HomeMy WebLinkAbout02-09-11 (2)
1505610140
-' REV-1500 ~` I°'-'°'
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Cade Year File Number
PO BOX 280601 2 1 1 0 0 0 6 8 4
Hardsburg, PA 17126-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW
1 9 3 2 4 2 3 4 0 0 5 2 7 2 0 1 0 1 1 0 9 1 9 2 9
Decedent's Last Name Suffix Decedent's First Name MI
W E S T H A F E R W I N I F R E D A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Secudty Number
FILL INAPPROPRIATE OVALS BELOW
^X 1. Original Return
4. Limited Estate
® 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Retum
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust _
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
D e v T D H R A D C L I F F E S Q 7 1 7 2 3 6 9 3 1 8
First line of address
1 0 1 1 M U M M A
Second line of address
S U I T E 2 0 1
City or Post Office
RoaD
3. Remainder Retum (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Baxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
,..
_ _ r~
O
REGISTER OF
~ USE ONLK.`.
W -0
~
~
~
~
~~
rJC.,~ ~
QOQ
~ ~
A~
DATE FILED n,
State ZIP Code
L E M O Y N E P A 1 7 0 4 3
r~
-i C'-,
~' r ii
-~%
c-,
,,-r
'.i-i
~~
m
CorreapondenYs e-mail address: DHRADCc~IX.NETCOM.COM
Under penattiea of perjury, I deGare that I have examined Chia return, including accompanying schedules and statements, and to the bast of my knowledge and belief,
n la We, correct and compote. Daclarotion of proparor other than the personal ropresentative is based on all Iniortnation of whkh preparer has any knowledge.
SIG RE OF PERS R ONSIBLE FO FILING RETURN pATF,
(i.11.vr/ iiJ.ue' , ~ / 3 / 3Gl /
OF
1505610140
CARLISLE
LEMOYNE
PLEASE USE ORIGINAL FORM ONLY
Side 1
PA 17013
PA 1704
1505610140 J
'~~
J
1505610240
REV-1500 EX Decedent's Social Security Number
DeoedeM'sName: WINIFRED A• WESTHAFER 1 9 3 2 4 2 3 4 0
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1
2. Stocks and Bonds (Sdredule B) ...................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Notes Receivable (Schedule D) .......................... 4.
5. Cash, Bank DeposRs and Miscellaneous Personal Property (Schedule E)....... 5.
6. Jointly Owned Property (Sdredule ~ ^ Separate Billing Requested ....... 8.
7. Inter-Vhros Transfers 8 Miscellaneous I~Prot>ate Property
(Schedule G) U Separate Billing Requested ....... 7.
8. Total Gross Assets (total Linea 1 through 7) ........................... 8.
9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9•
10. Debts of Decedent, Mortgage Liabilities, and bens (Schedule I) ............. 10.
11. Total Daductlons (total Lines 9 and 10) ............................... 11.
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12.
13. Charkatrle and GovemmeMal Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... 13.
1 4 1 5. 4 0
4 1 3 6. 9 7
1 7 8 4 9. 3 1
1 2 7 2 6 2, 3 7
1 5 0 6 6 4, 0 5
9 9 0 9. 2 7
9 0 8. 9 8
1 0 8 1 8. 2 5
1 3 9 8 4 5. 8 0
14. Net Value SubJsct to Tax (Line 12 minus Line 13) .. ........... .. ....... 14. 1 3 9 8 4 5 . 8 0
TAX CALCULATION -SEE INSTRUCTiON8 FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
Vansfers under Sec. 9118
(a>(1z>x.o _ 0. 0 0 1s. 0. 0 0
16. Amount of Line 14 taxable
1 3 9
8 4 5
8
0
6 2 9 3
0
6
at lineal rate x .045 . 1s. .
17. Amount of Line 14 taxable
0
0
0
17
0
0
0
et slbling rate X .12 . .
18. Amount of Line 14 taxable
0
0
0
0
0
0
at cdlateral rate X .15 . 18. .
19. TAX DUE ...................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
6 2 9 3. 0 6
Side 2
L 1505610240 1505610240
REV-1500 EX Pape 3
Decedent's Complete Address:
FIN Number
21 10 00684
DECEDENTS NAME
WINIFRED A. WESTHAFER
STREET ADDRESS
5283 EAST TRINDLE ROAD
ctry
MECHANICSBURG sTATE
PA z1P
17050
Tax Payments and Credits:
t ~ Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments 5,600.00
B. Discount 294.73
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the differenos. This is the OVERPAYMENT.
Ffll In oval on P~ 2, Line 20 to roglmst a refund.
(1) 6.293.06
Total Credits (A + B) (2) 5, 894.73
(3)
(4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5) 398.33
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 trensferred : ................................................................. ..... ^
b. retain the right to designate who shall use the properly transferred or its incortle : .......................... ..... ^
c. retain a reversionary interest; a ........................................................................................... ..... ^
d. receive the promise for life of either payments, benefits or care? .................................................. ..... ^
2. If death occurred after December 12, 1982, did decedent transfer properly within one year of death
WlthWt feCBIVIIIg adequate consideratiar? .................................................................................. ..... ^
3. Did decedent own an "intrust 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~robate property, which
contains a benefiaary designation? ............................................................................................. ..... ® ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS 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 Baths of death on or after Jan.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 N the surviving spouse is the only beneficlary.
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 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 decedents lineal beneficlaries 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 decedents siblings is 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 bkwd or adoption.
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSnVAN1A STOCKS 8 BONDS
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE tN1MBER
WINIFRED A. WESTHAFER 21 10 00684
All propeAy JolMlyownsd MAh right of survivonihip must 6s dhebsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
35 shares MetLife
TOTAL (Also enter on line 2, Recapitulation) ~ i
(If mae space b needed Ngett additlaial aheeta of the same sine)
REV-1508 EX + (698)
SCHEDULE E
COMiAONWEALTH OF PENNSnVANIA CASH, BANK DEPOSITS, ~ MISC.
IN RESiDENTEDECEDEN RN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
WINIFRED A. WESTHAFER 21 10 00684
Indude the proceeds of IidgaUai and the date the proceeds vreB mceived by the estate.
All pro JoiMly4wned v+hh dOM of survivorship must be dhcbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. COMCAST -REFUND 27.61
2. PERSONAL PROPERTY (SEE ATTACHED) 450.00
3. VERIZON -REFUND 10.48
4. MEDICARE PART D REBATE 250.00
5. PENN TREATY -PREMIUM REFUND 35.11
6. PENN TREATY -PREMIUM REFUND 253.27
7. PENN TREATY - AT HOME CARE REIMBURSEMENT 1,648.50
8. PENN TREATY - AT HOME CARE REIMBURSEMENT 1,462.00
TOTAL (Also enter on line 5, RecapllUlation) ~ i 4 136.97
(M more space b needed, insert addilbnal sheets of the same sae)
ESTATE OF WINIFRED A WESTHAFER
FILE N0.21-10-00684
S.S. #193-24-2340
PERSONAL PROPERTY
Refrigerator
Microwave
Washer
Furniture
TV
Small Appliances
Push Mower
Dinnerware
Pots/Pans
Keepsakes
$ 50.00
$ 25.00
$ 25.00
$ 100.00
$ 25.00
$ 75.00
$ 25.00
$ 50.00
$ 25.00
$ 50.00
$450.00
REV-1509 EY.+ (01.10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
WINIFRED A. WESTHAFER 21 10 00884
H an asset was made jointly owned wkhin one year of the decedent's date of death, k must be reported on Schedule Q.
SURVIVING JOINT TENANT(S) NAME(S)
A.
t ROAD
PA 17013
s.
C.
JOINTLY~OYYNED PROPERTY:
ADDRESS
TO-0ECEDENT
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FaIMlCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYalG NUMBER ATTACH DEED FOR JONJTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET %OF
DECEDENTS
INTEREST DATE OF DEATH
VALUE OF
DECEDENT5INTERESI
1. A. 9/1!79 PNC BANK ACCT #5070089285 35,698.61 50. 17,849.31
TOTAL (Also enter on Line 6, Recapitulation)
K more apace is needed, use additional wheels of paper of tl~ same size.
REV-1510 EX+ (OB-09)
Pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
WINIFRED A. WESTHAFER 21 10 00684
Th's sche~le must be completed and filed if the answer to any of questions 1 through 4 an page three of th REV•1500 re yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
nicwoETNENU,EaFn~ErRANeFr~EE,nieaREUrwNaraPTOOECEDENru+o
niEOAleoFTa~NaFl:R.ArrecNACOProFTNeoe~FORRFxESTATE.
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
EXCLUSION
nFw~~
TAXABLE
VALUE
1. PNC BANK CD#31800338053 5,083.49 100.00 5,083.49
KAREN RUSNAK, DAUGHTER, BENEFICIARY ON DEATH
2. PNC BANK CD#31600337915 5,049.36 100.00 5,049.36
KAREN RUSNAK, DAUGHTER, BENEFICIARY ON DEATH
3. PNC BANK CD#31900339251 5,132.63 100.00 5,132.63
KAREN RUSNAK, DAUGHTER, BENEFICIARY ON DEATH
4. AMERIPRISE FINANCIAL ACCT#011239399105002 TOD 42,980.54 100.00 42,980.54
5. RIVERSOURCE LIFE ANNUITY #930041745157004 19,421.45 100.00 19,421.45
6. RIVERSOURCE LIFE ANNUITY #930051029229004 33,148.12 100.00 33,148.12
7. RIVERSOURCE LIFE ANNUITY #930070069867004 6,970.98 100.00 6,970.98
8. PNC BANK ACCT #5001105376 9,475.80 100.00 9,475.80
TOTAL (Also enter on Line 7, Recapitulation) I s 127 262 37
ff more space Ls r~ded, use additional sheets of paper of the erne size.
REV-1511 EX+ (10-09)
Pennsylvania
DEPARTIYENi OF REVENUE
INHERfTANCE TAX RETURN
~SIDEPfT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
WINIFRED A. WESTHAFER 21 10 00684
Decedent's debts must be reporbd on Schedub I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS FUNERAL HOME 5,312.00
2. ROLLING GREEN CEMETERY 285.00
3. FUNERAL LUNCHEON 185.77
B.
1
2.
3.
4.
ADMINISTRATIVE COSTS:
Personal Representative Commissiars:
Name(s) of Personal Represerrlative(s)
Street Address
City Sfafe _
Year(s) Commission Paid:
A16onreyFees: RADCLIFF LAW OFFICE, P.C.
Family Exemption: (If decedents address is not the same as daimarrCs, attach explanation.)
Claimant
Street Address
City State _
Relationship of Claimant to Decadent
Probeb Foes:
5. Accarrrtant Fees:
6. Tax Rehrm Preparer Fees:
7. I FILING FEE - INH RETURN 8~ INVENTORY
8. ADDITIONAL PROBATE
71.50
30.00
25.00
TOTAL (Also enter on line 9, Rec~itulation) I S o ono ~~
ZIP
4,000.00
ZIP
If more space is needed, use addftiareJ sheets of paper of the same s1aB.
riEV-1512 Eic+ fez-oe>
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
WINIFRED A. WESTHAFER 21 10 00684
Report debts, Incurred by the decedent prior to loth that remained unpaid at the date of death, Including unrefmburesd medial expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. DR. EUGENE KILMORE 60.00
2.
3. ~ LULA LAWTON - AT HOME CARE
4. (VISITING ANGELS
TOTAL (Also enter on Une 10, Recapitulation) I ;
If more space is needed, insert adr~tional sheets of Me same sae.
40.98
420.00
388.00
REV-1513 EX+~(01-10)
Pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE I BENEFICIARIES
INHERITANCE TAX RETURN
RE6IDENT DECEDENT
WINIFRE D A. WESTHAFER Z1 10 00654
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustes{s) OF ESTATE
I TAXABLE DISTRIBUTIONS (include M meal distributiare and transfers under
sec. si~6 (a) Itz).1
1. KAREN A RUSNAK Lineal 139,845.80
82 HOOVER ROAD
CARLISLE, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. s
If more space is needed, use addi5onal sheets of paper of the same size.
LAST WILL AND TESTAMENT OF WINIFRED A. WESTHAFER
I, WINIFRED A. WESTHAFER, of the Township of Hampden, County
of Cumberland and State of Pennsylvania, being of sound and dis-
posing mind, memory and understanding, do make, publish and de-
Clare this my Last Will and Testament.
1.
I direct the payment of all my just debts and funeral expenses
as soon after my decease as the same can conveniently be done.
2.
I give, devise and bequeath all the rest, residue and remainder
of my estate, of whatsoever nature and wheresoever the same may
be situated, to my husband, Merrill W. Westhafer, absolutely and
unconditionally.
3.
In the event that my husband, Merrill W, Westhafer, should
predecease me or should he die at about the same time as I do,
such as in an accident common to both of us, then in such event,
I give, devise and bequeath my entire estate, real, personal and
mixed, whatsoever and wheresoever the same ,may be situated, to my
daughter, Karen A. Rusnak, absolutely and unconditionally.
LASTLY, I nominate, constitute and appoint my husband, Merrill
W, Westhafer, Executor of this my Last Will and Testament, and in
the event that my said husband should predecease me or should he
be unable or unwilling to serve in such capacity for any reason,
then in such event, I nominate, constitute and appoint my daughter;
Karen A. Rusnak, Executrix of this my Last Will and Testament
in his place and stead.
-1-
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~___._ day of ~S'D_- ~... , A. D. 197r .
~ ~ ',L` C, ~ i/r~ ~ SEAL )
~~~i re esth er
Signed, sealed, published and declared by the above named.
Winifred A. Westhafer, as and for her Last Will and Testament,
in the presence of us who have subscribed our names hereto as
witnesses, at the request of said testatrix, in her presence and
in the presence of each other.
-~
-z-