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HomeMy WebLinkAbout09-15-111505610101 OFFI_ C~A~ E ONL-~ REV-1500 Ex(oi-io) ~ File Number ennsylvania County Code Year '~ ~ - PA Department of Revenue INHERITANCE TAX RETURN ~- Bureau of Individual Taxes PO BOX ~8o6oi RESIDENT DECEDENT~_ Harrisburg, PA 1'7128-0601 MMDDYYYY Date of Death MMDDYYYY Date of Birkh ENTER DECEDENT INFORMATION BELOW d ~ ~ ~ ` Q Social Security Number t~ ~~' ( -` MI !~ ~ ~ ~.0 ~ _ ` °~ ~ v ~ ~ ~ Suffix Decedent's First Name o ,~ i ~ ~3 Decedent's Last Name ~ ~ ~,r,) ~_ Q <~ ~' ~ '+R MI U Enter Surviving Spouse's Information BeI~W Suffix Spouse s First Name (If Applicable) Spouse's Last Name rit Number THIS RETURN MUST BE FILED IN DUPLICATSE WITH THE Spouse s Social Secu v REGISTER OF WILL C~ 3. Remainder Return (date of death FILL IN APPROPRIATE OVALS BELOW O 2 Supplemental Return prior to 12-13-82) ~ 1. Original Return 5. Federal Estate Tax Return Required O 4a. Future Interest Compromise (date cif ~ 4. Limited Estate death after 12-12-82) Trust 8. Total Number of Safe Deposit Boxes 0 7. Decedent Maintained a Living (Attach Copy of Trust) ~ 11. Election to tax under Sec. 9113(A) 6. Decedent Died Testate Credit (date of death (Attach Copy of Will) (Attach Sch. O) 10. Spousal Poverty ~ O between 12-31-91 and 1-1-95) -~~ O g. Litigation Proceeds Received ST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED Daytime Telephone Number CORRESPONDENT -THIS SECTION MU ~ ~ ~ ~ ,1 ~ ~ ~ ~ I Name ~ L ~ * e O ~ /~ I~ +M ~ G ~' ~ .~ ~ r REGISTER OF WILLS USE ONLY V -- First line of address I .7 00 ~~ov E s~r ~E ~r ~ ~: j ~~ ~ Second line of address ~ ~ ~~rILED -- State ZIP Code . Ja ~~ / ~ +(: , -r~ City or Post Office F L 3 a ~ ~ C~ ~~---~ ` ~ ~~ ~ _ ~ ~'- kno le Correspondent's a-mail address: t0.~~ '~ 1 accompanying schedules and statements, and to the beetaf mhas any ~ er u I declare that I have examined this return, inclu ing -- DATE ~of p 1 ry~ re arer other than the personal representative is based on all informatio= hich p P Under p lete. Declaration of p P -- it Is true, correct and comp _-~~r~~_... SIGN~A~ T,~U ~~ PERSON RESPONSIBLE FOR FILING RETUR --!~ ~ ~ ,, ~ e ADDR_~ S_+SY--^ ( _ I~ ~~~~'~-'C-°' DATE _ ~ 1 r 1 R Tn~r~E ._~--~° ~..e. SIGNATURE OF PREPARER OTHER THAN RENKC~~' ~ _^~ °~-° ADDRESS Side 1 1505610101 FORM ONLY 1505610101 `~ , - - ;r* i :.~ C and- b •', r ~~ J REV-1500 EX Decedent's Name: RECAPITULATIpN~~ 1505610105 1 Real Estate (Schedule A)...... . ............. . 1 2~ Stocks and Bonds (Schedule B) .. . y P 3. Closel Held Cor oration, Partnershi or Sole-Pro rietorshi 2 P p P (Schedule C) ... 3 4. Mortgages and Notes Receivable (Schedule D) , .. , P Cash, Bank De osits and Miscellaneous Personal Pro ert 4 P y (Schedule E).... . 6. Jointly Owned Pro ert 5 P y (Schedule F) ®Separate Billing Requested ... . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 6. ~ Separate Billing Re u Decedent' ;Social Security Number -- ~ • _., _' ~~ • .. _, ~ ~ >• - 353 p ~ • ~ j„ q ested........ 7, ~ ~ • 8. Total Gross Assets (total Lines 1 through 7) _ ~ ~ _~..,__ 9. Funeral Expenses and Adminish~atrve Costs (Schedule Hl 8 ~~ ~_~ C 3 t1 rJ 2 e 01 10. Debts of Decedent. Mortgage Liahiiities, and Liens (Schedule I) .. 10. • 11 Total Deductions (total Lines 9 and 10).. . ~, ~ 12 Net Value of 11 Estate (Line 8 minus Line 1?) "3. Charitable and Governmental Bequests/Sec 9113 Trusts fcr which • 12. an election to tax has not been made (Schedule J) .. , ~ ~~ J ~ 7J • ~' 13. .~ 14. Net Value Subject to Tax (Line 12 minus Line 13j TAX CALCULATION - 14_ • SEE INSTRUCTIONS FOR APPt_ICABLE RATES 15. Amount of Line 14 taxable ? r ~ ~ :J S 3. ~_ at the spousal tax rate, or r-°`---~°=-~.. transfers under Sec. 9116 (a)(1.2) X .0 16. Amount of Line 14 taxable at lineal rate X .0 ' 15. 1 ~ Amount of Line 14 to ble + at sibling ra±e X .12 ~ 16. j ii 18. Amount of Line 14 taxable ' ~ ~ ~ ~ t at co!!ateral rate X .15 1 ~~ 19. TAX DUE .... • 18. ............ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610105 Side 2 1505610105 File Number :EV-15017 EX Pa9~ 3 - - - --- ------- Decedent's Complete Address: _ __ - 1a~ - - -- - DECEDENT'SNAME -- ~(' Gf,~- - --- - STREET ADDRESS „ _- --- ~ _ - - -- i-STATE (~ d l -- - -- - p~ cirr ~ r~ ~t ~ +' ~ I Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments _ - ments A. Prior Pay ~_ o_ - i3. Discount 3. Interest This is the OVERPAYMENT. If Line 2 is greater than Line 1 + Line 3, enter the differuest a refund. 4• Fiil in oval on Page 2, Line 20 to req 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. 5• If Une c (1) _ ~ Total Credits (A + B) (2) (3) '~ . o© (4) l ~~Co,oi (5) a able to: REGISTER OF WILLS,, AGENT. Make check p y LACING AN "X" IN THE APPROPRIATE BLOCKS Yes SE ANSWER THE FOLLOWING (IUESTIONS BY ^ PLEA 1. Did decedent make a transfer and: ro erty transferred;.. ••~~-•~~~•• ~~ " ro erry transferred or its income;..~•••~ •~~~••~~ ~"' '• ~~•~ a. retain the use or income of the p P ........................................................................................... b, retain the right to designate who shall use the p P or .............................. .... . interest; c, retain a reversionary a ments, benefits or care?"within one year of death romise for life of either p Y ro ert ........ d. receive the p 1982, did decedent transfer p P Y ..... 2, If death occurred after Dec. 12, ~ • ... . without receiving adequate consideration . which "'n trust for" or payable•~upon-death bank account or robate p oper[y r her death ............::: ^ 3. Cid decedent own an i ............................................................ 4. Did decedent own an individualiroetirementaecount, annuity or other non- D n? ...•~~~•~~~ ••~~~'•'~~~•••~• ••~•~•• ~~••~ ~••~~ •• ~ • • FILE IT AS PART OF THE RETURN. contains a beneficiary designat ESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G A use of the surviving spouse IF THE ANSWER TO ANY OF THE ABOVE QU the tax rate imposE;d on the net value of transfers to or for the 1994, and before Jan. 1,1995, souse is 0 pert sed on the net value of transfers to or for the use of the surviving For dates of death 9116 (a) (~ 1) (11• and the statutory requirements for disclosure of assets 3 percent [72 P.S § 1995, the tax rate impo souse from to , t a transfer to a surviving p For dates of death on or after Jan. 1 ~ souse is the only beneficiary. arer 9116 (a) (1.1) (ii)]. The statute does not exemp [72 P.S. § liable even if the surviving p filing a tax return are still app ~ ild 21 years of age or younger at death to or for the use of a natura p 2000: t as not For dates of death on or after July 1, g116(a)(1.2)]. ercent, excep osed on then of theuclii d s 0 percent [72 P.Sc§ase c •ve fers to or for the use of the decedent's lineal beneficiaries is 4• p A sibling The tax raaeent or a steppa ',s defined, adopts P g116(a)(1.3)] osed on 9116(a)(1)~lue of trans s is 12 percent [72 P.S•tion. The tax 9116(1 2) [72 P.S. § blood or adop 72 P.S. § ed on the net value of transferneo arent in commontwi h the decedenbtliwhether by The tax rate impos Section 9102, as an individual who has at least o SCHEDULE E ~ CASH, BANK DEPOSITS, 8~ MISC. , ~` ~~' ` ~-~''~ `' PERSpNAI PRt}PERTY ~] sea )r.$a r, _ ,;~ i ----------~- FTIE NUMBER ~ ~ _ , ~ /,, / ~~ ESTATE OF rt =`, ~; v,.~ ~Q ~ ;;,~ t f'•'~ '-- -__-~•' must De disclosed on Schedule F. (~f ~ t 7 Q.- r~ t ~ ~ >f"k'%~ inti owned with the right of survivorship s were received rzy the estate. All property jo s es lit atop and the date'he o'oceed ~F D`a:'H ~ncr~de the prot~ee 9 ----._'__"__._- ____--_ -----_----""_`---_ i, ~~ ~ j c (, wtd'~' ~ I ~ _ ~ i ~ -~ ~ ~ r-. ~ ~ ~ yJ~1~ ~ ~r r,[,~ J -~ 70TAL iAis er.',er on ilre ~ ~eca_ 'tu!a~'c_` ~ reeds rt ad I fold ~i sheets of i~ he salve s~-- ~ i( more spa..e ~ . , ~~ •. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: MACKEY MARTHA L 500 GROVE STREET MELROSE, FL 32666 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER ------- fold ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 209-16-1427 2111-0736 WEBSTER MARJORIE BRENNA 09/15/2011 09/12/201 1 CUMBERLAND 06/29/2011 TOTAL AMOUNT PAID: REMARKS: CHECK# 7 SEAL INITIALS: CJ RECEIVED BY: REV-1162 EX(11-96) NO. CD 014971 AMOUNT $1,006.01 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ~yr~.-.p~. ..... ~M,~,~,,,(ya „~yr,k r -1 II ~~9~ 0~~~ 86~~ 428 ~ IIIIII~IIIII~~IIIII ~ i u.s. POS ~ IIIIIlII111IIIIlII TAGE U+V/TFO STi]TFS I I nosre- I MELRpSE ~L ~'~Cnn SEP~'12;'''11 . AMOUN7 rnnn ' ~ ~ 17013 ~~ ~~ 00031975-08 `