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HomeMy WebLinkAbout09-22-10~ 1505610140 .~ REV-1500 EX (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 0 0 4 8 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 8 9 0 9 4 5 2 5 0 4 0 7 2 0 1 0 0 2 2 2 1 9 1 5 Decedent's Last Name Suffix Decedent's First Name MI M E N T Z E R G E O R G E K (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate OX 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) State ZIP Code CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number M U R R E L W A L T E R S I I I E S Q? 1 7 6 9 7 4 6 5 0 First line of address 5 4 E A S T M A I N S T R E E T Second line of address City or Post Office M E C H A N K S B U R G 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) REGISTER OF WILLS U~ONLY ~ © i ~ -F-~ ~~ k m iV - i ~ ,~ r/ ~__ :~7 ~ ~ ~ r.y~ ~ "~~ i FILED -- ~,p ~ r .. ~' -- ~ --.. 4 .~ ~~ "" ~.-~ _~~. P A 1 7 0 5 5 ~ --~ Correspondent's a-mail address: 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. SIGf~TUR~~ERSON~ P,ONSIB~ FILING RET , N 11ffLLii~f~~ ~`/~yy//JJ ~ DATE ~~f- rJ ADDRESS f'l ,f~ BEVERLY JEAN A I 48 UNION DEPOSIT HARRISBURG SIGNATURE OF PREP OT R T R ESENTATIVE ADDRESS MURREL R ALT RS III 4 E• MAIN ST MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 PA 17111 TE ,~~~ ~ PA 17055 1505610140 `~.~ Continuation of REV-1500 Inheritance Tax Return Resident Decedent GEORGE K. MENTZER 21 10 0483 Defredent's Name Page 2 File Number Correspondents Name Daytime Telephone Number G E O R G E K M E N T Z E R 7 1 7 6 9 7 6 2 7 2 First line of address 6 0 4 S B R O A D S T R E E T Second line of address City or Post Office State ZIP Code M E C H A N I C S BU R G P A 1 7 0 5 5 Corresponder~;s a-mail address: Under penaltie of 'ury, 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, come and mplete. D aration reparer other tha a pe onal representatwe is based on all information of which preparer has any knowledge. SIGNATUR N RES SIB I N °~~T~'"i.~ loo Name J OA N E S H O W E R S First line of address 3 0 G O R D O N Second line of address City or Post Office C A R L I S L E Correspondent's a-mail address: Daytime Telephone Number State ZIP Code P A 1 7 0 1 3 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 infom~ation of which preparer has any knowledge. S NA URE OF PER N R SP N LE FOR FILING RETURN DATE ~ Q -~s-~~ D R I V E ADDR9SS 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: GEORGE K• MENTZER 1 8 9 0 9 4 5 2 5 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 1 0 2 2 7 2. 9 0 2. Stocks and Bonds (Schedule B) ...................................... 2. • 3. Closely 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 E)....... 5. 2 5 5 8 6 . 0 7 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 1 2 7 8 5 8 . 9 7 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9• 5 7 2 6 • 5 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 2 1 4 3 • 8 8 11. Total Deductions (total Lines 9 and 10) ............................... 11. ? 8 7 0 . 3 8 12. Net Value of Estate (Line 8 minus Line 11) ................... ......... 12. 1 1 9 9 8 8 . 5 9 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. 1 1 9 9 8 8 . 5 9 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 1 1 9 9 8 8. 5 9 16, 5 3 9 9. 4 9 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 0. 0 0 19. TAX DUE ...................................................... 19. 5 3 9 9• 4 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610240 Side 2 1505610240 J Decedent's Complete Address: 21 10 0483 DECEDENT'S NAME GEORGE K. MENTZER STREET ADDRESS 1501 W. TRINDLE ROAD CITY ;STATE 'ZIP MECHANICSBURG PA 117015 Tax Payments and Credits: ~ • Tax Due. (Page 2, Line 19) 2. Credits/Payments 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. 5. If Line 1 + Line PLEA; payable to: REGISTER OF WILLS, AGENT This is the TAX DUE. (1) 5,399.49 (3) 0.00 0.00 (5) 5,399.49 QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. uia aeceaent make a transfer and: Yes No 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; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3. Did decedent own an "intrust for" orpayable-upon-death bank account 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? .................................................................................................. ^ 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 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 surviving 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 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 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 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)(1.3)]. Asibling is defined, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Credits (A + B) (2) (4) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: GEORGE K. MENTZER 21 10 0483 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real properly that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 1501 W. TRINDLE ROAD 102,272.90 CARLISLE, PA 17015 NEW SALES PRICE TOTAL (Also enter on Line 1, Recapitulation.) I $ 1 If more space is needed, use additional sheets of paper of the same size. SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER GEORGE K. MENTZER 21 10 0483 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CITIZENS BANK 25,586.07 CHECKING ACCOUNT TOTAL (Also enter on line 5, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) .07 V-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER GEORGE K. MENTZER 21 10 0483 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HICKORYTOWN METHODIST CHURCH -RECEPTION 150.00 FUNERAL PREPAID B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) BEVERLY JEAN NARDI (RENOUNCED) Street Address 5480 UNION DEPOSIT ROAD City HARRISBURG State PA ZIP 17111 Year(s) Commission Paid: 2, Attorney Fees: MURREL R. WALTERS, III 5,250.00 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: CUMBERLAND COUNTY REGISTER OF WILLS 326.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7 TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 5,726.50 Continuation of REV-150Q Inheritance Tax Return Resident Decedent GEORGE•K. MENTZER De'cedent's Name Page 1 21 10 0483 File Number Schedule H -Funeral Expenses & Administrative Costs - B1 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative Commissions: 2• Name(s) of Personal Representative(s) GEORGE K. MENTZER (RENOUNCED) Street Address 604 S. BROAD STREET City MECHANICSBURG State PA ZIP 17055 Year(s) Commission Paid: 3. Name(s) of Personal Representative(s) JOAN E. SHOWERS (RENOUNCED) Street Address 30 GORDON DRIVE City CARLISLE State PA ZIP 17013 Year(s) Commission Paid: SUBTOTAL SCHEDULE H-B1 REV-1512 EX+ (12-08) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER GEORGE K. MENTZER 21 10 0483 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TAXES 287.50 COUNTY/TOWNSHIP REAL ESTATE 2. MET ED 72.01 ELECTRIC 3. TREEMEN 450.00 REMOVAL AND TRIMMING OF TREES 4. CARLISLE MEDICAL PATHOLOGY 18.28 MEDICAL 5. ALEXANDER SPRINGS EMERGENCY 36.10 MEDICAL 6. LUNG, ASTHMA & SLEEP ASSOCIATION 45.40 MEDICAL 7. MOFFIT HEART & VASCULAR 59.43 MEDICAL 8. PHARAMERICA 31.17 MEDICAL 9. SMITH RADIOLOGY 1,77 MEDICAL 10. CARLISLE HMA PHYSICIAN 131.66 MEDICAL 11. DR. DAVID WENGER 20.19 MEDICAL 12. KINETIC IMAGING 34.81 MEDICAL 13. MOBILE X-RAY 21.98 MEDICAL 14. CARLISLE REGIONAL CENTER 933.58 MEDICAL TOTAL (Also enter on Line 10, Recapitulation) I $ 2,1 If more space is needed, insert additional sheets of the same size. pennsylvania SCHEDULE J ~ , ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: GEORGE K. MENTZER 21 10 0483 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 outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. BEVERLY J. NARDI Lineal 39,996.20 5480 UNION DEPOSIT ROAD HARRISBURG, PA 17111 2. GEORGE K. MENTZER Lineal 39,996.19 604 S. BROAD STREET MECHANICSBURG, PA 17055 3. JOAN E. SHOWERS Lineal 39,996.20 30 GORDON DRIVE CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 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, use additional sheets of paper of the same size.