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HomeMy WebLinkAbout08-03-11 (4)J 1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes PO Box 2sosol County Code Year File Number INHERITANCE TAX RETURN Harrisbur , PA 17128-OS01 EN RESIDENT DECEDENT 2 0 1 0 0 1 2 7 0 TER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 9 6 1 4 5 3 4 0 1 1 0 7 2 0 1 0 0 5 2 1 2 0 2 4 Decedent's Last Name Suffix Decedent's First Name U P H O L D MI M Y R T L E Y (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI 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 ~ 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate ~ prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Re ui d d th OX 6. Decedent Died Testate ~ A q re ea after 12-12-82) 7. Decedent Maintained a Livin Trust g ( ttach Copy of Will) 9 Liti ati P 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) . g on roceeds 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 T N ame AX INFORMATION SHOULD BE DIRECTED TO: J O H N C Daytime Telephone Number Z E P P I I I 7 1 7 5 2 8 8 9 0 0 REGISTER OF WILLS USE ONLY C7 First line of address =- „-- ~?,~ C.' O P O B O X 2 0 4 '~' ~ n ~-~ - _ Second line of address ~ > ~ ~ o ,jam -~•~ r_- City or Post Office State ZIP Code 7~ ~ ~ _ ' ~. 7 Y O R K S P R I N G S P A 1 7 3 7 2 ~" ~ ~` `-'~ Correspondent's a-mail address: Under p ties 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 tru rrect and complete. Decl ration of p aver other than the personal representative is based on all information of which preparer has any knowledge. G ~~ERSO - SIBLE R FILING RETURN 5[i.5 GARRFTT Rnnn Side 1 L 1505610140 1505610140 tj J 1505610240 REV-1500 EX Decedent's Social Security Number 1 9 6 1 4 5 3 4 0 Decedent's Name: MYRTLE U P H O L D REC APITULATION 1. .. 1. Real Estate (Schedule A) ......................................... 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. . • 4 5 ~ 5 1 . 1 D 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 ^ Separate Billing Requested .... ... 7. 4 6 9 3 4 8, 3 9 (Schedule G) 5 1 5 D 9 9. 4 9 8 Total Gross Assets (total Lines 1 through 7) ............. . $ . 9 8 9 2 2. 6 6 9 .......... Funeral Expenses and Administrative Costs (Schedule H) .... . . ... . 1 1 5 5 1. 1 9 10 Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... 10. .. . . 11 2 0 4 7 3. 8 5 11 . Total Deductions (total Lines 9 and 10) ............................ . .. . 12. .......... Net Value of Estate (Line 8 minus Line 11) ........ . ....... ..12. 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which 13. . an election to tax has not been made (Schedule J) ...... . 14. Net Value Subject to Tax (Line 12 minus Line 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 D D D 15. (a)(1.2) X 16. Amount of Line 14 taxable 4 9 4 6 2 5 6 4 16. at lineal rate X .045 17. Amount of Line 14 taxable D D D 17 at sibling rate X .12 18. Amount of Line 14 taxable D D D 18. at collateral rate X .15 .. 19. ... 19. TAX DUE ............................................ ..... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15D561O24D Side 2 4 9 4 6 2 5.6 4 4 9 4 6 2 5.6 4 0. D D 2 2 2 5 8. 1 5 0. D 0 o. D D 2 2 2 5 8. 1 5 15D561D24O J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME 'MYRTLE UPHOLD STREET ADDRESS 505 GARRETT ROAD CITY DILLSBURG 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. File Number 20 10 01270 STATE PA ZIP 17019 (1) 22,258.15 Total Credits (A + B) (2) 0.00 (3) (4) 0.00 (5) 22,258.15 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 t f rans er and. a, retain the use or income of the property transferred; b Yes No . retain the right to designate who shall use the property transferred or its income; ......................... c retai ^ . X ^ . n a reversionary interest; or .............................. d i h ..... ^ . rece ve t e promise for life of either payments, benefits or care? • .. 2 If d ~ ~ ~ ~ ~ ~ X ^ . eath occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................... ^ .................................. 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? 4 Did d ...... ~ ^ X Q .... . ecedent own an individual retirement account, annuity or other non-probate property, which ...,. contains a beneficiary designation? ..................................... ........................................................ ..... ^ a 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 survivin sous 3 percent [72 P.S. §9116 (a) (1.1) (i)], g p e 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(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, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-9g) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MYRTLE UPHOLD SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Include the All property. ITEM NUMBER FILE NUMBER 20 10 01270 of litigation and the date the proceeds were received by the estate. ~ned with right of survivorship must be disclosed on Schedule F. DESCRIPTInN 1. Highmark B1ueRX 2• RiverSouce Long Term Car Insurance 3 • Members 1st Checking Account 4• Members 1st Savings Account 5• $50 US Savings Bond 6• Refund of Advisory Fee from Ameriprise Financial 7• Commonwealth of Pennsylvania Tax Refund TOTAL (Also enter on fine 5 Recapitulation) I $ (If more space Is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 81.38 740.00 43,712.72 5.00 50.00 999.00 163.00 751.10 REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY MYRT FILE NUMBER LE UPHOLD 20 10 01270 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET % OF DECD'S EXCLUSION TAXABLE 1. Ameriprise Financial INTEREST OP APPLICABLE) VALUE 32,191.81 Acct. 01013854900 0 002 100.00 32, 191.81 2. Ameriprise Financial 1,680.77 Acct. 01807901866 1 002 100.00 1,680.77 3. Ameriprise Financial 180,080.76 Acct. 93007539197 7 004 100.00 180,080.76 4. Ameriprise Financial 35,800.03 Acct. 9300772978 4 004 100.00 35,800.03 5. Ameriprise Financial 58,547.79 Acct.93008323043 1 004 100.00 58,547.79 6. Ameriprise Financial 30,079.68 Acct00016956922 5 021 100.00 30, 079.68 7. Ameriprise Financial 75,968.14 Acct..00010796353 0 133 100.00 75, 968.14 8. Ameriprise Financial 54,999.41 Acct.00010804731 7 133 100.00 54, 999.41 TOTAL (Also enter on Line 7 Recapitulation) I $ 469,348 39 If more space Is needed, use addltlonal sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT tSIAIt OF MYRTLE UPHOLD SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE NUMBER 20 10 01270 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A, FUNERAL EXPENSES: AMOUNT 1. Myers-Hamer Funeral Home 3,971.00 B ADMINISTRATIVE COSTS: 1 • Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State Zlp Year(s) Commission Paid: 2. Attorney Fees: John C. Zepp, III 3,500.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4 Probate Fees: Cumberland County Register of Wills 328.50 5 Accountant Fees: 6• Tax Return Preparer Fees 7. The Sentinel 8• Cumberland Law Journal 198.16 9• Kern and Company (Income Tax Preparation) 75.00 10. Cumberland County Register of Wills Inventor 800.00 11. , y Cumberland County Register of Wills Return 15.00 12• , Cumberland County Register of Wills, Family Agreement 15.00 20.00 TOTAL (Also enter on Line 9 Recapitulation) I $ If more space is needed use additional sheets of paper of the same size. 8 922 66 REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS tSiATE OF FILE NUMBER MYRTLE UPHOLD 20 10 01270 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Contuing Care RX 15.00 2. Bethany Village 11,536.19 TOTAL (Also enter on Line 10 Recapitulation) I $ If more space is needed insert additional sheets of the same size. 1 1 551 19 REV-1513 EX+ (Ot-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES wirricvr: MYRTLE UPHOLD 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. BONNIE L. MARCHI 505 GARRETT ROAD DILLSBURG, PA 17019 2. CONSTANCE RAE UPHOLD 3017 NW 62ND TERRACE GAINESVILLE, FL 32606 FILE NUMBER: 20 10 01270 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal Lineal 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; AMOUNT OR SHARE OF ESTATE 0.50 0.50 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.