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Home My WebLink About07-25-111505610105 ~' REV- i 50o EX (o2-il) (FI) j ~„~ OFFICIAL USE ONLY PA Department of Revenue pennsytvania oEVnarNenr of aE~E~~E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX z8o6oi ~ ~ 1 Harrisburg, PA i~128-0601 RESIDENT DECEDENT ~ ~ Cl ~ D ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 211-22-6918 03/23/2010 04/26/1931 Decedent's Last Name Suffix Decedent's First Name MI Ancheff Agnes S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MB Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O O 4. Limited Estate O O 6. Decedent Died Testate O (Attach Copy of Will) O 9. Litigation Proceeds Received O 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust.) 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) O 3. Remainder Return (Date of Death Prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Mary Lou Snyder (717) 732-6326 First Line of Address 105 S. Enola Drive Second Line of Address City or Post Office State ZIP Code Enola PA 17025 ~~ REGISTER WILLS USE C!l~ILY .- ~ ~~ ~~a _:? ~ " c..P.. r C.." { .i_._j , r ~ t ~ ~ ~ n f , _ >;~rn ~~ r [3~'E~ILED Y r _~' ' _ . , ' ~ ~~ Correspondent's a-mail address: mlSnyder49@COmcaSt.net 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 preparer has any knowledge. S NATURE O~EvR\SON R~~~1SIBL~IG E~ ~ DAT~ ~_~ -~ 105 S. Enola Drive, Enola, PA 17025A SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 r 1 J 1505610205 REV-1500 EX (FI) Decedent's Name: Agn@S $. Al1Ch6'ff Decedent's Social Security Number 211-22-6918 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and No#es 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. 11,250.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 9. Funeral Expenses and Administrative Costs (Schedule H) .............. ..... 9. 9,235.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) .......... ..... 10. 11. Total Deductions (total Lines 9 and 10) ............................ ..... 11. 9,235.00 12. Net Value of Estate (Line 8 minus Line 11) ......................... ..... 12. 2,015.00 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. 2,015.00 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_ 15. 16. Amount of Line 14 taxable at lineal rate X .0._ 90.68 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate ~; .15 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYM ENT Side 2 1505610205 1505610205 90.68 O J REV-1500 EX (Ft) Page 3 Decedent's Complete Address: File Number DECEDENTS NAME Agnes S. Ancheff _________ _ _ ---- STREETADDRESS 105 S. Enola Drive CITY - - - - - --- -- _ STATE T ZIP Enola PA ; 17025 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 0.00 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. 0.00 (3) t . C,~ (4) ,5, 9a ae 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 .............................................................................................................................. ^ 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 year of death 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 awn 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. §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(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. 90.68 Total Credits (A + B) (2) ~. :.. _ _ ^, - . _ _.- s -..... .-..ax, arsr ~-~+, .: ~.~~,,.~.~.w.aecrc~a-s~su~ M a>G, ; } -: ., .+,~ ...:_;.c.~s;s:~..~.._.;.::,. .. -. F -:~ *aa .amc..s~sa~ =.ar.€ _ xis «. _ s...,.,, ~=: 4 ._. ~_ r ~. ., * ~. ~~ ..-_, - -, .. ~. .__ -.~._. _..~.. _...-~~. _ ..- i r . f 1# a.P. t _k rP _ - ~~ . _ .,..,..E , ' .. _... _ -.~__,~ e.~.m .._.~.. ~ . .. ~, / /j l ~,.' _ 5, - n _ ~... ,.~l:f,i.-.. .. , .~ ,. Gi; f ~~ ~i, ;~ .~.~ti. _ ~ _.. 1-~-- FQ~ -~ --- . _ - / ~~ .fir 1 s, ..,.c_vw~e+~«.xs~arrs~ _c.~ac~nxum~-c.m.~esa~ _~ rr ,~sw ....rr_ r mrs.,~m, ~. ~u-.~.rc.a _~~! ~ } ,~ : :-- _; '. 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' ' HT ^ ~ ~~ ^' s..>aW.a, - s.:...xa .°nv~T&...'~sae. ax __3~ nc: ,:. ^ami~34 ,. xP+ .ai s ¢. ..2_.ts "a-'ear: nom. . ..vim .. ~ y v.:'.x.5 .s. . ~~ aA .~ __. 4"a ~-; .a _.l~ ~_ .. ~ 3idC. :~ ~w $ ~ ,_, _ _ _, _ ,._ - v._. . `..^ ~ _ _ -. ~ .._.... ._.. ~, r-" P ~ ~ t a„~ , a.. ..W ...._, s >__ .b~ . W 3,i G,s1 _. ,,}.i ICsli ,.. .(.~~' r";'CL~CI'J`~I :.c'.i = i .' :. ';':c.l,.. ,.... v~ ~.i, _ ,. c..l . ~ ~ .. _. _t J4 . ~_, ~ .... .. .. .. -. ~. .'.~.. .. _,. ._. r~. ~..t.i.t:~ }.,,~-~, _G._u' Q~C ~Q~~ F~ MN 'W ^W 1 V W M~ W W t ;~- _ _ _ -- CERTiF"iCATE C3ir TITLE: FC~R A ~IEi-iit:i_E ~ ~, ~ - .. - '~ ^{ 1 d a ~ A d. 1 f W '{ '' :~ ~ ~ + ~ s ' ~ ~ .~ ._I ~} y ; : a ~ ~'~ ~ n tt ,,,, ) - ~ _ ~ `~ r n ~ Y '"' L = ~ VEHICLE lDENTlFICATiOhI NUMBER YEAR I MAKE OF VEHICLE TITLE NUMBER ~;~ J-i ~ ~f.. ~ ~ ~ ... ,.3 x.., ~ ~ -` ~ ..-. ,y, .~ .p T. ~ BODY TYPE ~ DUP SEAT CAP PRIOR TITLE STATE TE ODOM. OCD. ODOM MtLES ODONI. STATUS A ~ , ~ ~ ~ F I ~ ~ I I ~ D E P T D LE DA O SSUE UNLADEN WEIGHT GVWR GCWR TITL6 BRANDS REGISTERED OWNER(S) `~ a ~~ ~;, 3 g - ~_ _,~~. .. FIRST UEN FAVOR OF: SECOND LIEN FAVOR OF FIRST LIEN RELEASED DATE BY AUTHORIZED REPRESENTATIVE MAILING ADDRESS O[~METEA STATUS p =ACTUAL MILEAGE 1 -MILEAGE IXCEEDS THE MECHANICAL LIMITS 2 . N07 THE ACTUAL MILEAGE 3 = tJOT THE ACTUAL MILEAGEOOOMETER 'PAMPERING VERIFlED 4 . EXEMPT I=ROM ODOMETER DISCLOSURE TFTLE BRANDS A = ANT{C1UE VEHICt.E C =CLASSIC VEHICLE D = COLLECTfl3LE VEHtCl.E F = OUT OF COUNTRY . ~ C:.. - !TRKiINAi:LV#+:F+rr. 6C1R-NON: L.S. DISTRIBU'TtOPI H =AGRICULTURAL VEHICLE L - LOGt:rItJCi VEHICLE P = IS.M+AS A POLICE VEHICLE A =RECONSTRUCTED S =STREET ROD T =RECOVERED THEFT VEHIGI.E V =VEHICLE CONTAINS REISSUED VtN W =ROOD VEHICLE X . ISANA~S A TAXI N a second lienhotder is tilted upon satisfaction of the first Lren, ~ fiBt lienhuider musF forward this Title to the Bureau of Nbtor Vehicles vaith the appropriate form arxi tee. SECOND LIEN RELEASED DATE BY AUTHORIZED REPRESENTATIVE 1 cerYity a5 of the date of issue, ttu: official records of the Pennsylvania Department of Transportation reflect that the persons} or cdrnpany named heretn is tha tasviul or.-ner ~ • of ttra said vehicle. 3SCRIBED ANb SWORN BEFORE ME: of OATH the rmderstgned treaby makes application for Certdxate of Title to die vehXle descrtlted above. salt to the encumbrances and other legal claims set fotfh rove. SrGNATURE OF APPLICANT QR AIiTHORIZED SIGNER SIGNATURE OF C.Q-APPLtCANTRiTLE ~ AEITHDRIZED SIGNFA Secretary of Traacportatan If a co-purchaser other than your spouse is listed, and yov'warrt the title fo be fisted as "Joint Tenants Wdh Right of Survivorship" (On death of one owner, tine goes to surviving owner.} CHECK HERE ^. Otherwise, the title will tie issued as 'Tenants in Common" {On death of one owner, interest of deceased owner goes to hislher heirs or estate}, 1ST LIEN DATE: "'~' IF NO LIEN, CHECK a 1ST LIENHOLDER STREET CITY STATE ZIP IF THIS IS AN ELT, CHECK HERE ^ NUTS: FIN REQUIRED FINANCIAL INSTITUTION NO. 2ND LIEN DATE: --~ IF NO LIEN, CHECK 2ND LIF_tdHOLDER STREET CITY STATE ZlP !F THIS 1S AN ELT, CHECK HERE (-"( ~ FINANCIAL NOTE: FIN REQUIRED (~ INSTITUTION NO °;;~~= t~r~_ ~ j S H \~ ~ ~ %~ REV-i5og EX+ (oi-io) pennsylvania SCHED~ILE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Agnes S. Ancheff If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Mary Lou Snyder 105 S. Enola Drive Daughter Enola, PA 17025 B. C 70INTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET ~o of DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A . . 09/29/05 N/A Title to Mobile Home Attached 22,500.00 50 11,250.00 TOTAL (Also enter on Line 6, Recapitulation) I $ 11,250.00 If more space is needed, use additional sheets of paper of the same size. REl/-1511 EX+ 110-09) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Agnes S. Ancheff Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 5,485.00 B. 1 2. 3. 4. 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City _____- ----__-_ -State _-__---ZIP Year(s) Commission Paid: Attorney Fees: 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 Probate Fees: Accountant Fees; Tax Return Preparer Fees: Appraisal for Mobile Home 3,500.00 250.00 TOTAL (Also enter on Line 9, Recapitulation) $ 9,235.00 If more space is needed, use additional sheets of paper of the same size. Practitioner Portal Page 1 of 1 Penalty and Interest Calculations CALCULATION DATES- 12/24/2010 TO 7/25/2011 TAX DEFICIENCY $ 90.68 CALCULATED INTEREST $ 1.60 BALANCE AS OF 7/25/2011 $ 92.28 (~ start over~~ hops://wvwv.doreservices.state.pa.us/pitservices/Default.aspx 7/21/2011