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HomeMy WebLinkAbout10-06-10 (2)J 1505610101 REV-1500 Ex (°1-1°' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes `~"~"`"'' ' "`"' County Cude Year File Number Po Box z8o6oi INHERITANCE TAX RETURN - ~ / Harrisburg, PA i'71z8-o6oi RESIDENT DECEDENT ~ j / ~ (~~ 7 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Mh1DDYYYY Date of Birth Iv1M0DYYYY 192-30-0903 07/25/2010 08/07/1939 Decedent's Last Name Suffix Decedent's First Name MI Bourdette Barbara S (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 p 2. Supplemental Return O 3. Rerlainder Return (date cf death O 4. Limited Estate p da. Future Interest Compr~imi~,e (date o' prior tc i?.-13-82) (~ 5. F~sde~ral Eskite T;~x Ra:urn Rc~cc~r.;r death after t2-12-82) . C7 o Decedent Died Testate O (Attach Ca of Will) 7. Der.,edent Maintained a Living Trust _ 8. Taal Number of Safe Cepcsit Boxes, py (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. SF~~ousal Poverty Credit idate of death O 11 Eier..tion to ~;~,~ ,,,,r,i,,,~ ^,~~:. 9'113[x; between 12-3 i-91 ,and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTI A Name L 7AX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Ni.imber James W. KOllas (717) 731-1600 rv First line of address Kollas and Kennedy Second line of address 1104 Fernwood Avenue City or Post Office State ZIP Code Camp Hill PA 17011 Correspondent's a-malt address: 'amesl~kollasandkennedv.com ^ REGISTER~®LLS USE Y t=~7 ~ C") f ~ l ~ n ^--~1 t ~ r- - r-- ~~ rn I ~- :~ ~ ~ ~,, - ;~ a t ~~ ~ -` ~ ~_ -~ ~ L ~ DA~r~ FILED Under penalties of perjury. I declare that I have examined this return, including accompanyin ,schedules and >tatements. and to the b°st o! my kr,arole~dge :md 7eli~=f, i• ue corre t and c°mplete. Declaration of preparer ocher than the personal rc;presentalrve s based on all ~nforrranon of which preparer has any kno~nledge. 510NATUKE F pER50N~F2E" N5IBLE FOR FILING RETLRN DATE SIGI`JATU( ~pARE6T~'THER THAN REPRE'~EP~T"ATIVE CATE J ~•.~ur«a~ -- L D l/try ~~, ~~ ~.,., ~~ ~~. ~ ~ ~ s ~~ i~ v C<,,, ~ ~i" 7r d=?~ ~ ~,~ ~ PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 ~~ -7 1 _, ;~ -,; Ty ~~~~ --- t 15D5610105 REV-1500 EX Decedent's Social Security Number Decedent's fVame: 192-30-0903 RECAPITULATION 1. Real Estate (Schedule A) ........................................... . . 1. 157,200.00 2. Stocks and Bonds (Schedule B) ............... . ............. .. 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 143,908.35 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 18,630.97 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billuig Requested...... .. 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) ...... .................... . . 9. 319,739.32 '.3. Funeral Expenses and Administrative Cosks (Schedule H) . ....... ...... . . 9. 7,686.65 10. Dr:bts of Decedent, Mortgage I_iabi!ities, and Liens !'Schedule I) ........... ... 10. 825.72 11. Total Deductions +total i_inPS 9 <+nd ;9' ................ .............. 11. 8,512.37 ^. 2. Net Value of Estate (Line 8 minus Line 11) ....... .................. 1:%. 311 226.95 13. Charitable and Governmental Bequests,'Sec 9113 Trusts for which , an election to tax has not been made {Schedule J) ..................... .. 13, 500.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 310,726.95 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. 0.00 16. Amount of Line 14 taxable at lineal rate x .0 45 310,726.95 1g, 13,982.72 17. Amount of Line 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 18. 0.00 19. TAX DUE ............................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 13,982.72 O REV-1500 EX Page 3 File Number Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditsiPayments A. Prior Payments _ __ _ ___.0.00.._ B. Discount 699.14 3. Interest 4. If L'me 2 is ~,reater than Line 1 + Line 3, enter the difference. This !s the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. ~. f Lane ": + Mile ~ ~8 yr(?itAr than ~ Isle 2, Enter the dlffe"?rCe. T'li$ IS the TAX DUE. (1) 13,982.72 Total Credits (A + B) (2) 699.14 (3) 0.00 (a; 0.00 (5) 13,283.58 NTake check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent m,,<~ke a transfer and: Yr~s No a. retain the use or income of the property transferred :.................................................................................... ...... ^ K^ 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 rare? ................................................................ ...... ^ 2. If death occurred after Dec. 12, 1982. did decedent transfer property within cne year of death without receiving adequate consideration? ........................................................................................................ ..... ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? ........ ...... ^ 0 4. Did decedent ewn an individual retirement account, annuity or ether non-probate property, which contains a beneficiary designation? .................................................................................................................. ...... fr^ ^ 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 dales 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 far 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 for the use cf 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. §9116ja)11.2)]. 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. §9116ia)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent [72 P.S. §91f6(a)r1.3j] A sibling 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-1502 EX+ (11-08) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Barbara S. Bourdette 21-10-0777 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 property that is fotntly-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' 115 Cedarhurst Lane, Camp Hill PA 17011 TOTAL (Also enter on Line 1, Recapitulation.) ~; 157,200.00 157,200.00 If more space is needed, insert additional sheets of the same size. REV-1508 EX+ (6-98) 'g~ COMh10NWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8 MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Barbara S. Bourdette 21-10-077 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 en C~I~.eI~J. e [~~ ~~w~c aNa~c is nceucu, insert d001[IOnal SheeTS OT the SaRle SIZe) REV-35og EX+ (oi-io) ~ i~, Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDVLE F JOINTLY-OWNED PROPERTY C~IATE oF: FILE NUMBER: Barbara S. Bourdette 21-10-0777 If an asset became jointly owned within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Lisa B. Bock 15 Cedarhurst Lane, Camp Hill, PA 17011 Daughter B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER 1. LETTER FOR ]CINT TENANT A. DATE MADE ]CINT DESCRIPTION OF PROPERTY INCLUCE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMIIAR ICENTIF'fING NUMBER. ATTACH DEEG FOR )CINTLY HELD REAL ESTATE PNC Bank Account #xxxxxx5643 DATE OF DEATH ~A_'JE OF ASSET 13,215.78 ^„ of DECEDENT'S INTEREST 50 GATE of Dearth ~Ai.JE GF ^ECEDENTS INT[RE~T 6.607.89 2 A PNC Bank Account #xxxxxx2713 24,046.15 50 12,0~3.C8 TOTAL (Also enter on Line 6, Recapitulation) I $ 18.630.97 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) fi` Pennsylvania SCHEDULE G >~ DEPARIMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Barbara S. Bourdette 21-10-0777 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 RELATIDNSMiD TD DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION If APDUCAau: TAXABLE VALUE 1• IRA PNC Bank Account # xxxxxx9732 29,309.46 100 100.00 0.0( See 72 P.S. 9111(r) for exclusion. TOTAL (Also enter on Line 7, Recapitulation) ; I 0.00 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Barbara S. Bourdette FILE 21-10-0777 Decedent's debts must be reported on Schedule I. A. 1 B. 1 2. 3. a. 5. 6. ~. FUNERAL EXPENSES: Musselman Funeral Home, funeral services ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address ___ City _______, Year(s) Commission Paid: State _ ZIP 2,485.00 0.00 Attorney Fees; 1,000.00 Family Exemption; (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00 Claimant Lisa B. Bock street Address 15 Cedarhurst Lane City Camp Hill ___ State PA ZIP 17011 Relationship of Claimant to Decedent Daughter Probate fees: 701.65 Accountant Fees: 0.00 Tax Return Preparer Fees: 0.00 SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS TOTAL (Also enter on Line 9, Recapitulation) I; 7,686.65 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT esrnre of FILE NUMBER Barbara S. Bourdette 21-10-0777 Report debts Incurred by the decedent prior to death that remained unpaid at the date er d.~rti in~~~~et..,. ,..,.es_~..__. __~~__~ _ _~ ~~~~~_ ~Na~= ~~ ~~__~_~, mser[ aaDiaonai sneers or me same size. REV-1513 EX+ (01-10) i i~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF: FILE NUMBER: Barbara S. Bourdette 21-10-077 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).j 1• Lisa B. Bock, 15 Cedarhurst Lane, Camp Hill, PA 17011 Daughter 50% 2. Leslie J. Sansone, 3310 W. Bright Terrace Tucson Arizona 85741 Dau hter , , g 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. Christian Life Assembly, 2645 Lisburn Road, Camp Hill, PA 17011 500.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I# 500.00 If more space is needed, use additional sheets of paper of the same size.