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HomeMy WebLinkAbout08-14-121505610105 REV-1500 Ex toz-~~, tFT, ~~ enns lvania OFFICIAL USE ONLY PA Department of Revenue P Y o~PApr~,~N,o~gEVEN~E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi ~~( Harrisburg, PA iyi28-o601 RESIDENT DECEDENT ~ ~ ~ ~ v ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 204-03-9266 05/13/2012 03/04/1921 Decedent's Last Name Suffix Decedent's First Name MI Mohler Marjorie (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 FILE D IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder 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 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 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: Name Daytime Telephone Number Kathy A. Kron/Kron Law (570) 523-7845 First Line of Address 109 Harold Pawling Lane Second Line of Address City or Post Office State ZIP Code REGISTER OF WILLS USE ONLY C7 ~` r~-; rti __,, _.rw, ~;. Li ;' =~- C~ .. M~~ ._~ ~_ w3 ~ _~ _ ^"i ' `._. ~ , _~ . a Lewisburg PA 17837 ~-~,~,' ~ t., ~_,~. ~_~_? -- ., ,_ _~ ~~ ..:. 7 .-... , . - _ - ~- Correspondent's a-mail address: kakfon@yahOO.COm ~ ^' f'" r`r' Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge acl~belief, -~"7 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. SIGN E OF PERSON RESPONSIBLE FOR FILING RETUR / ~~i~~ . ~ 1 ~ / / L.I ~ /I `~4\ / t /1~,~ F1 /! ~f/ 1 \! / YI _~i/Y ~ ~D TE r E l~, ~ / ~L~7C 206 Rock ~d, Trout Run, PA 17771 9 Oak Flat Rd, Newvill~.r.PA 17241 SIGN T E! F REPARER O E THAN REPRESENTATIVE PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 15056101D5 J h1 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number 204-03-9266 Decedent's Name: 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. 14,271.22 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 8,632.92 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 5,224.88 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 565 88 63 (Schedule G) O Separate Billing Requested..... ... 7. . , 8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 91,694.90 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 8,867.28 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 10,125.77 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 18,993.05 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 72,701.85 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. 72,701.85 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 72,701.85 16, 3,271.58 17. Amount of Line 14 taxable 0 00 at sibling rate X .12 17. . 18. Amount of Line 14 taxable 0 00 at collateral rate X .15 ~ g, . 19. TAX DUE ...................................................... ... 19. 3,271.58 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 150561,0205 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Marjorie Mohler STREETADDRESS 210 Big Spring Road CITY 'STATE T ZIP Nevwille PA ~ 17241 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 2. Credits/Payments A. Prior Payments _ 0.00 B. Discount 0.00 Total Credits (A + B) (2) 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,271.58 3,271.58 0.00 0.00 3,271.58 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" 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 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 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)]. 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. REV-1507 EX+ (6-98) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Marjorie Mohler All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-i5o8 EX+ (ii-io) ~~~~~~ SCHEDULE E -~: ~ ~ pennsylvania DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. ._ INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Marjorie Mohler 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 on Schedule F. If more space is needed, use additional sheets of paper of the same size. REV-i$og EX+ (01-i0) ~ ~-~ pennsylvania DEPARTMENT OF REVENUE ____- INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Marjorie Mohler 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 OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 08107/09 ACNB Bank Checking #14053 10,449.76 50 5,224.88 TOTAL (Also enter on Line 6, Recapitulation) $ 5,224.88 If more space is needed, use additional sheets of paper of the same size. If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. REV-1510 EX+ (08-09) ~~ ~E' SCHEDULE G ~~ ~ .~~ Pennsylvania ~_- DEPARTMEN70FREVENUE INTER-VIVOS TRANSFERS AND 1NHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Marjorie Mohler This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) ~y~.~ `°~~~~ SCHEDULE H ~~ ~ _ pennsylvania ' DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Marjorie Mohler Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' Hoffman-Roth Funeral Home 6,436.88 2. John F. Hess, Pastor 100.00 3. Food and Hall Rental 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Name(s) of Personal Representative(s) Sharon Lightner and Jerre Mohler Street Address 9 Oak Flat Road, Newville, PA 17241 ____. city ?06 Rock Road, Trout Run state PA _ ZIP 17771 Year(s) Commission Paid: 1,938.40 2. Attorney Fees: 0.00 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: 15.00 5. Accountant Fees: 175.00 6. Tax Return Preparer Fees; 7. TOTAL (Also enter on Line 9, Recapitulation) $ 8,867.28 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) ~~~~~ SCHEDULE I f~~~~'~~° ~ pennsylvania ' DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Marjorie Mohler Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) ~~~~~ ~ :m ;::E;-:~~. , .:~ ~. ~~~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ] BENEFICIARIES ESTATE OF: FILE NUMBER: Marjorie Mohler 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. 9116 (a) (1.2).] 1~ Jerre Mohler 206 Rock Rd, Trout Run, PA 17771 Son 2. Sharon Lightner, 9 Oak Flat Road, Newville, PA 17241 Daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. 50% 50% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If mare space is needed, use additional sheets of paper of the same size.