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Home My WebLink About04-27-11c 1505610105 REV-1500 Ex ~oz-~~, ~Fr> enns lvania OFFICIAL USE ONLY _ PA Department of Revenue p y County Code Year File Number Bureau of Individual Taxes ,t~a~,ME~,~.~_~-~~~t PO BOX z8o6oi INHERITANCE TAX RETURN ~ ~ ~ ~l ~ ~1~~ Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth tv9MDDYYYY 565-26-6226 12/26/2010 07/02/1924 Decedent's Last Name Suffix Decedent's First Name MI Amnott Thelma I (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 CID 1. Original Return p O 4. Limited Estate O O 6. Decedent Died Testate O (Attach Copy of Will) O 9. Litigation Proceeds Received O 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: Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE :DIRECTED T0: Name Daytime Telephone Number Bruce D. Foreman (717) 236-9391 First Line of Address Sixth Floor Second Line of Address 112 Market Street City or Post Office State ZIP Code Harrisburg PA 17101 ~~ _ REGISTER ~'Q~I_S IUSE 61VLY f_ =-Y,,T ~~~ '1,- C~'7 ::.1 I •~..1 _ :~~a - 4 i " ~~ _ :.J - - --I DATE FILED ", Correspondent's a-mail address: brUCe@ffClaW.net SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 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. ADDRESS SIGNATURE OF PARER THAN REPRESENTATIVE ,DATE 1 t' (V\ ~ r. PLEASE US ORIGINAL FORM ONLY 15~56101~5 Side 1 1505610105 J _~-~ - ~-~t "-7 _. ~~ J 1505610205 REV-1500 EX (FI) ' Decedent s Social SE~curity Number Decedents Name: Thelma I. Amnott 565-26-6226 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. 15,768.55 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. 15,768.55 9. Funeral Expenses and Administrative Costs (Schedule H) .................. . 9. 5,124.58 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I} .............. . 10. 11. Total Deductions (total Lines 9 and 10) ................................ . 11. 5,124.58 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. 10,643.97 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. 10,643.97 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 0.00 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610205 1505610205 REV-1500 EX (FI) Pege 3 File Number Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest (1) 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. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIp-TE 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 IT AS FART 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 no'ed 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-iso8 EX+ (il-io} -~ pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETUP.N PERSONAL PROPERTY RESIDENT DECEDENT ESTATE UF: FILE NUMBER: Thelma I. Amnott :?010-01279 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. 1 REU-15:1 EX-~ (].i~~-C>>?} ~ Pennsylvania DEP,4RTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Thelma I. Amnott 2010-01279 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION _ AMOUNT A. FUNERAL EXPENSES: 1' Richardson Funeral Home 1,947.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representatives} _Sherri L. Dove street Address 316 Albion Avenue z. 3. 4. 5. 6. 7. city _Lakeland state FL zIP 33815 Year(s) Commission Paid; Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees; Tax Return Preparer Fees: Advertising Costs ZIP TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 1,000.00 2,ooo.ao 177.58 5,124.58 f~Eil-151.:% EXt ;1~-t1~ ~ pennsylvania SCHEDULE I DEP,4RTMENT OF REVENUE DEBTS OFF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER' Thelma I. Amnott 2010-01271 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size.