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Home My WebLink About06-22-11 (2)J 1505610105 REV-1500 ~` t°'-"'tom OFFlCULL USE ONLY PA Department of Revenue pennsylvaMa County Code Year Rle Number Bureau of Individual Taxes «"~"`~"~"~""~" PO BOX ztiD6ot INHERITANCE TAX RETURN hh Harrisburg. PA 1~12B-0601 RESIDENT DECEDENT O~ I ; ' I U; O ~ ~~ Sortial Security Number Date of Death '. 202-20-7093 ' 11/12/2010 Decedent's last Name HELMAN (If Applicable) Enter Surviving„Spousa's Information Below Spouse's Last Name Spouse's Social Security Number MMDDYYYY Date of Birth MMDDYYYY 1 011 2/1 929 Suffix Decedents First Name JACQUELINE Suffoc Spouse's First Name MI M MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ___ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13.82) O 4. Limited Estate O 4a. Future Interest Corrlpromise (date of O 5. Federal Estate Tax Return Required death after 12-12A2) O 6. Decedent Dfed Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Wili) (Attach Copy of Trust.) O 8. Litigation Proceeds Received O 10. Spousal Poverty CredH (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 121-91 and 1-1-g5) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATWN 8HOULD BE DIRECTED TO: Name Daytime Telephone Number JANE MAUST ', ', (717) 580-7475 REGISTER OF WILLS USE ONLY First Line of Address 107 BOYER STREET Second Line of Address City or Post Office ENOLA ~ , 'm s, ~ t~ x ~_~ i fV =si f~ State ZIP Code O C"~ <~, - A ~ ~ PA 17050 - ~.~ - `° ~ ~ - r;-, Correspondent's e-mail address: J.MAUST c~COMCAST.NET UMer penalties of perjury, I declare that (have examkted this realm, irxiurWtg accanparrying scFbdrle8 end statemenm, and m the bast of my knowledge and belief, jt~gtrue, correct and cgmplets. Decleretlon of preparer fiber than the personal representetlve Is based on all 7nformaeon Qt wNCh paperer lies ant knowledge. BOYER ST, ENOLA PA 17025 TORE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASB UEB ORIGINAL FORM ONLY L 1505610105 Side 1 1505610105 ~~ J 1505610205 REV-1500 EX (FI) Decedents Sodal Security Number Decedent's Name: JACQUELINE M HELMAN 202-20-7093 RECAPITULATION 1. Real Estate (Schedule A) ............................................. L ' 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2 ' 0.00 3. Closely Held Corpora5on, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ', 0.00 4. 5. 8. 7. 8. Mortgages and Notes Receivable (Schedule D) ........................... 4. ' Cash, Bank Deposits and Miscellaneous Pensonal Property (Schedule E)....... 5. ', Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 8. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. Total Gross Assets (total Lines 1 through 7) ............................. 8. , 0.00 21,311.15 1,311.15 ', 9. Funeral Expenses and Administrative Costs (Schedule H) .................. . 9. '', 7,573.50 10. Debts of Decedent, Mortgage LIabIIINes and Liens (Schedule q .............. . 10. '' 177.84 ', 11. Total Deductions (total Lines 9 and 10) ................................ . 11. ' 7,751.34 '. 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. ' 13,559.81 ', 13. Charitable and GovemmeMal Bequests/Sec 9113 Trusts for which ~ "~~"" ~ ~~~` ~ ~~ ~ ~~~ an election to tax has not been made (Schedule J) ....................... . 13. '' 0.00 14. Net Value Subject to Tax (Line 12 minus line 13) ....................... . 14. ' 13,559.81 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _ ._ __ 18. Amount of Line 14 taxable ~'~ ~ ~ ~ ~~ ~ ~ ~ ~ ~~ ~ - - __ at lineal rate X .0 45 13,559.81 16. 610.20 '' 17. ,. ~.~ .. ~~.~. .~.h. Amount of Line 14 taxable ..~., .. at sibling rate X .12 ' 17. ': 18. _ _ ._~ _ _m ~ Amount of Line 14 taxable __ ._. at collateral rate X .15 ' 18. 19. TAX DUE ........................................................ .19.s 610.20 ', 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 150561D2D5 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: Fik Number DE E NAM JACQUELINE M HELMAN STREETADDRESS 1100 GRANDON WAY, STE 216 CITY MECHANICSBURG STATE PA Z1P 17050 Tax Payments and Credits: 1. Tax Due (Pew 2, Line t9) (1) 2. CreditslPayments A. Prior Payments B. Discount _ Total Credits (A + B) (2) 3. Interest (3) 4. If L1ne 2 is greater than Line 1 + tine 3, enter the diUsrence. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) 610.20 0.00 610.20 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. D~ decedent make a transfer and: Yes No a. retain the use w ir>come of the properly transferred .......................................................................................... ^ b. retain the right to designate who shall use the properly trnsfemed or its income ............................................ ^ c, retain a reversionary interest .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent trensfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable~uporndeath bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retiremem aarount, annuity or other non-probate property, which contains a beneficiary designafion? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. ~e; "~,~i v' i .as ~( To r rl, ray u~rc~ i ~,yp. ~. ~*¢'"R".8+'mC:& ¢ tl a++-a ., i gg ~¢ u %~rAii E`~"~q sfs ..~i.l Gi x~~„ 9~a. c., ri ~~m~o~a e.. .ux'z ~ " i~~°rl°t ~ ~ ~ s7$~s .dr~i~a~Zfi7.`.~. ,,. ~~F ~ ~a'X 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. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer tb a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even 'rf the surviving spouse is the only benefidary. 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 young at death m 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 robe imposed on the net value of transfers th or for the use of the decedents lineal benefidaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to w for the use of the decedents siblings is 12 percent [72 P.S. §9116(a}(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood a adoption. REV-i5oa EX+ (u-io) ~ Pennsylvania SCFIEpULE E DEPARTMENTOF REVENUE CASH, BANK DEPOSITS St MISC. INHERRANCE TAX RETURN PERSONAL PROPERLY RESIDENT DECEDENT ESTATE OF: FfLE NUMBER: JACQUELINE M HELMAN 21-10-1183 Indude the proceeds of litigation and the date the proceeds were received by the estate. Ali Property jointly owned with right of survlvonMp neat be disclosed on Schsduk F, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 _ Checking Acct at Blue Chip FCU, 5050 Deny St, Harrisburg, PA Acct fr6041 DOD Value 17,765.23 2, U. S. Inwme Tax Refund 1 100.00 3. AARP Supplemental Hospital Insurance Payment 280.00 4, Verizon -Refund of overpayment 17.00 5. United Healthcare-Refund of Premium 100.80 8. Emeritus -Rent Refund 1,703.00 7, National Geographic -Refund 14.25 g, Omnicare Pharmacy -Refund 330.87 TOTAL (Also enter on Line 5, Recapitulation) ; 21,311.15 if more space Is needed, use addidona! sheets of paper of the same size. REV-151.1.EX+ (10•U9) ~~ pennsyLvania DEPARTMENT OF REVENUE INHERITANCE TAx RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER JACQUELINE M HELMAN 21-10-1183 DeadeM's debts must be reported on Sdteduk i. REM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' JOHN E NEUMYER FUNERAL HOME, INC. 7,093.00 1334 N. 2ND ST, HARRISBURG, PA B. 1. 2. 3. ZIP Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Attountdnt Fees: 6. Tax Retum Preparer Fees: z ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address city stare _ Year(s) Commission Paid: Attorney Fees: Family Exemption: (If decedent's address is not the same as daimant's, attach explanation,) Claimant TOTAL (Also enter on Une 9, Recapitulation) I; If more space Is needed, use additional sheets of paper of the same size. 120.50 360.00 7,573.50 REV-751.2 EX+ {'t2-08} pennsytvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERRANCE TA%RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JACQUELINE M HELMAN 21-10-1183 Report debts inprrred by the decedent prbr to death that remained unpaid at the date of death, indudirg unrcimburaad madiesl expenses. if more space Is needed, insert additional sheets of the same size.