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Home My WebLink About12-09-11 (2)1505610105 --~ REV-1500 Ex (~ ii) (Fn OFFICIAL USE ONLY County Cafe Year File Number n PA Department of RevenueP~ K'~.~..~ ~ ' ~ ~ (~ ~ ' 1 Bureau of IndtviduatTaxes INHERITANCE TAX RETURN V 111 PO BOX 280601 RESIDENT DECEDENT Harrisbur PA 1128-o6oi MMDDYYYY ENTER DECEDENT INFORMATION BELODW to of Death MMDDYYYY Date of Birth Social Security Number 09/17/11 10/05/1923 MI 195163961 Suffix Decedent's First Name Decedent's Last Name F ISABELLE OMMERT MI lff Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name Spouse's Last Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WI~•~S FILL iN APPROPRIATE OVALS BELOW 2 Supplemental Retum p 3. Remainder Return (Date of Death prior to 12-13-82) ~ 1. Original Return O romise (date of st Comp wired O 5. Federal Estate Tax Return Req O 4. Limited Estate O 4a. Future Intere death after 12-12-82) sit Boxes Total Number of Safe Depo g O 7. Decedent Maintained a Living Trust . --- p 6. Decedent Died Testate (Attach Copy of Trust.) O 11. Election to Tax under Sec. 9113(A (Attach Copy of Will) Credit (pate of Death 10. Spousal Poverty O (Attach Schedule O) O 9. Litigation Proceeds Received Between 12-31-91 and 1-1-95) MATION SHOULD BE DIRECTED T THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR Daytime Telephone Number CORRESPONDENT - Name 71i'2338757 JOSEPH J. DIXON, ESQ• REGISTER OF LLS USE ON4Y_~ " ..~. ~ ~ t '~ ..~ ~ , ~ ~ ~ . .' ~'~' -y 1'~-t 4 ~ First Line of Address l: Cl~~ ~ -••-~ 26 STATE STREET 1 Second Line of Address `-~ ~ -•. • City or Post Office HARRISBURG Correspondent's a-mail address: - Under penalties of perjury, I dedare that 1 have exami Sher than thee peursfonal it is true, and complete. Dedaration of Pa SIGN RE F PERSON RES SIBLE (LING RETURN OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS State ZIP Code pA 17101 Side 1 ~D--'TS "3"' .,...,. - f 'i ~. _ ~~~, -, i- . - •--{ ,~~ -a-~t schedules and statements, and to the best of mY ~`~~e and belief, e is based on all infarnation of which Preparer has any knowledge. 15056101D5 1505610105 150561D205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: RECAPITULATION ..................... 1. .......... 1. Real Estate (Schedule A) ............. . ..... 2. .............. 3. 2. Stocks and Bonds (Schedule B) .. • • • • • • • • • ~ • ' ' ' ' ' ~ ' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . • • • • 4. Mortgages and Notes Receivable (Schedule D) .. • • • • • • • • • • ' ' ' ' ' ' ' ~ • • • 4 Schedule E).. ~ • ~ ~ 5. 5. Cash, Bank Deposits and Miscellaneous Personal Property s. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... . 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Prope O Separate Billing Requested.. ~ • ~ ~ • ~ 7~ (Schedule G) .... 8. .................. i.,..~i i inaa 1 through 7) ...... . 8. TOtal Vrvsa ~~°^ ~-- - 9. g. Funeral Expenses and Administrative Costs (Schedule H) .................. . 10. Debts of Decedent, Mortgage Liabilities and liens (Schedule I) ............... 10. .................... 11. 11. Total Deductions (total Lines 9 and 10) ............ . .................12. 12. Net Value of Estate (Line 8 minus Line 11) ............ . 13. Charitable and Governmental BequestslSec 9113 Trusts for which 13 an election to tax has not been made (Schedule J) . • ............. 14. .. T_.,n~„ot2minusLine13)..~•••••••• 376,952.67 0 0 158,569.93 36,118.00 0 33,043.92 57.25 33,101.17 538,539.43 0 14. Net vawe ~.+~~~~• -- -- TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or 15 transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable 16. at lineal rate X .0 17. Amount of Line 14 taxable 17. at sibling rate X .12 18. Amount of Line 14 taxable 18. at collateral rate X .15 ...................... 19. TAX DUE ..................... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 538,539.43 80,780.91 O 1505610205 File Number Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments (1) AD-Z80.9.~ A. Prior Payments _ _ - _ _ d n~o nd. B. Discount _ -_ __ - _ _ 4,039.04 Total Credits (A+ B) (2) 3. Interest (3) 4 Fiili in ovalgon Page 2, Line 20 toi request a refunderence. This is the OVERPAYMENT. (4) (5) 5. If Line 1 + Line 3 is greater than Line 2, enter the difrerence. This is the TAX DUE. Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRsATE BLOCKS No 1. Did decedent make a transfer and: transferred .......................................................................................... ^ a. retain tfie use or income of the property ^ 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? ••wdhin one year of death ... ^ ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property ^ ............................................................................ without receiving adequate consideration? ............................. . 3. Did decedent own an "in trust for" or payable-upon-death bank account or secunty at his or hu-heath? .::::::::::::: ^ ^ 4. Did decedent own an individual retirement account, annuity or other non-probate properly, contains a beneficary designation? .................................................................................. . NSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE, G AND FILE IT AS PART OF THE RETURN. IF THE A 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)]. use is 0 percent For dates of death on or after Jan. 1, 1995not exempt a transfereto a survey ng spouse from taxe and the statutory requi ements for d scloure of assets and [72 P.S. §9116 (a) (1.1) (ii)]. The statute does 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 ~2 PecSe §9 11 6(a)(1 2)~ ears of age or younger at death to or for the use of a natural paren , an adoptive parent or a stepparent of the child is 0 perce [ • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaas 1 ~s ~e cPe ~~'P S §9116(a)(1~.3)][ A siblings s1 defined, • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings P under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 pC+ (7-ii) M ~ pennsylvar~ia INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~E s STOCKS & BONDS FILE NUMBER ESTATE OF - - ~-~-a- REV-i5og EX+ (ii-io) pennsylvarria DEPARTMENT OF REVENUE INHERITANCE TAX RETURN SCNEp1~~E E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY {ZC~1VCn, vww.. ESTATE OF: FILE NUMBER: s of litigation and the date the proceeds were received by the enlace. Indude the p °W~ ~ ~9~ ~ ~I~~Ip mutt be disdosed °^ mule F. VALUE AT DATE All i?rop~'~ ~ Y OF DEATH ITEM DESCRIPTION UMBER 140,009.56 CERTICATE OF DEPOSIT SOVEREIGN BANK 1. 2,146.63 CHRISTMAS CLUB SOVEREIGN BANK 13,700.00 2 PROCEEDS FROM SALE OF 2007 BUICK SEDAN 2,513.74 3. PROCEEDS FROM PERSONAL PROPERTY 200.00 4. PROCEEDS FROM SALE OF SCOOTER 5. TOTAL (Also enter on Line Vii, Recapitulation) $ tf more space is needed, use additional sheets of paper of the same size. REV-1$o9 DC+ (oi-lo) Pennsylvania gCNEp1~LE F 70INTLY-OWNED PROPERTY INHERITANCE TA% RETURN ~NNMIBER: RESIDENT DECEDENT ESTATE OF: vr;tl~in ene year of the deoede~s date of death, it nwst bes reported ~ ~'~-°~~_.6' ----- ~ ~ abet ~~ owned ADDRESS RELATIONSHIP TO DECEDENT SURVIVING JOINT TENANT(S) NAME(S) NEPHEW 3 DEVONSHIRE SQUARE A ,LAMES A. KEYS MECHANICSBURG, PA 17050 B. C. % OF DATE OF DEATH 70INTLY OWNED PROPERTY: pECEDENT'S VALUE OF DESCRIPTION OF PROPERTY NUMBER WI SIMRAR DATE OF DEATH MTERESi DELEDE~ ~~' IfTTER DATE INCLUDE NAME ~ FINANCIAL [NSTmTTION AND BANK ACCOUNT YALIE OF ASSET ITEM WR IOUIT MADE IDENTIFYING NUMBER• ATTACH DEED FOR 701NRY NEID REAL ESTATE. NIkIBER TENANT ]DINT 500 36,118.00 72,236.00 1. A. 8113108 ORRSTOWN BANK CERTIFICATE OF DEPOSIT ACCOUNT # 14700093 36,118.00 TOTAL (Also enter on Une 6, Recapitulation) ~ ce is needed, use additional sheets of Paper of the game size. If more spa REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN ESTATE OF SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE NUMBER on 5cheduk I. peoedent's debts must be roported AMOUNT ITEM DESCRIPTION (UMBER 530.32 A FUNERAL EXPENSES: I~ NEUMYER FUNERAL HOME 415.88 MEMORIAL LUNCHEON g. ADMINISTRATIVE COSTS: 15,765.00 I personal Representative Commissions: - - Name(s) of Personal Representative(s) ~p,M~S-A~KI<X~- - __-_ ---_-- r~r~ inAlCl-11 G Street Address ~_~~„~,;~. RL-SQ ----- - State _I?Ar -ZIP '17 150 ---- - ------ City MF(:''~e~,".IICSRLIR~____------------ Year(s) Commission Paid: 201'L - _ - - -_ - 15765.00 Z, Attorney Fees: 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant - -- - Street Address _ - - - _ - - State -----ZIP-- -- --.. City ___--___-------------------------__-___ ___-- - _- -- --_---- Relationship of Gaimant to Decedent _._____-_---------- ---------- 420.00 4, Probate Fees: 5, Accountant Fees: 6. Tax Return Preparer Fees: 75.00 ~• CUMBERLAND COUNTY LAW JOURNAL 72 72 CARLISLE SENTINEL TOTAL (Also enter on Une 9, Recapitulation) ~ is needed, use additional sheets of paper of the same sae. If more space REV-1512 EX+ (12-08) SCHEDULE I , pennsylvarria DEBTS OF DECEDENT, DEPARTMENT OF REVENUE E$ $t LIENS INHERITANCE TAX RETUR~'+ MORTGAGE LIABILI'TI ~ ~ R RESIDENT DECEDENT _ .e~~7'C AF .__.~~..~ .rnansel. REV-1513 EX+ (01-10) SCHEDULE ] Pennsylvania BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [IncluSec. 9116t(aj (12);istributions and transfers under 1' JAMES A. KEYS 3 DEVONSHIRE SQUARE MECHANICSBURG, PA 17050 PAUL R. KEYS, JR. 26 PROSPECT GARDENS LUDLOW, MA U1056 FILE NUMBER: Al U Y~~ SHARE RELATIO ECEDENT OF ESTATE DO Not List TrustEC(s) Nephew I 50% 50% Nephew ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROP® II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAK 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTa~~ ONS OWN oN~~r of h ~,m5e o1Z OVER SHEET. $ If more spas is nee1~, use