Loading...
HomeMy WebLinkAbout03-30-11 (2)J 1505610140 REV-1500 EX `°'-'°' OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po sox 28oso1 2 1 1 0 1 1 2 8 Harrisbu PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 2 0 0 2 8 6 7 1 3 1 0 0 6 2 0 1 D 0 1 2 3 1 9 1? Decedent's Last Name Suffix Decedent's First Name MI E R B H A Z E L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI FILL IN APPROPRIATE OVALS BELOW 1. Original Return 0 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe 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. 9113(A) h O S between 12-31-91 and 1-1-95) . ) c (Attach CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number J A C Q U E L I N E A K E L L Y 7 1 7 5 4 1 5 5 5 0 First line of address 8 4 5 S I R T H O M A S C O U R T Second line of address S U I T E 1 2 City or Post Office H A R R I S B U R G State ZIP Code ~ REGISTER OF WILLS USE_ONLY ~ -~-t ~ r-~ 1 C ] r`'~n ~ ~ ~,`i ~ ;1 ~ ' ' , ~ T i ~ i i C~.7 '~ ,' 1 ~ 1 J t ? C/7 ~ ~ f, ~ = c~ 6A~FILED ~~ : ;-ri - _ __ _-- r- -- ~, c~ ~~ °ri P A 171 09 u- Correspondent's e-mail address: JACKIEJLB@VERIZON NET Under penaltles of pery'ury, I deGare that 1 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. SI TURE OF PERSON R~O SIBLE FOR FILING RETURN DATE ~ 3- ~ ~ '~1 1... 85G TRAVER ROAD SIG TURE OF P EPARE T AD ESS 8 5 S R THOMAS COUR 1505610140 LEWISBERRY REPRESENTATNE STE 12 HARRISBURG PLEASE USE ORIGINAL FORM ONLY Side 1 PA 17339 DATE 3~~Q-1~ PA 17109 1505610140 ~ n l~-~ J 1505610240 REV-1500 EX necedent's Name: HAZEL E R B Decedent's Social Security Number 2 0 0 2 8 6 7 1 3 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. ......................... Mortgages and Notes Receivable (Schedule D) 4. . 0 . 0 0 7 5 2 2. 1 2 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ...... . 6. 0. 0 0 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property ~ Separate Billing Requested ...... . 7. Q • Q Q (Schedule G) 8. ............ Total Gross Assets (total Lines 1 through 7) .............. . 8. 7 5 2 2. 1 2 9. ............ Funeral Expenses and Administrative Costs (Schedule H) .... . . 9• 3 4 5. 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ . 10. Q ' Q Q 11. Total Deductions (total Lines 9 and 10) .............................. . 11. 3 4 5 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ........................... . 12• 7 1 7 ? . 1 2 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. 7 1 7 7 . 1 2 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15. 0. 0 0 (a)(1.2) x.o - . 16. Amount of Line 14 taxable 7 1 7 7 1 2 1 s 3 2 2. 9 7 at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 Q 17. 0 • 0 0 at sibling rate X .12 18. Amount of Line 14 taxable Q 0 0 18 0 . 0 0 at collateral rate X .15 . 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610240 Side 2 3 2 2. 9 7 Dx 1505610240 REV-1500 EX Page 3 File Number 21 10 1128 LJCG15aaailRa vvn~pr~`w .-.v... ...... DECEDENTS NAME HAZEL ERB --- - STREET ADDRESS 46 Erford Road ---- ----- - -- - STATE ZIP CITE PA 17011 Camp Hill Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 322.97 2. CreditslPayments A. Prior Payments B. Discount Total Credits (A + B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 00 0 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) 322.97 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 propeRy 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 December 12,1982, did decedent transfer property within one year of death ^ without receiving adequate consideration? ..................................................................................... 3. Did decedent own an "in trust for' orpayable-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? ................................................................................................ .. 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)J. • 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)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. REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY FILE NUMBER HAZEL ERB 21 10 1128 -ndude the proceeds of litgation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. GGNSC Administrative Services; refund from Golden Living Center 7,372.12 2. PA Department of Revenue; refund on 2010 tax return 150.00 TOTAL (Also enter on line 5, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER HAZEL ERB 21 10 1128 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A, FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: 1 AMOUNT Attorney Fees: Jan L. Brown & Associates 225.00 2. g, Family Exemption: {If decedents address is not the same as claimants, attach explanation.) Claimant Street Address Chy State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5 Accountant Fees: g, Tax Return Preparer Fees: Steven Fahnestacht; preparation of final 1040 and PA-40 90.00 7, Register of Wills; filing fee for Supplemental Inheritance Tax Return & Inventory 30.00 State ZIP TOTAL (Also enter on Line 9, Recapitulation) I S 345.00 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: HAZEL ERB NUMBER NAME AND ADDRESS OF PER~SgON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Inclus~ 91 i6 (a)~(1u ~~distnbutions and transfers under 1. Jerry L. Erb 856 Traver Road Lewisberry, PA 17339 2. Dale E. Erb 105 Park Drive Dover, PA 17315 3. Gary L. Erb 625 Elliott Drive Lewishberry, PA 17339 II. 1 1. FILE NUMBER: 21 10 1128 ~TIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Lineal 2,392.37 1/3 residue Lineal 2,392.37 1/3 residue Lineal 2,392.38 1/3 residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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. I S If more space is needed, use additional sheets of paper of the same size. ~v ~~L.~~~~~~ INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA ~ SS COUNTY OF CUMBERLAND File Number 21 10 1128 Personal Representative(s) of the Estate of HAZEL ERB deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end o//f this i~nv~entory. I verify that the statements made in this Inven- off. ~t/1-~ tory are true and correct. I understand that false state- JER L. ER ,Executor ments herein are made subject to the penalties of 18 Pa. C.S. § 4904 relating to ttnsworn falsification to authorities. Attorney -- (Name) Jacqueline A KeIIV (Supreme Court I.D. No.) 91973 (Address) 845 Sir Thomas Court Suite 12 Harrisburg PA 17109 (Telephone) 717-541-5550 DATE OF DEATH LAST RESIDENCE DECEDENTS SOC. SEC. NO. 46 Erford Road 10/6/2010 Cam Hill PA 17011 200-28-6713 FIGURES MUST BE TOTALED GGNSC Administrative Services; refund from Golden Living Center 7,372.12 PA Department of Revenue; refund on 2010 tax return 150.00 n •~r ~ =~ ~ ~ -- ` ` : ~=:`::3 . i '~t f ~t _{ ._ / \_a ~J . .1 rte. v '+..J __ r..E y ~ ~ `~ II W (Attach additional sheets as needed) 7 12 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b)) Form RW-09 rev. 10.13.06 JAN L. BROWN 8~ ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW .JAN L. BROWN, ESOUIRE JACQUELINE A. KELLY, ESQUIRE Q-IRISTA IVI. APLIN, ESQUIRE Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 OLDE ENGLISH GAP $45 SIR THOMAS COURT SUITE 12 f"IARRISBURG, PA 17109 EMAIL: jlbassoc@verizon.net wvvw. janbrownlaw.com TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 March 29, 2011 Re: Estate of Hazel Erb Estate No. 2010-01128 Executor: Jerry L. Erb Gentlemen or Ladies: r -.~ C7 ~o c.e-> 4 :~.~ _~ ;-., ~ ~7 ~"' -rt C_'~ ~ - gym -~ cry ~ w Gy •, ,. --, --~' ~ J - ~ ,-j -,~ ~ ~.~ ' ~ w c.~ .- ~~ ~, Enclosed please find the following items for filing with the Register of Wills: I . Original and one copy of a Supplemental Inventory. 2. An original and two copies of a Supplemental Inheritance Tax Return. 3. Check payable to Register of Wills, Agent in the amount of $322.97 representing the inheritance tax liability shown to be due. 4. Check payable to Register of Wills in the amount of $30 for the filing fees for the Supplemental Inventory and Supplemental Inheritance Tax Return. Please time stamp and return our file copies of the Inventory and Inheritance Tax Return. Also, please provide us with the appropriate receipts. If you have any questions, feel free to contact this office. Sincerely, Jacque ine A. Kelly BRENDA F. KEPHART, LEGAL ASSISTANT PAULA K. WHITE, LEGAL ASSISTANT JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT Enclosures ~ i i ~~~~ * O r I ~ i r.~ m ~1 ~ W \ ~~ ~ 1 / ~ ~~,~ +V ~ C d ~~. ~~ ~ ~a ~~ a ,.- "- O Q. ~ ~~ ~ N O ~ S031Mn o ~ ~ J~ Ul c4'~ ~, u~ ._` c - - ~~ F--- ~ -- ,, ~~ _ , c; ~- -- u-- Q ~..3 c=,c~ ~ ~ ° o , ? ch v~ ==`~ ~z " " `~ ~~ ~ r ^± © ~-! V , C J G~ W ~ $ D ~ ~ rr O ~ y ~ a ~V a O ~ ~ z~ N '+ ~~ U ~ M a H °'o ~ ~z a o ~ ~ o~ ~a -a 2 Hew ~ ~ ~ ~ a a ] w oa ~~~ o a oAm ~~ ~ wawa ~-l ~ ~ ~i UH fl~W ~ W D Z ~ a~o~ F-