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HomeMy WebLinkAbout04-05-11~ 1505610105 REV-1500 EX (02-11) (FI)B!, iii OFFICIAL USE ONLI/ PA Department of Revenue Pennsylvania DEiARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ~ ) ~ ~3 7 Harrisbur , PA 1 i28-otios RESIDENT DECEDENT ~ ~ L t ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Z I l- I ~+ - ~ f y 0 r5' 09/02/2010 '...08/03/ 1924 _ Decedent's Last Name Suffix Decedent's First Name MI _ ___ _ REPLOGLE EMILIE S _ _ __ _ _ (lf 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 Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax. Retum Required death after 12-12-82) m 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) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number _. _ __ ,DWIGHT B. REPLOGLE (859) 512-0894 First Line of Address P O BOX 1523 _ _ _ Second Line of Address City or Post Office State ZIP Code REGISTER OF 1 l~! L.S USE ONL~',.;=,` - -_) ~ ~, _ _, ~...ri I ,~--, ~_ ~_~ ; .:~ ~ ~.,.._.. J~ i ~ ~ .. ,, _ ...~7 ..~-...,, 1'1ATC t'tl 1~r1 •~ '~ DELTA JUNCTION PA 17055 Correspondent's a-mail address: dwightreplogle@yahoo.com ~Z`t _'.~ r ._ _~..1 l.'r~ ~Y' 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 tr rrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN OF PERSOp6 SPON FO IL G ETU , DATE ~~ .~ .. 1: ~~ _ _ ~_ _ ~/ __. 03/14/2011 SIGNATt~RE OF 1505610105 RESENTATIVE n D~_, ~c1R~N~ro~~ PL ASE USE ORIGINAL FOR I Side 1 ar 1505610105 DATE: 03/14/2011 J J 1505610205 REV-1500 EX (FI) Decedent's Social :security Number decedent's Name: EMILIE S. REPLOGLE .~' : ' ~'- `f tF~'S 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. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 11,606.00 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. 11,606.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9.: 7,013.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 7,013.00 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 4,593.00 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. ! 4,593.00 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 4,593.00 1g, 207.00 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., 207.00 __ __ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-?500 EX (FI) Page 3 Decedent's Complete Address: File Number EMILIE S. REPLOGLE - -_ STREET ADDRESS ~ .336 MESSIAH CIRCLE CITY MECHANICSBURG -- STATE - - - - i ZIP _ _ _ __ PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 207.00 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest (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) 207.00 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 .............................................................................................................................. ^ 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? ........................................................................................................................ ^ 1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS lS 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 an 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)]. 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 u>e 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 notE;d in [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;1). 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-4500 EX (FI) Page 3 File Number Decedent's Complete Address: EMILIE S. REPLOGLE STREET ADDRESS 336 MESSIAH CIRCLE CITY _ - - - STATE _ __ - ZIP MECHANICSBURG I, PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 207.00 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest (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. (~) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 207.00 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 .............................................................................................................................. ^ 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? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE 1T 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)]. 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 u:>e 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 notE;d in [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-iso8 EX+ (11-io) ~ ~ ,P~ pennsylvan~a DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: EMILIE S. REPLOGLE 2010-00927 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with ri4ht of survivorship must hp d~~~i~~p.~ .,., c~1,va~~~e c •~ ~ ~,~~ ~ ~Na~~ ~~ ~ ~ceueu, use aaaitionai sneers or paper of the same size. f~EV-15I1 EX~- (10-09) ' ~ ~ ~ pennsylvan~a SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER EMILIE S. WEAVER 2010-00927 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; 1' S. GERALD WEAVER FUNERAL HOME 6,856.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) ___ Street Address City _ _ __ _ -___ _ _ _ State ZIP Year(s) Commission Paid: Z• Attorney Fees: 3. Family Exemption: (If 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: 82.00 S• Accountant Fees: 6• Tax Return Preparer Fees: 7• H &R BLOCK 75.00 TOTAL (Also enter on Line 9, Recapitulation) $ 7,013.00 If more space is needed, use additional sheets of paper of the same size REV-1.513 EX+ (01-10) ' i ~ Pennsylvania SCHEDULE ~ DEPARTMENT OFREVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: EMILIE S. RELOGLE 2010-00927 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• DWIGHT 6. REPLOGLE SON 91g P.O. BOX 1523, DELTA JUNCTION, AK 99737 2. DAVID D. REPLOGLE SON g 1 g 274 MEDIA RD, OXFORD, PA 19363 3. DORCAS KNUTSEN DAUGHTER 919 132 SUNNY SLOPE LN., MANHEIM, PA 17545 4. DEBORAH HOLLINGER DAUGHTER 918 755 WHITE OAK RD., DENVER, PA. 17517 5. DARLENE BYLER .DAUGHTER 918 139 BRIAR HILL RD., LITITZ, PA. 17543 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ If more space is needed, use additional sheets of paper of the same size. ,~ w t W fe' I ENIILIE S . REPLOGLE presently residing at 7$ ALLEN ROAD EPHItATA, PA 17522 do hereby make, publish and declare this tc~ be my Last V~ill and Testament and do hereby rf:voke any and all other Wills and Codicils heretofore made by me. First. I am married to DARLE I GH B . REPLOGLE Second. I order and direct that my just debts and funeral expenses, expenses for administration of my estate and any inheritance and succession taxes, state or federal, up©~ my estate shall be paid as sooner my . ,~, death as may be practical. ~ ,,~, ,-, `'4 ~ ` ~ ~~ Thud. I give all my .estate to my husband. In the event that my said husband sh ceas~ne off:` ,__~ fails to survive me for sixty (60) days, I give all my estate to my children, if any, why survi ual~aresz~.`b - _~ per stirpes. If I am survived by neither rxly husband, nor children, then I give my estate .cn~ ~,,.. ~..- ,~-- .~ ~ y,~ ~ ; -~ ~ ~:. ~. to be his/hers/theirs in equal shares or their survivor. <;~ ~ ~ ~ . ~` ....~ Fourth. i nominate and appoint my husband as Executor of this Will. In the event ghat my husband shall predecease me or fails to survive me or fails to serve as such Executor then in such event, I nominate and _. _. _. r._ _-~- --- appoint 17WT~HT R . RFPfi,O~T.F~ - _____,~ 1/XeCtltOr~~~O~ th1S my~ rSnd __ _ .__ _.__.~ Testament.. I further direct that nr~ appointee hereunder shall be required to give any bond: for the faithful performance of his /her duties. Fifth. i hereby authorize my Executor/~~ to exercise all the powers, rights, discretlons, duties and immunities conferred upon fiduciaries to the extent permitted by law with full power to sell, iease, mortgage, invest, reinvest, or otherwise dispose of the assets of my estate. I subscribe my name to this Will this 2 5th Day of NO V . ^,~~ 19 91 . ' ~ ~ -~ ~ (Sign here) Signed, sealed, published and declared to be her Last'~Vill and Testament by the within xlamed Testator in the presence of us, who in her presence and at her request, and in the presence of each other„ have hereunto subscribed our names as witnesses this ~ ~~ r day of _Nnv _ _...~, I9__9..~. (1) "~ of ~, r~ ~ j ~ ' y) ~ (State) ~~~~.-. (2) of ~ _ ~ ~ ~ ~ (City) .~ ' (Sate) ~ 1989 by AFBP. A11 rights reserved. ~. Affidavit of Execution and Attestation I sign my name to this, my Will, and being duly sworn, declare that I sign voluntarily for the purposes expressed therein, and am of lawful age, of sound mind and under no undue .influence. t ~ ~ ',,-- (Testator) The undersigned witnesses being. duly sworn, each declares that. the Testator signed this Will consisting of one page with writing on both sides thereof, at the end thereof, an+d on each side thereof, in our presence, and signi#ied, published and declared in-our presence that this instrumeht is her Fast Will and 'Testament, and that at the requESt of and in the presence of Testator and in the presence of-each other and in the presence of a Notary public: each has subscribed hiss name to this Will as witness to Testator signing this 2 ~ th day of NOV~E,F~, 191._, and to the best of his~c~knowledge `t'estator is of lawful age, of sound mind and ender no undue influence. .1 ,. r (l} ~' residing at ~' ~- ~--' ' - A ~.. (2~ '' residin at .~ (3) residing at f J' 1 State of PENNSYT.VANT A County of RT. A T.R City or Town R n n R T err S pu T ~ t, ; n n Subscribed,- sworn to and acknowledged before me by the Testator EM~LIF S .. ~EFLn~LE and J . KENNETH OVER and __ .TnNN N _ OVER __ ,and CHESTER. R , ER ,the witnesses, this 2.5~h._ day of NOV . _ , 19~~, lr .~ ~Sea~} (Notary Public} - -. ~ .....-r...r..~.~.. ~~ ~~ ~~, Y 5 ~ ~f` n d 7 ~ Q ~ ~ F-- J O -~ ~- C17 '~- - (~- '^ u 0 ti w O N v1 ..,,i O .a w _ ~ q .-......-~1 ~„ N ~ \t( y / y \\V\1 r U s.. "t_ r~' ~ S 1 m' .,, 1 ._F r. ((~ ~ 4 \ ^, ,~ i ~ (.7 ~ ~/ \~ ~I ..l `~ ~ ~ ~,_ ~~, ~ ~ ~~ ~~ ~ ~~ ~~ "~ ~J ~CQ ~~ ~ .~ ,~ ~~ M~ _. ;.ti~~ ,,.~, {. *~ ~ _~ ~ a ~. M;~, ~~ .~Y ` ~....... J 1 e ~T~) ~1