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Home My WebLink About02-07-11-~ REV-1500 Ex (01-1U' ~ 1505610143 4 PA De artment of Revenue ~"~" OFFICIAL USE ONLY __ p Pennsylvania County Code Year File Number Bureau of Individual Taxes ~EVAH,MENTOF RE~EN~r PO 80X.280601 INHERITANCE TAX RETURN 2 1 1 0 ;t ~ o Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 198 22 9682 10 21 2010 06 10 1927 Decedent's Last Name Suffix Decedent's First Name COURY MARY (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name COURY DANI EI, Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1 Original Return ^ 4 Limited Estate ® 6 Decedent Died Testate (Attach Copy of Willi ^ 9. Litigation Proceeds Received ^ 2 Supplemental Return ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 0 8 Total Number of Safe Deposit Boxes ^ 11 Election to tax under Sec. 9113(Al (Attach Sch O) MI K MI G - -- CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD E3E DIRECTED TO: Name Daytime Telephone Nunnber GREGORY M KERWIN 717 362 3215 First line of address 4245 ROUTE 209 Second line of address City or Post Office ELIZABETHVILLE State ZIP Code PA 17023 Correspondent's a-mail address: g m k e r W l rl ~ h O t m a I I. C 0 m THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS REGISTER OF WILLS USE ONL`( ~.~ r,, . `~- Cwt t:__ _r~ ~ ,.,,,;,? _ _ ~.,f^7 ~ ~.,.,,J `_ ~-. ..T, . DATA-~F~~D ~:,.. -r' -~- "" --;.., T',i ; ` .t n~:: -~ r • _ C.;'1 ~-'~ C'~ ; Under penalties of perjury, I declare that I ave examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true, c ect c . Declarat n preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUR SON RESP B E F R ILIN TU DATE Gregory M. Kerwin, Esquire ;t ~ % ~.,:~~_ ;, 4245 St Route 209, Elizabethville, PA 17023 SIGNATURE 0 REP ,RER OT THA EP SENTATIVE DATE t Gregory M Kerwin ' :'%;; ~ ~a~ + ADDR~ L/ 4245 Ro to 209, Elizabethville, PA 17023 Side 1 1505610143 1505610143 J J 1505610243 REV-1500 EX Decedent's Social Security dumber Decedents Name C O U R Y, M A R Y K 1 9 8 2 2 ~~ E• 8 2 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 & Notes Receivable (Schedule D) ....................................................... ... 4. 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E).... ...... .. 5. 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) ....................................................... 8 0 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ___ ................ _ _ _ 9. 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)_... 10. 11. Total Deductions (total Lines 9 & 10) ................................................................ ... 11. 0.00 12. Net Value of Estate (Line 8 minus Line 11).._ .............................._.......... _..... ... 12, O 0 0 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. 0.00 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 16. 17. Amount of Line 14 taxable at sibling rate X 12 17. 18. Amount of Line 14 taxable at collateral rate X 15 18. 19. Tax Due............ _...... ................................................................................ ... 19. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 2'1 - 10 Decedent's Complete Address: Coury, Mary K ----_ ___ STREET ADDRESS 1103 Yverdon Drive, Apt. B-1 __ CITY ~ STATE ',' ZIP Camp Hill I PA 1170'11 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2 Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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) O.Op Total Credits (A + B) (2) 0.00 (3) 0.00 (4) t5) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRO~P121AT'E BLOCKS 1. Did decedent make a transfer and: Yes No a retain the use or income of the property transferred :..................... .............._......... _ _ ~~ ' x ' 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 for life of either payments, benefits or care?... ' 'i x. it 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............. _ ' _..........._ ..................._..........._........................_.........._. i .x. 3. Did decedent vwn 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 .4S 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 Januarryy 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the suniivi~g spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)] The stafute does not exempt a transfer to a surviving spouse from tax, and the statutory requirE~ments 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 vn 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 uses 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, exc:epl 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)1. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w ether by blood or adoption. •~ t r M ;t.' ;, :,~~'-' ~~ 1 ~~ ~ ~ •-- ~^ Q ~ ~^ ~~ ~a Z N ~ O ~ O O N ~ N T ~ W M ~ W -~ ~ ~ ~~' ~ ~~ ~~~~ at-~~~ ~ ~ ~ ~ • ~ ~ Z ~o J ~ ~ i ~ ~ ~ O ~ o Q ~ ~ ~ Q ~ ~ a w N N ~ ~ W r H ~ ~ a ~ ~ w x w ~ z ~ ~' J O U ;~ .