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Home My WebLink About10-14-11 (2)J 1505610101 REV-1500 t:xt°1.1°~ PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes ° ~"""`" ' "`"`""' Pl7 Box 280601 INHERITANCE TAX RETURN Harrisbur PA i' 1z8 6 RESI County Code Year ~ ~ ~ ~ File Number ~ ~~ , 7 -o o1 DENT DECEDENT , ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 577-14-2125 02/15/2011 12/23/1913 Decedent's Last Name Suffix Dec:edent's First Name Sullivan MI Maurice M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW O 1. Original Return ~ 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Com romise date of p ( O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Tru:>t 0 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 Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Jerry J. Sullivan (717) 730-6089 ~~ First line of address 28 Kensington Drive Second line of address City or Post Office Camp Hill State ZIP Code PA 17011 RZ1F ' LLS USE OIULY ,~~-i~ I r-n `' __ _.. ~Ci`; ' - Y= ~r~ ,.~ ---t 1> DATE FILED +..~ 7~ ~~i . `~-~ -~ n _.~ 7 Correspondent's a-mail address: j~S7848@aOLCOm 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 t and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ATUR OF PE SON E SIB/I, OR FILING RETURN AD SIGNATURE OF PREPARER OTHER THAN EPRESENTATIVF ~ y CS. DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1505610101 J 1505610105 REV-1500 EX Decedent's Social Security Number ~eoedenc's Name: Maurice M. Sullivan 577-14-2125 RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 0.00 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. 6. Jointly Owned Property (Schedule F) C~ Separate Billing Requested .... ... 6. 997.27 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. 99].2] 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 405.22 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 405.22 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 592.05 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. 592.05 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_ 15. 16. Amount of Line 14 taxable - at lineal rate X .0 45 592.05 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 1505610105 1505610105 26.64 26.64 J REV-1500 EX Page 3 Decedent's Complete Address: File Number Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 26.64 2. Credits/Payments A. Prior Payments 13,661.69 B. Discount 719.04 ___- -_ ----__-- _-----_- -------- -- 14,380.73 Total Credits (A + 6) (2) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 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) 26.64 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 : ...................................... ...... ^ x^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ ^K d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ x^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 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 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 Jan. 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)]. 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-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY tSIATE OF: FILE NUMBER: Maurice M. Sullivan 201100345 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Jerry J. Sullivan 28 Kensington Drive Son Camp Hill, PA 17011 B C, JOINTLY OWNED PROPERTY: LETTER DATE ITEM FOR JOIN T MADE DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTIDN AND BANK ACCOUNT NUMBER OR S]MILAR % of DATE OF DEATH NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FORJOINTLY HELD REAL ESTATE DATE OF DEATH DECEDENT'S VALUE OF 1 A . VALUE OF ASSET INTEREST DECEDENT'S INTEREST . • Sovereign Bank 1,994.54 50 997.27 TOTAL (Also enter on Line 6, Recapitulation) I $ 997.27 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-Q8) ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT `V ~„~ ` v~ FILE NUMBER Maurice M. Sullivan Report debts incurred by the decedent prior to death that remained unpaid ar rtia ~~ro „f ae~a :.,~~„a:__ ..___:_~..___.. _ _,_ __. .~ ~~~~~~ ~Na~e o neeueu, inser[ aaoiuonai sheets of the same size.