The URL can be used to link to this page

Home My WebLink About11-09-11 (2)_J 1505610105 REV-1500 Extoz_11,~FI, PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes "" " ~"' " County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN -~ Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ~ ~ ~ ~ VL.PCP~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 466-82-9719 02/04/2010 04/04/1947 Decedent's Last Name Suffix Decedent's First Name MI Jones David B (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 ~ 1. Original Return O THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) 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 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 __ _ _ _ _ ~ _ Jason D Jones ' (717) 761-170€x? -- -,~ First Line of Address ` 123 E Main Street Second Line of Address City or Post Office. _ _ _ _ _ ._ _ _ Shiremanstown Correspondent's a-mail address: REGISTER QFa~1(IF3.~-1~ _t__ - ~.) .'~ .= - 7 ~J`~, ;_,,_._ ~'=~~ _O _ . d ;L'y State ZIP Code PA '17011 DATE FILED -r, --; ? -_ ~_ °, L~ --r"1 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 tru, , orrect and corr,p~ete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG ATURE OF PERSON ESPgtl IBLE FOR FILING RETURN DATE ,'! .F''~~'3--~ '(,: ' / ~..~ -.~-- 11/01/2011 123` E Main Street ~$hiremanstown, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 J~ 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: David B JOnes 466-82-9719 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. 9 9 ( ) ....................... Mort a es and Notes Receivable Schedule D 4. ' .... 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... .... 5. 22,333.53 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .... 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 00 0 (Schedule G) O Separate Billing Requested.... .... 7. . 8. ( 9 ) ......................... Total Gross Assets total Lines 1 throw h 7 8. .... 22,333.53 9. Funeral Expenses and Administrative Costs (Schedule H) ............... .... 9. 7,722.36 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) :.......... .... 10.1 0.00 11. Total Deductions (total Lines 9 and 10) ............................. .... 11. !, 7,722.36 12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. i 14,611.17 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 00 0 an election to tax has not been made (Schedule J) .................... .... 13. : . 14. 1 ( ) .................... Net Value Sub'ect to Tax Line 12 minus Line 13 14, .... 14,611.17 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 14,611.17 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. ` _ 657.50 19. TAX DUE ...................... ..... ..19. __ .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 150561D205 1505610205 J REV-1500 EX (FI) Page 3 r)pr_a~anit'c ('.mm~lafp Aridrpss~ File Number DECEDENT'S NAME David B Jones STREET ADDRESS 1121 North Pitt Street CITY j STATE Carlisle PA ZIP 17013 Tax Payments and Credits: 1: Tax Due (Page 2, Line 19) 2. CreditslPayments 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) 657.50 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) 0.00 (5) 657.50 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-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? ........................................................................................................................ ^ 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(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 adopticn. REV-i5o8 EX+ (ii-io) ~i`, Pennsylvania ~+u SCHEDULE E e.~ DEPARTMENT OF RED/ENUE CAJII~ BANK DEPOSITS & MISC. INHERITANCE TAX RETURPJ PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: David B Jones 21 11-0665 Include the proceeds of litigation and the date the proceeds were received by the estate. All nrooerty iointly 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. OFFICIAL CI1>/CK ` 1~iM&TBanlc 200185341-[]3 Manufacturers and Traders Trust Company BUFFALO, N.Y. 14240 10-4/220 j ~ ~ " DATE ._ .. -. 8 ~:;~~ ~~~,REMITfER t ea°1ck~ PAY TO THE ORDER OF ~~~ °`` ~' `~'~~' ~~~ $ < _ . !', j a C~STOMF~R RE( ~ `~, ~ ~° COPIh NQ~ Z' _ i ~:0 2 2000046: L 700 20 194 2604 7~~' I - n~ irmy rvn ~ v~r i 1 1 r w --~-....,_ ._. `.. . RE'v-1511 EX+ (Std-GG) ~ i`1 pennsylvania !~ 3 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER David B Jones 21 11-0665 Decedent's debts must be reported on Schedule I. ITEi~t NUMBER DESCRIPTION APIOUNT A• FUNERAL EXPENSES: I' Hoffman-Roth Funeral Home: all services provided 7,722.36 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: ~• 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: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. State ZIP TOTAL (Also enter on Line 9, Recapitulation) I $ 7,722.36 If more space is needed, use additional sheets of paper of the same size. ! ~:'~'` Y FUNERAL HOME bz CREMATORY, INC. ~~ Jason Jones 123 East Main Street Shiremanstown, PA 17011 Statement of Funeral Expenses for: David Bruce Jones Date of Death: February 4, 2010 219 North Hanover Street Carlisle, Pennsylvania 17013 717.243.451 1 toll free 1.866.451.451 1 fax 717.243.3723 www.hoffmanroth.com info ahoffmanroth.com October 13, 2011 Total Funeral Cost $7,722.36 (Itemized Memorandum Previously Furnished) Total Invoice: Less Payments Received by: Balance: $7,722.36 Apr 1, 2011 $6,350.00 $1,372.36 t, a~ SERVING OUR COMMUNITY SINCE 1 907 N N '" W N [n r+ ~ O ~ ~ ~ N N '~ ~ ` O n C '~f ~~ ~ ~ C"1 ~ fl, O C") =r ~ ~ C 3 ~ -p O ~ C ._ qy 7p, c~ c~ ~ - --~ N =- o ~' = ~ ~ w ~ -~ t~D Oti N