HomeMy WebLinkAbout03-24-11 (3)-~ REV-1500Ex(°'-'°' 1505610143
PA De artment of Revenue ~ OFFICIAL USE ONLY
P pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 60X.280601 INHERITANCE TAX RETURN 2 1 --A-~'""~' ,~ ,~ ~ '-~
Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~`,` ~ `' ~~~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
162 22 5371 12 24 2009 10 26 1927
Decedent's Last Name Suffix Decedent's First Name MI
GRANT FLORA 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
® 1. Original Return ^ 2. Supplemental Return
^ 4. Limited Estate ^ 4a. Future Interest Compromise
(date of death after 12-12-82)
® g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
^ 3, Remainder Return (date of death
prior to 12-13-82)
^ 5. Federal Estate T'ax Return Required
8. Total Number of Safe Deposit Boxes
^ 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 TO:
Name Daytime Telephone Number
TERRENCE J KERWIN 717 238 4765
First line of address
27 NORTH FRONT STREET
Second line of address
City or Post Office
HARRISBURG
State ZIP Code
PA 17101
REGISTER OF WILLS USE ONLY
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Correspondent's a-mail address: TJK@Kerwinlawfirm.com
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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.
SIGNAT F PERSON RESPONSIBLE FOR FILING RETURN DATE
• Marianne White ~,._ ~ ~--
ADDRESS "~ "- - " '" - - ~ `~
1049 N. Fairville Avenue, Harrisburg, PA 17112
SIGNATURE OF PREPARER OTHER THA REPRESENTATIVE DAVE
fit.-. Terrence J Kerwin '3 _._ ~ , _ ~
ADDRESS
27 North Front Street, Harrisburg, PA 17101
Side 1
1505610143 1505610143
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~_~,~
1505610243
REV-1500 EX
Decedent's Social Security Number
162 22 5371
~e~ede~~~s Name: GRANT , FLORA R .
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3.
4.
9 9 ( ) .......................................................
Mort a es & Notes Receivable Schedule D 4•
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5.
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 1-7 .........• ..................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10.
11. Total Deductions (total Lines 9 8~ 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.
TAX COMPUTATION -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 .00 15.
16. Amount of Line 14 taxable 2 0 9, 5 7 0 7 4 16
at lineal rate X .045 .
17. Amount of Line 14 taxable
at sibling rate X •12 17.
18. Amount of Line 14 taxable
3, 0 0 0 0 0
18
at collateral rate X .15 .
19. Tax Due .................................................................................................................. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
42,559.85
177,643.89
220,203.74
7,633.00
7,633.00
212,570.74
212,570.74
9,430.68
450.00
9,880.68
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 0 9
Ivl~ ___
Grant, Flora R.
_-_ - -
STREET ADDRESS
103 Arnold Road
CITY STATE ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
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.
Check box 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.
Total Credits (A + B)
(1) 9,880.68
(2) 0.00
(3) 167.28
(4)
(5) 10,047.96
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 ............................................................................................................... x
d. receive the promise for life of either payments, benefits or care? ............................................................ x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .................................................................................................................... x
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? .................................................................................................................. x __
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 January 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 (aj (1.1) n)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 )].
• 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)J. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by bloodd or adoption.
SCHEDULE E
CASH, BANKD~ EPOpSITS, &~MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERT i
INHERITANCE TAX RETURN
RESIDENT DECEDENT
____
FILE NUMBER
ESTATE OF Grant, Flora R. 21 - 09
Include 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 disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1 Sovereign Bank Money Market Savings Account #924087315 24,562.55
2 Sovereign Bank Premier Checking Account #211118672 735.29
3 Sovereign Bank Certificate of Deposit Account #0925539793 6,268.99
4 Sovereign Bank Certificate of Deposit Account #0925541179 1,080.65
5 Morgan Stanley Account #724-03750 -mortgage and asset backed securities 9,052.12
6 Morgan Stanley Account #724-03786 110.25
7 Household items 750.00
TOTAL (Also enter on Line 5, Recapitulation) I 42,559.85
' SCHEDULE G
COMMONWEALTH OF PENNSYLVANIA INTER•VIVOS TRANSFERS &
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
__
ESTATE OF Grant, Flora R. ,FILE NUMBER
21 - 09
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCR{PT10N OF PROPERTY DATE OF DEATH % OF EXCLUSION
Include the name of the transferee, their relationship to decedent VALUE OF ASSET DECD'S TAXABLE VALUE
NUMBER and the date of transfer. Attach a copy of the deed for real estate. INTEREST (IF APPLICABLE)
1 Sovereign Bank Certificate of Deposit, Account s29.9o 100% 629.90
#0925427965 ITF, Michael A. White, beneficiary
(grandson)
2 Sovereign Bank, Certificate of Deposit, Account s29.9a 100% 629.90
#0925427973 ITF, John D. White, beneficiary
(grandson)
3 Sovereign Bank, Certificate of Deposit, Account s~7.~4 100% 617.14
#0925496465
4 Lincoln Financial Group, annuity contract ss,o22.s9 100% 68,022.69
#953078680; beneficiaries-grandchildren- Michael A.
White, John D. White, Randle Kuharic and John
Kuharic
5 The Hartford, annuity contract #711574453, 19,468.75 100% 19,468.75
beneficiaries-grandchildren-Michael A. White, John D.
White, John L. Kuharic
6 MetLife, annuity contract #0442790; beneficiaries, 1o,s7s.49 100% 10,676.49
Michael A. White, John D. White, John L. Kuharic
7 Genworth Financial, annuity contract #706131353, 22,607.85 100% 22,607.85
beneficiaries-grandchildren, Michael A. White, John
D. White, John L. Kuharic
8 Genworth Financial, annuity contract #708022749, 36,030.33 100% 36,030.33
grandchildren, Michael A. White, John D. White, John
L. Kuharic
9 Genworth Financial, annuity contract #706134690, 4,500.54 100% 4,500.54
grandchildren, Michael A. White, John D. White, John
L. Kuharic
TOTAL (Also enter on line 7, Recapitulation) 177,643.89
' ~ SCHEDULE G
COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS &
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF Grant, Flora R. FILE NUMBER
21 - 09
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY °lo OF
DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER Include the name of the transferee, their relationship to decedent VALUE OF ASSET INTEREST (IF APPLICABLE)
and the date of transfer. Attach a copy of the deed for real estate.
- _ - _ --
10 Genworth Financial, annuity contract #706156084, ~4,~6o.so 14,460.30
grandchildren, Michael A. White, John D. White, John
L. Kuharic
Page 2 of Schedule G
SCHEDULE H
' FUNERAL DCPENSES &
COMMONWEALTH OF PENNSYLVANIA n/~
INHERITANCE TAX RETURN A~~TIY L. ~~'~
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Grant, Flora R. 21 - 09
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER FUNERAL EXPENSES:
A. 1 Neill Funeral Home 936.34
B. ADMINISTRATIVE COSTS:
~ , Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Kerwin & Kerwin -- Terrence J. Kerwin 4,000.00
3. Family Exemption: (tf 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 317.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Register of Wills, additions{ Short Certificates 8.00
TOTAL (Also enter on line 9, Recapitulation) 7,633.00
Schedule H
Furx~l E~enses &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
~'~ (;(X'~
RESIDENT DECEDENT
_
FILE NUMBER
ESTATE OF Grant, Flora R. 21 - 09
2 Register of Wills, filing fee for inheritance tax return and Cumberland County Inventory 30.00
3 American Home Patient 20.67
4 West Shore EMS 934.34
5 West Shore EMS 444.38
6 Pryme -account payable 25.00
7 Comcast -account payable 4.44
8 IRS - 2009 income taxes 70.00
9 PPL -electric 35.42
10 Golden living -account payable 360.00
11 Diane Selinkle (cleaner) 100.00
12 Advanta -account payable 94.00
13 American Water -account payable 56.10
14 East Pennsboro -sewer 116.27
15 UGI -gas 23.54
16 HealthSouth 14.00
17 Register of Wills -filing Releases 8.00
18 Closing costs, e.g. postage, copies 35.00
Page 2 of Schedule H
REV-1513 EX+ (11-08)
SCHEDULE J~+
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN R
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Grant, Flora R.
21 - 09
........._..... .
__ _
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Marianne Whilte (formerly Cochran) 1049 N. daughter 50% residue
Fairville Avenue, Harrisburg, PA 17112
2 Linda Sue Kuharic (formerly Cochran) 315 Fifth daughter 50% residue
Street, Box 323, Summerdale, PA 17093
3 German Caraballo friend 3,000.00
946 S. 21st Street, Harrisburg, PA 17104
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00