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Home My WebLink About02-16-111505610101 ""'~ REV-1500 ~ `01-1°' '~' .u nnsylvania oFFICaL usE i PA Department of Revenue p~' ry Ye un Bureau of Individual Taxes ~""a'.~~.o..E.`.~ INHERITANCE TAX RETURN r - PO BOX 280601 Harrisburg, PA !7128-o60i RESIDENT DECEDENT ~ j ;~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~ ~ t a35- file Number 007-14-9889 ~ 01/29/2010 05/12/1923 Decedent's Last Name _ Suffix Decedent's First Name ~ MI Beaudry ~ ~ ~ ~ Robert ~ a M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name . ~ ._..__ ._...__~.__. _._ __ _ _ _ _ MI .. .__ __. Beaudry I ~ ~ ~ ~ Jacqueline ~~ __. C _ .. __ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WI h'HE 007-22-os44 __ _ _~ REGISTER OF UVILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Retum O 3. Remaind r Return (date of death prior to 1 - 13182) O 4. limited Estate O 4a. Future Interest Compromise (date of O 5. Federal E tats Tax Retum Required death after 12-12-82) t~ 8. Decedent Died Testate O 7, Decedent Maintained a Living Trust ,,. 8. Total Num er lof Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Electlon t tai under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach S h. ) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SH L BE DIRECTED T0: Name Daytime Teleph ne umber Tricia D. Naylor, Esq. 717 249-6 ~ ( ) ' -~-J ~ ~ , rr REGISTER USE t,Y ~l"J_ First line of address _ _ _ p~ yY? ~ ~ ~ Baric Scherer ~n = -~ Second line of address 19 West South Street N --- St t 21P C d A FILED City Or POSt Office a e o e Carlisle _ ~ PA 17013 _ ~I Correspondent's e-mail address: tna for baricscherer . com Under penalties of perjury, l declare that 1 have examined this return, including accompartyi~g schedules end statements, and to the 1 my knowledge and belief, It is tnre, correct and complete. Dedaratbn of preparer other than the personal representative is based on all Information of which pr pa r has any knowledge. SIGNATU F R PONSIBLE F FILING RETURN DATE i/t ~ v L~ ADDR SS 40 West 1 h Street, C land, OH 44135 SIGN E OF PREP OTH N ENTATIVE p E ADDRE 19 W st South St Carlisle A 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610 0!,1 J ~ f~/ ~--) .~~ -'r t~+r-r -rl ., 1505610105 REV-1500 EX Decedent's Name: ROb@It M. Decedent's Sojcial Security Number ___ ._ --.--------t-.--., . __- ._. __ __._. _ ._ 007-14-98$9 RECAPRULATION 1. Real Estate (Schedule A) ........................................ ..... L 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. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).. ..... 5. ' 659.96 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .. ..... 6. ; 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7.. ~ 6. Total Gross Assets (total Lines 1 through 7) ............................. 6. ' 659.96 ' 9. Funeral Expenses and Administrative Costs (Schedule H) .............. ..... 9. ' 261.50 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule !) ......... ..... 10. 11. Total Deductions (total Lines 9 and 10) ............................ ..... 11. ~ ~I 261.50 12. Net Value of Estate (line 8 minus Line 11 } ......................... ..... 12 398.46 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ................... ..... 13. 14. Net Value Sublect to Tax {Line 12 minus Line 13) ................... ..... 14. , ~ 398.46 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _._. _ _ _ __ ______ ___----- .__________I I___..-- ___._.__ _._ _I ..----._ - - ___._ __-- (a)(1.2) X .O Q 398.46 ~ 15 , i 0.00 16. Amount of Line 14 taxable I I at lineal rate X .0 . 16 ~ ~ 17. ` Y - - '^ i _. .._ .. _ ~_. Amount of Line 14 taxable _._._ .._ __ ..._ .. _._ _. _ i . . . ...... . ... _ .. _ .. at sibtin rate X .12 g .... ._ 17 18. .... _ .._. ..... , .. .. ... Amount of Line 14 taxable at collateral rate X .15 - i 18 19. TAX DUE ......................................................... 19 ___ __ ... I 0.00 -._ . __ _ _ _... 20. FILL fN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 , 1505610105 1505610105'. O REV-1500 EX Page 3 Flle Number Decedent's Complete Address: DECEDENTS NAME Robert M. Beaudry _ STREETADDRESS 118 West South Street CITY Carlisle STATEPA ZIP17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (1) Total Credits (A + B) (2) 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. (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. " " ~RIATE BLOCKS PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPRO 1. Did decedent make a transfer and: Y s 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 Dec. 12, 1982, did decedent Vansfer property within one year of death without receiving adequate consideration? .............................................................................................................. 3. did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .............. 4. Did decedent own an individual retirement account, annuity or other non-probate properly, which contains a beneficiary designation? ........................................................................................................................ IT T OF THE RETURN. _ THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE AS PAR IF THE ANSWER TO ANY OF 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 forthe' 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 tfje 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 require ents 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 fc 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 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)J. e 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( Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. the use of a natural parent, an percent, except as noted in .3)]. A sibling is defined, under REV-i5o8 EX+ (ii-1o) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT scN~ou~E E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: ~IL~ NUMBER: Robert M. Beaudry I 21-10-1035 Include the proceeds of Ntigation and the date the proceeds were received by the estate. All property jointly owned wfith Hght of survivorship must be disclosed on Schedule F ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Guardian LTC -refund of medical expenses ' 45.36 2, Forest Parts Health Center - refund of medical expenses ' 462.30 3. Members 1st Federal Credit Union savings acxount #362951 152.30 TOTAL (Also enter on Line 5, Recapitulation) 659.96 If more space is needed, use additional sheets of paper of the same size. REV-1737-7 EX + (6-08) REVERSE ~' ~ pennsylvania SCfiEpYLE J ~ DEPARTMENT OF REVENUE BENEEICIARIis INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF FILE NUMBER Robert M. Beaudry 21-10-1035, When flat rate method is elected, list the beneficiaries of the Pennsylvania grope When proportionate method is elected, list all beneficiaries. RELATIONSHIP T ITEM DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY !>o Not List Trustees OF ESTATE I. TAXABLE DISTRIBUTIONS [indude outright spousaY distributions and transfers under Sec. 2116 (a)(1.2)] 1. Estate of Jacqueline C. Beaudry 4055 W. 166th St., Cleveland wife 398.46 ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV•1737 COVER SHEET OR THE PROPORTIONATE METHOD OF REV 1737 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. .ET ON THE REVERSE SIDE ( Torw~ or Pwl>Rr >~ I' Enter total non-taxable diaMbutions on Line 13 of REV 1737 cover sheet $398.46 (If more space is needed, use additional sheets of paper of the same size)