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Home My WebLink About08-12-11 (2)1505610105 REV-1500 EX (oz-u) (FI) 7.1 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY ~E~<a.„E„, County Code Year File Number Bureau of Individual Taxes ~ pINHERITANCE TAX RETURN PO BOX 28o6oi //~~ i ~ ~ "~ Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT d 1 (C ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 179-38-2120 11 /13/2010 04/12/1951 Decedent's Last Name Suffix Decedent's First Name MI AMSPACHER THOMAS E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI AMSPACHER TERESA M 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 O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (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 FIONA K. FADNESS, ESQ. (717) 991-1382 First line of Address 301 SOUTH HANOVER ST Second Line of Address City or Post Office CARLISLE State ZIP Code PA 17257 REGISTER OF WILLS USE ONLY r L7 _,-:. r.}~ :c "~_ ~ ~ - ~ ~, DAT~EffiCED - _ --~ ". . » ~, `3;7 -- ~? -, - >. ,. ..~ ~ ~_; -~r, Correspondent's a-mail address: FKLESQUIRE a(~J40L.COM 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. FILING RETURN ADDRESS i7 ' 16 SCRAFFORD ST, SHIPPENSBURG, PA 17257 OF PREPARE,yrOT}iFJ2 THAN REPRESENTATIVE DATE /4V Ur(CJJ " 301 SOUTH HANOVER ST, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15D5610105 15D5610105 J 1505610205 REV-1500 EX (FI) Decedent's Name: THOMAS E AMSPACHER Decedent's Social Security Number 179-38-2120 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. 110,148.30 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. 110,148.30 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 23,374.68 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 1,369.42 11. Total Deductions I:total Lines 9 and 10) .............................. ... 11. 24,744.10 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 85,404.20 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. 85,404.20 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 0 85,404.20 15. 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 18. 19. TAX DUE ...................................................... ... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 0.00 0.00 O 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) 2. CreditslPayments A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) o.oo 0.00 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 o~an an "in trust for" or payable-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 Jarl. 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 [72 P.S. §9116(aj(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-1508 EX+ (u->o) j ~ Pennsylvania SCHEDULE E ~l DePARTMENT aF aeveNUe CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: THOMAS E AMSPACHER 21-10-1178 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. If mare space is needed, use additional sheets of paper of the same size. Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER THOMAS E AMSPACHER 21-10-1178 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' FOGELSANGER-BRICKER FUNERAL HOME -FUNERAL SERVICES 10,646.9:, 2 SHULL-KOONTI -HEADSTONE/GRAVE MARKER 3,341.00 3 SPRING HILL CEMETERY ASSOCIATION -GRAVE LOT WITH PERPETUAL CARE 1,450.OG a VET'S CANTEEN ASSOCIATION -FUNERAL RECEPTION 519.75 e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City _ _ __ - State _._ ZIP Year(s) Cornmission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant TERESA M. AMSPACHER -_ Street Address 16 SCRAFFORD STREET City SHIPPENSBURG State PA ZIp 17257 Relationship of Claimant to Decedent SPOUSE 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: ~ INHERITANCE TAX FILING FEES s THE SENTINEL -ADVERTISING s CUMBERLAND LAW JOURNAL -ADVERTISING TOTAL (Also enter on Line 9, Recapitulation) I $ 3,275.00 3,500.00 314.50 15.00 212.50 100.00 23,374.68 If more space is needed, use additional sheets of paper of the same size. REV-i~'~iL =~,k; ~:.. ~4; Pennsylvania SCHEDULE I DEPARTMENT or REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETU~iN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER THOMAS E AMSPACHER 21-10-1178 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. REV-1513 EX+ {01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF: FILE NUMBER: THOMAS E AMSPACHER 21-10-1178 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~ TERESA AMSPACHER, 16 SCRAFFORD ST, SHIPPENSBURG, SPOUSE 100% PA, 17257 II ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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. .:°: