HomeMy WebLinkAbout03-22-11 (2) 1,50561,01,40
REV-1500 EX (°'-'°'
OFFICIAL USE ONLl__
PA Department of Revenue _
Bureau of Individual Taxes County Code Year File Number
PU BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 ~' 1, ~~ 1. 1, 8 8
ENTER DECEDENT INFORMATION BELOW
Social Security Numbe~ Date of Death MMDDYYYY Date of Birth MMDDYYYY
1, 8 0 0 9 6 3 4 9 1 0 2 8 2 0 L 0 L D 2 9 1, 9 L 6
Decedent's Last Name Suffix Decedent's F=irs t Name MI
B A K E R E L I S E f1
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Las# Name Suffix Spouse"s First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE 1=ICED IN DUPLICATE V111'TH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder I~.eturn (date of death
prior to 12-~1;3-•g2)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 6. Decedent Dieci Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of ;>afe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 911;3(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 Daytirne Telephone Number
~1 U R R E L W A L T E R S I I I E S Q- 7 ~, 7 6 `~ "r' 4 6 ~i 0
REGISTER OF YVILI_S USE ONLY
First line of address
5 4 E A S T
Second line of address
f1 A I N S T R E E T
City or Post Office
S E C H A N I C S B U R G
Correspondent's a-mail address:
State ZIP Code 1.
P A 1, 7 0 5 5
DATE FILED
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules ;and statements, and to the best of my knowledge anti belief,
it is true, correct and co pNete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT ~ E PE Ot~RESPONSIBLE FOR FILING RETURN DA -~,
~ f
J/E REY W. BAKER, ],08 E• KELLER ST MECHANIC:SBURG PA_ 1~7D55
SIGNATURE OF,P ARE~t OTHER THAN REPRESENTATIVE y I~A~-E
f ' ,~, i' ~ ~' rf
ADDRESS ~' ~~ „/ i' f, , ~ ---
MURRE "~ • ~ WA RSG ESQ • 54 E - h1AIN ST MECHANIC:SBURG PA 17055
1505610140
PLEASE USE ORIGINAL FORM ONLY
Side 1
1,50561,01~4~0
~~~
~,.
~.~~
J
],50561,0240
REV-1500 EX
Decedent's Social Security Num ber
Decedent's -vame: ELISE f`1 BAKER I, 8 0 0 `~ 6 5 4 9
RECAPITULATION
1. Real Estate (Schedule A) ......................................... .. 1. ~' 2 ~ l{ 3 B 0 0
2. Stocks and Bond:s(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. 7 5 8 _3 9 I, 7 9
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 through 7) ......................... .. 8. 8 8 ~ ~~ 2 4 . ~ 9
9. Funeral Expenses and Administrative Costs (Schedule H) ............ ...... 9 2 5 ~~ 3 9 . 5 0
10. Debts of Deceden ,Mortgage Liabilities, and Liens (Schedule I) ..... , . ..... 10. I ~5 9 6 . 5 2
11. Total Deductions (total Lines 9 and 10) ......................... ..... 11. 2 i 6 B 6 . 0 2
12. Net Value of Estate (Line 8 minus Line 11) ....................... ...... 12. 8 5 6 1~ 8 8 . 7 7
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax, has not been made (Schedule J) ............... ...... 13 4 [) 0 Q . Q Q
14. Net Value Subject to Tax (Line 12 minus Line 13) ................ ...... 14 8 5 2 1, 8 8 . ~ 7
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax. ~~ate, or
transfers under Sec. 9116
(a)(1.2) X .0 0 0 Q 15.
16. Amount of Line 14 taxable
at lineal rate X .045 8 5 2 1, 8 8 7 7 16.
17. Amount of Line 14 taxable
at sibling rate }; .12 0 0 0 17.
18. Amount of Line 14 taxable
at collateral rate :X .15 0 0 0 18.
19. TAX DUE ........... ........................... .. ..... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0. 0 0
3 8 .I 4 8. 4 9
0. 0 0
0. 0 0
5 8 2 ~4 8. 4 9
Side 2
1,50561,0240 1,50561,0240 J
REV-150o EX Page 3 File Number
Decedent's Complete Address: 21 1 ~ 1188
DECEDENT'S NAME
,ELISE M. BAKER
r- ------- _ - _ _
~ STREET ADDRESS
X125 E. KELLER STREET
CITY
,SHIREMANSTOWN
STAGE
PA
Tax Payments and Credits:
~ Tax Due (Page 2, Line 19)
2 Credits/Payments
A. Prior Payments 33,000.00
B. Discount 1,650.00
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.
(1} 38,348.49
Total Credits (A + B) (2) ~_ 34,650.00
(3)
(4)
0.00
(5) ___~ 3,698.49
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: 'y'es ~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 .............................................................................................. .. ® Q
d receive the promise for life of either payments, benefits or care? ......................................., ............ .. ^ [~
2. If death occurrecti after December 12, 1982, did decedent transfer property within one year of death
without receivinc 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 ow~~ an individual retirement account, annuity or other non-probate property, which
contains a benerf ciary 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) (1.1j (i)].
For dates of death on or after Jan. 'I 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is t) percent
[72 P.S. §9116 (a) (1.1) (ii)j. The sta~.ute 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 benefici,~ries 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(ai(1.~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.
REV-1502 EX+ (01-10)
pennsylvania ~ SCHEDULE A
DEPARTMENT OF RE`JENl1E
INHERITANCE TAX RETUR~J REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ELISE M. BAKER 21 10 1188 _ _
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value 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, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has beer sold
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. 125 E. GREEN STREET 125,433.00
SHIREMANSTOWN, PA 17011
COUNTY ASSESSED VALUE
TOTAL (Also enter on Line 1, Recapitulation.), $ Y_ 125,433.00
If more space is needed, use additional sheets of paper of the same si?e.
REV-1508 EX + (6-9E~)
COMMONWEALTH OF PENNSti'LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ELISE M. BAKER _
FILE NUMBER
21 10 1.188
Include the proceeds of litigation and the date the proceeds were received by the estate.
Afl property jointly-owned with right of survivorship must be disclosed on Schedule F.
{TEM _
i VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. METRO BANK _ _
_ 9,907.25
CHECKING
2. PROCEEDS FROM SALE OF HOUSEHOLD CONTENTS 7,648.25
3. WACHOVIA 62,192.63
CERTIFIGAI"E
4. HERSHEY TRUST COMPANY 678,643.66
REVOCABLE TRUST
TOTAL (Also enter on line 5, Recapitulation) ~ :6 +_ 758,391.79
(if more space is needed, insert additional sheets of the same size)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
REV-1511 EX+ (10-09~
pennsylvania SCHEDULE H
DEPARTMENT OF RE\JEN lE FUNERAL EXPENSES AND
INHERITANCE TAX RETUF?t' ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ELISE M. BAKER 21 10 1188
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXF'E_NSES:
1. GEORGE STUBER -GRAVE OPENING 175.00
2. PASTOR FLOYD CAREEN -MEMORIAL SERVICE 300.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name() of Personal Representative(s) JEFFREY W. BAKER 15,000.00
Street Address 108 E. KELLER STREET
Citti~ MECHANICSBURG State PA- _ ZIP 17055
Year!;s`, Commission Paid: 2011
2. Attorney Fees: MURREL R. WALTERS, III 9,625.00
3, Family Exemption, !If decedent's address is not the same as claimant's, attach explanation.)
Clamant
Street Address
City ~ State _ ZIP
Relationship of Claimant to Decedent
4. Probate Fees. CUMBERLAND COUNTY REGISTER OF WILLS 639.50
5 Accountant Fees
6. Tax Return Prepa~er Fees.
7.
TOTAL (Also enter on Line 9, Recapitulation) I $i_ 25,739.50
If more space is needed, use additional sheets of paper of the same size.
REV-151?_ EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RE1UR~
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ELISE M. BAKER 21 10 1188
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. VERIZON 65.39
PHONE
2. PA WATER 132.78
WATER
3. DONEGAL INSURANCE 409.00
HOME OWNERS
4. PPL 257 11
ELECTRIC
5. U-HAUL 69.37
TRANSPORTATION FOR AUCTION
6. IWS 37.02
REFUSE
7. BROUGH OF SHIREMANSTOWN 50.00
SEWER
8. WEST SHORE EMS 325.11
MEDICAL
9. JUDY C. PROWELL 550.74
201t~ COUNT'YlBOROUGH TAXES
TOTAL (Also enter on Line 1Q Recapitulation) ~ _$ .- 1,896.52
If more space is needed, insert additional sheets of the same size.
11EV-1513 EX+ (G1-10)
pennsylva~ia SCHEDULE J
DEPARTMENT OF REVEIV 1E BENEFFIC~QR~EJ
INHERITANCE TAX RETUFih R J
t~iHitvr: ------- ---
ELISE M. BAKER 21 10 1188 _~
RELAI-IONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) ~~ OF ESTATE
j TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 911& (a) (1.2).]
1. JEFFREY W. BAKER Lineal
108 E. KELLER STREET
MECHANICSBURG, PA 17055
2. CAROL A. BAKER' Lineal
108 E. KELLER STREET
MECHANICSBURG, PA 17055
3. ZACHARY W. BAKER Lineal 25,000.00
108 E. KELLER STREET
MECHANICSBURG, PA 17055
4. DARIA N. CARR Lineal 10,000.00
435 E. FREEMAN STREET, #2A
NORFOLK, VA 235-10
5. CASSANDRA J. CRAWFORD Lineal 25,000.00
108 E. KELLER STREET
MECHANlCSBURC-~, PA 17055
6. RACHEL E. CRAWFORD Lineal 500.00
108 E. KELLER STREET
MECHANICSBUR~~, PA 17055
7. DARTAN{AN A. CRAWFORD Lineal 500.00
108 E. KELLER STREET
MECHANICSB URG, PA 17055
ENTER DOLLAR AMOL-NTS FOR DISTRIBUTIONS SHOWN ABOVE ON L1NES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS ,APPROPF;IATE.
jj_ NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBI_--'-IONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1. FIRST CHURCH OF GOD
33 S. LOCUST STREET
SHIREMANSTOWN, PA 17011
4,000.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1:i00 COVER SHEET. $ 4,000.00
If more space is needed, use additional sheets of paper of the same size
Continuation of REV-1500 Inheritance Tax Return Resident Decederlt
ELISE M. BAKER Z1 10 1188
Decedent's Name Page 1 File Number
Schedule J -Beneficiaries - 1
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Duo Not List Trustee(s) _ ,4MOUNT OR SHARE
_P OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
8. GWENDOLYN K. STEWARD Lineal 1,000.00
6250 BEDFORD STREET
HARRISBURG, PA 17111