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Home My WebLink About05-21-12 I ~, 1505610105 --1 REV-1500 EX (oz-it)(FI)'1~1 ~ OFFICIAL USE ONLY PA Department of Revenue pennsylvania ~~~°.H,^~^~ ~~ ^F•~~~~~ County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 + ? Harrisburg, PA iyiz8-o6oi RESIDENT DECEDENT '=-~' ~ ' I -x~ ' j C ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 10/24/2011 04/08/1992 Decedent's Last Name Suffix Decedent's First Name MI Weaver Mark H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW QD 1. Original Return O O 4. Limited Estate O O 6. Decedent Died Testate O (Attach Copy of Will) O 9. Litigation Proceeds Received O THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust.) 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) O 3. Remainder Return (Date of Death Prior to 12-13-82) O 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes O 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number «-: C-7 ~== H Anthony Adams (717) 532-32~ C> ~= ~~ .. _x. t:U =,~, ~ REGISTER QF3 i ILLS USE O1~iY ~ - t ~ ~ - ! ftii First Line of Address ~%' ~- ~ ~~ ' 49 West Orange Street - ~ _ _ `` Second Line of Address _ _ _ ~... ?~ ___ r~'-; ., G ~„ Suite 3 ~ ' ' City or Post Office Shippensburg State ZIP Code PA 17257 Side 1 1505610105 1505610105 DATE FILED ~.~~. ~_ r. Correspondents a-mail address: htadamslaw@embargmail.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and 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. ],50561,0205 REV-150(1 EX (FI) Decedent's Name: Mark H. Weaver Decedent's Social Security Number RE CAPITULATION 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. 6,432.81 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... .. 6. 10,237.75 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. 16,670.56 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 3,987.00 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. 12,683.56 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. 12,683.56 SAX 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 45 12,683.56 1B. 17. Amount of Line 14 taxable at sibling rate X .12 1 ~ 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 Side 2 i,50561,OC05 1,50561,02015 570.76 O REV-1500 EX (FI) Page 3 Decedent's Complete Address: Mark H Weaver ---_ -- STREETADDRESS 701 Shippensburg Road CITY Newville 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. File Number STATE ZIP ---~~ PA 17257 J (1) Total Credits (A + B) (2) (3) (4) (5) 570.76 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 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 far" or payable-upon-death bank account or securit 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. 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(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-iso8 EX+ (ii-io) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: 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. ~~ Ilwre space Is neeaea, use admtional sheets of paper of the same size. ' REV-15og EX+ (oi-1o) '~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY CJIAI C Ur: FILE NUMBER: Mark H. Weaver If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• Mary M. Weaver 701 Shippensburg Road, Newville, PA Mother B. C. JOINTLY OWNED PROPERTY: LETTER DATE ITEM NUMBER FOR JOIN TENANT T MADE JOINT DESCRIPTION OF PROPERLY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTERES 1. A• 10101/98 ACNB Bank account 9633154 20,475.50 50 T 10,237.75 2 TOTAL (Also enter on Line 6, Recapitulation) I $ 10,237.75 If more space is needed, use additional sheets of paper of the same size. REV-111.1 EX+ (7D-09) ~ _ pennsylvania ~~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF PILE NUMBER Mark H. Weaver 21111239 Decedent's debts must be reported on Schedule I. ITEM NUMBER _ DESCRIPTION AMOUNT _ A. FUNERAL EXPENSES: 1' Eby Granite Works (marker) 3,319.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Atldress City _ _ _ Year(s) Commission Paid: State ZIP __ _ _ 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: ~ US Treasury B Department of Revenue TOTAL (Also enter on Line 9, Recapitulation) ~ $ If more space is needed, use additional sheets of paper of the same size. ~- 81.OC> 412.06 175.06 3,987.60 • REV 1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES WIHIC Ut: Mark H. Weaver NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1~ Nelson M. Weaver 701 Shippensburg Road, Newville, PA 17241 2 Mary M. Weaver 701 Shippensburg Road, Newville, PA 17241 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal/Father Lineal/Mother 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 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. FILE NUMBER: AMOUNT OR SHARE OF ESTATE 50% 50% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE~ If more space is needed, use additional sheets of paper of the same size. ~