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Home My WebLink About12-07-111505610140 REV-1500 EX `°'-'°' OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 0 0 8 8 8 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 5 2 8 6 4 7 5 9 2 0 8 1 4 2 0 1 0 0 2 2 8 1 9 5 3 Decedent's Last Name Suffix Decedent's First Name MI D Y K S T R A A N N M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI C R I B B I N S P A U L S Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 2 4 6 9 2 2 2 6 2 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return O 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 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 B E N J A M I N J B U T L E R 7 1 7 2 3 6 1 4 8 5 First line of address 1 0 0 7 M U M M A Second line of address City or Post Office R O A D S T E 1 0 1 State ZIP Code REGIST F WILLS USE~ONLY ~:! L ~_ `a t_~-~t7 1 .._ . ,. ~ -~..i ~" ~ _; -, . ~ <--=~ - _..,-- -~ ..> -„ ' '. --- .: n _.. - ~j7 __i .. ._ .3~ATE FILED :~ - ~` c_~; L E M O Y N E P A 17 0 4 3 Correspondent's a-mail address: LAWYERS n,BUTLERLAWFIRM.COM _~, ;~, 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 true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA R OF PE SOf~ RESPONSIBLE FOR FILING RETURN D TE ADDRESS 4110 C INGTON COURT WEST MECHANICSBURG PA 17050 SIGNATU OF ~Pi~ER THER THAN RE RESENTATIVE DAT ~/ (( l '~~~ • l ~ 1D07 MUMMA ROAD, STE 101 LEMOYNE PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 ,~ J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: ANN M• D Y K S T R A 5 2 8 6 4 7 5 9 2 REC APITULATION 1 0 ~ 0 0 1. . ........................................... Real Estate (Schedule A) 2. ...................................... Stocks and Bonds (Schedule B) 2, 0 ' 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0 • 0 0 4. .................. Mortgages and Notes Receivable (Schedule D) ...... , 4. 0 • 0 0 4 2 5 6 . 1 8 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 0 0 (Schedule G) ^ Separate Billing Requested ....... 7. • 8. ( 9 ) ........................... Total Gross Assets total Lines 1 throu h 7 g, 4 2 5 6. 1 8 9. .................. Funeral Expenses and Administrative Costs (Schedule H) 9. 0 ' 0 0 10. 9 9 ( ) ............. Debts of Decedent, Mort a e Liabilities, and Liens Schedule 1 10. 0 • 0 0 11. Total Deductions (total Lines 9 and 10) ............................... 11. 0 • 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 4 2 5 6 . 1 8 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 0 0 0 an election to tax has not been made (Schedule J) ...................... 13. • 14. .. ax ( ne m o u ject Net Value ........... .. ..... . .. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 4 2 5 6 1 8 15 0. 0 0 (a>(1.2) x.ooo . . 16. Amount of Line 14 taxable 0 0 0 0 0 0 at lineal rate X .0 _ . 16. . 17. Amount of Line 14 taxable 0 0 0 17 0• 0 0 at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 0. 0 0 at collateral rate X .15 18. 19 O • O O 19. ................................. TAX DUE ............ .. ..... . .. 4 2 5 6 . 1 8 14 inus Line 13) Li 12 t T S b 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 L 1505610240 1505610240 J REV-1500 EX Page 3 n......d...,+~~ ~`~rr~r~lntn Arlrtlrncc• .........~.~..~. -----r---- - ------ - - - - DECEDENT'S NAME ANN M. DYKSTRA STREET ADDRESS 4110 Capin ton Court West CITY STATE ZiP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments 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 10 0888 Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT o.oo 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes ^ No X^ a, retain the use or income of the property transferred : ................................................................. ..... ^ X ^ 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 receiving adequate consideration? ................................................................................. h? ...... ^ 0 ... 3. Did decedent own an'in trust for" or payable-upon-death bank account or security at his or her deat ...... Did decedent own an individual retirement account, annuity or other non-probate property, which 4 . contains a beneficiary designation? ............................................................................................ ...... X^ ^ 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 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)]. 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. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ANN M. DYKSTRA 21 10 0888 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash 4,256.18 TOTAL (Also enter on line 5, Recapitulation) ~ $ 4 256.18 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: ANN M. DYKSTRA NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).j 1. Paul S. Cribbins 4110 Carrington Court West Mechanicsburg, PA 17050 FILE NUMBER: 21 10 0888 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Spousal 4,256.18 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS 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: 1. 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: SCHEDULE J BENEFICIARIES AMOUNT OR SHARE OF ESTATE TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ 0 00 If more space Is needed, use addltlonal sheets of paper of the same size. N }j N O ~ ~ O ~ o 1.~ O ~ ~ ~ ~i Q O ~ Lt, a ° Z U N M a d f~+ ~ /~ 6 a 0 ~ r~ +-~ '~ I~ ..~ ~n w E ~ vi z r--1 ~+ p+ r-I .,.., v~ a ~ .a ~ ° o b ~ F a ~ G O ~ o ~ c~ ~ a~ w a~~+~~ CCl .u ~+ ~+ ~ a ~ a~ ~ •~ .,~ ,n o ~ ~ U ~ ~ P; U '-+ U 0 1007 Mumma Road Tel: 717236.1485 Suite 101 Fax: 717236.7777 ~ Lemoyne, PA 17043 lawryersQbutlerlawfirm.com ~ ~ ~ Mailing Address: Post Office Box 1305 Camp Hill, PA 17001.1305 December 6, 201 l Ronald D. Butler Jana Butler Toole Beniamin J. Butler Register of Wills Suzanne M• Butler Cumberland County Courthouse 1 Courthouse Square Room 102 Carlisle, PA 17013 Re: Estate of Ann M. Dykstra a/k/a Ann Marie Dykstra 2010-00888 Dear Sir or Madam: I have enclosed two originals and one copy of a Supplemental Pennsylvania Inheritance Tax return and one original and one copy of a Supplemental Inventory for the above referenced estate. Please time~dae pelo en I have alpo enclosed a check for $30 OOhmade enclosed self-addressed sta p p payable to Register of Wills for supplemental filing fees. Ycur cooperation in this matter is appreciated. Very truly yours, i . `,,~ x: Benjamin J. Butler BJB/mot Enclosure `~ =i-` ~L~ -- ~;.~ -t''~ -,., ._ *. -~;;~~ -. ..._ ~' 4- .... C:_