HomeMy WebLinkAbout10-24-1115D5610140
REV-1500 EX (°,_,°)
PA Department of Revenue
Bureau of Individual Taxes OFFICIAL USE ONLY
PO BOx 2806D1 INHERITANCE TAX RETURN County Code Year File Number
Harrisbu , PA 17128-0601 RESIDENT DECEDENT 1 1
ENTER DECEDENT INFORMATION BELOW 2 1 0 3 6 8
Social Security Number
Date of Death MMDDYYW Date of Birth MMDDYYYY
1 8 4 3 6 6 4 9 9 0 1 2 5 2 0 1 1 1 0 1 5 1 9 4 6
Decedent's Last Name
M l n l C h Suffix Decedent's First Name
MI
(If Applicable) Enter Survivin S A n n E
9 pouse's Information Below
Spouse's Last Name
Suffix Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
FILL IN APPROPRIATE OVALS BELOW REGISTER OF w~LLS
1. Original Return
^ 2. Supplemental Return ^
^ 4. Limited Estate 3. Remainder Return (date of death
^ 4a. Future Interest Compromise (date of pnor to 12-13-82)
death after 12-12.82) ^ 5. Federal Estate Tax Return Required
^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust
(Attach Copy of Will)
9. Litigation Proceeds Received (Attach Copy of Trust) 8• Total Number of Safe Deposit Boxes
^ 10. Spousal Poverty Credit (date of death ^
CORRESPONDENT -THIS SECTION MUST BE COMPLETED ALL CORRESPONDENCE AND CONFIDENTIAL 11 Election to tax under Sec. 9113(A)
Name (Attach Sch. O)
TAX INFORMATION SHOULD BE DIRECTED T0:
S t e p h e n ~ Daytime Telephone Number
H o g g E s g 7 1 7 2 4 5 2 6 9 8
r----
First line of address
1 9 S H a n o v e r
Second line of address
S t e 1 0 1
City or Post Office
C a r l i s l e
S t r e e t
State ZIP Code
P A 1 7 0 1 3
Correspondent's e-mail address:
'Un~der,penalties of Perjury, 1 deGare tear i times ,,..__~_ _ ... .
ntc;ISTERQF WILLS USE"OILY
- i-~ ,
I-r't
-~~ r~,a
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I .
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-- - -~-TE`~ILED
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r
~
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-- ~~~~~.~ ana plete. Declaretion of ~~~~~~~~"' ""S re[um, including accompanying schedules and statements, and to the
SIGNAT OF pE Preparer other than the personal representative is based on all information of which pre~pasre~fhas any knowledse belief,
N SPONSIBLE FOR FILING RETURN
ADDRESS DATE
420 Telfor enue ~ ~o
SIGNATURE OF P .~~.; _...._ _ R o ~ .J ; .~
TIVE
9 S• Hanover st et,
Ste. 101
PLEASE USE ORIGINAL FORM ONLY e
L 1505610140
Side 1
A---1--0 9
DATE
PA 1701
1505610140
15D5610240
REV-1500 EX
uecedent's Name: Ann E• M i n i c h
RECAPITULATION
1. Real Estate (Schedule A) ............... .
.......~ .................... 1.
2. Stocks and Bonds (Schedule B) ... , , , ,
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
7. Inter-Vivos Transfers & Miscellaneous N~P obate Pr P'ertY Requested ....... 6,
(Schedule G) ~ Separate Billing Requested ....... 7,
8. Total Gross Assets (total Lines 1 throw h 7
9 ) ........................... 8.
Decedent's Social Security Number
1 8 4 3 6 6 4 9 9
1 4 5 9 9. 4 6
3 3 0 7. 7 9
1 7 g n 7 ~ r
a. Funeral Expenses and Administrative Costs (Schedule H) ........ .
...... 9.
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ... , , , , 10
11. Total Deductions (total Lines 9 and 10) ................... .
........... 11.
12. Net Value of Estate (Line 8 minus Line 11) . , , , , , .. 12
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) ....... .
TAY Cep r~ u . .............. 14.
• - roc uvs ~ KUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 _
16. Amount of Line 14 taxable D ' D D 15.
at lineal rate X .04.5
17. Amount of Line 14 taxable ~ 16.
at sibling rate X .12 D 0 0
18. Amount of Line 14 taxable 17.
at collateral rate X .15 D D D
18.
19. TAX DUE ................... .
.................................. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L 1505610240
Side 2
_ ~ , ~ ` J
1 1 5 0 8. 3 4
7 5 9 3. 5 5
1 9 1 0 1. 8 9
- 1 1 9 4. 6 4
- 1 1 9 4. 6 4
O.Do
0. D 0
0. D 0
0. 0 0
a
1505610240
REV-1500 EX Page 3
Decedent's Complete Address: File Number
DECEDENT'S NAME 21 11 0368
Ann_ E. Minich
STREETADDRESS
CITY
STATE ZIP
Tax Payments and Credits:
~~ Tax Due (Page 2, Line 19)
2. Credits/Payments (1)
A. Prior Payments 10 000.00 0.00
B. Discount
3. Interest Total Credits (A + B) (2)
10 000.00
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (4) 10 000.00
(5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRiAT
1. Did decedent make a transfer and: E BLOCKS
a. retain the use or income of the property transferred;
b. retain the right to designate who shall u
th Yes No
^
se
e property transferred or its income; ...............
c. retain a reversionary interest; or .......... ^ ^
......
d. receive the promise for life of either payments, benefits or care? ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~"""
2 """ ^ ^
. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consid ^
eration?
' y ......
3. Did decedent own an "in trust for" orpayable-upon-death bank account or securit 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 tra
3 percent [72 P.S. §9116 (a) (1.1) (i)), nsfers to or for the use of the surviving spouse is
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 survivin sous '
[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 '
filing a tax return are still applicable even if the surviving spouse is the only beneficiary. g p e is 0 percent
For dates of death on or after July 1, 2000: disclosure of assets and
• 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 n
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 r atural parent, an
72 P.S. §9116(1.2) p2 P.S. §9116(a)(1)].
pe cent, except as noted in
• 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 . A '
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
( )( )] sibling is defined, under
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ann E. Minich
mGUae the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned yyith right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
~• 2005 Ch DESCRIPTION
rysler Sebring
2• 1964 Plymouth Fury
3• Unum Disability payment
4. Highmark Insurance Refund
5• Highmark Prescription Insurance Refund
6. Footlocker stock dividend
7• Unum Disability lump sum benefit
8. 2010 Federal Tax Refund
9• Estate checking account interest May 2011
10. Estate checking account interest June 2011
11. Estate checking account interest July 2011
12. Footlocker stock
13. Estate sale
14. Footlocker stock dividend
TOTAL (Also enter on line 5, Recapitulation) S
(If more space is needed, insert additional sheets of the same size)
SC
REDUCE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUM1
VALUE AT DATE
OF DEATH
3, 750.00
4,000.00
1, 092.44
28.67
10.28
1.50
4, 096.65
1,413.00
0.05
0.26
0.24
180.22
24.50
1.65
REV-1509 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CPT w ~.- ..
SCHEDULE F
JOINTLY•OWNED PROPERTY
.. ~ .~, ~ ~ vr:
Ann E. Minich FILE NUMBER:
ff an asset was made jointly owned within one year of the decedent's date of death, it mu t be reported o nSchedule G.
SURVIVING JOINT TENANT(S) NAME(S)
ADDRESS
A. Jessica A. Dalinsky RELATIONSHIP TO DECEDENT
113 Pearl Street
Carlisle, PA 17013 daughter
s. Jessica and Matt Dalinsky 113 Pearl Street
Carlisle, PA 17013
c
JOINTLY-OWNED PROPERTY:
LETTER DATE
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL IDNSTI TUTION AND BANK ACCOUNT NUMBER OR SIMILAR
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
~ ~ A• Members 1st
Checking Account# 76591-11
2' A. Members 1st
Savings Account# 76591-00
3' A• 0040-19 month CD 76591-40
Maturity Date 2/28/2011
4' B• Members 1st Account# 104389-11
Checking Account
DATE OF DEATH
VALUE OF ASSET % ~
DECEDENT'S DATE 0
VALUE OF
INTEREST DECEDENT'S INTEREST
1,424.12 50. 712.06
4, 022.72 50. 2, 011.36
623.82 50. 311.91
1,634.71 16.667 272.46
TOTAL (Also enter on Line 6, Recapitulation)
If more space is needed, use additional sheets of paper of the same size.
a
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CCTATe ~r-
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
Ann E. Minich FILE NUMBER
21 11 0368
Decedents debts must be reported on Schedule 1.
ITEM
NUMBER
A. FUNERAL EXPENSES: DESCRIPTION
~• Hoffman-Roth Funeral Home
2• Waggoners UMC Ladies Loyalty -Food
3• Thank you cards, postage, video production
4• Grave excavation
5. Tombstone engraving
B. ADMINISTRATIVE COSTS:
~ • Personal Representative Commissions:
Name(s) of Personal Representative(s) CUrtIS L. MIr11Ch
Street Address 420 Telford Avenue
city Reading
State PA ZIP 19609
Year(s) Commission Paid:
2. Attorney Fees: Stephen J. Hogg, Esquire
3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address 19 S. Hanover Street Ste. 101
city Carlisle
State PA ZIP 17013
Relationship of Claimant to Decedent
4' Probate Fees;
5. Accountant Fees:
6• Tax Return Preparer Fees:
~• Advertising: Cumberland Law Journal
The Sentinel
8• Accounting (Est)
9• Tax Return and Inventory Filing Fees
TOTAL (Also enter nn I ho 0 0,.,.__:.... _.. , I _
It more space is needed, use additional sheets of paper of the same size, _ V VG~"u'a`IV"/ ~
AMOUNT
5,617.41
725.51
400.00
300.00
116.00
500.00
3,000.00
367.50
75.00
176.92
200.00
30.00
11
REV-1512 EX+ (12-08)
Pennsylvania SCHEDULE I
DEPARTMENT pF REVENUE
INHERITANCE 7AX RETURN DEBTS OF DECEDENT,
RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Ann E. Minich FILE NUMBER
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, inc udinglunre0mburse
ITEM d medical expenses.
NUMBER
DESCRIPTION VALUE AT DATE
~• Members First (car loan) OF DEATH
2 5,184.61
JC Penney
20.00
3• Bon Ton
75.00
4. Members 1st Visa
125.00
5• Donald Heishman -lawn care
40.00
6• PPL Electric January
252.00
7• PPL Electric (over budget amount 2010)
924.74
8• Comcast
129.73
9• Keller Financial Group 2010 Federal, State & Local tax returns
265.00
10. Estate sale classified ad
24.50
11. York Waste Disposal
48.54
12. York Waste Disposal - dumpster rental
360.93
13. Pest control
143.50
If mare space is needed, insert additional sheelsOT he samse sizeer on Line 10, Recapitul8ti0n) a
Ann E.
NUMBER
1.
1
2.
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outr~' ht spousal distributions and transfers under
Sec. 91 f6 (a) (1.2).J
Curtis L. Minich
420 Telford Avenue
Reading, PA 19609
Jessica A. Dalinsky
113 Pearl Street
Carlisle, PA 17013
FILE NUMBER:
21 11 0368
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SH
OF ESTATE
Lineal
Lineal
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV- I
II• NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NO 1500 COVER SHEET, AS APPROPRIATE.
1.
T TAKEN:
I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART 11 _ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 CO
If mve space Is needed, use additional sheets of paper of the same size. SHEET. S
REV-tSS 3'cX? !0i-10)
pennsylvania
DEPARTMENT pF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: