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HomeMy WebLinkAbout03-06-12 (2) 15056051058 REV-1500 EX (D~-D5) PA Depattmentof Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280801 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death ~ -205_26-2115 ~ J ~ 02/25!2010 --~ Decedent's Last Name Suffix _ Bonin _ - -- - - (If Applicable) Enter 5urvlving Spouse's information Below Spouse's Last Name __ -_ -- _. _ . Spouse's Social Security Number Date of Birth 07/02/1928 Decedent's First Name MI Martha ~ L~ Suffix Spouse's First Name MI l ~ ~ ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _ __ _-. ____-- __J REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1. Original Return ~ 2. Supplemental Return p 3. Remainder Return (date of death prior to 12-13-82) L"~ 4. Limited Estate t~ 4a. Future Interest Compromise (date of (~ 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes i (Attach Copy of Will) (Attach Copy of Trust) C3 9. LRigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death CJ 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 CONFIDENTIAL TAX INFORMATION SHOULD 8E DIRECTED T0: Name _ ___ Daytime Telephone Number - j Lisa Marie Coyne, Esq. ~ (717) 737-0 ~' ~ Firm Name (If Applicable) _ _____ ' ~- f._______-_ --.__. ._._ _.__-_._._._- REGISTER LLS USr~ LY : Coyne & Coyne, P.C. ~~+. ~~ ~ First line of address _ ~~~ ~ _ x3901 Market Street ~ ~~CJ -,o L"; Second line of address ~ ~p ~ m . l D .. w ~ . City or Post _Offlce State ZIP Code DATE FILED Camp Hill ~ PA ~ 17011 -~ --_ ~__ _._ _ ~ ~ -~_~J Correspondent's e-mail address: 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 preparet other than the personal representative is based on all information of whicli preparer has any knowledge. -31Gr~ RE OF PERSON RESPONSIBLE FOR FILIN RETURN j Carol L. Maurer 3541 March Drive, Camp Hill, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE PLEASE USE ORIt31NAL FORM ONLY Side 1 15056051058 15056051058 ,,. d'r~r~ ti,..( OFFICUIL USE ONLY County Code Year File Number 21 { ~ 10 10261 J 15056052059 REV-1500 EX Decedent's Name: Maltha G Bonin .m....,_..._.____ _____.___~, RECAPITULATION Decedent's Social Security Number ._ -- 205-26-2115 1. Real estate {Schedule A) ........................................... .. 1. ' 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2, i 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. ': 0.00 4. Mort a es & Notes Receivable (Schedule D) ........................... 9 9 .. 4. 0.00 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E} ...... .. 5. ~' 31,945.95 _... 6. Jointly Owned Property {Schedule F) C~-3 Separate Billing Requested . ...... 6. 0.00 i 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) C~ Separate Bi11Ing Requested.. ...... 7. 0.00 8. Total Gross Assets (total Lines 1-7) .............................. ...... 8. ', 31,845.95 !. 9. Funeral Expenses & Administrative Costs (Schedule H) ............... ...... 9. 2,115.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .......... ...... 10. ', 0.00 , 11. Total Deduetlons (total Lines 9 & 10) ............................. ...... 11. I 2,115.00 ' 12. Net Yalue of Estate (Line 8 minus Line 11) ........................ ...... 12. ~ 13. Charitable and Governmental BequestslSec 9113 Trusts for which ~ " an election to tax has not been made (Schedule J) .................. ...... 13. '. D.00 ' 14. Net Yalue Sublaot to Tax (Line 12 minus Line 13) .................. ...... 14. ~ 29,830.85 j 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 .0_ 15. 16. Amount of Line 14 taxable _..... at lineal rate X .0 - 16. ', 17. Amount of Line 141axable _ _ _ _. at sibling rate X .12 17. ; 18. Amount of Line 14 taxable ~_.. __....._ _.. _ _ .__ 29 830.95 '! 4 474 64 at couateral rate X .15 , 18 , . 19. TAX DUE ........................... .............................. 19.! 4,474.64 20. FILL IN THE OPAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C~ 15056052059 Side 2 l.__ 15056052059 REV-1500 EX Page 3 Fty Number _,_~ y,,_,_ -,._„ ,, Decedent's Complete Address: 21 ii 10 0261 ..~..J.% _ DECEDENTS NAME DECEDENTS SOCIAL SECURIT~(NUMBER Martha G Bonin 205-26-2115 STREET ADDRESS 3541 March Drive CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 4,474.64 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 4, 474.64 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interesf/Penatty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,474.64 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4,474.64 Make Check Payable to: REGISTER OF WILLS, AGENT ~~~~w" 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 care7 ...................................................................... ^ 2. If death oa.uned after December 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 properly 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 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 J72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 Ju{y 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-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 (O) percent [72 P.S. §9116(aj(12)J. 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) [72 P.S. §9116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)J. 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+ (6-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDYLE E CASH, BANK DEPOSRS, & MISC. PERSONAL PROPERTY Martha G. Bonin 21-10-0261 InGude the proceeds of litigation and the date the proceeds were received by the estate. All properly Jolntlyowned with right of aurvivorehip must be disclosed on Schedule F. t DESCRIPTION QF DEATN 1. Proceeds from Pennsylvania Unclaimed Property 31,736.51 " 2. Reissued replacement check for dividend ! 209.44 C~m~iionrvealth of~Penns3rlvani~ ~' REiglL~3t1C8 ACI VICE' _ 1 ce 1 , 000105 57 16109133 ~ _. ~ • Pennsylvania Treasury, -.Bureau of Unclaimed Property ~ Payment , '- 'CLASAL # 100654288 ~ ~ - '------- Properpy ID Holder Name .. Deacriptioa~' Amount 8261891 UNITED HEALTHCARE INSUR CLAIMS PAYMENT CHECK 210.00'• 8261892 UNITED HEALTHCARE ZNSUR CLAIMS PAYMENT CHECK 390.00 9345240 UNITED HEALTHCARE INSUR CLAIMS PAYMENT CHECK 600..00 10345155 CHEVRON CORPORATION DIVIDENDS 2,018.17 10345156 CHEVRON CORPORATION STOCK UNDELIVERABLE 12,650.09 ' ~ Total: 15,868.26 l ~ O I ,? . O O O i m N ~ ' ~~ PAYEE INFORMATION: ' BONIN MARTHA G. ESTATE OF CJO CAROL L MAURER EXECUTRIX 3541 MARCH~DRIVE CAMP HILL PA 17011 Fru n nu 1 ( ~ NOTE: Direct payment inquiries to: PA Unclaimed Property 1.800.222.2046 P.O. Box 1837 Harrisburg, PA 17105-1837 THEN DETACH CAREFULLY R 4 PAY N ~ ~ ns s ~~ ~~ ;:: _ ,, }.t ~ ~E ~ VOID AFTER 180 DAYS ~ PTO THE ORDER OF ~, ~~~'~'~~.wr..~..,x~..,~::~,,=~a;,.,. ,'.'~ 60NIf~4hAARTHA G ESTATE OF `~ ' ~~~~~. ~ .~„~...!~i :xr}; d? C/O CAROL,1~ A+IAURER EX~CUTRI~ -' ' , v ~"".~-~' 7~"~.~.~^-a' ~=M ~ ~'-~µ'+"' ~ "" ~ 354E MARCH DRIVE`' 5 t~~~~ Y ~~`~ ~ ~ ~~ ~~ !'~ CAMP HILL.. pA 17011, t .. °' ' ; ~,~ _> r ~~ , v > :'" .. a, : x ~ ~ I s -'S3b s;-. c(/ i i i t ~ r: -t" s..s t ~- ./ 'J/z~ a } ~ q.si zu za, ..s :: k ,v.~.'~3tlr s. i,. w :. n'.a .., tx )'::` ~ ti 9„~,F:T~:`ii.SUF~~.l4j`.F7.6w~P.~~~4`~"3 -L V`~.J'IA. ..~s.~ ii' i6 i09j133ii' x:03 ~ 1002 25~: 20 799 5000860 2i~' Comtnonw.eait}~ of PeniisytvaYyia 1 of 1 ;~2emittan;ce Advice 000043 57 15861472 ~ , Pennsylvania Treasury - Hureau ©£ Unclaimed Property Payment CLAIM # 77233805 i' - Property ID Holder Name Description Amount 10345155 CHEVRON CORPORATION DIVI-DENDS 2,018.17 10345156 CHEVRON CORPORATION STOCK UNDELIVERABLE 12,650.08 ` ~ Total: 14,668.25 f t . ~". A r~ N ~ O O O O ~ -a t N . ~ r~ PAYES INFORMATION: BONIN MARTHA G ESTATE OF' C/0 CAROL L MAURER EXEC 3541 MARCH DRIVE CAMP HILL PA 17011 FOLD ON F I NOTE: Direct payment iarn,;riea to: PA Unclaimed Property 1.800.222.2046 P.O. Box 1837 Harri3burg, PA 17105-•1837 THEN DETACH CAREFULLY ~~' i5$6 L4? 2~i• i:03 i i00 2 25~: 207~i95D00$60~2i~' REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scN~ou~E x FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Martha G. Bonin 21-10-0261 Delete of decedent moat be roported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: L B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Numt>er(s)IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AttomeyFees 1,200.00 `' 3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation) Claimant Street Address City State 21p Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees z. Supplemental Inheritance Tax Filing Fee 15.00 a. Income Tax Due 800.00 ' s. Reserves 100.00 10. 11. I 12. TOTAL (Also enter on line 9, Recapitulation) $!' 2,115.00 (If more space Is needed, insert additional sheets of the same size) REV-1513 EX+ (i1-08) ~ :` Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES ESTATE OF FILE NUMBER Martha G. Bonin 2~_~n_m~~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Carol Maurer .niece 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION 70 TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~' .~ mule apace is neeaeD, mser<aamaonai sneers or the same size.