HomeMy WebLinkAbout01-13-12 (2)-~ REV- EX (01-t0)
1500
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 2$0601
ENTER DECEDENT INF
Social Security Number
1 8 5 2 0
Deotadent's Last Name
1505610140
OFFICIAL USE ONLY
INHERITANCE TAX RETURN County Code Year File Number
RESIDENT DECEDENT 2 1 1 1 1 0 9 8
OR~IIATION BELOW
Date of Death MMDDYYYY
5 !9 0 3 0 5 1 0 2 0 0 2
Suffix
A D A M S
(If Applicable) Enter Surviv~ng Spouse's Information Below
Spouse's Last Name ', Suffix
A D A M S
Spouse's Social Security Nu{nber
Date of Birth MMDDYYYY
0 8 2 2 1 9 2 8
Decedent's First Name MI
J O H N R
Spouse's First Name MI
REGISTER OF WILLS
FILL IN APPROPRIATE OWLS BELOW
Q 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
^
4. Limited Estate
'~
^
4a. Future Interest Compromise (date of ^ prior to 12-13-82)
5. Federal Estate Tax Return Required
^
6. Decedent Died Test
(Attach Copy of Will
to
^ death after 12-12-82)
7. Decedent Maintained a Living Trust
8. Total Number of Safe DeposR Boxes
^
9. Litigation Proceeds
eoeived
~ (Attach Copy of Trust)
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)
~:VKKtSPVNDENT -THIS S~CTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUL TAX INFORMATION BHOULD BE DIRECTED T0:
Name ~ Daytime TelephoQeaNumber ,
W I L L I A M A - D U N C A N 7 1 7 2 ~i~ 7 ;`~' 8~ ~:_'
1 7~J - }
~•
REGISTER OF "" ~°A USE ONLY -
_x_1
~,..-~
First line of address ~ , ~' f -w,
1 I R V I N ~E R 0 W - ~~" '`
Second line of address ~:> " ~ -
', ,: ~~~
City or Post Office ', State ZIP Code L DATE FILED
C A R L I S L I,E P A 1 7 D 1 3
Corrospondent's e-maN add~sss: b i 11 a d u n c a n h a r t m a n l a w- c o rn
Under penalties of perjury, I dada that I have examined this return, Including accompanying sdteduos and statements, and to the best of k
ft Is true, oortecx and compote. aretlon ~ preparer other Vran the personal representative o based on all fnforrrration of which ~ nOrvledpe and belief,
SIGNATUR F PERSON RESP NSIBL OR ILING RETURN ~~~ ~ any knowledge.
339 W- NORTH ST CARLISLE
SIGNATURE OF PREPARER OTH R THAN REPRESENTATNE
PA 1701
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 150561140 1505610140
J
1505610240
REV-1500 EX
Decedent's Social Security Number
Decedents Name: J O IN N R. ADAMS 1 8 5 2 0 5 9 0 3
RECAPITULATION
1. Real Estate (Schedule ~4) ........................................... 1.
2. Stocks and Bonds (Schedule B) ...................................... 2. 8 7 6 0. 1 5
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4.
5.
6.
7.
8. Mortgages and Notes R
Cash, Bank Deposits a
Jointly Owned Property
Inter-Vivos Transfers 8
(Schedule G) ~,
Total Gross Assets (t eceivable (Schedule D) .......................... 4.
~d Miscellaneous Personal Property (Schedule E)....... 5.
(Schedule F) ^ Separate Billing Requested ....... 6.
Miscellaneous Ng~Probate Property
U Separate Billing Requested ....... 7.
tal Lines 1 through 7) ........................... 8.
6 6 6
5 4 2
9 .
0 .
9 .
6
0
8
7
0
2
9. Funeral Expenses and dministrative Costs (Schedule H) .............. .... 9. 1 0 0 6 2 . 4 9
10. Debts of Decedent, Mo ~tgage Liabilities, and Liens (Schedule I) ......... .... 10. 3 0 0 8 . 7 5
11. Total Deductions (tota l Lines 9 and 10) ........................... .... 11. 1 3 0 ? 1 . 2 4
12. Net Value of Estate (L ne 8 minus Line 11) ........................ .... 12. 2 3 5 8 . 5 8
13. Charitable and Govem ental Bequests/Sec 9113 Trusts for which
an election to tax has n
l t been made (Schedule J) .................. .... 13.
14. Net Value Subject to ax (Line 12 minus Line 13) ................... ... 14. 2 3 5 8. 5 8
TAX CALCULATION -SEE NSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxa le
at the spousal tax rate, r
transfers under Sec. 9116
16. (a>(1.2> x .o _ 1 1 7 9. 2 9
Amount of Line 14 taxable 15. 0. 0 0
17. at lineal rate x .045 1 1 7 9. 2 9
Amount of Line 14 taxa~le 16. 5 3. 0 7
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxafple
at collateral rate X .15 ' 0 0 0
I 18, 0. 0 0
19. TAX DUE .........
,. ......................................... ... 19. 5 3 • 0 ~
20. FILL IN THE OVAL IF 1~OU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
L 150561040
II 1505610240 J
REV-1500 EX Page 3
Decedent's Complete Address:
JOHN R. ADAMS
343 W. NORTH ST.
cm-
CARLISLE
Tax Payments and Credits:
~ • Tax Due (Page 2, Line 19)
2. CreditslPayments
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, Une 20 to request a refund.
5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
File Number
21 11 1098
STATE ZIP
PA 17013
(1) 53.0?
Total Credits (A + g) (2) 0.0 0
(3) 2 5.2 6
(4) 0.00
(5) 78.33
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER T
~iE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make ~ t f
a. retain the use w ans er and.
ncome of the property transferred; Yes No
b. retain the right to
c
i
t designate who shall use the property transferred or its income; .........................
. ^
. re
a
n a reversion
d .
ry interest; or ........................................................................................ ^
. receive the promi
2 ......
for life of either payments, benefits or care? .................................................. ..
^
. If death occurred aft ...
r December 12, 1982, did decedent transfer property within one year of death ..
without receiving
3. Did decedent own a
4
D uate consideration? .....................................................................................
'intrust for" wpayable-upon~eath bank account w security at his w her death? .... .. ^
^
,
id decedent own an ...
individual retirement account, annuity or other non-probate property, which ..
contains a benefiaa
designation? .................................................................................................
. c
F THE ANSWER TO ANY OF THE A OVE 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, 194, 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.1,19 5, 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 eve if the surviving spouse is the only benefiaary.
For dates of death on or after July 1, 20
• The tax rate imposed on the net valu 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 th child is 0 percent [72 P.S. §9116(a)(1.2)).
• The tax rate imposed on the net valu of transfers to or for the use of the decedents lineal benefiaarles is 4.5 percent, except as noted in
72 P.S. §9116(1.2) p2 P.S. §9116(a)~1}).
• The tax rate imposed on the net value~of transfers to or for the use of the decedents siblings is 12 percent [72 P.S. §9116(a)(1.3)). Asibling is defined, under
Section 9102, as an individual who ha at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX + (&98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
JOHN R.
ADAMS FILE NUMBER
21 11 1098
All property joinUyowned with right of survivorship must be discbsed on Schsduk F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1. FIRST UNIO CORPORATION 15 OF DEATH
0 SHARES X #3.33
[SEE SHARE~i
I INFORMATION ATTACHED] 499.50
2- STERLING F
N NANCIAL CORPORATION 663 SHARES X #13.05 8
26D
65
[SEE DOD I FORMATION ATTACHED] ,
.
TOTAL (Also enter on line 2, Recapitulation) i 8 , ? 6 0
(If more space ig needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHED~/LE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC.
IN RES DENT DECEDENTRN PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
JOHN R• ADAMS 21 11 1098
Include the proceeds of litigation and the date the proceeds mere received by the estate.
Ail properly joirrtlyowrrsd rvifh right of turvhorship mutt be disclosed on Schedule F.
ITEM
NUMBER ' DESCRIPTION VALUE AT DATE
~. ORRSTOWN BANK CHECKING ACCOUNT # 413372 OF DEATH
[SEE ATTACHED DOD LETTER] 6,669.6?
TOTAL (Also enter on line 5, Recapitulation) i 6 , 6 6 9
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (10-09)
Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
FILE NUMBER
JOHN R• ADAMS 21 11 1098
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER ~' DESCRIPTION
A. FUNERAL EXPENS S:
~. HOFFMAN-R TH FUNERAL HOME
2• FUNERAL R CEPTION - SON OF A BUTCHER CATERING
3• ORGANIST USHERS
4• PROGRAMS FLOWERS
B. ADMINISTRATIVE C STS:
1 • Personal Represe tative Commissions:
Name(s) of Personal Representative(s) JOAN D • ADAM S
street Ada 339 W • NORTH ST •
city CA LISLE state PA z1P 17D13
Year(s) Co fission Paid: 2 012
2. AttomeyFees: DUNCAN 8 HARTMAN PC
3. Family Exemption: (If decedents address is not the same as daimanYs, attach explanation.)
Claimant JOAN D • ADAM S
Street Add 339 W • NORTH ST •
cny CARLISLE state PA zIP 17013
Reladonshi of Claimant to Decedent W I F E
4• Probate Fees: RE ISTER OF WILLS
5 Accountant Fees:
6. Tex Retum Preparer
~. REGISTER OF WILLS - BOND FILING FEE
8• FICKEL INSURANCE SURETY BOND
9• CUMBERLAND LAW JOURNAL - LEGAL NOTICE
10• THE SENTINEL - LEGAL AD
11• REGISTER OF WILLS - FILING FEE
AMOUNT
2,196.07
1,350.00
150•DO
150.00
1,000.00
1,000.00
3,500.00
112.50
15.00
320•DO
75.00
178.92
15.00
TOTAL (Also enter on Line 9, Recapitulation) I = 10 , 0 6 2 4
If more space ~ needed, use additional sheets of paper of the same size.
REV-1572 EX+ (12-OB)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8 LIENS
ESTATE OF
FILE NUMBER
JOHN R• ADAMS 21 11 1098
Report debts incurred by th{e decedent prior to death that remained unpaid at the date of death, including unreimbursad medical expenses,
ITEM
NUMBER DESCRIPTION VADF SEAT DHTE
1. BANK OF AM RICA 3,DD8.75
TOTAL (Also enter on Line 10, Recapitulation) I S 3, 0 0 8 7 5
L Ii more space n needed, Insert addifanal sheets of the same size.
REV-1513 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE SCHEDULE J
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
~v~n~G Vr.
JOHN R. ADAMS
NUMBER NAME AND ADD ESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTION [Indude ouhipht spousal disfibutions and transfers under
Sec. 91 6 (a) (1.2)
J
1. JOAN D • ADAM .
339 W. NORTH ST.
CARLISLE, PA 17013
2. JOHN R• ADAM
804 JACARAND DRIVE
LARGO, FL 33 70
3. JENNIFER A• USTOFF
1001 EASTON D•, # 606
WILLOW GROVE PA 19D90
4. JEANNETTE SC OONOVER
PO BOX 1660 '~
CARTHAGE, NC 28327
FILE NUMBI
21 1
~TIONSHIP TO DECED
Do Not List Trustees)
Spousal
50%
Lineal
16.6%
Lineal
16.6%
Lineal
16.6%
-UNT OR SH
OF ESTATE
ENTER DOLLAR AMOUNT FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUT ONS:
A. SPOUSAL DISTRIBUTIO SUNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
L
B. CHARITABLE AND GOVE~2NMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENT~R TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET I
s
If more space Is needed, use additional sheets of paper of the same size.
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The PNC Financial Services Group takes no responsibility for this informatron
anrf makP.c if availahfP sn/a!v a~ a r`nnvt~niPnnp to sharPhnlrlPrc
S#erling Financial Corporation
t•ti~toricat Stack Price
6!3/2002 through 44/2008
.titi:~f:lC ! rir^.~?:. iF#i~ie` ti~Crr.ii ~~l~ta idr't:~~':? ~,~:::i:`.:!^:li-
Data u:.,ti ~ _
06/03/200 -~
2 13.5579
13.056 vWpC
2 13.0562
06/04/200 2 13.3888 12.256 0 13.3888
06/05/2002 13.6000 13.1200 13.5744
06/06/2002 13.6640 12.9728 13.0880
06/07/2002 13.5040 12.8320 13.5034
06/10/2002 13.5488 13.3952 13.5488
06111 /2002 13.6960 13.3760 13.6192
06/12/2002 13.6448 i 3.1712 i 3.6320
06/1312002 13.6320 i 3.3824 13.4400
06!1412002 13.8240 13.4208 i 3.7606
06117!2002 14.1120 13.7088 14.1126
06/18!2002 14.2400 14.G8uG t 14.2272
66119/2662 'i 4.1376 -I 3. "I 840 1.x.4144 t
alb/2U/2UG2 '14."i05b "I295sb 1 1~f.UU.iLI
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I OtiI25/20u2 13.952u 13.tsU4ti l 13.913ti
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~' U7/U5l20U2 16.6912 16.0000 16.6~J12
I 0 7/08/2 002 16.96641 16.0448 16.3200
i 07!09/2002.1 16.8000 16 32DOt 16.38401
~ ~ 07110/7.002 16.6656 16 16001 16-16-'0-011
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.4 Trurliliun of Excelle~ue
October 20, 20i 1
Duncan & Hartman, P.C.
At omeys At Law
William A. Duncan, Esquire
Once Irvine Row
Carlisle, PA 17013
Fax: 249-7800
Re: Estate of John R. Adams
Social Security Number 185-20-5903
Date of Death 5/10102
Best Regards,
ill R. Worthington
Deposit Processing Cterk
2695 Phila:Jeipli~,; Avenu~~
Cnam~ersbur~. PA 1 Imo: i t
1.888.ORRSTOWN
IT IS HEREBY CERTTFIED THAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNT WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Accowit No.-
Account Ty~-c-
Date Opened-
,Toint Account (namcidatc)
Balance-
Accrucd Intcrest-
413372
50+ Interest Checking
1/8; 97
No
$ti,tib9.ti?
$a.oo
In regards to your request to change our banks records for the purposes of 1099's, I am unable to
assist you with that change. I would advise you to visit Orrstown Bank, Stonehedte Otlice
located at 427 Village Dr., Carlisle, PA 17015 to receive assistance with this matter.