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Home My WebLink About04-20-12 J 1505610105 REV-1500 tx t°z", tFt, ` OFFI(:IAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~I ~ I ~ ~\ ~~ Po Box z8o6ot RESIDENT DECEDENT ••I 1 (J Harrisburg, PA 171z8-o6ot ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth PAMDDYYYV 11/09/2011 04/18/1916 Decedent's Last Name Suffix Decedent's First Nante MI BOONE MARY I (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffiz 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 O 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 :i. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ i3. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poveny Credit (Date of Death O 1 I. 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 TO: Name Daytime Telephone Number MARILYN SHEARER (717) 697-1686 First Line of Address 924 WEST TRINDLE RD Second Line of Address City or Post Office MECHANICSBURG State ZIP Code PA 17055 REGISTER OF WILLS USE ONLY C'> r--o ~O rU ~~n ~ Zrn ~i cfi ~ tV0 J C7:7 DATDy1E0'~ xn '2', ~D n t.~ ,-1r17 ~~ `r =, „- ; ' ri "= C 7 r_ ITI :.rD Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules antl statements, antl 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. 'MGNAiURE OAF PERSON-jtESPONSB~FAR91~91G RETURN' `' / DAT VVII ~A ~ /~ /"~ 924 WEST TRINDLE RD, MECHANICSBURGH, PA 17055 SIGNA~FI~iC~-YRtYHtttt%LJintn l/rn~rtvr'rttaovwiivt ,/ ~~ 5128 ERBS BRIDGE ROAD, MECHANICSBURG, PA 17050 PLEASE USE ORIGINAL FORM ONLY L 1505610105 Side 1 1505610105 J`~\ I~°' 1505610205 REV-1500 EX (FI) Decedent's Name: Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 2. Siocks and Bonds (Schedule B) .................................... ... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages antl Notes Receivable (Schedule D) ........................ . . . 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 4,205.48 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8, 4,20$.48 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. $,304.26 10. Debts of Decetlent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 8,304.26 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 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 1g, 19. TAX DUE ....................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 O J ~- REV-1500 EX (FI) Page 3 Decedent's Complete Address: MARYIBOONE STREET ADDRESS 924 W TRINDLE RD MECHANICSBURG Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2, Credits(Payments A. Prior Payments B. Discount 3. Interest File Number ZIP PA ~ 17055 (1) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Lino 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A+ ES) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. ~,;r¢ l s, 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 income ...................................... ...... ^ c. retain a reversionary inlerest ........................................................................................................................ ...... ^ d. receive the promise for life of either payments, benefits or rare? ................................................................ ...... ^ 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, whictl 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, a:?: ii; , For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of tnsnsfers to or for the use of the surviving spouse is 3 percent j72 P.S. §9116 (a) (1.1) {i)J. 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) (Lt ] (ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the sta4utory 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 adaptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)J. • 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 j72 P.S. §9116(a)(1)]. • The lax 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 al least one parent in common with the decedent, whether by blood or adoption. REV-i5og E%+ (maD) fl7 pennsylvania fi7 OEPPRTMENT OF PEVENUE /NHERITANCE TA% RETURN 0.ESIDEM DECEDENT SCHEDULE F 70INTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: MARYIBOONE If an asset became jointly owned within one year of the decedent's date of death, it must lx reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. MARILYN L SHEARER 924 W TRINDLE RD, MECHANICSBURG, PA 1'7055 DAUGHTER B. C. JOINTLY OWNED PROPERTY: REM NUMBER LEr1ER FO0. JOINT TENANT DATE MADE ]DINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSnTUTIDN AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DALE OF DEATH VAL11E OF ASSET ~ of DECEDENT'S INTEREST DATE of DEATH VALUE OF DECEDENT'S INTEREST 1. A . 04123/83 SOVEREIGN BANK ACCOUNT 2331032939 8,410.95 50 4,205.48 TOTAL (Also enter on Une 6, Recapitulation) I ¢ 4,205.48 [f more space is needed, use additional sheets of paper of the same size. REV-1571 EX+ (10-09, SCHEDULE H "'> Pennsylvania DEGARTMrNT DE REVENUE rrvraEwTarvcE rnx R>=ruaN RESIDENT DECEDENT FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' SECUR CHOICE 6,738.00 2 LUNCHEON 301.26 3 HEADSTONE 1,265.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions; Name(s) of Personal Representative(s) Street Address GtY _.. .... ___.-- State ..._ TIP Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exempflon: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City i_ ____ ____ State _ ZIP Relationship of Claimant to Decedent 4. Probate Fees: S. Acrnuntant Fees: B• Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) $ 8,304.26 If more space is needed, use additional sheets of paper of the same s ~e