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Home My WebLink About02-13-12 (2)1 ___J 1505607121 REV-1500 ~ (x.05) iJCFlCIAi_ USE t~NLY PA Deparbnent of Revenue County Code Year .File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 2 1 1 1 4 4 9 Hartisbura PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 3 7 1 2 0 5 1 7 0 3 2 6 2 0 1 1 0 4 0 7 1 9 2 1 Decedents Last Name Suffix Decedent's First Name MI H o u s k a E m m a L (If Applicable) Eater Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1.Original Return Q Z. Supptemental Return ~ 3. Remainder Return (date of death pnor to 12-13-82) 4. Limfied Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of WIiQ (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. g113(A) between 12-31-91 and 1-1-95) (Attach 3ch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIOENTUIL TAX q~tFORMATI~I SHOULD i3E DNiECTED T0: Name Daytime Telephone Number W a y n e F S h a d e E s q u i r e 7 1 7 2 4 3 0 2 2 0 Flan.. Name (If Applicable) REGIBTEAt"irlPrMLl8 U8E ONLY _ •~: , s ~' 3 First line of address ~ 53 We st Pom f ret S tr eet `~ ,. -- r., Second line of address ~ ~ ~"~ ~ ~` ~~ 3 City or Post Office State ZIP Code FLLED ~ ~ .. C a r l i s l a P A 1 7 0 1 3 ~ w c~ Correspondent's a-mail address: waynefshade~a~comcast.net Under penaitles of perjury, I dedare that I have examined this return, induct"rrg accompanying schedules and statements, and tD the hest of my krawbdge and befef, it is true, correct and complete. Declaration of preparer other than Ute personal representatme rs based on all Mfomratlon of whkfr preperer has arry Ivro~wledge. SIGNATURE OF PER N IBLE FO FILING REn.lRN DATE 2/13/2012 ADDRESS P•0• B x 76 Mt• Holly Sprinas PA 17065 SIGNA RE OF PREP R T N REPRESENTATIVE DATE ~,ujy~ ~,~ 2 / 13 /2 012 53 West Pomfret Street Carlisle PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 f ~ ~ J 1505607221 REV-1500 EX Decedent`s Social Security Number DeCeaenfs luame: Emma L. H o u s k a 1 3 7 1 2 0 5~? RECAPITULATION 0.D 1. Real estate (Schedule A) ........................................ 1 2 2 8 2 3. 6 6 2. Stocks and Bonds (Schedule B) .................................. . 3. Closely Heid Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. • 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. • 6. Jointty Owned Property (Schedule F) ^ Separate Billing Requested ....... 6• 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property t Billi R ested l [~ S S h d G 7 • ....... ng epara e equ ( e e ) c u . 8. Total Gross Assets (total Lines 1-7) ........................... 8. 2 8 2 3. 6 6 8. ................ Funeral Expanses & Administrative Costs (Schedule H) 9. 1 5 • D D 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. • 11. Total Deductions (total Lines 9 & 10) ........................... 11. 1 5 • D D 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 2 8 D 8 . 6 6 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. 2 8 0 8 . 6 6 TAX COMPUTATIONS-8EE INSTRUCTIONS FOR APPLICABLE RATES T5. Amount of Lirie.~l~taxable at the spousal;t6ix.rate, or tra4~sfers u`Md er Sec. 9116 _ (a~r2) x.D';_ O. O D 15. 0. 0 0 16. Amount of Line 14 taxable 6 6 2 8 D 8 1 2 6 3 9 . at iir(8al rate ~c ;oar 16, . 17. Amount of Lin@:1~ taxable D D 0 17 D• D D at sibling rate +X .12 . `'18. AMOUnt of Line 14 taxable 0 0 0 D 0 0 . at collateral rate X .15 18. . 19. Tax Due ................................................ 19. 1 2 6. 3 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 L 1505607221 1505607221 J i 1505607121 REV-1500 Ex (os-o5) ~7f'=f ICfAL USE ONLY PA Department of Revenue Bureau of Individual Taxes Courlry Code Year File Number PO BOX 28()6(11 INHERITANCE TAX RETURN 2 1 1 1 4 4 9 Ffartisbum, PA 17128-oepl RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 3? 1 2 0 5 1 7 0 3 2 6 2 0 1 1 0 4 0 7 1 9 2 1 Decedent's Last Name Sulfur Decedent's First Name MI H o u s k a E m m a L (If AppllcaWe) 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 Return Q 2. Supplemental Return ^ 3. Remainder Return (dam of death ,- prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) ^ 6. Decedent Died Testate ^ T. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Wilq (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 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) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTWL TAX WFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number W a y n e F S h a d e E s q u i r e 7 1 7 2 4 3 0 2 2 0 Firm Name (If Appiicabte) REGISTER~ORfWiLL8 USE ONLY, _._ >.,. _. ~ First line of address +~s ~ ~ 5 3 W e s t P o m f r e t S t r e e t '~ Second line of address ~ ,_ ~Ci~ W ~, ~~ -- ;~ 7~~ ~ ~- City or Post Office i State ZIP Code px Fn -- ~ C a r l i s l e W ~~ P A 1 7 0 1 3 ~ ComespondenYs e-mail address: waynefshade(acomcast.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and tD the best of my krrorlrledge and belief, R is true, coned and complete. Declaration of preparer other than the personal representative Is based on an lrlfomlatlon of which preparer has any knowledge. SIGNATURE OF PER N IBLE FO FILING REl'URN DATE 2/13/2012 aoDRESs P•0• B x 76 Mt• Holly Springs PA 17065 S RE 0„P; EP R T N REPRESENTATNE DATE ~ , 3G1~~`S~ 2/13/2012 53 West Pomfret Street Carlisle PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505607121 1505607121 REW1S00 EX Page 3 Decedent's Complete Address: File Number 21 11 449 DECEDENTS NAME Emma L. Houska STREET ADDRESS Cumberland Crossin s 1 Lon sdorf Wa CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InterestiPenalty if applicable D. Interest E. Penalty (1) 126.39 Total Credits (A + B + C) (2) 0.00 Total Interest/Penalty (D + E) (3) 0.50 4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill to oval on Page 2, Line 20 to request a refund. 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (4) 0.00 (5) 126.89 (5A) (5B) 126.89 Make Check Payable to: REGISTER OF W-LLS, AGENT .`,~~f~~~ ' 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; ............................... ^ c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration7 ....................................................................................... ^ 3. Did decedent own an "intrust 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 benefiaary designation? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. .,-. -..r.., .. .. _. _ , _ .r ~ For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 zero (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 beneficlary. For dates of death on or after July 1,2000: The tax rate imposed on the net value of transfers from a deceased childtwenty-one 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 zero (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 four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [!2 P.S. §9116(a)(1)]. The tax rate imposed on the net value of Vansfers to or for the use of the decedent's siblings is twelve (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-1503 EX + (8-98) . SCHEDULE B ConmuwNWEAITH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Emma L. Houska 21 11 449 ' All properly jointly~owned with right of survivorship moat be diacbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH .. „ common TOTAL (Also enter on line 2, Recapitulation) ~ S (If mae space is needed, insert additional sheets of the same size) REV-1511 EX + (10-08) f COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF hlLt KUMlftK Emma L. Houska 21 11 449 Debts of dscedern must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3, Family Exemplan: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 4. City State Zip Relationship of Claimant to Decedent Probate Fees 5 Accountant's Fees 6. Tax Return Preparers Fees ~, Register of Wills, file Supplemental Inheritance Tax Return 15.00 TOTAL (Also enter on line 9, Recapitulation) I ; 15.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH of PENNSYLVANIA BENEFICIARIES INHERRANCE TAX RETURN RESIDENT DECEDENT F.mma T,_ Hnuska 21 11 449 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS [include o ht spousal distributions, and transfers under Sec. 91166 (~a (1. )2 ] 1. Richard V. Houska Lineal 936.22 115 West Peachtree Place NW, #306 Atlanta, GA 30313 2. Janet L. Wylie Lineal 936.22 P.O. Box 76 Mt. Holly Springs, PA 17065 3. Nancy M. Houska Lineal 468.10 123 Porter Avenue, Apt. 1 Carlisle, PA 17013 4. Megan Schneeberger Lineal 234.06 2722 West Potomac, Apt. 3 Chicago, IL 60622 5. Sally C. Newman Lineal 234.06 43 Broad Street, Suite 300 Charleston, SC 29401 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size)