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Home My WebLink About03-09-11 1505610105 REV-1500 ~ t~-11> ~~ ~ PA Department of Revenue pennsylvarria OFFICIAL USE ONLY Bureau of Individual Taxes °~`""°"`"~°`"~"'~ County Code Year Frle Number Po Box 2sosoi INHERITANCE TAX RETURN Harrisbu , PA i i2$-p6pi RESIDENT DECEDENT ~ ~ ~ ~,~ ~C~.._:. ENTER DECEDENT INFORMATION BELOW Soria( Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 201-18-5722 01!04!2010 08/27/1926 Decedent's Last Name Suffix Decedent's First Name M! McClain Mary Jane (if Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Soria{ Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL fN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (Date of Death O 4. Limited Estate O Prior to 12-13-82) 4a. Future interest Compromise (date of O 5. Federal Estate Tax Retum Required d eath after 12-12-82) O 6. Decedent Died Testate O (Attach Copy of Will) 7. Decedent Maintained a Livin Trust Q 9 $. Total Number of Safe Deposit Boxes {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) B . etween 12-31-91 and 1-1-95} (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTtAL TAX INF~tMATION SHOUL N ame D BE DIRECTED T0: Daytime Telephone Number Linda McClain (717) 873-2141 First Line of Address 225 Autumn Woods Ct Second Line of Address Ciry or Post Office Dittsburg State ZIP Corte Pa 17019 REGISTER ~S USE OILY -,~. r, ~ `_: ~, , .~ ~ ,N,..l r , -- ~ ~r~ J'; ~; ~~_.~~ _~ "" ~.~'7 ---~ . s -t-- r E.. DATE~`ILED ~~~_, 4~ .... _.:: ~:'~ ~) --r~r Correspondent's e-mail address: lam1866@comcast.net Under penalties of perjury, i declare that 1 have examined this return, including acxompanying schedules and statements, and to the best of m knowie it is true, correct and complete.. Declaration of preparer other than the personal representative is based on all information of which Y dge and belief, SIG A E OF P RSON S SIB ILlNG RETURN Arepaner has any knowledge. DAT AD ES ~ J 5 ~ G~ ~~~u ~ l7oi SIGNATURE OF PREPARER OTHER THAN REPRESE ATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 1505610105 Side 1 1505610105 J REV 1500 EX (Fl) 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) ...............10, 11. Total Deductions (total Lines 9 and 10) ........... . ..................... i1. Decedent's Social Security Number Decedenfs frame: 201-18-5722 RECAPnvLAnON 1. Real Estate (Schedule A)... • • • , . _ , , , . ............................... 1. 2. Stocks and Bonds (Schedule B} ................ . ...................... 2. 3. Ckisety Held Corporation, Partnership or Sale-Proprietorship (Schedule Cj . ~ ... 3. 4. Mortgages and Notes Receivable (Schedule D) ................... . ... . ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Properly (Schedule E)....... 5. 3, 973.49 6. Jointly Awned property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Tota! Gross Assets (total Lines 1 through 7) . _ .... , ...................... 8. 3,973.49 9. Funeral Expenses and Administrative Gosts (Schedule H) ..... , ............. 9. 1,459.47 1505610205 12. Net Value of Estate (Line 8 minus Line 11 ..............................12. 2,514.02 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. 2,514.02 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_ 16. Amount of Line 14 taxable 15. at lineal rate X .0 _ 17. Amount of Line 14 taxable 1 s' 113.13 at sibling rate X .12 18. Amount of Line 14 taxable 17. at co{lateral rate X .15 19. TAX DUE .............. . ..........................................19. 20. FILL IN THE OYAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505610205 Side Z 15056],0205 1,459.47 113.13 O J REV-15oo EX (Ft) Page 3 Decedent's Complete Address: Mary Jane McClain STREET ADDRESS Golden Living Center 4fi Erford Road cmr ____-_--- Camp Hill Tax Payments and Credits: L Tax. Due (Page 2, Line 19) 2. CreditslPayments 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. Fill in ova! on Page 2, tine 20 to request a refund. File Number STATE --- -- --- ~ Z(P -- Pa a 17019 (1) 113.13 Total Credits (A + g) (2} (3} - /• 7~ (4} 5. !f Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. ~ ~~ 3 (5) _ ! ~ 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 tr f a ans er and. a. retain the use or income of the ro P party transferred .............................. ............................................... b t i ~~~ ~ Yes ~ ~~~ No ^ . re a n the right to designate who shall use the ro P PedY transferred or its income ................... c t i _ . . re a n a reversionary interest ............. d ^ . receive the promise for life of either payments, benefits or care? ....... . .......................................... 2 !f ......... . death occurred after Dec. 12, 1982, did decedent transfer .... Property within one year of death ....... without receiving adequate consideration? .............................................................................................. 3 D " Q .......... . id 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 acco t ...... ...... [] un , 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 sunrivin is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. g spouse 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 survivin souse is [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 d sclosure f 0 percent filing a tax return are still applicable even if the surviving spouse is the only beneficiary. ° assets and 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 arent adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. P , an • 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 2 P.S. 9116 • The tax rate imposed on the net value of transfers to or for the use of the decedents siblin s is 12 ~ § (a)(1)]. under Section 9102, as an individual who has at least one parent in common with the decedent, whether by bl7ood or adoptio(n.)(1.3)]. A sibling is defined, REV-1506 EX + (1-91) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY r~' ~ ~ FILE NUMBER Inclu a 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 di ITEM sclosed on Schedule F. NUMBER DESCRIPTION VALUE AT DATE ~ • ~1 ~~,,~ OF DEATH s _ `/ N ~-- "' ~ ~ rU y I•~t ~%~-n ~ ,-v d(,/tom Ct~ TOTAL (Also enter on line 5, Recapitulation) $ ~ ~ ~ ~, (If more space is needed, insert additional sheets of the same size) ~~ ~ ~ ~ ~ ~ o ~ ~ '~" o ~a~ ~- ~ e '~ ~ ~ ~ `, z , , ,J k ,~ ~I ~ ~- ~ ~ ~~ ~ ~ , , ~ ~ ~ ~ ; ~ , ~ r~ f:~ yy~~ ~. ~ may. ~ 9v ~ ~~ ~ ` - _ ~ ., ,. ~ ... ~ 1 ~1 1/I ~'^ )j ~ ~ „~ ~~ r' /j /i j ~/ ~ ( ~ 7 ~~f i , ~ Q ~ )~ t 7 ~ ~`C ~ ~, ! i ~~ ~ ~L.4 ~. ~ ~ ~ ` ~ { ~ " , ,.~,, __. ~ } a~ _ j .;: _. ~~ Q' g ~~ j 4Sj ~ ~ - ~. ... T 4..,7 ..... ~ L ~~ ~ L ~ /~~ .... L ~. _ O ~~ f ~ ~~ ~ ' ' V. , :,, ~ : ~ o o ~"~ U ~~ K ~ ~~ ~ ~~. ~ ~„~ gm ~" ;:1 ~ ~ `~~ r ~'_' :1,. a i ~ ~ } ~~ ;~ x~. • REV-1511 EX+ (10-06) . , 7r COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~ t ur n s, SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ueots or aecedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION 1. ~~~d~ AMOUNT 137, ~7. B. ADMINISTRATIVE COSTS: ~ ~ Personal Representative's Commissions Name of Persona! Representative(s) _ _/~)-rV f~ ~4- ~ ~ ~ ~ ~ ~ ~J Street Address __-~~~~ ~~ cc ~'y ,~ -_ -- (~~_, c~ ~ S-_ ~1 ~ - --- c~ty -_ ~ i l S ~ r , ~~, State tf~ Zip ~ ~Q/ --- Year(s) Commission Paid: 2. Attorney Fees 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 ~~r ~ 5• Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ ~ ~~S ~ y 7 (If more space is needed, insert additional sheets of the same size)