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Home My WebLink About04-25-11J 1505610101 REV-1500 Ex `°1-'°' ~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes GEI~NTNENTOEREVENUE Count} Code Year File Number PO BOX 28o6oi INHERITANCE TAX RETURN ~~ ~~ ~, ~~ Harrisburg PA 1128-0601 RESIDENT DECEDENT r I I , J ~ (J 'Ty(~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY 174-05-2852 ~ 04/14/2011 Decedent's Last Name Suffix Setlock (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth NIMDDYYYY 12/23/1915 Decedent's First Name MI Evelyn Spouse's First Name MI C._ _ -- - THIS RETURN MUST BE FILED IN DUPLIICATE WITH THE l REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received O 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 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 Return 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 Telephone Number Carry) L Wafter ~ (717') 697-0331 REGISTER OF WILLS USE ONLY First line of address 253 Key West Blvd ~? a ~w' ,...-.. ~ Second line of address __ _ ~.~ ~ ...,. T... °~:~ F~` ; .~ _ I i ~ ° City or Post Office State ZIP Code - - -' Carlisle -~ -'~~ PA 17015-8546 .y c ~+ _. ~ ~ _ - -j- ~ '~ ;~ - Correspondent's a-mail address: ~:: ~ ; ~=•~ G ,. ~~ 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 informatior~ of which preparer has any knowledge. SIGNATURE F PERSON RESPONSIBLE FOR FILING RETURN DATE DD ESS 253 Key West Blvd, Carlisle, PA 17015-8546 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1~i05610101 J 1505610105 REV-1500 EX Decedent's Social Security Number oecedent's Name: Evelyn A. SetIOCk ~74-05-2852 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. 20,859.58 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. 20,859.58 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 6,294.48 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 6,294.48 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 14,565.10 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. 14,565.10 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_ 16. Amount of Line 14 taxable at lineal rate X .0 45 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 655.43 19. TAX DUE ......................................................... 19. 655.43 20. FILL IN THE OVAL tF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 15056],0105 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENTS NAME Evelyn A. Setlock STREETADDRESS 253 Key West Blvd CITY Carlisle STATE PA ZIP 17015-8546 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 32.77 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. (1) Total Credits (A + B j (2) (3) (4) (5) 655.43 32.77 622.66 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 :.......................................................................................... ^ >r^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ Q 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 0 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? .............. ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ^ 0 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 transifers 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(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)]. 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 fi737.4 EX + (6.08) ~ Pennsylvania SCMEpVLE E, PART 1 DEPARTMENT OF REVENUE MISCELLANEOt~S INHERITANCE TAX RETURN PERSONAL PROPERTY NONRESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn A. Setlock Part 1 must include all tangible personal property having its situs in Pennsylvania. Examples of tangible personal property are jewelry, furniture, paintings, etc. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. Complete Part 2 on reverse side ONLY when the proportionate method of tax computation is elected. (If more space is needed, use additional sheets of paper of the same size) ' REV-X737-6 EX + (6-08) REVERSE ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN NONRESIDENT DECEDENT SCNEDVLE H FI/NERAL EXPENSES & ADMINISTRATIVE COSTS Use Schedule H ONLY for proportionate method of tax computation. ESTATE OF FILE NUMBER Evelyn A. Setlock Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: - _ ~~ _::; ---~- Hollinger Funeral Home, Mt. Holly Springs, PA 3,621 50 _,, ___.. 3 ____ __ .~ ~~ 6. ADMINISTRATIVE COSTS: _ _ ....._ __ _.____, 1, 042 98 1. Personal Representative's Commission(s) - - _ . _ Name(s) of Personal Representative(s)!Carryl L. Walter (Submit requested information for additional personal representative's on additional sheets) Social Security Number(s) or EIN Number(s) of Personal Representative(s)f 204-26-9194 Street Address(es) 253 Key West Blvd. City(ies)Carlisle state(s).PA zIP(s) 170'15 Year(s) Commission Paid 2011 2• Attorney Fees 1, 500 00 _ _,.; 3. Probate Fees 130 00 __ --- 4• Accountant's Fees ., 5• Tax Return Preparer's Fees 6• Miscellaneous Expenses 4 ~ ~ REV-1513 EX+ (11-08) ~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn A. Setlock 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. Carryl L. Walter, 253 Key West Blvd., Carlisle, PA 17015 :Daughter 50% 2. Stanley S. Setlock, Jr., 253 Key West Blvd., Carlisle, PA 17015 `Son 50% .. _.._..... ._.._. .._...:5 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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 1. _ _ _ _-_., _ _ _ _.,, i i { j 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, insert additional sheets of the same size.