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Home My WebLink About11-05-10 (2)150561014D REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Numb PO BOX 280601 INHERITANCE TAX RETURN , ~ ~ ~ ~~( Harnsburg, PA 17128 0601 RESIDENT DECEDENT ,^~ `~ i3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 8 9 0 9 0 6 7 3 0 4 0 3 2 0 1 0 0 4 1 1 1 9 1 4 Decedent's Last Name Suffix Decedent's First Name Mi B A I L E T S E L I Z A B E T H C (lf 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 tN APPROPRIATE OVALS BELOW 0 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) 0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 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 :iHOULD BE DIRECTED T0: Name Daytime Telephone IJumber C HA R L E S E P E T R I E 7 1 7 5 6 1 1 9 3 9 First line of address 3 5 2 8 B R I S B A N S T R E E T Second line of address City or Post Office H A R R I S B U R G State P A r.a REGIS'i;'~t OF LNILLS l~. ONLY .; ,..... r......_ ' -~f- a /~ ..~ ~ L.J ~ i . __ 1 t ~ ~+ f t ~ 1 ~~ ~ -,-y ~~ r_ ~ L __ ; -, '~~ ~~~-1 "~"' _ - ~-' _.~ `~7 ~ r ,, -~ATEi FILED ~ _ a `~`~' ~? - ,,,~ ZIP Code 1 7 1 1 1 Correspondent's a-mail address: PetrieLaw@AOL.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best o'F my knowledge and belief, it is true, correct and compete. Declaration of preparer other than the personal representative is based on al! information of which preparer has any knowledge. SIGNATURE PERS N RESPONSIBLE FOR FILING ETUR DATE -~~Z ~ ~ ~%~ ~, ,~~,~~~~,~ 10/27/2010 50 OLIVER ROAD `°' ENOLA PA 17025 SIGNATU PREP ~E ~OTHf,,F~ REPRESENTATIVE CC ~~ DATE ADDRESS 3528 BRISBAN STREET HARRISBURG PA 17111 L Lsas6LO14o PLEASE USE ORIGINAL FORM ONLY Side 1 1,505610140 N~ _J J 1505610240 REV-150D EX Decedent's Social :Security Number Decedent's Name: ELIZABETH C. BAILEYS 1 8 9 O g 0 6 7 3 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. 7 ~ 7 6 1 9 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 9 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ...... 9. 1 !' 0 1 5 0 10. Debts of Decedent. Mortgage Liabilities, and Liens (Schedule I) ....... ...... 10. • 11. Total Deductions (total Lines 9 and 10) ........ ................. ......11. 1 7 0 1 . 5 0 12. Net Value of Estate (Line 8 minus Line 11) ...................... ...... 12. 6 0 7 4 6 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 lax (Line 12 minus Line 13) ............... ...... 14. 6 0 7 4 6 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. 16. Amount of Line 14 taxable at lineal rate X .0 0 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 6 0 7 4 7 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 1 g, 19. TAX DUE ... ................. .......................... ..... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0.0 0 0. 0 0 7 2 8. 9 6 0. 0 0 7 2 8. 9 6 Side 2 1,50561,0240 150561D24CI J REV-1500 EX Page 3 File Number Decedent's Complete Address: 0 0 Tax Payments and Credits: 1. 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 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) Total Credits (A + B) (2) (3) (4) (5} 728.96 0.00 0.00 728.96 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 : ................................................................ ...... ^ Q b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ Q c. retain a reversionary interest; or .......................................................................................... ...... ^ 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' or payable-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? ............................................................................................. ..... ^ 0 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 us;e 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-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ELIZABETH C. BAILEYS 0 0 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. ACCOUNTS AT SOVEREIGN BANK 7,739.19 2. REFUND FROM DRS. BRONSTEIN & JEFFRIES 37.00 TOTAL (Also enter on line 5, Recapitulation) I $ 7, 776.1 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ELIZABETH C. BAILEYS 0 0 ITEM NUMBER A. 1. B 1 2 3. 4. 5. 6. 7. Decedent's debts must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: MEAL AFTER FUNERAL ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees: CHARLES E. PETRIE Family Exemption: (If decedents address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent __ Probate Fees: Accountant Fees: Tax Return Preparer Fees: DEATH CERTIFICATES ZIP 100.50 36.00 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 1, 701.50 If more space is needed, use additional sheets of paper of the same size. ZIP AMOUNT 65.00 1, 500.00 REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: FI 17ARFTH ~ RAII FTS n n 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 [Indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. BEATRICE BALOGH Sibling 2,024.90 50 OLIVER ROAD ENOLA, PA 17025 2. GERALDINE KOLLER Sibling 2,024.90 CIO ESSEX HOUSE 12TH STREET LEMOYNE, PA 17043 3. HARRIET TRAVITZ Sibling 2,024.90 5776 PENGUIN DRIVE ROANOKE, VA 24018 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S I-fEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ it more space is neeaea, use aaalnonal sneers of paper of the same size. LAST WILL AND TESTAMENT I, ELIZABETH C. BAILEYS, of 4238-F Catalina Lane, Harrisburg, County of Dauphin, Pennsylvania, do hereby make, publish, and declare this to be my LAST WILL AND TESTAMENT, revoking any and all prior wills and codicils, in manner following, that is to say, FIRST, that I direct that my Personal Representative shall pay all of my just debts and funeral expenses as soon as this shall be practicable. SECOND, that upon my death I give and bequeath the _Eollowing items of personal property to the beneficiaries indicated: a. I give and bequeath my glass mirror to my sister HARRIET TRAVITZ. b. I give and bequeath my curio cabinet and the contents therein to my granddaughter JENNIFER HANNOLD. c. I give and bequeath the vehicle that I own at the time of my death to my grandson JASON HANNOLD. THIRD, that I give, devise, and bequeath all of the rest, residue, and remainder of my estate, real, personal, and mixed, to be divided equally among my sisters and brother who survive me: HARRIET TRAVITZ, EVELYN HARTER, HARRY HARTER, GERALDINE KOLLER, and BEATRICE BALOGH. FOURTH, that I hereby appoint my sister BEATRICE BALOGH as the Executrix of my estate. I direct that my Personal Representative shall not be required to post bond in this or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this seventh day of October, 1997. 1 ~- ~---- ELIZ ETH C. BAILEYS °~ ~~~ WITNESS '~....i' WITNESS ~ ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, ELIZABETH C. BAILEYS, testatrix, whose name is s~_gned to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I have signed and executed the instrument as my Last Will and Testament; tYlat I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by ELIZABETH C. BAILEYS, the testatrix, this seventh day of October, _!997. l .._~ ~ ELI AB,~`I'H C . BAILEY S `, ~,,, ,r` . ,~., ~,. " ~ '---i~10TARY ; BLIC ,. MOTARIAl. SEAL KELUI P. ROBERTS, NOTARY PUBItC PAXTANG BORO. DAUPHIN CO. PA. M11 C~IMISSION E~PiRES 1AN. 2f, 2001 COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN WE, CHARLES E. PETRIE and TERESITA E. PETRIE, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her LAST WILL AND TESTAMENT; that ELIZABETH C. BAILEYS signed willingly and that she executed it as her free and voluni~ary act for the purposes therein expressed; that each of us in ttze hearing and sight of the testatrix signed the will as wii~nesses; and that to the best of our knowledge the testatrix was at tYlat time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by CHARLES E. PETRIE and TERESITA E. PETRIE, witnesses, this seventh day of_ October, 1997. [~:~G E/o.G~ wzTrrESs ~i W I T HE S S ~ ~' ` '~ ' "'~~~ ,. ,,~ .. ~ , _-. f, I ~.~ ~ ,. ,J ~ ,l j ~ ~ ~~ ._ ~` NOTARY-P'' $L C NOIARML. SEAL •..r 1~tY P. R08ERTS, NOTARY PUBLIC ~~ BORO DAUPHIN CO PA M1- aQMMlSSpp E~lPIRfS JAN. 2I, 2001