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Home My WebLink About01-19-12_, 15D5b10105 REV-1500 ~ (oa-1st tFl) slit OFFICIAL USE ONLY Y i -"' PA Department of Revenue lvanta y Renns `"'"` `""`"~` County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN __. ___ _... _. __ PO BOX 280601 Harrisburg PAi'7tz8-0601 RESIDENT DECEDENT 21 10 1 253 ENTER DECEDENT INFORMATION BELOW Social SecurVty Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 182-40-8399 11/ 14/2010 ': 02/02/1911 Decedent's Last Nama __. Suffix Decedent's First Name MI WILLIS ADA C (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 O 1. Original Retum ~ 2, Supplemental Return O 3, Remainder Return (Dale 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) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of WIII) (Attach Copy of Trust.) O 9. Lilfgation Proceeds Received. O 10. Sppusal Poverty Credit (Date of Death O 11, Election to Tax under Sec. 9113(A) ~ Between 12-31-91 and 1-1-95) (Aiach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number _.. EDMUND G. MYERS (717) 761-4540 First Line of Address 301 MARKET STREET Second Llne of Address PO BOX 109 City or Post Office LEMOYNE Correspondent's a-mail address: EGM~a JDSW.COM ___. _ State ZIP Code PA l 17043 ` _~-. Under penalties of perjury, I deGare that I have examined this return, Including accompanying schedules antl statements, and to the best of my knowledge and belief, it Is true, correct and complete. DeGaretion of preparer other than the personal representative is based on ail Infor at o ich reparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN .DATE ADDRESS ~ ~ 't7C101'~~ E r')'')U1L,~+1'J~ ~/~ ,UE/2 ~ ~ rL. I s i . ~ ~ ~ SIGNAT OF PREPAR~R THER TITAN REPRESENTATIVE ~~fpa~ Q,- L ~ ~7~ f DATE L !v ~ ~ y ,(7 f/~hs11 J~~L ADDRESS 3nl fuI~KEP ST'. LtE+KOyo.~'~ pfi ~7a~f ~, PLEASE USE ORIGINAL FORM ONLY Side 1 150561D105 1505610105 J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER _= WILLIS, Ada Catharine 21-10-1253 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. Signature #2 Name Robert H. Willis = AddreSS1 108 Pin Oak Drive Address2 Clty, State, Zip New Cumberland. PA 17070 Date /,//.~/ 1 J 150561D205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name; 182-40-8399 RECAPITULATION 1. Real Estate (Schedule A) .... .............. . .......... . ................ 1, 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 Mlscellaneous Personal Property (Schedule E)....... 5. 10,691.15 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers &Mlscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. B. Total Gross Assets (total Lines 1 through 7) . . ........................... 8. 10,691.15 9. Funeral Expenses and Administrative Costs (Schedule H) ..... . ............. 9. 65.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . ... 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 10,626.15 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... . 13. 14. Net Value SubJect to Tax (Line 12 minus Line 13) ........................ 14. 10,626.15 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. Amount of Line 14 taxable _.. _. _ ... . .... _._ _ ._ _ _ _. _ at lineal rate X .0 45 10,626.15 ! 16. 478.18` 17. Amount of Line 14 taxable at slbiing rate X .12 17 _ _ 18. Amount of Line 14 taxable -- at collateral rate X .15 18 . 19. TAX DUE ................................... ......,.. ...19.. 478.18., 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME WILLIA, Ada Catharine STREETADDRESS 4837 E, Trindle Road CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 478 18 2. CredltsJPayments A. Prior Payments ___ B. Discount _ 3. Interest Total Credits (A + B) (2) (3) 6.23 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This Is the TAX DUE. (5) 484.41 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 ............................................ ^ ^ o, 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 "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 designatlon? ........................................................................................................................ I-I [-1 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)J, 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)j. 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)J, • 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. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of fhe decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)j. A sibling 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-15o8 EX+ (il-io) ~~ ~ Pennsylvania ?~~~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER; WILLIS, Ada Catharine 21-10-1253 Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly owned with right of survtvorshlp must be disclosed on Schedule F. Ir more space Is needed, use additional sheets of paper of the same size. REV-1511 EXa (10-U9) ~ Pennsylvania ~' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WILLIS, Ada Catharine 21-10-1253 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES; i. B. ADMINISTRATNE COSTS; 1. Personal Representative Commissions; Name(s) of Personal Representative(s) Street Address City ~ State ZIP Year(s) Commission Paid; 2. Attorney Fees; 3• Family Exemption: (If decedent's address is not the same as cialmant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5• Accountant fees: 6. Tax Return Preparer Fees; ~~ Filing Fee for Supplemental Return 15.00 s Cumberland County Register of Wills -Additional Probate fees 50.00 TOTAL (Also enter on Line 9, Recapitulation) I; 65.00 If more space is needed; use additional sheets of paper of the same size,