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HomeMy WebLinkAbout11-02-10~ 1505610101 REV-1500 Ex `°i_1°' ~ _ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania oEOAaTMENTOFRE~EN~E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~ ~ ~ O 1 ~ ~,~ PO BOX 280601 Harrisburg, PA 1128-0601 RESIDENT DECEDENT _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~~~~,~s~~~ Ca~~~~o9 0~ ~b~ ~3a Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ~a~i ck~'~~ ~~~~~~ ~ 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 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 f~equired death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. 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 under Sec. ~i113(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 First line of address SeAcotnd line of address ' /~~ City or Post Office State ZIP Code --~ REGIS+Q~ WILLS UQSONLY_.,,,._ C7~ r ~. ~ r= ~,~ . ': ~ f~- ~ K.r: -,'~ r.... ~ N .f ! .: ' -r ~ ~~o~ ~ - t- ~~ .. b DATE FILED ~.:~. , ~evsJ~7_~`-- Correspondent's a-mail address: Cc° cS,/f % (° ~Q~S 3~ L~11l~CZSL~. ~(,°~ 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE • - ~ ~- u ADDRESS ~t~'~'LC.lF /~J: , '~/~/C'~/1/~ ~_~._~ ,._,.._.__ !D/~/ aG'f fr:GKar~fnGJn d. ~ ~Qrl,'s/e, ~°~ /7~s' SIGNATURE~pS~'RE AF3,ER OTJ-F~R THA RE~NT/JtTIVE DATE ADDRESS CR? ~ ~y/EL~ ~ ~_~ ..~._~~ _._._ !O/e..~~.~~ .. ~ G o~~ sew - sb ~7os~" _ _.~~_ - PLEASE U ORIGINAL FORM ONLY Side 1 1505610101 1,505610101 J J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~ ~° ~ ~ ~ ~ 6 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. • © Q 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • ~ ~ • D Q 4. Mortgages and Notes Receivable (Schedule D) ....................... .... 4. ~ D O 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. ~ ~ D 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .... 6. • D ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested.... .... 7. 7 7 (p ~ ~ • ~, 3 8. Total Gross Assets (total Lines 1 through 7) ......................... .... 8. 7 7 ~p ~ g' . ~ 3 9. Funeral Expenses and Administrative Costs (S~hedule H) ............... .... 9. ~ ~. O ~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... .... 10. ~ 0 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. f S. p U 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12 ? ? (~ ~ 3 ~'J 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which D an election to tax has not been made (Schedule J) .................... .... 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. ` ? 7 G ~ 3 ~ ,,j 3 TAX CAL' CULATION -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~ 7 7 ~ ~ 3 . ~ 3 15. ,r~ . v 16. Amount of Line 14 taxable at lineal rate X .0~ + Q ~' 16. Q 17. Amount of Line 14 taxable at sibling ra#e X .12 s Q ~ 17. • U 4 18. Amount of Line 14 taxable 1 • ~ ~ 18 ' Q O at collateral rate X . 5 . 19. TAX DUE .................................................... ..... 19. O; Q 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1,505610105 C~ J RE_V-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME STREETADDRESS --- -__ -- - - al _ ~r~ ~~ ~~~-_ Q~ ~ - --- _ _ - - _ --_ _-- --- __ ___ i-STATE-- --- ..--- ---- --_ _ZIP- ---- -- CITY Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 2. Credits/Payments ~ - A. Prior Payments _ __-__- -- -_ - __.-__ -__- _ _ B. Discount ~ Total Credits (A + B) (2) 3. Interest (3) Q 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fil! in oval on Page 2, Line 20 to request a refund. (4) 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 :.......................................................................................... ^ 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 care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? .............. ^ H 4. Did decedent own an individual retirement account, an! nuity or other non-probate property, which contains a beneficiary designation? ..~~~ ....................................................................................................... ~ ^ 1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. f=or dates of death on or after Jul 1 1994 and before y Jan 1, 1995, the tax rate imposed on the net value of transfers to or for the use of th e survivin souse is 9 P 3 percent [72 P.S. §9116 (a) (1.1) (i)]. f=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 filing a tax return are still applicable even if the surviving spouse is the only beneficiary. f=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(x)(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(x)(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(x)(1.3)). 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-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & 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 the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO 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 APPLICABLE TAXABLE VALUE ~ . cc.rz~ -ry r lea4 -- Refrem tmf /~-r- n k; iy , s E C l Lc~1 F ~ T ~,t7. ~ 01~1~ SCG.(. r ~Ty I~ ~ P.-`, t {~~4GE.~ lo~Je~4, J'~S ~o CO (0 3 6 - Ooo / Cun~ract' u~. 7 003 fob ~) S A-nnci~font: ~~nald ~.. ~vr; ~kn~r' C'on~r~a.c,~ ~~ Oct. l ~, Zodb o al G ~el~~e~~ci a.ry ~ ~u ~v~' ••; ~ t.,- i r.R,o~, il~1e.~ l i e /1'1. ~r i c.~ChC r ~7 ?~ 6 3 8'. 23 ~°~ ~ --c,-- 7 63~.~3 ~No~: V~U~~av1 Ob~v~ ~~ ~1~crt LGrh~.m, , o~ ~~-~~ns X11, $rokel~.~ cW,r,~P 1 ~ nam.~.~ra ,f~, Sera ~1 vi S-an) ~~,GG ~~ ~ ~I/,~ ~SS'+~ af~ac,~iul~ TOTAL (Also enter on line 7, Recapitulation) , $ 7 7~ (~ 3 ~. Z ~ (If more space is needed, insert additional sheets of the same size) Date 10/27/2010 From Rob Durham Company C1tlzens Phone cel1:497-4168 FAX Taken By rn~~ Message rime 3:30:52 PM Phoned Please Call Back Returned Your Call ^ Will Call Back ^ Was Here to See You ^ Urgent ^ ~e6~,e /~~i~~ Re: Brickner ... Nellie's husband, Donald ... dod: 12/26~~ (Saturday) ...valuation for IRA: 12/28/09... $77,638.23 ... letter to be sent to Nellie .. . REV-1511 EX+ (10-06) SCHEDULE H a: a COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ~3~2I C~(1u~~2j ~taN,i4~ L, . ~ I -- f ca Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) /vP~`l / ~ ~• i//'~ G/~C,Me/" ~~t /~~ - _. _ _ _ _ Street Address a~ ~! GI~O~'~/ ~trlrf __ °n ~' City C.'t~~S~e State ~~' Zip ~70~~_ Year(s) Commission Paid: 2. ~ Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) _/-Y_ _.___~D n U,`,~~L t„ ~' Claimant / /"L_ __/1A ~ 5 $eTS Qs 4 ~~ ~TG///s O~ (J ~I Street Address 7~_ s~~l~~'1~.F[ G -_ lt~'e/1C_ ~~ e/71~7 /'Gn P S City State Zip __ _ _ Relationship of Claimant to Decedent __ 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. ~ f i,I! fCt ~ ~ r Skr' D~ ,Cl/i~~s ~~5: ac' TOTAL (Also enter on line 9, Recapitulation) $ ~~' Bs (If more space is needed, insert additional sheets of the same size) REV:1513 EX+ (9-00) SCHED~ILE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~3~.~cX nr~-a2. ~N~ ~ . a, _,a 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 ~ /Ue/!~ c ,/J~, ,~~~'c~r lu; ~~ ~a a ~., ~~ /Yi~GI~O,I~~Lthrt ~OGrI.Gt C'~,rl,'s/e, /,/~~' ~ 70 ~s ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 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, insert additional sheets of the same size) CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) October 28, 2010 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Donald L. Brickner No. 21-10- Dear Register of Wills: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Donald L. Brickner Estate as well as Check No. 2799 in the amount of $15.00 for the filing fee. Thank you for your kind attention to this matter. Very truly yours, . ~ ~i ;l~ Charles E. 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