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Home My WebLink About04-17-121505610105 REV-1500 ~``°~-11"~' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania oM.~E .«~~~E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN I~ PO BOX 28o6oi RESIDENT DECEDENT ~ ( V U ' ~~ I o~ Harrisburg PA i'Ji2&o6oi ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY __ _ _~. 185-24-7636 10/29/2008 ', ! 03/24/1932 __... ___ Decedent's Last Name Suffix Decedent's First Name MI Kelley _ _ _ Beatrice M _.. .........___ ................_____ __ (If Applicable) Enter Surviving Spouse's Infonnation 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 O 1. Original Retum m 2. Supplemental Retum O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) O 6. Decedent Died 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 CredR (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 ... _... __ __.... ___ 'Karen M. Balaban (7171232-3708 ,.. __ First Line of Address 223 State Street -Suit Second Line of Address PO Box 821 City or Post Office __ _. ''Harrisburg State ZIP Code PA ! 17108 . '7- , _ , REGISTER O~.S USE Of~ ~ `~ ~ -~J 3L.3.~,~ ~ ~J -~ '1 .. DA~ FILED -"' _~ ~r1 r-r T`7 r~7 ". J ~ J 't3 i ,,. .::i ,_ -'~_~ _ -,-i T L~ Q "'t"1 Correspondent's a-mail address: KMBalaban BalabanLLC.com Under penalties of perjury, i dedare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corned and cpmplete. Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE F PERSON RESPONSIBLE FOR FILING RETURN DATE ~,,,,,~ ~ 04/16/2012 ADDRESS PO Box 821, Harrisburg, PA 17108-0821 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 REV-1500 EX (FI) Decedent's Name: Decedent's Social Security Number 185-24-7636 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. ii, 3,981.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. __.,.,.~~,,.~_,,, ~T ........_.,• _ _, _--. 7. Inter-Vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. ' 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 3,981.00 9. Funeral Expenses and AdminisVative Costs (Schedule H) ................... 9. ' 215.00 ', 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. ! 215.00 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 3,766.00 ', 13. Charitable and Governmental BequestslSec 9113 Trusts for which ` °'µ" ~° 13 -- ---_.. _,.._ _.._._. _. . _ . 3 766 00 an election to tax has not been made (Schedule J) ........................ . , . 14. Net Value Subject 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. 16. Amount of Line 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 ' ' 18. ', 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O 1505610205 Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 Decedent's Complete Address: Beatrice Kelley ----- --__ STREETADDRESS 28 Country Club Road West clTv Camp Hill Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 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. 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. Flle Number STATE Zlp PA 17011 (1) Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Dld 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 payments, benefits or care? ........................................................... ^ ........... 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............. . 3. Did decedent own an "in trust for" orpayable-upon-death bank t accoun or security at his or her death? .............. 4. Did decedent own an individual retirement account, annuity or other non-probate property, which ^ contains a benefiaary designation? ........................................................................................................................ ^ 0.00 0.00 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 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 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 [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 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 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent, except 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 common with the decedent, whether by blood or adoption. REV-15o8 EX+ (11-io) ~ ; Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Beatrice M. Kelley 2008-01112 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 :Cash (4/13/12 obtained from East Pennsboro Police Dept) 3,981.00 TOTAL (Also enter on Line 5, Recapitulation) $ 3,981.00 If more space is needed, use additional sheets of paper of the same size. REV-1517. EX+ (10-09) ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Beatrice M. Kelley 2008-01112 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: _ _ L B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 200.00 2. Attorney fees: 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: 5. Accountant Fees: 6. Tax Return Preparer Fees: ~• Supplemental Inheritance Tax return filing fee 15.00 TOTAL (Also enter on Line 9, Recapitulation) $ 215.00 If more space is needed, use additional sheets of paper of the same size. LAW OFFICE OF KAREN M. BALABAN LLC L ion 223 State Street Suite 200 Harrisburg, PA 17101 DIRECT DIAL 717.232.3708 Mailing Address P.O. Box 821 Harrisburg, PA 17108-0821 Register of Wills 1 Courthouse Square Room 102 Carlisle, PA 17013 KMBalabanCcilBalabanLLC. com October 25, 2011 RE: Estate of Beatrice M. Kelley, Deceased File No. 2008-01112 To Whom it may concern: Enclosed please find a supplemental inheritance tax return to report additional cash recently disclosed by the East Pennsboro police department. Since the sole heir is the Cumberland County library system, no inheritance tax is owed. Respectfully yours, Karen M. Balaban n ~., ~:r ~?3 ~ Sr.. ~ ~ , Cr• - ~ - '^. G --- . - i_ - 7 ,- :..L7 - - _y _ ~..•` `~ ~' _-~„ r ~ f ~` ~. ~!~ .. ~' N 7r 1 i ~ e _p t ~. P n, ,• t~ _) p ~,~ _. t..,_. ~ _ _..:. ~--- ~- _ _ _ ~_ - 4ti C) C:: ~=- ~ ~- f'" , , ~ cn cx_ -~-• O _ U r- N O ~r-O Rl~yr ~ ~ ~ m m ~ Dl ~. A. .-. .~ C7" O O c`1 ~ ~ O O ~U~ _M O a N .--~ .,. U