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Home My WebLink About03-29-11~ 1505610101 REV-1500 Ex `°1.1°' ~ erns lvania OFFICIAL USE ONLY PA Department of Revenue P Y OEP~PiMENt OF FEVENl1E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~ ~ ~~ PO BOX 28o6oi ~~ Harrisbur , PA i 128-o6oi RESIDENT DECEDENT ~ , ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 301-22-4612 03/02/2006 01 /13/1927 Decedent's Last Name Suffix Decedent's First Name MI Manhollan Ruby A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O O 4. Limited Estate O O 6. Decedent Died Testate O (Attach Copy of Will) O 9. Litigation Proceeds Received O THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax I;etum 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. TO: Name Daytime TelephotTO Number ~'-:_- '.~.D Mary Ellen Stilo (717) 506-0~~ ~ ` .~ ,. z C') ~ , : - REGISTERFOF USE ONLY ~ ~: i` ~, .. __. ~ t.~3 y.^ .. . . .- - ~_ C ` rr -...... ~ ° /' \ First line of address ~.~~ '~~~ ~ _.~ ^ , 65 Lori Circle ~ ~ :-'`i ~' ~ :~ Second line of address ^ 7 ~ ~-~... ~: ~ --r~ City or Post Office Mechanicsburg Correspondent's a-mail address: State ZIP Code I DATE FILED Pa 17050-3665 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. De ration of preparer other thanRlt~he personal representative is based on all information of which preparer has any knowledge. N~~R~OF~E~S~O~ RE ~~ IB~FOR ILS~~f l~l~~/ d DATE ADDRES SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE= ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 ~(,~q"-- 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: 301-22-4612 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 56,500.00 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 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 56,500.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 27,020.00 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 23,739.67 11. Total Deductions (total Lines 9 and 10) ................................. 11. 50,759.67 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 5,740.33 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. 5,740.33 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 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 (~ANG~?~ ,~ ~N~ 5,740.33 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. TAX DUE ...................................................... ...19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 688.83 688.83 O J I~pcpclpnt's Comntete Address: DE EDENTS NAME STRE ADDRESS ~ 1: ZIP CI - -- ,STATE Tax Payments and Credits: 1. Tax Due (Page 2, Line 19} 2. CreditslPayments A. Prior Payments B. Discount 3. Interest Total Credits (A + B) (2) (3) 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) Make check payable to: REGISTER OF WILLS, AGENT. (1} 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 transfier property within one year of death without receiving adequate consideration? .............................................................................................................. ^ ^ 3. Did decedent own an "in trust fora 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 propertyr, which contains a benefiaary designation? ........................................................................................................................ ^ ^ !F THE ANSWER TO ANY OF THE ABOVE QUESTIONS !S YES, YOU MUST COMPLETE SCHEDULE G AND FILE !T 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 survNing spouse is 0 percent [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 disdosure of assets and filing a tax return are stall applicable even if the surviving spouse is the only benefiaary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased cthild 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 decedents lineal benefiaaries is 4.5 percent, except as no#ed in 72 PS. §9116(1.2) [72 P.S. §9116(a)(1)j. • The tax rate imposed on the net value of transfers to ~ for the use of the decedent's siblings is 12 percent (72 P.S. §9116(a)(1.3)j. 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.