~ I 15.00 TOTAL (Also enter on Line 9, Recapitulation) 4,063.2 If more space is needed, use additional sheets of paper of the same size. ll s I _--~. L- ~~ ESTATE OF FILE NUMB~!# Dorothea Mae Gillespie 21 -1 0 - 0 6 ~ 6 Decedent' d bts must be re orted on Schedule I 3 -, . REV-1512 EX+ (12-OB} Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT , INHERrrANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE Of FILE NUMB R Dorothea Mae Gilles ie 21-10 - 0 6 6 Report dNita incurrod by the dacadeM prior to death that romained unpaid at the date of death, including unroimbursed adieal expenses. ITEM NUMBER DESCRIPTION ~ VALUE AT DATE Op pEpm 1• AARP Health Care -insurance premium I 209.50 2. 'Alert RX -medication ~ i 18.01 3. '..Alert RX -medication ~ 61.67 4. 'BCC Shippensburg -nursing home I' ', 480.75 5. WSEMS - ambulance service ~; i 208.46 ~~ TOTAL (Also enter on Line 10, Recapitulation) ; 978.39 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) ~`° Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHfRRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FI E NUMBER: Dorothea Mae Gillespie 21 -1 0- p 6 4 6 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 ouhight spousal distributions and transfers under Sec. 9116 (a) (11).] i 1. Nellice Gillespie 173 Stony Point Ave., Shippensburg, PA 17257 daughter ~~ 9057.13 2. Jacqueline Bums-Ritsch PO Box 1475, Buffalo, MO 65622 daughter ~ 20040.48 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS API II NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: L TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET. ~ If more space is needed, use additional sheets of paper of the same size.