HomeMy WebLinkAbout04-0836 COMMONWEALTHOFpENNSYLVANiA I REV'1500 I
IINHERITANCE TAX RETURN
~HARRI~URG, PA 17128~601
I RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I-- Small, Lillian K 164-07-9899
Z
III DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
t'-* THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
u.I 05/09/2004 02/17/1919 REGISTER OF WILLS
I.LI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
1:3 N/A
[~]1. Original Retem
[~4. Umited Estate
[~6. Decedent Died Testate {At,ch ,~p/of W~
[] 9. Litigation Proceeds Received
]2. Supplemental Retem
~-~ 4a. Futura Interest Compromise (~ d ~ a,~ ,2-u~2)
[~7. Decedent Maintained a Living TpJst (roach copy of
NAME
George H Small
FIRM NAME
TELEPHONE NUMBER
(717) 737-6508
COMPLETE MAILING ADDRESS
837 Mandy Lane
Camp Hill, PA 17011-1536
1. Real Estate (Schedu~ A) (1)
2. Stec~ and Becds (Schedule B) (2)
3. Closely Held Co~oralJon. Partnership or So~e-Prophetomhip (3)
4. Modgages & Notes Receivable (Schedule D) {4)
5. Dash, Bank Deposits & Misce~aneous Pemonal Property (5)
(Schedule E)
6. Joi,tly Owned Propp~ (Schedule F) (§)
[] S~pemta Billing Eequ~ted
7. Inter-V~vos Tramfers & Misceltanems NomProbate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administm~ve Costa (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) (10)
11. Total Deductions (total Li~es 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemrnental Bequesbl/Sec 9113 TPasta for which an election to tax has nol been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
o.~.
66,283.~. ~
O.O0
445.00
26 445.~i8,'
0.O0
OFFICIAL USE ONLY
(B)
8,625.88
842.73
(11)
(12)
(13)
93,174.62
9,468.61
83,706.01
0.00
(14)
83,706.01
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable at me spousal tax
rate, or ~ans~s under Sec. 9116(a)(l.2) 0.00 x .0
16. Amount of Line 14 texable at lineal rata 94,991.57 x .0 45 (16)
17. Amount of Une 14 taxable at sibling rate 0.00 x .12 (17)
18. Amount of Une t4 taxable at collateral rate 0.00 x.15 (18)
19. Tax Due (19)
0.00
3,766.77
0.00
0.00
3,766.77
Decedent's Complete Address:
STREETADDRESS
20 N 12th Street, Apt 123
CI3~'Lemoyne
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
J STATEpA
(1)
r z)P17043
Total Credits (A + t~ + C ) (2)
3. Interest/Penafiy if appricable
D. Interest
E, Penalty
Total Interest/Penafty ( D * E ) (3)
4. If Line 2 is greater than Lina l + Line 3, enterthedilference. This is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refund (4}
3,766.77
0.00
0.00
3,766.77
0.00
3,766.77
if Line 1 + Line 3 is greater than Line 2, enter the dilfemnce. This is the TAX DUE. {5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BAI..~NCE DUE. (5B)
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 pmpafiy transferred; .......................................................................................... [] []
b. retain the fight 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 cam? ...................................................................... [] []
2. if death occurred after December 12, 1982, did decedent transfer propady within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust for' or payable upon death bank account er secudty at his or her death? .............. [] []
4. Did decedent own an Individual Refirement Account, annuity, or other non-probate pmparty wh~h
contains a beneficiary designatk)n? ........................................................................................................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
SIGNATURE OF PERSON RESPQfitSIBLE FOR FILING RETURN DATE
ADDRESS !
837 Mandy Lane, Camp Hill, PA 17011
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfem to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (I.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% [72 RS. §9116 (a) (1.1) (ii)J.
The statute does net exemut a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable oven if
the surviving spouse is the only beneficiary.
For dates of death co or after July 1, 2000:
The tax rate imposed on the net value of transfem from a dsceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adopfive parent,
or a stepparent of the child is 0% [72 RS. §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%, except as noted in 72 P.S. §9116(1.2) [72 RS. §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% [72 P.S. §911§(a)(1,3)]. 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-1503 EX+ (6-98)
COMMONWEALTH OFPENNSYLVAN~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lillian K Small
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
All properly jolntly-own~l w;th right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1451.02 sh Vanguard Wellington Fund
61.73 sh Vanguard 500 Index Fund
693.28 sh Vanguard Windsorll Fun~
41,237.85
6.272.07
18,774.02
TOTAL (Also enter on line 2. ReCaDitulatJom /
$ 66.283.94
(If mom space is needed, inse~t additional sheets of the same size)
REV-1508 EX+ (~-98)
COMMON~/EALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lillian K Small
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
include the proceeds of litigatien and the date the proceeds were received by the estate.
All property jofnfly-ovmed with Hght of survivorship must be disclosed on Schedule F,
iTEM
NUMBER DESCRIPTION
Wearing aooaml
Household and furnishings
2
VALUE AT DATE
OF DEATH
195.00
250.00
TOTAL (Also enter on fine 5, Recapitulation) $ 445.00
(ff more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (6-98)
COMMONV~,~-ALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
E~¥AYE OF
Lillian K Small
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
If an asset was made Joint within one year of the decedent's date of death, It must be reported on Schedule G.
RELATIONSHIP TO DECEDENT
SURVIVING JOINT ~ENANT(S) NAME ADDRESS
A' Leslie J Her~h 211 Winthrop Lane, Saginaw, MI 48603
S' George H Small
Judith S Iserman
837 Mandy Lane, Camp Hill, PA 17011
5033 Dellwood Drive, Rossville, GA 30741
Daughter
Daughter
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE 0~ DEATH
1. A. 09/01/2002 US Treasury Bill, CUSIP 912795QV6, acct 4800-407-0225 10,000.00 50 5,000.00
2 B 09/01/2002 US Treasury Bill, CUSIP 912795QV6, acct 1300-037~648 10,000.00 50 5,000.00
3 C 09/16/2002 lNG Direct CD, acct#489635 10,000.00 50 5,000.00
4 B 09/01/2002 lNG Direct savings account ~189635 139.72 50 79.86
5 B 02/01/2000 Citizens bank check acct ~105654646 22,731.24 50 1 1,365.62
I
TOTAL (Also enter on line 6, Recapitulation)S 26,445.48
([f mom space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Lillian K Small
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
RLE NUMBER
Ddet~ of decedent must be reported on Schedule I.
DESCRIPTION AMOUNT
ITEM
NUMBER
A.
2
3
4
5
6
7
5.
FUNERAL EXPENSES:
Professional services
Automotive equipment
Merchandise (casket, folders, etc)
Cemetary charge
Other services (advertising, hairdresser, clergy, organist, sexton, vault seffing,engmving)
Flowers
Food
ADMINISTRATIVE COSTS:
Personal ReDresentalJve's Commissions
Name of Personal Representative(s)
Sod, a[ Security Number(s)/EIN Number of Persona~ Representative(s)
Stmet Address
City State Zip
Year(s{ Commission Paid:
Altomey Fees
Family Exemption: (~f decedent's address is not the same as daimanrs attach explanatfon)
Claimant
Street Address
City Slate .23p
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
3,210.00
600.00
1.960.00
1,285.00
1 ,O04.90
356.98
209.00
TOTAL {Also enter on line 9. Recap~tulahon) $ 8.625.88
(If more space is needed, insa~l additional sheets of the same size)
RE%c1512 EX+ (12-03)
ESTATE OF
Lillian K Small
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & UENS
FILE NUMBER
Report debts Incurred by the decedent prm- to death which remained unpaid as of the date of death, including unrelmburead medical expenses.
iTEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2
3
4
5
6
7
8
9
10
11
Delco Radioligic-ckno 1064
Jeffquip (wheelchair rental~ckno1065
Bank One (credit card)-ckno 1066
Delco Radilogic-ckno 1069
Keystone Cardiac-ckno 1070
Ebenezer Church (outstanding check)-ckno 1058
Bdght Small (outstanding check)-ckno 1046 1054
Vedzon (outstandin9 check)-ckno 1061
Einstein Medical-ckno 1071
AD&D-auto withdrawal
LaWall Orthotics-ckno 1072
71.25
214.98
253.02
20.8t
16.30
45.00
50.00
20.75
21.22
6.60
122.80
TOTAL [Also enter on line 10, RecaDiturationl $
(If more space JS needed, insert addi~onal sheets of the same size}
842.73
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-060~
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 004368
SMALL GEORGE H
837 MANDY LANE
CAMP HILL, PA 17011-1536
........ ford
ESTATE INFORMATION: SSN: 164-07-9899
FILE NUMBER: 2104-0836
DECEDENT NAME: SMALL LILLIAN K
DATE OF PAYMENT: 09/13/2004
POSTMARK DATE: 09/1 3/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/09/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 93,766.77
TOTAL AMOUNT PAID:
93,766.77
REMARKS:
CHECK# 1073
INITIALS: JA
SEAL RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF /NDZVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG, PA 17128-0601
COHHONNEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTZCE OF /NHERITANCE TAX
APPRAZSEMENT, ALLONANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
REV-1S4? EX AFP
GEORGE H SHALL
857 HANDY LN
CAHP HILL
PA 17011
DATE
ESTATE OF
DATE OF DEATH
FZLE NUHBER
COUNTY
ACN
11-15-200q
SHALL
05-09-200q
21 0~-0856
CUHBERLAND
101
Amount Remitted
LILLIAN K
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLTSLE, PA 17015
CUT ALONG THZS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLO#ANCE OR
DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX
ESTATE OF SHALL LILLIAN K FZLE NO. 21 0q-0836 ACN 101 DATE 11-15-200R
TAX RETURN #AS: (X} ACCEPTED AS FZLED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
4. Mortgages/Notes Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7).
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/M/sc. Expanses (Schedule H) (9)
10. Debts/Mortgage Liabilit/as/Ltans (Schedule Z) (10)
11. Total Deductions
12. Nat Value of Tax Return
O0
66~285.9q
O0
O0
qq5 O0
26~q~5.68
O0
(8)
8,625.88
8qZ.75
NOTE: To insure proper
credit to your account,
subeit tho upper port/on
of th/s fore w/th your
tax payeont.
15.
lq.
NOTE:
93,17q.62
INTEREST/PEN PAID (-)
.0O
ASSESSHENT OF TAX:
15. Aeount of L/ne 14 at Spousal rate
16. Aeount of L/no 14 taxable at Lineal/Class A rate
17. Amount of L/ne 14 at S/bl/ng rate
18. Aeount of L/ne 14 taxable at Collateral/Class B rate
19. Pr/ncipal Tax Duo
TAX CREDITS:
PAYMENT ~. RECEIPT
DATE ~ NUNBER ,
09-13-200q ~CDOOq368
i~'~
(is) .00 x O0 = .00
(16) 83,706.01 x Oq5= 3,766.77
(17) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= 3,766.77
AHOUNT PAZD
3,766.77
ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
reflect flgures that lnclude the total of ALL returns assessed to date.
TOTAL TAX CREDZT 3,766.77
BALANCE OF TAX DUEI .00
ZNTEREST AND PEN. .00
, TOTAL DUE .00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CA), YOU MAY BE DUE
A REFUND. SEE REVERSE SZDE OF THZS FORM FOR ZNSTRUCTZONS.)
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0
Net Value of Estate Subject to Tax (14) 83,706.01
Zf an assessment was lssued previously, lines lq, 15 and/or 16, 17, 18 and 19 will
(11) ~ ,~&8.61
(12) 83,706.01
RESERVATION:
PURPOSE OF
NOTICE=
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class 8 (collateral) rate on any such future interest.
To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF #ZEES, AGENT
A refund of a tax credit, ahich ams not requested an the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available
online at wee.revenue.state. Da.us, any Register of Hills or Revenue District Office, or from the Department's
Z4-hour answering service for fores orders: 1-800-562-2050~ services for taxpayers with special hearing and/or
speaking needs: 1-800-447-50Z0 [TT only).
Any party in interest not satisfied with the appraisment, allowance or disalloaance of deductions or assessment of tax
(including discount or interest] as shown on this Notice may object within 60 days of the date of receipt of this notice
by filing one of the following:
A) Protest to the PA Department of Revenue, Board of Appeals. You say object by filing a protest online at
waw.boardofappaals.stata.pa.us on or before the expiration of the sixty-day appeal period. In order for
an electronic protest to be valid, you must receive a confirmation number and processed date from the
Board of Appeals websJte. You may also send a written protest to PA Department of Revenue, Board of Appeals
P.O. Box ZBIOZ1, Harrisburg, PA 17128-1021. Petitions may not be foxed.
B) Election to have the matter determined at the audit of the account of the personal representative.
C) Appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601) Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (5) calendar months after the dacedant's death, a five percent (BX) discount of
the tax paid is a11oeed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (62) percent par annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after
January 1, 1982 will bear interest at a rate ahich will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z004 are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
~ ZOZ .000548 ~"~)"~ - 1991 11Z .000501
1983 162 .000458 1992 92 . O00247
1984 112 .000501 1995-1994 72 .00019Z
1985 152 .000556 1995-1998 9Z .000247
1986 IOZ .000274 1999 72 .000192
1987 IOZ .000Z74 ZOO0 7Z .00019Z
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
2001 92 .000Z47
2002 62 .000164
2005 52 .000157
2004 4Z .O00llO
X NUNBER OF DAYS DELINQUENT X DAXLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ail1 reflect an interest calculation to fifteen (lB) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.