HomeMy WebLinkAbout08-11-11 (2)r
1 1505610105
REV- 1 500 EX (OZ-li) (FI) ~:,~
PA Department of Revenue pennsytvartia OFFICIAL USE ONLY
OLP4ttTMf fll'!11'F!EViiMU( County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 28o6oi
Harrisburg, PA 1128-0601 RESIDENT DECEDENT ~ f ~ ~ ~) `rte
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
186-10-1625 ' 05/10/2011 ' ' 07/18/1919
Decedent's Last Name Suffix Decedent's First Name MI
Eitler 'Margaret M
(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 WILILS
FILL IN APPROPRIATE OVALS BELOW
O 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.)
1t). Spousal Poverty Credit (Date of Death
Between 12-31-91 and 1-1-95)
O 3. Ftemainder 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
Douglas Eitler
First Line of Address
319 Equus Drive
Second Line of Address
City or Post Office....... State ZIP Code
Camp Hill ' PA .17011
REGISTER OF V~.S USE ONLY---?
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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 on all information of which preparer has any knowledge.
SIGNATURE RSON RESPONSI E O LINFG FTURN nnT~
SIGNATURE OF
ADDRESS
Side 1
1505610105 1505610105 J
~~
~~"~
_A. ~
REV-1500 EX (FI)
Decedent's Name:
1505610205
Decedent's Social Security Number
186-10-1625
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 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. ! 82,364.45
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. i 82,364.45
9. Funeral Expenses and Administrative Costs (Schedule H) ............... .... 9. ' 13,258.00
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... .... 10.
11. Total Deductions (total Lines 9 and 10) ............................. .... 11. 13,258.00
12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 69,106.45
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. ', 69,106.45
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. 3,109.19 ''
__
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 1 g
19. TAX DUE ......................................................... 19. 3,109.19
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205 J
REV-1500 EX (FI) Page 3 ~ File Number
Decedent's Complete Address:
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 3,109.19
2. Credits/Payments
A. Prior Payments _____ _ ___ _
B. Discount __ 155.46
Total Credits (A + B) (2} 155.46
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) 2,953.73
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" orpayable-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.
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 [7'2 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-15og EX+ (oi-io)
~~ pennsywania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDIJLE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
Margaret M. E7itler
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• Douglas Eitler
B.
C.
JOINTLY OWNED PROPERTY:
319 Equus Drive
Camp Hill, PA
son
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 % OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. Margaret M. Eitler and her son Douglas Eitler, owned Account 132112-5
and Account 132112-11 in Members 1st Federal Credit Union in 1993.
On December of 2010 they withdrew $100,000.00 and on December 8,
2010 $40,000.00 with which they purchased Mass Mutual annuity
05L2470378 for $140,000.00. Date of death value was $140,000 see
attached 141),000.00 50% 70, OOO.OC
2. B. 04/06/93 Members 1st Account 132112-03 ;?,552.51 50% 7, 781.2E
3. C. 04/06/93 Members 1st Account 132112-11 !x,166.38 50% 4, 583.19
TOTAL (Also enter on Line 6, Recapitulation) ($ 82, 364.45
If more space is needed, use additional sheets of paper of the same size.
RF~/..3.5_'•.I. El't' {1{)'C191 ~r
`~~ pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Margaret Eitler
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1' Wiedeman Funeral Home 9,243.00
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 decedent's address is not the same as claimant's, attach explanation.)
claimant Dou~las_Eitler ___ __
Street Address _319 Equus Drive
_. _ _ __ _
City Camp Hill _ _ ___ _ _ _ State PA ZIP 17011
_ _ _ __ __
Relationship of Claimant to Decedent SOtI
4• Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
~• Filing Fee
TOTAL (Also enter on Line 9, Recapitulation) ~
If more space is needed, use additional sheets of paper of the same size.
250.00
3,500.00
250.00
15.00
13,258.00
~ran~mi~tal far ALL Client Checks & Securities Certificates
Note: You need a total of 4 copies plus the original, as follows: WBIA Use Oniv
1. Forward: Original 8~ 2 copies to the Agency New Business office or Agency OSJ ReC'd:
2. Forward: a separate copy for your District Office Check Log or Agency Compliance ~ Fwd'd:
3. Retain: a copy in the client fife
OSJ Use Onfy
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Recd:
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Financial Planning ^
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Reason Ch®ck Forwarded Late:
60-8224/2313 2 ~ 5 2
IV~,RGARET M EITLER 2,8~~2»~
319 EQWS DR. ~~ ~ D`
CAMP MILL, PA 17011 DATE ~ ~
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FEDERAL CREDIT UNION '~~
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* if a Alon~ecur~ties Product -Check off the box to the right =~
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Note: You need a total of 4 copies plus the original, as follows:
1. Forward: Original 8~ 2 copies to the Agency New Business office or Agency OSJ ,
2. Forward: a separate copy for your District Office Chedc Log or Agency Compliance
3. Retain: a copy in the went file
All Products -Fixed & Securities ~ ---,
Securities Products
MARGARET M EITLER
319 EQWS DR
CAMP HILL, PA 17011
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to
W&A Use Only
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