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Home My WebLink About07-25-11 1505610105 REV-1500 EX (o2-l i) (FI) ~ PA Department of Revenue enns lvania OFFICIAL USE ONLY P Y Bureau of Individual Taxes ~E~aH.M~N, ~~ HE~EN~E County Code Year File Number INHERITANCE TAX RETURN PO BOX 28o6ai 1 ~ ~ ~ ~'~ C~~C~ Harrisburg, PA s~i28-0601 ~ RESIDENT DECEDENT ~- ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 171-62-1166 10/03/2009 07/17/1981 Decedent's Last Name Suffix Decedent's First Name MI Bowser Mrs Kristin M (If Applicable) Enter Surviving Spouse's Infor mation Below Spouse's Last Name Suffix Spouse's First Name MI Bowser Mr Christopher Spouse's Social Security Nurnber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 197-58-8401 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 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 Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) C>~ 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) GORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Robert F. Claraval, Esq. (717) 233-4780 First Line of Address 500 North 3rd Street Second Line of Address Second Floor City or Post Office State ZIP Code Harrisburg PA 17101 REGISTER t!CF~1fYILLS USE C~N1r"t-Y r L..,J ........- .. r.. ~~- ~` ~ '-~ „ _ - .i _ _ ~ ~ F; =~ --I ~ ~" ' D FILED • ~ I°~,: Correspondent's a-mail address: rfclaw@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. SIGN OF P SOIy, RE~P~~ FO FILING RE`URN ~ pA;E // ~. ADDRESS / - - - ~~ ••.~ l ' / ~ jt T EP ER OTHER THAN REPRESENTATIVE DATE IZ. ~~ P ~,r~-~ r - r ~ o i USE ORIGINAL FORM ONLY ~~~ ~~ :~ ., ~ ~ r-. ~~ r-`; -1- s`-7-, ~~ ~~ Side 1 1505610],05 1505610105 J REV-1500 EX (FI) Decedent's Name: 1505610205 Decedent's Social Security Number . ..................._......... __.. 171-62-1166 i;ECAPITULATION 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 Notes Receivable (Schedule D) ........................... 4. ,' 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. '~ 20,000.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7 Inter-Vivos Tra f & M' - - - ns ers iscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................ . 8. 20,000.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. ` 15,015.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) .............. . 10. ' ' 11. Total Deductions {total Lines 9 and 10) ................................ . 11. ` 15,015.00 12. Net Value of Estate (Line 8 minus Line 11 } .............................. 12. .,. ..~~...a...% ...... 4,985.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ' "~H~ ` `~ ~ ~'°' ~ -- °°- - ~-~-__-~- ' an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax {Line 12 minus Line 13) ........................ 14. ' .. 4,985.00 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 3 ___ _ _ _ _ (a)(1.2) X .o_ 4,985.00 15. 0 00 16. Amount of Line 14 taxable .~ .~.... ... ...., ...~. ..: .,~. .~_ ..,.. at lineal rate X .0 __ 16 17. Amount of Line 14 taxable ..... ..~ ... ._ ... '. _.,...... at sibling rate X .12 17 ', 18. Amount of Line 14 taxable ~ ~ - at collateral rate X .15 18. ......_.._. 19. TAX DUE ......................................................... 19.: 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: Kristin M. Bowser STREET ADDRESS 129 South 17th Street Camp Hill ----------------------- --T---- STATE 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. ZIP Fa ; 17011 (1) 0.00 0.00 0.00 Total Credits (A + B } (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT :_ ».., ~. 'i . ~. . - . ., . , ~. y. ., ..'.iNT~ r+ : ~~r :': `:"~ r.~!\( aa., :iy} .fi'''r x. 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 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. :~~~ . ~~ S~ K~ Y~ . , .. .,. ~'^ °''""' r .. ~.;,g r.. ~ ~ ~ ~~;:: T .. .. :. ~ . ~ 4~"~~3i 1» ~ ~»l~f~,;.5 1~ Ar ~~,'i.. st ~'7rw ~ :«.r. 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. REV-1513 EX+ (OI-10} ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: Kristin M. Bowser NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• Christopher Bowser 129 South 17th Street Camp Hill, Pa 17011 FILE NUMBER: 2109-0967 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Husband 100% I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: L _ B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, use additional sheets of paper of the same size. . REV-1511 EX+ (1Q-09} r pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kristin M. Bowser Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1' Goble - Barrick Funeral Home Dubois, Pa FILE NUMBER 2109-0967 AMOUNT 10,104.00 --: B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) ___ _ __ _ _____ - Street Address City _ _ _ _-----......---- _.__.__..._...-----...._._..__.._......__. _._ ............._ ___ _ _-----......._._. ._ __........._.__ State ZIP Year(s) Commission Paid: 2• Attorney Fees: 3• Family Exemption: (If decedents address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 90.00 5• Accountant Fees: 6• Tax Return Preparer Fees: ~• Claraval and Claraval 20% allocated to Survival Claim 4,440.00 $• Dauphin County Registe of Wills Filing Fee - 30.00 s. 'Litigation Costs 20% allocated to Survival Claim 351.00 TOTAL (Also enter on Line 9, Recapitulation) $'; 15,015.00 If more space is needed, use additional sheets of paper of the same size. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS