HomeMy WebLinkAbout04-17-121505610140
REV-1500 ~` ~°'-'°'
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO Box 280601 2 1 1 1 0 8 3 1
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Securityy Number Date of Death tvIMDDYYYY Date of Birth A~ADDYYYY
1 8 9 3 0 4 9 0 5 0 7 2 6 2 0 1 1 0 5 1 0 1 9 3 9
Decedent's Last Name Suffix Decedents First Name MI
C R O C H U N I S MAR Y A N N E K
(If Applicable) Enter Surviving Spouse's Ir>formation 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
a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
pnor to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
8. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. 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 T0:
Name Daytime Telephone Number
C H A R L E S E P E T R I E 7 1 7 5 6 1 1 3 9
First line of address
3 5 2 8 B R I S E A N S T R E E T
Second line of address
City or Post Office
H A R R I S B U R G
State ZIP Code i
P A 1 7 1 1 1
REGISTE WILLS U36QNLY i
N i
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Correspondents e-mail addrBSS:
Under penalties of perjury, I declare that t have examined this return, including accompanying schedules and statements, and tD the best of my knowledge and belief,
it is true, correcx arni complete. Declaration of preparer other than the personal representative is based on aII information of which preparer has any knowledge.
---- -- -
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 J
SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE DATE
150561D240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: MARY ANNE K. CROCHUNIS 1 8 9 3 0 4 9 0 5
RECAPITULATION
1. Real Estate (Schedule A) ........................................... 1. 1 2 3 9 2 6. 0 2
2. Stocks and Bonds (Schedule B) ...................................... 2. •
3. Closely Hekt Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Notes Receivable (Schedule D) .......................... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6 1 4 0 9 2 . 9 6
6. Jointly Owned Properly (Sd~edule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property
(Schedule G) ~ Se
ar
te Billin
R
t
d
7
g
.......
p
a
eques
e .
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 7 3 8 0 1 8 . 9 8
9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 1 7 2 5 1 6 0
10. Debts of Decedent, Mortgage Liabilities, and liens (Schedule 1) ............. 10. 3 4 2 3 . 6 5
11. Total Deductions (total Lines 9 and 10) ............................... 11. 2 0 6 7 5 . 2 5
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 7 1 7 3 4 3 . 7 3
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. 7 1 7 3 4 3 . 7 3
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. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 7 1 7 3 4 3. 7 3 16. 3 2 2 8 0. 4 7
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18. 0. 0 0
19. TAX DUE ......................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
3 2 2 8 0. 4 7
Side 2
L 150561D240 150561D24D J
REV 1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
DC E
MARY ANNE CROCHUNIS
STREETADDRESS
4608 S. CLEARVIEW DRIVE
CITY
CAMP HILL STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditsJPayments
A. Prior Payments 33,000.00
B. Discount 1,650.00
(1) 32,280.47
Total Credits (A + g) (2) 34,650.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
FIII In oval on Page 2, Llne 20 to request a refund., (4) 2,369.53
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
Make check payable to: REGISTER OF WILLS, AGENT.
PLEA$E 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 properly 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 owd 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 property, which
contains a beneficiary designation? ........................................................................................................................ ^ ~
I~ 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 requinments 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 decedent's lineal beaefiaaries 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 indvidual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 FJ(+ (01-10)
Pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
MARY ANNE K CROCHUNIS 21 11 0831
Ail real property owned sol~y or as a tenant in common must be reported ~ fair market value. Fair market value is defined as the price at which property
would be exchanged ter a willing twyer and a willing seller, neither being compelled to twy or sell, both having reasonable knowledge of the relevant facts.
(teal DroDert,- ilat is bintlv-owned wNh rinht of wrvivorshia must be disclosed on Schaduk F.
Attach a copy of the settlement sheet if the property has been sdd.
ITEM Indude a copy of the deed showing deoedenYs interest if owned as tenant in oanmon. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
REAL ESTATE AT 4608 S. CLEARVIEW DR
EAST PENNSBORO, PA
SEE ATTACHED SETTLEMENT SHEET
TOTAL {Also enter on Line 1, Recapitulation.) ~ ;
123, 926.02
ff move spade is needed, use addl~'onal sheets of paper of the same sine.
Ar. ~ettle~8nt ~ta~~rient (HUt~~1)
OMB Approval Na 26029
FINAL
1. ~ FHA 2. ~ kH8 8. ~ GoM. Unina. . File ~ . ~°°n hlum ortdia~ 111a11ran0e bet;
1107$6pC 151007812p
4. [~ VA S. ^ Conv. lna, v ''
a wqe~ aem w 8utlahae 1o you a ~ amiai sMOBnw~t slats. Amanb 1o ants bYth...arhiwt IpatMa an ahoert~. Mwen merimd
'~.odf walb pakf Wailes ess eWalta ~ ae shown lots for Yeamatlond putpoarr oxf ae not inciud~d in C~i 1aiYls.
D. Wtbne & AtfdreM of Botrwrel:
8o6CA. Palir. Retieoa t.1~'af~er
42 l3aMoRw Road CetoP N4 PA 17011 E• Name & Addrea o1 Seller.
Fie d !vary Ame K Cnxlrmfr, Rabat W.
Clbohatk, ExieiAot
48~ Si Cbwlalr ~0. Camp ffi4 PA 17011 ~. NaAt6 f4 Addreee of Lelndar:
~ralbtiric
8100 NeBuis VMaI; Jackaaw~rt FL 37258
6. Ptopelly Loce>torc
X08 3. geeirvi0rr lkive
Camp HAI, PA 17011
Hampden Towrnshlp H. Sewement Apaht
l3urdyn Tralaifar Carpntiga-
X073 AferkaR 8L. Camp t11f, PA 17011
717$1440p8 i. 3Mdsmint Da1e:1 Y102011
DiabUrasmant llete:l'Y108011
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NamA ai Belip~r;
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1104.tsrddslgeiauarres-TNkRaaereestQb'l>IlbRaeoretes 1,1Y6.76
1,190.70
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DATE
WARNINQ R t8 A CRNE TO MalO1NIN~3lY NIAIQr fALBE STATEMENT8 T'0 THE UNITED BTATES ON TH18 Olt ANY 81AMLAR FORbL PEMALTIEB UPON
CGNVICTION CAN INCLUDE A FINE AND BrPRISONNEN7'. FOR O@7An.8 8EE TITLE 1& U.B. CODE SEC'110N 1001 AND sE~CTION 1010.
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REV-1508 EX ~ (8-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC.
INHE ~E ~E~~EpR MRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
MARY ANNE K. CROCHUNIS 21 11 0831
include the of Ntlgatlor- end the date the pr0o~dg were received by the estate.
Alt properyl ~C~il w~h of eurviirorship must bs disclosed on Scdledule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. IDEAL FINANCIAL CENTER 27,032.30
CONTRACT N0.8500232573
2. IDEAL FINANCIAL CENTER 200,558.18
CONTRACT NO. 8500234740
3. IDEAL FINANCIAL CENTER 386,502.48
CONTRACT NO. E0412958
TOTAL (Also enter on lime 5, Recapitulation) ~ s
(ti more space is needed, avert edd'dionel sheets of the same size)
REV-1511 (,(+ (10-09)
Pennsylvania
DEPARTMENT QF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE tJF FILE NUMBER
MARY ANNE K. CROCHUNIS 21 11 0831
Decederris debts must be reporbd on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. NEILL FUNERAL HOME 11,117.23
2. FLOWERS 305.00
3. LUNCHEON 286.30
4. GINGRICH MEMORIALS 270.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
tine(s) of Persorml Represerdative(s) WAIVED
Street Address
City State ZIP
Year(s) Canulrssion Paid:
2_ AttomeyFees: CHARLES E. PETRIE
3, Family Exemption: (tf deoeder>rs address is not the same as daimarrYs, attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Clafmant m DeDedent
4. ~ Probate Fees:
5. Accourrlant Fees:
6. Tau Return Preparer Fees:
7. EXECUTOR TRAVEL EXPENSES
8. TRASH
9. LAWN CARE
10. HOME REPAIRS NEEDED FOR SALE
11. HANDYMAN
1,000.00
312.50
470.36
300.00
290.00
1,100.21
1,800.00
TOTAL (Also enter on Line 9, Recapitulation) I i 17,251.60
H mare space La needed, use adder sheets of paper of the same sine.
REV-1512 FJ(+ (12-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
MARY ANNE K. CROCHUNIS . ___ _ 21 11 0831
Report debt incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2011 2012 SCHOOL TAXES 1,178.81
2. COMCAST 145.33
3. PPL ELECTRIC 793.73
4. UGI UTILITIES 46.07
5. WATER 72.66
6. VERIZON 98.49
7. SPRINT 90.73
8. HACC MEDICAL INSURANCE gg7.83
TOTAL (Also enter on Line 10, Recapitulation) I =
ff Wane space is needed, insert additional sheets of Use same size.
REV-1513 EX+ (Ot-10)
Pennsylvania ~ SCHEDULE J
DEPAR7I~AEN7 OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE ~: FILE LIMBER:
MARY ANNE K (:RC](`HI INIC ~~ ~ ~ nQ~~
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 pndude qq~~ggM disb~utlola and transfers under
Sec.91~6(a (1.2).]
1. ROBERT CROCHUNIS Lineal 717,343.73
5629 AIKEN ROAD
MCKEES ROCKS, PA 15136
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OFPART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ;
rr more space Is neeaea, use aaamona sneers a paper a me same size.