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HomeMy WebLinkAbout05-11-11J 150561014D REV-1500 ~` j°'-'°' ow n~~~r......~ s o........~.e " ""''°'"""""" ' "'"~""'" County Code Year File Numtx+r Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 2 1 1 0 1 1 8 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 7 2 3 6 1 6 9 8 1 0 3 1 2 0 1 0 1 0 0 9 1 9 4 7 Decedent's Last Name Suffix Decedent's First Name M R O C H E I I I E D G A R E (N Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW © 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death pnorto 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Requi death after 12-12-82) ® 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Bo es (Attach Copy of Wilp (Attach Copy of Trust) r 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113( ) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTE TC Name Daytime Telephone Number M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 ,4, 6 5 0 -- :~~ REGIS '~WILLSUSEONLY~? -~ First line of address ?~ i~ ~T - ', :'. ~ 5 4 E A S T M A I N S T R E E T ='`'~~ ca - ~~~ ~ -- Second line of address ~ -'-' ~'~' ' ~ ~ u~ ~ -v ~CTE FILED p J City Of POSt Office State ZIP Code M E C H A N I C S B U R G P A 1 7 0 5 5 i Correspondent's e-mail address: 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 lief, it is correct and complete. of preparer other than the personal roprosentative is based on all informatlon of whkh preparor has any knowledge. SIG AT RE OF PER RE IB F FILING URN ATE ADDRESS IRENE H• RADA GH•'02 AMS ST EXT ENOLA PA 17025 SIGNATURE OF P AR R AN REPRESENTATIVE DIE' f, ( ' / J ADDRESS MURREL LT RS III ESQ 54 E MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY ~•, I Side 1 1505610140 1505610140 ~~ C.~ _~ ~ .J 1505610240 REV-1500 EX Decedent's Social Security Number Decedern'sName: EDGAR E• ROCHE, III 1 7 2 3 6 1 6 9 ~'' RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1 • 0 • 0 OI 2. Stocks and Bonds (Schedule 8) ...................................... 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. 4 3 6 2 8. 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 6 9 6 5 0. 0 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property (Schedule G) ~ S Billin R t t d 7 epara g e eques e ....... . 8. Total Gross Assets (total Lines 1 through 7) ......................... . . 8. 1 1 3 2 7 8 , 5 9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9. 5 5 9 6 . 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10. 2 8 9 5 6. 9 11. Total Deductions (total Lines 9 and 10) ............................ ... 11. 3 4 5 5 3. 4 12. Net Value of Estate (Line 8 minus Line 11) ......................... ... 12. 7 8 7 2 5. 0 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. 7 8 7 2 5 . 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or Vansfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X • 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate x .1 s 7 8 7 2 5. 0 2 1g, 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 0. 0 o. o 0. 0 1 1 8 0 8. 7 1 1 8 D 8. 7 i 1505610240 Decedent's Complete Address: 21 10 1189 DECEDENT'S NAME EDGAR E. ROCHE III STREET ADDRESS 402 ADAMS STREET EXTENDED CITY ENOLA STATE PA ZIP 17025 Tax Payments and Credits: 1• Tax Due (Page 2, Line 19) (1) 2. CreditslPayments 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) Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................................................... ... ^ Q b. retain the right to designate who shall use the property transferred or its income : ............................ ... ^ ^X 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 without receiving adequate consideration? .................................................................................... ... ^ ^X 3. Did decedent own an "intrust 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? ............................................................................................... ... ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE 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 survi~ring 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 p2 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 o 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 pare t, 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 decedents 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 d~fined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. rcr=v-i 5ua tx + to-aa~ SCHEDULE E CO O CASH, BANK DEPOSITS & MISC. MM NWEALTH OF PENNSYLVANIA , IN N PERSONAL PROPERTY RESIDENT DE EDENT ESTATE OF FILE NUMBER EDGAR E. ROCHE III 21 10 1189 Indude the proceeds of Ihigatlon and the date the proceeds were received by the estate. All property joi owned with ht of survivorship must be discbsed on Schedule F. ITEM VALUE A DATE NUMBER DESCRIPTION OFD TH 1. MBrT BANK 7,818.19 CHECKING 2. M&T BANK 0,861.83 SAVINGS 3. 2003 CHEVROLET TAHOE 0,429.00 VOLUNTARY REPOSSESSION VALUE PA CENTRAL FEDERAL CREDIT UNION 4. 1998 FORD F-150 2,000.00 SALE PRICE 5. SEARS 12,48 CREDIT CARD BALANCE REFUND B. STATE AUTO 317.00 REFUND OF PREMIUM 7. BOAT -TRACKER 800.00 NET SALE PRICE 8. 2010 PENNSYLVANIA DEPARTMENT OF REVENUE 1,390.00 TAX REFUND II TOTAL (Also enter on line 5, Recapitulation) S 3 628.50 ilt more space is needed, insert addltlOnal sheets of the same size) REV-1509 EX+ (01-10) pennsylvania ~ SCHEDULE F DEPARTMENT OF REVENUE I JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: k an asset was made jointly owned wkhin one year of the decedent's date of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. IRENE H. RADABAUGH 402 ADAMS STREET, EXTENDED ENOLA, PA 17025 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DAT OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS V LUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDE TS INTEREST 1. A. 1998 402 ADAMS STREET, EXTENDED 139,300.00 50. 9,650.00 ENOLA, PA 17025 COURT ASSESSED VALUE ~~ I TOTAL (Also enter on Line 6, Recapitulation) i 850.00 FILE NUMBER: n mon; space ~ neeaea, use aaamonal sneers or paper of me same size. REV-1511 EX+(10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS EDGAR E. ROCHE, III 21 10 1189 Decedent's debts must be reported on Schedule I. i~ ITEM NUMBER DESCRIPTION AMOU T A. FUNERAL EXPENSES: 1. SULLIVAN FUNERAL HOME 3,537.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) IRENE H. RADABAUGH (RENOUNCED) Street Address 402 ADAMS STREET. EXTENDED City ENOLA State PA ZIP 17025 Year(s) Commission Paid: p. Attorney Fees: MURREL R. WALTERS,111 1,925.00 3. Family Exemption: (If decedenCs address is not the same as claimants, attach explanatbn.) Claimant SVeetAddress City Slate ZIP Relationship of Claimant to Decedent 4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 134.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. i I II TOTAL (Also enter on Line 9, Recapitulation) E 5 596.50 Ii .nnm nnn .... :.. ......J..J ...... ~JJYi I l V i ..tLL ~ 'i ~~~~~v~ .a,.a.wr~.vw , ouv,uv,~a~m~ww ~,Alaa, v~u~c oaiiia J~[.G. REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS EDGAR E. ROGME III z~ ~u Tina Report debts Incurred 6y the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses ~ ITEM VALUE AT ATE NUMBER DESCRIPTION OF DEA H 1. PENNSYLVANIA CENTRAL FEDERAL CREDIT UNION 0,820.82 AUTO LOAN 2. UNION PLUS p1,475.82 MASTERCARD 3. PENNSYLVANIA CENTRAL FEDERAL CREDIT UNION 4,581.34 VISA ii I 4. VETERANS AFFAIRS 147.00 MEDICAL 6. INTERNAL REVENUE SERVICE 1,932.00 2010 INCOME TAX ~I TOTAL (Also enter on Line 10, Recapitulation) S 8 958.98 If more space is needed, insert additional sheets of the same size. i REV-1513 EX+ (01-10) Pennsylvania SCHEDULE J DEPARTMENTOF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: rat nuMetr=n: cnneo c ennuc w 71 1A 91R0 '~~ RELATIONSHIP TO DECEDENT AMOUNT 0 SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Liat Trustee(s) OF ES TE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and hansfers under Sec. 91 f6 (a) (1.2).] 1. IRENE H. RADABAUGH Collateral 402 ADAMS STREET EXTENDED ENOLA, PA 17025 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROP IATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. I li 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.