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Home My WebLink About02-03-12Ex co,-to> ~ REV-1500 1505610143 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania count' coda veer File Number Bureau of Individual Taxes DEPAN7MEM OF REVENUE Po Box.28oso~ INHERITANCE TAX RETURN 21 11 012 2 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 186 24 8255 11 07 2011 02 14 1930 Decedent's Last Name Suffix Decedent's First Name MI JUMPER SR VICTOR L (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 INAPPROPRIATE OVALS BELOW ® 1. Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death pnorto 12-13-82) ^ 4. Limited Estate ^ qa, Future Interest Compromise ~ 5. Federal Estale Tax Retum Required (data of dealt, aver 12-12-82) ® 8 Decedent Died Testate ^ ~ Ae ~ C pyionttTNg )a Living Trust _ 0 8. Total Number Of Safe Deposit Boxes (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ 10. betweent2~3a1 si ^a dit (da95a death ^ 1 t.Election to tart under Sec. 9113(A) ~f (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES M ROBINSON 717 245 9688 First line of address 129 SOUTH PITT STREET Second line of address City or Post Office CARLISLE State ZIP Code PA 17013 REGISTER OF WILLS USfrIDNLY '~ "'"' .~ {~ ~ r ~ cxs !-- rn cn ~ ~ - w ~. i V ~ ~ f ~ ;;~ C~ - :p .a. -.~ Correspondent'se-mailaddress: jrobinson a~turolaw.com Under penaRies 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, coned and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Victor L. Jumper, Jr. a 13 70 Garrick Hill Road, Shermans Dale, PA 17090 SIGNA RE OF PREPARER OTHE AN 9EPRESENTATIVE James M Robinson ~ ~S ~ 12':~ South Pitt S~reet, Carlisle, PA 17013 Side 1 1505610143 1505610143 J J 1505610243 REV-1500 EX Decedent's Social Security Number oecedenrsName: JUMPER, VICTOR LEE SR 186 24 8255 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 5 9, 9 0 0. 0 0 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) .......................................................... 4. 5- Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ................ 5. 8 0 , 4 2 6 . 4 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7- 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 1 4 0, 3 2 6. 4 0 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. -_ - 1 5 , 5 6 4 . 7 2 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 4 , 4 4 5 . 6 5 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 2 0 , 0 1 0 . 3 7 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 12 0 , 316.0 3 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. 1 2 0 , 316.0 3 -. TAX COMPUTATION -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 .00 15. 16. Amount of Line 14 taxable at lineal rate x .045 12 0 , 316.0 3 16. 5 , 414.2 2 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. Tax Due ..................................................................................................................... 19. 5 , 414.2 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L 1505610243 Side 2 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: Fite Number 21 - 11 - 01223 Jumper, Victor Lee Sr __ _ _ ---- -- - - STREETADDRESS 237 Stane House Road __ __ ---____- -_..__ TSTATE ZIP - _ - ---- CITY Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2, line 19) (1) 5, 414.2 2 2. CreditslPayments A• Prior Payments _ B. Discount 270.71 Total Credits (A + B) (2) 270.71 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box 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. (5) 5,143.51 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 :.................................... ^ [x] c. retain a reversionary interest; or .................................................................................................................. ^ d. receive the promise for life of either payments, benefds or care? .............................................................. ~ [xJ 2. If death occurced 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?......... ~] [x] 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 January 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 retturn 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 ears 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 beneficiaries is 4.5 percent, 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 percent [72 P.S. §9116 (a) (1.3)1. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blo or adoption. SCHEDULE A COMMONWEALTH OF PENNSYLVANIA ~ REAL ESTATE ~.. INHERRANCE TAX RETURN RESIDENT DECEDENT '~~ -._ _.. _. _ -- _.- _~ __--.- _-.-r.... __- __--_ FILE NUMBER ESTATE OF Jumper, Victor Lee Sr 21 - 11 - 01223 All real property owned solely or as a tenant in common must be re orted at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a wilting seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold. Include a coov of the deed showing decedent's interest if owned as tenant in common. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 237 Stone House Road, Dickinson Township, Cumberland County, PA -valued at assessed 59,900.00 value ($59,900.00) times common level ratio (1.0) TOTAL (Also enter on Line 1, Recapitulation) 59,900.00 SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. CDbMONWEAL,H OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN ~. RESIDENT DECEDENT ESTATE OF ~URI er, Victor Lee Sr FILE NUMBER P 21 - 11 - 01223 Include the roceeds of litigation 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 M&T Bank -Certificate of Deposit -Account No. 031003908161894 8,665.40 2 ~ M&T Bank -Certificate of Deposit -Account No. 031003913904031 ~ 13,994.13 3 ~ M&T Bank -Savings Account No. 015004208624715 ( 42,892.08 4 ~ M&T Bank -Savings Account No. 021000001191428 ~ 14,874.79 TOTAL (Also enter on Line 5, Recapitulation) 80,426.40 SCIfDU.E H conenoNVUEUrN of PENNSV~vANw ~ ~~+~}~w w INHERRANCE TAX RETURN ~S 1 IV'171Y~ ~~ RESIDENT DECEDENT ---'----. -. -. -1 ._ .-._- -- ESTATE OF Jumper, Victor Lee Sr _ Debts of decedent must be reported on Schedule I. ITEM NUMBER ~ FUNERAL EXPENSES: DESCRIPTION A. 1 ;Ewing Brothers Funeral Home, Inc. FILE NUMBER 21-11-01223 AMOUNT 7,905.62 B. ;ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative(s) I i ' ~ Street Address ~~,' City State Zip ', Year(s) Commission paid 2. i Attorney's Fees Turo Robinson Attorneys at Law 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip it Relationship of Claimant to Decedent 4. Probate Fees Register of Wills ' Cumberland Law Journal II The Sentinel 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. ' Other Administrative Costs 1 ~ Recorder of Deeds -Record Deed to 237 Stone House Road, Carlisle I 7,016.32 295.00 75.00 210.78 62.00 TOTAL (Also enter on line 9, Recapitulation) 15,564.72 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COM.IONWEALTH OF PENNSYLVANIA LIABILITIES, ~ LIENS INHERITANCE 7AX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Jumper, Victor Lee Sr , 21 - 11 - 01223 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION NUMBER 1 Carlisle Regional Medical Center 2 Cumberland Goodwill Fire Rescue EMS 3 Mount Rock inpatient Services 4 Alexander Springs Emer. Phys. 5 Watershed Urology, P.C. 6 Pennsylvania Gastroenterology Consultants 7 Hershey Kidney Specialists, Inc. 8 Physicians of Rehabilitation, Industrial & Spine Medicine, P.C. 9 Mohammad Ismail, MD 10 CenturyLink 11 Interstate Waste 12 PPL Electric Utilities 13 Comcast 14 Cardiology Diagnostic, LLC 15 Spring Road Family Practice, Inc. 16 Pinnaclehealth Cardiovascular Inst., Inc. AMOUNT 1,132.00 161.55 336.26 33.80 33.90 363.46 79.22 144.33 58.31 222.01 42.60 203.49 32.31 3.50 10.39 13.36 TOTAL (Also enter on Line 10, Recapitulation) f 4,445.65 SCHEDULEI I DEBTS OF DECEDENT, MORTGAGE ~~ COA9dONWEALTN DF PENNSYLVANIA LIABILITIES, & LIENS INHERRANCE TAX RETURN RESIDENT DECEDENT continued ' !FILE NUMBER ESTATE OF Jumper, Victor Lee Sr ~ ~~ _ ~ ~ _ n~~~n 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 17 ~ Summit Physician Services 6.90 18 'Kinetic Imaging j 15.00 19 I Holy Spirit Hospital ~ 277.28 20 Charles R. Inners, MD ~ 258.97 21 ;West Shore Anesthesia Associates 17.53 22 Internists of Central PA 609.94 23 Camp Hill Emergency Physicians ~I ! 108.20 24 I' Kantor & Tkatch Associat s e 2628 25 ~ Pulmonary & Critical Care Med. Assoc. 232.12 26 ~ c....l~w o,.a~,.L..... L... I 15.75 27 ~ West Shore Pathology 7.19 Page 2 of Schedule I REV-1513 EX+ (11.08) i SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN ~i RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER Jumper, Victor Lee Sr 21 -11 - 01223 - --------- RELATIONSHIP TO ~ SHARE OF ESTATE ~ AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY ooNotuuTrusces(s) I, TAXABLE DISTRIBUTIONS [inGude outright spousal ~ distributions, and transfers under Sec. 9116 (a) (1.2)] 1 ~ Victor L. Jumper. Jr. Son Entire 70 Garrick Hill Rd. Shermans Dale, PA 17090 ~ I j I II. I i I I '~ f 'Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. j I 120,491.54 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0