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Home My WebLink About06-29-12 15.05610105 REV-1500 ex(°~-11't~' OFFICIAL USE.ONLY PA Department of Revenue PenYlv~anila County Code Year File Number Bureauof.IndividualTaxes INHERITANCE TAX RETURN PO BOX z8D6oi ' Harrisburg, PA i71z8-o6oi RESIDENT DECEDENT - , f ~ j `-~ ~ MI L' _.. _._, ML:... =C m 1. Ongmal Return O 2. Supplemental Retum O 3. Remainder Retum (Date of Death Prior to 12-13-82) O 4. Limited Estal:e O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousat 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) ENTER DECEDENT INFORMATION BELOW . Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 02/27/2011 ~ 03/17/1933 __ _ Decedent's Last Name Suffix Decedent's First Name _.. __. _ _ __ KROH ' PATRICIA __ __ _ (If Applicable) Enter Surviving Spouse's Information Below Ouse s Last p Name Suffix Spouse's First Name _.,~,,. ~W.,.,._ ._..._d__. ~ __~... _..__ .... ~. _ . _. ~_ _ _. ___ _ ~...__ _ __ _ s KROH ', LEMMERMAN Spouse's Social Security Number " "" " "" " ~ ~ _ - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW CORRESPONDENT - THIS 5ECTION MUST BE COMPLETED.. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number THOMAS D. GOULD (717) 591-1755 State ZIP Code REGISTER OF WILLS USE ONLY _~ _ ~--~.. _ i1 L /.I "r, ~.. . _:._) ~~ .. ~ti ~,~ ' _ PV ~7 ^ ~J 1~~~ l "' /~ l ~ -.... ~""A D/t~FILED ~- PA 17050 ~ --, .wr- .l` ~ -ri ~~ Z (:..! S '1 _._ ~1 ~ ( ' ~ i': /, . Jl / ' ~ ` i -r ~~ ~ __ , rt L/) --ry Correspondent's a-mail address: tgOUld@pjr18W.COm Under penalties of perjury, I dedare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, .it.is.ltie, correct and complete. Declaration of preparer other Than the personal representative is based on all information of which preparer has any knowledge. e e __ RESPONSIBLE FOR FILING RETURN DATE ADDRESS 803 Wentzville RDad, ENOLA, PA 17025 U SIG RE OF PRF~PARER OT THAN REPRESENTATIVE DATE ~~M ~D . . ~~ b/Z~'/`/~ A DRESS 5006 E. TRINDLE ROAD, SUITE 203, MECHANICSBURG, PA 17050 PLEASE USE ORIGINAL FORM ONLY Side 1 15175610185 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number ... _ _. _. decedent's Name: PATRICIA L KROH RECAPITULATION 1. Real Estate (Schedule A) .................................... . ........ 1. 1;33,200.00 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. ~ 6,000.00 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. ; 139,200.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. i~~i, '13,426.92 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 1,395.72 11. Total Deductions (total Lines 9 and 10) ......:.......................... 11. 14,822.64 12. Net Value of Estate (Line 8 minus Line 11) ................. ........ . ... 12. 124,377.36 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. 124,377.36 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or trans ers under Sec. 9116 35,208.10 (a)(1.2) X .0 __ 15. 0.00 16. Amount of Line 14 taxable at lineal rate x..0 45 89,169.26 16. ' 4,012.62 17. Amount of Line 14 taxable at sibling rate :X .12 ~ 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. .................. TAX DUE......... ............................. .19.' 4,012.62 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: Flle Number DECEDENT'S NAME PATRICIA L. KROH STREET ADDRESS 803 WERTZVILLE ROAD CITY ENOLA STATE 21P PA ~ 17025 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 4,012.62_ 2. CreditslPayments A. Prior Payments ____ B. Disr;ount ___ Total Credits (A + B) (2) 3. Interest - (3) 70.74 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,083.36 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 consideration7 .............................................................................................................. ^ 3. Did decedent own an "in trust 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 8 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 far 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(aj(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-1502 EX+ {ll-OB) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE A INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER PATRICIA L. KROH 2111-0747 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 a~py 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. '803 WERTZVILLE ROAD, ENOLA, PENNSYLVANIA 133,200.00 133,200.00 REV-i5o8 EXt (il-io) '~ ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDDLE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTX ESTATE OF: FILE NUMBER: PATRICIA L. KROH 2111-0747 Include the proceeds of litigatioh and the date the proceeds were received by the estate. All properly jointly owned w)th right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. JEWELRY A,ND MISC HOUSEHOLD GOODS AND FURNITURE 6,000.00 I TOTAL (Also enter on Line 5, Recapitulation) $ 6,000.00 If more space is needed, use additional sheets of paper of the same size. REU-1511 EX+ (10-09) ~ pennsytvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER PATRICIA L. KROH 2111-0747 Decedent's debts must be reported on Schedule I. ITEM NUMBER _ DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1' SULLIVAN FUNERAL HOME 5,590.00 2 URN 495.00 3 CUMBERLAND VALLEY MEMORIAL GARDENS 4,125.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address ~ City ___ Year(s) Commission Paid: State ZIP 2• Attorney Fees: 1,500.00 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 4. Probate Fees; 321.50 S• Accountant Fees: 6• Tax Return Preparer Fees: 7. TOTAL (Also enter on Line 9, Recapitulation) I $. 13,426.92 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER PATRICIA L.KROH 2111-0747 Repork debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION I)F DEATH 1° :EAST PENNSBORO AMBULANCE: SERVICE 150.00 2 .:WEST SHOR',E EMS-ALS 1,002.82 3 "FIA MASTERCARD #5490-9990-1860-4032 55.96 4 'PPL 101.24 5 I PAWC 26.50 6 VERIZON 59.20 ' I . REV-1513 EX+ (Oi-10) ~ ~~ Pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: PATRICIA ~. KROH 2111-0747 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDEN7 Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1• 'LEMMERMAN C. KROH SPOUSE 35,208.10 2, MELINDA SUE: WALBORN DAUGHTER 44,584.635 3 TONI ELAINE PORTER :.DAUGHTER 44,584.635 ENTER DOLLAR AMOUNTS FOR DISTRIBUT10N5 SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. YI NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B, CHARITABLE POND GOVERNMENTAL DISTRIBUTIONS: L TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ ': If more space is heeded, use additional sheets of paper of the same size. REV-1514 EX+(4-09) SCHEDULE K ': Pennsylvania DEPARTMENT OF REVENUE LIFE ESTATE, ANNUITY Bureau oflndividualTaxes & TERM CERTAIN PO Bax 280601 Harrisburg PA 17iz8-o6oi (CHECK BOX 4 ON REV-i5oo COVER SHEET) - - -- ESTATE OF FILE NUMBER PATRICIA L. KROH 2111-0747 This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of death prior to 5-1-89, actuarial factors for singe-life calculations can. be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return. ® Will ^ Intervivos Deed of Trust ^ Other NAME OF LIFETENANT DATE OF BIRTH NE EST` A EAT PATE DF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE LEMMERMAN C. KROH 04/02!1933 78 ®Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payabli> .......:. . .......... . ... . ... . ........... .$ 133,200.00 2. Actuarial factor per appropriate table ... . . . ... . ...... . .. . ................... . ........ 0.21928 Interest table rate - ^ 3.5°ro ^ 6% ^ 10% ^ Variable Rate % 3. Value of life estate (L.ine 1 multiplied by Line 2) ....................................$ 29.208.10 NAME OF FIFE ANNUITANT DATE aF BIRTH NEAREST AGE AT DATE OF DEATH TERM ;OF YEARS ANNUITY IS PAYItBIE ^ Life or ^ Term of Years ^ Ufe or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable .................. . ..................... . ..$ 2. Check appropriate block below and enter corresponding number ................ . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^ Semi-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payrrient, Line 2 multiplied by Line 3 ................................:. . 5. Annuity Factor (see instructions) Interest table rate - ^ :3.5°f° ^ 6% ^ 10°6 ^ Variably Rate 6. Adjustment Factor (See instructions.) ................................................. . 7. Value of annuity - If using 3.5, 6, or 10%, or if variable rate and period payout is at end of period, calculation is Line 4 x Line 5 x Line 6 ......... . .......... . ......$ If using variable rate and period payout is at beginning of period, calculation is (Line 4 x Line 5 x Line 6) + Line 3 ..............:..... ....... , , ......... ....$ NOTE: The values of the fund's that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax.rate on Lines 13 and 15 through 18 of the return. If.more space is needed, use additional sheets of the same size.