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Home My WebLink About04-21-11 (2)1505610105 REV- i 500 EX (02-11) (FI) ;~;1 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY OERAR'fMENT OF REVENUF County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOxZ8o6o~ 16 ~ Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth Mti1DDYYYY 514-12-1814 03/05/2010 Decedent's Last Name Suffix Decedent's First Name MI __ FOUST 'NADINE 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 O 1. Original Return ~ 2. Supplemental Return O 3. I~emainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. 1=ederal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. ~rotal 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 Num~er ~ " '~-' . a z .. ,- ,, RICHARD W. STEWART .- ~ ~ ~ _---~~ i REGISTER OF WILLS" _ ~ ..- First Line of Address ~~' r ~ ~"~~ ~ °`~ ,~~:~ .-. C~ 301 Market Street `-.-~r'~?~ ~,~: Second Line of Address P.O. Box 109 City or Post Office Lemoyne Correspondent's a-mail address: EGM(C~JDSW.COM State ZIP Code PA 17055 DATE FILED --c :~ 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. SIGN TU~OF PERSON RES ON I LE FO FI G RETURN DATE ~ r~ ADDRESS 5903 Stephens Crossing, Mechanicsburg, PA 17050 SIGNATURE O RE RER OTHE~~t~]~~V REPRESENTATIVE ~, TE ~~ ll ADDRESS 301 Market Street, PO Box 109, Lemoyne, PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX {FI) Decedent's Name: Decedent's Social Security Number 514-12-1814 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) .................................... . .. 2. 5,903.89 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 & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ........ . .......... 9. 1,165.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 1,165.00 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 4,738.89 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. 4,738.89 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 - 4,738.89 16. 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 213.25 213.25 O J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENTS NAME Nadine R. Foust STREET ADDRESS 5225 V~Ison Lane CITY Mechanicsburg STATE ~ ZIP PA 17055 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. 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. Total Credits (A + 8) (Z) (3} (4} (5) 213.25 2.52 215.77 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 d~sath? .............. ^ 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)]. 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(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)]. 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-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA sTOCKS & BoN~s INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FOUST, Nadine R. 21-10-0239 All property jointlyowned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) Estate Valuation Date of Death; 03/05/2010 Valuation Date: 03/05/2010 Processing Date: 04/05/2011 Shares Security or Par Description 1) 153 METLIFE INC (591568108) COM New York Stock Exchange 03/05/2010 Total Value: Total Accrual: Total: $5,903.89 Estate of: Nadine Foust Account: 13090-1 Report Type: Date of Death Number of Securities: 1 File ID: foust Mean and/or Div and Int Security High/Ask Low/Bid Adjustments Accruals Value 39.04500 38.13000 H/L 38.587500 5,903.89 $0.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.1) ~ Pennsylvania DEPARTMENT ~FREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER FOUST, Nadine R. 21-10-0239 Decedent's debts must be reported on Schedule Y. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXFENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid; _ 2. 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; 5. Accountant Fees: 6, Tax Return Preparer Fees; ~~ Cumberland County Register of Wills Office ~ Filing Fees for Supplemental Return s Walborn Naugle Associates ~ Tax Preparation TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 200.00 15.00 950.00 1,165.00