HomeMy WebLinkAbout02-28-11J REV-1 J~'00~` (01-10' 1505610143
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
Po Box.2soso~ INHERITANCE TAX RETURN 21 10 - 0 719
Harrisburg, PA 17128-OS01 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
200 60 4008 05 26 2010 09 27 1980
Decedent's Last Name
TAYLOR
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix Decedent's First Name MI
ELISE M
Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Retum ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
^ g Decedent Died Testate ^ ~, Decedent Maintained a Living Trust ~ 8. Total Number of Safe De osit Boxes
(Attach Copy of Will) (Attach Copy of Trust) p
^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95) ^ t 1. 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
BRADLEY L GRIFFIE 717 243 5551
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REGISTER
~ILLS USE(~NLY ;-''~
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First line of address ~ ~ _
200 NORTH HANOVER STREE ~-'t~/\
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Second line of address ~"' ~ ,- `~
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City or Post Office
State ZIP Code DATE FILED r> ~ ~~~
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CARLISLE PA 17013
Correspondent'se-mail address: bgriffie@griffielaw.com
Under penalties of perjury, 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 personal representative is based on all information of which preparer has any knowledge.
Bradley L Griffie ~ ~dS~~ / /
200 North Hanover Street, Carlisle, PA 17013
Side 1
1505610143
1505610143
___I
760 East Lowther Street, Carlisle, PA 17013
SIG '~o-TO'.'S"~~~°+",.°.~`.~° OTHER THAN REPRESENTATIVE DATE
REV-1500 EX
1505610243
Decedent's Social Security Number
oeoeeenrs Name: TAYLOR, ELISE M. 2 0 0 6 0 4 0 0 8
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 De osits & Miscellaneous Personal Pro e
p p rty (Schedule E) ................
5. 7 3 . 5 0
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. 7 3 . 5 0
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 8 , 4 9 9 - 8 3
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 4 0 , 5 4 6 . 9 5
11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 4 9 , 0 4 6 . 7 8
12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. - 4 8 , 9 7 3 . 2 8
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. - 4 8 , 9 7 3 . 2 8
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
L 1505610243
1505610243 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 10 - -0719
DE EDENT'S NAM
Taylor, Elise M.
STREET ADDRESS
131 Elm Street
CITY
Carlisle STATE
PA ZIP
17013
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.
Total Credits (A + B)
Make Check Payable to: REGISTER OF WILLS, AGENT.
(1) 0.00
(2) 0.00
(3) 0.00
(4)
(5) 0 .
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 :.................................... ^
c. retain a reversionary interest; or .................................................................................................................. ^
d. receive the promise for life of either payments, benefits or care? .............................................................. ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ....................................................................................................................... ^ 0
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? ...................................................................................................................... ^ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS 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 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 re{um 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 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)1. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w ether y blood or adoption.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERRANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Taylor, Elise M. 21 - 10 - -0719
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.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 United States Savings Bond - $50.00 31.62
L618165210EE
(See attached)
2 United States Savings Bond - $50.00 32,88
L597108203EE
(See attached)
3 ~ Cash ~ 9.00
TOTAL (Also enter on Line 5, Recapitulation) ~ 73.50
SCHEDULE H
FUNERAL DCPENSES &
COMMONWEALTH OF PENNSYLVANIA w~~'~w /~
INHERITANCE TAX RETURN /"11./Ir~\I~ / f W~ ~.-W I J
RESIDENT DECEDENT w . , vim, ' -
FILE NUMBER
ESTATE OF Taylor, Elise M. 21 -10 - -0719
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Egger Funeral Home Inc. 5,103.28
B. ADMINISTRATIVE COSTS:
~, Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Griffie and Associates
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
5. Accountant's Fees
6. ~ Tax Return Preparer's Fees
7. Other Administrative Costs
1 The Sentinel (Advertising)
3,000.00
96.50
225.05
TOTAL (Also enter on line 9, Recapitulation) 8,499.83
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Sdied~~e H
A~,~,Ft,neralME~er~ses &
!'~1^I~W~IG~
FILE NUMBER
ESTATE OF Taylor, Elise M. 21 - 10 - -0719
Cumberland Law Journal
75.00
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
C~NHERITANCEDTAX RETURN~IA LIABILITIES, & LIENS
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Taylor, Elise M. 21 -10 - -0719
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses
ITEM DESCRIPTION AMOUNT
NUMBER
1 United States Treasury 2,085.45
2004 Personal Income Taxes
2 (United States Treasury ( 525.83
2005 Personal Income Taxes
3 Cumberland County Probation Office 1,302.00
(Fines and Costs)
4 Carlisle Regional Medical Center 12.00
5 First USA Credit Card 5,361.25
XXXX-XX)CX-XX)CX-9004
6 Comcast 627.53
(2 statements)
7 Old Navy GE Credit Card 539.21
8 American Express Charge Card 5,829.56
009
9 PA Turnpike Comission 97.90
(Easy Pass Charge - 2 violations)
10 AES (Student loans) 15,619.46
11 Verizon Wireless 555.22
12 Kohl's 425.41
XXX-XXXX-160
TOTAL (Also enter on Line 10, Recapitulation) ~ 40,546.95
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN LIABILITIES & LIENS
~
RESIDENTDECEDENT continued
ESTATE OF
Taylor, Elise M. FILE NUMBER
21 - 10 - -0719
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medi cal expenses.
NUM ER DESCRIPTION ~' AMOUNT
13 GE Money Bank Credit Card 568.21
~CXX-~CXX-X~CX-0680
14 Reading Professional Services 340.00
(Medical billing)
15 St. Joseph's Medical Center 887.00
(Medical billing)
16 Bethel Community Ambulance 1,426.00
(medical billing)
17 West Reading Radiology Associates 807.00
(medical billing)
18 Victoria Secrets ~ 1,518.42
19 Camp Hill Emergency 1,939.00
(medical billing)
20 i
R. Lynn Margarle, M.D.
60.00
(medical billing) i
21 Carlisle Borough Tax Account 5.50
(2010 Per capital Tax)
22 Carlisle Police Department 15.00
(Parking ticket)
Page 2 of Schedule I
REV-1513 EX+(tt-06) ~
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Taylor, Elise M. FILE NUMBER
21 - 10 - -0719
NUMBER
NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO ~ SHARE OF ESTATE
DECEDENT ~, (Words) AMOUNT OF ESTATE
($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I~ TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Noah Jaden Taylor Son ~ One Hundred
48 Chambersburg Street 'Percent
Apartment No. 7
Gettysburg, PA 17325
i
Enter dollar amounts for distributions shown above on lines 1 i
I
5 through 18 on Rev 1500 cover sheet, as appropriate.
II~ NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 0.00
SCHEDULE
«E»
8/26/2010
Calculated Value of Your Paper Savings...
Calculated Value of Your Paper Savings Bond(s)
Calculator Results for Redemption Date 05/2010
Totai 'rie Total Valiue ~"ot:ai Interest YTI:~ Interest
$50.00 $64.50 $14.50 $0.58
Bonds: 1-2 of 2
eriai series i0enorn Isss~e Next ~E~r~ai Iss~~e Interest xr~eer~st ~aie Note
gate Aorraai Mat~s€°it I?rye mate
L597108203EE'' EE $50~12J200206~2010' 12/2032` ,$25 00 _ $6.62:
2.19% $31.6,2
L618165210EE EE $50 x12%2001.. 06/2010, _12/2031; $25.00 ,
. $7.,88 2.19% $32,.88
Totals for 2 Bonds ; $50.00 $14.50; $64.50
Notes
NI `Not Issued
NE Not eligible for payment _ N _ v r , ~,.. , .
P5 Includes 3N month interest~~enalty~ ~. ~I~
MA 'Matured and not earning interest