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Home My WebLink About07-28-11 (2)1,50561,01,05 REV-15QQ EX (02-11) (FI) PA Department of Revenue penn5ylvania OFFICIAL USE ONLY Bureau of Individual Taxes ~``"''u°~""' """"" Coun;y Code Year PO Box 280601 INHERITANCE TAX RETURN /, Harrisburg, PA 1'71.28-0601 RESIDENT DECEDENT ~ ~ ~ C/ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 199-36-5745 07/08/2010 09/15/1954 Decedent's Last Name Suffix DecE~dent's First Name Vary Thomas (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Vary Kathleen Spouse's Social Security Number 191-42-8788 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death O 4. Limited Estate O 4a. Future Interest Compromise (date of Prior to 12-13-82) O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O (Attach Copy of Will) 7. Decedent Maintained a Living Trust __ 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust.} O 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) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO Name : Daytime Telephone Number Joseph J. Dixon, Esq. First Line of Address 126 State Street Second Line of Address City or Post Office State ZIP Code Harrisburg PA 17101 dixonlaw@paonline.com Correspondent's a-mail address: REGISTER OF WILLS USE ONLY C7 - ~.~ _ ` ~ ~ .._. --- ~~ ~~r'_ ~ F L . "~- rn rv ,. s ~7~ -=, ILED -z-~ --1 .. t... MI C MI A ~~ -n, C"-'~ -=~ ~~~ ~, ` J r~..~~ i^r. W ~~~ Under penaltj~s of perjury, I declare that I have exan~rned this return, including accort7panying schedules and statements, and to the best of my knowledge and belief, it is true, c rect and complete. Declaration of rep~rer other than the personal representative is based on all information of which preparer has any knowledge. SI NA RE OF P R t~.~SR S F E O(~';R-ILI,~IG 63FT , N DATE l ~ C../C_ 07/27/2011 ADDR S 5902 Stephens Crossing, Mechanic rg, A 17050 SIGNATURE OF PREPARER OTHER THAN RE RESEN TIVE _..... DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 150561015 1505610105 ~ `~'v _ __ _ File Number ~~ 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: Thomas C. Vary 199-36-5745 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 19,228.39 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) O Separate Billing Requested .... ... 6. 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. 19,22$.39 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 7,629.06 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 3,971.10 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 11,60.16 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 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. 7,628.23 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. 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 1 ~ 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ......................................................... 19. 0.~0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1,50561,0205 1,50561,0205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Thomas C. Vary STREET ADDRESS 5902 Stephens Crossing CITY _ _ _ _. Mechanicsburg j STATE ;ZIP ~, PA 1700 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1} 0.00 2. Credits/Payments A. Prior Payments - __ ____ . _.____ -- _.__ _- -- B. Discount Total Credits (A + B } (2) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3} Fill in oval on Page 2, Line 20 to request a refund. (4} 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 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 awn an "in trust for" or payable-upon-death bank account ar 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, 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)J. The statute does net 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)J. 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-1503 EX+ (6-98) G ~, ~'` ` ~' . ~~~ Y, ~~ y~,. COP/iMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Thomas C. Vary 2110-0784 All property jointly-owned with right of survivorship must be disclosed on Schedule F_ fir more space is needed, insert additional sheets of the same size) ~ pennsylvania DEPARTMENT Or REVENIIE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Thomas C. Vary SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE NUMBER 2110-0784 ITEM NUMBER A. 1. Decedent`s debts must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: Malpezzi Funeral Home 2. Pealers Flowers 3. Hershey Country Club -Funeral Luncheon B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Persona! Representative(s) Street Address City - -. ___ State ZIP Year(s) Commission Paid: 2• Attorney Fees: ~• Family Exemption: (If decedent's address is not the same as claimant's, attach expianation•) Claimant Street Address City _ _ _ _ _ _ State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 5• Accountant Fees: 6• Tax Return Preparer Fees; ~. TQTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. AMOUNT 3,895.04 227.12 1,875.00 300.00 95.50 275.00 7,629.06 ~~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE T,AX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Thomas C. Vary 2110-0784 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. pennsylvania SCHEDULE J DEPARTMENT QFRFVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Thomas C. Vary 2110-0784 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 A. Vary spouse 100% 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; 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS; 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size.