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HomeMy WebLinkAbout06-21-11 1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box 28oso1 INHERITANCE TAX RETURN _ Harrisburg, PA 17128-0601 2 1 1 1 D 5 2 2 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 6 2 1 2 1 8 3 8 1 2 2 3 2 0 1 0 0 5 1 9 1 9 1 8 Decedent's Last Name Suffix Decedent's First Name MI I R W I N R I C H A R D B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI K A T H L E E N I R W I N L Spouse's Social Security Number 1 6 6 1 4 0 2 0 3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder 12eturn (date of death prior to 12-13-£i2) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total NumbE:r 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 sunder 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 T0: Name Daytime TelephonE: Number R O G E R B- I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 B First line of address 6 0 W E S T Second line of address City or Post Office C A R L I S L E Correspondent's a-mail address: State P A REGISTER OIF VI~IILLS USE ONLY ~} : _ - ,._ .. zC .,.., `f~ ~7 ~» -~ ~'' ~~ 7 _..v_ / 1..% --~ .~dFILED ~~ _._~ ~:. _,- __ ~ "-'t :~~`=~ ZIP Code L 1 7 0 1 3 c 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 representative is based on all information of which prepa~rer has any knowledge. SIGNATU F PE SON RESP SIBL R FILING RETURN )AT ADDRESS 8 STRAYER DRIVE CARLISLE PA 17013 SIGNATURE OF~EQARER OTH THAN PRESENTATIVE GATE ' ' ~~ ~a ,/ L~ // ADDRESS -'F- 60 WEST POM1 ET STREET CARLISLE PA 17013 PLEASE IJSE ORIGINAL FORM ONLY Side 1 1,505610140 15056101,~41~ P O M F R E T S T R E E T r aa2o29sns2 Oh20'C950S'[ Z aP!S 1N3WJlddb3n0 Nt/ ~O aNf1~32! d JNIlS3f1D321 3214 f10J1 ~I ltln0 3Hl NI lll~ 'OZ 0 0 '0 •61 ...................................................... 3flQ XHl '61 ~ ~• ~ •81 ~ 0 ~ 51• X a}e~ lea}elloo }e ' algexe} ~,~ aul~ ~o }unowy gl 0 0' 0 L 1 0 0. 0 Z 1' X a}e~ 6ullgls }e ' algexe} ~~ aul~ }o }unowy L1 0 0. E •96 O ~ ~ 0• X a}e~ leaull }e ' algexe} ~ ~ aul~ }o }unowy g ~ 0 0' 0 .5 ~ Z 2' 0 E 6 6 2 0• x (z• 1)(e) g ~ lg •oag aapun spa}sues} ~o 'a}e~ xe} lesnods ay} }e algexe} ~ ~ aul-l ~o }unowy .g ~ S31H2! 3l9dOllddd 2lO~ SNOIlOf12l1SN1 33S - NOIlH'lflOldO Xt/1 Z 2 ' 0 E 6 6 2 •~~ • • • • • ~ • • • • • • ' • • • • • ~ ' ' ' (£1 aul~ snulw Z6 aul~) xel o;;oafgng amen;aN •~~ •£ ~ • • • • • • • • • • • • • • • - • • • • • • (~ alnpayog) apew uaaq }ou sey xe} o} uol}oala ue yolynn ~o~ s}sn~l £ 116 oaS/s}sanba8 le}uawuaano0 pue alge}l~ey0 •£ ~ L 2' 0 E 6 6 2 •Z1 ...... ...................... (11 aul~ snulw g aul~) a;e;s3 ~o amen;aN 'Z1 0 5' 2 9 2 2 ' l l ...... ......................... (01 pue g saul~ le}o}) suol;onpaa le;ol ' l l •O L ' ' • ' • ' ' • ' • ' ' • (I alnpayog) sual~ pue 'sal}lilgel~ a6e6}~olN `}uapaoaa ~o s}qaa •O 1 0 5 ~ 2 9 2 2 .6 • • ~ ~ ~ • • • ~ ~ • • • ~ ~ • • • (H alnpayog) s}sod and}e~}slulwpy pue sasuadx3 le~aun~ 'g ~. ~ ~ 2 6 2 2 E .8 ........................... (L y6nay} 1 saul-i le}o}) s;assb ssoa0 le~ol '8 • •L • • • • • • • pa}sanba~l 6u!II!8 a}e~edag ~ (O alnpayoS) ' ~(}~adoad a}egad- N snoauellaos!W 'S s~a~sue~l sonln-~a}ul L •g • • • • • • • pa}sanba~{ 6u!il!8 a}e~edag ~ (d alnpayog) ~(}~adad paunnp ~(pulop 'g •5 • • • • • • •(3 alnpayog) ~(padad leuos~ad snoaueilaos!W pue s}lsodaa ~lue8 'yse0 .5 Z ~. ' 2 6 'C 2 E .~ .......................... (d alnpayoS) aigenlaoaa sa}oN pue sa6e6}~oW •b •£ • • • • • (O alnpayog) dlys~o}al~doad-slog ~o dlys~au>ued `uol}e~odao0 plaH ~(lasol~ •£ •Z ...................................... (8 alnpayoS) spuo8 pue s~loo}g 'Z ~ ........................................... (d alnpayoS) a}e;s3 lead ' 1 NOlldlfllidb~~321 S E Q 'L 2 2 2 9 2 N I m~ I ' 8 Q ?1 d H~ I~ :aweN s,}uapaoaa aagwnN ~(}l~noag leloog s,}uapaoaa X3 0051-^321 on2o29sas~ r REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 0522 DECEDENT'S NAME RICHARD B. IRWIN __ STREET ADDRESS --- 8 STRAYER DRIVE CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments 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 + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 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 : ................................................................ ...... ^ Q b. retain the right to designate who shall use the property transferred or its income; .......................... ...... ^ Q c. retain a reversionary interest; or .......................................................................................... ...... ^ 0 d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. ..... ^ Q 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? .... ..... ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ............................................................................................. ..... ^ Q 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(x)(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(x)(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(x)('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. RE'V-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER RICHARD B. IRWIN 21 11 0522 _ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SUNAMERICA 32,192.77 ANNUITY #7208932A BENEFICIARY: THE ESTATE OF RICHARD B. IRWIN TOTAL (Also enter on line 5, Recapitulation1 $ 32,192.77 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS to i A i t uli- FILE NUMBER RICHARD B. IRWIN 21 11 0522 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B 1 2. 3. 4, 5. 6. 7. City State Zip Year(s) Commission Paid: ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ,_,. ZIP Relationship of Claimant to Decedent Attorney Fees: IRWIN & McKNIGHT Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address Probate Fees: REGISTER OF WILLS Accountant Fees: Tax Return PreparerFees: PATRICIA A. ROSENDALE, CPA REGISTER OF WILLS -FILING FEE 1,750.00 107.50 375.00 30.00 TOTAL (Also enter on Line 9, Recapitulation) J ;$ 2,262.50 If more space is needed, use additional sheets of paper of the same size. ~ REV-1513 EX+ ((}1-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RICHARD B. IRWIN ~~ ~ ~ n~~~ 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. KATHLEEN L. IRWIN Spousal 29,930.27 8 STRAYER DRIVE REMAINDER CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWY ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN; 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. I TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. g~ SCHEDULE J BENEFICIARIES n inure s{~dce is neeaea, use aaaiuonai sneers or paper of the same size. -! i ~T1I ~Yt~ ~PSt~ritPltt I, RICHARD B. IRWIN, of South Middleton Town ship, Cumberland County, Pennsylvania, declare this instru ment to be my last will and testament, hereby expressly revokin g all wills and codicils heretofore made by me. 1• I direct my executrix to pay all of my debts funeral and administrative expenses as soon as may be done co nveniently after my decease. 2. I authorize and empower my executrix to sell a ny r~_alty owned by me at my death, and not specifically devised her ' either eir~, at public or private sale, and to give good and suffi :' c lent deeds therefor, in fee simple, as I could do if livin 9• 3• I give, devise and bequeath all of my estate of every nature and wherever situate to my wife, Kathlee n L. Irwwin, providing she shall survive me by sixty days. 4. Should the gift in Paragraph No. 3 not take e ffect., I devise and bequeath all of my estate of every nature and wherever situate to my two children, share and share alike the child or children of any deceased child taking the share th ' eir parent would have taken if living. 5• I nominate and appoint Kathleen L. Irwin to be i:he executrix of this my last will and testament; she is to se <~ rve a., such without bond. Should she die before my death re nounce or• refuse to serve for any reason, or die leaving an of m Y y estate unadministered, I nominate and appoint Thomas R. Irwin .and Larry E. Irwin, as substitute executors, also to serve as such without bond with the same powers as are given herein to my executrix. 6. I hereby suggest that my personal representative retain the services of Irwin, Irwin & McKnight, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal th i s L~ ~' day of January, 1990. ~` - C RD B.~ RWIN Signed, sealed, published and declared by Richard B. Irwin, the above named testator, as and for his last will and testament, in the presence of us, who at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. -~..7Llo~rl~~2 ~f~ . _ d°4~ !_ o , ACKNOWLEDGEMENT AND AFFIDAVIT WE, RICHARD B. IRWIN, BETZI A. MORRISON and SHARON L. SCHWALM, the testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it ass his free and voluntary act for the purpose herein. expressed, and that each of the witnesses, in their presence and hearing of the testator, signed the Will as a witness and that to the best of their knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. B. R .~, ,~° ap , p~ COMMONWEALTH OF PENNSYLVANIA: ss. COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by RICHARD B. IRWIN, the testator, and subscribed and sworn to before me by BETZI A. MORRISON and SHARON L. SCHWALM, witnesses, this ~e day of January, 1990. 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