HomeMy WebLinkAbout07-02-10 (3)
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REV-1500 Ex (01-10) '('~'
OFFICIAL USE ONLY!.
PA Departmentof Revenue ~ ,,,,,,
Bureau oflndividualTaxes INHERITANCE TAX RETURN County Code Year ' File Number
Po aox 2aoeol 21 10 0062
Harrisburg, PA 17128-0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYY Date of Birth MMDDYYYY
206 36 8869 01 02 2010 08 07 1952 I~
Decedent's Last Name Suffix Decedent's Frst Name II
Gutshall MI
David A. i
(If Applicable) Enter Sunriving Spouse's Infomretlon Below
Spouse's Last Name Suffix Spouse's First Name Iii
Gutshall MI
Michelle I M
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATI
FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS
~ 1. Original Retum C~ 2. Supplemental Retum !~ 3. Remainder Retu
prior to 12-13-8
O 4. Limited Estate [~ 4a. Future Interest Compromise (date of p 5. Federal Estate T
death after 12-12-82)
0 6. Decedent Died Testate C.~ 7. Decedent Maintained a Living Trust 8. Total Number of
(Attach Copy of Will)
O 9. Litigation Proceeds Received
action to tax ul
tech Sch. O)
CORRESPONDENT - This section mua Informafl tno
Name
Stephanie Kleinfelter ~ Telephone Nu
~ 01_
` iEGISTER
First line of address
K
eefer Wood Allen & Rai- ~
Second line of address
635 N. 12th Street,Suite
Clfy Or Post OffICe DATE
Lemoyne
Correspondent's a-mail address: Skle~
..
WITH THE
(date of death
Retum Required
rfe Deposit Boxes
Ir Sec. 9113(A)
ould be Directed to:
per
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Under penalties of perjury,) declare that l hays examined this return, including accompanying schedules and statements, and to the beat of my knowledge and
and belief, it is true, correct and complete. Decl ation of prsparer other than the personal representative is based en all information of which preparer has any
know) s.
SIGN U' EOF~ERS~ RESP >jIBLEF FILIN E RN ~ _ ___
Carlisle, PA 17013
l~
PLEASE USE ORIGINAL FORM ONLY
L
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Side 1
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J
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Rev-1500 IX
Decedern's Social Security Number
Decedern's Name: David A. Gutshall 206 36 8869
1. Real estate (Schedule A) .................................... 1,
2. Stocks and Bonds (Schedule B) ............................... 2,
3. gosely 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 ~ .. 5.
6.
7. Jointly Owned Property (Schedule F) L7 Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested ... e.
7,
8. Total Gross Assets (total Lines lthrough 7) ..... ... ...... g,
9. Funeral Expenses and Administrative Costs (Schedule H) ............. 9,
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........ 10,
11. Total Deducflons (total Lines 9 and 10) ......................... 11.
12.
13. Net Value of Estate (Line 8 minus Line 11) ........................
Charitable and Govemmernal Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .................. 12,
13,
14. Net Value Subject to Tax (Line 12 minus Line 13) .................. 14,
rnx WMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amourn of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) x .o0 53
967.50
16.
Amourn of Line.14 taxable , 15.
at lineal rate X .045 0.00 18.
17. Arnourn of Line 14 taxable
at sibling rate X .12 0.00 17.
18. Amount of Line 14 taxable
at collateral rate X .15 Q, OQ 113.
19. TAX DUE .........
................. ..................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L,~, I ^ ^^I I ^
^ 0^I I ^
0.00
20,188.38
44,403.52
0.00
10,250.00
0.00
0.00
74,841.90
18,249.75
2,624.65
20,874.40
53,967.50
0.00
53,967.50
0.00
0.00
0.00
0.00
0.00
G7
Rev-1500 IX Page 3
Decedent's Complete Address:
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payrnerns
A. Prior Paymerns 0.00
B. Discourn 0.00
3. Irnerest
Fie Number
21 10 0062
PA
(1)
Total Credits (A + B) (2)
(3)
4. If Line 2 is greater than Line 1 + Line 3, erner the difference. This is the OVERPAYMENT. (4)
FIII In oval on Pale 2, Line 20 tO request a refund.
5. If Line 1 + Line 3 is greater than Line 2, erner the difference. This is the TAX DUE. (5)
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING GIUESTIONS BY PLACING AN "X" IN THE APPROPI
1. Did decedern make a transfer and: Yes
a retain the use or income of the property transferred; , ,
................................... Q
b. retain the right to designate who shall use the property transferred or its Income : ................
c. retain a reversionary irneresr, or ................................................ Q
d. receive the promise for life of either payments, benefits or care? ....... .
2. If death occurred after Dec. 12, 1982, did decedent transfer properly within one year of death
without receiving adequate consideration? ........ .
3. Did decedern own an'Sn trust fob' orpayable-upon-death bank accourn or security at his or her death? ..
4. Did decedent own an individual retiremern account, annuity or other non-probate property,
which cornains a beneficiary designation? .............................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE Q AND FILE IT AS P~
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 forth
spouse is 3 peroern [72 P.S. Sect. 9116(a)(1.1xi)).
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 sp
[72 P.S. Sect. 9116(ax1.1)(ii)j. The statue does not exempt a transfer to a surviving spouse from tax, and the statutory requiremern:
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
an adoptive parern or a stepparern of the child is 0 percent [72 P.S. Sect. 9118(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 peroern, except a'
in 72 P.S. Sect. 9116(1.2) [72 P.S. Sect. 9116(a)(1)).
• The tax rate imposed on the net value of transfers to or for the use of the decedern's siblings is 12 peroern [72 P.S. Sect. 9116(a
is defined, under Section 9102, as an individual who has at least one parent in common with the decedern, whether by blood of
ZIP _-
17013
0.00
0.00
0.00
0.00
tIATE BLOCKS
No
RT OF THE RETURN.
3 use of the surviving
>use is 0 peroern
for disclosure of assets
a natural parern,
noted
(1.3)]. A sibling
adoption.
REV-1503 EX+(B-8B)
COMMONWEALTH OF PENNSYLVANIA
INH ERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF
David A. Gutshall
FILE N
~~ ~n
SCHEDULE B
STOCKS & BONDS
All property ointly-owned with rlpht of survivorhslp must be dleclosed on Schedule F.
ITEM
JMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 PP&L Common Stock 9,712.36
Held In Dividend Reinvestment Account No. 3032449550
2 Banco Santander, S.A. II! 4,980.97
Dividend Reinvestment Account No. 7000425037 ',
3 Carlisle Companies, Inc. ~ 2,017.37
Account No. 00000017124
4 PP&L !,
4 1/2% Preferred Stock '~ 788.70
5 AgChoice Farm Credit ACA I~,
~~ 1,155.38
6 U.S. Series EE Savings Bond 778 40
No. M71475744EE
Issue Date 05/27/1998
Issue Price $500; Accumulated Interest $278.40
7 U.S. Series EE Saving Bond
M72062714EE
Issue Date 01/20/1999
Issue Price $500; Accumulated Interest $255.20
TOTAL (Also enter on line 2, Recapitulation)
755.20
20,188.38
(If more space is needed, insert additional sheets of the same size)
REV -1 S04 EX+ (8-lib)
SCHEDULE C
COMMONWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATION,
INHERITANCE TAX RETURN PARTNERSHIP OR
RESIDENT 0 ECED ENT SOLE-PROPRIETORSHIP
ESTATE OF
David A. Gutshall FILE NUMBI
21 10 006
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partners hip interest of the
sole-proprietorship. Seeinatructionsforthesupportinginformationtobesubmittedforsole-proprietorships.
ITEM
NUMBER DESCRIP110N
1 David A. and Dennis R. Gutshall Partnership
Farming Partnership
50% Interest In Business
EIN: 23-2127257
TOTAL (Also enter on line 3, Recapitulation)
(If more space Is needed, insert additional sheets of the same size)
R
lecedent, other than a
VALUE AT DATE
OF DEATH
44,403.52
44,403.52
REV -1508 EX+ (e-98)
COMMON WEALTH OF PENNSYLVANIA
INH ERITANCE TAX RETURN
RESIDENTDECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
David A. Gutshall FILE NUM
21 10 0(
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with rlyht of survivorship must be disclosed on Scheduel F.
ITEM
1 1995 Dodge Ram 1500 Pickup Truck Long Bed
2 1986 Ponderosa Trailer
3 1996 Eby Trailer
4 1998 Trailer World Trailer
AT DATE
>EATH
1,150.00
100.00
6,000.00
3, 000.00
TOTAL (Also enter on Tine 5, Recapitulation) 10,250.00
(If more space is needed, insert addkional sheets of the same size)
REV -1510 EX+ (08-09)
pennsytvallria SCHEDULE G
DEGARTNENi OE REVENUE
INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF
David A. Gutshall FILE NUMB
21 10 0
This schedule must bs completed and filed if the answerto any of questions 1 through 4an paps three of the REV-1600 is yea,
ITEM INCLUDE NAMEOFE RA~NSFEROEEOREL~A OPNSM PTODECEDENTfk DATE OF DEATH %OFDEC'S ExCLU$ION
NUM DATE OFTRANSFER. ATTACH COPYOF DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IFAPPLICABLE)
1 Carlisle Tire & Rubber Division Of Carlise 100 '
Corporation '~~
Retirement Benefits
Certificate 1253 Contract No. GA-0606 (1)
Beneficiary: Ralph R. Gutshall, Father ~
Not Taxable -Decedent Was 57 Years Of Age
TOTAL (Also enter on Line 7, Recapitulation)
If more space is needed, insert additional sheets of the same size,
TAXABLE
0.00
0.00
REV-1511 EX+(10-09)
pennsyvania
~iT DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENTDECEDEN7
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF
David A. Gutshall
FILE NUMB R
21 10 00 2
Decedent's debts must be roportad on Schedule I.
ITEM
A. FUNERAL EXPENSES:
1 George's Flowers -Casket Spray
2 St. Matthew Lutheran Church
3 Hoffman-Roth Funeral Home & Crematory, Inc.
B• ADMINISTRATIVE COSTS:
1 • Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If deceden's address is not the same as claimant's, attach explanation.)
aaimant Michelle M. Gutshall
street Address 351 Spring Road
aty Carlisle state PA zip 17013
Relationship of paimant to Decedent Wife
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7 Keefer Wood Allen & Rahal, LLP
Miscellaneous Disbursements
- Postage, Filing Fees (Disclaimers, Inventory, PA Inheritance Tax Return),
Photocopies, Telephone Charges, Insured Mail
TOTAL (Also enter on Line 9, Recapitulation)
221.54
75.00
9,151.71
5, 000.00
3,500.00
135.00
110.00
18,249.75
If more space is needed, insert additional sheets of the same size.
REV-1512 EX+(12-OB)
pennsy-lvania SCHEDULE I
OEPAgTNENT ~F REVENUE
INHERITANCE TAX RETURN DEBTS OF DECEDENT,
RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS
ESTATE OF
David A. Gutshall
Report debts Incurred by decedent prior to death th
ITEM
NUMBER
1 Members 1st
VISA Credit Card (Debt)
2 Walnut Bottom Radiology LLC
Medical Expense (Debt
3 Three Springs Family Practice
Medical Expense (Debt)
4 Lowe's
Credit Card Account (Debt)
5 CaMisle Regional Medical Center
Medical Expense (Debt)
at the date of
TOTAL (Also enter on Line 10, Recapitulation)
If more space is needed, insert additional sheets of the same size.
FILE NUMBER
21 10 00 2
unrslrttbur ed medical expenses.
VALUE AT DATE
OF DEATH
1,761.02
I
~,
li 86.00
~I 25.00
I~
677.63
I
75.00
2,624.65
REV-1513 EX+(01-10)
Rennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENTDECEDENT
ESTATE OF:
David A. Gutshall
NUMBE NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY
Z TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2).)
Michelle M. Gutshall
351 Spring Road
Carlisle, PA 17013
FILE N
21 10
TO DECEl7
urviving spouse
ENTER DOLLAR AMOUNTS FOR DISTRIBU710NS SHOWN ABOVE ON LINES 1b TH ROUGH 18 OF REV-1b00 COVER SH EET, ASI
_= NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET.
If more space is needed, iruert additional sheets of the same size.
AMOUNT OR SHARE
OF ESTATE
53, 967.50
RIATE.