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HomeMy WebLinkAbout12-15-11 (2)f i -~ REV-'~Jr00 °CtOt-10' 1505610143 OFFlCIAL USE ONLY PA Department of Revenue panne nia Bureau of Individual Taxes ~-~*~re~ ~ ~° veer FAe N"'"°°r Po Box2t30801 INHERITANCE TAX RETURN 21 11 0 0 0 0 4 Harrisburg, PA 1712s-oso7 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 123 30 7756 12 04 2010 07 27 1939 Decedent's Last Name Suffbc Det~denYs First Name MI BROWN ANN M (ff Appiicsble) 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 FlLED IN DUPLICATE WITH THE REGISTER OF WILLS FlLL IN APPROPRIATE OVALS BELOW ® 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa, FuNre Interest Compromise ^ 5. Federal Estate Tax Retum Required tdate a after tz-t2-ex) ^ g, Derxdent uteri Testate ^ 7, Decedent AAehrteMred a uwp trust 8. Total Number of Safe Deposit Boxes (nnacn coot a vva~ (Anacn copy d Tnpt> ^ 9. I.itlgatlon Proceeds ReceNsd ^ 10. br t2-9t Dt ~ ~-,tea demur ^ 11.Electlon to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTIAL TAX INFORMATION SHOULD BE DETECTED TO: Name Daytime TeMphone Number SAMUEL L ANDSB 717 761 5361 Flrst Ilse of address 525 NORTH 12TH STREET state aP cods PA 17043 REGISTER OF WILLS USE ONLY Q © ...:. ' f'~rr ~ ~~~ u ;~ e~`r ~.. ~.,.~rn ~~~ try ~ C`~ DAB ~E~ x~r ;~-.fi r~ 4` F ,; f .tee! a,:. . '_:: r ~`. rrr ~~ Second Itns of address City or Poet OHks LEMOYNE --r =•~, .~-- c.~~ Correspondent's e-ma11 address: l a w a n d es ~ a o l. C o m Urxier perleMiss of perjury, I declare that I have examktad this return, krcludi accom scaredules and ~~~ments. and to the best of my and belief, K b true, conera and coniplste. Decla-atbn of preparor other then the personal repress' rrf$tNi fa based on all IMorrnetlon of which preparer has s~dps. John P. O'Neill, Jr. ~ 'Z~ ~ 3 PA 17043 Samuel L Andes 525 North 12th Street, Lemoyne, PA 17043 Side 1 L 1505610143 1505610143 J ~~ REV-1500 EX oeoeaanrs Name: BROWN , ANN M A R I E Decedents Social Security Number 1a3 30 7756 RECAPITULATION 1. Real Estate {Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Ck>sely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mor~ages & Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 8. Jointly Owned Property (Schedule ~ ^ Separate Billing Requested ............. 8. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate P rty (Schedule G) ^ Separate illing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 4,069.14 5,988.81 10,057.95 9. Funeral Expenses if<AdministratNe Costs (Schedule H) .........................:............... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 12. N~ Value of Estate (Line 8 minus Une 11) ............................................................. 12. 13. Charitable and Governmental BequestslSec 9113 Trusts for whk:h an electlon to tax has not been made (Schedule J) ................................................. 13. 14. Nst Value Subject to Tax (Line 12 minus Line 13) ................................................. 14. 5,005.38 549.06 5,554.44 4,503.51 4,503.51 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rats, or transfers under Sec. 9118 (a)(12) X .00 15. 18. Amount of LMe 14 taxable at lineal rats x .045 4 , 5 0 3.51 1 t3. 17. Amount Of LMe 14 taxable et sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rats X .15 18. 19. Tax Due ..................................................................................................................... 19. 20. FlLL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 1505610243 aoa.66 aoa.66 REV-1500 IX Page 3 Ftle Number 21 - 11 - 00004 Decedent's Complete Address: Brown, Ann Marie STREET ADDRESS 4191 Gettysburg Road, #8 CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prbr Payments B. Discount 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 Une 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 202.66 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) (5) 202.66 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 incrome of the properly transferred :.................................................................................. b. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest: or ............................................................................................:..................... d. recehre the promise for Iffe 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 ca~sideration? ....................................................................................................................... ^ 3. Dkf decedent own an 9n trust for" or payable upon death bank account or security at h~ or her death?......... 4. Dkf decedent own an Individual Retirement Account, annuity, or other non-probate property which txMtains a benefk~ary designation? ...................................................................................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE Q AND FlLE R AS PART OF THE RETURN. For dales of death on or after Juy 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 f8 3 percent [72 P.S. §9118 ta) (1.1) (i)]. For Baths of death on or after Jan~ry 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percrent a~sseffi and flung a (tax r ((i§m 8 ~ tote does not exempt a transfegr~ surviving sp~use from tax, and the statutory requirements for disclosure of etu applicable even tf the sunrNin use is the on beneficia For dates of death on or after July 1, 2000: • The tax rate bnposed on the net value of transfers fnxn a deceased child 21 yyeeaars of age or younger at death to or for the use of a natural parent, an adoptive parent, Or a stepparent of the child fs 0 percent (72 P.S. §9118 (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. §9118 12) [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 p~ sibNng is defkied under Seclton 9102, as an indivktual who has at least one parent in common with the decedent, wfiether bbyy blloooodd or ado oowowweN.rnof vea+snv~ra MlN~TANCETAX RE7UF~1 RBDBtf D~B?r SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ESTATE OF BrOWn, Ann Marie 21 -11 -00004 Include the proceeds of 1i19gation and the date the proceeds were received by the estate. Ali property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 1968 Marlette mobile home located at Lot 8, 4191 Gettysburg Road, Camp Hill (Lower Allen 1,000.00 Township), Cumberland County, Pennsylvania, in extremely poor condition. 2 ~ Checking Account No. 0536582083 with Metro Bank ~ 2,669.14 3 ~ Miscellaneous items of furniture, clothing, and other personal property ~ 400.00 ~ TOTAL (Also enter on Line 5, Recapitulation) ( 4,069.14 oo~aNwpxTMOFa~rwsr~vnran SCHEDULE G ~w~r~Tnz INTER-VIVOS TRANSFERS & '~'~D~D°'"' MISC. NON-PROBATE PROPERTY ESTATE OF Brown, Ann Marie FILE NUMBER 21 -11 -00004 Thia schedule must be completed and flied if the answer to any of questlons 1 through 4 on page 2 is yes. NUM ER ma,ae me name a n~is -emaa,sh4 m d ^,e nie aea a nenere-. ,. copy a me deed ror red eseeme. vn~i~ue ~ n~ss~ °~D'$ irrtEr~sT pF,~~ TAXABLE VALUE 1 Decedent's account in Hoover Rehabilitation 5.988.81 100% 5,988.81 Services, Inc. 401 (k) plan. Account held with American Funds. TOTAL (Also enter on ilne 7, Recapltulatton) I 5,988.81 9Ch®ULEH caraNwFxniofPea~snv~wu- /~~~~~r~.• /~~//~8~t+ NHgiRMICETAX RENIN! rL~lI~~7 ~ ~Y'1~ / 1I G V~7 ~ ~7 t~DBiT D8C®BIT FILE NUMBER ESTATE OF Brown, Ann Marie 21 - 11 -00004 Debts of decedent must be reported on Schedule 1. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A 1 Parthemore Funeral Home 3,670.20 B. ADMINISTRATIVE COSTS: 1. Personal Represenffitlve's Commissbns Name of Personal Representative(s) Street Address Cfly Sffite Zip Year(s) Commission paid 2. Attorneys Fees Samuel L. Andes 3. FamHy Exemption: (If decedent's address is not the same as claimant's, attach explanatbn) Claimant Street Address City Sffite Zip Relatbnship of Claknant ~ Decedent a. Probate Fees Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administratlve Costs 1 Cumberland Law Journal (advertising) 1,000.00 104.50 75.00 TOTAL (Also enter on line 9, Recapitulation) S,Qp$,$g Sc~~eduleH oo~oNwErurn of a~NSnvnrw- ~ & irr~ r~x RAN ~S~Y@ C08ifi8 001'~IECI ESTATE OF Brown, Ann Marie 21 -11 -00004 155.68 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE „~~ """" LIABILITIES, & LIENS ~~ FILE NUMBER ESTATE OF' Brown, Ann Marie 21 -11 _00004 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Comcast Cable -final cable bill 100.00 2 ~ Citibank credit card i 449.06 ~, TOTAL (Also enter on Une 10, RecapltulaUon) ~ 549.pg nev-~sta oc. t»-osl OOMMONMNEALTN OF PErp~SYI.vANIA INHERrTANCE TAX RETURN RESIDENT DECEDENr SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Brown, Ann Marie 21 -11 -00004 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) (~$) RECEIVING PROPERTY Do Na ua T-usMe(s) I. TAXABLE DISTRIBUTIONS[include outright usal un~deb S~ec.s~1113 ( 2)l 1 John P. O'Neill, Jr. Son 100% 206 Herman Avenue Lemoyne, PA 17043 Eller dollar amounts for distributlons shovm above on lines 15 through 18 on 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETf 0.00