HomeMy WebLinkAbout07-23-10I 15056041046
REV-1500 EX (05-04) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes
~ : County Code Year File Number
Dept. 280601 INHERITANCE TAX RETURN
T DECEDENT ~ ~ ~ ~' ~~
~~
Harrisburg, PA 17128-0601 ~
~ RESIDEN
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
Decedent's La
st
Name Suffix Decedent's First Name MI
/
~
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
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)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Rf;quired
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
Firm Name (If Applicable)
~~ /~/~ ~ ~~ K ~J~~
First line of address
~~ ~ ~ ~ sr
Second line of address
City or Post Office State
Correspondent's a-mail address
ZIP Code
REGISTE~9F WILLS US~NLY
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
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~ESPONSIBLE FOR FILING RETURN ~ +D~ATE r°~
ADDRESS
NATUBbO
E
AC~,Bf~ESS ~ / ' , ~ ~ /'
PLEASE USE ORIGINAL FORM O LY
Side 1
15056041046
1,5056041,046
J~
J
REV-1500 EX
Decedent's Name
Decedent's Social Security Number
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 & Notes Receivable (Schedule D) ............................. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5.
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) C Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1-7) .................................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9
G' ~3 0
~~'~7 ~
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........... ..... 10.
11.
Total Deductions (total Lines 9 & 10) ..............................
..... 11. / .~
~ ~,
12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. ~ ~~
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. ~~r~
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 tax~le J ~.- ~
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. ,~,rl .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q
1,5056042047
Side 2
1,5056042047 1,5056042047
REV-1500 EX Page 3
Decedent's Complete Address:
File Number ~~ ~' ~G% •- ~~ j'~
DECEDENT'S NA ' _
STREET ADDRESS
CITY STATE ZIP ~, „~
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Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) ~ 3~~
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. InterestlPenalty if applicable
D. Interest
E. Penalty
Total InterestlPenalty (D + E) (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) _ _
i
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _____~~~:
A. Enter the interest on the tax due. (5A) _
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) _ ~j
Make Check Payable fo: REGISTER OF W-LLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOIGKS
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? ...................................................................... ^
2. If death occurred after December 12, 1982, did decedent transfer property 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 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 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 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 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.
t
REV-1508 EX + (1-97)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RFCIDFNT DECEDENT
ESTATE OF / FILE NUMfBER/ ?
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
__
~~ ~~ ~ ~ ~~
~f~~, ~~9~ ~~
~~~ 7
TOTAL (Also enter on line 5, Recapitulation) $ ~/'~G;• ~,~ Cam'
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
QGCin~nir n~n~n~~ir
~~~ ~~'~G~~~~ r
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
1. -- / p
~~ ~ ~
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City ____ State Zip _
Years} Commission Paid:
2• ~ 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's Fees
6• Tax Return Preparer's Fees - ~~~-'~~L ~~~(,~ ,/d ~D/fLu~o~j
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AMOUNT
y ~~
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TOTAL (Also enter on line 9, Recapitulation) $ ~~ ~°l~
(If more space is needed, insert additional sheets of the same size)
REV-1 X13 EX+ (9-00)
~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
f
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESI~ATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVEFI SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECT{ON 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space is needed, insert additional sheets of the same size)
099999-00005lIviarch 21, 1997/HAJ/PAR/62093
?Ji~zsY 3~i11 <~zni~ (7~ e~Y~cnrnt
OF
THELMA I. REICHERT
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I, THELMA I. REICHERT, of East Pennsboro Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and revoke any Will previously made by
me.
ITEM I: DEBTS.
I direct the payment of all my legal debts, and the expenses of my last illness and
funeral from my Estate as soon after my death as conveniently may be done. I direct that
3
all taxes that may be assessed in consequence of my death, of whatever nature and by
whatever 'urisdiction im osed, shall be paid from my Residuary Estate as part of the
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expense of the administration of my Estate.
ITEM II: TANGIBLE PERSONAL PROPERTY.
'; I may leave a written list in my safe deposit box or elsewhere disposing of certain
items of m tan ible rsonal ro ert The Executor shall dis ose of items of m
y g Pe P P y P y ~.
' 099999-00005/March 21, 1997/HAJ/P~,R/62093
use the principal as well as income from time to time for the minor's support and
education (including college education, both graduate and undergraduate and vocational
training) without regard to his or her parents' ability to provide for such support and
education, or to make payment for these purposes without -further responsibility to the
minor or to the minor's parent or to any person taking care of such minor.
ITEM V: PERSONAL REPRESENTATIVE.
I name, constitute and appoint my son, WILLIAMS CHARLES REICHERT,
Executor of this my Last Will and Testament. Should my son, WILLIAM CHARLES
REICHERT, fail to qualify or cease to so act, I name, constitute and appoint my
granddaughter, DEBORAH R. FORGIE, Executrix of my Estate. Should she fail to
qualify or cease to so act, I name, constitute and appoint my granddaughter, ANGELA
BANKS, Executrix.
ITEM VI: BONDS. No person serving as Executor shall be required to give
bond for the faithful performance of his duties in any jurisdiction.
-3-
' 099999-00005/March 21, 1997/HAJ/PAR/62093
AFFIDAVIT
COMMON~WEALTI3 OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
We, THELMA I. REICHERT, _ ~ ~~~ ~~ yt c~ ~tc~ ~ V~~ ~ ~,, ~-w .~ and
~~ t~- ~ a~ ~~ ~:~ _ ~;~,~~ '~ = ~~,~-~~ ~'~S~r_ ,the Testatrix and the witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being first duly sworn, do
hereby declare to the undersigned authority that the Testatrix signed and executed the
instrument as her Last Will and that she had signed willingly and that she executed it as
her free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and
that to the best of his/her knowledge the Testatrix was at that time eighteen years of age
or older, of sound mind and under no constraint or undue influence.
i~ ~ f n r
THELMA I. REI ~ T
~'d f~l-1~'~
Witness
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Sworn to or affirmed to and subscribed to before me by THELMA I.
REICHERT, Testatrix, and `~;'~ ~~n~:. ~c~ ~ ~ ~'~ ~. ~~~ &~...~ and
~~ c--~. ,~~ ~ ~ - ~= y~% ~` <;~ -~,., .~~-:~ witnesses, this r~ :'~ ~~' day
of ~~.~;~~ ~-t 1997 .
Notary Public''
My Commission Expires:
Notarial Seat
l+tgDO'y L. Bistline, Notary Pubic
Lemoyne Boro. Cumberland Gounty
My Corrtroisslon Explrea Nov. 23,199
~l~nbar, Pencasy~~n-a ~ssacGatlQrt at Ncds