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Home My WebLink About05-15-12 (2).,~,," 1505610105 RE\(~ ~ ~00 EX (az ul (Fp'd!f; Y Y7 OFFICIAL USE ONLY PA Department of Revenue pennsylvanfa County Code Year File Number Bureau oflndwiduatTaxes INHERITANCE TAX RETURN , PO BOX z8o6ot zi ri o Sot $ Harrisburg PA 1.91.z8-0601 RESIDENT DECEDENT _ _ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDVYVY Date of Binh MMDDYYYY 04/02/2011 05!25/1923 Decedent's Last Name Suffix Decedent's First Name MI GOUSE WILLIAM L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Secudry Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return OD 2. Supplemental Return O 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate lax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust S. 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 Yt. Election to Tax under Sec. 9113(A) Between 12-31-91 arid 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 !_~ THOMAS E. FLOWER (717} 243-551~~ REGISTER O 1 - ~ SE ONLY I ~ `-'? uT ~`~ First Line of Address FLOWER LAW, LLC Second Line of Address 10 W. HIGH ST. City or Post Office CARLISLE Correspondent's e-mail address: State ZIP Code PA 17013 vc-. -o J ~ ~ ~„~ -p_' r O W E FILED ~-~^, rn ~`~ L)<~ ti:.; -~ i_r 'n c >, ~; _, ; ~~' m ~n Under penalties of perjury, I declare that I have examined thin return. including accompanying schedules and statements, and to the best of my knowledge and belief, is true, coned and complete. Declaration of preparer other than Ne personal representative is based on all Intormetion of which preparer has any knowledge. SIG AT E OF PERSON RESPONSIBLE FOR ILINGiiETUgN E ~ ~.LC~ G, Y~- , - Ylt~. R S f/ ~~ 381 Criswell PA 17007 FLOWER LAW, LLC, 10 WEST HIGH ST., CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 15175610105 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: WILLIAM L. GOUSE RECAPITULATION 1. Real Estate (Schedule A)...... _ .................... .............. .. 1. 5,000.00, 2. Stocks and Bonds (Schedule B) ................... ................. .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule G) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 5,000.00 9. Funeral Expenses antl Administrative Costs (Schedule H) ................ ... 9. 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ....... .... ... 10. 11, Total Deductions (total Lines 9 and 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 lax (Line 12 minus Line 13) ..................... ... 14. 5,000.00 ___ 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 5 000 00 , . at collaterel rate X .15 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 750.00 750.00 O J REV-1500 EX (FI) Page 3 Ffi• Number , f - I ~ ' h ~ ~~ Decedent's Complete Address: " ~ - DECEDENT'S NAME WILLIAM L. GOUSE STREET ADDRESS 3B1 CRISWELL DRIVE MONORE TOWNSHIP CITY STATE ~ 21P BOILING SPRINGS PA 17007 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 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. (1) 750.00 0.00 (3) 8.05 (4) 0.00 (g) 758.05 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 .................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or Its inwme ...................................... ...... ^ ionary inlerest ........................................................._.........................................._.,............... e l ...... ^ o p mise for life of either payments, benefits or wre? ................................................................ d. rece ive the ...... ^ 2. I(death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "intrust 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? ......................................................................_.......................................... .,.... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~~~ Far 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 dales 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 p2 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 benef ciaries is 4.5 pf:rceni, 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 percerrt [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. Total Credits (A+ g i (2) REV-150'2 EX+ (11.-08J `~ . °~ Pennsylvania SCHEDULE A INHERRANCE TA% RETORN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER WILLIAM L. GOUSE 21-11-0528 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market va~.ue 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 that is jointly-owned with righ! of survivorship must be disclosed on Schedule 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 One-halt interest in common in one-acre lot with hunting cabin, Abbott Twp Potter County ` subject to decedent's agreement of sale far $5,000 5,000.00 TOTAL (Also enter on Line ], Recapitulation,) I ¢ 5,000.00 If more space is needed, insert additional sheets of the same size.