Loading...
HomeMy WebLinkAbout06-25-12 1505611185 REV-1500 EX (02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes Po Box zaosot INHERITANCE TAX RETURN 21 1,1 0 9 2 7 Harrisburg, PA 1 7 1 28-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date Of Blrth MMDDYYYY 0729201,1 05011931 Decedent's Last Name Suffix Decedent's First Name M I EPPLEY ARLENE A (If Applicable) Enter Surviving Spous e's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 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 dea±h 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 1 1. 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 KEITH 0- BRENNEMAN, E SQ- 717-697-8528 First Line of Address 44 WEST MAIN STREET Second Line of Address City or Pest Offic., MECHANICSBURG State 7_IP Code PA 17055 REGISTER OF WILLS USE ONLY r*a K,..;+ Q r f~ ~G 4~ ~ r°i r~rl =' - - ~ N `~° . r' ~ ~ ~ r . ~ c„ ,-; __ U _, j. ILED - .D .. ,._ rv ~~ s~`~ ,=~'c is ; . ~, -? = '':? Correspondent's a-mail address: 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. LINDA A- LYSLE; ADMINISTRATRIX 185 NORTH ('1IDDLESEX ROAD,CARLISLE, SIGNAT}~RE OF PREPARER OTHER THAN REPRESENTATIVE DATE PA 17013 I~' l~ G - /G - zoo Z ADDRESS KEITH 0- BRENNEMAN, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 1505611185 Side 1 OM4647 3.000 1505611185 1505611285 REV-1500 EX (FI) Decedent's Social Security Number DecedenPS Name: E P P L E Y A R L E N A RECAPITULATION 1. Real Estate (Schedule A) 1 0 • 0 ~ 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. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8. Total Gross Assets (total Lines 1 through 7) 8 Side 2 9. Funeral Expenses and Administrative Costs (Schedule H). g, 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 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 un~er Sec. 9116 16. Amount of Line 14 t xable ~ at lineal rate x 0 4 . 310 , 4 0 8 •3 6 1 s. 17. Amount of Line 14 taxable at sibling rate X .12 0 • 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 • 0 0 18. 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505611285 1505611285 0.00 0.00 0.00 102,009.99 0.00 218,068.30 320,078.29 6, 399 •28 3,270.65 9,669.93 310,408.36 0.00 310,408.36 0.00 13,968.38 0.00 0.00 13,968-38 X^ OM4648 3.000 REV-1500 EX (FI) Page 3 File Number ~l 1.1. f19a7 U@G@uCllab a+VmNlcac nuu~caa. -- -- - - DECEDENT'S NAME EPPLEY ARLENE A STREET ADDRESS CUMBERLAND COUNTY STATE ZIP CITY CARLISLE PA 7013- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ~+ 4, 0 0. 0 B. Discount 6 9 8. 4 2 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 730.0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ ' ~ ~ Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING 4UESTIONS 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 ~ a 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 rr~~{ u without receiving adequate consideration? . ? ~~ 0 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, 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 i , 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. Total Credits (A + B) (2) (1) 13, 968 •38 14,698.42 (3) ~ • 0 ~ OM4671 2.000 REV-1508 EX+ (7~-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, 8 MISC. RESIDENTDECEDENTTURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Arlene A. Epplev 21 11 0927 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 ~. Sovereign Bank 14,701.49 checking account No. 2891032705 2 Sovereign Bank 16,093.55 money market account No. 2891047095 3 Sovereign Bank 21,753.52 certificate of deposit No. 1695350627 4 M&T Bank 5,774.17 checking account No. 3740136456 5 M&T Bank 13,455.25 checking account No. 9835625568 6 M6T Bank 10,002.02 certificate of deposit No. 31003911012547 7 1995 Buick LaSabre sedan 1,850.00 8 U.S. Treasury 31.00 refund due the decedent on 2011 Federal Income tax return 9 Pennsylvania Insured Municipal Income Trust Series 98 5,433.60 account No. 02271383 - 32 units valued at $169.80 per unit 10 Nuveen Tax-Free Pennsylvania Insured Trust 249 12,915.39 account No. 01363191. 347.188 units valued at $37.20 per unit TOTAL (Also enter on line 5, Recapitulation) $ 102 , 009.99 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX + (OB-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT EST SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY Arlene A. Eppley 21 11 0927 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBE DESCRIPTION OF PROPERTY inr.~werr~nruneoFrrErixnnisFeRee.r~iRREUnonisHiarooECEOeNrnw n-e w+reoFrRU,sFea. nrrncrincow of rHE oeEO FoR Rea. esrnre. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~• Sovereign Bank 32,535.36 100.0000 0.00 32,535.36 IRA account No. 2895470538. Transfer to Linda A. Lysle, daughter of the Decedent and Michael M. Eppley, son of the Decedent. Transfer as of date of death July 29, 2011. 2 Sovereign Bank 185,532.94 100.0000 0.00 185,532.94 IRA account No. 2898166505. Transfer to Linda A. Lysle, daughter of the decedent and Michael M. Eppley, son of the Decedent. Transfer as of date of death July 29, 2011. TOTAL (Also enter on line 7, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 068.30 9W46AF 2.000 REV-T511 EX+ (10.09) Pennsylvania SCHEDULE H DEPARTMENTOF REVENUE FUNERAL EXPENSES AN D INHERITANCE TAx RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Arlene A. E~,nley 21 11 0927 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ None B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Wgived Name(s) of Personal Representative(s) Street Address _ City State ZIP Year(s) Commission Paid: z. Attorney Fees: Snelbaker & Brenneman, P.C. 4,500.00 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 a. Probate Fees: $98.50; additional probate fee $215.00 313.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 300.00 7. 1 Reserve for accountant fees, filing fees and miscellaneous administrative expenses. 1,000.00 Total from continuation schedules I 285.78 TOTAL (Also enter on Line 9, Recapitulation) ~$ 6 , 399.28 swasnc 2 00o If more space is needed, use additional sheets of paper of the same size. Estate of: Arlene A. Eppley Schedule H Part 7 (Page 2) 2 Advertise Grant of Letters of Administration a. Cumberland Law Journal $75.00 b. The Sentinel $210.78 21 11 0927 285.78 Total (Carry forward to main schedule) 285.78 REV-1512 EX + (12-08) pennsylvania SCHEDULE I DEPARTMENTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS RESIDENT RECEDE NT ESTATE OF FILE NUMBER Arlene A. Eppley 21 11 0927 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. swasAH z.ooo If more space is needed, insert additional sheets of the same size. REV-1513 EX+(Ot-10) SCHEDULE J Pennsylvania DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN ESTATE OF FILE NUMBER: Arlene A. Eppley 21 11 0927 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Linda A. Lysle 185 North Middlesex Road Carlisle, PA 17013 50~ of Residue: 155,204.18 Daughter 155,204.18 2 Michael M. Eppley 153 North Middlesex Road Carlisle, PA 17013 50~ of Residue: 155,204.18 Son 155,204.18 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APP ROPRIATE. (( 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. $ 0.00 RESIDENT DECEDENT swasAi 2.00o If more space is needed, use additional sheets of paper of the same size.