HomeMy WebLinkAbout12-22-10 (2)15056041125
. REV-1500 EX (06-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box 2aosol INHERITANCE TAX RETURN
Harrisbu , PA 17128-0601 RESIDENT DECEDENT ~~ 0 9 0 0 6 6 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 9 6 1 4 2 5 7 6 0 6 0 5 2 0 0 9 0 3 2 5 1 9 2 6
Decedent's Last Name Suffix Decedent's First Name
B R A M E MI
L O I S M
(If 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 IN APPROPRIATE OVALS BELOW
a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
4. Limited Estate ~ prior to 12-13-82)
4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust _ 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 SHOULD BE DIRECTED T0:
Name
Daytime Telephone Number
J A N E A DA M S E S Q U I R E 7 1 7 2 4 5 8 5 0 8
Firm Name (If Applicable)
r.3
REGISiF WILLS US~NLY
C7 ~ Z7
First line of address ss'i f~'l
1 7 W S O U T H S T ~
rv
Uj N ~ :
Second line of address ~j
C7~~`i ss C
City or Post Office State ZIP Code ~ _ ~~ FILED ~ ~.
C A R L I S L E p A '~
Correspondent's a-mail address: @sgademS@gtT18iLCOn1
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, co nd complete. Declaratio of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA RE O P SON R O I OR FILING RETURN
oL~ ~a lV DATE
31L')~ /~nnn
ADDR
17 w
SIGNATI
outh St., Carlisle,
= PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041125 15056041125
PA 1707
' ~ 15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: LO1 S NI . Brame 1 9 6 1 4 2 5 7 6
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 8~ Notes Receivable (Schedule D) ..................... ... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... ... 5. 2 6 0 3 5 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 1-7) ... , , , .... • . • .. , g 2 6 0 3 5 9
9. Funeral Expenses & Administrative Costs (Schedule H) ...... , , . , , . • . • • g. 6 9 5 5 6
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......... ... 10.
11. Total Deductions (total Lines 9 8~ 10) ........................ ... 11. 6 9 5 5 6
12. Net Value of Estate (Line 8 minus Line 11) ...... , , , , • • • , . • . • • 12. 1 9 0 8 0 3
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............... ... 13. 2 0 0 0
14. Net Value Subject to Tax (Line 12 minus Line 13) .. , ... , , , , • _ • . • . • . 14 1 $ $ $ 0 3
TA
X COMPUTATION -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.o ._ 0 0 0 15. 0 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 1 6 9 8 0 3 16 7 6 4 1
17. Amount of Line 14 taxable
at sibling rate X .12 4 0 0 0 17 4 $ 0
18. Amount of Line 14 taxable
at collateral rate X .15 1 5 0 0 0 18 2 2 5 0
19. Tax Due ................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 15056042126
1 0 3 7 1
15056042126
REV-1500 EX Page 3
Decedent's Complete Address:
QECEDENT'S NAME
Lois M. Brame
File Number
00661
STREET ADDRESS _ _ _ _ _ _ - --
324 Chestnut St., apt. 1
_ -_
CITY __ _.._ _ _ _ _ _
--
_ _._.
STATE Zlp
Mt Holly Springs PA 17065
Tax Payments and Credits:
~• Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments $88.14
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(1) $103 71
Total Credits (A + g + C) (2) $$$ 14
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENTTotal InteresUPenalty (D + E )
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.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 +5A. This is the BALANCE DUE.
(3) $0 00
(4) $0 00
(5) $0 00
(5A) $15 57
(56) $15 57
Make Check Payable to.• REG/STER OF W/LL S, 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 ro ert transferred;
P P Y ..................................................................... ^
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ 0
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 "intrust for" or payable upon death bank account or security at his or her death? ......... ^ X^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^ X^
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 January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [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 zero (O) percent
(72 P.S. §9116 (a) (1.1) (ii)j. 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 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 zero (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 four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)j.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling isdefined, under
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
C~INAAONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
i2ESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lois M. Brame 00661
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1. M&T Bank, checking account $1,334.50
2. I Personal property I $640.00
3. I Rent Rebate I $600.51
4. (Telephone Rebate I $28.58
TOTAL (Also enter on line 5, Recapitulation) I $ 2
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
COMrvtON1NEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
f~E31DENT DECEDENT
ESTATE OF
Lois M. Brame
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
A• FUNERAL EXPENSES:
1.
FILE NUMBER
00661
AMOUNT
B• ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State Zip
Year(s) Commission Paid:
2. Attorney Fees Jane Adams, Esquire
3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation) $200.00
Claimant
Street Address
City State
Zip
Relationship of Claimant to Decedent
4• Probate Fees
$75.00
5. Accountants Fees
6• Tax Return Preparel's Fees
~• Register of Wills, filing releases
8. Rowe's printing $30.00
9. Additional Releases $80.56
10. Additional Probate Costs $15.00
11. Fee to File Inventory & Tax Return $240.00
12. Family Settlement Agreement $30.00
$25.00
SCHEDULE H
FUNERAL EXPENSES ~
ADMINISTRATIVE COSTS
TOTAL (Also enter on line 9, Recapitulation) ~
(If more space is needed, insert additional sheets of the same size) 695.56
REV-1513 EX + (9-00)
COMIVfONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE)
BENEFICIARIES
ESTATE OF
Lois M. Brame
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
See Attachment Page(s)
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Mt. Holly Springs United Methodist Church Food Bank
Mt. Holly Springs, PA 17065 (food items and canned goods)
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)
$20.00
20.00