HomeMy WebLinkAbout09-07-10-T I
1505610101
REV-1500 °`~°'-'°' 'del
w- Departrnent of Revenue ~ oFFIaAL usE ol~Y
&"'~' °# "~ Tam INHERITANCE TAX RETURN ~ Code Yetr ~ Number
Po Box zsoeoa. ~, Q°l G y l ~ -7
itarrlsburq, PA s7~a8-o6oi RESIDENT DECEDENT
ENTER DECEDEIfT MIFORMATTON BELOW
Sodel SecurNy Number Date of Death MMDDYYYY Date of Binh MI~DYYYY
177.24-6142 09/06/2009 01/28/1923
Decederd's Last Name Sulroc Decedent's First Name i MI
~ ~~L ....L i.
r-w ~ w~/f~M~~ ~ I~~PG 'i /'~
(K AppNesbN) Ert1K Surviving Spouss's In/onnaHon Below
Spouse's Last Name SuIBx Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FEED M DUPLICATE WITH TH~
REGISTER OF WILLS ~,
FILL IN APPROPRIATE ovALts sELO'W
On 1. Original Return O 2. Suppi Rebrm O 3. Rerrreinder (date or death
prior b 12-13-&2)
O 4. Limited Estate O 4s. Fubxe h Camprondse (dale of O 5. Feder Estate Return Required
death attar 12-12-82)
O 8. Decedent hied Testate O 7. Oeoedent hlair-fained a LMrg Tn~ 0 8. Total Number of Deposit Boxes
(Attach Copy or WM) (Attach Copy of Tnrst)
O 9. LMigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election b tax U Sec. 9113(A)
between 12-3181 and 1-1-95) (Attach Sch. O)
CORRESPOIN)ENT - flNS 8ECTION MUST SE COMPLETED. ALL CORRESPONDENCE AND CONfOENTUL TAX INFORMATION SFIOIILD ~ T0:
Name Daytime Telephone N
Roger L. Amsbaugh (717) 448-9307
REtiWSTER OF USE ONLY
First Nne of address rv
__
1038 Roddedge Drive
n
_
i
I
II o
o
Second line Of address ...rr
'
~'C7
I (~ ~ f
t'*1 ~~
c
~
~~
(
__ _ ~~~
~ ..
City Or Poet Oflioe State ZIP Code
Car~sle
,7+Q- ~
PA 17015 v ~~
~: --
y
~
-"-'
-
tv ~~
Gortwpondsttt's e~ttaN address: v
,~ .
a
,
llndar psnaltiss of per)ury, I dedars that 1 have examined tlds rshxn, inducting aooompsrgring sd-sdules and statement, and b the beat d rhy and
i< is true, correct and cartplsb. Dselaratlon ar properer anrer than the pa+acnsl roproserdatlve is based °n aq Mionrxrlion d whbn preparor! any knorrlectge.
31 OF P62 F FILMIG
('06/10
1038 R Drive Carlisle, PA 17 5
SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE p~q
ADDRESS
a1LR~R l~!<i Aa1aAq~~^ CNY AYE v
Side 1
L 1505610101 150561010]
J
1505610105
REV 15~ ~ DecederrPs Social Security Number
Dsoedsrrt's Name: 177-24-612
RECAPI7ULATiON
1. Real Estate (Sc~redule A) ............................................. 1. i 0.00
2. Sbodcs and Bonds (Schedule B) ....................................... 2. 0.00
3. Cbsety Held Corporation. Parbiership or Sole-Protxieborahip (Schedule C) ..... 3.
_ I 0.00
~ _. , ._ .
4. AAortgages and Notes Receivable (Schedule D) ........................... 4. 0.00
5. Cash. Bank Deposits and M~oeNaneous Personal Properly (Schedule E)....... 5.
_ '', 9,376.37
_.
8. Jointly Owned Property (Stiredule F) O Separate BiNkrg Requested ....... 6. 0.00
7. ransfers & Misoetlaneous
n
y _ _ ~ _ _.
Sdiedule t
Requested........
rate ~
( 7. 0.00
8. Total dross Assets (total lines 1 through 7) .................... . . . ...... 8. ~ 9,376.37
9. Funeral Expenses and Administrative Cosh (Schedule H) ................... 9. ~ 7,147.83
10. Debra of Decederrt, Mortgage LiabilNies, and wens (Sdredule q .............. 10.
_ ~ 2,139.00
_..._ .. _ . j ._._ ...__
11. Total Dsductlons (total lines 9 and 10) ................................. 11. 9,286.83
12. Nst Ysdre of Estats (L.ine 8 minus tine 11) .............................. 12. 89.54
13. Charitable and GOVemmenral Bequests/Sec 9113 Trusts For which
an election to tax has not been made (Schedule J) ........................ 13. 0.00
14. Nat Vahrs 8ubJsct ~ Tsx (Line 12 minraz l.~e 13) ........................ 14. I 89.54
TAX CALCULATION -SEE INSTRUC710NS FOR APPLICABLE RATES
15. Anwtmt of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 91113
(ax1.2) x .o.
__.
18. Amount of line 14 taxable
at lineal rate X .0 4i
17. Amount of Line 14 taxable _ . __ .... .
et sling rare X .12
18. Amount of lme 14 taxable
at collateral rate X .15
15. ~'
18. 89.54
_. _.
17.
........... 18. ~
19. TAX DUE .............................................. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERP/1YMENT
Side 2
1505610105 1505610105
4.03
O
RE1h1500 EX Pape 3
_ ~_~a._ w_.._~t_a~ Ad.1.~ssQ•
Fla Number
Ana a vv... fr.va~ .~+............
S NAME
Mae A Amsbaugh
STREET ADDRESS
1 Longsdorf Way
~ ~ srnTEpq 77015
~
Tax Payments and Ctrsdits:
1. Tax Due (Page 2, Line t9)
2. CredilslPaymarris
A Prior Payments
t3.Oisoount
3. Interest
(1) --4.03
Total Credits (A + B) (2) ' 0.00
(3) 0.02
4. f f Line 2 is greater than Line 1 + Line 3, enter the diRerenaa. This ~ the OYEt2PAYlABlT.
t~ in oval on Papa 2, line 20 b request a retrrrrd. (4) ',
5. ff line 1 + line 3 is greater than Line 2, enter the dilGerenoe. This is tl~e TAX OUE. (5) 4.05
~ ~ r ~, Make check payable to: REGISTER 0~ WILLS, AGENT '1.~ ~~ti V r~~ r. , , ,
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN '7(" IN THE APPROPi~ITE BLOCKS
1. Did decedent make a transfer and: Yes ~~, No
a. retain the use or income of the properly transferred :.......................................................................................... ^ ~',
^ o
b. main the right to desigr~te who shah use the properly transferred or its arcorrre : ............................................
........................................... ^ ~' a
c. retain a reversionary interest; or ...............................................................................
I
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^
2. ff death ooaared after Dec. 12, 1982, did decedent trans<er properly within one y~r of d~th ',
witl~out receiving adequate oonsideration? ........................................................... I~ x
3. Did decedent own an tin bust for" orpayable-upon-0eath bank account or security at his or her d~th? .............. ^
4. Db decedent own an irrdirridual retirerrrerrt account, annuity or other non-probate property, which
contains a beneficiary desigrration? ........................................................................................................................ ^
IF THE ANStlYER TO ANY QF THE ABOVE QUESTIONS IS YES, YOU MUST GOMPL.ETE SCHEDULE G ANO FU.E IT A~; PART OF Tt1E RETI~N
,` Yt~t6 ' ~ , ..kry: i ~ ~,.. ~ _fs ~`; -~ ~~" ; ~ , - 2z~. , - s r ~' JS` ~ t d'-.~°j' . r ~~~~ T ~-~~S~~aA'ac9FYlAY~ .
For dates of death on or attar July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or far the 4~ of the surviving spouse is
3 peroent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the rret value of transfers to a fa the use of ttre s I rviving spouse is 0 perctmt
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer b a surviving epees from tax, and the statutory requirerrrent~ for disdosrue of assets and
filing a tax remum are still applicable even if the surviving spouse +s the only berrefittisry.
Far dales of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years ~ age or younger at death to or for i~ use of a natural pansnt, an
adoptive parent or a s~pparent 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 lirteal benefiaaries is 4.5 p~eroent, except as noted in
72 P.S. §9116(1.2) ]TZ P.S. §9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for tits use of the decedent's sib6 rs 12 percent [72 P.S. §9118(a)().$)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in txxnrran with the decedent, ~ by blood or adoption.
RE1F~1506 DCt (8'Yd)
uTM ~ ae~snvww-
re~ar~ ~c r+En~
r~oEarr oec~vr
f~tILE E
CASH, BAi~C DEPO5tT5, ~ MISC.
PERSONAL PROPERTY
6aTA7E OF I FILE gtAA'fER
Mae A. Amsbaugh 2009.00917
1~ 1M Noe~~te d apNai and 1bt d~M we pooMe: wws aioMwd e'r •e ww.
u n.nr.w~. wrrw..r..a r.aM rwr d ~nieslrle ..r e. a.~..a.~ ~.aW. c
pr nrur~ ap~os s nwwo. met[ i0~ AMR a we t~M ~9)
REY-1511 EX+ (10-09)
pennsylvarria~
aretrr~ we a~
aPSneR oec®®rr
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATII/E COSTS
ESTATE OF FILE
Mae- A. Amebaiugtt _ _ _ Z00~-OO~tl7
DaoaianR's delfts satrat 6e nsperasd ea Edt~le L
rr~
Y NCO 11FMCiQf~IW ~WYrIT
I ~VICIW.
i' Funeral Home - Par/terrtore Funeral Home ~ (~errtetlort Services, ktc.
6,839.01
8. ADlQNISTRATIVE C05T5:
1. Flnsoml Repn!seketlre CAmnisdorr;:
Nis) ~ Pbsonal mss)
St{eet Address
~Y Sgbe __~ Z1P
Nex(s} Camnipion Pdd• _--
Z Atbomer Fees:
3. Feniy 8aenprfon: (H decedent's addRSS is net the same as daiment+s, attadt explsnatiort.)
Oeimnt
Shat Address
ah Stabs IIP
Rt#etlorrsh(p d Qairrant to Decedent i
4. Robabe Fees:
~I
5• A000rlltarrt Fag;
6. 'r~tr Rehm Preperer Fees:
7. Canbetiaftd Cotetly - Regieler Of YYis
95.00
~ Ctmberkrtd County Lsw Journd - Eeieia NoGoe Ldier Of Tesfarrtenlery 75.00
7c The SexNirei - Esmle hla6oe aTe~errterrtery ~ 123.82
7d (~snberlaM Courtly - RegieieF Of Mlis - ktltarNartoe Tax Rehm Fits Fos 15.00
TOTAL (At9o steer an Lore 9, Rerapibeaiort) ;I 7,147.83
S more space is needed, ux addltlonal sheets of piper aF the same size.
aev-isi2 ac+ ti1-os)
penr~sylv~ia
a~
SCHEDULE I
~sTS of orr,
~ u ~ ~
~sr~~ of
u ~~~z ~ ~ neeaeo, ~ sowoa~ s~~aas a me saint size.
• , RH/--1513 IX+ (01-10}
~v~ia SCHEDULE ~
EiTATE Of:
Mae a 17
,ooeca>~r Al~ouNraRSwelE
NINA MANE Alp AD01~5 of s~ Ae~smss weDVEmY o.11et uc,-w~..~:~ '~ of ~
z rAXAeLe oLSrll»ur~or6 treduee asbM~ht spoesd dborrbutias aie transtess Hader
sec. nia cep tea
i• Roger L Mlebeegh 1036 Rockledge t)riue Cadde, PA 17015 Son ', 44.77
2 Rodney C. Mlebelrgh 1320 Sou6l Dube Street l.arlceeler, PA 171602 San ', 44.77
e~rtet otxrert AMOlMtS tatOR OrSrA®unOt~s 51101rN ABOilE ON Lulu 15111N0116i11A aF r1~19DO QOVER 9H~ AS APPI
a NoN-~u~er,E o~snmeur~or~s
A. SPOUSAL DI51RlaUTI016 INIOHt SECi10N 9113 FOR rMFBCiI Art ElECT10N'r~ TAX S NOr'IAi®1:
i• wa
e. aiARtrAeLe AND aDVeaiNeiirAL lasrR®imoNS:
1.
wA
TaTA~ lIf tsART II - ENiBt 7DRALHON-TAXABLE D~SiR~Ui~Dr6 ON LHE 13 OF RHF1560 COVER SFIffL
0.00
If mpe speae is needed, uee ed~iaal wheels d paper d the senx size.