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Home My WebLink About08-03-12rr 1505610105 REV-1500 °` f~"'(r" "~. OFFICIAL USE ONLY PA Department of Revenue P~Yt~a Bureau of Individual Taxes INHERITANCE TAX RETURN Courdq Cade Year Ftla Nlat~er PO BOX 28O60i ~ ~ ~ a ~ ~ 5 Harrisburg, PA 17>Z8-000i RESIDENT DECEDENT - 7 ENTER DECEDBriT INFORMATION BELOW Socal Security Number Date of Death MMfK)YYYY Date of BIM MMDDYYYY 177-24-5458 OM08/2012 07/25N 917 Decedent's l.~t Name Suffix Decedents First Name MI SIPE CHARLES E (ff Appileable) Enbr SurvNing Spouse's InFortnation Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number _ _.. __ THL4 RETURN ~~ BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS F~L IN APPROPRIATE OPALS BELOW OIb 1. Original Return O 2. Supplemental Rum O 3. Reme4rder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-62) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Sefe Deposk Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Porreriy Credk (Date of Death O 11. Election to Tax urx~r Sec. 9113(A) Between 12-31-91 and 1-1~5) (Attach Sdredule O) SIT - THIN ACTION MUST BE COMPLETED. ALL CORRESPON06tCE AND CONFIDENTIAL TAX NIFORIUITION MOULD BE DStECiED T0: ~~ Daytlme Telepfgne Number RAYMOND W SIPE (717) 254.5041 ~s REGISTER USE ~Y First Line of Address 321 RUN ROAD Second Line of Address City or Post Office CARLISLE State ZIP Code PA 17015 A r r:t +h !~ ~ ~-~ f ~ ~ s~ `= 8 `~ } C~ ~ 3 _ ,w •: -~ DATE flLED N ~ CormponderH's a-rrrail address: Under perrelties of par-ury. I dedme that I have exardrred This return, indud'mg acoanpany'ag sdredulea and sue, and to the bit d my Imowledge end belief. k Y true. eorted end mnplele. Dadarakarr d preperer carer than the personal repreaereatiwe ie based on ab inforrnetion of whidi praparer free any knoMAedpe. SIGNATIJ@fc OF PERSON RESPONSIBLE FOR FILMG RETURN n~rr= 321 PA 17015 DATE 07/1 817 FACTORY STREET CARLISLE, PA 17013 PLEASE tl/8E OR161NAL FORM ONLY - Side 1 1505610105 1505610105 J ,~ W ~: , 1505610205 REV 1500 EX (FI) Der~denYs Social Security Nurt~6er oecedsnPs tame: CHARLES E SIPE 177"24-6458 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely HeM Corporation. Partnership ar Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash. Bank Deposits and Miscellaneous Personal Properly (Sr~edWe E)....... 5. 76.246.12 6. Jointly Owned Property (Schedule F) O Separate BiNing Requested ....... 6. 7. Irrter-Vrvos Transfers & Miscellaneous Non-Probate Property (Sdredule G) O Sepera~ BiNing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 76,246.12 9. Funeral EXPen~ and Administrative Costs (Schedule H) ................... 9. 8,022.49 10. Debts of Decedent, Mortgage Uabilifies and Liens (Scdiedule I) . . . . ........... 10. ' 11. Total Deductions (total Unes 9 and 10) ................................. 11. 8,022.48 12. Nst Vale of Estate (Line 8 minus urre 11) ................. . • - . - - ....... 12. 68,223.63 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. ~, .. ''° • 14. Net Valor Subject to Tax (Line 12 minus Une 13) ........................ 14. 68,223.63 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLfCABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (ax12) X .0_ 15. 16. Amount of Una 14 taxable at Nneai rate X .0 45 3,070.06 ' 16. 3,070.06 17. Amount of Une 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. $.070.06 20. FILL MI THE OVAL ~ YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX (FI) Pee 3 Decedent's Complete Address: Fik Number DECEDENT'S NAME CHARLES E SIPS sTr:EETnDDRESs 321 RUN ROAD aTy CARLISLE srnTE PA ZIP 17015 Tax Payments and Credits: 1. Tax (hie (Page 2, Line 19) (1) 3,070.06 2. CredffslPayrrrents A. Prior Payments 0.00 B. Discount 0.00 Total Credits (A + B) (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Lure 1 + Lure 3, enter the dlfererrce. This is the OVERPAYMENT. Fpl In ova! on tie Z, LGte ZO to request a refired. (4) 5. If Line 1 + Line 3 is greater than Line 2, enthr the dfiference. This ~ the TAX DUE (5) 3,070.06 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "l(" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retaRt the use or atcome of the property trYarrsferted ............................................ b. reiain the right to designate who shag use fhe properly 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 consideretiorn? .............................................................................................................. ^ 3. Did decedent own an 'in trust for' or payal>te-upon-0eath bank account or waxily at his or her death? .............. ^ 4. Did decedernt own err individml retaerttertt account, annuity or other non~probaM property, vrlrch contains a benefiaarY desigrtatrtion? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUEST~NS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 is 3 percent [72 P.S. §9116 (a) (1.1) (i)j. For dates of death on or after Jan. 1, 1995, the tax rate imposed ce 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)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even 'rf the surviving spouse is the qtly benefidary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased dtild 21 years of age a yourge at death to or for the use of a natural parent, an adoptive parent or a stepparertt of the child is 0 percent (72 P.S. §9116(a)(1.2)]. The tax nab imposed on the net value of transfers to or for the use of the decedents lineal ben~idaries is 4.5 percent, except as noted in (72 P.S. §9116(a)(1)j. The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent [72 P.S. §9116(a)(1.3)j. Asibling is defined, under Section 9102, as an individual who has at least one parent in cartmon with the decedent, whether by blood or adoption. ~,.. _ T. :,= ~ ~ ~ ~~ [ ` ~~~~`~ l11 tl i~ ~J N3n3 55`/17. YS(i 2012 AUG -3 P~4 2~ 24 M- ~~ ~`-/l(=t'1{. .fir':: w °` ~" '~.' .~:. .... ~ ~ t, ~' f'~j ~., r1' ~` M . S t !'` . ~ M1 s~ ` : -~._. Q .~ "1 j J ry , ~~ 4 ~ ~ '+.~ ~Tl 11 '~ , ~ ~ ;~ .r~i .` ~ ~ ~ ~AS~ _.-