HomeMy WebLinkAbout03-11-11J 1505610105
REV-1500 °` cot-==> cFn
PA Department of Revenue pennsytvania
Bureau of Individual Taxes °""""`"`"`"`""`
PO BOX 280601 INHERITANCE TAX RETURN
_ Harrisbur PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth
092-14-8317 02/12/2011 08/27/2011
MMDDYYYY
Decedent's Last Name Suffix Decedent's First Name
MI
Failing Margaret
R
(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 OVALS BELOW
OD 1. Original Return O 2. Su
pplemental Return O 3. Remainder Return (Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of
death after 12-12-82) O 5. Federal Estate Tax Return Required
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe De
(Attach Copy of Will) (Attach Copy of Trust.) Posit Boxes
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death Q 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESP~IDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
Daytime Telephone Number
Franklin L Failing (717) 938-1756
First Line of Address
534 Ellencroft Rd
Second Line of Address
City or Post Office
Lewisberry
OFFICIAL USE ONLY
County Code Year File Number
State ZIP Code
PA /~33s
REGISTER OF WILLS USE ONLY
n
' ~ lJ .
i~
L C7 ,
r__ -
I - .
r.? .m . .
:- ,.
t. ~, ~, ,
DA'rJr"FiLEbi -
_,
-~
z,, . .
~.:
Correspondent's a-mail address: flfailin epiX.net
Under penalties of perjury, I deGare that I have examined this return, inGuding accompanying schedules and statements, and to the best of m know)
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has anyekd9owledge.lief,
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS ~~ 03/07/2011
534 Ellencroft Rd Lewisberry, PA 17339-9516
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
1505610105
Side 1
1505610105 J
7J
-,.~ . .,
r~
;~--;
_,_,~
~..-~ ~. ,
--;--,
1~~
f
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: Margaret R Failing 092-14-8317
RECAPITULATION
1. Real Estate (Schedule A) ..........
............................... .... 1. 0.00
2. Stocks and Bonds (Schedule B} .....
.............................. .... 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00
4. Mortgages and Notes Receivable (Schedule D) .
................
.......
... 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5.
0.00
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....
7 ... 6.
6
285
18
. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property ,
.
(Schedule G) O Separate Billing Requested..... ... 7. 0.00
8. Total Gross Assets (total Lines 1 through 7} ..
........................ ... 8. 6,285.18
9. Funeral Expenses and Administrative Costs (Schedule H) ......... 9
....... .. .
.
0.00
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) .... 10
........ ...
.
0.00
11. Total Deductions (total Lines 9 and 10) ....
........................... .. 11.
0.00
12. Net Value of Estate (Line 8 minus Line 11)
............ .
...............
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
.. 12.
6,258.18
an election to tax has not been made (Schedule J) ............... 13
....... ..
.
0.00
14. Net Value Subject to Tax (Line 12 minus Line 13)
...................... .. 14.
6
258
18
TAX CALCULATION -SEE INSTRUCT ,
.
IONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 _
16. Amount of Line 14 taxable 15.
at lineal rate x .0 45 6,258.18 16
17. Amount of Line 14 taxable . 281.62
at sibling rate X .12
18. Amount of Line 14 taxable 17.
at collateral rate X .15
18
19. TAX DUE ......................................................... 19.
1505610205
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610205
Side 2
1505610205
281.62
O
REV-1500 EX {FI) Page 3
Decedent's Complete Address:
Margaret R Failing
-__.
STREET ADDRESS
4905 East Trindle Road
bldg 4 room 110
- --
_---_--_
arr -
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
- --
B. Discount 14.82
3. Interest
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.
Flle Number
-- -_ -
STATE __ _ _ _ - - _ _- -----
PA ~ z1P~70SC'~
(1) 281.62
Total Credits (A + g) (2) 14.82
(3)
(4)
(5) 266.80
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:
a. retain the use or income of the property transferred .......................................................... Yes No
b. retain the right to designate who shall use the ro ~~~~~~~~~~~~~~~~~~~~ ^
p party transferred or its income ........................
c. retain a reversionary interest .............................................................................................................................. ^
d. receive the promise for life of either payments, benefits or care? ..................................................................... ^ ^
2. If death occurred after Dec. 12, 1982, did decedent transfer 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 property, which
contains a beneficiary designation? .................................................
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)j. 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)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5 percent, except as noted in [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)). 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-i$og EX+ (oi-io)
Pennsylvania
DEPARTMENT OF REVENUE
tNNERrrANCE rAX RETURN
RESIDENT DECEDENT
SCNEp1~LE F
70INTLY-OWNED PROPERTY
ESTATE OF:
Margaret R Failing
If an asset became jointly owned wig ane year of the deoedenYs date of death, i< nwst be
SURVIVING )DINT TENANT(S) NAME(S) ADDRESS
A• Franklin L Failing 534 Ellencroft Rd
Lewisbeny, PA 17339
B.
C.
JOINTLY OWNED PROPERTY:
FILE NUMBER:
092148317
ed on Schedule 6.
RELATIONSHIP TO DECEDENT
son
------ -• r-r~• ••• u~c xme D~cC.
IOS.805 REV (01/07~
J
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee far this certificate, $6.00
P 17316606
Certification Number
This is to certify that the information here biven is
correctly copied from an original Certificate of Death
duly filed with me as, Local Registrar. The original
certificate will be f~~rwarded to the State Vital
Records Office for permanent filing.
---r..r .~ '7.''~r i .
Loc Registrar Date Issued
X1061.3 REV 1 Vl000
TYVE~~~M{N COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH .VITAL RECORD
"
S
~` ~ CERTIFICATE OF DEATH
(Sas InstTMeNona and axemplas on nvsraa)
1. Nr1a a Da••aa Iflr coral, bll aM•1
Margaret Rose Failing 2 ~ 2 soot STATE vllE NUMBER
7ia""r r.m.
Fenale
~ "°' a.r ~rln uroa, urea, a O.r d e:n 092 _ 14 _ 8317
7
-
ra. ~. ow r ora (Harr, aM. vrl
February 12
2011
.
• 0•n rp„ rrl•w
ar mll a Ia Plp d DrR a„
~ r ,
_
n. August 27, 1921 gam py I+a•w: ~,
b. Cary r DIM k. C1y. Ba4 T+N. r DIaN !!
^ NgaaN ^ ER I pubr
f
w
N
• ^
.
ao
y
a
OCA
r• IN r•1 ~«. yir• anll w
Qn~berla7d ~+ 9. Wr Dlal••• r INIPar OnpnT
R
~t~ ~'
C Nom' ^ Rwras
^ Orr • SrcNr
P •
/ rr 1a Rrr Nnrbal Nan efa NNr. r:
ountry M~dows - Mecher7icsburg d ra +o•dN coon
• ,,
o.1•oar
u
.
/
aw K.rd.oa aa. mlra Mlnoar. Plrab Rrn, ,t) ~
M.Oa nll rl• 12 Wr 0•oleaN Nnr N M ld Oumaafl Easaaon BP•rP ap Nprr111 p/r rrr0.1•a 1
laraw•m faeaa.rrwrNaaNy u
B
Amae f ISa•d1/
1`~lite
.
.
aa,.T
1. MMNa 31ra: Mar4a, N••Ir
Retail 'Sales ^ Y
EMnwwry i ~~~ Ca0.0• I++ a 6.) wra..d, Ohara /7b•aryJ
~ N
- Mlnre, 10.
w•yp 9aaa1 P •il•. VI• mlbr retry
«
I
tf. C•o•elr's
MrIq A•asr,SCr1. W/am.a.r.+acorl. o.c•eax/
Wldoiied
534 IIlei7croft Road N/A
PA aeoxw.,
,~Rl.aac. Insa1.
Ievi9berry, PA 17339 Im
York T~„n;,, 'T~.~r«,oa.aa•uwN Fairview
°
.
lE. frh.r7 N.an ~fNA etas., rr: orb)
ajiy ,Ta ^ Ir. Ola.er• tH•e •+IUn T~
Erwin Burl /aMar.r~Nrr~F.Kn,e,r.maena.•.m.~ '~h"'~•roa cayfeao
20• ••a•nm'• Nrrb (Tfp/ va•1 EIIIIIB [rlutehead
Franklin L. Failing A0. Nbm•TI MMrp AOYM R10•Il aM / bral art. •P •Pel)
Q1Wro0d°i00"1en ^aanrla ^oar•~a~ Tro.or,a 534 Ellencroft Road, Lewisberry, PA 17339
o.PraallManm. •IY. Y•n 71a~•aprr•m Ornadarr•a
BuW ^ arro.•1 Nam 71111 i wr OrrrMbn
O
a
ar7w ANNalra
y,aa•IbrYaaMaaop
~'•'- 'MMIarlEawhr,caara,y ^Y«^NO FebxT7ar'y 16, 2011
7h 7grhw
(Xnlberlard Valley Marorial Gard
tla.tauron+GMlb.nar.+oooeq
~
ens
. . ~' 01aaw ~~ IIC. NUnI ae Aealr a
f"'~' Beaver Urich Funera Hone Inc
"oi3$ ~' 305 W Pern7sboro TWP., PA
,
W. Front Street, I.ewiaberry, PA 1733
~°"a"i7inij~•^+'••«la+~rw :x ••b a
dry•kin Yr111awlrNrrrrawnb ••r my ab•bep/,era ala•rMra/ar.eN/rr Plr arse. (9ipaaal ar aY)
stay r•r a al•n y~SQ. m ze. Uoar• Mnd•r
~ 77c D•b sq•e Ihlarl ay, 7•.0
.ml x4e •.. a. •rwb• ar oa•ai H. Tm a own a. or, aabar~.e o..a ~. R N z$2-'~'~3 L
a0• pagar. alr4 - p ~• ~)
S
~ la W'
70. wr w R•Nrme b MMrI
~ f M. Qa (z ~ ( ~ E+rrM., Caaw br. Rwan aw fwn Ganwon a DNrirT
CAIIIB tlv DEATH
^ rl• N
a
l
/
.. NI•allrlOrr• rK •
MNn r. M k Erw N
~-a~ - all•1./. ~•~•' •r rnie0iollar • w a••M arr/0 M e
r •YPamab Nana:
~
lNn OO
wr•
brm4r •.Irr •rA r
nIP"•a7 int. a r•rMapr Ibrarkn Mllbr M Drat anK i
Iho•ip ra•7!- L'q aw orb tir• a+rdi Nr
Onr b DIM
b
' .
0u1 rp malap N tlb ayay~q a~ th
a:"^`Aw^ ~; ~° .
I N ry-r~/ I -1 I 0 ~ an N PM L ^ r Q vip010y
^
, _
l~-T~• ~ ~
Oal b Rr • a I
"v •- ~ Na ~I~aa
' Qlarlr ~ r
~M Oorlaea•. / a7. 4
Era bIR10E1kYN10 CAU1E ~ olr b ro r • 4 an ~ I r4-- i ~
(al••1• a Yl
a
i 21. N Far•IC
L
J Fnila• r Ym• d r
R
jut
r
lalNe h r T
•rar• 1•r/Mq n alwll LAET. c ~ ,
a
~-
^ 11r anO~w. OM ppw• rwln •2 arA
Ora b for a aw•IPar•• aQ. r
de•171
' r ~ ~~ ^Nr PrpaA01l1 q•Vr'•UeMblyaR
701. Wr M AMaply 704 Wa• Aubpy Finarr0/ N. Manes a0.1/1 r
7a~ ar d Nf.y ~w.4 ar. wn m. alobl w. NN,y aaa,,,,e -'~
w
~~
a
a hMa• abn
'-- ^ unbrm N p,ow, wnN>nl ar ra
.r ^ H,,,,,«
~
a C
rr. r ENar.hdaY.
~0 n
t~
^ Yr. ~Na ^ Yw ^ Np ^ •iaelrll ^ P•11dp M.alpNar 77L TNr d •{ay 37c M~uy rYlpltT 3N, N Try•PaaNyl N
r
'- ~ ~~ a
~
MIy l3
G•a/y
- ^ aiar ^ CaM Nr a D/bmilile M
^ Yr ^ N/ ^ Daa/Orrr,r ^ Pampa UL lawan d Njy ry ISb•q rl / b1a1 Or)
.
70c Cwww Mbrr aVy anN O/rr- SP•'rK
~
aarl•gaa. a r•a ryn nlollw 37b. Elvhn aM
•. T•ONfYeLrlfMrian a71h11har aanallreara rr
aomylbe Nang)
•RNw•Maal~alAl arawa a.rar
•wMgwm..wrrr.a_-_-
wa+•'/•p PNYlkll•1l14tla•n Naa a••al•+pelrlwP.rwl•pbaa
' T
-•-----------
•
•Iaell•11
•
• M.aerE~/~eca.rMru^MI..Mw-~•1•.a•aa•ru. wyalwmww.rrr_-_-- ~
^
-----
730.
O•om4•W
•al
o•.+rN.br --
!v(d L3 Ps r-
------
..rrlww~«r«ryrNtiar^yr++wa.ln.lawrwrw.+ma.ar.arww
warra. ./
2
ICI ( 1
~ .
•++NHw ••mwr rrlL ^ >•. Nar rr
~ a /Y1 ~LlT ~ nIN
F ~• L~ 17 ~ IZI~S I ~6 ` rr.'
~
O
- -
A
~~ g"~Y
I Y (,~
• fill
/
uloawoa vans Na os99oz7
~
I~a'~•l
j V
~ C / U
2 O ~, ~..Ad Q1
~ z ^ cD
V7 20.11- 1 _o
OGJI~ •Z •~
d~~oc~0
QWI~-O L~~o
(nOE-(L2 V ~o
~ ,_
~ U ~
3
W
Z
~~~
o
-~ r
~~
W
W V
F ~ O
N M O
O --
W
h f
~ Q
~ C
G~ ~~
~'~
~
.. .,,
~v ~-"
' - ,
~
',~
, ~
~_;__ - _;,,
-
,< ~, ~,~=
, -
_ _
7.. 3 "- ; ~
C~
{^~ ~~,
"~ <
L;
}j
d
M
M
~~
~~
L
~~~~ ~.
~r'3
{ rT I,
.,;_
y~ r~~
~^~
\~~~'
r"`1~\ r~
J
~~
1+ \
~ ~
~I r~
~ L~~ ~ ~,
~~ w
~ _ `~ ~ ~~~
~~,
~~, \~ ~ t\
t; ,i ~
~~~~
~t ~ r
~~
~ ~ c~ \
~~ ~ ~~,
~~ ti ., :~
~y ~`
.~ ~ V
~~~ ~ ~~
~~~ n
~~ ~~ '~
_~I-gal, ~ ~ ~~
IJ
J .;
#,.
~7t
Y
~Yf
t~
-rx
h'•E
E:~
•r•E