HomeMy WebLinkAbout03-23-12J REV-1500 Ex(°'-'°' 1505610143
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
Po Box.zaosol INHERITANCE TAX RETURN 21 11 0 0 9 0 7
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
187 12 7879 05 26 2011 O1 19 1921
Decedent's Last Name Suffix Decedent's First Name MI
DAHL LENA
(If Applicable) 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 IN APPROPRIATE OVALS BELOW
® 1. Original Return ^ 2. Supplemental Return ^ 3_ Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
^ g Decedent Died Testate
(Attach Copy of Wilq ^ ~ Decedent Maintained a Living Trust 8. Total Number of Safe De osit Boxes
(Attach Copy of Trust) P
^ 9. Litigation Proceeds Received ^ 1 p, 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 CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
Daytime Telephone Number
ROBERT P KLINE 717 770 2540
First line of address
714 BRIDGE STREET
Second line of address
PO BOX 461
City or Post Office
NEW CUMBERLAND
State 21P Code
PA 17070
REGISTER OF WILLS USF,.QNLY
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Correspondent's a-mail address:
Under penalties of perjury, I declare that 1 have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU PERSON RESPON OR NG R UR DATE
Charles R. Dahl „~ /~" ~
ADDRESS
31 venue, New Cumberland, PA 17070
SI NATURE OF P PAR OT TH REPRESENTATIVE DATE
Robert P Kline )5 ~~~ ~c : )2
ADDRESS
714 Bridge Street, New Cumberland, PA 17070
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Name: D A H L, LEN A
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 & Notes Receivable (Schedule D) .................................................... ...... 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............ .... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .......... ... 6.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested .......... ... 7.
8. Total Gross Assets (total Lines 1-7) ................................................................. ...... 8.
9. Funeral Expenses & Administrative Costs (Schedule H) .................................... ..... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........................... ..... 10.
11. Total Deductions (total Lines 9 & 10) ............................................................... .......11.
12. Net Value of Estate (Line 8 minus Line 11) ....................................................... ......12.
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.
- - __
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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 12 8, 5 9 4. 2 6 16.
17. Amount of Line 14 taxable
at sibling rate X ,12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due ............................................................................................................. ......19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Decedent's Social Security Number
187 12 7879
133,800.00
2,646.94
136,446.94
7,637.33
215.35
7,852.68
128,594.26
128,594.26
5,786.74
5,786.74
Side 2
1505610243 1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 11 - 00907
Dahl, Lena
- ---
STREET ADDRESS
317 Fifth Avenue
~'~ ~ T ~~ STATE ~ ZIP
New Cumberland PA 17070
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 5,786.74
2. Credits/Payments
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.
Check box 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.
0.00
0.00
(4)
(5) 5,786.74
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 :.................................................................................[] [x]
b. retain the right to designate who shall use the property transferred or its income :.................................... ~ ]x
c. retain a reversionary interest; or ...............................................................................................................~ x]
d. receive the promise for life of either payments, benefits or care? ..............................................................~ [X]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .....................................................................................................................~ ~x]
3. Did decedent own an "in trust for° or payable upon death bank account or security at his or her death?......... [_] [x~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which _
contains a beneficiary designation? ...................................................................................................................:. ] i x I
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR
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 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 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 beneficiary.
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 ears 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 0 percent [72 P.S. §9116 (a) (y.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 percent, except as noted in
72 P.S. §9116 1.2) [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 1.2 percent (72 P.S. §9116 (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 bloo~or adoption.
Total Credits (A + B) (2)
(3)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
ESTATE OF Dahl, Lena 21 - 11 - 00907
All real property owned sole)y or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 317 Fifth Avenue, New Cumberland, Cumberland Co. (Parcel # 25-24-0811-085) 133,800.00
TOTAL (Also enter on Line 1, Recapitulation) ~ 133,800.00
SCHEDULE E ~'
CASH, BANK DEPOSITS, 8~ MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Dahl, Lena ~ 21 - 11 - 00907
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1 Fulton Bank #3629-44223
DESCRIPTION VALUE AT DATE OF
DEATH
2,646.94
- -- -
___ __
TOTAL (Also enter on Line 5, Recapitulation) 2,646.94
SCF~DULE H
COMMONWEALTH OF PENNSYLVANIA ~ ~ '
INHERITANCE TAX RETURN Ar1A~w~CTpAT1~/L ^/'~'T~
RESIDENT DECEDENT /"LLAr~~rJ ~ f`F\ ~ ~YG Wv7 ~ ~7
ESTATE OF Dahl, Lena ~ FILE NUMBER
21 - 11 - 00907
Debts of decedent must be reported on Schedule I.
ITEM - _ _ _- _
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
_ Y N - -- - _~_ -- __ --
A. 1 Stone & Murra Funeral Home, ew Cumberland, PA 17070 ~ 3,816.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
I
Street Address
Clty State Zip
Year(s) Commission paid
2. ~ Attorney's Fees Kline Law Office ~ 2,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 327.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 UGI
34.70
--
- -- -. __
TOTAL (Also enter on line 9, Recapitulation) 7,637.33
Schedule H p
COMMONWEALTH OF PENNSYLVANIA Funeral «
INHERITANCE TAX RETURN /QC~1'1111~'~V@ L`~~ ~~~~
RESIDENT DECEDENT _~
ESTATE OF Dahl, Lena FILE NUMBER
_ ~1 - 11 - 00907
-- - - -
-- --- --
2 PPL -~- _--- 77.64
3 ~ New Cumberland Borough 195.10
4 Robin Gasperetti, tax collector 1,124.39
5 Recorder of Deeds 62.00
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COM NHER`rcnNCEOTAX RETURN ANIA LIABILITIES, & LIENS
RESIDENT DECEDENT ~~,
FILE NUMBER
ESTATE OF Dahl, Lena 21 - 11 - 00907
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Simmons First National Bank#4610-0015-2164-5962 103.61
2 West Shore EMS 111.74
TOTAL (Also enter on Line 10, Recapitulation) I 215.35
REV-1513 EX+ (11-06)
SCHEDULE J
COM NHERV11TANCEOTAXRETURNANIA ~ BENEFICIARIES
RESIDENT DECEDENT R
ESTATE OF Dahl, Lena
NUMBER ~, NAME AND ADDRESS OF PERSON(S)
RECEIVING PROPERTY
I~ TAXABLE DISTRIBUTIONS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Charles R. Dahl
317 Fifth Avenue
New Cumberland, PA 17070
I~ FILE NUMBER
_ 21 - 11 - 00907
RELATIONSHIP TO j SHARE OF ESTATE AMOUNT OF ESTATE
DECEDENT (Words) ~($$$)
Do Not List Trustee(s)
Son
ALL
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate.
III NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHE T 0.00
P-f01-CP-Warrnntr Dad-Short Form-Aet 1909•-Amn9ad !or PLoto-Beootdlne ~O~V~
Hears Hall. ine.. Indlaaa, Pa. I~ ~ r~r~E
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MADE THE 25th day of October in the year
of our Lord one thousand nine hundred sixty-three ( 1963 )
BETWEEN WILLIAM J. GOIIFFER and JESSIE V. GOII~'FER, his wife,
of the Borough of New Cumberland, County of Cumberland
and State of Pennsylvania, parties of the first part,
Grantors ,
and EDWIN F. DAHL and LENA F.
Borough of New Cumberland,
and State of Pennsylvania,
part,
DAHL, his wife, of the
County of Cumberland
parties of the second
Grantees :
WITNESSETH, that in consideration of Ten Thousand Five Hundred and No/100
in hand ( X10, 500.00 ) Dollars,
paid, the receipt whereof is hereby acknowledged, the said pmntor s do hereby grant
and convey to the said grantees, their heirs and assigns,
ALL that certain piece or parcel of land situate in the Borough of
New Cumberland, County of Cumberland and State of Pennsylvania,
more particularly bounded and described as follows, to wit:
BEGINNING at a point at an iron pin on the line of the western
edge. of.Fifth Avenue, formerly Chestnut Avenue, being 30 feet in
a southerly direction by same from Locust Avenue; thence South
25 degrees 1~7 minutes West by the western line of Fifth Avenue
60.51} feet to the northern line of a 10 feet wide alley; thence
North 57 degrees 52 minutes West 187.92 feet by the northern line
of a 10 feet wide alley to the eastern line of a 10 feet wide
alley; thence North 35 degrees East by the eastern line of a
10 feet wide alley 10.79 feet to a point at a stake at the southern
line of Lot No. 39 on the hereinafter mentioned Plan of Lots; thence
South b1~..degrees 3 minutes East by the southern line of Lot No. 39
180.3 feet to the point and place of BEGINNING. _.
BEING Lots Nos. 1}0 and 1{.1 on Plan of Keebaughs, Addition to
New Cumberland, as recorded in the Cumberland County Reeorder~s
Office in Plan Book 1, Page 6.
HAVING thereon erected a two and one-half story frame dwelling
with. detached frame garage known as No. 317 Fifth Avenue.
BEING the same premises which Pearl G. Berg by her deed dated
October 2, 191~Ja_ and recorded in the said Rerorderts Office in
Deed Book 12-W, Page 119, granted and conveyed unto the Grantors
herein.
Schsel lat. CdrT,G. CD. Pa. Boraogh. rr.
fta . C a.
1% RcslEstzte Transfer Tax lqa Beal s tote Transfer Taa
Dat Amt. ~G Dzta/c .ir-i -~ ~'.mt. S`.7.J U
AND the said grantors , do hereby canvenant that they w~.11 WARRANT Severally
the property hereby conveyed.
IN WITNESS WHEREOF, said grantor s ha'Pe hereunto set their hands and seal s
the day and year first above written.
~EgnsD, ~FealeD ana ~stixix+reb ~' ~!/[/ s ss~ex.
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State of PENNSYLVANIA )
County of '~ ) ss.
~ ~'~~ the -'ZY: day of )) Oeteber 19 63, before me,
a Notary Public, `2'~ -
the undersigned offacer, personally appeared WILLIAM J, GOUFFER and JESSIE V.
GOUFFER, his wife,
known to me (or satisfactorily proven) to be the persons whose name s are subscribed to the
within instrument, and acknowledged that they executed same for the puq~est~'therein
contained. ,
IN WITNESS WHEREOF, I hereunto set my hand and o,~cEai~~s//~°/~/y,r,,~~'~+ '~ ~ `~ ~ ~ ~ ~ ~ • ~ yr~,~'.
~'~~~~q~ti~ NOTARY ~IiBR.~''~~ , r
My Commdssion Exbins SeQt; I~~t~• ~y
Aew Eiim3eitie~'--- "~' - ------,----
RECORDED-0FfICE OF THE 1~ ;`
RECORDER OF DEEDS + ~ ~ .!''~~
.......,.~1~"
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g1MBERUN-y'"COUNTt
F'ENNS VANIA
do hereby eertif y that t e precise residence and comp post o,~ee address
of the within med grantee •ES 317 `(~ CiE,.t..,.~ ~ 1'~"~`~~^-~
~~`- ~ 5 19 6 3
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RECORDED on this__- __-p`/~ _~/,~ „-?-~={-~'
A. D. 1~9_f2~ in the Recorder's o
.ice of the said Co
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Given under my hand and the seal of the said
e, the date above +vritten.
-~-_ ,Recorder.