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Home My WebLink About05-19-11---~ REV-1500 EX (01-10) 15 0 5 61014 3 '~,, PA Department of Revenue '~ OFFICIAL USE ONLY pennsylvania count code Year Bureau of Individual Taxes DEPARTMENT OF REVENUE y File Number PO 60X.280601 INHERITANCE TAX RETURN 21 11 0 2 5 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 201 18 8124 02 18 2011 12 17 1926 Decedent's Last Name Suffix Decedent's First Name MI ZEITERS JUNE S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ® 1. Original Return ^ 2. Supplemental Return ^ 3, Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Re uired q ® g. Decedent Died Testate (Attach Copy of Will) ^ 7 Decedent Maintained a Living Trust (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 11. Election to tax under Sec. 9113 A ^ ( ) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE Name AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number JEAN D SEIBERT 717 236 9301 First line of address 109 LOCUST STREET Second line of address City or Post Office State ZIP Code HARRISBURG PA 17101 Correspondent's a-mail address: wz s@ m i n d s p r i n g. c o m c, :'1 _~., -,., -. - ,-; . ,_..J -- . "r1 ~~ ~ ~ _~ ~~~~c~ NC~iaiues yr pequry, I aeclare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tru orrect and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNAT E OF PERSON RESPONSIBLE FOR FILING RETURN ~ ,n/) I ~~ ~ _ DATE i Russell S. Zeiters %~/~c} ~ 31 Oakwood Avenue, Mechanicsburg, PA 17055 SIGNATUR OF P EPARE OTH THAW REPRESENTATIVE DATE - Jean DSeibert / ~ ADDRE 109 ocust Street, Harrisburg, PA 17101 Side 1 L 150561U143 1505610143 J ADDITIONAL Personal Representatives Zeiters, June S. SS# 201-18-8124 2/18/2011 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. ._ 2 Signature c'~~-L ~,~,<<, Name Carol Z. Hull Address 821 Belle Vista Drive city, state, zip Enola PA 17025 Date ~ ~ ~ ~ 3 Signature Name Address City, State, Zip Date 4 Signature Name Address: City, State, Zip Date 5 Signature Name Address: City, State, Zip Date 6 Signature Name Address: City, State, Zip Date J 1505610243 REV-1500 EX Decedents Name: Z E I T E R S, JUNE S. Decedent's Social Security Number 2 01 18 812 4 RECAPITULATION - 1. Real Estate (Schedule A) ................. ......................................................................... 1. 2. Stocks and Bonds (Schedule B) ................ ............................................................... 2. 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .. ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 5 2 , 1 1 4 . 5 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) ^ Separate Billing Requested ............. 7• 8. Total Gross Assets (total Lines 1-7) ............. ............... ................, g, 5 2, 1 1 4 5 6 9. Funeral Expenses & Administrative Costs (Schedule H) ....................... .................. 9. 3 , 4 9 6 . 9 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 6 , 0 3 5 . 7 3 11. Total Deductions (total Lines 9& 10) .... .................................................................. 11. 9, 5 3 2 6 3 12. Net Value of Estate (Line 8 minus Line 11).. ........ ................................................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12. 4 2 , 5 81.9 3 an election to tax has not been made (Schedule J) ...... ........................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ................................... •••••••••••••• 14. 42 , 581.93 TAX COMPUTATION -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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 4 2 , 5 81.9 3 17. Amount of Line 14 taxable 16. .1 , 916.19 at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18 19. Tax Due ..................................................................................................................... 19. 1 , 916.19 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L 1505610243 Side 2 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 11 - 0256 Zeiters, June S. STREET ADDRESS - Sarah A. Todd Memorial Home cITY Carlisle 1000 West South Street Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A• Prior Payments B. Discount 3. Interest STATE ZIP PA 17013 (1) 1,916.19 95.81 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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 + B) (2) 9 5.81/ (3) 0.00 (4) (5) 1,820.38 Make Check Payable to: REGISTER OF WILLS, AGENT. _. ~.,, ,;_ v:~ k x - "w y~ ~c ~ _ y.,, .. ~,.,a .• ri 1a.~~~r.R h} ~'u^Yj (~pyiY.. , ~ yk ~~~'i~ s ':. ¢yyN ~. iC y' ~ ~~_. :. ~ i V .. ,~ '"15J~ '6!~~.u~ ~ .. .. ... a. - .. ~.. .. ~~j:'I.tY ~.... 5 ~A~ Y .i`T ~~ .. _ _F~~}~~~~Z ~t~`1, TT +~,, ~~~'`~;,•'kw . 1 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 ...................... . .......................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? .............................................................. ^ a 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 "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 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 orYfor the use of the surviving) spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 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 reffurn 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)]. • sibling is definepd under Sectiont9102, as an indiv tlual whotha at least one parent ,n colmrnon withp he decedent wfiether ba) ti ood or ado ti Y p on. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Zeiters, June S. FILE NUMBER 21 - 11 - 0256 Include the proceeds of litigation and the date the proceeds were received by the estate. All survivorship must be disclosed on schedule F. property jointly-owned with the right of ITEM NUMBER DESCRIPTION VALUE AT DATE OF 1 PNC Bank Savings Account No. 5006131434 DEATH 50,118.66 Accrued Interest 11.98 2 M&T Bank Checking Account No. 108951 868.55 3 Members 1st FCU Savings Account No. 35841200 761.19 4 Refund from Buse Funeral Home -Prepaid 311.58 5 Refund from Mutual of Omaha Insurance 16.60 6 Refund from Hummelstown Sun 26.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 52,114.56 ~SCHEDULF HH+~~+ Q COMMONWEALTH OF PENNSYLVANIA ~~"'~' `^~ ~v ~I ~K7W p~ INHERITANCE TAX RETURN w ~ w'~~~~ ~~ RESIDENT DECEDENT ~J~Y1 ESTATE OF Zeiters, June S. Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION A. FILE NUMBER 21 - 11 - 0256 AMOUNT B• ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Wion, Zulli and Seibert -- Jean D Seibert 3,000.00 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 Register of Wills 202.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Cumberland Law Journal -Advertising 75.00 TOTAL (Also enter on line 9, Recapitulation) 3,496.90 - C Schedule H COMMONWEALTH OF PENNSYLVANIA Funeral INHERITANCE TAX RETURN ~m~n'~^+~ ~ continued RESIDENT DECEDENT ~7~1Q11V ~+W ~.aJ1 n1 ESTATE OF Zeiters, June S. FILE NUMBER 21 - 11 - 0256 2 The Sentinel -Advertising - 219.40 Page 2 of Schedule H SCHEDULE I DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zeiters, June S. FILE NUMBER 21 - 11 - 0256 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical ex penses. ITEM _ NUMBER DESCRIPTION AMOUNT 1 02-25-11 West Shore EMS - 137.00 2 03-05-11 Millenneum Pharmacy 708.09 3 03-07-11 Century Link -Final phone bill 9.23 4 03-16-11 Sarah A. Todd Home -Final payment 5,121.14 5 03-24-11 H&R Block -Final Income Tax Preparation 41.00 6 04-05-11 Millennium Pharmacy 19.27 TOTAL (Also enter on Line 10, Recapitulation) ~ 6,035.73 REV-1513 EX+ (11-08) COMMONWEALTH OF PENNSYLVANIA SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Zeiters, June S. 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 Russell S. Zeiters 31 Oakwood Avenue Mechanicsburg, PA 17055 FILE NUMBER ~ 21 - 11 - 0256 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($~~) Do Not Llst Trustee(s) Son 150% of Residue 2 Carol Z. Hull Daughter 50% of Residue 821 Belle Vista Drive Enola, PA 17025 Enter dollar amounts for distributions shown above on lines 15 through 18 on 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00