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HomeMy WebLinkAbout08-19-10J 1505610101 REV-1500 Ex`°'-'°' OFFICIAL U5E ONLY PA Department of Revenue Pennsylvania Coun Code Year File Number Bureau of Individual Taxes "~ ' ' ~ I PO Box z8oliot INHERITANCE TAX RETURN ~ (~ f/` / Harrisburg, PA t tz8-o6ot RESIDENT DECEDENT l / V ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYVVY Date of Birth MMDDVVVY 174-OS-3567 09/23/2009 05/13/1914 Decedent's Last Name Suffix Decedent's First Name MI Dewalt Sara K (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 (~ 7. 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 Required death after 12-12-82) ~ 6. Decedent Dietl Testate O 7. Decedent Maintained a Living Trust _0_ g. 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 untler Sec. 9tt3(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) GORRE5PONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Tricia D. Naylor, Esq. (717) 243-7437 First line of address 104 S. Hanover Street Second line of address City or Post Office Carlisle State ZIP Code PA 71013 rv REGISTE _ JKILLS U5E ~Y ~ ~ _.. 1 ~ n Q'~ r ~ ;. _ ==.nm tD -- ,c-n 3C ~~ C _ w~~ , _~.. ~.I ~ '> E FILED CJT Correspondent's e-mail address: tnaylOr(O7CafIiSlepalEIW.COn1 Under penalties °I perjury, I declare that I have examined this return, including accompanying schedules and statements, and Io the Dest o1 my knowledge and belief, it is true, correct and Complete. Declaration of preparer other tnan the personal representative is based °n all information of which preparer has any k °wledge. SIGt~I~RE ~ PE O~RESP~SIBLE FOR I I RETURN DATE _ - 1 Stoneh se Rd., Car' PA 17015 SI RE OF P ER ER AN REPRESENTATIVE DATE I S AD ESS -~ 1 S. Hanover eet, Car I , PA 17013 150561U101 Side 1 1505610101 J zM, r-t _) ~__I -`I-i "T"Y C) --~ J 15D5610105 REV-1500 EX Decedent's Social Security Number oecadam's Name: Sara K. Dewalt 174-05-3567 RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) ..... .... .. .... ........ ... ... 2. 27,376.02 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). _ 5 175,229.1$ 6. Jointly Owned Property (Schedule F) O Separate Billing Requestetl .. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) Q Separate Billing Requested_ 7 19,498.56 8. Total Gross Asaets (total Lines 1 through 7) ......................... ... 8. 222,103.76 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 21,246.74 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 360.27 11. Total Deductions (total Lines 9 and 10) ......... ..................... .. 11. 21,607.01 12. Net Value of Estate (Line 8 minus Line 11) ...... ............. ....... .. t2. 200,496.75 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. 200,496.75 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_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 200,096.75 ts. 9,004.35 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 400.00 18 60.00 19 TAX DUE ............ .. .................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 9,064.35 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Sara K. Dewalt STREET ADDRESS 801 N. Hanover Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 9,064.35 2. CreditSlPayments A. Prior Payments 9,400.00 B. Discount 453.22 Total Credits (A + B) (2) 9,853.22 3. Interest --- ---- (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) 788.87 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to; REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :..............................__............_.................................. ....... ^ x^ b. retain the right to designate who shall use the property transferred or its income :..................................... ....... ^ ^X c. retain a reversionary interest; or ........................................._........................................................................ .. . ^ d. receive the promise for life o(either payments, benefits or care? ............................__...._........................ . ... ....... ^ Q 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................._...................._.............................................................. ...... ^ 0 3. Did decedent own an "in trust for" or payable•upon•death bank account or security at his or her death? ........ ...... ^ X^ 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 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 far 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 D percent [72 P.S. §9116(a)(1.2)J. • 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)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)(1.3)j. 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. REV•1603 EX. (6.96) ~ SCNEdULE B COMMONWEALTH OF PENNSYLVANIA STOCKS Sc BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sara K. Dewalt 21-09-1013 All property jointly awned with right of survivorship must be disclosed on Schedule F lu nwie space Is neeae0, InSen a0tlrtl0nal sheets 01 the same size) REV-1508 EX. (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Sara K. Dewalt 21-09-1013 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 1. Merrill Lynch Bank Deposit Program 2. Accrued interest on #1 3. Morgan Stanley Smith Bamey Bank Deposit Program 4. Accrued interest on #3 5. 50,000 New York Community Bank Certificate of Deposit CUSIP 649447PY9 6. Accrued interest on #5 7. 44,000 Amcore Bank Certificate of Deposit CUSIP 02341VSG1 8. Accrued interest on #7 9. 51,000 Keybank National Certificate of Deposit CUSIP 49306SEZ5 10. Accrued interest on #9 11. Church of God -nursing home refund 12. Capital Blue Cross -insurance refund 13 Mt. Zion Cemetery Burial Plot -Lot No. 9 Section E 14. PA Income Tax Refund 15. Federal Reserve Bank - proceeds of savings bond redemption prior to decedent's death 16. M&T Bank Checking Account No. 28333640 TOTAL (Also enter on line 5, Recapitulation) S OF 90.00 0.15 2,032.18 0.03 49,934.50 39.45 45, 326.60 434.45 52,876.84 146.22 2,201.46 469.20 1,600.00 9.00 505.44 19,563.66 175,229.18 (It more space is needed. insert additional sheets of the same size) R E'J ~ 151 U F'R ~ ! 08 6y pennsylvania SCHEDULE G DEPARTMENT Of RFVf NUF INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY 0.ESIDENT DECEDENt ESTATE OF FILE NUMBER Sara K. Dewalt 21-09-1013 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INnuoE rnE HARE of rnE rRAnsfeREE, rHEIR REUnonsnlP ro DECeoenT Ano THE DATE of TRANSFER. AITACH A [OPY OF THE DEED f00. REAL ESTATE. DATE OF DEATH VALUE OF ASSET ^/P OF DECD'S INTEREST EXCLUSION ;Ir APOLIUeiEI TAXABLE VALUE i Jackson National Life Annuity No 0058919310 . 19,a98.56 100 I '~ i 19,498.5! TOTAL (Also enter on Line 7, Recapitulation) ~ 19,498.56 If more space is needed, use additional sheets of paper of the same size. RFV-]Sli FX+ IID-09) ~; pennsytvania SCHEDULE H ~ DERARTMENTDFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Sara K. Dewalt 21-09-1013 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Ronan Funeral Home 10,572.92 2. Evans Cemetery Memorial -lettering for momument 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State 2IP Year(s) Commission Paid, 2. Attorney Fees: 10,000.00 3. Family Exemption: ([f 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: 356.00 S. Accountant Fees: 6. Tax Return Preparer Fees: ~ Advertising -Sentinel 123 82 tl. Advertising -Cumberland County Law Journal 75.00 9. Short Certificate 4.00 to. Inheritance Tax Filing Fee ~ 15.00 TOTAL (Also enter on Line 9, Recapitulation) I; 21,246.74 if more space is needed, use additional sheets of paper of the same size. RFV-1512 F..X+ (t2-O8) Pennsylvania SCHEDULE I DEPARTMENT DE REVENUE DEBTS OF DECEDENT, INMER1TaNCE Tax REruRN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Sara K. Dewalt 21-09-1013 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (Oi-30) ~~~~~ ~~pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Sara K. Dewalt 21-09-1013 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under 1. 2. 3. 4. 5 6 7 8. 9. II Sec. 9116 (a) (1.2).] Michael Lloyd Dewalt 104 Stonehouse Rd., Carlisle, PA 17015 Barbara M. Dewalt 104 Stonehouse Rd., Carlisle, PA 17015 Michael Stephen Dewalt 235 Mills Dr., Carlisle, PA 17013 Virginia Dewalt 235 Mills Dr., Carlisle, PA 17013 Jennifer Kummer 8 Fairfax Circle, Shrewsbeny, PA 17361 April L. Gibb 155 Farm Rd., Newville, PA 17241 Jeremy Stone 26 Mall Rd., Etters, PA 17319 Casey Kummer 8 Fairfax Circle, Shrewsberry, PA 17361 Athena Stone 23 E. South Street, Carlisle, PA 17013 san daughter-in-law grandson wife of grandson granddaughter granddaughter great grandson great granddaughter great granddaughter 54248.82 400.00 54248.83 400.00 44099.55 44099.55 1000.00 1000.00 1000.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECitON TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART TI - FNTFR T(1TG1 NrIN-TAYARI F hICTRiRI ITIr1NC (1N I TNF 1 Z f1F RF\1-1 Snn fl1VFC CNFFT I t If more space is needed, use additional sheets of paper of the same size.