The URL can be used to link to this page

Home My WebLink About08-01-12i 1505610105 REV-15 00 EX (oz-ii) (FI) PA Department of Revenue Pennsylvania OFFICIAL USE ONLY oEP...~E~, o~ w~~En~E ureau of Individual Taxes County Code Year File Number PO 60X280601 INHERITANCE TAX RETURN ', Hamsbur , PA iyiz8-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 209-12-5858 ' 10/25/2011 09/13/1917 Decedent's Last Name Suffix Decedent's First Name MI LIKE VIOLET (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW 01D 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death O 4. Limited Estate O 4a. Future Interest Compromise (date of Prior to 12-13-82) O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O (Attach Copy of Will) 7. Decedent Maintained a Living Trust (Attach Copy of Trust.) 8. Total Number of Safe Deposit Boxes O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death B O 11. Election to Tax under Sec. 9113(A) etween 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 N ame : Daytime Telephone Number David P. Perkins, Esquire (717) 532-9537 REGISTER (~F~IIILLS USE O~LL1f ~ ~ ~ i ~ First Line of Address ~ ~-C3 . -. C_ _ C r~ ~ ~_~ Attorney at Law ~ ~- C7 r' - ~ = r~ I ~ , Second Line of Address ~' ' - C7 r~` ~ ' 4 James Circle ~ C'1C% ~ ~ a -r ,-, City or Post Office - _ State ZIP Code D flL/ED ~ t-1-1 ` Shippensburg ' PA ' 17257 m n ~ ~" Correspondent's a-mail address: _DPPESQ@GMAIL.COM 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 th e personal representative is based on all information SIGN UR O F P ER SON R ~P~ NSIB~.E FOR FILING RETURN ~ , of which preparer has any knowledge. ~ , / ~ 1 ~ ~~' ` ' - I DATE ~ ~~ ~ ~'K- l / ADDRESS / ''~~""" 07/25/2012 PATSY M. RHINE 4865 Philadelphia Avenue Chambersburg, PA 17202-8949 GNATU ~ F P A THER N REPRESENTATIVE r. DATE ADDRESS 07/25/2012 DAVID P. PERKINS, ESQUIRE 4 James Circle Shippensburg, PA 17257-2165 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 REV-1500 EX (FI) Page 3 Decedent's Complete Address: LIKE, VIOLET I __ _ _ __ --_ -- STREETADDRESS Shippensburg Health Care Center 121 Walnut Bottom Road _ __ clrv Shippensburg Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ . ____ _ B. Discount 0.00 File Number -- -_-- STATE ZIP _ _ PA I 17257 122.84 0.00 Total Credits (A + B) (2) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 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) 0.00 0.00 0.00 122.84 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 "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 a beneficiary designation? .................................................................................................................. ... ~l ^ N WER TO ANY OF THE ABOVE QUESTI V ~~ ONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. a ..n ~~ 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. J 15D5610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: LIKE, VIOLET I 209-12-5858 RECAPITULATION 1. Real Estate (Schedule A) ......................................... .... 1. 0.00 2. Stocks and Bonds (Schedule B) ................................... .... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 4,753.47 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 0 00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) O Separate Billing Requested..... ... 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 4,753.47 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 1,749.24 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 274.49 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 2,023.73 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 2,729 74 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. 2,729.74 TAX CALCULATION -SEE INSTRUCTIONS 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. ' 0.00 16. Amount of Line 14 taxable - - ~ - - - _ at lineal rate X .0 45 2,729.74 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 18, 0.00 19. TAX DUE ...................................................... ... 19. 122.84 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 L 1505610205 1505610205 J REV-1508 EX+ (u-1o) ~ Pennsylvania DEPARTMENT OF REVENDE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: LIKE VIOLET SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY FILE NUMBER: 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 nn Rrhnd~Jn c ~~ nwre space is neeaeo, use aaarcionai sneets of paper of the same size. REV-1511 EX+ (10-09) ~ i~' Pennsylvania DEPARTMENT DF REVENDEDEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LIKE VIOLET I Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Fogelsanger-Bricker Funeral Home-advertising & stationary 356.74 Parklawns Memorial Gardens -monument name plate 310.00 e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address ____ City Year(s) Commission Paid: State -- ZIP z• Attorney Fees: 3. Family Exemption; (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City _ -- _- __- - _ State Relationship of Claimant to Decedent __ 4. Probate Fees: 5. Accountant Fees: 6, Tax Return Preparer Fees; 7. ZIP TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 1,082.50 15.00 1,749.24 REV-1512 EX+ (12-08) ~ .~~ pennsy(vania SCHEDULE I DEPARTMEN70FREVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF Like Violet I FILE NUMBER Report debts incurred by rtie ae,...~__. __.