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HomeMy WebLinkAbout09-14-11REV-15pp Ex~o~-~o~ ~ 1505610101 ~ ~~partment of Revenue pennsy(vania Bureau of Individua l Taxes ~EFAR7MENT OF gEVENUE OFFICIAL p0 BOX 280601 USE ONLY Harrisburg, pA 17128-0601 INHERIT AX RETURN County Code Year ENTER DECEDENT INFORMATION BELO 'ONCE T RESIDENT D Fi-e Number Social Security Number W ECEDENT ~' ~ / ~~ Date of Death - ~ 1 C~ ~ Q -- MMDDYYyY Dat S Q ~ Y © _ e of Birth MMDDYYYy Decedent's Last Name ~ ©J ~, ~ ~ j ~ ~_- /~ '~' ~`p l ~l ~ S ~ ~ O Suffix ~ , (~~ Li Decedent's Firs t Name (If applicable) Enter Surviving Spouse's Inform MI Spouse's. Last Name anon Below ~ T ~~ '~ f Suffix Spouse's First Name Spouse's Social Security Number ~ MI THIS RETURN MUST BE FILED IN FILL INAPPROPRIATE OVALS BELOW REGIS DUPLICATE WITH THE ® 1. Original Return TER OF V'I/ILLS O 2• Supplemental Return O 4. Limited Estate O 4a. Future Interest Compromise da O 3. Remainder Return (date of death O 6. Decedent Died Testate death after 12-12-82) ( to of prior to 12-13-82) (Attach Co O 5. Federal Estate Tax Return Py of Will) O 7. Decedent Maintained a Required O 9. Liti anon Proceeds (Attach Co Lwmg Trust g Received PY of Trust - 8. O 10. S ) Total Number of Safe De CORRESPONDENT - P°usal Poverty Credit (date of death Posit Boxes THIS SECTION MUST BE COMPLETED. between 12-31-91 and 1-1.95) O 11. Name ALL CORRESPONDENCE AND CON Election to tax under Sec. 9113(A) _ (Attach Sch. O) U ,Gf ~j FIDENTIAL TAX IN OF RMgTION SHOULD BE DIREC / ~ G ~, '' Da TED T0: (/ /~~j ~ yt~me Telephone Number First line of address REGIST ~ "~ WILLS US]_'ONLY _. ,. nd line of address ~ j ~ ~ C, ~ _ C.'rj ~? - ~-- `~,~~ ' City or Post Office ' -~; - h~ ~y .. ;: State ~,%. ~-.~ti{ a~~ C'~T /~ ~ / ~ s' ZIP Code ~,. U CC ~~ ~~ _ DATE FILED ~ ~ ~ _ ~-~ Correspondent's e- ~s ~ f • j' / mail address: Under penalties of perjury, I declare that I have examined this return, includin it is true, correct and complete. Declaration of preparer other th _ SIGNAT an the g accompanying schedules and statements, and Co the be ON personal representative is based on all information o of chic OR FILING RETURN st of my knowledge and belief, ESS ~ -°° - ~ h preparer has any knowledge, SIGNATURE OF PREPARER OTHER THAN REPRESENTA ~~ / / / IVE ? ~ ADDRESS ~ 7C ,S~' .~-'~' - DATE L 1505 Side 1 610101 Y 15056:L0101 1 .1 1505610105 J REV-1500 EX Number Decedent's Social Security s' z ~ ~ ~,. ~~ Decedent's Name: 1 _ a ~ ~ . RECAPITULATION .............. ...... ~~ .. ~ ....... u1e A). Real Estate (Sched .... • . • • • . 2. 1 µ~°. ~~ . Schedule B) ................... 3. Stocks and Bonds ( Schedule C) • • • • ~ ~: ,~.~~~::r ~ 2, rietorship ( oration, Partnership or Sole-Prop Held Corp 4. • x ~;,~, ~ ~ ~~: C .............. 3. Closely ~~ 3 . Schedule D) .......... 5. a es and Notes Receivable ( Schedule E). - • • ~ • • Mortg 9 4 ~ ( ~ , ~~ ;f r.,-- ` , . Y osits and Miscellaneous Personal ProPe 6 Cash, Bank Dep Requested . • • • ~ • • 5 ~ 3~, ~ ~.,;, ~ ~~~ ' Separate Billing Schedule F} D 7• Owned Property ( Miscellaneous Non-Probate Prope Y 6. Jointly te Billing Requested.. • • • ~ r -~`- ... x"~ ~~• y ~ ~1 ~ ~ C'~ Separa -Vivos Transfers & Inter 7 ~'K ' ~ L/ ~ _ (Schedule G) 8" .............. M , . ~-. ' total Lines 1 through 7) ........... Total Gross Assets ( • ... g ~ ~ ~ ~ ~ ~ ~ ~ • ~ , ;_. .,_ . and Administrative Costs (Schedule H} • . • • • • nses 10. ~ ~ „ g. Funeral Expe and Liens (Schedule I) • ~ • ~ ~ ~ ~ ~ ~ ilities i~'7 , t ~ ~ , nt Mortgage Liab of Decede ..... 11. 10. Debts .._.. ••• 0 • ~ ~~, _,~ ., , ~ ~ .;,~r~ ) . ~ ~ • Total Deductions (total Lines 9 and 1 11. Net Value of Estate (Line 8 minus e' . 13. tslSec 9113 Trusts for which ~~''~~~' . s 12 .... Schedule J) ~ • ~ Charitable been made ( ~ ~ 3 a a "' ~ ~ :1 ~ ,~ - . 1 x has not 14. t _,..-.... an election o .. . • ... , ...... lue Subject to Tax (Line 12 minus Line 13) • ~ • • 14. Net Va - SEE INSTRUCTIONS FOR APPLICABLE RATE TAX CALCULATION 15. Amount ou gal tax rate, ole 15. at the sp „ : :~ transfers under Sec. 9116 14 taxable ~ '"~~~'~ Amount of Line ~ ~ r~:~~"-"° .. <:,.~.:. at lineal rate X . --~-`~ 17. T~ t~ 17 Amount of Line 14 taxable '~4 ~~ , ~,~,., ~ t at sibling rate X .12 _ '`'~ 18. ~ s,. 4 ~ '~ 1 g Amount of Line 14 taxable _ at collateral rate X .15 • .. 19. ~ ~_~ 19. TAX DUE ..................... . EQUESTING A REFUND OF AN OVERPAYMENT 20 FILL IN THE OVAL IF YOU ARE R Side 2 150!i610105 C~ J 1505610105 f File Number REV-1500 EX Page 3 Decedent's Complete Address: STATE CITY Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments _____ A. Prior Payments ~ ~ ~+ 2 B. Discount __- 'Total Credits (A + B ) Z~ 7~~ (2) ~ ~ (3) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) -. Fill in oval on Page 2, Line 20 to request a refund. (5) ~` ~~ ~~_.L-- 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. heck a able to: REGISTER GF WILLS, AGENT.. • y fi Make c P Y _: ~, ~~ AN "X" IN THE APPROPRIATE BLOCKS SE ANSWER THE FOLLOWING QUESTIONS BY PLACING Yes No PLEA ~./ 1. Did decedent make a transfer and: ...•,.,,_.• ............... ^ transferred : .................................. a. retain the use or income of the property ', ^ b. retain the right to designate who shall use the property transferred or its income; .......•••••~••••••~~~ c. retain a reversionary interest; or... d. receive the promise for life of either payments, benefits or care? .....••••••~•~~•~•~••••••~••~•~•~•~"""""""""'"'~~•~•~~~~~~~~ If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death ^ ~--' 2. ........................ without receiving adequate consideration . . ecedent own an "in trust for" or payable-upon-death bank account or security at his or her death?.....••••••~•~ 3. Did d Did decedent own an individual retirement account, annuity or other non-probate property, which ^ 4. ..... contains a beneficiary designation UST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN , ~ YOU M ,. ~ .~, ~, ~.~ ~ ~~~t .x. ~.,.~.. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS~IS YES, ~ :: -~ ~ F ~~ m r~ ~ r , , ~ _,~, z ~ _ 4 ~ __ { .~ '~~ - ~ ` ~ Y x rate im osed on the net value of transfers to or for the use of the surviving spouse is For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the to p use is 0 ercei 3 percent (72 P.S. §9116 (a) (1.1) (i)]. the tax rate imposed on the net value of transfers to °e stat to u requi ements for disclosure of assets an For dates of death on or after Jan. 1, 1995, 1.1 ii .The statute does not exempt a transfer to a surviving a pouse from tax, and th [72 P.S. §9116 (a) ( ) ()] filin a tax return are still applicable even if the surviving spouse is the only benefic ry 9 rom a deceased child 21 years of age or younger at death to or for the use of a natura paren , For dates of death on or after July 1, 2000: • The tax rate imposed e n vent of theuchild is 0 percent [72 P.S. §9116(a)(1.2)]. rcent, except as noted adoptive parent or a st pp t value of transfers to or for the use of thE; decedent's lineal beneficiaries is 4. pe • The tax rate imposed on 9116 a 1 A siblin is defined, un~ 72 P.S. §9116(1.2) [72 P.S. § ()( )]• transfers to or for the use of the decedent's siblings is 1 by blood or adopt on116(a)(1.3) . 9 • The tax rate imposed on the net value of ' 9102 as an individual who has at least one parent in common with the decedent, whether y Section , REV-1508 EX + (t-97) SCHEDULE E VANIA CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYL PERSONAL PROPERTY INHERITANCE TAX RETURN FILE NUMBER RESIDENT DECEDENT ESTATE OF _ _ J ~ ~ oint owned with the right of survivorship must be disclosed on Schedule F. Include the proceeds of litigation and the date the proceeds were received by the estate. All property j IY- VALUE AT DATE OF DEATH ITEM DESCRIPTION NUMBER / ~ ~ S ~~ (~ ~ ~ ~ ~ J G ~ _/ ~~ ~ ~~ Reca itulation) S ~~V ~' TOTAL (Also enter on Ilne 5, p (If more space is needed, insert additional sheets of the same size) ~. BUREAU OF INDIVIDUAL TAXES Pennsylvania PO BOX 280601 HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE REV-1543 EX AFP (05-11) JOHN SINCAVAGE 332 WISTER CIRCLEPA 17055 MECHANICSBURG EST. OF STEPHANIE MESHKO SSN 165-20-5094 DATE OF DEATH 07-05-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. ou are the spouse of the rovided the department with the infoowner/bebef~ciaWylof thisuacdCOUntcal Ifa~inbet dUenhbutayoU mUStue. P MEMBERS 1ST FCU "s ouse" in PART 2. d an amount other than zero is reoflected below on the Potential Tax Due line, note no a Records indicate that at the death of the above-named decedent, you were a ~01n financial institution, attach a copy to this form and return the deceased by checking Box.f in PART 1 below and writing p deceased an Y notify the department of your relationship If you believe the information is incorrect, please obtain written correction from the it to the above address. Please call 717-787-8327 with questions. . „~~~W x cFE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTION ~~.,, rrn~~nt. two COMPLETE rwR~ 1 y~~--- Account No . 123516 -11 Date 11-25-1991 Established $ 1,972.61 Account Balance X 50.000 Percent Taxable 986.31 Amount Subject to Tax $ , 045 Tax Rate X 44.38 Potential Tax Due $ TAXPAYER RESPON E To ensure Proper c,'eui~ ~~ -••- -- copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 Percent discount on the tax due. Anv inheritance tax due will become delinquent nine months after the date of death. PART ~ ~ ~~~ ~~, ~ ~ ~~ ~ ~ ~ ~. \ ~ The above information and tax due is correct. A. Remit payment to the n{e~estr or ~returnwthistnoticelto thetRegistercoftWillsaand a discount or avoid i CHECK an official assessment will be issued by the PA Department of evenue. he above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax re urn ONE BLOCK B• 0 N L Y filed by the estate representative. C, ~ The above inform2 land/or1PARTre3t below. debl:s and deductions were paid. Complete PART PART If indicating a differe{t tax rate, please state - ; relationship to deceden - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS ~ \ TAX RE TURN ~~ LINE !. e d Date Establish 1 , ~ 2. Account Balance ble 2 3 X ~ ~~ \ 3. Percent Taxa $ \ ~ ~ 4. Amount Subject to Tax 4 \~\ 5. Debts and Deductions 5 $ \~~\ \ 6. Amount Taxable 6 7 X ~ \~~`" ~\ 7. Tax Rate $ ~ ~• g. Tax Due 8 DEBTS AND DEDUCTIONS CLAIME PART AMOUNT PAID DESCRIPTION DATE PAID PAYEE s TOTAL (Enter on Line 5 of Tax Computation) I declare that the facts I reported above are true orreCt,.~nd Under penalties of perjury, ~~~ ~ ~ ~ 3 t est of mY nowledge and belief. H 0 ME ~ li comp ~~r• . WORK ( ~ ~,~-•~ DA TELEPHONE NUMB PENNSYLVANIA INHERITICEE TAX FILE N0. 21 INFORMATION NO AND ACN 11149920 TAXPAYER RESPONSE DATE 07-26-2011 PAYER SIGNATURE REV-1509 EX * (~-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF _ SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER _~ If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. ADDRESS SURVIVING JOINT TENANT(S) NAME A. ~~ f~~l /ic~/r/3-rte 11~~ B C. JOINTLY-OWNED PROPERTY: DESCRIPTION of PROPERTY LETTER DATE ITEM FOR JOINT MADE Include name ohel Id reallestate tion and bank account number or similar identifying number. Attar NUMBER TENANT JOINT deed for jointly ~~~~ ~~ /l=~'_. ~~ 7 RELATIONSHIP TO DECEDENT ~~~ d ~y~ ~~d ¢yz/ OF DATE OF DEATH DECD'S VALUE OF ASSET INTEREST D ~~ ~~ ~~~ DATE OF DEATH VALUE OF DECEDENT'S INTEREST yC ~, ~~ TOTAL (Also enter on line 6, Recapitulation) S (If more space is needed, insert additional sheets of the same size) ~~ r REV-1512 EX+ (12-03) SCNEDI~LE 1 DEBTS OF DECEDENT, S COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MORTGAGE LIABILITIES, ~ ~~E RESIDENT DECEDENT FILE NUMBER ESTATE OF_ red b the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. Report debts incur y VALUE AT DATE OF DEATH ITEM DESCRIPTION -yJ ~j .~ NUMBER ~ ~-- ,,,~j-~ ~~~ ~/ ~(/~~'~ "6 G~~Sf~~ ~O~P 2 ~ ~ S l ~ o ~' ~. ~~~~ TOTAL (Also enter on line 10, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX~11-96) NO. CD 014966 SINCAVAGE JOHN 332 WISTER CIRCLE MECHANICSBURG, PA 17055 -------- fold ESTATE INFORMATION: SSN: 165-20-5094 FILE NUMBER: 211 1-0977 DECEDENT NAME: MESHKO STEFFIE DATE OF PAYMENT: 09/ 14/201 1 POSTMARK DATE: 09/14/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 07/05/201 1 REMARKS: ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 598.87 TOTAL AMOUNT PAID: $98.87 CHECK# 977 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS