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HomeMy WebLinkAbout09-28-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: KURTZ MICHAEL P 405 MOUNTAIN VIEW LANE DAUPHIN, PA 17018 -------- fold REV-1162 EX111-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssrv: 21 ~-24-1004 FILE NUMBER: 211 1-0415 DECEDENT NAME: KURTZ CLYDE R JR DATE OF PAYMENT: 09/28/201 1 POSTMARK DATE: 09/28/201 1 couNTY: CUMBERLAND DATE OF DEATH: 02/ 1 5/201 1 ACN ASSESSMENT CONTROL NUMBER N0. CD 015008 AMOUNT 101 ~ 532.00 TOTAL AMOUNT PAID: REMARKS: 532.00 CHECK# 0108 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 15Q561Q1115 RE1l- i x/00 EX (az-is} (FI} 1 ~1 {,~ OFFICIAL USE ONLY PA Department of Revenue pennsylvartia Bureau of Individual Taxes "`" "`" Gounly Code Year File Number PO BOx aBo6of INHERITANCE TAX RETURN J % ` I Harrisburg PA i~~8-o6of RESIDENT DECEDENT c%l. / ~ y~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDQYYYY Date of Birth MMDDYYYY 211-24-1004 02f 15f2011 01 /30!1931 Decedent's Last Name Kurtz Suffix Decedent's First Name Jr. Clyde (tf Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse`s First Name MI R Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW t~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death Priarto 12-13-82} O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-122) 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 See. 9113(A} Between 12-31-91 and 1-1-95} (Attach Schedule Q) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CQRRESPONDENCE AND CONFIDENTUL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Michael P. Kurtz (717} 921-3228 First Line of Address 405 Mountainview Lane Second Line of Address City or Post C~fifice Dauphin Correspondent's a-mail address: GDa1178342QaoI.COm State ZIP Coda PA 17015 REGISTER LLS USE ONLY -~ - '~ _"L7 C_7 7 -- _ `1- i-t~ . ~J ~r~ - ~. .. .--. `~ ..~, - _ FILED -- 'J Under penalties of perjury, I declare that I have examined this return, including arxampanying schedules and statements, and to the best of my know and belief, it is true, carrect and te. Declaration of aifler than the personal representative is based on all information of which preparer has any knowledge.. SI~NAO PER RE FILING RETURN DATE] ~~ G~ 2 ~ t ADDRESS 405 Mountainview Lane, auphin PA 17018 SI : ~1F~'PREP R O~ R ESENTATIVE DATE ~ 3 • t ! I ADDRESS 25 West econd Street, PQ Box 403, Hummelstown„ PA 17036-0403 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15Q5610185 15056101115 J ,~ t ,,`!- 150561D2D5 REV-1500 Ex (FI} Decedent's Social Security Number Decedent's wane: Clyde f2. Kurtz, Jr. 211-244-1004 RECAPITULATION 1. Real Estate (Schedule A} ........................................... .. 1. 0.00 2. Stocks and Bands (Schedule B} ..................................... .. 2. 0.00 3. Closely Held Corporation, Partnership ar Sole-Proprie4orship (Schedule C} ... .. 3. 0.00 4. Mortgages and Notes Receivable (Schedule D} ......................... .. 4. 0.00 5. Cash, Bank Deposits arxt Miscellaneous Personal Property (Schedule E}..... .. 5. 7,723.09 6. Jointly Owned Property (Schedule F} O Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vrvos Transfers & Miscellaneous Non-Probate Property 00 0 (Schedule G} O Separate Billing Requested...... .. 7. . 8. Tamil Gross Assets (total Lines 1 through 7} .......................... ... 8. 7,723'.08 9. Funeral Expenses and Administrative Costs (Schedule H} ................ ... 9. 506.36 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule f} ............ ... 10. 6„5©3.88 11. Total Deductions (total Lines 9 and 10} .............................. ... 11. 7,010.24 12. Net Value of Estate (Line 8 minus Line 11} ........................... ... 12. 712.85 13. Charitable and Governmental BequestsJSec 9113 Trusts for which an election to tax has not been made (Schedule J} ..................... ... 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13} ..................... ... 14. 712.85 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 .o_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 16. 32.00 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. 32.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15~561Q2~5 155610205 J REV-1500 Ex (FI) Page 3 Decedent's Comlalete Address: Fire Number Tax Payments and Credits: 1. Tax Due (Page 2, Line 19J 2. CreditslPayments A. Prior Payments B. Discount Total Cred"As { A + B } (2} 3. Interest f~~ 4. ff Line 2 is greater than Lrcre 1 + Line 3, enter the diterence. This is the OVERPAYAAEIVT. Fill in oval on Page 2, Line ZQ to request a refund. (41 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1l (5} Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS t. Did decedent make a transfer and', Yes No a. retain the use or income of the property transfened .................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred ar its income ...................................... ...... ^ c. retain a reversionary interest ........................................................................................................................ ...... ^ d. receive ttte promise fa life of eittrer payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after Dec 12,1982, did decedent transfer properly wilh~t are year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did deoederrl own an "~ trust far' or payable-upon-death bank arxaunt or security at his or her death? ........ ...... ^ 4. Did decedent own an individual retirement arxxxint, annuity or otl~r na~~-probate properly, which cordains 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 ar far 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 role imposed an the net value of transfers do or for the use of the surviving spouse is 0 percent (T2 P.S. §9116 (a} (1.1 } (ii}]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements far disclosure of assets and filing a tax rettim are still applicable even if the surviving spouse is the only beneficiary. For dates of death an or after July 1, 20Q0: e The tax rate imposed on the net value of transfers Pram 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 #x the use of the dec~ctent's lineal benefiaari~ is 4.5 percent, except as noted in [72 P.S. §9116(a}(1}]. The tax rate imposed an 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 oomman with the decedent, whether by blood or adoption. REV-i5o8 EX+ (ii-toy Pennsylvania DEPARTMENT OF REVENUE FNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDI~LE E CASH, BANK DEPOSITS & MISC. PER50NAL PROPERTY ESTATE OF: FILE NUMBER: Clyde R. Kurtz,. Jr. 21-11-0415 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of wrvivorslrip mum be d'tscbsed on Schedule F. If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-49) pennsylvania DEPARTMENT OF REVENUE iuu~ntTS N/'L TAY OCTI ION SCHEDULE H FUNERAL EXPENSES AND wnuilllTCTDATTVC f ACTC ESTATE OF FfLE NUMBER Clyde R. Kurtz, Jr. - Decedent's debts must be reported on Schedule I. ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: I' Obituary insert in Patriot News 1 fi6.94 B. 1 2. 3. 4. 5. 6. 7. s. ADMINISTRATIVE COST5: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City - - ---- - _- -State -- Year(s} Commission Paid: Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.} Claimant Street Address City State _ Relationship of Claimant to Decedent ___ Probate Fees: Acwuntant Fees: Tax Retum Preparer Fees: Legal Advertisement -Cumberland County Law Journal Legal Advertisement -Carlisle Sentinel ZIP Z1P TOTAL (Also enter on Line 9, Recapitulation) I ~ If more space is needed, use additional sheets of paper of the same size. 0.00 0.00 85.80 0.00 0.00 75.00 178.92 506.36 REV-1512 EX+ (12-OH) Pennsylvania l.~l DEPARTMENT Df REVENUE 1NNERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILTTiES & LIENS ESTATE dF FILE NUMBER Clyde R. Kurtz, Jr. o.........~~ I..~.~..,~ ~,., ~p dor~.elnnt Brier m death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets or me same size. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN ..ec.ncur nvcncrrr ESTATE OF: Clyde R. Kurtz, Jr. RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSONS} RECEIVING PROPERTY Do Not List Trustee(sj I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 4116 (a) (L2).] 1 • Michael P. Kurtz ~°~ 2. Joyce Kurtz Daughter 3. Gary Kurtz San 4. Arthur Kurtz FILE NUMBER: AMOUNT OR SHARE OF ESTATE 25% 25% 25% 25% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN AB(?VE ON LINES 15 THROUGH 18 OF REV•15ttQ COVER SHEET, AS APPROPRIATE. ~ NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 4113 FOR WHICH AN ELECTION TO TAX. IS NOT TA14EN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15DO COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size.