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HomeMy WebLinkAbout06-19-12a REV-1500 ExIo2.11,tF„ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes u" ' ` ~ County Code Year File Number PO BOXz8o6oi o INHERITANCE TAX RETURN 21 1 1 1 325 Harrisburg, PA>'7i28-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 181-05-5568 11 /22/2011 11 /02/1917 Decedent's Last Name Suffix Decedent's First Name MI __ Prowell Pearl M 1505610105 (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name k, Lisa P. Sn~"der, ~;o-Execs., c/o Placey & Wright Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW GD 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 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. 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 Richard L. Placey, Esq. (717) 236-9577 First Line of Address Placey & Wright Second Line of Address 3621 North Front St. City or Post Office Harrisburg State ZIP Code PA 17110 ~7 '~ ~-+-t r T t r'`` f._~ ~-'; -_ J 4, ~ i ^~ ~ ~= ;,.-, REGISTER OF~IILLS USE ONIt'F C ~ r:-T C Q ,°, ~. ~ ~ ~"= ; ~ ~~ r, ~ c~~.~ C a C-' n,,_ ~ .:a' f ~) MI I ~ ~ V7 Correspondent's a-mail address: pWIaW@eplX.net 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. GNATURE OF P SON RESPO BLE FOR FIL G ETURN n ,/ DATE ~/, , ~ ~.~il.~.. ~, . J~~ ~ /,_~ 7j/"/' 1=~(-~.~.[ 06/18/2012 ADDRESS Debra P. Diller, P meta R SIGNATURE OF RRI= R OTH ADDRESS ~( Richard L. Pla ey, EsquirerRi 15U5610105 REPRESENTATIVE DATE ~"`'--' 06/18/2012 ;ey & Wright, 3621 North Fron '~S-tr;~et, Harrisburg, PA 17110-1533 PLEASf'1rSE ORIGINAL FORM ONLY Side 1 150561105 J ~u~` J 150561,0205 REV-1500 EX (FI) Decedent's Name: Pearl M. Prowell Decedent's Social Security Number 181-05-5568 RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 545,200.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 58,976.79 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. 9 9 ( ) ......................... Mort a es and Notes Receivable Schedule D 4. . 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 414,629.52 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 00 (Schedule G) O Separate Billing Requested...... .. 7. . 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 1,018,806.31 9. Funeral Expenses and Administrative Costs (Schedule H) ............. ...... 9. 42,656.82 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10. 4,426.04 11. Total Deductions (total Lines 9 and 10) ........................... ...... 11. - ____ 47,082.86 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. 971,723.45 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................. ...... 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. ...... 14. 971,723.45 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 00 (a)(1.2) X .0 0 . 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 971,723.45 16. 17. Amount of Line 14 taxable ' at sibling rate X .12 0.00 17, 18. Amount of Line 14 taxable 0 00 ' at collateral rate X .15 . 18 19. TAX DUE .......................... ............................. ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1,505610205 Side 2 0.00 4 3, 727.56 0.00 0.00 43,727.56 O 1505610205 REV-1500 EX (FI) Paye 3 File Number 21 -1 1 -1 3 2 5 Decedent's Complete Address: DECEDENT'S NAME Pearl M. Prowell STREET ADDRESS 4934 Simpson Ferry Road CITY Mechanicsburg ___. STATE ZIP PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 43,727.56 2. Credits/Payments A. Prior Payments ___ 41,000.00 B. Discount 2,157.83 Total Credits (A + B) (2) 43,15_7__.83 3. Interest (3) 569.73 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. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 569.73 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 "intrust for" orpayable-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. 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. t REV-1502 EX+ (01-10) 'r i Pennsylvania SCHEDULE A ~~ DEPARTMENT OE REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: PEARL M. PROWELL 21-11-1325 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value 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 right 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 Real estate situate in the Township of Hampden, Cumberland County, Pennsylvania, bounded and described in Cumberland County Recorder of Deeds in Deed Book "W", Volume 13, Page 409, known and numbered as 4940 Simpson Ferry Road, Mechanicsburg, PA (See copy of Deed attached. Valued at assessment.) 2. Real estate situate in the Township of Hampden, Cumberland County, Pennsylvania, bounded and described in Cumberland County Recorder of Deeds in Deed Book "Y", Volume 24, Page 975, known and numbered as 4934 Simpson Ferry Road, Mechanicsburg, PA (See copy of Deed attached. Valued at assessment.) TOTAL (Also enter on Line 1, Recapitulation.) I $ If more space is needed, use additional sheets of paper of the same size. 167.900.00 377,300.00 545,200.00 REV-15o3 EX+ (7-v) i~ Pennsylvania ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER PEARL M. PROWELL 21 -1 1 -1 3 2 5 All property jointly owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size REV->5o8 EX+ (u-io) ~~ i~~ pennsylvania SCHEDULE E ~y7 DEPARTMENT OF REVENUE CASH BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF. FILE NUMBER: PEARL M. PROWELL 21-11-1325 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, M&T Bank Checking Account 69667608 (Principal-$8,220.88; Interest-$.20) 8,221.08 2. M&T Bank Savings Account 15004206021111 (Principal-$48,392.63; Interest-$10.91) 48,403.54 3 M&T Bank Certificate of Deposit 31003916011734 (Principal-$5,681.42; Interest-$1.30) 5,682.72 4 M&T Bank Certificate of Deposit 31003920413356 (Principal-$13,584.28; Interest-$3.72) 13,588.00 5, Sovereign Bank Checking Account 571119824 9,154.33 g, Western & Southern Life Assurance Company Annuity W0020902128 174,710.52 7, National Life Group Annuity 662422X 83,641.86 g. Transamerica Life Insurance Company Annuity 02CBT063964 28,894.23 g. Western National Life Insurance Company Annuity VP222591 14,695.84 10. Erie Insurance -premium refund 13.00 11. Antique & Collectible Tools, Inc. -purchase of tools 582.40 12. AAA Central PA -membership cancellation refund 50.00 13. 2009 Chevrolet Equinox (Kelley Blue Book value) 15,115.00 14. Coins per attached appraisal 11,270.00 15. Household Goods per attached list 607.00 16. Miscellaneous Personal Effects NO VALUE TOTAL (Also enter on Line 5, Recapitulation) $ 414,629.52 If more space is needed, use additional sheets of paper of the same size. P.EV-1511 EX+ (10-09) -, i~ Pennsylvania !.~ DEPARTMENT OF REVENUE INHERITANCE TAx RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER PEARL M. PROWELL 21-11-1325 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' Parthemore Funeral Home 10,379.48 z. Hamtpon Inn West -rental of room for funeral luncheon 106.00 3. Juice & Java -funeral luncheon 316.09 B. ADMINISTRATIVE COSTS; 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City __ ---- - _-- -- - -State _ . _ ---ZIP Year(s) Commission Paid: 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: ~• The Patriot-News Company-$123,38; Cumberland Law Journal-$75.00 -estate advertising B. Cordier Auctions & Appraisals -coin appraisal s. Commonwealth of PA -duplicate title for Equinox ~ o. Reimb. to Placey & Wright -short certificates-$20.00; notary fees-$12.00; MDJ 09-3-04-$45.37 ~ 1. J. Michael Ward -constable services ~ 2. Reserve for future costs, taxes and expenses 25,000.00 419.50 400.00 198.38 190.00 22.50 77.37 547.50 5,000.00 TOTAL (Also enter on Line 9, Recapitulation) ~ 42,656.82 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-OSj i Pennsylvania SCHEDULE I t)EPARTMENT~FREVENUE DEBTS OF DECEDENT, zNHERITANCETnxREruRN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER PEARL M. PROWELL 21-11-1325 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, Insert additional sheets of the same size. REV-1513 EX+ (01-10) . i `' Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES -- - -- ESTATE OF: FILE NUMBER: PEARL M. PROWELL 21-11-1325 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Elizabeth R. Diller, 1874 Sandal Brook Road, Fort Mill, SC 29715 Granddaughter 312.96 2. Lauren R. Diller, 4934 Simpson Ferry Rd., Mechanicsburg, PA 17050 Granddaughter 312.96 3. Aimee R. Hancock, 507 Colony Road, Camp Hill, PA 17011 Granddaughter 312.96 4. Thomas S. Keating, 21 Water Tupelo, Bluffton, SC 29910 Grandson 312.96 5. Jortlann A. Smak, 100 N. Federal St., Unit 3, Salem, MA 01970 Granddaughter 312.96 6. Kyle G. Snyder, 625 Moores Mt. Road, Mechanicsburg, PA 17055 Grandson 312.95 7. Debbie P. Diller, 621 Moores Mt. Road, Mechanicsburg, PA 17055 Daughter One-Third Residue 8. Pamela R. Smak, 31 Hellam Drive, Mechanicsburg, PA 17055 Daughter One-Third Residue 9. Lisa P. Snyder, 625 Moores Mt. Road, Mechanicsburg, PA 17055 Daughter One-Third Residue II ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. 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. TATAI /1C DA OT TT _ CAITCD Tf1TA1 AI(1AI TAVAQI C f1TCTDTnIITi/I AIC (CAI I iAIC 17 (1C OC\/_i CIl l1 !"'(1\/CD CL.ICCT 11. 00.00 If more space is needed, use additional sheets of paper of the same size.