HomeMy WebLinkAbout05-20-114t
' 1505610140
REV-1500 EX (01-10)
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN
j ~ 0 ~ d~
Harrisbur PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 5 9 2 4 9 5 2 1 1 2 1 6 2 0 0 9 1 0 1 5 1 9 2 9
Decedent's Last Name Suffix Decedent's First Name MI
ALEXANDER S R BRUCE J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
S C H I L L E R JANET M
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
1 9 2 3 0 4 3 2 2 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 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 ^ 5. Federal Estate Tax Return Required
death after 12-12-82)
^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
H ANTHONY ADAMS 7 1 7 5 3 2 3 2 7 0
S T R E E T
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First line of address
49 WEST ORANGE
Second line of address
S U I T E 3
City or Post Office
SHI PPENSBURG
State
PA
ZIP Code ~
1 7 2 5 7
Correspondent's a-mail address: htadamslaw embargmail com
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Under penalties of perjury, I declare that i nave exammea mis re[urn, If1GIUUIIICJ au:vniNanyuiy a~.~icuww any ~•a•~~~~.-~~•~~ M~~~ •~- •••-- -----• -• ••~, ~-~.___.__~_ _ _
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.
SIG RE OF PERSO SP~NSIBLE R FILING RETURN ~ ~A~~ ~ ~~
. ~_ / ~/(
SIGNATU
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49 WEST ORANGE STREET, SUITE 3 SHIPPENSBURG A 1
PLEASE USE ORIGINAL FORM ONLY
L 1505610140
Side 1
1505610140
J
1505610240
REV-1500 EX
~,mo• BRUCE J. ALEXANDER, SR
Decedent's Social Security Number
1 5 9 2 4 9 5 2 1
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. •
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 4 2 2 5 ~ ' ~ ~
7. Inter-Vivos Transfers 8~ Miscellaneous N -Probate Property
(Schedule G) ~ Separate Billing Requested ....... 7. •
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 4 2 2 5 0 • ~ ~
9. .. _
Funeral Expenses and Administrative Costs (Schedule H) ................. . 9. 3 8 9 6. 6 8
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. •
11. Total Deductions (total Lines 9 and 10) ............................... 11. 3 8 9 6. 6 8
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12• 3 8 3 5 3. 3 2
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. 3 8 3 5 3. 3 2
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
3
3 8 3 5 3
2
15
(a)(1.2) X.0 . .
16. Amount of Line 14 taxable
~ 0
~
at lineal rate X .0 16.
17. Amount of Line 14 taxable
~ 0
~
17
at sibling rate X .12 .
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
0. 0
0. ~ ~
~. 0 ~
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~• 0 0
Side 2
1505610240 1505610240
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.
Total Credits (A + E3) (2)
(3)
(4)
(5)
o.oo
0.00
0.00
0.00
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;
.
^
X
^
b. retain the right to designate who shall use the property transferred or its income; .............................. .
^ 0
c. retain a reversionary interest; or ............................................................................................... . X
d. receive the promise for life of either payments, benefits or care?
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
^
0
without receiving adequate consideration? ...................................................................................... .
^ 0
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? ..................................................................................,.........:..... . ^
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 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, unde
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
• File Number
REV-1500 EX Page 3
Decedent's Complete Address: 0 0
REV-1509 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
BRUCE J. ALEXANDER SR. 0 0
If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. JANET M. SCHILLER 20 COVERED BRIDGE ROAD Spouse (Commom Law
NEWBURG, PA 17240
e.
c.
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE, OF ASSET % OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. 5/16/66 REAL ESTATE KNOWN AS 84,500.00 50. 42,250.00
20 COVERED BRIDGE ROAD
NEWBURG, PA 17240
TOTAL (Also enter on Line 6, Recapitulation) I $ 42,250.00
If more space is needed, use additional sheets of paper of the same size.
J
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
BRUCE J. ALEXANDER SR. 0 0
Decedent's debts must be reported on Schedule I.
ITEM AMOUNT
NUMBER DESCRIPTION
A, FUNERAL EXPENSES: 2,876.68
1. FOGELSANGER-BRICKER FUNERAL
B
2.
3.
4
5.
6.
7.
City State ZIP
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
Attorney Fees: H. ANTHONY ADAMS
Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant
Street Address
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
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
20.00
3.896.68
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF:
BRUCE J. ALEXANDER SR.
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. JANET M. SCHILLER
II.
FILE NUMBER:
0 0
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Spousal
100%
AMOUNT OR SHARE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
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.
If more space is needed, use additional sheets of paper of the same size.
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (OMB a~ 2502-0265) (Expires 1 113 0/2 0 09)
~ A, HUD-1 UNIFORM SETTLEMENT STATEMENT
.Type of Loan
1.[ ]FHA 2.[ ] FmHA 3.[ ]Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4.[ ] VA 5.[ ]Conv. tns.
C. NOTE: This form furnishes a statement of settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
"(p.o.c.)" were paid outside the closing; they are shown for informational purposes and are not included in the totals.
D. Name & Address of Buyer: E. Name, Address & TIN of Seller: F. Name & Address of Lender:
Isaac L. Hostetler Estate of Janef M. Schiller
Susan L Hostetler THERE ARE NO FEDERALLY BACKED
MORTGAGE PROCEEpS INVOLVED
Franklin County Pennsylvania Cumberland Pennsylvania .
County
G. Property Location: TIN of Seller: H. Settlement Agent:
Hopewell Township Place of Settlement H. Anthony Adams
Cumberland County, Pennsylvania 49 West Orange Street
Shippensburg, PA 17257 I. Settlement Date: May 14, 2010
J. Summary of Borrower's Transaction K. Summary of Seller's Transaction
_ _ _ _ _ - ... _ _________ AAA rrncc Amn~~n4 r111P +A SPIIer'
IVV. V~v~a ru~.v.+..~....... ....... ~~.. ____..
101. Contract sales price
84,500.00
401. Contract sales price
84,500.00
102. Personal Property 402. Personal Property
103. Borrowers settlement charges (line 1400) 1282.50 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes to 132.80 406. City/town taxes to 132.80
107. County taxes to $ 0.00 407. County taxes to $ 0.00
Assessments to $ 0.00
108 408. Assessments to $ 0.00
.
109. School Taxes to 71.72 409. to 71.72
110. 410.
111. 411.
112. 412.
113. 413.
120. Gross Amount Due from Borrower 85,987.02 420. Gross Amount Due to Seller 84,704.52
200. Amounts Paid by or in Behalf of Borrower: 500. Reductions in Amount Due to Seller:
201. Deposits or earnest money 1,000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) 5915.00
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204 504. Payoff of first mortgage
205. 505. Payoff of second mortgage
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. City/town taxes to $ 0.00 510. City/town taxes to 199.20
211. County taxes to $ 0.00 511. County taxes to $ 0.00
Assessments to $ 0.00
212 512. Assessments to $ 0.00
.
213. to $ 0.00 513. to $ 0.00
214. 514.
215 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid By/for Borrower $ 0.00 520. Total Reduction Amount Due Seller 6114.20
300. Cash at Settlement From/to Borrower 600. Cash at Settlement To/from Seller
301. Gross amount due from borrower (line 120) 85,987.02 601. Gross amount due to seller (line 420) 84,704.52
302. Less amounts paid by/for borrower (line 220) 1,000.00 602. Less reductions in amount due seller (line 520) 6114.20
303. Cash x from to Borrower 84,987.02 603. Cash x to from Seller 78,590.32
Substitute Form 1099 Seller Statement
The information in Blocks E, G, H, I & line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being
furnished to the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this item is required to be
reported and the IRS determines that it has not been reported. If this real estate is your principal residence, file Form 2119, Sale or
Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form
4797, Form 6252 and/or Schedule D (Form 1040). You are required to provide the Settlement Agent (named above) with your correct
taxpayer identification number. If you do not provide the Settlement Agent with your taxpayer identification number, you may tie subject to
civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct
taxpayer identification number.
(Seller} (Seller)
.•
-.
~_..~_~_... ~....r.....
00. Total Sales/Brokers Commission: (based on rice 84,500.00 6 % Paid from Paid ftom
Division of Commission line 700 as follows: Borrower's Seller's
701. Centu 21 Piscioneri Real Estate $2,535 Funds at Funds at
702.Sailhamer Real Estate $2535.00 Settlement Settlement
703. Commission aid at Settlement 5070.00
704.Centu 21 Piscioneri Real Transaction Fee 225:00
800. Items Pa able in Connection with Loan
801. Loan Ori ination Fee
802. Loan Discount
803. A raisal Fee
804. Credit Re ort
805. Lender's Ins ection Fee
806. Mort a e Insurance A lication Fee
807.
808.
809.
810.
811.
812.
813.
814.
900. Items Re uired b Lender to Be Paid in Advance
901. Interest from to $ er da
902. Mort a e Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000. Reserves De osited with Lender
1001. Hazard insurance months $ er month $ 0.00
1002. Mort a e insurance months $ er month $ 0.00
1003. Ci ro taxes months $ er month $ 0.00
1004. Coun ro ert taxes months $ er month $ 0.00
1005. Annual assessments months $ er month $ 0.00
1006. months $ er month $ 0.00
1007.
1008.
1009. A re ate Accountin Ad'ustment
1100. Title Char es
1101. Settlement/closin fee
1102. AbstracUtitle search to Purit Abstract 150.00
1103. Title examination
1104. Title insurance binder
1105. Document re aration
1106. Nota fees
1107. Attorne 's fees POC
includes above item numbers
1108. Title insurance
includes above item numbers
1109. Lender's twera e
1110. Owner's covers e
1111.
1112.
1113.
1200. Government Recordin and Transfer Cha es
1201. Recordin fees: Deed 52.50 Mort a e Release 52.50 $ 0.00
1202. Ci /coun tax/stam s: Deed 845.00 Mort a e 845.00
1203. State tax/stam s: Deed 845..00 Mort a e $ 0.00 845.00
1204.UPI to Recorder of Deeds 10.00
1205.
1206.
1300. Additional Settlement Char es
1301. Surve
1302. Pest tns ection
1303.
1304.
1305.
1306.
1307.
1308.
1400. Total Settlement Charges (This Number Transfers to Lines 103 8r 502 Above 1282.50 5915.00
ctrc t ~rt~w t tvn
I have re Ily rev' we H -1 Settle t Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and
disbu m ('~ rna e o m nt or me in this transaction. I further certify th have receiv d a copy oft THUD-1 Settlement Statement.
Seller ~y Borrower
Seller f,~,t,w_ -}~lU Borrower
To the best of m know) - tatement which I have prepared is true and accurate accou t of the funds which were received and
have been or ill Isbu d by t nd e s part of the settlement of this transaction. !~r~
Settlement Agent ~~ C7~~ ~ ~ Date
WARNING: It is a aims to knowingly make false statements to the United States on this or any other similar forth. Penalties upon convicti can inGude a fine and imprisonment. For details see: Title 18 U.S.
Code Section 1001 and Secion 1010.
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