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Home My WebLink About08-06-1215056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 26oso1 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 10 0114 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 01 /28/2010 06/21 /1925 Decedent's Last Name Suffix Decedent's First Name MI Kapp Louise I (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 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 death 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 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Dennis E. Boyle, Esq. (717) 737-2430 Firm Name (If Applicable) r`~ REGISTER OF W USE ONLY "~ Boyle, Autry & Murphy ~O "' ~ ~a Fi t li f dd S1 A C ~~ - rn C: 3 rs ne o a ress ~ ~ T C (.; 4660 Trindle Road ~ ~- ~ ± ~ ?J Second line of address ~~- - ` "D ~ -" ~-~ . t .E . Suite 200 C7 C=~ 0~== ~ =~=>`= City or Post Office State ZIP Code DATE Dv°+ w F.n Camp Hill PA 17011 ~ Correspondent's a-mail address: deboyle@dennlSboylelaW.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 the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS Helen E. Rank 1000 Foxianna Road, Middletown, PA 17057 --- SIGNATURE OF P ARER THER THAN REPRESENTATIVE - ------------ DATE -----~ - -t l ~J ~i a. ADDRESS r 4660 Trindle Road, Su 200, 15056051058 Hill, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number Louise I Kapp ' .. Decedent s Name: 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 & Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 249,784.96 6. Jointly Owned Property (Schedule F) "w z Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) = Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 249,784.96 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 25,237.93 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 14,707.82 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 39,945.75 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 209,839.21 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. 209,839.21 TAX COMPUTATION -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. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable at sibling rate x .12 104,919.60 17 12,590.35 18. Amount of Line 14 taxable 104 919 60 15 737 94 , . at collateral rate X .15 18. , . 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 28,328.29 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0114 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Louise I Kapp _ 174-20-5184 STREET ADDRESS 626 Hummel Avenue _ CITY Lemoyne STATE PA ZIP 17043 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. I nterest _ E. Penalty (1) Total Credits (A + B + C) (2) Total InterestlPenalty (D + E ) 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. 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. (3) (4) (5) (5A) (56) 28,328.29 28,328.29 28,328.29 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 :.................................................................................... ...... ^ 0 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 "intrust for" or payable upon death bank account or security at his or her death? ........ ...... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefciary designation? .................................................................................................................. ...... ^ 0 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [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 zero (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 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 zero (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 four and one-half (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 twelve (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-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Louise I. Kapp 21-10-0114 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. (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 Louise I. Kapp 21-10-0114 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 12,489.25 Name of Personal Representative(s) Helen E. Rank Social Security Number(s)IEIN Number of Personal Representative(s) XXX-XX-1030 street Address 1000 Foxianna Road city Middletown state PA Zip 17057 Year(s) Commission Paid: 2012 2. Attorney Fees 12,489.25 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 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Register of Wills -Filing fee for Inventory and Return 60.00 s. Helen E. Rank -Expenses incurred during Administration 194.68 9. Boyle, Autry & Murphy -Reimbursement of Expenses Incurred 4.75 10. 11. TOTAL (Also enter on line 9, Recapitulation) I $ 25,237.93 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-~8} ~i,~ Pennsylvania SCHEDULE I ~ DEPARTMENT OF REVENUE DEBTS OF DECEDENT, c"HERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Louise I. Kapp 21-10-0114 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. REM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 • Lemoyne Borough -Sewer & Water 1011110 - 3131111 154.97 2. Travelers Insurance -Insurance on property 1,068.00 3. Camp Hill Emergency Physicians 33.76 4. Brian lerley -Cleaning out of property and maintenance 3,850.00 5. Pennsylvania American Water -Water Bills 10/11110 - 1218111 630.09 6. UGI -Gas bills 911110 - 12/2/11 695.95 7. lerley's Lawn Care -Grass cutting and trimming at property 819/10 - 10/20111 906.30 8. PPL Electric -Electric bills 9/7110 - 12/22/11 315.99 9. Faith A. Nicola, Tax Collector -Real Estate & School Taxes for 2011 1,142.76 10. Settlement costs incurred in sale of property 5,750.00 11. Enders Insurance Associates -Fee for Bond 160.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 14,707.82 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (7.1-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Louise I. Kapp 21-10-0114 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1. Charles lerley Brother 34973.21 2. Marilyn lerley Sister-In-Law 34973.20 3. Margaret Bemesderfer Sister 34973.20 4. Helen Rank Sister 34973.20 5. Doris Musser Sister-In-Law 34973.20 6. Mary Ann Gingrich Sister-In-Law 34973.20 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 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. $ If more space is needed, insert additional sheets of the same size. i~~~~c~e -i~- ynZ~ ~ i~ .CX) DB