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Home My WebLink About06-15-11 (2)],50561,0],48 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year Fi le Number PO BOX 280601 INHERITANCE TAX RETURN 2 L 10 1, ], 6 0 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 206-1,0-91],5 1,1,062D],D 01,081,920 Decedent's Last Name Suffix Decedent's First Name M I KIRBY HELEN B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number - - FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ ^ 4. Limited Estate ^ 6. Decedent Died Testate ^ (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 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 RICHARD C • SNELBAKER ?],?-697-8528 ~.., REGISTER R LS USE Olnt..Y First line of address ~ ~ ~~~ ,. 44 WEST MAIN STREET ' r-, , r~J Cl.~ ~ tJ2 _ .,r. st , -, x~ fir, a~ O Second line of address ~~ ~ ~ -... P • 0 • BOX 31,8 ~ rrr ~~ `~ '~ City or Post Office State ZIP Code DATE FILED C.' MECHANICSBURG PA 1,7055 Correspondent's a-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 belief, it is true, correct and complete. Declaration of preparer other than the personal re resentati e i b d l p v s ase on al information of which preparer has any knowledge. SIG RE OF,PERS S NSIBLE FILIN G RE URN DATE ~~ .j '~ ~~ ADDRESS CARL D • KIRBY, EXECUTOR 704 E • MARBLE STREET, MECHANIC p[~ SIGNA E F R OTHER THAN REPRES ENTATIVE DATE 17055 RICHARD C• SNELBAKER 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 Side 1 1505610148 9M46474.000 1505610148 J 1505610248 REV-1500 EX Decedent's Social Security Number 206-],0-91,15 Decedent's Name: HEL EN RECAPITULATION B 1. Real Estate (Schedule A) 1 ~ • 0 0 2. Stocks and Bonds (Schedule B) . 2. 5 , 0 ~ ~ • 8 2 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. 0 • 0 0 4. Mortgages and Notes Receivable (Schedule D) _ 4 . 0 • O O 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 4 , 5 0 4 •0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. ], 6 , 5 9 2.0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 6 ,15 9.9 7 8. Total Gross Assets (total Lines 1 through 7) $. 3 2 , 2 8 6.7 9 9. Funeral Expenses and Administrative Costs (Schedule H) , , 9 2 , 7 8 8.2 8 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) _ 10 4 , 2 4 8.6 5 11. Total Deductions (total Lines 9 and 10) , 11. ? , 0 3 6 •9 3 12. Net Value of Estate (Line 8 minus Line 11) 12 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which . 2 5 , 2 4 9.8 6 an election to tax has not been made (Schedule J) , 13 . . ~ • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) _ , 14. 2 5 , 2 4 9.8 6 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a)(1.2)X.0_ ~•~D 15. x•00 16. Amount of Line 14 t xable O 4~ at lineal rateX 17. . 25, 249 • 86 Amount of Line 14 taxable 16. 1,136.24 ~~ at sibling rate X .12 ~• ~ ~ 17 0. ~ ~ 18. Amount of Line 14 taxable at collateral rate X .15 ~• ~ ~ 18 ~• ~ ~ 19. TAX DUE . 19. 1„ 1,~6 • 24 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 7,505610248 9M4648 4.000 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME STREET ADDRESS CITY Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments D - D D B. Discount 0 - D 0 3. Interest File Number 21 1,0 ],1,60 (1) 1„1,36.24 Total Credits (A + g) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in 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. 0.00 (3) 0 • D 0 (4) 0.00 (5) 1,1,36.24 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; ^ 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? . ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one ear of death y without receiving adequate consideration? . ^ 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 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 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. X9116 (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. X9116(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. STATE ~ ZIP 9M4671 2.000 REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS CIA FILE NUMBER Helen B. Kirb 21 10 1160 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1.Edward Jones 5,030.82 investment account #608-06880-1-0 TOTAL (Also enter on line 2, Recapitulation) I $ 5, 030 82 3wasss t.ooo (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6.98} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~.~ ~ ~+ ~ ~ yr FILE NUMBER Helen B. Kirb 21101160 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. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1 (United States Treasury refund on 2010 income tax return 4,504.00 TOTAL Also enter on line 5 Reca itulation $ 4 , 504.00 3W46AD 1.000 (If more space is needed, insert additional sheets of the same size) REV-1509 IX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF: FILE NUMBER: Helen B. Kirby 21101160 if an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G SURVNING JOINT TENANT(S) NAN~(S) ADDRESS RELATIONSHIP TO DECEDENT A Kirby, Carl D 704 East Marble Street, Mechanicsburg, PA 17055 JOINTLY OWNED PROPERTY: Son ~~ NUIVBER LETTER FOR JOINT TENANT DATE N-ADE JOI(.(j' DESCRIPTION OF PROP'ERT'Y INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUM3ER aR SIMLAR IDENTIFYINGNUM3ER. ATTACH DEED FOR JgNTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENTS INTH~EST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 6/1/1971 Bank of America 20,619.41 50.0000 10,309.71 checking account #000001271016 2 A Inception pentagon Federal Credit Union 672.75 50.0000 336.38 savings account #109806-O1-8 3 A Inception pentagon Federal Credit Union 2,.019.04 50.0000 1,009.52 checking account #1023031-03-0 4 A Inception Wachovia Bank, N.A. 9,872.78 50.0000 4,936.39 checking account #1010072157132 TOTAL (Also enter on Line 6, Recapitulation) $ 16 , 5 92.0 0 9W46AE 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX + (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY "' ' ~" ` "' FILE NUMBER Helen B. Kirby 21 101160 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBE DESCRIPTION OF PROPERTY INCLLOETI-ErlMAEOFThETRANSFEREE, TF~IRRELATIONSFpP70 DECEDENT AND TFEDATEOFTRMISFER.ATTACHACOPYOFTF~DEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD~S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1• Bank of America 17.44 100.0000 0.00 17.44 savings account ending #3313. Payable on death to Carl D. Kirby 2 Pentagon Federal Credit Union 2,012.49 100.0000 0.00 2,012.49 money market savings account #1075272-03-7. Beneficiary is David Kirby (grandson) 3 Pentagon Federal Credit Union 2,112.80 100.0000 0.00 2,112.80 money market savings account #1253740-03-7. Beneficiary is Angela Kirby Kessler Seitz (granddaughter) 4 Pentagon Federal Credit Union 2,017.24 100.0000 0.00 2,017.24 money market savings account #1427785-03-3. Beneficiary is Candace A. Kirby Engle (granddaughter) TOTAL (Also enter on line 7, Recapitulation) $ 6,159.97 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS w ~ H ~ ~ ur FILE NUMBER Helen B. Kirb 21101160 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ , None B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address 2 3 City State Z1P Year(s) Commission Paid: Attorney Fees: Snelbaker & Brenneman, P. C. 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: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 Bank of America fee to obtain date of death balances 2 Cumberland Law Journal advertising Executor Notice Total from continuation schedules . 1,665.00 123.50 20.00 75.00 904.78 TOTAL (Also enter on Line 9 Recapitulation) ~ $ 2 788 23 9W46AG 2.000 If more space Is needed, use addltlonal sheets of paper of the same size. ~ Estate of: Helen B. Kirby 21 10 1160 Schedule H~Part 7 (Page 2) 3 H&R Block accountant fee to prepare 2010 tax returns 192.00 4 Register of Wills short certificate 4.00 5 The Sentinel advertise Executor Notice 208 78 6 Reserve reserve for filing fees, accountant fees and other miscellaneous costs associated with the administration of the decedent's estate 500.00 Total (Carry forward to main schedule) 904.7$ REV-1512 EX+ (12-08) pennsylvania SCHEDULE I DEPARTMENTOF REVENUE DEBTS OF DECEDENT, WHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF Helen B. Ki FILE NUMBER 21 10 1160 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. 8W46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Helen t~. xirn 2110 1160 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Angela Kirby Kessler Seitz 801 Stoneybrook Lane Lewisberry, PA 17339 Pentagon Federal Credit Union Inventory Value: 2,112.80 Granddaughter 2,112.80 2 Candace A. Kirby Engle 1010 N. Curson Avenue, #104 West Hollywood, CA 90046 Pentagon Federal Credit Union Inventory Value: 2,017.24 Granddaughter 2,017.24 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. ~~ NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00 swasAi z.ooo it more space is needed, use addiUOna1 sheets of paper of the same size. Estate of: Helen B. Kirby Schedule J Part 1 (Page 2) I tem No. Description 3 Carl D. Kirby 704 East Marble Street Mechanicsburg, PA 17055 A11 of Residue: 19,107.33 4 David Kirby 43 Argali Lane Mechanicsburg, PA 17055 Son Relation 21 10 1160 Amount 19,107.33 Pentagon Federal Credit Union Inventory Value: 2,012.49 Grandson 2,012.49 --x.a1- _ _ ^' R •[+a 'f?' ~`CL~ .£'.' . s ..~.,. ~ .. ~ _ - _ _ -. _ . -~ ~%ryersq+~i _ eel .. , .. ,•}4, i~.. r, ~;~ }_.11 1 ~T.~.J r'x t I ~. ''ir f fifi x r ,~., ~ ~~••t ,. ._~ _... _~ f~ [[ ,gypp \\ ~ f i f{t7 .i~a!'v ~ ~~ ~ n F'~ ~ ~ L Y ~.. y I • i ~ ~ .~. 1. J J ~1~'~~~i~ ~3. ~~Ift.~~~, n~' 11.r~' a ~1~;•t~ !~ Ci~Aii+,V• n '~C~. •~'~ ~,* ~ ~~f }Jr:':LnE; C).~' ~~ra7..e.~]i~ F.i1~,~d c~~Cl. ?i7.c.',:7Et~l"~7T.,, Q'S°) I11 a~:~.E., X71,. ~7. C;~ r3 ~ -~ •, ~ a- x ~-. r a 1 ~.l . z c).n{'~. C~' C. ::..7 E:;' ~, h .a..~ t C.:7 ~t~ rn;~r sti=wit :'a~~,_~_ anal. `~'L?t-it,3rr1~1Z~, ! t1~ere?a,~~r rev~.~~•:, ~ ~- 1 ~~ ~; all w~i.._.1• s ~, na c; ~,~~ y •~~ ~ h re c.x ~_s r U~.l1. try ~i' made ~)f me. 4 ~~ Af4T~.C:f,F I: Z declare thaf-, al1_ my ~7Last dek~t-~s s.;~~. ~"~.~r~er^a.~. e~~~en~~.~; °f ?:~e X;a•? d h~~ m~,r 1~~ecut,or. ~~~~TICLE TI : I t~..:1..1~ ~1Ve, be c~ueath anal c'~e~~~.s~ a:1.:!- of m~r~ e, real, X~ersGn~.1 c~ n rn.i.x_er.~., and whe;~ever the carne ~:~e ~~.t;uated c:.t thc,~~ t~" 3~-a o f rn- d ea t r ~.m., ~ h t,o m.~~ son. C~~~:, U. i,I~..~Y, if he clarvi.v~-: a ni.e. I:f' he does noa, surv~,~Te me , :t: ~:i.ve, wi:l.1., k~et~ue~~,th a.n.d dev~.se mY es~,ate tc my ~rand.c~•~~a_ldren, na~ne~,.y, ~a.vid ~. ~irtr~, ~.n~;e:~a Ressler cE.nd Cand~.ce F~. ~_ K~..rla~, share anc3 sharpy al.:i.l~e. an i?T~:.CI~F III : I c3.~ rect that =~11 t-.a.:~es, }~.o~~•~ever d.-.,:.iii. ,rf~.~te~ , tyat; sl~a.%.1 ,r ~azT~,%~~:.e b;~. rease~n of rrE .th ;- r'4 ~~ a ., ~ t`~~~ ~ ~ A .. ` rn ..M , ., ~.~'c~1_if.~~t..~ ..~f '^E'=~~.~i~1 a•E ~fl t,'4i~;~';.°a~ C>irt ,. 9 _. ... ~ , ~~ - P "i i I ~ r y~ ' t `~ .?"YT ,, 5.,~ `~ i' i``•"ia tJ:~,~ ~,7 M ts~'11 •~~ ~~' t i~ t 4~i~ d :]~ ~ P7~ S ~ ~c a~i"~ ~r ~. q S i Pf ., •- . .. r,~ ..y .. r , .. - t'':!•7 ,1w ':~n ~_,.etp. f (~ f'~, S ~.? i1"(/ 2 ' S I F' ~ ~~-~ ~ C` .. .1 .... .. ~ .c ._.a . J , ~r ~ ~ ~ r 4"0 ,^ ~ { ~ .. t" ~ - t~ •~.~~"~. ~ .i_(~1; C ~ i7'`:, ryt•, ~ 'b /,'x '-" y,r, _ .. §~~...,...~.., ,,~~I_t .ti"t ^..,. ....,... 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