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Home My WebLink About04-27-121505610145 REV-1500 ~``°'-'°' PA Department of Revenue pennsylVania OFFICIAL USE ONLY Bureau of Individual Taxes DEP~RTMENTOFREVENUE County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN ~ ~ ~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~--' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 08022007 10061937 Decedent's Last Name Suffix Decedent's First Name MI Jones Kay A (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 BOXES BELOW 0 1. Original Return 0 2 Supplemental Retum . 0 3. Remainder Retum (date of death 0 4. Limited Estate 0 prior to 12-13-82) 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Retum Required death after 12-12-82) Q 6. Decedent Died Testate Q 7 Decedent Maintained a Livin T t ~ (Attach Copy of Wiil) . g rus 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 0 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death Q 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 Robert G. Frey 7172435f~3R First line of address 5 South Hanover Street Second line of address City or Post Office State ZIP Code Carlisle PA 17013 REGISTER OF. USE ONL~!r ` ~ ~. r J Y ~ ~? r~ ~ ._ ~ ~ y D~ FILED C_~ '~`1 ~ l l~1 -;~;; ~~ "~ - _._ . __ _a_~ r-- %-T7 ~•O ~ >> Correspondent's a-mail address: rf rey@f reyt i ley . com Under nalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my true_ ct and complete. Dedaration of preparer other,Ntan the personal representative is based on all information of which preparer has anv ~'b ilur:t ~r rtrclSON RESPON,Sf¢LE FOR FIKING RETURN 555 Mount Road Road, Newville, PA 17241 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS 5 South Hanover Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 DATE 03/30/11 L 1505610145 1505610145 J -- - - _ _ -- J 1505610245 REV-1500 EX DecedenCs Name: j{a ~T A Jones Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) ........................................ ... 1. NONE 2. Stocks and Bonds (Schedule B) ................................. . . ... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. NONE 4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4. NONE 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... .. 5. NONE 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested ...... .. 6. 1115 6 O O 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) Separate Billing Requested ...... .. 7 9 7 54.0 0 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 121314.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. NONE 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ..... . ...... . 10. NONE 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 0 , 0 O 12. Net Value of Estate (Line 8 minus Line 11) ............................ . 12. 121314.0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... 13 0 • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) 14 121314 0 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 19. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 0 121314.0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X 0 4 5 17. . Amount of Line 14 16. 0. 0 0 18. taxable at sibling rate X • 12 Amount of Line 14 taxable 17. 0 . 0 0 at collateral rate x , 15 18. 0 . 0 0 19. TAX DUE ............................................ 19. 0 . 0 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 L, 1505610245 1505610245 J REV-1500 FJC Page 3 File Number 161-34-4450 Decedent's Complete Address: 21-os-o4as DECEDENT'S NAME STREET ADDRESS CITY Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest (1) 0 00 Total Credits (A + B) (2) 0 00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (3) (4) 0 00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 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 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 Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................................. ^ 3. Did decedent own 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? ........................ X 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 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 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. STATE ZIP 217 REV-S5Gb EX+!o-9E) COMMONWEALTH OF PENNSYLVP,NIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kav A Jones SC~iEDC~~,E F JOINTLY-OWNED PROPERTY FILE- NUM .,, ~ I'VO-VV40L1 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Donald G. Jones 555 Mount Rock Road, Newville, PA 17241 Spouse B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ITEM FOR JOINT NUMBER TENANT MADE INCLUDE NAME OF FINANCIAL. INSTIMION AND BANK ACCOUNT NUMBER OR SIMILAR JOINT IDENTIFYING NUMBER ATTACH DEE % ~F DATE OF DEATH DECD' DATE OF DEATH . D FOR JOINTLY-HELD REAL ESTATE. S VALUE OF 1 • A. 7/14/98 555 Mount Rock Road, Newville, PA 17241 VALUE OF ASSET INTEREST DECEDENTS INTEREST 223,121 50.00% 111,560 0 0 0 0 0 0 0 0 0 0 0 ' 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 TOTAL Also enter on line 6, Reca itulation) ~ (If more space is needed, insert additional sheets of the same size) 111 z1. REV-?510 EX--(6-9&) ~~~~~_ _~~ CDIviMONWEALTHOFPENN'SYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAXRETUP,N MISC. NON-PROBATE PROPER i Y RESIDENT DECEDENT CCTATG nr FILE NUMBER Ka A Jones 21-08-00488 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-15D0 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDEMAND THE DATE OF DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPP~ICABLEI VALUE 1. Annuity through Pension Board of United Church of Christ 9,754 100.00% 0 9,754 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0. 0 0 0 0 0 0 0 0 0 0 0 TOTAL Also enter on line 7 Reca itulation $ (If more space is needed, insert additional sheets of the same size) 9.7 P.EV-1513 EX+(11-08) p~rrt~yfv~naa DEPARTMENT OF REVENUE INHERITANCE 7AX RETUP,N ESTATE OF Ka A Jones NUMBER I. ~C~E~C~LE ~ BEt~EFlCl.4RIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Do Not List Trustee(s) Sec. 2116 (a) (1.2).j FILE NUMBER 21-08-00488 AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. Donald G. Jones, surviving spouse, 555 Mount Rock Road, Newville, PA 17241 100% B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. If more space is needed, insert additional sheets of the same size. ~ 1