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HomeMy WebLinkAbout01-21-111505610143 REV-1500 ~`(°'-'°' OFFICIAL USE ONLY PA Department of Revenue pennsylvania county code Year File Number Bureau of Individual Taxes DEFARTMENTOFREVENUE Po Box.28oso1 INHERITANCE TAX RETURN 21 10 0553 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 218 38 4056 04 13 2010 12 04 1938 Decedent's Last Name Suffix Decedent's First Name MI KLINE MARION R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 0 1, Original Return ~ 2, Supplemental Return ~ g, Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required a 6 Decedent Died Testate (Attach Copy of Will) ~ ~ ecede t Main ned a Living Trust Attach Copy o~~rust) 8. Total Number of Safe Deposit Boxes g. Litigation Proceeds Received ~ 10. b~tween 1131 ~~a d~t~dat~e5pf death ~ 11 Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT CLOFINE ESQUIRE 717 747 5995 First line of address 120 PINE GROVE~COMMONS Second line of address City or Post Office State YORK PA Correspondent's a-mail address: rob@estateattorney.com ZIP Code 174035151 Y .-Tl ~~ ,~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 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 and complete. Declaration of preparer other than the persona representative is based on all information of which preparer has any knowledge. SIGNATUR F PERSON RESPONSIBLE FOF~.EILING RETURN IIATC ADDRESS 44'Vs Lucy Ann Jones •_/ 7~1 ! Crossville TN HAN REPRESENTATIVE Robert Clofine Esquire DATE ADDRESS / A / ~ ~-/ 120 Pi Grove Commons, York, PA 17403 Side 1 REGISTER ~ WILLS USE--ONLY.. - _ i- ~'"? ~ : ti -- ~r? ~, ~.. « .,.,.., ~ ~t°'I J t•s ~1 - DAT~FFD ~ ,.. 1505610143 1505610143 1505610243 REV-1500 EX Decedent's Name: Kline, Marion R. Decedent's Social Security Number 218 38 4056 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. 4 5 ,14 5.2 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous I~nq Probate Property (Schedule G) ^ Separate Billing Requested............ 7, 4 $'7 7 62.5 7 r 8. Total Gross Assets (total Lines 1-7) ..................................................................... g, 532 , 907.77 9. Funeral Expenses & Administrative Costs Schedule H ( ) ....................................... 9. 4 , 4 8 6 . 4 2 10. Debts of Decedent, Mortgage Liabilities, & Liens Schedule I ( ) .............................. 10. 555.00 11. Total Deductions (total Lines 9 & 10) ................................................................... 11 5 , 0 41.4 2 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12 5 2 7 , 8 6 6.3 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 4 94 7 91.35 ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 3 3 , 0 7 5. 0 0 TAX 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 0 • 0 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 3 3, 0 7 5. 0 0 18. 19. Tax Due ................................................................................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 0.00 0.00 4,961.25 4,961.25 S(de 2 1505610243 1505610243 J REV-1500 EX Page 3 rlei-e~lont'c [`mm~l~+tra 0['Itr~IrE±it~t_ File Number 21-10-0553 DECEDENT'S NAME Kline, Marion R. STREET ADDRESS Chapel Pointe Nursing Home 770 South Hanover Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 4,961.25 2. Credits/Payments A. Prior Payments 3,990.00 B. Discount 210.00 Total Credits (A + 6) (2) 4,200.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5. 1f Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 76 ~ .25 Make Check Pa able 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 :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................ x d. receive the promise o e p y ? ............................................................ ' f r lif of either a ments benefits or care ^ 0 2. If death occurred after Decembe?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. H ...:. .. i" 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 January 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 Juiy 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)]. 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. Rev-1508 EX+ (g.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Kline. Marion R. _ 21-10-0553 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 fa(+ (6-88) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kline. Marion R. 21-10-0553 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATENO TF ROA,NSFERSATfACN ACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST { EXCLUSION IF APPLICABLE) TAXABLE VALUE The following assets were held in the Marion R. Kline Revocable Trust Agreement dated 07/02/04, a copy of which is attached hereto. 1 Aviva Life 8< Annuity Company Contract No. 457866 24,603.00 100.000°l° 24,603.00 2 NBRS Bank CD No. 1150 -includes accrued interest. 219,519.33 100.000% 219.519.33 3 NBRS Bank CD No. 1151 -includes accrued interest. 109,235.87 100.000°t° 109,235.87 4 NBRS Bank Checking Account No. 1105 27,321.36 100.000% 27,321.36 5 Wachovia Bank CD No. 2849 -includes accrued 107,083.01 100.000% 107,083.01 interest. TOTAL (Also enter on Line 7, Recapitulation) I 487,762.57 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (10-06) COMM~TECE~~RN ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kline. Marion R. 21-10-0553 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(sl Commission raid 2, Attorney's Fees Robert Clofine Esquire 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 Register of Wills 4,000.00 234.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 251.92 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 4,486.42 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kline, Marion R. 21-10-0553 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Cumberland Law Journal -estate notice 75.00 2 The Sentinel -estate notice 176.92 H-B7 251.92 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) scNe~u~e ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONVbE4LTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kline. Marion R. 21-10-0553 Reoort debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursad medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (9-00) COM~~~ECE~~=NT~ANIA SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Kline, Marion R. 21-10-05 53 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Christopher Hatfield Cousin $3,000 2 Lucy Ann Jones Aunt $10,000 3 Debbie Montoro Cousin $2,000 4 Fred Montoro Cousin $2,000 5 James Montoro Cousin $2,000 See continuation schedule attached Continuation Total n r Ilr fr i ri in hwn v nlin 1 r h1 r ri nRv1 y r III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See continuation schedule(s) attached 494,791.35 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 494,79'1.35 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) - _ - SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Marion R. Kline 04/13/2010 218-38-4056 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 6 Mike Montoro Cousin $2,000 7 Peter J. Montoro Cousin $2,000 8 Karen Ann Yox Cousin Specific bequest of automobile and $2,000 9 Rachelle Yox Cousin $3,000 1 SCHEDULE J-11B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS continued ESTATE OF FILE NUMBER Kline, Marion R. 21-10-0553 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J-IIB (Rev. 6-98)