Loading...
HomeMy WebLinkAbout10-14-101505610140 REV-1500 EX `°'-'°' OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ~~ ' /~ I b ~~ Harrisburg PA 17128-0601 RESIDENT DECEDENT V ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 8 6 2 4 8 6 9 9 0 3 0 1 2 0 1 0 0 2 0 6 1 9 2 6 Decedent's Last Name Suffix Decedent's First Name MI B E C K A M E L I A D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit .(date of death ~ 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 TO: Name Daytime Telephone Number C L I F F O R D B L E P A G E E S Q 6 1 0 3 7 4 8 2 1 1 First line of address 2 0 0 2 C A R L I S L E Second line of address City or Post Office C A M P H I L L Correspondent's a-mail address: DIANNCONN@AOL . COM State ZIP Code REGISTER OF WILLS USE ONLY ~ rv - C7 ~ ~ Q r~ = r; - - ; - -~ :~J r _. ' ~ 7 ..© DATE.FI~~'ry .~,.. _-- _., -a .. P A 1 7 0 1 1 .r, tV -.~ --} _. ~~ __ . ; - -~.1 Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and compl~ete~.AD*eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI T~PF~SOI /'~l./L~ SO~I~L'I'NG RETURN DATE o i0-il-i0 ADDRESS 43 HAFTZING T 0 MOHRSVILLE PA 17111 SIGNATURE OF PR RE H NTATIVE D/~ZE' ~ ~ / ~ ADDRESS (( UU PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 R 0 A D 1505610240 REV-1500 EX Decedent's Social Security Number 1 8 6 2 4 8 6 9 9 Decedent's Name: A M E L I A D• BECK 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 and Notes Receivable (Schedule D) ........................ .. 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. • 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 9 1 4 3. 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ^ Separate Billing Requested ..... G .. 7. 9 2 0 0 . 0 0 ) (Schedule 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 1 8 3 4 3 . 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) 9. 2 5 0 . 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. ...............................11. 11. Total Deductions (total Lines 9 and 10) 2 5 0 ' 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 1, 8 0 9 3 . 0 0 13. Charitable and Governmental BequestslSec 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 8 0 9 3 • 0 0 TAX CALCULATION -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 taxable at lineal rate X .045 1 8 0 9 3. 0 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610240 Side 2 B ], 4. 1 9 8 1 4. 1 9 1505610240 REV-15D0 EX Page 3 Decedent's Complete Address: F(le Number 0 0 DECEDENT'S NAME IAMELIA D. BECK STREET ADDRESS 2002 CARLISLE RD CITY CAMP HILL STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) ?. Credits/Payments A. Prior Payments - B. Discount _ 3. Interest t. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 10 to request a refund. i. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 819.19 Total Credits (A + g) (2) 0 . 0 0 (3) (4) 0. 0 0 (5) 814.19 Make check payable to: REGISTER OF WILLS, AGENT ~. 4, ~ ~ ,; ~.... , a ..~. ,a~ ..~....~,. ~.. ~~~r .._. ..,~_~. ._~. ~. _,.z~~.... .~ ,..... ...W ._. ~, _ _.._ _.._~ n __,_ ....~ _ ,. , ....~ .....: ~5.... ., 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; ............................... ^ 0 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? ....................................................................................... ^ 0 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 1T AS PART OF THE RETURN. ~~ ~or 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 1 percent [72 P.S. §9116 (a) (1.1) (i)]. ~or 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 fling a tax return are still applicable even if the surviving spouse is the only beneficiary. =or 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. REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: AMELIA D. BECK 0 0 If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ( ADDRESS (RELATIONSHIP TO DECEDENT A. SHARON CHRISTIANSEN 43 NAFTZINGERTOWN RD MOHRSVILLE, PA 19591 B. C JOINTLY-OWNED PROPERTY: DAUGHTER ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTERESI ~. A, 1/05 METRO BANK 2,862.00 50. 1,431.00 ACCT 536892276 2 A METRO BANK 15,424.00 50. 7,712.00 ACCT 537210478 TOTAL (Also enter on Line 6, Recapitulation) $ 9, 193.00 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (OB-o9) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER 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 INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATEDFTRANSFER.AITACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE ~. WACHOVIA BANK, N.A. IRA ACCOUNTS 9,200.00 100.00 9,200.00 257910067520909 $ 4900.00& 257410067520405 $9300.00 Sharon Christiansen 500 and Karen L. Brandl 50o daughters TOTAL (Also enter on Line 7, Recapitulation) ~ $ 9 , 2 0 0. 0 0 If more space is needed, use additional sheets of paper of the same size.