HomeMy WebLinkAbout02-15-12J 1505610140
REV-1500 EX ~°'-'°>
PA Department of Revenue
Bureau of Individual Taxes OFFICIAL USE ONLY
PO Box 2aosol County Code Year File Number
INHERITANCE TAX RETURN
Harrisbur PA 17128-0601
ENTER DECEDENT INFORMATION BELOW RESIDENT DECEDENT ~'- 1 1 0 0 7 8 3
Social Security Number Date of Death MMDDYYYY
Date Of Birth MMDDYYYY
2 0 6 3 8 8 5 5 5 0 7 2 3 2 0 1 0 0 3 0 1 1 9 4 9
Decedent's Last Name
M a h o n e y Suffix Decedent's First Name
MI
J o h n T
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
M a h Suffix
Spouse's First Name MI
o n e y
Spouse's Social Security Number
D e b o r a h K
FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS
Q 1. Original Return ^ 2. Supplemental Return
^ :S
Rem
i
d
^ 4
Limited E .
a
n
er Return (date of death
i
.
state ^ pr
or to 12-13-82)
4a. Future Interest Compromise (date of ^ 5
Federal E
t
^ 6. Decedent Died Testate
^ .
s
ate Tax Return Required
death after 12-12-82)
7
D
(Attach Copy of Will)
^ 9
Liti
ti .
ecedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
.
ga
on Proceeds Received ^ 10. Spousal Poverty Credit (date of death
Ele
^ 11
ti
.
c
on to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX NFORMAT
Name
ON SHOULD BE DIRECTED TO:
C o r t n e y N M Daytime Telephon~umber
`
a h o n e
Y 7 :1 7 5~ 3 `~7 ~' .x~
~ ~
'~
~ ~ , 7
____ _ "3 C"` { _'1
REGISTER GIF~~ - -
First line of address ~~ ~ ~ ~ ~
~ Ct?~ ~ ~!',
ce;
9 1 4 G o b i n S t i
C.~7E..3
. r-;
r e e t ~ '~ ~ ~' ~~ ~
Second line of address --r
~~~
City or Post Office ~
C State ZIP Code I _ _ _ _ DATE FILED
__ --_
a r l i s l e ____
P A 1 7 0 1 3
Correspondent's a-mail address: C O r t n e y• m a h o n e V a g m a l l. c n m
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.
SI A URE OF PER ON SP SIBLEAAF''O..R FILI~ ~E~TURN -
...___-- ~C~ta 1161.///d /~R~i ~Ii i ,DATE
914 Gdb~in Street ~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Car 1 i s 1 e P A 17 013
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140
1505610140 J
1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: John T• Mahone 2 0 6 3 8 8 5 5 5
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 Miscellaneous Personal Property (Schedule E)....... 5.
1 7 0 5 0. 7 5
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Nan-probate Property
(Schedule G) u
X Separate Billing Requested ....... 7. 2 6 9 4
8. Total Gross Assets (total Lines 1 through 7) D 6
........................... 8. 1 9 7 4 4. 8 1
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .
9. 1 3 2 9 6. 3 9
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 2 2
9 4 9. 0 6
11. Total Deductions (total Lines 9 and 10) .............................. .
11. 3 6 2 4 5
12. Net Value of Estate (Line 8 minus Line 11) ~ 4 5
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not b 12 1 6 5 D 0 .
6 4
een made (Schedule J) ... , ... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable 14 - 1 6 5 D O ' 6 4
at the spousal tax rate
or
,
transfers under Sec. 9116
(a)(1.2) X.000
16. Amount of Line 14 taxable 0 D D 15.
D ' ~ D
at lineal rate X .045
0 ~ 0 D
17. Amount of Line 14 taxable 16. D . D D
1 at sibling rate X .12
D
D D
8. ~
Amount of Line 14 taxable 17
0 • D D
at collateral rate X .15
0. D 0 18. 0. 0 0
19. TAX DUE
....................................................19.
0. D 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L Side 2
1505610240
1505610240
REV-1500 EX Page 3
Decedent's Complete Address: File Number
21 10 0783
DECEDENT'S NAME
John T. Mahoney
STREET ADDRESS
___ -- --
__
101 Alexander Springy Road -
- - - - ----
CITY --- -------------- ----
-------
Carlisle STATE ZIP -
PA .17013
Tax Payments and Credits:
~• Tax Due (Page 2, Line 19)
2. Credits/Payments (1) 0.00
A. Prior Payments
B. Discount
3. Interest
Total Credits (A + g) (2)
0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3)
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)
Make check payable to: REGISTER OF WILLS, AGENT
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLO
1. Did decedent make a transfe d' CICS
2.
3.
4.
ran .
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; ..........................
c. retain a reversionary interest; or .............................
d. receive the promise for life of either payments, benefits or care?
If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?
Did decedent own an "intrust for" or payable-upon-death bank account or securit at his or her death
Did decedent own an individual retirement account, annuity or other non-probate property, which '
contains a beneficiary designation? ...................................................................-
Yes No
..... ~ 0
o
::::: a
.... 0 ^
.......... a a
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 th
3 percent [72 P.S. §9116 (a) (1.1) (i)]. a surviving spouse
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(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)]. Asibling is defined, unde
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
J hn
SCH
EDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
o T. Mahone FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate0 0783
All property jointly-owned with ri
ht
f
ITEM g
o
survivorship must be disclosed on Schedule F
NUMBER .
~ ~ Metro Bank Personal Checking Account NoE537945883 VALUE AT DATE
OF DEATH
4,372.83
2• Woodforest National Bank Account No. 1384309306
0.00
3 • Proceeds from sale of 2003 Dodge Dakota
8,000.00
4• Proceeds from sale of Winchester 30-30 and ammu
iti
n
on
75.00
5• Miscellaneous Cash
125.11
6• Veterans LZII Refund
100.00
7• Auto Insurance premium refund
36.00
8• Price-Less Storage Security Deposit refund
20.00
9• Sale of cart, small refrigerator and truck straps
55.00
10. VA Burial Benefit
2,000.00
11. Refund of overpayment of taxes and occupancy rate from Days Inn
2,066.81
12. Personal Property and Miscellaneous Household Furnishings
200.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size) 17 050.75
REV-1510 EX+ (08-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CCTATe Ae
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
......-. ~ ~ yr
John T. Mahone FILE NUMBER
21 10 0783
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY
NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TD DECEDENT AND DATE OF DEATH %OFDECD'S EXCLUSION
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. TAXABLE
1 ~ Woodforest National Bank Personal Savings Account VALUE OF ASSET INTEREST pFAPPLICABLE) VALUE
Account No. 1384801666 -POD to Cortney N. Mahoney, daughter, 2,694.06 100.00 2,694.06
Paid 11/18/10 (DOD amt. includes accrued int. of $4.96)
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 SCHEDULE H
DEPARTMENT OF REVENUE
FUNERAL EXPENSES AND
RESIDENTDECEDENTTURN ADMINISTRATIVE COSTS
ESTATE OF
John T. Mahone
FILE NUMBER
21 10 0783
Decedents debts must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
A•
FUNERAL EXPENSES: AMOUNT
1 • Funeral Home
2• Funeral Luncheon 9,859.35
3• Memorial cards 1,668.03
4. Grave marker foundation 110.72
334.00
B• ADMINISTRATIVE COSTS:
~ • Personal Representative Commissions:
Name(s) of Personal Representative(s) CortneY N. Mahoney
Street Address 914 Gobin Street
852.53
City Carlisle
State PA
ZIP 17013
Year(s) Commission Paid: 2011
2. Attorney Fees:
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant
Street Address
City
State
ZIP
Relationship of Claimant to Decedent _
4• Probate Fees: Register of Wills
l 72.50
5• Accountant Fees:
6• Tax Return Preparer Fees:
~• Storage Fees
8• Vehicle tow 189.40
9• Federal Express 87.50
10. Postage 9.16
13.20
TOTAL (Also enter on Line 9, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size. 1
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
~~~h~~ yr
John T. Mahone FILE NUMBER
2l 10 0783
Report debts incurred by the decedent prior to death that remained unpaid at the d
t
ITEM a
e of death, including unreimbursed medical expenses.
NUMBER DESCRIPTION VALUE AT DATE
1 • Days Inn lodging due OF DEATH
1,894.83
2• Days Inn damage claim
1,000.00
3• Midland Credit Management, Inc. -Montgomery Wards Credit Card
588.20
4• CitFinancial, Inc. Personal Loan No. 372009080307825
1,133.82
5• BonTon HSBC
253.50
6• 2001 Federal Income Tax Due
6,565.79
7• 2002 Federal Income Tax Due
5,036.92
8• 2003 Federal Income Tax Due
2,325.12
9• 2004 Federal Income Tax Due
4,147.41
] 0. 2006 Federal Income Tax Due
3.47
TOTAL (Also enter on Line 10, Recapitulation) I $
If more space is needed, insert additional sheets of the same size. 22 949 06
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
John T. Mahonev
SCHEDULE J
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Cortney N. Mahoney
914 Gobin Street
Carlisle, PA 17013
2. Kristine M. Mahoney
7 Liefs Way
Ithaca, NY 14850-1080
3. John T. Mahoney, Jr.
503 S. West Street, Apt. C
Carlisle, PA ] 7013
4• Deborah K. Mahoney
503 S. West Street, Apt. C
Carlisle, PA 17013
FILE NUMBER:
21 10 0783
RELATIONSHIP'1.0 DECEDENT
Do Not List Trustee(s)
Lineal
Lineal
Lineal
Spousal
AMOUNT OR SHARE
OF ESTATE
0.00
0.00
0.00
0.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
If more space Is needed, use addltlonal sheets of paper of the same size. $