The URL can be used to link to this page

Home My WebLink About02-02-12 1505611180 -~ REV-1500 EX (02-11)(FI) Pennsylvania OFFICIAL USE ONLY PA Department of Revenue DEPARTMENTpF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ~ ' ~ ~ ~ 1 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 186-16-6663 11212011 09301923 Decedent's Last Name Suffix Decedent's First Name MI SEARS LEE g (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE BOXES BELOW 1. Original Return Q 4. Limited Estate [] 6. Decedent Died Testate (Attach Copy of Will) Q 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGfSTER OF WILLS 0 2. Supplemental Return Q 4a. Future Interest Compromise (date of death after 12-12-82) [~ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) Q 1 D. Spousal Poverty Credit (Date of Death Between 12-31-81 and 1-1-95) Q 3. Remainder Return (Date of Death Prior to 12-13-82) [~ 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes Q 11. Election to Tax under Sec. 9113(A) (Attach Schedule 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ROBERT G. FREY 7172435838 REGISTER 0 LAS USE ON~ ~Q7 `*T f`rl C~ r,-~ ;f~T, l v~ t (V ~~o~ ~ ~ ~ DAT~'FILED First Line of Address 5 S HANOVER ST Second Line of Address City or Post Office CARLISLE State ZIP Code PA 17013 Correspondent's a-mall address: R F R E Y a9 F R E Y T I L E Y. C O M _~~ 5.~:~ ':, ..=L;3 ~ y.J fr"~: t.-..f --, ~.~, f"~ i-ri C~ C7 Under penalties of perjury, I deGare that I have examined this return, inGuding arxompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaration of preparer other than the personal representative is based on all information of which preparer has anv knowledge SIGNATU OF PERSON RESPONSIBLE~ING RETURN DATE ~ _ 02/02/12 ADDRESS 61 W. OAKWOOD DR CARL SIGNAT F P PA OTHE THA EPI ADDRESS 5 SOUTH HANOVER ST, C~ 1505611180 PA 17015 DATE 02/02/12 SLE, PA 17013 PLEASE USE ORIGINAL FORM Side 1 1505611180 J 1505611280 REV-1500 EX (FI) Decedent's Social Security Number oecedent'sName: LEE B SEARS 186-16-6663 RECAPITULATION 1. Real Estate (Schedule A) ........................................ . 1. NON E 2. Stocks and Bonds (Schedule B) ................................... . 2. NON E 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. . 3. NON E 4. Mortgages and Notes Receivable (Schedule D) ....................... . 4. NON E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) ... . 5. 3 4 4 8 5 . Q 0 6. Jointly Owned Property (Schedule F) (Separate Billing Requested ..... .. 6. 41782 • 00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G} Separate Billing Requested ..... .. 7. 0 . 0 0 8 Total Gross Assets (total Lines 1 through 7) ... .. . .. 8. 76267.00 9. Funeral Expenses and Administrative Costs (Schedule H) ............... . 9. 4 4 8 . 0 0 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . 10. 1 Q 21 • 0 0 11. Total Deductions (total Lines 9 and 10) ............................ . i 1. 14 6 9 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. 74 798.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which Q Q Q an election to tax has not been made (Schedule J) .................... .. 13. • 14 Net Value Sybiect to Tax (Line 12 minus Line 13) .. 14. 7 4 7 9 8 . 0 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 (a)(1.2} X .0 0 15. . 16. Amount of Line 14 taxable at linealrateX.o 45 74798.00 16. 3365.91 17. Amount of line 14 taxable at sibling rate X • 12 17. 0 . 0 0 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18. . 19.TAx DuE ..................................................... ..1s. 3 3 6 5.9 1 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .. + Side 2 L 1505611280 1505611280 REV-1500 EX (FI) Page 3 File Number 186-16-6663 Decedent's Complete Address: DECEDENT'S NAME LEE B SEARS STREET ADDRESS 61 WEST OAKWOOD DRIVE CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 3365.91 2. Credits/Payments A. Prior Payments 3205.70 B. Discount 160.29 Total Credits (A + B) (2) 3365.99 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. {4) 0.0$ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 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: nsferred tr i f th rt i h Yes ^ No ................................................................................ e prope ncome o y a e use or a. reta n t ....... b. retain the right to designate who sha11 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 "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. 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 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 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-1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Include the proceeds of litigation and the date the proceeds were received by the estate. If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+ 101-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER; If an asset became jointly owned within one year of the decedent's date of death, it must be reported en Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Sharon Passeri 8. C JOINTLY OWNED PROPERTY: SCHEDULE F .JOINTLY-OWNED PROPERTY 1 West Oakwood Drive :arlisle, PA 17013 Daughter ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE of ASSET % OF DECEDENT INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST M&T Bank Acct. 374119327 t A 9,632.00 50.00% 4,616.00 Morgan Stanley Acct 620-041154-015 2 A 73,932.00 50.00% 36,966.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OAO 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL (Also enter on Line 6, Recapitulation) I g 41 782.00 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+(p8_pg) ! SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS & DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER rr,;~ ~~no~~.m rn,,~f np mmnlated and riled if the answer to anv of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF 7HE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF 7HE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF RPPLICABI.E) VALUE 1. Sharon Passeri 998 100.00% 998 0 2. Freddie Sainz 3,000 100.00% 3,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on Line 7 Recapitulation) $- _ ~ If more space is needed, use additional sheets of paper of the same size. REV-1511 EX + (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE 7AX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATNE COSTS ESTATE OF FILE NUMBER Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRlPT10N AMOUNT A. FUNERAL EXPENSES: 1. Post funeral lunch 358 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as Gaimant'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: 7. 75 15 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 448 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12.08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Reoert debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. Final Medical Expenses Omnicare Stoken Ophthalmology Diakon Lutheran -Nursing Home 672 20 329 Total Medical Expenses 1.021 WESTERN-SOUTHERN LIFE ASSURANCE COMPANY aC CINCINNATI OHIO ~! STATEMENT OF DEATH CLAIM SETTLEMENT INFORCE DEPT 12-23-2011 MAIL T~ 980 5149 SEARS LEE B PAYEE W0020195887 CHECK #OC 07520528 HAS BEEN ISSUED FOR $15,135.58 THE CLAIM ON THE ANNUITY LISTED ABOVE HAS BEEN APPROVED AND A CHECK FOR YOUR SETTLEMENT AMOUNT ZS ATTACHED BELOW. WESTERN-SOUTHERN LIFE WILL NOTIFY THE IRS THAT THE TAXABLE AMOUNT OF THIS PAYMENT ZS $112..79 FOR THE 2011 TAX YEAR. IF YOU HAVE ANY QUESTIONS, CALL A WESTERN-SOUTHERN LIFE REPRESENTATIVE AT (800) 926-1702. AMOUNT OF CONTRACT $15,112.95 TOTAL PAYABLE THIS CONTRACT INTEREST FEDERAL INCOME TAX WITHHELD STATE INCOME TAX WITHHELD AMOUNT OF THIS CHECK $15,112.95 ~~ $37.28 $11.27 $3.38 $15,135.58 ~® ~.~ ~_ Detach the check below. •,~«ooiz• ses __ ~ ~&T B~~Ic ................... ...... .......... ..... ..... .. . ACCOUNT NO. ACCOUNT TYPE 3741139327 M&T SELECT 00 0 04345M NM 017 LEE B SEARS SHARON K PASSERI 61 WEST OAKWOOD.DR CARLISLE PA 17015 INTEREST EARNED FOR STATEMENT PERIOD 0.00 12416 ACCOUNT SUMMARY STATE1~tENT PERIOD PA&E DEC.24-JAN.26,2012 1 OF 1 STONEHEDGE >::86.tNNING BALANCE DEPO.S.I : . B. bTHER ;:ADDxTIflNS .. ?' >: CHECKS .PAID ;:Q M .R .,:: SUBTRACTIONS <~RR ;>; ; ;Ii~'tE~iEST z:PD END ! :: BALANCE No. AMOUNT No. aho~T No. AMOUNT 26,327.83 Z 26,848.45 1 5,000.00 0 .0.00 0.00 48,176.28 ACCOUNT ACTIVITY a!OST. >tiATE _. ,. ,>.:.;,. ,:.;: ,- TRANSA ON DESCR PTION: POSTS; . N7ERFS &- OTHER DIT ONS ;::>CM. '8;:~?TNER .. << . SCl$TRACTZO?HS. ..: , '!AA •L1~ BA 12-24-i1 BEGINNING BALANCE 526,327.83 12-28-11 DEPOSIT 18,624.11 44,951.94 01-03-12 CHECK NUMBER 2265 5,000.00 39,951.94 01-05-12 DEPOSIT 8,224.34 48,176.28 ENDING BALANCE 548,176.28 Gk1ECKS .PAx9 S~1MMllRY 2265 01-03-12 5,000.00 *~ GRON YOUR SAVINGS THE EASY NAY ** EASY SAVE IS A CONVENIENT SERVICE THAT ALLONS YOU TO SET UP AUTOMATIC TRANSFERS FROM YOUR M&T CHECKING ACCOUNT TO YOUR M8T SAVINGS ACCOUNT. ^* YOU CHOOSE THE AMOUNT AND FREQUENCY ** YOU CAN CHANGE OR STOP IT AT ANY TIME TO GET STARTED, LOG ON TO M&T NEB BANKING AND CLICK THE TRANSFERS TAB OR STOP BY YOUR LOCAL M8T BRANCH. LEARN MORE AT MTB.COM/EASYSAVE. MEMBER FDIC. FOR CUSTOMER SERVICE QUESTIONS., PLEASE CALL (8007 724-2440 _ __ _ _ LOOBA (61071 m C Z Z~ N z~ N Z n v o n ca Z '~ -'1 O NZ C C Z C C Z Z ~ ~N w ~ N -+ N W 029632 MSGD0174 020666 ~ -~ r_ n n n D --i CC m r m -+ m~ 0 N ~ m ~ Z ti ~ m o .a D c) m 1 t n _ti ' o x ~'. ~ N ^ C m N ~ ~ O Q ~~ a °__: ~ ; _ ~ N ~ ~ _~ n m m N n ~ ~.. "` 7 O ) CD K ) ~ C7 ~ ~ , 3 ~ ' -, ~D ~ Sn 6t ~ n n ~ O ~' d G ~' N W N V v" pNQ W Wo, Ol W OD tp t0 " 000001 W W~•* NtOON Nr~ ocnoow wig NWN O N O V v W W V 'IV 00 ~ OC' "' .-~ lD 01 V V ~ H VtD~ V V~'o i-+ C17 t31 ~ ~ ~ tJ~ .A C1 Qf V °a i7 _ .. t~i~ O~ D ~ Z <° .~+ _ ~ -, ~ a ~ ~ ~ C7 fD n• N ° -~ x ~' d m ~' D O ~ w a ~ m ,C N 3 3 N p IV W ~ (Jt CTS 'o0 0 N O i.+ A N N ~ ~ O o0 O ~ n Z ._.~ < C ~C $ m m m v t!- Nlr`+ N O r fin. n Q Z ~ ~ ~ N r + D ,~ f n V m ~ ~ m ~ h i. + ~~ 'TI O -~ CU 'fl rn o" 0. Z m rn 3 -. w N O f.. n 01 O N n O C _~ O (~ 'p m `'~ y b A ~ _ o 0 ~ 3 r ~+ -* u' m =m ~ O 03 z ~' ~, tp ~ ~ ~ ~ ~ r ~! ~ ~ ~o ~ ~ m ¢° ~ CD z ~ -~ CA .~ 00 W w O O ~ A' cn to ~~~ O O Owy ~~ N N ~p Ol Q1 00 r~. a