HomeMy WebLinkAbout03-03-11~ Lsos61o1o1
OFFICIAL USE ONLY
REV-1500 ~` ~°'-'°'
PA Department of Revenue pennsylvania ^.~A
J)[PlJtT-fNT aE RE:lFNiJf. COUr1ty Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po sox 280601 RESIDENT DECEDENT ~ ` ~ ~ ` ` ~~
Harrisburg, PA 1128-0601
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ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
210-18-9591 03/19/2010 06/13/1920
Decedent's Last Name Suffix Decedent's First Name MI
Clouser Pearl J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First f~iame Mt
Spouse's Social Security Number TNIS RETURN MUST BE AILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of 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. 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
David L. Styer, Esq. {215) 757-8345
First line of address
10 Pepperell Drive
Second line of address
City or Post Office
Langhorne
State ZIP Code
PA 19053
REGISTER OF WILLS USE ONLY
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Correspondent's a-malt address: d15~j/eSgf~VeflZOn.t1Ct
Under penalties of perjury, t declare that l have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, co d complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN URE OF P RSON R PON~S'fBLE~ (LING RETUR ~ ~~ ~ j~U,~
ADDRESS
284 Countryside Cir I New p , PA 1 8
SIGNATUR `P,R-EfPA O ER PRESENTATIVE
2 ~A3 2-~~l
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ADDRESS t
10 Pepperell Drive, Langhorne, PA 053
PLEASE USE ORIGINAL FORM ONLY
~n
Side 1
15D561D1D1 15D561D1D1
J
150561D105
REV-1500 EX
Decedent's Social Security Number
210-18-9591
Decedent's Name:
RECAPITULATION
1. Real Estate (Schedule A) ............................................. 1. 0.00
2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00
3. Closely Held Corporation, Partnership or Sale-Proprietorship (Schedule C) ..... 3. 0.00
4. Mort a es and Notes Receivable Schedule D ...............
9 9 ( )............ 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 5,050.26
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.
8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 5,050.26
9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 13,819.97
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) .............. 10. 0.00
11. Total Deductions (total Lines 9 and 10) ................................. 11. 13,819.97
12. Net Value of Estate (Line 8 minus Line 11 } .............................. 12. 0.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts far which
an election to tax has not been made (Schedule J) ........................ 13. 0.00
14. Met Value Subject to Tax (Line 12 minus Line 13} ........................ 14. 0.00
TAX CALCULATION -SEE 1NSTRUCTlONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, ar
transfers under Sec. 9116
0
00
(ax1.2} X .0.! 15. .
16. Amount of Line 14 taxable
00
0
at lineal rate X .0 ,._ 16. .
17. Amount of Line 14 taxable
00
0
at stbting rate X .12 1~. .
18. Amount of Line 14 taxable
00
0
at caNateral rate X .15 18_ .
19.
....................................
TAX DUE .................... . 19. 0.00
ZQ. Fti[.L (N THE OVAL !F YOU ARE REQUESTING A REFUNO OF ~1N OVERPAYMENT CO
Side 2
1505610105 15056101D5
REV-1500 EX Page 3
flor~ortent'c r'_mm~1E++~- OririrpsS_
File Number
DECEDENT'S NAME
heart J. Clouser _,____`
STREET ADDRESS
Claremont Nursing/Rehab Center
1000 Claremont Road
CITY j STATEPA ~ ZIP17013
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19}
2. Credits/Payments
A. Prior Payments _-
B. Discount
3. Interest
4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the QYERPAYMENT.
Fill in oval on Page 2, Line 2g to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(1}
Total Credits (A + B) (2)
(3}
(~)
(5)
Make check payable to: REGISTER QF W1LLS, AGENT.
o.oo
0.00
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 :...................................................................................
i
i ...... ^
^
ncome : ......................................
ts
b. retain Fhe right to designate who shall use the property transferred or ......
c. retain a reversionary interest; or .................................................................................................................... ...... ^
^
d. receive the promise for life of either payments, benefits or care? ................................................................ ......
tf death occurred after Dec. 12, 1982, dad decedent transfer property within one year of death
2
.
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? ........ ...... ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ................................................................................................................. ....... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS lS 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or far the 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 the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (iij]. 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.
Far 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
adaptive 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 #cr 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(aj(1)].
• The tax rate imposed an 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)]. 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.
REV-~So8 EX+ (li-lo}
pennsylvania SCNEpYLE E
DEPANTMENT OF REVENUE CASH BANK DEPOSITS S't MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DKEDENT
ESTATE OF: FILE NUMBER:
Pearl J. Clouser, Dec. 20-10-1127
Indude the proceeds of litigation and the date the prooeeds were received by the estate.
Alt aropertY saintly owned with right of survivorship must be disdosed on Schedule F.
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
r pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
ESTATE OF FILE NUMBER
Pearl J. Gtouser, Dec. 20-10-1127
Decedent's debts must be reported on Schedule i.
ITEM AMOUNT
NUMBER i?ESCRIPTION
A. FUNERAL EXPENSES:
1' Ronan Funeral Home, Carlisle, PA 13,093.61
B.
1.
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant`s, attach explanadon.~
Claimant
4.
5.
6.
~.
s
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Vitalchedc; death certificate
(Votary, copy charges
TOTAL {Also enter on Line 9, Recapitulation) I $
If mare space is needed, use additional sheets of paper of the same size.
State ZIP
ZIP
380.00
102.50
200.00
36.00
7.86
13,819.97
REV-1513 EX+ (01-10)
~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DKEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF: FILE NUMBER:
Pearl J. Clouser, Dec. 20-10-1127
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS jInciude outright spousal distributions and transfers under
Sec. 9116 (a} (1.2).J
1. ~ Judy A. Murphy, 284 Countryside Circle, New Hope, PA 18938
Niece
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
n ( NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
I.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
100%
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, ~$
If mare space is needed, use additional sheets of paper of the same size.
Habib ~.. ~tper, ~E~g.
10 Pepperell Drive
Langhorne, PA 19053
215-5757-8345
dlstyesg~werizon.net
February 28, 2011
Glenda Farner Strasbaugh
Register of Wills
Cumberland County
I Courthouse Square
Carlisle, PA 17013
Re: Estate of Pearl J. Clouser, Dec.
File # 21-10-1127
Dear Ms. Strasbaugh:
Enclosed please find two copies of the Inheritance Tax Return, my check for filing fee in the
amount of $15.00, and a return envelope for forwarding a copy, clocked for my records. It is my
understanding that your office will advise if further probate fees are due.
Do not hesitate to contact me if you are in need of further information.
Ve truly o rs
~•
David L. Shyer
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