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HomeMy WebLinkAbout07-05-12 (2)1505610140 '~ REV-1500 EX `°'-'°' OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 1 0 5 6 4 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMI7DYYYY 1 0 5 0 4 2 0 1 1 0 8 2 7 2 CI 2 5 Decedent's Last Name Suffix Decedent's First Name MI D O N I V A N R O Y A L S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI D O N I V A N L O U I S E J Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 1. Original Return 4. Limited Estate ^X 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust ~ (Attach Copy of Trust) 70. Spousal Poverty Credit (date of death between 12-3i-91 antl 7-1 -95) 3. Remainder Return (date of death prior to i2-13-82) 5. Federal Estate Tax Return Required B. Total Number of Safe Deposit Boxes r- 11. Election ax under Se5~113(A) Attach ~i.81 ^' .C7 ' ( Rt c CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOI Name Daytime Te C A T H Y S W A T E R S 7 1 7 REGISTER First line of address 1 1 6 W H I L L C R E S T Sewnd line of address City or Post Office C A R L I S L E D R I V E grrtwnnuei I r--~ f_a 1 C.5 ~IryLLS USE ONLY ~ ~; ~ ' ~ n d J State ZIP Code DATE FILED P A 1 7 0 1 3 Correspondent's a-mail address: Under penalges 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 or preparer other than the personal representative is based on all information of which preparer has any knowledge. NARIRE DF PERSON RESPONSIBLE FOR FILING RETURN DATE ~l0/3 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE PLEASE USE ORIGINAL FORM ONLY Side 7 1505610140 1505610140 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: ROYAL S• D O N I V A N 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. • 4 5 6 9 • 7 9 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 1 9 6 • 0 4 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................ ... 8. 4 7 6 5 . 8 3 9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9. 1 2 1 6 1 . 4 9 10. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 9 9 ( ) .......... 10. ... 6 4 2 . 1 8 11. Total Deductions (total Lines 9 and 10) ............................ ... 11. 1 2 8 0 3 . 6 7 12. Net Value of Estate (Line 8 minus Line 11) ......................... ... 12. - 8 ~ 3 7 . 8 4 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 under Sec. 9716 (a)(1.2)X.0 _ ~ 0 ~ 15. 16. Amount of Line 14 taxable at lineal rate x .045 1 9 6. 0 4 1s. 17. Amount of Line 14 taxable 0 0 0 17 at sibling rate X .12 . . 18. Amount of Line 14 taxable ~ ~ 0 at collateral rate X .15 18. 19. TAX DUE ...................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT - 8 0 3 7. 8 4 o. 0 0 8. 8 2 o. o a ~. ~ ~ 8. 8 2 Side 2 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 0564 DECEDENT'S NAME ROYAL S. DONIVAN STREET ADDRESS I I6 W HILLCREST DRIVE CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 8.82 2. Credits/Payments A. Prior Payments 8.82 B. Discount Total Credits (A+B) (2) 8.82 3. Interest (3) 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 i +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 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 : .......................... ..... c. retain a reversionary interest; or ........................................................................................ ..... ^ ^X d. receive the promise for life of either payments, benefits or care? .................................................. ..... ^ 0 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................. ..... ^ ^X 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? .... ..... ^ 0 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 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 benefciaries 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 [7 2 P.S. §9116(a)(1.3)]. Asibling is def ned, undo Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+(t x_10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIOENroECEDENr PERSONAL PROPERTY ESTATE OF: FILE NUMBER: ROYAL S. DONIVAN 21 11 0564 Include the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ORRSTOWN BANK CHECKING ACCOUNT 146001840 3,069.79 2. 11989 JACKSON HORSE TRAILER 3. TEAMSTERS BURIAL BENEFIT TOTAL (Also enter on Line 5, space is needed, insert addiUOnal sheets of paper of the same size 500.00 1,000.00 $ 4.569.79 REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEF JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: ROYAL S. DONIVAN 21 11 0564 If an asset was made 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) I ADDRESS RELATIONSHIP TO DECEDENT A. CATHY S W. 116 W. HILLCREST DRIVE CARLISLE, PA 17013 B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE CIF DEATH VALUE OF ASSET %OF DECEDENT'S INTEREST DA7E OF DEATH VALUE OF DECEDENTS INTEREST 1. A. 10/21/08 SOVEREIGN BANK CHECKING ACCOUNT 1,176.19 16.667 196.04 ACCOUNT NO. 0591134373 TOTAL (Also enter on Line 6, Recapitulation) I $ 1 oA na more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OE REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ROYAL S. DONIVAN 21 11 0564 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. RONAN FUNERAL HOME 8,576.99 2. HEADSTONE 3,451.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2, Attorney Fees: 3. Family Exemptlon: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State Relalionship of Claimant to Decedent 4. Probate Fees: REGISTER OF WILLS 6 Accountant Fees: 6. Tax Return Preparer Fees: 7 ZIP 133.50 TOTAL (Also enter on Line 5, Recapitulation) I b 12,161.49 If more space is needed, use addilional sheets of paper of the same size. REV-1512 EX* (12-0a) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER ROYAL S. DONIVAN 21 it 0564 Report 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 OF DEATH t. NATIONWIDE INSURANCE-PREMIUMPAYMENT 52.22 2. IPP&L -ELECTRIC BILL 3. (BILL MCCULLOUGH -HORSE BOARDING FEE 4. ICRUMAY PARNES ASSOCIATES, INC. -MEDICAL BILL 5. WORTH MIDDLETON AUTHORITY -WATER & SEWER BILL TOTAL (Also enter on Line 10, Recapitulation)' $ If more space is needed, insert additlonal sheeLS of the same size. 173.46 240.00 94.20 82.30 REV-1513 E%+(01-i n) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE. NUMBER: o nvnr c nnwnveTa 21 11 0564 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LietTruetee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outs' ht spousal distributions and transfers under Sec. 9116 (a)(1.2).) 1. LOUISE J DONIVAN Spousal 0.00 116 W HILLCREST DRIVE CARISLE PA 17013 2. CATHY S WATERS Lineal 196.04 116 W HILLCREST DRIVE CARLISLE PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. lI. NON-TAXABLE DISTRIBUTIONS: t. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE t3 OFREV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size.