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Home My WebLink About03-05-12r 1505610105 REV-1500~`t°~-"'tom' ~ PA Department of Revenue pmnsylvaMa OFFICUIL USE ONLY Bureau of Individual Taxes °~~"`"" ~~tT Code Year File Number PO BOX ~8o6ot INHERITANCE TAX RETURN f I I O l ~~ Harrtsbury, PA i71z8-o601 RESIDENT DECEDENT ~ I _ ENTER DECEDENT INFORMATWN BELOW Social Security Number Date of Death 086-28-9409 12/30/2010 Decedent's Last Name Burwell (If Appllwble) Enter Surviving Spouse's Irtfomtation Below Spouse's Last Name MMDDYYYY Dale of Birth MMDDYYYY 09/06/1915 Sufix Decedent's First Name MI Joyce N Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FlLED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (ip 1. Original Return O 2. Supplemental Return O 3. Remainder Relum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O1D 6. Decedent Died Testate O]p 7. Decedent Maintained a Living Trust U 8. Total Number of Safe Deposit Boxes (Attach Copy of 1MII) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Ronald J. Burwell (717) 432-706 ~> REGISTER O~ USE OlIJjY ~ '~~''~ a T1 ~ ~ ~_?Q ~~5 =~T1 First Line of Address ='7 a ~ r'fT 1 c:. r 19 Park Drive Second Line of Address ~ O _n 3°. - T~ ~ ~-' z='> 1 ~ 4~ ~ City Or POSf Office State ZIP Coda DATE FILED Dillsburg PA 17019 Correspondent's small address: Under penalties of perjury, I declare I have examined this return, including accompanying sdredules and statements, end to the best of my knowledge and belief, it Is true, coned and comp preperer omer than the personal ropreaentative is based On all informatlon Of which preparer has arty knowledge. SIGNAT R SI FOR NG RETURN pp~ A~ p 03/01!2012 ADDR SS `R !~ D lf..t..S Q(~ ~ P/4" 17 DI ~I SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEAaE UEE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J ~~ _J 155610205 REV-1500 EX (FI) Decedent's Social Security Number I~cedent's Name: JOyCe N, i3urvvell 086-2&9409 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. 421.08 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Groan Assets (total Lines 1 through 7) .......................... ... 8. 421.03 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 10. Debts of Decedent, Mortgage LiabilRies and Liens (Schedule I) ............ ... 10. 2,149.63 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 2,148.63 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 0.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an electron to tax has not been made (Schedule J) ..................... ... 13. 14. Net Value SubJeet to Tax (Line 12 minus Line 13) ...................... .. 14. 0.00 TAX CALCULATION -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. 18. Amount of L'me 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1g, 19. TAX DUE .................................................... ..... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505610205 Side 2 1505610205 0.00 O J REV-150D EX (FI) Page 3 Fik Number Decedent's Complete Address: Joyce N. Burwell STREETADDRESS Messiah Village -Room 93 100 Mt. Allen Drive - _--- CITY STATE ZIP Mechanicsburg PA ~ 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments ___ ^_. B. Discount 3. Interest 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. 5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. (1) Total Credits (A+ B) (2) (3) (4) (5) o.oo 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: 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 .......................................................................................................................... .... ^ d. receive the promise for life of either paymerds, benefds or care? .................................................................. .... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideratbrl? .......................................................................................................... .... ^ 3. Did deoedeM own an "in trust for' or payabk~-upon-death bank account or sewrily at his or her death? .......... .... ^ 4. Did decedent own an irxlividual retirement arxoum, annuity or other non-probate property, which contains a beneficiary designatbn? .................................................................................................................... .... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS {S 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 percerit 172 P.S. §9116 (a) (1.1) (i)). For dates of death on or after Jan. 1, 1995, tite 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 tram tax, and tite statutory requirements for disclosure of assets and filing a tax return are still appkcable even 'rf the surviving spouse is the onty benefiaary. 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 w a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tau rate imposed on the net value of transfers to or for the use of the decedent's kneel beneficiaries is 4.5 percent, exompt 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 comnrce with the decedent, whether by blood or adoption. • REV-iso8 EX+ (ii-io) pennsylvania ~ DEPAgTMENT OF gEVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT S~NEDYLE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Joyce N. Burwell 1002025 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned wkh Nght of survivorship must be disclosed on Schedule F. If more space is needed, use additional sheets of paper of the same size. (~PNC February 11, 2011 Ronald Burwell 19 Park Dr Dillsburg, PA 17019 RE: Joyce N Burwell SSN: 086-26-9409 DOD: 12-30-2010 Dear Mr. Burwell: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account # 5003547936 Established: 04-03-2008 JOYCE N BURWELL RONALD J BURWELL DOD balance: $ 421.08 non interest bearing Please note that this office provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N,A. Member FDIC This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error, please notify me immediately by reply or by telephone at 800-J62-1775 and immediately destroy this faxed document. Page ] of 1 pennsylvania SCHEDULE I ' ~ DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE Of FILE NUMBER Joyce N. Burwell 1002025 Report debts tnalrred by the decedent prior to death Neat remained unpaid at the date of d~th, including unrNmbursed medical experuas. If more space is needed, insert additional sheets of the same size. ~ S..~SS~ v ~ 100 MOUNT ALLEN DRIVE. MECIiANICSBURG, PA 17055 RONALD J BURWELL 19 PARK DRIVF, DILLSBURG, PA 17019 Fam ce-e± RESIDENT # UNIT STMT. DATE 10207 093 D 12/31/2010 RESIDENT S Mrs. JOYCE N. BURWELL TOTAL AMOUNT DUE $3 599.63 DATE DUE 01/31/2011 DATE DESCRIPTION RATE ~~ CHARGE3 CREDITS BALANCE Balance Forward 16,646.05 12/27/2010 PAYMENT RECEIVED -THANK YOU!!! 16,646.05 0.00 12/31/2010 2CAL PER OZ. 0.20 66.0( 33.20 33.20 12/31/2010 HEALTH SHAKES (PER CONTAINER) 0.30 28.00 8.40 41.60 *** Nursing Care *** 12/31/2010 PATIENT LIABILITY 29.00 3,558.03 3,599.63 RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 10207 3,599.63 0.00 0.00 0.00 0.00 $3,599.63 RESIDENT NAME Mrs. JOYCE N. BURWELL F°""PB~01 N/A Please make check payable to Messiah Village. A I'% Tinance charge may be assessed on accounts for which payment has not been received by the due date. Thank ,you! if you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You!