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HomeMy WebLinkAbout06-13-121505610140 REV-1500 EX (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 ( (~ ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 2 2 8 2 0 1 2 0 4 1 9 1 9 4 5 Decedent's Last Name Suffix Decedent's First Name MI S H E A F F E R J R R A L P H L (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 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. 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 TO: Name Daytime Telephone Number R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3 First line of address I R W I N & Second line of address 6 0 W E S T City or Post Office C A R L I S L E REGISTER OF WILLS US~NLY n ~ f` ^ N ~ -., ~ 1 ~. r'~ c ~ r.r ..; M c K N I G H T~~ _... -- P C ~~ : ~-~ CJ ~-; , 7~ r^~~ P O M F R E T S T R E E T ~'~~ ~_ - ~~ _ State ZIP Code ' D _ FILED a P A 1 7 0 1 3 e.~ Correspondent's a-mail address: :~'? ~~ ~:-~ ;,, ~~ - r, r`T'1 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. SI NATUR OF PERSON RESP/O~N_SIBLE FOR FILING RETURN DATE ~i L1/if~2. ~3~1 /~ L ADDRESS 3454 SPRING ROAD CARLISLE PA 17013 SIGNATURE PREPARER OTHER THAN R RESENTATIVE DATE ADDRESS ~~ 60 WEST P M RET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J J 1505610240 REV-1500 EX Decedent's Name: RALPH L- $HEAFFER~ JR Decedent's Social Security Number RECAPITULATION 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. 8 2 1 4. 0 7 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ...... . 6. 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property ~ Separate Billing Requested ...... G . 7. ) (Schedule 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 8 2 1 4 . 0 7 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9• 3 1 2 7 . 0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10. 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 3 1 2 7. 0 0 12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12• $ 0 8 7 . 0 7 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. 5 0 8 7 . 0 7 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15. 0. 0 0 (a)(1.2) x.o _ . 16. Amount of Line 14 taxable 5 0 8 7. 0 7 ts 2 2 8. 9 2 at lineal rate X .045_ . 17. Amount of Line 14 taxable 0 0 0 17. 0 • 0 0 at sibling rate X .12 18. Amount of Line 14 taxable 0 0 0 18 0 • 0 0 at collateral rate X .15 19. 2 2 8. 9 2 19. ................................. TAX DUE .............. ..... .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610240 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME RALPH L. SHEAFFER, JR STREET ADDRESS 3454 SPRING ROAD ciTv CARLISLE Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 11 45 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 21 12 0 STATE ZIP PA 17013 (1) 228.92 Total Credits (A + B) (2) 11.45 (3) (4) 0.00 (5) 217.47 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; ....................................................... ^ ^ X .............. b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^ X c. retain a reversionary interest; or ................................................................................................ d receive the romise f lif f i h ^ 0 . p or e o e t er payments, benefits or care? ............................................... ^ O ........ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................... ^ 0 ........ 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... ^ Q 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................. ^ 0 ................................ 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. REV-1508 EX+ (11-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY RALPH L. SHEAFFER JR FILE NUMBER: 21 12 0 Include the proceeds of litgation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 7• SOVEREIGN BANK -CHECKING ACCOUNT 2.2005 CHEVY IMPALA TOTAL (Also enter on Line 5, Recapitulation) If more space is needed, insert additional sheets of paper of the same size VALUE AT DATE OF DEATH 4,214.07 4,000.00 8,214 REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS wiAitvr FILE NUMBER RALPH L. SHEAFFER JR 21 12 0 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT 1. EWING BROTHERS FUNERAL HOME 2,362.00 B• ADMINISTRATIVE COSTS: 1 • Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address Cry State ZIP Year(s) Commission Paid: 2. AttomeyFees: IRWIN & McKNIGHT, P.C. 750.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State Zlp Relationship of Claimant to Decedent 4• Probate Fees: 5. I Accountant Fees: 6. I Tax Retum Preparer Fees: 7. I REGISTER OF WILLS -FILING FEE I 15.00 TOTAL (Also enter on Line 9, Recapitulation) I S 3 127 If more space is needed, use add~6onal sheets of paper of the same size. REV-1513 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES w~r~~~ Vr: RALPH L. SHEAFFER, JR NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).J 1. RALPH L. SHEAFFER, III CARLISLE, PA 17013 FILE NUMBER: 21 12 0 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Lineal AMOUNT OR SHARE OF ESTATE 5,087.07 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. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I ; If more space Is needed, use addltlonal sheets of paper of the same size. ::f `l`vn*T+ 4~ aik H 'K~Ak. aF M. 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S ~ f .. ~ m ,*. .~ $ ' 1:±9 . ~m y ~ ~~ ~ ~ a . .- 'O. to ! 9 ~ ~ http:'i~n~il.aol.~,~am'35775-1 ll/aol-6/en-us/mail/get-attachme~~t.~~... :3'~(~':'_~)~ ~' Ewing Brotllers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 March 7, 2012 Ruth A. (Cameron) Sheaffer 3454 Spring Rd. Carlisle, PA 17013 The Funeral Service for Ralph L. Sheaffer Jr. We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Basic Services of Funeral Director/Staff $1200.00 2. FACILITIES/SERVICES/STAFF/EQUIPMENT Basic Use of Facility , $200.00 Document Prep/Permanent Recording, $250.00 3. AUTOMOTIVE EQUIPMENT ~ ' Vehicle to transfer remains to Funeral Home, $200.00 Utility Car $125.00 C. SPECIAL CHARGES ' Direct Cremation FUNERAL HOME SERVICE CHARGES $345.00 ' $2320.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $2320.00 Cash Advances Certified Copies of Death Certificate TOTAL CASH ADVANCES AND SPECIAL CHARGES Total Total Cost SUB-TOTAL INITIAL PAYMENT /DISCOUNT /CREDITS $42.00 $42.00 $2362.00 $2362.00 r ~,~t.~-- ~_ ~v2~CPy~.: 4214.07 ~q~„ti TOTAL AMOUNT DUE $-1852.07 ~ f[~,~~.,~ The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 % per annum. ~~// ~~~~~o / Z -~~ 1 -~