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Home My WebLink About10-31-11 (2) J 1505610105 REV-1500 ~t02-11~IFn PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes °`"""'"`"'°'"`""'"` County Code Year File Number Po BOxz8o6oi INHERITANCE TAX RETURN Harrisbu PA 1 iz8-o6os RESIDENT DECEDENT ~ ( (j S~3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Suffix Decedent's First Name MI Calhoun Hazel R" (If Applicable) Ertter Surviving Spouse's Information Below SpOUSe'S Last Nama Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supp-emental Retum MI O 3. Remainder Retum (Date of Death O 4. Limfted Estate Prior to 12-13-82) O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Livin Trust (Attach Copy of Will) g 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 T0: Name Daytime Telephone Number Angela R. Winslow, Esquire 412-667-6216 First Line of Address 1500 One Gateway Center Second Line of Address City or Post Office Pittsburgh Correspondent's e-ma11 addr~§s: Q wt /ls ~t%tA) q 1- Underpenalties of perjury, I dedare that I have examined this return, including ac it is true, correct and complete. Dedaretion of preparer other than the personal r SI~TURE OF PERS~N RESPONSIBLE FOR FJLWG RETURN 1014 ~enk~is Grove,vEr~pla, PA 17A25 ~~ State ZIP Code PA 15222 ~ /~ ~ p ~hS ~Dn . 5 .;_,.' REGISTER O USE ONf:Y- ='~ 4_~ C'7 ` t 3 ' : ' - - - r-- - - _ ~ ~ r _, - .~_ A ~ ~~ - - . - - ;-. , _,~ _-..~ '~ ^~ ~ , ,' ~ ,"rr ules and statements, and to the best of my knowledge and belief, e is based on ali infonnation of which preparer has any knowledge, ~. n iln DATE ~ DATE ~ 1500 One'Gateway Center, Pittsburgh, PA 15222 PLEASE USE ORIGINAL FORM ONLY L Slde 1 15056101D5 1505610105 J THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS r ' J 1505610205 REV 1500 EX (FI) Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate (Schedule A) ....... ............ . ......................... 1. 0.00 2. Stocks and Bonds (Schedule B) ...... .......... . ...................... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3 ..... , 0.00 4. Mortgages and Notes Receivable (Schedule D) .. .................. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 53, 642.63 6. 7. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... Inter-Vivos Transfers & Miscellaneous Non-P b t 6. 169, 187.03 ro a e Property (Schedule G) O Separate Billing Requested........ 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) ............... . """'•••••• 6• 222,829.66 9. Funeral Expenses and Administrative Costs (Schedule H)..... . ............. s. 14,897.23 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 0.00 11. Total Deductions (total Lines 9 and 10) ................................. 11. 14,897.23 12. Net Value of Estate (Line 8 minus Line 11) .. , , . , ........................12. 13. Charitable and Governmental BequestslSec 9113 Trusts for which 207 , 932.43 an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subiect to Tax (Line 12 minus Line 13) ........................ 14. , 207, 932.43 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._ 16. Amount of Line 14 taxable 15. at lineal rate X .0 17. Amount of Line 14 taxable 16' 9 , 35 6.96 at sibling rate X .12 18. Amount of line 14 taxable 17. 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 1505610205 9,356.96 1505610205 O J REV-1500 EX~(FI) Page 3 Decedent's Complete Address: File Number DECEDENTS NAME Hazel R. Calhoun STREETADDRESS 325 Wesley Drive arv Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments (1) 9,356.96 A. Prior Payments B. Discount 3. Interest Total Credits (A + g) (2) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT (3) 0.00 . Fill in oval on Page 2, Line 20 to request a refund . (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 9 , 356.96 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: 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-death 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? ........................................................................................................................ ^ Ix I 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)j. 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)j. 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)j. • 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)J. 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. m w m m x A O v x o~ p ~O 17 yZ y ~ cm~~ ~~z~ x D~~O ~m °Am Z ~ my ° m< D Z D y ~O ZA ~~ a~ ow ~o z° ~v H ~+ m -i r= ~ O z -Di m c m c W ~ v m z N pxi z F-+ N C ~, ~ Z n F-+ -~ O ~ Z V n ~ ~ w w x ~ m ~ ~ REV-1502 EX+ (O1-10) ~:; ~ ~ ` Pennsylvania DEPARTMENT OPREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE w~n~c vrc - FILE NUMBER: Hazel R. Calhoun 21-11-0573 of 2011 All real property owned solely or as a tenant in common must be reported at fair marker vail~o_ F~~~ ,.,~.~o« ..el~... ;. J..C.__J __ .~ _ .......I J L. -. -L _ _ _ _ ~ ~- .... _ -~_-- ._ ..__......, ,,,,, ,,,,,,,,,,,,,,, ,,,«u OI yeper or me same sae. REV 1503 ~(+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt~LE B STOCKS & BONDS ESTATE OF FILE NUMBER Hazel R. Calhoun 21-11-0573 All property Jointly-owned with right of survtvorshtn mucr ~ .~ie,.i„~ea .,., c..~...,..~_ ~~~ nwlc aNOw IJ IICCUCU~ ulcer[ aaainonai sneers or the same size) REV-1504 FJ(+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~E c CLOSELY HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF Hazel R. Callhoun FILE NUMBER 21-11-0573 of Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporationlpartnershipinterest of the decedent, other than a LU 11 sole-proprietorship. See instructions for the supporting information to be submitted forsole-proprietorships. (If more space is needed, insert additional sheets of the same size) REV-1505 EX+ (6-98) ' SCHEDULE C-1 COMMONWEALTH OF PENNSYLVANIA CLOSELY HELD CORPORATE INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Hazel R. Calhoun 21-11-0573 of 2011 1. Name of Corporation N/A State of Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Employer I.D. Number Business Reporting Year_ 3. Type of Business Product/Service 4. TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK VotingMon•Voting SHARES OUTSTANDING pAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred $ Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? ................................ ^ Yes ^ No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ................................. ^ Yes ^ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock in this company within one year prior to death or within iwo years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedents death? ....^ Yes ^ No If yes, provide a copy of the agreement. 10. VVas the decedents stock sold? .................................................. ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedents death? ................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, incuding dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • •~ ~ ~ A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECENABLE ESTATE OF FILE NUMBER Hazel R. Calhoun 21-11-0573 Ail property jointly-0wned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-i5o8 EX+ (ii-io) ~~~i ~ Pennsylvania SCHEDULE E 1~ DEPARTMEN70FREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Hazel R. Calhoun 170-12-9839 Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+ (oi-lo) a,~ `; pennsylvania DEPARTMENT OFREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCNED~ILE F ]OINTLY-OWNED PROPERTY ESTATE OF: Hazel R. Calhoun If an asset became jointly owned within one year of the decedent's date of death, it must be SURVIVING ]OINTTENANT(S) NAME(S) ADDRESS A• Karen L. Moyer e• Terry E. Calhoun C. ]OINTLY OWNED PROPERTY: FILE NUMBER: 21-11-0573 as o ed on Schedule G. 2011 RELATIONSHIP TO DECEDENT Daughter Son ITEM NUMBER LETTER FOR ]DINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANGAL IN5TI7UTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FORlOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET ^~ of DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1• A. PNC - Account Number 55915172 338,374.05 50 7 169,187.03 TOTAL (Also enter on Line 6, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. ~ 169 ,18 7.03 REV-1510 EX+ (08-09) j i~-~~ pennsylvania ~. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Hazel R. Calhoun 21-11-0573 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONShDP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COP`( OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION APPUasLE TAXABLE VALUE 1. NSA TOTAL (Also enter on Line 7, Recapitulation) ~ I 0.00 If more space Is needed, use additional sheets of paper of the same size. REV-1511 ~X+ (10-09) ~.~ pennsylvania ~` DEPARTMENT OF REVENUE INNERrrANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF Hazel R. Calhoun Decedent's debts must be reported on Schedule I. 21-11-0573 as of 201 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1~ 9,523.00 Boyer Funeral Home Flowers 89.23 Luncheon 150.00 Organist 135.00 Christ Lutheran Church 100.00 e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address 1s not the same as claimants, attach explanation.) Claimant 4. 5. 6. 7. 4,535.00 Street Address City State ZIP Relatlonship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: 365.00 TOTAL (Also enter on Line 9, Recapitulation) I;14, 897.23 If more space 1s needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) r:'~ i~, Pennsylvania '..~' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Hazel R. Calhoun FILE NUMBER 21-11-0573 as of 201 ooMrr dpntn tncurrea iiv the decedent Drior to death that remained unpaid at the date of death, Including unreimbursed medical expenses. if more space is needed, insert additional sheets of the same size. REV-1513 EX+ (O1-10) "~' ~ pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: Hazel R. Calhoun NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] i. Karen L. Moyer 1014 Jenkins Grove Enola, PA 17025 2. Terry E. Calhoun 75 Medinah Drive Reading, PA 19607 21-11-0573 a; LATIONSHIP TO DECEDENT AMOUNT OR SHARE f 2011 Do Not List Trustee(s) OF ESTATE Daughter ~ 50 Son I 50 ENTER DOLLAR AMOUNTS FOR D]STRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE, II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: i. N/A B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. N/A TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. REV-1514 EX+ (4-09) ~ - Pennsylvania ~'~ DEPARTMENT OF REVENUE Bureau of Individual Taxes Po Box zso6oi Harrisburg PA i~u8-o6oi SCI~IEDtlLE K LIFE ESTATE, ANNUITY & TERM CERTAIN (CHECK BOX 4 ON REV-t5oo COVER SHEET) ESTATE OF Hazel R. Calhoun FILE NUMBER 21-11-0573 as of 2011 This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME OF LIFE TENANT DATE OF BIRTH • NEAREST AGE AT DATE OF DEATH TERM F YEARS LIFE ESTATE IS PAYABLE N/A ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ lafe or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable .........................................$ 2. Actuarial factor per appropriate table ............................................... . Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) ....................................$ NAME OF LIFE ANNUITANT DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM F YEARS ANNUITY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ...........................................$ 2. Check appropriate block below and enter corresponding number ................ . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (See instructions.) ................................................ . 7. Value of annuity - If using 3.5, 6, or 10%, or if variable rate and period payout is at end of period, calculation is Line 4 x Line 5 x Line 6 ...........................$ If using variable rate and period payout is at beginning of period, calculation is (Line 4 x Line 5 x Line 6) + Line 3 ...............................................$ NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the return. If more space is needed, use additional sheets of the same size.