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HomeMy WebLinkAbout03-13-12 (2) 1505610105 REV-1500 °` `°'-11' f~' PA Department of Revenue pennsylvaMa OFFICULL USE ONLY oE..x.ruxra„evexue Bureau of Individual Taxes Po BOx 28t>fioi INHERITANCE TAX RETURN Harrisburg, PA >7az8-o6of. RESIDENT DECEDENT ~Y Code Year ~~ ~/ Fria Number C/~~ ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death MMDDYYW Date of Binh MMDDYYYY 204-03-2s77 0415/2011 o2rzs~1 s21 Decedent's Last Name Suffix Decedent's First Name MI SHUGHART THELMA M (N Applicable) ErMer Surviving Sporrss's Inforrrration Below Spouse's last Name Suffix Spouse s First Name MI FlLL IN APPROPRIATE OPALS BELOW tib 1. Original Return O 2. Supplemerrtal Return O 3. RemairWar Return (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) O 6. Decedent pied Testate O 7. Decedent Maintained a Living Trust 8. Total Number Of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election W Tax under Sec. 9113(A) Between 121-91 end 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRE ED Name CT T0: Daytime Telephone Number BEVERLY S. LEHMAN n,~t d7~_,n~o Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS First Line of Address 280 BARNSTABLE ROAD Second Line of Address City or Post Office State ZIP Code CARLISLE PA .17015 ~,.., REOI LS USE ~.Y -?+: ~ r ~V (^ J A. ~ ~ w ~ -: JCS ~ ~~ a - ?~ F._ DATE FILED (*~, ~ Correspondent's e-mail addross: Urxkr pens ' of perjury, 1 dedere that 1 examined this return, Including a°canpanying schedubs and s[a~ments, and to the best M my knowledge and belief, it is true and prepener aster than the personal representatlve is based °n ail inf°rrnation of which preperer iras any krowledge, RE OF OR FILING RN 280 BARN~'ABLE ROAD, CARLSLE, PA 17015 ~ DATE 0 3/1 31201 2 '.~7 ~? c':: r j ~~_p 1720 MILLER ROAD, PO BOX 517 DAUPHIN, PA 17018-0517 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J _J 1505610205 REV-1500 EX (FI) Decedents Soaal Security Number Decedents Name: THELMA M. SHUGHART 204-43'2677 RECAPITULATWN 1. Real Estate (Schedule A) ............................................ . 1. 47,760.00 2. Stocks and Bonds (Sdredu~ B) ...................................... . 2. 43.00 3. Closely Held Corporation, Partnership wSole-Proprietorship (Sdiedule C) .... . 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) .......................... . 4. O.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 7,112.00 6. Jointly Owned Property (Schedule F) r~ Separate Billing Requested ...... . 6. 4,385.00 7. Inter ~vos Transfers & Miscellaneous Non-Probate Property B i d 7 28 437 00 ng Requeste ....... lN (Schedule G) O Separate . . . , 6. Taal Gross Asssa (total Lines 1 through 7) ............................ . 6. 87,737.00 9. Funeral Expenses and Administrative Costs (Sr~redule H) .................. . 9. 9,546.00 10. Debts of Decedent, Mortgage Li~iNties and Liens (Sdiedule I) .............. . 10. 6,161.00 11. Total Dsductlons (total Lines 9 and 10) ................................ . 11. 15,707.00 12. Nat Value of Estate (Line 8 minus Line 11) ............................. . 12. 72,030.00 13. Charitable and t;ovemmental BequestslSec 9113 Trusts fw which an election to tax has not been made (Schedule J) ....................... . 13. 0.00 14. Nst Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. 72,030.00 TAX CALCUtAT1ON -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line i4 taxable at the spousal tax rate. w transfers under Sec. 9116 16. Amount of Line 14 taxable at lineal rate X .0 4~5 72,030.00 is. 3,241.00 17. Anwunt of Line 14 taxable O ~ at sibling rate X .12 17. • 18. Amount of Line 14 taxable 0 00 at cdlataral rate X .15 18. . 19. TAX DUE ....................................................... .. 19. 3,241.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15D5610205 15D5610205 J REV-1500 EX (FI) Page 3 File Num6ar Decedent's Complete Address: CEDENTS NAME THELMA M. SHUGHART srREETADORESs 5 MIDDLETON AVENUE CITY STATE ZIP CARLISLE PA 17013 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 greaQer than Line 1 + Line 3, enter the difference. This is the OVERPAY~NT. flN M oval on Page 2, LHIe 20 to roquset a r+efirnd. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This Ls the TAX DUE. (1) 3,241.00 Total Credits (A + B) (2) 0.00 (3} 0.00 (4) 0.00 (5} 3,241.00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" fN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use «income of the property translerred .......................................................................................... ^ ^ b. retain the right to designate who Shan ire the property transferred « its income ............................................ ^ ^ c. retain a reversionary interest .............................................................................................................................. ^ ^ d. receive the promise f« nfe of either payments, benefits or care? ...................................................................... ^ ^ 2. If death occurred ether Dec.12,1982, did decedent transfer property within one year of death widrout receiving adequate consideration? .............................................................................................................. ^ ^ 3. Did decedent own an "in wst for' or payable-upondeath bank account «security at his «her death? .............. ^ ^ 4. Did decedent own an individual retirement account, annuity or other non-probate propefij, which cadains a beneficiary designation? ........................................................................................................................ ^ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE n 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 «for the u~ of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or otter 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 p2 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse Iran tax, and the statutory requirements f« disclosure of assets and filirg a tax return are still applicable even 'rf the surviving spouse is the onty beneficiary. For dates of death on «after Juty 1,2000: The tax rate imposed on the net value of transfers from a deceased child 2t years of age «younger at death to «f« 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 on the net v~ue of transfers to or for the use of the decedents line~at beneficiaries is 4.5 percent, except as nc~d in [/2 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or f« the use of the decedents siblings is 12 percent (12 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, whetlter by blood or adoption. REV-1502 EX+ (i1-08) ' Pennsylvania DEPARTMENT OF REVENUE W HERITANCE TAx RETU0.N RESIDENT DEGEDENi SCHEDULE A REAL ESTATE ~~ rw ~ e ur FILE NUI~ER THELMA M. SHUGHART 2011-00523 Att root property owned soINY or ~ a tenant In common must be ropptad at hir market value. Fair market value is defined as Me price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled m huy or self, bolt having reasonable knowledge of the relevant Facts. Rat propertythat lejointly-owned with right of survivorship must lx dttdaed on Sdreduk F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' ALL THAT CERTAIN ONE THIRD INTEREST IN REAL ESTATE SITUATE AT 5 MIDDLETON 47,760.00 AVENUE CARLISLE, PENNSYLVANIA, KNOWN AS TA PARCEL NUMBER 4Q22-0489044. ASSESSED VALUE $119,340 COMMON LEVEL RATI01.22 =FAIR MARKET VALUE $143280 TOTAL (Also enter on Line 1, Recapitulation,) I # 47,760.00 If more space is needed, insert additional sheets of the same size. REV-y50; EX+ (y-i1) ~ " Pennsylvania OEVARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT scNeou~ s STOCKS & BONDS ESTATE OF FTI.E NUMBER THELMA M. SHUGHART 2011-00523 All P-aP~9 3~~Y orrn~ ~rIN right of sutvivorshia must be disclosed on Schedule F. u more space is neeaea, insert aaaitional sheets of the same size REV-15D8 F~(+ (ii-io) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDEM SCNEpULE E CASH, BANK DEPOSITS 8t MISC. PERSONAL PROPERTY ortare vr: FIIE NUMBER: THELMA M. SHUGHART 207100523 Indude the proceeds ~ litigation and the date the proceeds were received by the estate. All property joirrdy ownal with right of wrvhrorslriD must be discbsed on Selbdule F. u more space is neetletl, use atltlitional sheets of paper of the same size. 0.EV-1510 EX+ (08-09) " Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF RLE NUMBER THELMA M SHUGHART 2011-00523 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page those of the REV-1500 is Yes. ITEM NUMBER DESCRIPTION OF PROPERTY MafioE ~ Nam ~ TrrE , n~Em aaanah;R~ To o~err am IHEaehorTRArsFa~.AnnaAmwaFniED®wRR~~rAiE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION uFavuc~eEi TAXABLE VALUE 1. WESTERN SOUTHERN DERRED ANNUITY #W002Q627901 28,437.00 100 0.00 28,437.00 TOTAL (Also enter on Line 7, Recapitulation) # 28,437.00 IE more space is needed, use additional sheets of paper of the same size. AEV-1511 EX+ (10.09) _,~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER THELMA M SHUGHART 2011-00523 Decedent's debts must be reported on Shcednk I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' GOOD SHEPPARD CHURCH 750.00 2 EWING BROS FUNERNAL HOME 5,511.00 3 LUNCHEON 200.00 a SENTINEL - ADVERTISEMENT OF ESTATE 129.00 s REGISTER OF WILLS 12.00 s NOTARY FEES 10.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Name(s) of Personal Representative(s) Street Address _ City State ZIP Year(s) Commission Paid: 0.00 2. Attorney Fees: 0,00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State _J ZIP Relationship of Cfaimant to Decedent 4. Probate Fees: 324.00 5. Accountant Fees: 2,500.00 6. Tax Return Preparer Fees: 100.00 7, TOTAL (Also enter on Line 9, Recapitulation) ~; If more space is needed, use additional sheets of paper of the same size. __ 9,546.00 REV-1512 EX+ (12-08) ~`~' ~~"~`"' Pennsylvania DEVAR7MEN7 OF REVENUE INHERITANCE TAX RENRN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8c LIENS ESTATE OF FILE NUMBER THELMA M. SHUGHART 2011-00523 Report debts incurred btr the decedent prior to death that remained w~paid rt the date of death, inducting unreimbureed medial expanaea. ITEM VALUE AT DATE NUM6ER DESCRIPTION OF DEATH 1• BARRYVINCENT-MOWING 100.00 2 JOHN & JUDY WERT -PLOWING 100.00 3 BARRY VINCENT -MOWING 100.00 4 UGI 63.00 5 BARRY VINCENT -MOWING 40.00 e COMCAST 7.00 7 PHARMERICA 488.00 8 PHARMERICA 130.00 9 LISPS 14.00 10 PP&L ELECTRIC 37.00 11 CENTURY LINK 30.00 12 ROBERT CARNS TAX COLLECTOR -REAL ESTATE TAX 1,286.00 13 TRUST AMBULANCE 73.00 14 RACE WECKARDE (FOOD STAND ~ SALE) 49.00 15 KEVIN WICKARD (AUCTIONEER) 1,023.00 16 LOWES (SINK REPAIR) 109.00 17 UGI 12.00 18 SHERWIN WILLIAMS 93.00 19 CASH PAID TO HELPERS AT SALE 600.00 20 PP&L ELECTRIC A37.00 21 VISA 32.00 22 CENTURY LINK 130.00 23 SHERWIN WILLIAMS 130.00 24 ERIE INSRUANCE 134.00 25 LOWES 108.00 TOTAL (Also enter on Line 10, Recapitulation) f # 5,325.00 If more space is needed, insert additional sheets of the same size. -• REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE iNNeR[r~NCE TAX RETURN RESiDEMr oE~Dercr SCHEDULE BENEFICIARIES ESTATE OF: _ _ - - - _ FILE NUMBER: T1IELMA M. SHUGHART 2011-00523 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Dp Not List TruKee(s) Of ESTATE I TAXABLE DI5TRIBUTIONS [Include outright spousal distributlons and transfers under Sec. 9116 (a) (1.2).] 1. BEVERLY S.LEHMAN DAUGHTER 50°~ 280 BARNSTABLE ROAD, CARLISLE, PA 17015 2 VONNY L. BAILEY 19 FAIRV[EW STREET, CARLISLE, PA 17013 DAUGHTER i ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER BECKON 9113 FOR WHICH AN ELECTION TO 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. ~! If more space is need, use additional sheets of paper of the same size. 50°~ ,~ REV-1512 EX+ (12-08) ~~ ~~ pennsylvania DEPAPTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT (~i~G ~ Z SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8c LIENS ESTATE OF FILE NUMBER THELMA M. SHUGHART 2011-00523 Report debts incurred by the decedent prior to death that remaitkd unpaid at tfie date of death, induding unreimburaed medlral expenses. If more space is needed, insert addhional sheets of the same size.