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HomeMy WebLinkAbout06-13-11150561143 REV-1500 Ex `°'-'°' OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes oErnRTMENr of REVENUE Po Box.2soso~ INHERITANCE TAX RETURN 21 lD 0559 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 194 44 97Q3 Q4 l© 20.0 Decedent's Last Name LYBRArTD (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number Date of Birth D9 15 1953 Suffix Decedent's First Name MI CLPiIR L Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 1. Original Return ~ 2. Supplemental Return 4. Limited Estate ~ 4a. Future Interest Compromise death after 12-12-82) (date of g Decedent Died Testate (Attach Copy of Will) ~ r~ ~• (AttacfeGoMa~of Trust a Living Trust PY ) 9. Liti ation Proceeds Received g ~ 10. S ousal Povert Credit (date ~f death b~tween 12-31 ~J1 and 1-1-95 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required A 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ADAM R SCHELL~ASE ESQ 717 263 2121 First line of address 7 g S T" Pl~'i-U'L DR.I VE Second line of address City or Post Office CHAMB~RSBURG State ZIP Code PA- 172D1 REGISTER OF WILt~~E ONLY rim '-` ~ r i ~~~ ~ ~~~ ~~~ -~ --~ DATE FIL~D -_._. Er- ~~; r--~ ~,~,_ C; r ~ry ~~T ,:~.7 t'r-t ~e'3 Correspondent's a-mail address: ~s~h6111h~~t~St~1~1"IrtarMril'll.tg~'1e~.CE"~lt'n 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 complet~Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSOAIRES N IBL~ FOR FILING RETw N _DATE Lybrand /~ °~/ 5-- 199 Le o d Gardners PA 17324-8825 SIGNAT EP E T AN REPRESENTATIVE DATE Adam R. Schellhase Esq. ~ _ /`~ ~- Zo ( ~ ADDRESS 79 St. Paul Drive, Chambersburg, PA Side 1 L 1505610143 150561143 J J REV-1500 EX Decedents Name: ~yaranti, CaEr Ll~ther Decedent's Social Security Number 194 44 97Q3 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 1 ~ +4 , J o o . ~ o 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ............... 5. ~.~ , ~? ~~' . o0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous lynn; Probate Property (Schedule G) ^ Separate Billing Requested............ 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. ~. ~ 8 , 2'7 ~ . o 0 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 1 , 3 0 4 . 7 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 ~ 10) ................................................................... 11. 1 , 3 0 4 . 7 ~ 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 13 6 , 9 7 0.21 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. 1 ~ ~ , 9'~ o . 2 ~,. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 13 fi 97 f? . 21 15 (a)(1.2) X .00 ~ . 16. Amount of Line 14 taxable 0 ~ ~ 16 at lineal rate X .045 • . 17. Amount of Line 14 taxable at sibling rate X .12 Q • o ~ 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 • o 0 18. 19. Tax Due ................................................. ................................................................ . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 15D56~D243 b5O561©243 15D561O243 o.oo o.oo O.oo 0.©0 0.00 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-10-4568 DECEDENT'S NAME Lybrand, Clair Luther STREET ADDRESS 189 Leaper Farm Road CITY Gardners STATE PA ZIP 1 T324-8825 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount ti.44 (1) 4.4i1 4.(}Q a.oo 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. (4) 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. (5) Make Check Pa able 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 :............................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income :.................................. ^ 0 c. retain a reversionary interest; or ............................................................................................................... ^ 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 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?....... ^ ^x 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 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 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 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)). A sibling 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-1502 EX+ (11-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Lybrand, Clair Luther 21-10-0569 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-0wned with right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1508 EX+ ~6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~~~~~~~~ CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Lybrand, Clair Luther 21-10.0569 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+ (10-06) COMM_Q~W~DE~EQF_ P~NNN~RN ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Lybrand, Clair Luther FILE NUMBER 21-10-0569 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N M ER A, FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(sl Commission paid State Zip 2. Attorney's Fees 917.50 See continuation schedule(s) attached 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 74.50 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 312.79 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 1,304.79 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Lybrand, Clair Luther 21-10-0569 ITEM NUMBER DESCRIPTION AMOUNT Attorney Fees 1 Salzmann Hughes, PC 917.50 H-B2 917.50 Probate Fees 2 Register of Wills 74.50 H-B4 74.50 Other Administrative Costs 3 Cumberland Law Journal, estate notice 75.00 4 The Sentinel, estate notice 237.79 H-B7 312.79 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) REV-1513 EX+ (11-08) COMMO ~SIIDENT DECEDEN~RNANIA BENEFICIARIES ESTATE OF I FILE NUMBER Lybrand. Clair Luther 2~_~n~sa4 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Carl Lybrand Son 199 Leaper Farm Road Gardners, PA 17324 2 Eric Lybrand Son 46 Franklin Street Carlisle, PA 17013 3 Nancy R Lybrand Spouse 136,970.21 199 Leaper Farm Road Gardners, PA 17324 Total 136,970.21 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. 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 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)