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Home My WebLink About11-28-11 (2) 1505610140 REV-1500 ~` ~°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 County Code Year File Number Harrisburg PA 17128-0601 RESIDENT DECEDENT I'- 1 1 1 0 7 4 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 2 0 4 4 6 5 8 3 1 0 5 2 9 2 0 1 1 1 1 2 6 1 9 5 6 Decedent's Last Name Suffix Decedent's First Name L I B E R A T O R D I A N N E MI K (If Applicable) Enter Surviving Spouse's Information Bel ow 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 INAPPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required a death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D O U G L A S G M I L•L E R 7 1 7 2 4 9 2 3 5 3 First line of address I R W I N & Second line of address 6 0 W E S T City or Post Office C A R L I S L E M c K N I G H T p C- P O M F R E,T S T R E E T State ZIP Code REGISTER OF WILLS USE ONLY t7 C~ ~- r ~- ,f,_ 7 ~ -;n rv tt, ( f _ ~ \_,7 ~-, ~~~ - - FILED ` ~~a - ,~: -~ i_. _..T..' ~,., ;~ P A 1 7 0 1 3 Correspondent's a-mail address: V 1 3> c ~i ~~ r~ Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statement;r, and to the best of my knowledge and belief, ft is true correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT OF P RSON R SP NSI FOR FILING RETURN r ~ DATE 60 WEST~POMFRET STREET CARLISLE SIGNA U OF P PARER HE T REPRESENTATIVE ADDRES 60 WEST POMFRET STREET CARLISLE PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 PA 170 DATE 170 1!505610140 J~ REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME DIANNE K. LIBERATOR STREET ADDRESS 170 E. PENN STREET CITY CARLISLE 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. File Number 21 11 0'745 STATE PA Total Credits (A + IB) (2) (5) ZIP 17013 (1) 622.31 0.00 (3) (4J 0.00 622.31 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; .................. ............ ^ 0 c. retain a reversionary interest; or ................._............................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receivin ade uate consideration 9 4 ....................................................................................... ^ 3. Did decedent own an "intrust for" orpayable-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? ................... ~............................................................................. ^ n 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 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 oi'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.°i 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 pr for the use of the decedent's siblings is 12 percent [7??. P.S. §9116(a)(1.3)]. Asibling is defined, undE Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DENT DECEDENT N PERSONAL PROPERTY ESTATE OF FILE NUMBER DIANNE K. LIBERATOR 21 11 0745 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned wkh right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2011 CHEVROLET HHR 14,609.00 TOTAL (Also enter on line 5, Recapitulation) I $ 14 609.00 (If more space is nerded, insert addfional sheets of the same size) REV-1511 EX+ (10-09) ' pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNE~2AL EXPENSES AND ADMINISTRATIVE COSTS ~~ i A i t ~r FILE NUMBER DIANNE K. LIBERATOR 21 11 0745 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1. B• ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: ' 2. AttomeyFees: IRWIN & McKNIGHT, P.C. 750.00 3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation.) Claimant Street Address City State ZIP _ Relationship of Claimant to Decedent 4• Probate Fees: 5 Accountant Fees: 6. Tax Retum Preparer Fees: , 7. REGISTER OF WILLS -FILING FED 30.00 TOTAL (Also enter on Line 9, Recapitulation) 3 7$0.00 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) ' Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES CJIAIt V DIANNE NUMBER I. 1. 2. 3. 4. II. 1 r: K. LIBERATOR ' NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outr' ht spousal distributions and transfers under Sec. 91'(6 (a) (1.2).] NATHANIEL L. LIBERATOR PO BOX 1000 HOUTZDALE, PA 16651 JEREMIAH R. LIBERATOR 170 E. PENN STREET ' CARLISLE, PA 17013 PORTIA A. LIBERATOR 427 N. PITT STREET CARLISLE, PA 17013 ALICIA A. LIBERATOR 170 E. PENN STREET CARLISLE, PA 17013 FILE NUMBER: 211 11 0745 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal Lineal Lineal Lineal AMOUNT OR SHARE OF ESTATE 3,457.25 1/4TH REMAINDER 3,457.25 1/4TH REMAINDER 3,457.25 1/4TH REMAINDER 3,457.25 ~1/4TH REMAINDER ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE If more space is needed, use additional sheets of paper of the same size. ON LINE 13 OF REV-1500 COVER SHEET. 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