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Home My WebLink About01-04-11 (2)1505610140 REV-1500 ~` ~°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 0p ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 1 7 4 2 0 2 2 4 9 1 0 0 9 2 0 1 0 0 8 1 4 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI K I S T L E R B E T T Y J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW a 1. Original Retum 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) CORRESPONDENT -THIS SECTION MUST 8E COMPLETED. ALL GORRESPONDENGE AND GVNFIUtN I IAL I Ax INhUKMAI K7N SKVULU tit UIKtG I tU 1 V: Name Daytime Telephone Number J A C Q U E L I N E A K E L L Y 7 1 7 5 4 1 5 5 5 0 First line of address 8 4 5 S I R T H O M A S C O U R T Second line of address S U I T E 1 2 City or Post Office H A R R I S B U R G State ZIP Code 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) REGISTER OF WILLS USE ONLY ~. J ,-"3 O ...~- F ~ f._.._ _ ~ , ; -E? C'7 ~~~. "t" -z? t> t- ^ " ~rn _ s __ ~ ~ z rr> ;~ ~~ C~:1 - c 7 C 7 - _ ~,..., r...._ r3 ~ -'~ xx ' P A 1 7 1 0 9 Correspondent's e-mail address: JACKIEJLB@VERIZON.NET ~') ~', f~i~~7 ~'_> _ _; -_f: '~.,=_. ~,.., ~-, --r' __ ~.~ -T, 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, ~rrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ~TUREC~SC~IJ~ESP~IBRFI~LI~N\~G~RETURN D~1T~' 1' ADDRESS ~~,,[[`` t11 545 N ENOLA DRIVE ENOLA PA 17025 SIGN URE OF PR PARER T N REPRESENTATIVE DATE t .~i~i~a ,~-1 C~ /I-I C~ /I ADDADD SS~ 845 SIR THOMAS COURT, STE 12 HARRISBURG PA 17109 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number Decedents Name: BETTY J• K I S T L E R 1 7 4 2 0 2 2 4 9 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. 6 6 . 7 3 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 4 3 6 3. 3 1 7. Inter-Vivos Transfers & Miscellaneous N-Probate Property uested te Billin Re r ~ S 7 1 5 0 1 4. 0 6 ....... g q epa a (Schedule G) . 8. ............... Total Gross Assets (total Lines 1 through 7) ............ 8. 1 9 4 4 4 . 1 0 9. ............ Funeral Expenses and Administrative Costs (Schedule H) ...... 9. 6 1 8 0 . 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ...... 10. 3 5 8 6 . 8 1 11. Total Deductions (total Lines 9 and 10) ......................... ...... 11. 9 7 6 6 . 8 1 12. Net Value of Estate (Line 8 minus Line 11) ...................... ...... 12• 9 6 7 7 . 2 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 Tax (Line 12 minus Line 13) ...................... 14. 9 6 7 7 . 2 9 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15. 0. 0 0 . (a)(1.2)x.o _ 16. Amount of Line 14 taxable 2 9 6 7 7 9 16 4 3 5. 4 8 . at lineal rate x .045 . 17. Amount of Line 14 taxable 0 0 0 17 0 . 0 0 at sibling rate X .12 18. Amount of Line 14 taxable 0 . 0 0 18 0 • 0 0 at collateral rate X .15 . 19 4 3 5. 4 8 19. ............................................... TAX DUE ....... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^X Side 2 1505610240 1505610240 REV-1500 EX Page 3 Decedent's Comalete Address: Flle Number 21 10 0 DECEDENTS NAME BETTY J. KISTLER STREET ADDRESS 545 N. Enola Drive _ - -_. --- CITY - -_-~ _ T Enola 8TATE PA ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 21.77 3. Interest 4. If Line 2 is greater than Une 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) 435.48 Total Credits (A + B) (2) 21.77 (4) (5) (3) 0.00 413.71 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 December 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? ......... 0 ^ 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 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 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 use 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 + (8-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY J. KISTLER 21 10 0 Indude 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. Principal Financial Group; pension payment for October 2010 66.73 TOTAL (Also enter on line 5, Recapitulation) ~ S 66.73 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: BETTY J. KISTLER 21 10 0 ff an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. 545 N. Enola Drive Enola, PA 17025 daughter ADDRESS TIONSHIP TO DECEDENT SURVIVING JOINT TENANT(S) NAME(S) A. Sandra K. Robbins B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. Sovereign Bank 6,679.49 50. 3,339.75 Money Market Account 2331048177 2, A. M&T Bank 2,047.12 50. 1,023.56 Checking Account 51565498 TOTAL (Also enter on Line 6, Recapitulation) S 4 363.31 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER BETTY J. KISTLER 21 10 0 This schedule must be completed and filed 'rf 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,THEIRRELATIONSHIPTOOECEDENiAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION pF nraucAe~l TAXABLE VALUE 1. Heritage Investment Services Fund 15,014.06 100.00 15,014.06 Certificate of Deposit 1010011 payable on death to daughter, Sandra K. Robbins TOTAL (Also enter on Line 7, Recapitulation) ~ = 15,014.06 If more space is needed, use addfional sheets of paper 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 BETTY J. KISTLER 21 10 0 Decederrt's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Musselman Funeral Home ~ Cremation Services 5,265.00 2. funeral luncheon 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Atromey Fees: Jan L. Brown & Associates 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. I Probate Fees: 5 Accountant Fees: 6. Tax Retum Preparer Fees: 7. ~ Cumberland County Register of Wills; inheritance tax return filing fee TOTAL (Also enter on Line 9, Recapitulation) I ; tf more space is needed, use additional sheets of paper of the same size. 800.00 15.00 1 REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS ESTATE OF FILE NUMBER BETTY J. KISTLER 21 10 0 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Golden Living Center; outstanding medical bills 2,743.81 2. Urology of Central PA; outstanding medical bill 693.00 3. Trust Ambulance; outstanding medical bill 150.00 TOTAL (Also enter on Line 10, Recapitulation) I S 3,586.81 If more space is needed, insert addfional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: BETTY J. KISTLER ~~ ~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 outrtrg' ht spousal d'istributbns and transfers under Sec. 91'f6 (a) (1.2).j 1. Sandra K. Robbins Lineal 8,677,29 545 N. Enola Drive Sch F & G property Enola, PA 17025 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E If more space is needed, use additional sheets of paper of the same size. 105.805 REV (01/07) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 16805129 Certification Number ~ REV I II200E I PRrlt w u~2c n~ This is to certify that the information here given i correctly copied from an original Certificate of Deat) duly filed with me as Local Registrar. The origina certificate will be forwarded to the State Vita Records Office for permanent filing. cal e Date~ssued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Inetnictlora end ezemples on reverse) srATE fl~ Nt1A78ER 1. Nanr a ara.+lFw, mm•, wl..nec> z sr a socw secant r~.nnr ~. ors a wtln 1~. dr, ~1 Batt J. Kistler female 174 -20 - 2249 Oct.9 2010 s. Aq (laM BYIWeY) lpider 1 UMr 1 6. Der d B6r1 7. ra etde a EA Pba d DeeEt or 8 6 "°°" °"' "°° ereer Aug . 14 , 19 2 4 West Fairview , P ^ hpWr1 ^ ER / tapadwp ^ DDA ^ NrseYp liar ~ Reddwue ^ Ww • spetlly Yrs. m. Cants d Oeslh Ee. Cry, Bao, d Deelh Ed Feoey Nrr (n not kleWdr, pM rted end reprAa) B. Wr Dredrd d treprk pipr7 ~] No ^ Yr 10. Rea: Mrrprn kKien, &edt wMe, er. (p rr, 4•mr ~, l~eail Cumberland E. Pennsboro 545 N. Enola Dr. M"'~"'""l"~"`I White n. DerarpY lbuel awak Aar art d n. Do na ebb Iz wr Drodwa «« r, rr Is. DeoedrRa EdurYOn lsa•ar •nN vd• anoM~l u. Medal sletr: MerM, Neww Merged, u. sawaw Spaea In wEe, pn ~+ rm.) VEdswe4 oharae fsvdA'1 lard a wak IOnd d trrrsllrerYy u.s. Nord Fawn ,„y I s,r„y,y (a12) Cor•9• (la « sv) roduction Iceland Produc s ^ yr [7L+o 11 idow ~ 18. 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