HomeMy WebLinkAbout02-0261XEV-I§00 EX
, o ~ COMMONWEALTH OF
~%,~ PENNSYLVANIA
*~~'~l, DEPARTMENT OF REVENUE
~'~"~.~,~,,,,~'~ DEPT. 280601
~HARRISBURG, PA 17128-0601
I.-
Z
LU
W
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR)
\ 2~--).-~--o k
DATE OF BIRTH (MM-DD-YEAR)
OFFICIAL USE ONLY
/¢- ¥
FILE NUMBER
COUNTYCODE YEAR NUMBER
LU (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
"''1,,~,~ · Original Return
,~, rz: ',,' Limited Estate
o ~ m . Decedent Died Testate (Attach copy of Will)
< Litigation Proceeds Received
I--
Z
LU
Z
o
uJ
n,,
o
LU
E~]2. Supplemental Return
[~] 4a. Future Interest Compromise (date of death after 12-12-82)
~'~7. Decedent Maintained a Living Trust (Attach copy of Trust)
[~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
NAME
FIRM NAME (if Applicable)
TELEPHONE NUMBER
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Padnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
(5)
E~' 3. Remainder Return (date of death prior to 12-13-82)
~]5. Federal Estate Tax Return Required
~ O '"~. Total Number of Safe Deposit Boxes
[~11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
--]Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines %7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) C~, ,~ ~
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) ~
11. Total Deductions (total Lines 9 & 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 (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14)
ON~
I to '-')
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15)
16. Amount of Line 14 taxable at lineal rate '"~'"'J""l ~ 7 x .0~-''~' (16)
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)
Decedent's Complete Address:
STREETADDRESS
ZIP
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE
(1)
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(3) ~
(4)
(5) 3 off o
(5A) ~
(5B) ,~ G ~ O
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; or .......................................................................................................................... [] ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [~ []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] J~
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.
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.
SIGNATURE O,~,,PERSON RESPONSIBLE FOR F~"~ RETURN DATE
AD[~'/~S
SIGNATURE OF PREPARER ~)Z'~ER THAN REPRESENTATI~E.~
ADDRESS ( U
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a)(1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [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 twenty-one 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% [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%, 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% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
Decedent's Complete Address:
iST.kT ?ESS I O O /'VW--,
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
STATE
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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.
(3) ~
(4)
(5) 3 o~' o
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
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; or .......................................................................................................................... []
d. receive the promise for life of either payments, benefits or care? ...................................................................... []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [~ []
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 RETU,~.
Under penalties oi 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 tree, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE Oj~,PERSON RESPONSIBLE FOR F~L~'N~ RETURN DATE
SIGNATURE OF (/~"~'-"~"'-~' ~ . ~
PREPARER/Q~HER THAN REPRESENTATIVE ~
ADDRESS
DATE
/ 6/-,...,--)
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (il) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable e~en 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive pamntr~
or a stepparent of the child is 0% [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%, 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 si~lings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section
individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNS~ LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF n'E .U,,"E.
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A.~ L.... /~J ,
JOINTLY-OWNED PROPERTY:
LEi ) ~-H DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for joinUy-held real estate. VALUE OF ASSET INTEREST DECEDENTS INTERES
TOTAL (Also enter on line 6, R~apitulation) $ ~ ~) ~ ~ ~
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (1-97),,
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 2, Recapitulation)
(if more space is needed, insert additional sheets of the same size)
REV-1508 EX * (1-97) ~ ~ ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State__Zip
Year(s) Commission Paid:
Attorney Fees
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
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV;1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I
1.
II
1.
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART I1 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST (IFAPPLICABLE)
1,
TOTAL (Also enter on line 7, Recapitulation) $ ~ / 0 ~ ~
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
PEARL COMPAGNONE
I, PEARL COMPAGNONE, being of sound mind, memory
and understanding, do make, publish and declare this as and for
my Last Will and Testament hereby revoking any and all Wills by
me heretofore made.
FIRST - I direct my Executor, hereinafter named,
to pay all of my just debts and funeral expenses as soon after
my decease as can conveniently be done.
SECOND - All the rest, residue and remainder of
my es.ta~e, I give, devise and bequeath to my son, JAMES R. NEWMAN
and my daughter, CAROL ANN MARTZ, equally share and share alike,
their heirs and assigns forever.
THIRD - I hereby nominate, constitute and appoint
my son, JAMES R. NEWMAN and my daughter, CAROL ANN MARTZ,
Executors of this my Last Will and Testament. Any Executor
serving under this Will shall serve without bond in any case.
IN WITNESS WHEREOF, I have hereunto set my hand
and seal this day of "~ , 1979.
Signed, sealed, published and declared
by the above named Testatrix as and for
her Last Will and Testament in the pre-
sence of us, who have hereunto subscribed
our names as witnesses thereto at her
request in the presence of the said Test-
at~. ' x ,/~d of each o~e.r.
'/ /,- '
,." ~ pre-marr±age agreement has bee~ e×ecuted bet~ee~ m~ husband,
Yra~ D. Compag~o~e a~d myself dated ~r~l ~, 1979 a~d th±s W±ll
.. .. ..:_ . , ......... . , . ,;
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2806O1
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 000948
SNYDER RICHARD W
26 DOOGWOOD LANE
GROVE CITY, PA 16127
........ fold
ESTATE INFORMATION: SSN: 168-28-3563
FILE NUMBER: 21 02-0261
DECEDENT NAME: COMPAGNONE PEARL E
DATE OF PAYMENT: 03/1 3/2002
POSTMARK DATE:
COUNTY:
03/11/2002
r
CUMBERLAND
DATE OF DEATH: 1 2/24/2001
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $3,090.00
TOTAL AMOUNT PAID:
$3,090.00
REMARKS'
JAMES R NEWMAN
C/O RICHARD W SNYDER
SEAL
CHECK# 2529
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
;)02 PI','I MAR ;1]20 , ' "!'IVI MAR
Mr. Richard Snyder
6 Dogwood Ln.
rove City, PA 16127
:26
BUREAU OF INDIVIDUAL TAXES
ZNHERTTANCE TAX DTVTSTON
DEPT. 280601
HARRISBURG, PA 17128-0601
RICHARD W SNYDER
26 DOGWOOD LN
GROVE CITY
CONNONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT, ALLONANCE OR DZSALLONANCE
OF GEDUCTZONS AND ASSESSHENT OF TAX
REV-ZS~7 EX &FP (01-02)
PA 16127~
DATE
ESTATE OF
DATE OF DEATH
FILE NUNBER
' i COI~ITY
ACN
11-19-2002
CONPAGNONE
12-24-2001
21 02-0261
CUNBERLAND
101
Aeoun~ Reml tted
PEARL E
HAKE CHECK PAYABLE AND RENIT PAYNENT TO:
REGISTER OF WILLS
CUMI)ERLAND CO COURT HOUSE
CARLISLE, PA I7013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF COHPAGNONE PEARL E FILE NO. 21 02-0261 ACN 101 DATE 11-19-2002
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON:
1. Real Estate (Schedule A)
2.
$.
4.
6.
7.
8.
ORIGINAL RETURN
(1).
Stocks end Bonds (Schedule B) (2).
Closely Held Stock/Partnership Interest (Schedule C) (3)
Nortgages/Notes Receivable (Schedule D) (~)
Cash/Bank Deposits/MLsc. Personal Property (Schedule E) (5)
JoLntly Owned Property (Schedule F) (6)
TranSfers (Schedule G) {7)
Total Assets
APPROVED DEDUCTIONS AND EXENPTZONS:
9. Funeral Expenses/Ado. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage LLebLlitLes/Liens (Schedule Z)
11. Total Deduct ions
12. Net Value of Tax Return
13.
14.
(9)
(10)
CharLtable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J)
Net Value of Estate Subject to Tax
.00
562.00
.00
.00
8z077.00
53.,468.00
ZO;O00.O0
(8)
9,820.00
.00
NOTE: To insure proper
credit to your account,
submit the upper port/on
of this form with your
tax payment.
NOTE:
82,107.00
(11) 9.820.00
(12) 72,287. O0
(15) . O0
(1~) 72,287. O0
Z~ an assessment was issued previously, lines 14, 15 and/or 16, 17,
reflect ~igures that include the total o~ ALL returns asSeSsed to date.
ASSESSNENT OF TAX:
15. Amount of Llne 1~ et Spousal rate
16. Amount of L/ne 14 taxable et L/heal/Class A rate
17. Amount of L/ne lq at Sibling rate
18. Amount of Line 14 taxable et Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYHENT RECETpT DTSCOUNT
DATE NUNBER INTEREST/PEN PAID (-)
03-11-2002 CD000948 162.63
18 and 19 will
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(15) .00 X O0 = .00
(16) 72,287.00 X 045= 3,253.00
(17) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= 3,253.00
ANOUNT PAID
3,090.00
TOTAL TAX CREDIT 3,252.63
BALANCE OF TAX DUEI .$7
INTEREST AND PEN. .00
TOTAL DUE .37
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REgUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)