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Home My WebLink About07-06-11 1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN County Code Year File Number Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 4 8 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Deat h MMDDYYYY Date of Birth MMDDYYYY 2 0 1 1 8 3 7 3 5 0 4 0 6 2 0 1 1 1 2 3 0 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI E p p l e y P a t r i c i a B (If Applicable) Enter Surviving Spouse's Information Below Spouse°s Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Q 1. Original Return ^ 2. Supplemental Return ^ 3 Remainder Return (date of death ® 4. LimitFd Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Return Required 6 D d t Di T death after 12-12-82) . ece en ed estate (Attach Copy of Will) ~ 7. Decedent Maintained a Living Trust A 8. Total Number of Safe Deposit Boxes ( ttach 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 T0: Name Daytime Telephone Number S t e p h e n J H o g g E s g 7 1 7 2 4 5 2 6 9 8 __ _ REGISTER OF WILLS USE ONLY i~ First line of address t7 a~ 1 9 S H a n o v e r S t r e e t I ;~ c° :` Second Irne of address n r--= ' -' m ~ I . cri ~ cz ~ _ ~' S t e 1 0 1 ~ ~_ ' ity or Post Office , ,... .- ~ _. - _, -P~ FILED _, , State ZIP Code . ; _ , i _ __ _. C a r l i s l e P A 1 7 0 1 3 ~ -` ~ ~::~Q f..'? ~', 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 representative is based ll i f on a n ormation of which preparer has any knowle dge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ___..~'_. -- 1 ,.-. ~.~ , DATE A RESS 231 Touch e Drive Carlisle PA 17015 SIGNATURE OF REPRESENTATIVE DATE ADDRESS ~ 19 S• Hanover S re Ste• 101 Carlisle PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J ;~` PA 17ni, 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: P d t r^ 1 C l d B• E p p l e y 2 0 1 1 8 3 7 3 5 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 1 2 0 0 0 0. 0 0 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. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ...... 7. 8. Total Gross Assets (total Lines 1 through 7) .. .............. ......... 8. 9. Funeral Expenses and Administrative Costs (Schedule H) .... . ...... ...... 9. 10. Debts of Decedent. Mortgage Liabilities, and Liens (Schedule I) ............. 10. 11. Total Deductions (total Lines 9 and 10) ............................... 11. 12. 13. 14. Net Value of Estate (Line 8 minus Line 11) ..... . .... ...... Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...... Net Value Subject to Tax (Line 12 minus Line 13) .. ....... .. ..... ........ ........ .. 12. .. 13. .. 14. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.0 0 0 0 15. 16, Amount of Line 14 taxable at lineal rate X .0 _ 0 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 1 6 8 2 4 0 2 18. 19. TAX DUE ............................ .........................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 2 8 6 1 2. 8 2 1 4 8 6 1 2. 8 2 1 6 9 2 9. 3 5 1 4 8 5 9. 4 5 3 1 7 8 8. 8 0 1 1 6 8 2 4. 0 2 1 1 6 8 2 4. 0 2 0. 0 D 0. 0 0 o. 0 0 1 7 5 2 3, 6 0 1 7 5 2 3. 6 0 Side 2 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 0489 DECEDENT'S NAME Patricia B. Eppley __ STREET ADDRESS 21 W. I Street _. CITY _ __ _ .STATE.. Carlisle PA ZIP 17013 Tax Payments and Credits: ~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 876.18 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 ~s greater than Line 2, enter the difference. This is the TAX DUE 17,523.60 Total Credits (A + g) (2) 876.18 (31 (41 0.00 (5) 16 647.42 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TF~E APPROPRIATE BLOCKS ~ . Ditl 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 December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. ..... ^ ^ 3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her .rF:ath? .... ..... ^ ^ a. Ditl 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 FI LE IT AS PA RT 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. §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 ~~ 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, 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+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Patricia B. Eppley 21 11 0489 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 that is jointlyowned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. Single family home located 21 West I Street, Carlisle, Cumberland County Pennsylvania 120,000.00 Settlement on May 31, 2011 to Meredith L. Hummel TOTAL (Also enter on Line 1, Recapitulation.) I $ 120,000.00 If more space is needed, use additional sheets of paper of the same size. REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Patricia B. Eppley 21 11 0489 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VAUJE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Checking Account No. 411361 12,193.63 2. M&T Money Market Account No. 15004198188748 10,535.40 3. First Alert Refund 29.63 4. (Kemper Insurance Refund I 60.00 5. Surbuban Heating Refund 53.52 6. The Sentinel Refund 86.63 7. Vanity Fair Magazine Refund 176.09 8. Proceeds from Auction -Rick Foreman Auctioneer 4,607.50 9. Kemper Insurance Refund 367.00 10. Reimbursement for County Taxes from real estate settlement 380.84 11. Reimburesment for School Taxes from real estate settlement 122.58 TOTAL (Also enter on line 5, Recapitulation) I $ 28 612 82 (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 ESTATE OF FILE NUMBER Patricia B. Eppley 21 11 0489 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hollinger's Funeral Home 3,715.84 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) John F. Eppley Street Address 231 Touchstone Drive City Carlisle State PA zIP 17015 Year(s) Commission Paid: 2 3 City State ZIP Relationship of Claimant to Decedent Attorney Fees: Stephen J. Hogg, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address 7,405.47 5,000.00 4. Probate Fees: 315.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. Advertising: Law Journal 75.00 The Sentinel 187 54 8. Accounting (Est.) . 200 00 9. Tax Return and Inventory Filing Fee . 30.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 16 929 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, RE~:ioENTOECEO NTTURN MORTGAGE LIABILITIES, & ! IENS ESTATE OF FILE NUMBER Patricia B. Eppley 21 11 0489 Report debts incurred by the decedent prior to death that remained unpaid at the date of death including unreimbursed medical ex ens , p es. ITEM NUMBER DES~;RIPTION VALUE AT DATE OF DEATH 1. Centurylink 58.55 2. PPL 74.68 3. PPL Final bill 41.09 4 Oiler's Lawn and Landscape 207.76 5. Lowe's 9188 6. Kemper Insurance 44.10 7. Gilbert's Pest Control 127.20 8. Old Town Homes, LLC 100.00 9. Centurylink 58.05 10. Commission from sale of real estate 6,930.00 11. Settlement brokerage fee 125.00 12. Deed preparation 200.00 13. Notary fee at settlement 10.00 14. Realty transfer tax 1,200.00 15. Seller assist costs 5,500.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 14 859 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-1C) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER: Natricia B . E le 21 11 0489 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. John F. Eppley Collateral 231 Touchstone Drive Carlisle, PA 17015 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET; AS APPROPRIATE. l 1. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART 11 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ it more space is needed, use additional sheets of paper of the same size.