HomeMy WebLinkAbout10-28-111505610143
REV-1500 Ex(o,_,o,
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania (:ounty Code Year File Number
Bureau of Individual Taxes cevueTMENr or REVENUE
Po Box.2soso~ INHERITANCE TAX RETURN 21 11 ~
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
146 24 4588 05 17 2011 10 25 1925
Decedent's Last Name Suffix Decedent's First Name Mf
VAN DYKE AVONNE B
(If Applicable) Enter Surviving Spouse'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
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Retum ~ 2. Supplemental Retum ^ 3. Remainder Retum (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise
(date of death after 12-,2-82) ^ 5. Federal Estate Tax Retum Required
8 Decedent Died Testate
(Attach Copy of Will)
^ ~ pe~edeat Mainte~'ned a Living Trust
(Att®ch Gopy of T
ru
st) e. Total Number of Safe De Sit Boxes
~
^ 9. Litigation Proceeds Received ~ C
r
10. between l2 311 ne d~t~dat9e5~f death ^ 11, Election to Tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JERRY A WEIGLE ESQUIRE 717 532 7388
First line of address
126 EAST KING STREET
Second line of address
City or Post Oftice State ZIP Code
SHIPPENSBURG PA 17257
Correspondent's a-mail address:
REGISTER ~ WiLLS USB-6NLY --~-
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DATE FILED --. ~'
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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. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNATURE OF PERS~ON/RESPONSIBLE FOR FILING RETURN DATE
~~la~ Urtr, „v1~p4„ Thomas Van Dyke, Jr. (~ -2~- ~~
ADDRESS ,'
tSyUS UIQe JCOilana KOaq ,nl ens t'A 77157
SIGNAT OF PREPARER OTHER THA REPRE NT/~FWE DATE
~i Jerry A. Weigle Esquire ~Q --ZI_ ~ 1
126 East Kinq Street, Shippensburq~A
L
1505610143
Side 1
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-11
DECEDENT'S NAME
Van Dyke, Avonne B.
STREET ADDRESS
8905 Olde Scotland Road
CITY
Shippensburg STATE
PA ZIP
17257
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
0.00
(1)
Total Credits (A + B) (2)
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box 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.
(3)
(4)
(5)
0.00
0.00
0.~0
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 ............................................................................................................... ^ ^
d. receive the promise for life of either payments, benefits or care? ............................................................ ^ x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .................................................................................................................... ^ ^x
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.
_.. 1
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 January 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)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the ~9ecedent, whether by blood or adoption.
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Van Dyke, Avonne B. 21-11
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+ (10-06)
COM INO ~W IDENNTEDECED~N~R~VANIA
SCHEDULE H
FUNERAL EXPENSES 8r.
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Van Dyke, Avonne B. 21-11
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N M R
q, FUNERAL EXPENSES:
See continuation schedule(s) attached
9,908.58
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio _
Year(sl Commission paid
2. Attorney's Fees Weigle & Associates, P.C. 75.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio _
Relationshio of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 20.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 10,003.58
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
' SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Van Dyke, Avonne B. 21-11
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Fogelsanger-Bricker Funeral Home 9,908.58
H-A 9,908.58
Other Administrative Costs
2 Register of Wills, Franklin County -filing Insolvent PA Inheritance Tax Return 20.00
H-B7 20.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+ (12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Van D ke, Avonne B. 21-11
Report debts incurted by the decadent prior to death that remained unpaid at the date of death, including unmimbursed medical expenses.
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1 (Rev. 12-08)
REV•1513 EX+ (11-08)
' ' SCHEDULE J
COMIN~I~WIIDENTEDECED~"~YLNANIA BENEFICIARIES
ESTATE OF I FILE NUMBER
Van Dvke• Avonne B• 21-11
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT
0 (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
~ distributions, and transfers
under Sec. 9116 a 1.2
Not relevant as estate is insolve t.
Total
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 150 0 cover sheet, as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
1505610243
REV-1500 EX Decedent's Social Security Number
Van D ke, Avonne B.
Decedent's Name: y 146 24 4588
RECAPITULATION
1. Real Estate (Schedule A) ......................................................................................
1.
2. Stocks and Bonds (Schedule B) .............................................................................
2.
•
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3.
.
4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4.
0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...............
5
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers 8~ Miscellaneous ~ SeparaterBilling Requested............ 7.
(Schedule G)
.. s 0 . 0 0
........................................................
g. Total Gross Assets (total Lines 1-7)...........
.
9 10,003.58
9. Funeral Expenses & Administrative Costs (Schedule H) .......................................
10 371.71
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..............................
.
10,375.29
11. Total Deductions (total Lines 9 i3< 10) ...................................................................
11
12 -10 , 375.29
.........................
. .
12. Net Value of Estate (Line 8 minus Line 1 .............................. . .
Charitable and Governmental BequestslSec 9113 Trusts for which
13 13
.
an election to tax has not been made (Schedule J) ....................... . .
.
14 -10 375.29
~
14. Net Value Subject to Tax (Line 12 minus Line 13) .............................................. .
.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or 0 . 0 0
transfers under Sec. 9116 15.
(a)(1.2) X .00
0 . 0 0
16. Amount of Line 14 taxable 0 , 0 0 16.
at lineal rate X .045
0 . 0 0
17. Amount of Line 14 taxable 0 , 0 0 17.
at sibling rate X .12
0 . 0 0
18. Amount of Line 14 taxable 0 . 0 0 18.
at collateral rate X .15
0.00
19
..
19. Tax Due ............................................................................................................... .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505613243 1505610243