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Home My WebLink About02-22-11 1505610.145 REV-1500 ~``°'-'°' Pennsylvania OFFICIAL USE ONLY PA Department of Revenue OEPM7AIENTOFREVENUE County Code Year File Number Bureau of individual Taxes INHERITANCE TAX RETURN /~/~ PO BOX 280601 ~ f v S v`-O ~ ~ 7 Harrisburg, PA 17126-0601 RESIDENT DECEDENT r ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 175-05-1641 09092005 09111916 Decedent's Last Name Suffix Decedent's First Name MI Adams C. Norman (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name 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 BOXES BELOW 1.Original Retum ® 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82) 0 4. Limited Estate ~ 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Retum Required death after 12-12-82) ® 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (date of death 0 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 Robert G. Frev 7172435838 First line of address 5 South Hanover Street Second line of address City or Post Office State ZIP Code Carlisle PA 17013 r w? REGISTEtrDF WILLS USE~ILY ~ O ~' .. _" ' rn~n c:y r- n.? ! ~ ,~ . r ~ .X7 t~J ---+ • • E FILED _ n ..~ tr yr _. , -,-, fT'- Correspondent's a-mail address: rf rey@f reyt i 1 ey . com Under penalties of perjury, l declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is SIGNA REI F PERSON RE ONSI~ FOR FILING RETURN ~ /~v~DATE ' ~~ o~ rt.v1~ivi ~ Z 2 Zo ~ ~ 23 Circle Drive, Carlisle, PA 17013 SIGNATURE OF PR RE O TH RE SENTATIVE /~ / DATE Robert Fre Y'r6 . 2 2 Z d// ADDRESS 5 South Hanover Street, Ca isle, PA 17013 PCEASE USE ORIGINAL FORM ONLY Side 1 L 1505610145 1505610145 J 1505610245 REV-1500 EX Decedent's Social Security Number Decedents Name: C . Norman Adams 17 5 - 0 5 -16 41 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. 2 6 3 2.11 3. Closely Hek1 Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. NONE 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ...... 5. NONE 6. Jointly Owned Property (Schedule F) Separate Billing Requested ........ 6. NONE 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ........ 7 NONE 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 2 6 3 2.11 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 115.0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. NONE 11. Total Deductions (total Lines 9 and 10) ............................... 11. 115.0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................. 12. 2 517.11 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... 14. 2 517.11 TAX CALCULATION -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 .0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .0 4 5 2 517.11 16. 113.2 7 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X , 15 18. 0 . 0 0 19. TAX DUE ....................................................... 19. 20, FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 113.27 0 L 1505610245 1505610245 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-05-0847 175-05-1641 DECEDENTS NAME C. Norman Adams STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (1) 113.27 Total Credits (A + B) (2) 0.00 (3) 32.18 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE 0.00 (5) 145.45 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 transferred : ............................................................................. ^ ^X b. retain the right to designate who shall use the property transferred or its income : ................................ ^ ^X c. retain a reversionary interest; or ............................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? .......................................................... ^ ^X 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .......................................................................................:......... ^ Q 3. Did decedent own 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? ............................................................................................................ ^ 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 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 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)j. • 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(ax1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Practitioner Portal Penalty and Interest Calculations CALCULATION DATES- 6/9/06 TO 2/23/2011 TAX DEFICIENCY $ 113.27 CALCULATED INTEREST $ 32.18 BALANCE AS OF 2/23/2011 $ 145.45 Start Over 2/18/11 3:10 PM https://www.doreservices.state.pa.usJpitservices/Default.aspx Page 1 of 1 REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER C. Norman Adams 21-05-0847 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 39 Shares Prudential Stock, 67.49 average price 2,632 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER C. Norman Adams 21-05-0847 Decedent's debts must be reported on Schedule I. ITEM A. ~ FUNERAL EXPENSES: 1 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: Attorney Fees: 2. 3 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. State ZIP ZIP 100 15 TOTAL (Also enter on Line 9, Recapitulation) ~ S 115 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERRANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: lV. IVOrma n /iaamS LI-US-Utf4/ 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 pnclude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] Ranelle L. Brown 1' 23 Circle Drive, Cariisle, PA 17013 Step Daughter 1/2 of Residue Stephen C. Adams 2' 816 Golden Eagle Drive, Conway, SC 29527 Son 1/2 of Residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUG H 18 OF REV-1500 COVER SHE ET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ff more space is needed, use additional sheets of paper of the same size. WS).com Stock Charting for PRU Date Pfrice High Low Volume s/s/os 67.41 s7so s7.oe 1,221,300 Financial Inc (PRU) (NYSE) U.S. Dollar No Splits Get another quote any day after 1 /211970 1 /2/1970 Symbol: Date. 9/9/~~^ G0 2/11/11 9:06 AM http://www.bigcharts.com/custom/wsjfe/wsjbb-historical.asp?symb=pru&close_date=9%2F9%2F05&x=0&y=0 Page 1 of 1 ~,'"_..' Quotes delayed at least 1s minutes. Market data provided by Interactive Data. Terms & Conditions. Powered and implemented by Interactive Data Managed Solutions.