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HomeMy WebLinkAbout03-16-11 (2) 1505610101 REV-1500 Ex ~a~-lo, w;.,:, PA Department of Revenue OFFICIAL USE ONLY Pennsylvania Bureau of Individual Taxes PO BOX 28o6oi CEiAFTMENT Of REJEKOE County Code Year File Number INHERITANCE TAX RETURN _ _ /'"~ ~_~ ~ Harrisburg, PA 1128-0601 ~ ~ RESIDENT DECEDENT („1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY j 252-54-3875 ' ' 06 /12/2008 03/31 /1936 Decedent's Last Name Suffix Decedent's First Name MI ._ _ 'Moore _ Mary Ann _ __ (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 iINILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return Q 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} L.otiuc,enn 17 Z7 n7 .....,~ 4 4 nG\ inu__~ n_~ .,~ - - CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Margaret Patrick (717) 774-8871 C '~ ~' REGISTER OF WIL~}USE ©AILY : - { ~ . I ~7 First line of address ~;~ ~• - 356 Futurity Dr. C , ~ ~ °'-- :- = Second line of address ,r' ~;,,~ ~~ __ _ _ _ __ _ _ __ .. ~ n~ t~ _~I 1~.7 Cit or Post Office Y State ZIP Code D FILED ~~ ~ -.z7 _ __ ~__ -, 7~ Cam Hill p _ s -~~' FA 1701 i ' ~ ~ z.~ ..- ' ~ ~ _. ~:: ._'s' ~...,.1 _.._~_ ~ Correspondent's a-mail address: -'^' `~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the besti ofi~tily>ICrnawledge-arid belief, : it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which prelfa~Rtaas any know•Tedge. _ _.. _ .. _! SIGNATURE OF SON RESPONSIBLE FOR FI G RET _. ~~E -r-~ G ~ ~ ~ :~- ,.. t"i ADDRESS _ I , ~ 1 ~r.~ /~ / ~• SIGNATURE OF PREPARER OTHER THAN EPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: Mary Ann Moore 252-54-3875 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 1,463.64 2. Stocks and Bonds (Schedule B) ................................... .... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. __ 4. Mortgages and Notes Receivable (Schedule D) ....................... .... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property _ _. (Schedule G) O Separate SiNing Requested.... .... 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 1,463.64 9. Funeral Expenses and Administrative Costs (Schedule H) ............... .... 9.. 10. Debts of Decedent, Mortgage Liabilities, and Liens {Schedule I) .......... .... 10. 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 1,463.64 13. Charitable and Governmental BequestslSec 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. ' 1,483.64 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,. 15. 16. _. .... Amount of Line 14 taxable . _ at lineal rate X .0 45 1,463.64 '' 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. 65.86. 20. FILL IN THE OVAL 1F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1,505610105 REV-1500 EX Page 3 Decedent's Complete Address: File Number Mary Ann Moore f/k/a Mary Ann SulUvan STREET ADDRESS 824 Lisburn Road, Room 222 ..CITY _ _ STATEPA ZIP17011 Camp Hill Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 65.86 2. Credits/Payments A. Prior Payments _ --_ ---~___ _ B. Discount Total Gredits (A + B) (2) 3. Interest (3) 5.94 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5} 71.80 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: 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 Dec. 12,1982, did decedent transfer property within one year of death 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? ........................................................................................................................ ^ 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)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 beneficiaries ' is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)J. • 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 1737-2 EX + (6-08) (FI) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCI~IEpVLE A, PART 1 REAL ESTATE IN PENNSYLVANIA ESTATE OF FILE NUMBER Mary Ann Moore Part 1 must include all real property owned by the decedent individually or as a tenant in common with another party(ies), having its situs in Pennsylvania. Property jointly-owned with right of survivorship should be disclosed on Schedule F. All real estate must be reported at fair market value, which is defined as the price at which property would be exchanged between a willing buyer and a (If more space is needed, use additional sheets of paper of the same size) • REV-1737-7 EX + (6-08) REVERSE ~ pennsylvania SCNEDt/LE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF FILE NUMBER Mary Ann Moore When flat rate method is elected, list the beneficiaries of the Pennsylvania property. When proportionate method is elected, list all beneficiaries. ITEM RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. 2116 (a)(1 2)] 1. . :Margaret Patrick, 356 Futility Drive, Camp Hill, PA 17011 .Daughter 487,88 2. Maureen Sullivan, 5311 N.E. 179th St., Vancouver, WA 98686 Daughter 487.88 3. Thomas Sullivan, 2640 Sandra Ave., Red Lion, PA 17356 Son 487.88 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II (Enter total non-taxable distributions on Line 13 of REV-1737 cover sheet.) $1,463.64 (If more space is needed, use additional sheets of paper of the same size) 1505610101 REV-1500 Ex ~O1.1°' ' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number DEPARTMENT Of REYERUE Bureau of Individual Taxes _....... _...... __ _ ................................... PO BOX z8o6o1 INHERITANCE TAX RETURN Harrisbur , PA 1 1z8-o6o1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Sirth MMDDYYYY 252-54-3875 ` 06/12/2008 03/31/1936 Decedent's Last Name Suffix Decedent's First Name MI Moore Mary Ann (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 ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. 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 T0: Name Daytime Telephone Number Margaret Patrick (717) 774-8871 REGISTER OF WIL~IJSE ONhY ~ } =. ~ ~i.t a ~-~ +i~~~ 1 V '7 1 E.. ~_ 7 ~- ~ 1 -..+ "`~ DATE FlL~D Camp Hill ! PA ' 17011 ~ =ll Correspondent's a-mail address: 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. SIGNATURE OF SON RESPONSIBLE FOR FI G RET DATE. ADDRESS ~~` `/ ~ `_ ~ / SIGNATURE OF PREPARER OTHER THAN EPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J J 1505610105 REV-1500 EX Decedent's Social Security Number Decedents Name: Mary Ann Moore 252-54-3875 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 1,463.64 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Sank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 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. 1,463.64 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. '. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 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. 1,463.64 1,463.64 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or trans ers under Sec. 9116 (a)(1.2) X .0_ 15. ..,..,.m..._.M ...m...~.~_.~_ ..... .................._..w. _....,..~.~.. _ .~ .... _.....:. 16. Amount of Line 14 taxable .... .:, , .._ ~. _......._.,~._..,~ ~..,_ .....~ ... ,..... ..~....... ~..:. .. .:_... at lineal rate X .0 45 1,463.64 ' 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. 65.86 19. TAX DUE ......................................................... 19.; 20. FILL IN THE OVAL 1F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 15D56101D5 REV-1500 EX Page 3 File Number Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 2, Line 19} (1) 65.86 2. CreditslPayments A. Prior Payments - ----------- -~---_-__-_- . B. Discount Total Gredits (A + B) (2) 3. Interest (3) 5.94 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 71.80 Make check payable to: REGISTER OF WILLS, AGENT. 5 ..... .... :. : ~c ]i. .... .%q...... ..... ~F ''.~4ui..'~1,. A~'.~~/i... :..L.:...k~~Y3. ~~~~ .. .w~'.x ... ~~. .... ...... a~:F..`~S".> 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 :.......................................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ ................................ c. retain a reversionary interest; or ............................................................. ...........................,. ^ 0 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" or payable-upon-death bank account or security at his or her death? .............. ^ 0 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)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and tiling 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 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)]. Asibling is defined, under Section 9102, as an individual wha has at least one parent in common with the decedent, whether by blood or adoption. REV 1737-2 EX + (6-08} (FI) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDt~LE A, PART 1 REAL ESTATE IN PENNSYLVANIA ESTATE OF FILE NUMBER Mary Ann Moore Part 1 must include all real property owned by the decedent individually or as a tenant in common with another party(ies), having its situs in Pennsylvania. Property jointly-owned with right of survivorship should be disclosed on Schedule F. All real estate must be reported at fair market value, which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell and both having reasonable knowledge of the relevant facts. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~ • 50 % ofi Unit 456, Int. No. 37, Faiway Village, Shawnee-on-Delaware, PA 18372 Timeshare 1, 463.64 PART 1 TOTAL 1, 463.64 PART Z TOTAL 0.00 (From reverse side.) $ 1,463.64 TOTAL (Also enter on Line 1, Recapitulation) $ (lf more space is needed, use additional sheets of paper of the same size) REV-1137-7 EX + {6-08) REVERSE ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCHEDt~LE J BENEFICIARIES ESTATE OF FILE NUMBER Mary Ann Moore When flat rate method is elected, list the beneficiaries of the Pennsylvania property. When proportionate method is elected, list all beneficiaries. ITEM RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) RECE1ViNG PROPERTY DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under Sec. 2116 {a)(1.2)] 1. __ : _ :Margaret Patrick, 356 Futility Drive, Camp Hill, PA 17011 :Daughter 487.88 2. Maureen Sullivan, 5311 N.E. 179th St., Vancouver, WA 98686 Daughter 487.88 3. !Thomas Sullivan, 2640 Sandra Ave., Red Lion, PA 17356 Son 487.88 ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE . .......................... .. __ __ __ ,' B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II (Enter total non-taxable distributions on Line 13 of REV-1737 cover sheet.) $1,463.64 (If more space is needed, use additional sheets of paper of the same size)