Loading...
HomeMy WebLinkAbout08-15-111505610143 REV-1500 Ex(o,_,o, OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 80X.280601 INHERITANCE TAX RETURN 21 11 (~ ~'~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 186 28 6985 03 29 2011 10 25 1934 Decedent's Last Name Suffix Decedent's First Name MI SMALLEN SANDRA B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI SMALLEN ~y Fi 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 prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required g Decedent Died Testate (Attach Copy of Will) ~ ~ Decedent Maint fined a Living Trust (Attach Copy of~rust) 0 8. Total Number of Safe De osit Boxes P 9. Litigation Proceeds Received ~ 10. Spousal PovertyY Creditl(date of death between 12-31 zJ1 and -1-95) ~ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) -- CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDWARD P SEEBER 717 533 3280 First line of address SUITE C400 Second line of address 555 GETTYSBURG PIKE City or Post Office MECHANICSBURG State ZIP Code PA 17055 REGISTER O'I~LS USE(Y its -~ f_,_. ~ _~ v:i ~ +~ ~ ' 'i .~ `~~ t.:_ ~~ _~ DA FLED " ~. Correspondent's a-mail address: eps@,jsdc.COn'1 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 OF PERSON RESPONSIBLE FOR FILING RETURN DATE Ra H. Smallen g ~d ~ I I ADDRESS ' 229 Windi Wa Cam Hill PA 17011 S-GNATUR R ER THER THAN REPRESENTATIVE DATE Edward P Seeber -~~~, ~-'~/~ Suite C-400, 555 Gettysburg Pike, Mechanicsburg, PA 17055 Side 1 L 1505610143 1505610143 J " J J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Smallen, Sandra B. 18 6 2 8 6 98 5 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 8~ Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ............... 5. 1 , 652.03 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8~ Miscellaneous -Probate Property arate Billin Re uested ~ Se 7 7 4 3 3 4 8 12 ............ g q p (Schedule G) . . , 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 350 , 3 95.15 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ....................................... 9. 16 , 0 4 6. 0 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 944.35 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 16 , 9 90.41 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 3 3 3 , 4 0 4 . 7 4 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. 3 3 3 , 4 0 4 . 7 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 3 3 3 4 0 4. 7 4 15. 0. 0 0 , (a)(1.2) X .00 16. Amount of Line 14 taxable 0 . 0 0 16. 0 . 0 0 at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17 0. 0 0 . at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 18 0. 0 0 . at collateral rate X .15 . 19. Tax Due .................................................................................................................. 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-11 DECEDENT'S NAME Smallen, Sandra B. STREET ADDRESS 229 Winding Way CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund (1) Total Credits (A + B) (2) (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make Check Payable to: REGISTER OF WILLS, AGENT. 0.00 0.00 ~.~0 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 :............................................................................... ^x ^ b. retain the right to designate who shall use the property transferred or its income :.................................. ^x c. retain a reversionary interest; or ............................................................................................................... x d. receive the promise for life of either payments, benefits or care? ............................................................ x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which contains a beneficiary designation? .................................................................................................................. ^ ^x 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 January 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)]. A sibling 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-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, 8 MISC. PERSONAL PROPER COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUI!VIBER Smallen_ Sandra B. 21-11 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smallen, Sandra B. 21-11 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TEEf ANSFERSATTACN A COPY OF TIHE DEED FOOREREAL ESTATE. DATE OF DEATH VALUE OF ASSET °i° OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 249.716 shares of 500 Index Fund Adm held in 30,345.49 100.000% 0.00 30,345.49 Vanguard Account No. 40025734 -titled in the name o the Sandra B. Smallen Living Trust; valued per statement 8 public listing 2 1,631.794 shares of GNMA Fund Investor Shares held 17,476.51 100.000% 0.00 17,476.51 in Vanguard Account No. 40025734 -titled in the name of the Sandra B. Smallen Living Trust; valued per statement 8~ public listing 3 1,713.503 shares of Growth 8~ Income Inv held in 47,618.25 100.000% 0.00 47,618.25 Vanguard Account No. 40025734 -titled in the name o the Sandra B. Smallen Living Trust; valued per statement & public listing 4 5,895.787 shares of I-T Investment Grade Inv held in 57,837.67 100.000% 0.00 57,837.67 Vanguard Account No. 40025734 -titled in the name o the Sandra B. Smallen Living Trust; valued per statement ~ public listing 5 707.944 shares of International Growth Inv held in 14,003.13 100.000% 0.00 14,003.13 Vanguard Account No. 40025734 -titled in the name o the Sandra B. Smallen Living Trust; valued per statement 8~ public listing 6 471.739 shares of Mid-Cap Index Fund Inv held in 10,250.89 100.000% 0.00 10,250.89 Vanguard Account No. 40025734 -titled in the name o the Sandra B. Smallen Living Trust; valued per statement 8~ public listing 7 One-half interest in real estate located at 229 Winding 123,350.00 100.000% 0.00 123,350.00 Way, Lower Allen Township, Cumberland County, PA titled in the name of the Sandra B. Smallen Living Trust; valued per tax assessment "common level rati (246,700/2 * 1) Total of Continuation Schedule ee attached page TOTAL (Also enter on Line 7, Recapitulation) I 348,743.12 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF RENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF FILE NUAABER Smallen, Sandra B. 21-11 ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TROANSFERSATTACii A COPY OF THE DEIED ~OREREAL ESTATE. DATE OF DEATH VALUE OF ASSET °k OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 8 263.429 shares of Parnassus Funds Account No. 7,228.49 100.000% 0.00 7,228.49 40025734 -titled in the name of the Sandra B. Smallen Living Trust; valued per statement 8~ public listing 9 1,676.81 shares of S-T Investment Grade Inv held in 17,975.40 100.000% 0.00 17,975.40 Vanguard Account No. 40025734 -titled in the name o the Sandra B. Smallen Living Trust; valued per statement ~ public listing 10 702.334 shares of Wellington Fund Inv held in 22,657.29 100.000% 0.00 22,657.29 Vanguard Account No. 40025734 -titled in the name o the Sandra B. Smallen Living Trust; valued per statement Bt public listing TOTAL (Also enter on Line 7, Recapitulation) I 348,743.12 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) ' REV-1151 EX+ (10-06) COMM_Q~WEgAENT DECEDEN~RNANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Smallen, Sandra B. 21-11 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission paid 2. Attorney's Fees James, Smith, Dietterick 8~ Connelly, LLP 3_ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Ray H. Smallen Street Address 229 Winding Way City Camp Hill State PA Zia 17011 Relationship of Claimant to Decedent Spouse 4. I Probate Fees 8,464.06 4,000.00 3,500.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 82.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 16,046.06 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Smallen, Sandra B. 21-11 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex ep nses 1 Musselman Funeral Home -funeral services 7.921.00 2 Patriot News -obituary advertisement fee 543.06 H-A 8,464.06 Other Administrative Costs 3 Recorder of Deeds, Cumberland County -filing fee for Deed 67.00 4 Register of Wills, Cumberland County -filing fee for inheritance tax return 15.00 H-67 82.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smallen, Sandra B. 21-11 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) (If more space is needed, additional pages of the same size) REV-1513 EX+ (11-08) SCHEDULE J COMMORESIDAENT DECEDEN~R~VANIA BENEFICIARIES ESTATE OF I FILE NUMBER Smallen, Sandra B. 21-11 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Ray H. Smallen Spouse Residue 333,404.74 229 Winding Way Camp Hill, PA 17011 Total 333,404.74 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 cover sheet as a r o riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO T,Ax IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)