HomeMy WebLinkAbout03-0010REV-1500 EX
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
COUNTY CODE YEAR NUMBER
O
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
LAVELY, LOIS C.
DATE OF DEATH (MM-DD-YEAR)
12/20/02
DATE OF BIRTH (MM-DD-YEAR
08/29/36
SOCIAL SECURITY NUMBER
272-32-7628
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FtRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
LAVELY, DANIEL D. 268-28-3583
[] 1. Original Return [] 2. Supplemental Return [] 3, Remainder Return (dae of death p~o 12-13-82)
[] 4. Limited Estate [] 4a. Futura Interest Compromise (dat~ of death a~er ~2-~2-S2) [] 5, Federal Estate Tax Return Required
[~6. Decedent Died Testate (A~ch copy of Will) [] 7. Decedent Maintained a Living Trust (AUac~ copy of Tr~s/) 8. Total Number of Safe Deposit Boxes
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (aaa of Ueath between ~2-3~-91 and ~-~-S5) [] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
NAME I COMPLETE MAILING ADDRESS
BLUE MOUNTAIN VISTA
I MECHANICSBURG, PA 17050
TELEPHONE NUMBER
(717) 766-3333
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Pemonal Prepedy (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
r-'-~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 46,635.05
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1,219.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10) (11)
12. Net Value of Estate (Line 8 minus Line 11) (12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
46,635.05
1,219.00
45,416.05
45,4'16.05
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2) 0.00 x .0 0 (15)
16. ~ount of Line 14 taxable at lineal rate x .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)
0.00
Decedent's Complete Address:
STREET ADDRESS
44 BLUE MOUNTAIN VISTA
CITYMECHANICSBURG I STATEpA I ZIP17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
0.00
0.00
0.00
0.00
0.00
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D * E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
IF THE ANSWER
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? ...................................................................... [] []
If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] []
Did decedent own an Individual Retirement Account, annuity, or other non-probata property which
contains a beneficiary designation? ........................................................................................................................ [] []
TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjuP/, 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 persona[ representative is based on all information of which preparer has any knowledge.
SIGNATU~PERSON RESP~N-'-~'~F~OR FILING RETURN( / .~, .o? ,¥/~.~.j~.~/~ ~ /.-- ~, ,. .~/i~71~
ADD RES'~J ~"] ~- -- ( C-~_~, ~,,....
SIGNATURE O/F PREP~R~-R-'~ER THAN REPRE§ENTATIVE - ' - I ' ' DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute dQeS net exemot 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 twenty-one 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% [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%, except as noted in 72 RS. §9116(1.2) [72 RS. §9116(a)(I)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 RS. §9116(a)(1.3)]. 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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This ~c.,hedule must be oompleted and filed If tho an=wer to any of queslion= 1 ~mugh 4 on t,~ re. veme -~ide of the REV-1500 COVER GHEET i~ yes.
DESCRIPTION OF PROPERTY % OF
ITEM ,.o-u~ ~ "~/~O~'mA~a~'~"~,~.m~.A~ON~He'TO~C~'rA~OT.~ OA'~ o~'m~N~-~. DATE OF DEATH DECD'~ EXCLUSION TA~BLE VALU~
NU MBE R An~ A ~ ~ ~ ~ED ~ ~ ESTA~.
VALUE OF ASSET INTEREST
TOT~ (~.t= on line 7, R~tul=i~)
(If more space is needed, insert additional sheets of the same size)
LAVELY
BLUE MOUNTAIN VISTA
MECHANICSBURG, PA 17050
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
BUREAU OF ZNDZVZDUAL TAXES
ZNHERZTANCE TAX D/VZSZON
DEPT. ZD0601
HARRISBURG, PA 17128-0601
COHHONNEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTICE OF ZNHERITANCE TAX
APPRAZSENENT, ALLO#ANCE OR D/SALLO#ANCE
OF DEDUCTZONS AND ASSESSMENT OF TAX
RE¥-1;47 EX AFP
DANIEL D LAVELY
44 BLUE NOUNTATN VTSTA
HECHANICSBURG PA 17050
DATE 05-05-2005
ESTATE OF LAVELY
DATE OF DEATH 12-20-2002
FXLE NUHBER 21 05-0010
COUNTY CUHBERLAND
'ACN 101
Amoun~ Remitted
LOIS C
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGISTER OF NXLLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THXS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~
D[SALLONANCE OF DEDUCTZONS AND ASSESSMENT OF TAX
ESTATE OF LAVELY LOXS CFZLE NO. 21 05-0010 ACN 101 DATE 03-05-2005
TAX RETURN #AS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATTON CONCERNXNG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Zntarast (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Totml Assets
APPROVED DEDUCTZONS AND EXEHPTZONS:
9. Funeral Expenses/Adm. Costs/Hist. Expanses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Nat Value of Tax Return
15.
14.
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Nat Value of Estate Sub~act to Tax
O0
O0
O0
461655.05
(8)
1,219.00
.00
O0 NOTE: To insure proper
O0 credit to your account,
O0 subeit the upper portion
of this form with your
tax payment.
NOTE:
46,655.05
(11) 1.219. oo
(1~) 45,416.05
(15) . O0
(14) q5,416.05
Zf an assess.ant ~as issued previously, lines 14, 15 and/er 16, 17, 18 and 19
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rata
17. Amount of Line 14 at Sibling rata
18. Aeount of Line 14 taxable at Collateral/Class B rata
19. Principal Tax Due
TAX CREDTTS:
PAYMENT RECETpT DTSCOUNT (+)
DATE NUHBER /NTEREST/PEN PAZD (-)
ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
(la) 45,416.05 X O0 = .00
(16) .00 X 045= .00
(17) . O0 x 12 = . O0
(:].8) .00 x 15 = .00
(19)= . O0
AHOUNT PAZD
TOTAL TAX CREDZT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
.°°I
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUZRED.
ZF TOTAL DUE 1S REFLECTED AS A "CRED/T" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE S/DE OF TH/S FORH FOR /NSTRUCTZONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 198Z -- if any future interest in the estate is transferred
[n possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Cosaonesalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the la~ful Class B (collateral) rate on any such future interest.
To ~ulfi11 the requirements of Section ZlfiO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S.
Sect[on 9140).
Detach the top port[on of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REG/STER OF N/LLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications ara available at the Office
of the Register of Hills, any of the Z5 Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers eith special hearing and / ar
speaking needs: 1-800-q47-30ZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sho~n on this Not[cs must object ~ithin sixty (60) days of race[pt of
this Not[cs by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. g810Zl, Harrisburg, PA 171ZB-lOZ1, OR
--election to have the matter determined at audit of the account of the personal raprasentat[ve~ OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601) Harrisburg, PA 171Z8-0601
Phone [7173 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Res[dent
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the dacsdsnt's death, a five percent (SZ) discount of
tho tax paid is allowed.
The 15Z tax amnesty non-participation penalty Ks computed an the total of the tax and interest assessed, and nat
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty Ks appealable in the same manner and [n the the same time per[od as you Nould appeal the tax and interest
that has been assessed as indicated on this not[ce.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
slx (6X) percent per annum calculated at a dally rate of .000164. All taxes which became delinquent on and after
January 1, 1982 ~ill bear interest at a rate which ~ill vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO3 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 ZOZ .000548 1987 9Z .000247 1999 7Z .00019Z
1983 16Z .000438 1988-1991 IIX .000301 2000 8Z .000219
1984 11Z .000301 199Z 9Z .000Z47 2001 9Z .000Z47
1985 13Z .000356 1993-1994 7Z .00019Z ZOOZ 6Z .000164
1986 102 .000274 1995-1998 9X .000Z47 2003 5Z .000137
--Interest is calculated as follo~s:
INTEREST = BALANCE OF TAX UNPAID
X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Not[ce issued after the tax becomes delinquent wlll reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sho~n on the
Notice, additional interest must be calculated.