HomeMy WebLinkAbout12-16-101505610101
REV-1500 °`~°~-~°~ m
PA Department of Revenue ~ OFFICIAL 11SE OBEY
Bureau ~ r~rfduat Taxes INHERRANCE TAX RETURN Code Year ~e ~~`
PO BOXZ8o6o1 a ~ d ~ ~ ~ ~
Hartisburg PA i~ix8-o6oi RESIDENT DECEDENT
ENTER DECEDENTINPORMA
TION BELOW
SOCial Security Number Date of Death MADDYYYy
_ Date of Birth MMDDYYYY
__
_ _
579-32-7077
__ _
',12/05/2009
08/17/1920
Deoederd's Last Name __ _ _.
SuEx Decedent's First Name
180000 MI
_
caroyn k ',
(K Applkabla) Enbr SlwvhNtp apaae'e hrfonnatlon Below _ _
Spouse's Last Name
_
_ Spouse's Fast Name MI
Spouse's Social Security Number ___:
__ THIS RETURN INlST.BE FlLED IN DUPLICATE WITH THE
-- REGISTER OF WILLS
FlLL W APPROPRIATE OVALS BELOW
m 1. Original RMum O 2. Supplemental Retum
O 3. Rarr~inder Retum (deb of death
O 4. Limited Esbb prior to 12-13$2)
O 4a. Fuhxa Interest ComprorMse (dab of O 5. Federal Esbb Tax Realm Required
death albr 12-12-82)
O 6. Decederd Died Testab
(Atbch Copy of ~) O 7. Decedent Makt6airred a LNirg Trust 8. Trial Number of Sale peposit Boxes
(Attadl COPY of Trust)
O 9. Litigation Proceeds Received O 10. Spousal poyany Credit (dab of deatlt O 11. Elacdon to tax under Sea 9113(A)
behveen 12-31-91 and 1-1-95) (Atbch S~_ O)
COR~ONDBfr - T155 SECTION MIST BE COfIPLETED. ALL Ot10ENCE AND CpRRDE1fnN. TAX SIFORMATiON 8NOIN,D BE DIIIECTEO 70:
Name
_ _ _ _ - Daytime Tebphone Number
mark c laooc:o --
(717) 732-0187
_ _ _ _--4:i? _ _ c..
REGISTER OF ONLY
First line ~ address ^`~'
49 victoria way _ _ _
Sewrtd line of address _ Q C ~
17
V
City Or POST OIRCe _ _ _ _. __ ~
_.. Siab ZIP Code DATE FILED
camp hill _ _
', pe I ..17011 _
Comeepondent's a~trleil
Under perreltles of pahury, I d
tt b true, correct and oompleU
91GNATURE OF PER90N R
hra tltat I have exarNrrad thh raha
tleUaroWn of prsparer other then
oFr~EPARER OTHER
cheiWass and ~ MW to the hest d my Itr
k based an aA irKOrrrrsson d vAVCh preperor tree
~\
G
ADDRESS
PLEASiE tISE ORIOf11AL frORM ONLY
L
150561D101
Side 1
1505610101
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REV-1500 EX
150561p105
ur. wm.; taro n k laoocp
RECAPtiUUT10N ~soedenFs Social ~,,,,~, lVumbef
579-32-7077
1 • Real Estate (Schedule A)........ .
.......
.......... .. ........... 1.
• ...
2. 3todcs and Bonds (Schedule B ".
-- -----
-_ _ _r.,___,~~~__, _.____ .._._.a.
U'00
............ 2
Closely HeM Capptalbn. P -
a<b~ershgr or Sole-P ....._
-- . _.,__.___ 0.00 ~
-opMiP (3cheduk C) ..... 3. ;
4. erM Receivabl
...,_ _ _. ,-________~i
....._
e (Schedule D) ......... ...._.._ __._ .__._,__..__._..____V_~_ ~`~
.
................. 4.
5. Cash ,
_o.
arM laneous Personal Pr
__.
000 Y
_ .,_
operty (Schedule E)....... 5.
6. Jolrgly Owned
P-a~e+ty (Schedule F) O - .
7. In6ar-Vtyps Separate8
~9 ~Q
m & Ml _ _.._.._ _.._
... _ 2,117.18
_ _ _.____.._..~.._.
_,
soe ~
....... 6
(Sc~edWe G
__
C Separate B+Iling Re
u _._.
_ ____
9
ested........ 7.
8. Total Gross AsaNs (total Lines 1 ~9h 7) .......
... _. _,_. _.....__
9. Funeral Expenses and Adm ~
................... 8.
inrshative Costs (Schedule H)... .
. __~
_117.18
.............. 9.
10. Debts of Decedent,
Mortgage LiabiMdea, and Liens
(Schedule q ..
5,733.00
_''~ __ _......__.____-
............ to.
11. Tool Deduetlory (total Entree 9 and 10) .......... --
_.. _ 0.00
___
....... .
12. Nat Value of Estate ............... 11.
(Line 8 minus Line 17) .........
13. Cheritsde and
..............
1
_ _..~._.
__ 5.7,00
.
_
.......
2.
Tnrsts for wtrch __.
an elecxlon to tax has not been~made ut _.~...,. 0.00
e ~
.......................
14. Nat Valve Su . 13.
bjact to Tax (Line 12 minus Line 13) ...
` - ._._ ° j
__. _
0.00 '
......
AX ~ALCUUT1pN . sEE MrSTR ..............
UC170NS FOR ~ 14.
15. Amount d Line 14 taxada ~~~ RATES _~..
0.00
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 _._.. ._ .._,_.__ ...._ , .
15
~~ _ - -
.
__._..._.. W._ _.w__ ,
at Mrreal rate X .0 ~
_.. _ ,_, __
0
17. Amount of Line 14 taxable _ ' 16 .._..~ _,.__._
____ .___ ~._
;_~
.
sibling rate X .12
. ..-~._. _
,'
___ 0.00
18. Amount of Line 14 taxable
_._ __..._..~.. _..____.. 17 _ . __--~I
.
at ooNateral rate X .15 ____..... _ ., _.._.
19. TAX _ _. 18.
DUE ......... __--_____...__
.......................
................ 19.
__ .
20, FlLL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAyyENT
0.00 f
O
L 1505610105
Side 2
1505610105 J
REV-1500 FJ( Page 3
Decedent'S Complete Address: ~"• """'b'r
~ S NMd=
oarolyn k lacoco
srr~T~oo E - ------ - __ _ _-
kinkora pylhian nursing home and rehabilitation cerrter -____ -
Pa
Tax Payments and Creldlts:
i. Tax Due (Page 2, Line 19)
2. CreddsfPayr~~
A Prior Payments (1)
0.00
B. Discamt - -----------__
3. Interest -- - Total Credits (A + 8) (2) 0.00
4. H Lirre 2 is greeter than Lhre 1 + ~ 3, erriar the dom. This ~ the OVt3iPAyMBiT
(3)
Fill h
e 0
00
.
r oval on t
ase ?, LNre 20 ib nqueet a rahNrd.
.
5. H Line 1 + (4)
Line 3 is greeter than Line 2. ender the dHference. This is the TAX DUE 0.00
(51 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
PLEA8E ANSWER THE FOLLOVhNG QUESTIONS BY PLACING AN "X"
IN THE APPROPRW
1. Did deoederd mire a 1renaFer and: TE BLOCKS
a. retain the use or' Yes
rnoome of the property transferred :.
No
.................................
b. retain the right >n designate who shat use the ........................................................
c. retain a rave prePeny transferred or its income : ................
rsanery i4 or ................... ............................ ^
.
...................................................................................................... ^
d. receive the
promise for life of eitlrer payments, benelNs or care? ........................
2
H death
......
^
.
occurred after Dec. 12, 1982, did decedent booster
........................................
withal receivin a Icy within °~ bear of death
9 dequate osrreideretion? ..
..................
..
3. Did decedent own an 'in trust for or .......................
~~~~~ bank account
or security at his or her deaCr9 .............. ^
4. Did deoedent own an individual
re~n~ account, annuity or other rron.probate
r
p
operty which
carlains a be
neficiary designatron? ..................
...................................................................................................... ^
iF THE ANSWER TO ANY OF THE ABOVE QUESTIONS I
S YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE
For dates of death on or otter July 1, 1994, and before Jan. 1, 1995, the tax rate i .
3 percent (72 P.S. §9116 (a) (1. t) (i)]. mP~ed ~ dre net value of transfers to rx for the use of the surviving spouse is
For dates of death on r# after Jan. 1, ,1995, the tax rate im
(72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer foto as u~ value of transfers to or for the use of the surviving spotrse is 0 pmt
filing a fax rehrm are sdil applic~le even H the surviving spouse is the on 9 ~~ from tax, and the statutory requirements for disdostae of assets and
For dates of ~ benetidary,
death on or alter July 1, 2000:
• The tax rate imposed on tl1e net value of 68nsfere from a
adoptive parent ar a stepparent of the child is 0 Pen;ent [72 P.Sd~§g ~a~~ )~ 1 of age or younger at d~fh to or for the use of a natural parerq, arr
• The tax rate im on the net value of transfers to or for the use of the decederrfs lineal t>aneficiaries is 4.5
72 P.S. §9116(1.2P.S. §9116(a)(111.
• The tax rate im P~t~ ext~pt ~ noted ar
posed on the not value of 6ansfers to or for the use of the dec~denPs sibl' s i f ~ ~2 Padop~r116(a)(1.3)]. A sibling is defi-red, under
Sec>ion 9102, as an individual who has at least one parent in common rvhh the decederd,
REV-1b08 F~(+(g.98~
~~~~
caaMONVU~AUH of aana~snvANw CASH, BANK DEPOSITS, 8e MI,SC.
INHERITANCE TAX ~RETl1RN ~pc~, -,
RESIDENT DECEDENT naanViL PRCIPERTY
ESTAT! OF
Carolyn k lacocD
Midude tAe aocaeda d ~ «._ ..._ ..- __-- _ -
.R....,Q.,~,~
FRE NU1~6t
21-09-1143
REV-1511 EX+ (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INNE1tITANCE TAx RE71iRr1
RESrDENr DECeDErtr
ESTATE OF
Carolyn laoooO
FILE NUMBER
2DDt;f.A1 ~a~
Dscadant's debts opal be repart~d on SdMStvN I. - - - • --
ITEM
NUMBER DESCRIPTION
A• FUNERAL EXPENSES: AMOUNT
1. Ilty9lg haR18r
5,733.00
B, ADMINISTRATNE COSTS:
1. Personal RepreseMaUve Commissbns:
Name(s) of Personal Rep'esentatiVe(s)
Street Address -
-- --
Cd1' _ _ State _ _ ZIP
Year(s) Commissimi Paid:
Z• Attorney Fees:
3• Family Exemptbn; (If detedeM's address is not the same as daimant's, attach explanation,)
Claimant
Street Address - - -
_- __ _-~
~ _- State ZIP __ __
Relationship ~ ClaimaM to Decedent
4• Probate Fees:
5• Acrountant Fees:
6• Tax Return Preparer Fees:
~.
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATII/E COSTS
TOTAL (Also etrter on Une 9, RecapiNlation) I # 5 733 00
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