The URL can be used to link to this page

Home My WebLink About10-25-11J 1505610105 REV-1500 Ex l°~-"' «" m PA Department of Revenue Pennsylvania Bureau of Individual Taxes °`°""'"`"'°`"`"`«"` Po Box z8o6o1 INHERITANCE TAX RETURN Harrisburg PA 17128-o6D1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BE Social Security Number 119-20-6978 OFFICUIL USE ONLY County Code Year_ File Number __ Date of Death MMDDYYYY Date of Birth MMDDYYYY _-- _ _ __. ___. _ 01/29/2011 - ~ 12/27/1926 Decedent's Last Name ~w Bailey _____ -- - - --- (IfApplicable) Enter Survivin® Spouse's Information Below Spouse's Last Name Spouse's Social Security Number Suffix Decedent's First Name _~ MI Mrs -! Barbara ~~ _ ---- - -~ Suffix Spouse's First Name MI -- - -- r-- - _ l .-. A.._..__ _._._._._._.______._~_ _._ ------J _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - -._____._____. _____ _..____._____..._..______~ REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW t~ 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (Date of Death O 4. Limited Estate O Prior to 12-13-82) 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O (Attach Copy of Will) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (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 -- - --- _ _ Robert L. O'Brien, Esq. j (717) 249-6873 _ __. __ .--.---_._.__.__..___________~..___.a First Line of Address __ _ _ _ __ - 19 West South Street l Second Line of Address - __ .-._- City or Post Office __ _ _ State ZIP Code _ ~ PA _ _ ______ _ __ Carlisle ~ ~ ~ A 17013 Correspondent's e-mail address: REGISTER OF WILLS USE ONLY r,.. C ~ ~3 r -`~~ca '~ R) -- '= R ~ Gr' .. ..~ L~ T~ ~~ DATED -~ - _ _ --- - 1-..~. -1 t\3 - ,'lam r. Under penalties of perjury, I deGare 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. DeGaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERS~~~~R Ftt,1NG RETURN DATE ADDRESS /y~ .... ~~r 10/25/2011 19 West South Street, Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY ~~ Z?~'~ F , ~~~ ---~ .-- I i t~'t l~ Q -~ Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedents Name: '; 119-20-6978 RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. L _ _ - ___ _ _ _ 2. Stocks and Bonds (Schedule B) ..................................... .. 2. - 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. ~ I, 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. $$6.26 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .. 6 7 Inter-Vivos Tra f 8 Mi ll '--° . ns ers ~ sce aneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 8. Total Gross Asaets total Lines 1 throu h 7 ........................... ( g ) .. 8. 886.26 ~ 9. Funeral Expenses and Administrative Costs (Schedule H) ........... ........ 9. I 886.26 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ....... ........ 10. 0.00 , 11. Total Deductions (total Lines 9 and 10) ......................... .. . 11 ' 12. Net Value of Estate (Line 8 minus Line 11) ...................... ........ 12. ~!, ~ ~ 0.00 n' 13 Charitable and G t l B . overnmen a equestslSec 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. ! 0.00 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 _ 16 17. Amount of Line 14 taxable at sibling rate X .12 17 18 A t f . moun o 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 O Side 2 L 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address Flle Number DECEDENTS NAME Barbara Bailey STREETADDRESS Green Ridge Village 210 Big Spring Road CITY Newville STATE ZIP PA 17241 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 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. 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) Total Credits (A + B) (2) (3) (4) (5) 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 own an "in trust for" orpayable-upon-0eath 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 p2 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 p2 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(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-15o8 EX+ (11-io) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: Barbara Bailey FILE NUMBER: 21-11-0148 Include the proceeds of litigation and the date the proceeds were received by the estate. All property ~olntly owned with ri®ht of survivorship must be disclosed on Schedule F. NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. Metro Bank checking # 0513036731 886.26 2, SBLI life insurance proceeds payable to estate due to death of named beneficiary Arthur Bailey who predeceased Mrs. Bailey. Proceeds paid to Roberta Bailey as sole heir. This is claimed as a non taxable transfer in the amount of $2,467.65, per 72 P.S. Sec 9111(d), see attached. TOTAL (Also enter on Line 5, Recapitulation) ; 886.26 If more space is needed, use additional sheets of paper of the same size. SCNEDIILE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS eaini~ ur FILE NUMBER Barbara Bailey 21-11-0148 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: L B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 825.00 Name(s) of Personal Representative(s) Robert L. O'Brlen street Address 19 West South Street city Carlisle state FA zIP 17013 Year(s) Commission Paid: 2011 Z• Attorney Fees: 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 85.00 s• Accountant Fees: 6• Tax Return Preparer Fees: 7, TOTAL (Also enter on Line 9, Recapitulation) $ 910.00 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (O1-10) Pennsylvania DEPARTMENT OF REVENUE INHERTfAN[F TAY RFTIIRN SCHEDULE ~ BENEFICIARIES ~aiwi~ vr: FILE NUMBER: Barbara Baile 21-11-0148 NUMBER NAME AND ADDRESS OF PERSONS RECENING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE () Do Not Litt Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2}.] 1. Boberta Bailey Roberta Bailey 1 Grces Llwyd Selattyn Road Glyn Ceiriog daughter, only child 100% LL 20 7H6, North Wales, UK ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRTATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN; 1• Roberta Bailey, Life Insurance proceeds, SBLI payable to estate due to prior death of decedent's 2467.65 husband Arthur Bailey. ` B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S 2467.65 If more space is needed, use additional sheets of paper of the same size. >D1682 6765771 DD1 D9214D BARBARA BAILEY 210 BIG SPRING RD NEWVILLE PA 17241 Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 1-888-937-0004 mymetrobank.com We're here 7 days a week, 24 hours a day at 1-888-937-0004. Statement 8alart~ as of 12!15!40 Plus Depos#ts and Other Cr~its lass Checks and Other Debits Rius Interest Paid s~tatsment Batsnvs +ts of; 01/1?M 4 50 PLUS CHECKING 0513036731 5886.14 50.00 50.00 50.12 1;886:26 Transactions By Date Date Description Debit 01Et'N11 SST PAYfIItENT Credit Balance 50.1x 5886.26 Interest Summary Beginnln~ Interest Race. Number at Eaaye in this Statement Pertod 0.15°k Intsresrt Earned this Statement Perbd 33 Annust Psrceotagie Yield Earned this Statement Partod (APY) 50.'IY , Mto~t Pak! Year to gate 0.15°le _ 50.12 Fees Summary total o~- Feet talus sets Period Total Overdraft Fees Year to Date So.Oa root read Itieea Fees aids nt 50.00 Total Returned Item Fess Year to Date so.oo 50.00 For your convenience, a summary of overdraft and returned item fees appears on your monthly statement. Please note that the overdraft fee summary includes non-sufficient funds fees, uncollected funds fees and unavailable funds fees. The summary does not reflect refunded or waived items credited to your account. Important Notice: Total Overdraft Fees Year-To-Date and Total Returned Rem Fees Year-to-Date in the Fees Summary box above are inclusive of all fees incurred from January 1, 2010 through December 31, 2010. Year-To-Date fees will reflect only 2011 fees beginning wRh your next statement. With Pay Anyone, a FREE feature of Metro Online Bill Pay, you can send payments to anyone just by using their email or cell number--in as fast as one business day! Not enrolled in Bill Pay? Visit mymetrobank.com and click "Online Banking." Looking for a credit card with an amazingly low interest rate, no annual fee and no late fees? Introducing the Metro Bank Personal Visa®Credit Card, America's Next Great Credit Cardl Apply at your nearest store or call 800.298.1015. 1s cy~ie Page 1 of 2 METRO-ROLL z S 0 o° S 0 ~_ i3 n co 0 SBLI® THE NO NONSENSE LIFE INSURANCE COMPANY® October 6, 2011 The Estate of Barbara Bailey Robert OBrien as Administrator 19 West South St Carlisle, PA 17013 Insured: Barbara Bailey Policy No: 001048673 Dear The Estate of Barbara Bailey: For information or service, contact SBLI Customer Service P.O. Box 4048 Woburn, MA 01888 80094-7254 8:00 AM to 6:00 PM ET www.sbli.com email - records@sbli.com We have received and processed the claim on the policy referenced above. The enclosed payment of $2,467.65 represents the proceeds due to you as beneficiary. The following is a breakdown of the payment: Coverage Amount: $2 000 00 Premium Adjustment: , . $35 78 Dividend Accumulations: . $352 35 Post Mortem Dividend: . $13 72 of Total Proceeds: . 100 00% Interest on Proceeds: . $65.80 Under Federal estate tax law, a portion of the proceeds may be considered taxable to the estate of Barbara Bailey. This depends on the value of the Insured's taxable estate as of the date of death. The enclosed Internal Revenue Service Form 712 should be filed with the estate tax return, if required. Any interest paid on the proceeds is taxable to the beneficiary as ordinary income in the year in which the claim was paid. If you are required to file an income tax return, the amount of interest is shown above. Please note: This is general information regarding tazation on life insurance proceeds and you may want to consult with a financial advisor for taz advice. If you have any questions, please feel free to contact our Customer Service Call Center at 800-694-7254. Sincerely, Linda J. Gibson Customer Service CS-365 0300001322