HomeMy WebLinkAbout03-0711REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
14.1
Z
14.1
Z
O
UJ
O
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SCHREFFLER, BERNICE M.
DATE OF DEATH (MM-DD-YEAR)
06-08-2003
DATE OF BIRTH (MM-DO-YEAR
07-03-1916
SOCIAL SECURITY NUMBER
] 98 05 8998
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I~1. Original Return
[~4. Limited Estate
[~6. Decedent Died Testate (Attach copy of Will)
r'~9. Litigation Proceeds Received
1~2. Supplemental Return
I-'-] 4a. Future Interest Compromise (date of death after 12-12-82)
[~7. Decedent Maintained a Living Trust (Attach copy of Trust)
r'~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
[~]3. Remainder Return (date of death pdor to 12-13-82)
[~5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
[~11. Election to tax under Sec. 9113(A) (Attach Sch O)
NAME
KRISTINA L. STAHL
FIRM NAME (IfApplicable)
TELEPHONE NUMBER
COMPLETE MAILING ADDRESS
611HALDEMAN BLVD
NEW CUMBERLAND PA
17070
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
72,668. O0
(8)
1,096.00
3,343.00
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
(11)
(12)
(13)
(14)
72; 668.
4,439.00
68,229.00
SEE INSTRUCTIONS ON REVERSE SlOE 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. Amount of Line 14taxable atlinealrate 68,229.00 x .o 45 (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
20. []
3,070.00
3,070.00
Decedent's Complete Address:
STREET ADDRESS
611 HALDEMAN BLVD
z~P
CITY NEW CUMBERLAND STATE PA 17070
Tax Payments and Credits:
1, Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
154.00
(1) 3,070.00
Total Credits ( A + B + C ) (2) 1 54. OO
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3) -O-
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5) 2,916.00
A. Enter the interest on the tax due. (5A) 2,916. OO
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
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; .......................................................................................... [] --,~7I
b. retain the right to designate who shall use the property transferred or its income; ............................................ [] ~
c. retain a reversionary interest; or .......................................................................................................................... []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [~
2. If death occurred after December 12, 1982, did decedent transfer properly within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust 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.
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.
ADDRESSI . t ~
DATE
SIGNATURE OF PR~C~k_.~.ER OTHER THA~REPR_~,ENTATIVE DATE
ADDRESS ~ --
264A S. PROGRESS AVE, HARRISBURG PA 17109
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [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
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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren
or a stepparent of the child is 0% [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%, 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% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as a
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-15~8 EX* (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
SHREFFLER, BERNICE M.
Include the proceeds of litigation and the date the proceeds were received by the estate. All propen~ jointly.owned with the right of survivorship must be disclosed on Schedule F.
ALLFIRST
ALLFIRST
NURSING HOME
ITEM
NUMBER
DESCRIPTION
BANK MONEY FUND #09502-6455-2
RELATIONSHIP WITH INT #00761-5092-5
REIMBURSEMENT
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
61,721.00
6,699.00
4,248.00
$ 72,668.00
REV-1511EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER SHREFFLER, BERNICE M.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
5.
6.
7.
FUNERALEXPENSES:
PARTHEMORE FUNERAL HOME & CREMATION SVCS INC
1303 BRIDGE ST, NEW CUMBERLAND PA 17070
CLOTHING, FLOWERS AND MISCELL FOR FUNERAL
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
STEPHEN S. SIMONIC
State Zip
361.00
435.00
300.00
TOTAL (Also enter on line 9, Recapitulation) $ 1,096. O0
(If more space is needed, insert additional sheets of the same size)
COMMOHWEALTH OF PENNSYLVANIA
I~',~HERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES~ & LIENS
ESTATE OF FILE NUMBER
~HREFFLER, BERNICE M.
Include unreimbursed medical expenses,
ITEM
NUMBER DESCRIPTION AMOUNT
1.
3,066. O0
e
MANOR CARE: FINAL NURSING HOME EXPENSE
From Allfirst Bank 09502-6455-2
NEIGHBOR CARE MED EXPENSE
VERIZON TELEPHONE BILL
251.00
26.00
TOTAL (Also enter on line 10, Recapitulation) $3,343. O0
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
SHREFFLER, BERNICE M.
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
!
1.
2
~XABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116(a)(1.2)]
SHIRLEY L. DOCKEY
820 LISBURN RD #814
CAMP HILL PA 17011
KRISTINA L. STAHL
611 HALDEMAN BLVD
NEW CUMBERLAND PA
17070
DAUGHTER
DAUGHTER
5O%
5O%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 002962
STAHL KRISTINA L
611 HALDEMAN BLVD
NEW CUMBERLAND, PA
17O70
........ fold
ESTATE INFORMATION: SSN: 198-05-8998
FILE NUMBER: 2103-071 1
DECEDENT NAME: SCHREFFLER BERNICE M
DATE OF PAYMENT: 08/29/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/08/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $2,91 6.00
TOTAL AMOUNT PAID:
~2,916.00
REMARKS: KRISTINA L STAHL
SEAL
CHECK# 1 221
INITIALS: AC
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF ZNDZVTDUAL TAXES
TNHER'rTANCE TAX DzVZSTON
DEPT. 280601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
R£V-l~47 EX AFP ¢n1-05)
KRISTINA L STAHL
611HALDEMAN BLVD
HEW CUMBERLAND
PA 1-7070
DATE 10-15-2005
ESTATE OF SCHREFFLER
DATE OF DEATH 06-08-200:5
FILE NUMBER 21 0:5-0711
COUNTY CUHBERLAND
ACN 101
Amount ReaJ. ttad
BERNICE H
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS 4
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF SCHREFFLER BERNICE HFZLE NO. 21 0:5-0711 ACN 101 DATE 10-1:5-Z00:5
TAX RETURN NAS: (X} ACCEPTED AS FILED { } CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I Real Estate (Schedule A}
2 Stocks and Bonds (Schedule B)
$ Closely Held Stock/PartnarshAp /ntarast (Schedule C)
Mortgages/Notes Receivable (Schedule D)
$ Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6 Jointly Owned Property (Sch~clula F}
7 Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expansas/Adm. Costs/H/sc. Expanses (SchaduZa H)
10. Dabts/Hortgaga Liabilities/Liens (Schedule Z)
11. Total Deduct/OhS
12. Nat Value of Tax Return
(1) .00
(2) .00
($) .00
(4) .00
(5) 72;668. O0
(6) .00
(7) .00
(9)
(8)
1,096.00
(10)
NOTE: To /nsura proper
crad/t to your account,
sube/t the upper port/on
of th/s form wAth your
tax payaant.
15.
14.
NOTE:
72,668.00
:5, :5q:5. O0
(11) 4.439. §§
(12) 68,229.00
Charitable/Governmental Bequests; Non=elected 9115 Trusts (Schedule J) (15)
Nat Value of Estate Subject to Tax (14)
Zf an assessment Has issued previously, lines 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Aaount of L/ne 14 at Spousal rata
16. Amount of L/ne 14 taxable at L/heal/Class A rata
17. Amount of L/ne 14 at S/bling rate
18. Amount of L/no 14 taxable at Collateral/Class B rate
19. Pr/nc] )al Tax Duo
TAX CREDITS
PAYMENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-)
08-29-200:5 CD002962 I5:5.q7
.00
68,229.00
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
18 and 19 #ill
(is). .00 x O0 = .00
(16). 68,229.00 X 0~5 = :5,070.00
('17), .00 x 12 : .00
(].8), .00 x 15 = .00
(~9)= :5,070. O0
AHOUNT PAZD
2,916.00
TOTAL TAX CREDIT :5,069.R7
· ALANCE OF TAX DUEI .5:5
J
ZNTEREST AND PEN. .00
TOTAL DUE .5:5
{ ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
IF TOTAL DUE 1S REFLECTED AS A 'CRED/T' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS.)
RESERVATZON:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 11, 1981 -- if any future interest in the estate is transferred
in possession or en]o~lent to Class B (collatara1) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collatara1) rata on any such future interest.
To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (71 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, amy be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Mills, any of the 23 Revenue District Offices, or by calling the special Z4-hour
answering service for fores ordering: 1-800-361-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-$020 (TT only).
Any partY in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 181021, Harrisburg, PA 17128-1021, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ge0601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-lEO1) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (EX) discount of
the tax paid is alia, ed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of
six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1981 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20Z .000548 1987 92 .OOOZq7 1999 71 .OOOigZ
1985 Z6X .000q38 1988-1991 112 .000301 gOOD 82 .000119
198q 112 .000301 1991 92 .000247 2001 92 .000247
1985 132 .000~56 1993-1994 72 .000191 ZOO2 62 .O0016q
1986 101 .000274 1995-1998 9Z .000247 2003 5Z .000137
--Interest is calculated as folloas:
ZNTEREST= BALANCE OF TAX UNPAZD
X NUIqBER OF DAYS DELZNQUENT X DALLY /NTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must ba calculated.