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Home My WebLink About01-09-121505610105 '-'J REV-1500 ex t°z-~'' `~' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number oEP..,,E.. aF wE~~~E Bureau of Individual Taxes INHERITANCE TAX RETURN 1 PO BOX 280601 RESIDENT DECEDENT ~ I I ~ D 6 3~ Harrisbur PA 1128-0601 - ENTER DECEDENT INFORMATION BELOW Soaal Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _ _.. :176-07-5985 05/18/2011 07/29/1919 Decedent's Last Name Suffix... Decedent's First Name MI _Spriggle Josephine K (If Applicable) 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 FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) t~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8~. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Day[ime Telephone Number __ __ Linda J Boch (717) 790-9043 _ __ _ _ __ First Line of Address __ _... __ 35 Skyline Drive _... Second Line of Address City or Post Office ', Mechanicsburg State ZIP Code !; PA 17050 ~3 ~ __ REGISTER ~~ LLS USE ~DNLY ~ T~ .._ ~m I ~~ ~ ; ,; - --; ~ ; . =, ~:- .- ~, '_` ,ti '-i ., DATE FILED ~~- ~.~ _~ . T~ C z Correspondents e-mail address: lindaboch yahoo.com Under penaHies 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. SI~NAT.URE OF PER N S NSI F R FIL,/NG RETURN DATE ~, ~ l ~//„~ 01/06/2012 r ,~ SIGNATURE OF PRE RER OTHER THA REPRESENTATI DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 ,J J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: Josephine K Spriggle 176-07-5985 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2,114.71 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash,. Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 3,231.80 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 5,346.51 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 4,293.86 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule p ............... 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 4,293.86 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 1,052.65 _ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which _ 00 1 250 an election to tax has not been made (Schedule J) ..................... ... 13. , . ........................................ 14. Net Value SubJect to Tax (Line 12 minus Line 13) ............. 14. 2,302.65 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_ 15. 16. Amaunt of Line 14 taxable at lineal rate X .0 45 2, 302.65 16. 103.62 17. Amaunt of Line 14 taxable at sibling rate X .12 17. 18. Amaunt of Line 14 taxable at collateral rate X .15 18• 103.62 19. ............ TAX. DUE ......................................... .... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505610205 Side 2 O 1505610205 J REV-500 EX (Fq Page :3 - -^_~af_ /~~.Y .~I~i.. A.ddrwc. cam" File Number DECEDENTS NAME Josephine K Spriggle STREET ADDRESS 35 Skyline Drive CfTY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 2. Tax Due (Page 2, Line 19) 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. (1) 103.62 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) (5) 103.62 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 "intrust 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 benefiaaries 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-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDI~ILE B STOCKS & BONDS ESTATE OF FILE NUMBER -:So~z~ ~1~~ ne ~'1. ~-pt~- ~~ le_ ~~ 11 _ 0~1 ~ ~ --. All orooerty iointty- d with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) Please Note: Your Sale Proceeds Check is Attached OMB NO 1545-0715 ' 2011 Proceeds From Broker and Barter Exchange Transactions BROKER'S Name, Address. ZIP Code, Instructions for Recipient Federal Identification Number and Form 1099'6 Telephone Number: Brokers and barter exchanges must report proceeds from transactions to SUbStltUte COPY B FOR RECIPIENT you and to the Internal Revenue Service. ThIS form is used to report The Bank of New York Mellon "'IMPORTANT TAX INFORMATION"' these proceeds 480 Washington Blvd. This is Important tax information and is being -__- _ _ _ _ __ J- - -~-- - Jersey City, NJ 07310 furnished to the Internal Revenue Service. If ' a Date o` Sale C'iolc '.-•.~ce~ you are required to file a return, a negligence 06i10l2011 59156R1D 13-5160382 penalty or other sanction may be imposed on - --- - -- - -- -- - - you if [his income is taxable and the IRS ~ Stocks Bonds etc o =~DER.AL !rvCOME '~x s ' HHE'~_G Telephone: 1-800-649-3593 $2 ,114.71 $0.00 determines that it has not been reported. TO `NHOM PAID REPORTED O/ gross P~oceeCs TO IRS ~ Foss Proceeos Bess commission antl oouons ore^~~~ums ~ Descnpt~on LINDA J BOCH METLIFE:. INC. n-+eStO''~ Rec ie^.:'S 'oe ~ifiCdGpn VumDer on PJe 35 SKYLINE DR -- - -- - -- - MECHANICSBURG PA 17050-1751 125263584758 163388549 Box 1 a. -Shows the trade date of the transaction. For aggregate reporting, no entry will be present. Box 1b. -For broker transactions, may show the CUSIP (Committee on Uniform Security Identification Procedures) number of the item reported. Box 2. -Shoves the proceeds from transactions involving stocks, bonds, other debt obligations, commodities, or forward contracts. Losses on forward contracts are shown in parentheses. This box does not include proceeds from regulated futures contracts. Report this amount on Schedule D (Form 1040). Capital Gains and Losses Box 4 -Shows backup withholding. Generally, a payer must backup ::dhhold at a 28% rate if you did not furnish your taxpayer identification number to the payer. See Form W-9. Request for Taxpayer Identification Number and Certification. for information on backup withholding. Include this amount on your income tax return as tax withheld. Box 7 - Shows a brief description of the item or service for which the proceeds or bartering income is being reported. For regulated futures contracts and forward contracts. "RFC" or other appropriate description may be shown. For inquiries about your account, contact BNY Mellon Shareowner Services, MetLife's Transfer Agent: Telephone: 1-800-649-3593 U.S. Mail: N E-Mail: metlife~bnymellon.com MetLife o Internet: www.bnymellon com/shareowner/isd c/o BNY Mellon Shareowner Services ° PO Box 358447 ° Pittsburgh, PA 15252-8447 0 0 YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECK REPRESENTS THE FULL VALUE OF YOUR ACCOUNT. ~ ^ IMPORTANT TAX RETURN DOCUMENT ATTACHED " TRANSACTION BETAIL SHAREHOLDER OF TRANSACTION DAT_ DESCRIPTION METLIFE, INC. I 0611 0/2 0 1 1 SHARES SOLD CUSIP INVESTOR ID ACCOUNT KEV CHECK NUMBER C-+EGK ~p'E CHECK aMOUN' 001 928 59156R10 125263584758 I BOCH-----LINDJ0000 934818 06/15/2011 I $2.114.71 OPENING TRUST INTEREST BALANCE SHARES SOLD PRICC PEE. SHORE :'S': GRO SS PROCEEDS 52.0000 ! 52.0000 40.6676000 $2.114.71 TAX WITHHELD ', NE' PROCEEDS ~'_OSING -RUS rJT=REST EA LANCE cn nn 52.1 14.71 00.0000 PLEASE DETACH BELOW CHECK NUMBER: 934818 ~aev~,soe ex ~ u-en SCHEDULE E COMMONWEALTHO'rPENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY ~ncaT n~rcncu7 ESTATE OF FILE NUMBER ~dse~D~lr~~ h. ~~~-I~q~P ~~~11 -~OCo3~' ~ ~ u. ~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ ~ - ~-i y ~ ' ~: '~ ~~ i - ~ ~ ~ R:-~ TOTAL (Also enter on line 5, Recapitulation) I $ 3 ~ '~ J, ~~ ~ flf mnra snare is neerlarl insert adrlitinnal cheats of the lama si~el REV-1511 EX+ (10-06) ~, _ ~~` COMMONWEALTH OF PENNSYLVANIA INHERITP,NCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF _ FILE NUMBER ~~ I l - O~~o ~i~ ' ` Deb`ts3f decedent must be reported on Schetlule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: _ ~ ~ 't ~ , ~,, (~; '~~ ~'~~ ~,~,~n~~ on I~~c~~~~~L~'~- Cue-~-ar~~~-~--~~ ~e (l~er~o~~~~l l' ~~~ ~~~-~` ~`~~ ~ ~.lou~ti~~~ ~tTJh ~--~n,~er-~~, I - C~p~~~,~r,.~ q-- ~a,ne la ~s ~=-/o~ti~~,~~ ~,. /~1~~ ~`~ ! ~~-~'resy~yY1°,~~s b`~~ r ~ se~v, c ~ V`~ ,~ 1 r -~ ~- ~~~j--~I~ce iYl~.~ ~ ~-~~J - Ta~ ~~e ~~o ~ ~' ~ ~ ._ -~1 ;c- ~, ~ ~ e 5 ~; s~.~~ ~~ _ ~~ ~ `~Pr~r,ce ~ ~ , ~C, ~~~~ u~r Ch~a;~ ~ onarltnm ~ - ~as~~~ Ur~c~~~~.5+ Ch~~,~-~. ~~c~~rs I ~/~~;~ - ~~rvi g. ~INISTRATIVE C t~ S~ J , 1 -~ -,~ J e I x w'' • ~ ~_ 1 ~~'a ~--~ t P I a~ ~ ~ i LL~:~. 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address _ __ City - ---- --- State -----Zip Year(s) Commission Paid 2. ~ Attorney Fees 3. Family Exemption: (If decedents address is not the same as claimants.. attach explanation) Claimant -- _ Street Address _ _ City __ _ __ State __ Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7 Zip ~1~-5-~~ TOTAL (Also enter on line 9, Recapitulation) $ ~,~ ~ j ~ 0 (-!~ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) ' SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN FILE NUMBER ESTATE OF / ~ ~ ( _ ~0 / ~~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] >~~ r-~ ,. belle ~. 1l)OC ~, ~G~ s~l~s~ f p~. y~~~~~~~~h ~ ~ , /~e~L~Cu~b~~)~ ~~~ P~ ~~~~~ j hom~is f} (3o~ti 30 S ~a~k~ ~ 5+. ~ ~ SZ~ , c2' ~nc~sn~~ C'(1~~ boy P,~ I ~5S ~, °J Jas~~ A. Qu~~~ CIS" IY~ead~>,~b~ookC;~le ~~,~dscr~ ~~s-o•~ St~~~ bL~ ~y> (~') ~ ~i ~~c~ s~ ~~an ~, Irv ~5 ~ sk~Ilne ~' ~a~olc~u~>~~~~-Pl ~~S 0• ~D ~ ~ ~ tYlechU~~csb~~yJ ~14 ~ ~0 ~"b r~, c ta~~50~? ~~ ~ 0, G~ Y~'~o.~k w ~ S ~ ~5 l~.l (~38~ Ua~ wavy ~~, ,~ C °,~ °'' ~ ~~ A), ~ , ~~ lv I ~ ENTER? DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 CC)VER SHEET $ (If more space is needed, insert additional sheets of the same size)