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HomeMy WebLinkAbout11-22-111505611180 -~ REV-1500 EX(°2_,,,(Fl) OFFICIAL USE ONLY PA Department of Revenue Pennsylvania DEPRRTMENTOINHERITANCE TAX RETURN county code Year File Number Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~! ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 450-71-0549 04192011 12011976 Decedent's Last Name Suffix Decedent's First Name MI HENRY NOAH q (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 BOXES BELOW ~x 1. Original Retum Q 4. Limited Estate 0 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE RE~t3iS ~`WtLLS Q 2. Supplemental Retum 4a. Future Interest Compromise (date of death after 12-12-82) 0 7. Decedent Maintained a Living Trust (Attach Copy of Trust) Q 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) Q 3. Remainder Retum (Date of Death Prior to 12-13-82) Q 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes Q 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUU. TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ROLAND HENRY 71779660[ First Line of Address 5215 SIMPSON FERRY RO Second Line of Address City or Post Office MECHANICSBURG State ZIP Code PA 17050 -» ;. ,.~ ~; ~_ ,~-~ Correspondentse-mail address: LISAaHARTMANACCOUNTING.COM er na es q declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, FOR FILING RETURN lb/~` ~t~ ADDRESS r ~© (~ Sl'^` '-°Yr ~.~ MPG~Qhtcg~u V~ ~7U ~~-~aGe9 SIG TU F PREP OT R THAN REPRESEfJj~4~E DATE ,,jj~~ _ 1D/26/11 P.O. BOX 342, GRANTHAM, PA 17027 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505611180 1505611180 V J REV-1500 EX (FI) Decedents Name: N O A H A H E N R Y RECAPITULATION 1505611280 Decedent's Social Security Number 450-?1-0549 1. Real Estate (Schedule A) ......................................... 1. N 0 N E 2. Stocks and Bonds (Schedule B) .................................... 2. N 0 N E 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. NON E 4. Mortgages and Notes Receivable (Schedule D) ........................ 4. NON E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... 5. 2 2 5 6 . 0 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 0 . 0 ^ 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ....... 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) .......................... 8. 2 2 5 6 . 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ................ 9. NON E 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ 10. NON E 11. Total Deductions (total Lines 9 and 10) .......................... ... 11. 0 , 0 0 12. Net Value of Estate (Line 8 minus Line 11) ........................ ... 12. 2 2 5 6 , 0 0 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) .................. .... 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. .... 14. 2 2 5 6 . 0 0 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 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .0 4 5 16. 0 .0 0 17. Amount of Line 14 taxable at sibling rate X . 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X . 15 1 g. 0 , 0 0 19. TAX DUE .................................................... ...19. ^ . 0 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 L 1505611280 1505611280 REV-1500 EX (FI) Page 3 File Number 450-71-0549 Decedent's Complete Address: DECEDENTS NAME NOAH A HENRY STREET ADDRESS 5215 SIMPSON FERRY ROAD CITY MECHANICSBURG STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ___ (1) 0.00 B. Discount Total Credits (A + g) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box 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) 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" or payable-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 adoption. REV-1508 EX+(11-10) SCHEDULE E Pennsylvania CASH, BANK DEPOSITS, ~ MISC. NHERITANCETOAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NOAH A HENRY Include the proceeds of litigation and the date the proceeds were received by the estate. If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+ (Ot-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JO{NTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: NOAH A HENRY If an asset became jointly owned within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT INTEREST DATE OF DEATH vA~uE OF DECEDENTS INTEREST 1. A. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL (Also enter on Line 6, Recapitulation) I 3 0.00 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+(OS-09) I SCHEDULE G Pennsylvania INTER-VIVOS TRANSFERS & DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NOAH A HENRY N/A 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,THEIRRELATIDNSHIPTODECEDENTAND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °lo OF DECD'S INTEREST EXCLUSION QF APPLICABLE) TAXABLE VALUE 1. I NG 401 K (JFC TEMPS INC) PLAN NO: PHS782 4,037 100.00% 4,037 0 2. EDS 401 K 30,755 100.00% 30,755 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on Line 7 Recapitulation) $I 0 If more space is needed, use additional sheets of paper of the same size.