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Home My WebLink About05-04-11 4 1505610140 ~' REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes 1 INHERITANCE TAX RETURN 2 1 1 1 0 2 4 9 PO BOX 28060 Harrisbur , PA 17128-0601 RESIDENT DECEDENT - ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 6 6 4 6 2 8 3 1 0 1 2 6 2 0 1 1 Decedent's Last Name Suffix Decedent's First Name MI GA R D N E R ANTHONY C (If Applicable) Enter Surviving Spouse's Inform ation Below MI ' Spouse's Last Name s First Name Suffix Spouse GARDNER GAI L I Spouse's Social Security Number C~ ~„' ~ ,_ O - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE i ~ ~ r 6 f / REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW inal Return ^ i 1 O 2. Supplemental Return ^ 3. Remainder Return (date of death g r . prior to 12-13-~62) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) B ~ Q 6. Decedent Died Testate ^ oxes 8. Total Number of Safe Deposit 7. Decedent Maintained a Living Trust (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ (Attach Copy of Trust) haC'under Sec. 9113(A) 10. Spousal Poverty Credit (date of death ^ 11 ~ h S c Attac between 12-31-91 and 1-1-95) ( ) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone IVumber Name H ANTHONY A DAMS 7 1 7 5 3 2 3 2 7 0 _. First line of address 4 9 WEST O R A N G E Second line of address S U I T E 3 City or Post Office S H I P P E N S B UR G S T R E E T State ZIP Code P A 1 7 2 5 7 Correspondent's a-mail address: htadamSlaWCa)embal'gmeIl.COm 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 prepare~r has any knowledge. SIN ,TURF C~F PEiR,'SON R~ONSIBLE FOR FILINGRETURN n _ I ,. A J ADDRESS 137 Hassin er Road SIGNATWR OF PRFDftRE L 1505610140 Side 1 nlo~~~h~ i ~ REGISTER ({E1~JIIILLS USE ONLY ~ -~-~ ~ ' ';--~ - Cy7 = ~` ~~ ~ , ~.~ ~ _ -r~, ~ ~~ ~ ~~ ~ i , ~ - -, _. --r'7 , I --r t y 1.. . ..~ ~ ' .. DAT'E~ILED '~ \1 A 17240 150561014() HUUI"(CJJ 49 West Orange Street, Suite 3 Shippensburg P,A 17257 PLEASE USE ORIGINAL FORM ONLY 1505610240 REV-1500 EX ANTHONY C. GARDNER - Decedents Name: 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. • 7 3 2 8 8. 3 1 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ... .... 6. • 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property arate Billing Requested ... ~ Se .... 7. • p (Schedule G) 7 3 2 6 8. 3 1 8. ...... Total Gross Assets (total Lines 1 through 7) ................ . .... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) .............. .... 9• • 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... .... 10. • 11. Total Deductions (total Lines 9 and 10) ........................... .... 11. 12 7 3 2 6 8 . 3 1 12. Net Value of Estate (Line 8 minus Line 11) ........................ .... • 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which . an election to tax has not been made (Schedule J) .................. .... 13. • 14. Net Value Subiect to Tax (Line 12 minus Line 13) ................. ..... 14. 7 3 2 6 8 . 3 1 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 7 3 2 6 8 3 1 15. (a)(1.2> x .0 16. Amount of Line 14 taxable Q Q Q 16 at lineal rate X .0 . 17. Amount of Line 14 taxable Q Q Q 17. at sibling rate X .12 18. Amount of Line 14 taxable Q Q Q 18 at collateral rate X .15 . 19. TAX DUE ................... ............................ ..... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1505610240 Q. Q Q Q. Q Q Q. Q Q Q. Q Q Q. Q Q J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME ANTHONY C. GARDNER _ ______ --___ ---__-- STREET ADDRESS 137 HASSINGER ROAD__ _ _____ ___ _. ______ CITY NEWBURG Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2, CreditslPayments 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. File Number 21 11 0249 _- -- --- - - STATE ZIP PA ~~ 1.7240 Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT o.oo 0.00 0.00 0.00 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; or d. receive the promise for life of either payments, benefits or care? ....................................................... ~ X 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ... .. ............. X .................................................................. . 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 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 requiremE:nts 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,se of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(x)(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(x)(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(x)(1.3)]. Asibling is defined, unde 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 RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ANTHONY C. GARDNER 21 11 0249 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. VALUE AT DATE ITEM OF DEATH NUMBER DESCRIPTION 1, UTILITY TRAILER 500.00 2. CAMPER-2003 27' SUNLINE 7,410.00 3. TRUCK-FORD F-250 1995 2,660.00 4. PAYMENT BY PA. STATE SYSTEM OF HIGHER EDUCATION 62,698.31 (PROCEEDS FROM ACCUMULATED LEAVE ETC.) TOTAL (Also enter on line 5, Recapitulation) 1 $ 73,268.31 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (01-10) ' ~ pennsylvania e SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: ANTHONY C. GARDNER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. GAIL I. GARDNER 137 HASSINGER ROAD NEWBURG, PA 17240 FILE NUMBER: 21 11 0249 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 100% Spousal AMOUNT OR SHARE OF ESTATE I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SI~EET, AS 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: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. L $ If more space is needed, use additional sheets of paper of the same size. Y ~~ .~. ~5 r tY M ~ W -, ~ ~ Q1 .. "V `~' E" d W W ,,, a z w Z ~' w o p ~ o. Q x z ~ a x F oa xa a ~ ~ x '~ •• ~ O •• U ~N ::: c~ .~ .. .. O ~ ~ ... . ~}~ O ~ ~ . "..'.. ~ Y ~ L ~ ~; V U ~ M :: L (/~ N ~ ~ O (n ~ O ._ ~- - U ~ ~ ~ r- .. o ,;~•I i L ~ ~ ~ ~ ,~ ~ N N j ,;•.~ T3 N ~ ~~ ~ (~ C1C V ~" ~Ui ~ . , ~ ~ ;~. ~ .,..~ r,: R ... ~ .,..,