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Home My WebLink About01-07-11• 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT o2I I ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ! 12/24/2009 03/08/1929 Decedent's Last Name Serene ', _. __ __ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name _... _. ..____ .................... Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW +• 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ~~s 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of r~ ;; 5. Federal Estate Tax Return Required death after 12-12-82) ~:,:~ 6. Decedent Died Testate ?~:;f 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ~xx~ 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 Carol A Lorence _ __ __ (717) 385-5327 Firm Name (If Applicable) __ __ - REGISTER OF WILLS USE ~Y C ~ ?J ,, ~ First line of address _ r--- `- ~ 551 Noble Blvd ~ " -' , ~ 7 ~ t - -~ - ~~ -_,! ? t r ~ ~ -- Second line of address ~ _ _ ~ C _ JOB --" D ~ -.~- n ity or Post Office _ _ State ZIP. Code ~FC~ _ '. ~.~ ~". Carlisle pa ..17013 '~"' rv ~ Correspondent's a-mail address Under penalties of pery'ury, 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,~nd complete. Declaration eparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE ®F RSON RESPONSIBL FOR FILI RN GATE _ ~ _ ~ _ 1 `" ~._ ~~ ADDRESS - l 9~_L4,.-~~t. 15 _ 17 ~~ SIGNPT OF P PARER OTH6f2 THAN R~.P~2ES TATIVE DATE U8E O Side 1 15056051058 15056051058 REV-1500 EX Decedent's Name: ROSe RECAPITULATION 15056052059 M Serene Decedent's Social Security Number 1 . Real estate (Schedule A) .......................................... ... L 0.00 2 . Stocks and Bonds (Schedule B) .................................... ... 2.' 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. ' 0.00 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 0.00 6. Jointly Owned Property (Schedule F) ~,~,'~ Separate Billing Requested .... ... 6. ' 14,347.80 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (Schedule G) ~ Separate Billing Requested..... ... 7. ' 0.00 8 Total Gross Assets (total Lines 1-7) ................................. ... 8. ' .~.. 14,347.80 9. Funeral Expenses 8 Administrative Costs (Schedule H) .................. 9. 6,277.04 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ' 0.00 11. Total Deductions (total Lines 9 8 10) ................................ ... 11. 6,277.04 _.__ 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ' 8,070.76 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which rr - -- -- an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14.: 8,070.76 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(L2) X .0 45 8,070.76 16. Amount of Line 14 taxable at lineal rate X .0 _ 17. Amount of Line 14 taxable t 'bl' 15. 363.18 16. a si mg rate X .12 17 18. Amount of Line 14 taxable "" at collateral rate X .15 18 19. TAX DUE .........................................................19.' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 363.18 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number Decedent's Complete Address: ------' " "' "' °"- DECEDENTS SOCIAL SECURITY Rose M Serene --- _ -- T EETADDRESS - - - - Apt 315, 1 West Penn cITY - --------- STATE TZIP Carlisle pa ' 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty 363.18 (2) 0.00 (3) (4) (5) 363.18 (5A) 4.12 (56) 367.30 Total Credits (A + B + C ) Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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? ........ ...... ^ ^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 p2 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 (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 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)]. 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 is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. PEV-1562 EX+ 11-6Bj Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT _- PILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATN DESCRIPTION L TOTAL (Also enter on Line 1, Recapitulation.) $ 0.00 If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER An property jointly-owned with right of survivorship must be disclosed on sctipd~~lp F lir more space is neeaea, insen aatlitional sheets of the same size) REV-1504 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt~LE C CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including afl supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorshios. (It more space is needed, insert additional sheets of the same size) REV-1507 EX+ (6-98) SCI~IEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY CJIAIt ur FILE NUMBER 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 Schpdula F t~~ uwie space is neeoeo, msen aaamonal sneers or the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Carol A Lorence 551 Noble Blvd Daughter Carlisle, Pa 17013 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 GEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET "%o OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST t' A• 04101/87 First National Bank of Chester County cd # 290005564 23,278.62 50 11,639.31 2 A -04101187 .First National Bank of Chester County Chkg #104388 5,416.98 50 2,708.49 TOTAL (Also enter on line 6, Recapitulation) 15 14,347.80 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ 08-09j -i pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER This schedule must be completed and filed if 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, THEIR 0.ELAT10NSHIP TO DECEDENT AND THE DATE OF T0.ANSFER. ATTACH A COPY OF iNE DEED FDR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION ~If APPLI.A6L1 TAXABLE VALUE 1. none TOTAL (Also enter on Line 7, Recapitulation) $ 0.00 If more space is needed, use additional sheets of paper of the same size. REV-15i' EX± 10-Q9) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Rose Marie Serene Estate 2110-0001 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Hoffman Roth Funeral Home 3,088.04 2 Westminster Cemetery and headstone 2,947.50 `' e. ADMINISTRATIVE COSTS: :. Personal Representative Commissions: Name(s) of Personal Representatives} Street Address City __ State ZIP Year(s) Commission Paid: 2• Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City __ __ State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 141.50 5. Accountant Fees: 100.00 6, Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) $ 6,277.04 If more space is needed, use additional sheets of paper of the same size 1/04/10 Branch Rose M Account Number......... 08 12 TO 17 MONTH CD Interest Rate.......... CD CLOSING ENTRY CALCULATION ADD 290005564 1.390000 12:54:30 Next Payment Date......... 1/17/10 Maturity Date ............. 10/17/10 01 3 MO PENALTY SHORT TERM Payoff date... 1/04/10 CS Accrued interest..... 15.96 Batch number .................. 951 Pr'nci~>al Due Depositor.......... 23,278.62 Fixed Federal W/H ................ N .00 Fixed State W/H .................. N Pay accrued Interest (Y,N)....... Y . Depositor Owes Penalty of........ N .00 Approving officer TM ------------ --- Customer Signatur ~ ~~ '~Q., Net Set:tlement ................... 23,294.58 Rea o e.......... _ Create Check for Settlement..... N C.C.# (F4 to list) Deposit to Account Number/Type.. _ F3=Exit F5=Inquiry F10=Add Transaction F12=Previous ~ro ~ ~~ uoa~`7m~ c~c ~ a?j28'1 ~~ ~. ~~Y 19~ ~ w y., uar.Iy'+~7 ~ ~~ J /~ First National Bank of Chester County Answers .Ideas .Access 0000042 C Rose M Serene Carol A Lorence 1 W Penn St Apt 315 Carlisle PA 17013-2354 9 N. High Street P.O. Box 523 West Chester, PA 19381 P 484.881.4000 w lnbank.com Date 12/15/09 Primary Account Enclosures STATEMENT Page 1 104388 10 ***************************** CHECKING ACCOUNT ******************************** Allpoint surcharge free ATM card now available to everyone. The Allpoint network has 39,000 ATMs available nationwide. Visit your branch or call 877.FNB.0100 to find out more. First Platinum Checking Number of Enclosures 10 Account Number 104388 Statement Dates 11/16/09 thru 12/15/09 Beginning Balance 5,372.31 Days in the statement period 30 1 Deposits/Credits 1,000.00 Average Ledger 5,309.35 14 Checks/Debits 958.49 Average Collected 5,129.88 Service Charge .00 Interest Earned 3.16 Interest Paid 3.16 Annual Percentage Yield Earned 0.75 Ending Balance 5,416.98 2009 Interest Paid 42.23 Activity in Date Order Date Description Amount 11/16 PURCHASE WAL-MART STORES 15.80- CHECK # 1058 11/20 RENEWAL THE SENTINEL 12.92- PPD 11/25 ELEC SVC PPL EU 46.67- PPD 12/01 DEC INSPRM MUTUAL OF OMA HA _ 169.78- PPD 12/04 Deposit 1,000.00 12/15 Interest Deposit 3.16 --- CHECKS IN NUMBER ORDER --- Date Check No Amount Date Check No Amount Date Check No Amount 12/01 985 65.00 12/08 989 45.45 11/16 1058 -See above- 12/03 986 21.11 12/10 990 19.50 11/20 1059 52.50 12/01 987 38.71 12/10 991 27.38 11/24 1060 100.00 12/08 988 309.00 11/16 1057* 34.67 * Indicates gap in number sequence Daily Balance Information Date Balance Date 11/16 5,321.84 11/24 11/20 5,256.42 11/25 Member FDIC Balance Date Balance 5,156.42 12/01 4,836.26 5,109.75 12/03 4,815.15 A Subsidiary of First Chester Courtly Corporation /; First National 8~orr~r .~.. Rose M Serene Carol A Lorence 1 W Penn St Apt 315 Carlisle PA 17013-2354 First Platinum Checking Daily Balance Information Date Balance Date 12/04 5,815.15 12/10 12/08 5,460.70 12/15 Date 12/15/09 Primary Account Enclosures 104388 (Continued) Balance 5,413.82 5,416.98 Interest Rate Summary Date Rate 11/15 0.750000$ Page 2 104388 10 ~~