HomeMy WebLinkAbout09-10-12J 1505610143
REV-1500 ex(°'-'°'
PA Department of Revenue peons Ivania OFFICIAL USE ONLY
Y County Cotle Veer File Number
Bureau of Individual Taxes ~^•eTMe^^~^
Po Box.zaosot INHERITANCE TAX RETURN 21
Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ a' f 7 /
ENTER DECEDENT INFORMATION BELOW
Social Severity Number Date of Death Date of Birth
162 54 9672 08 17 2011 02 26 1935
Decedent's Last Name
FOUGHT
Suffix Detxident's First Name
MILDRED
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
1. Original Retum
4. Limited Estate
8 Decatlent Died Testate
(Attach Copy of W Ip
9. Litigation Proceeds Receivetl
Spouse's First Name
MI
J
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Retum ~ 3. Remainder Relum (tlate of death
prior to 12-13-82)
qa Future Interest Compromise ~ 5. Fetlerel Estate Tax Return Required
(date W tleath after 12-12-82)
^ T DAttecetlenl ~ intBjneE1a Living Tmst 0 8. Total NUmhef Of Safe Deposll Boxes
10. P~hv en i23~i~i ~ ~deta~~r death ~ 1'I. Election to lax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD eE DIRECTED TO:
Name Daytime Telephone Number
JESSICA L FISHER 717 697 3223
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First line of address
555 GETTYSBURG PIKE
Second line of address
STE C100
City or Post Office State ZIP Code
MECHANICSBURG PA 17055
REGISTER ~-LS USFLfdNLY r-
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DATE FILED
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~l~(~CtA, ~° ~j~p~, p,~ , _ Jessica L Fisher !~_ ~ t3-~ Z
555 Gettysburg Pike ,Mechanicsburg, PA ~1 ~
Side 1
L 1505610143 1505610143
1505610243
REV-1500 EX
~a^rSN~ Fought, Mildred J
Decedent's Social Security Number
162 54 9672
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 8 Miscellaneous Personal Property (Schedule E) .............. . 5. 24 , 381 - 42
6. Jointty Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers 8 Miscellaneous t~oq-Probate Property
(Schedule G) Lf Separate Billing Requested............ 7, 21 , 274.10
8. Total Gross Assets (total Lines t-7) .................................................................... . 8. 45 , 655.52
9. Funeral Expenses 8 Administrative Costs (Schedule H) ...................................... . 9. 364.98
10. Deb[s of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............................. . 10. 24 , 016.44
11. Total Deductions (total Lines 9 8 10) ........................................_........................ . 11. 24 , 381.42
12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12. 21 , 274.10
t3. 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. 21 , 274.10
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
15
0
00
(a)(1.2) X .00 . .
16. Amount of Line l4 taxable 21 274
10 1s 957
33
.
at lineal rate X .045 ~ . .
17. Amount of Line 14 taxable
at sibling rate X .12 0.00 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 0 - 00 18. 0.00
t9. Tax Due ................................................................................................................. . 19. 957 .33
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3
Decedent's Complete Address:
Flle Number 21
DECEDENTS NAME
Fought. Mildred J
STREET ADDRESS
308 2nd Street
CITY
Summerdale STATE
PA ZIP
17093
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
3. Interest
(1) 957.33
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Llne 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Make Check Payable to:
Total Credits (A + g) (2) 0.00
(3)
(4)
(5> 957.33
AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yea 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 :.................................. x
c. retain a reversionary interest; or ............................................................................................................... x
d. receive the promise for life of either payments, benefits or care? ............................................................ x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate censideration? .................................................................................................................... ^
x ^
3. Did decedent own an "in trust for' or payabVe 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 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)].
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 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 disGosure of
assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of tleath on or after July 1, 2000:
• The tax rate imposed on the net value of transfers from a tleceased 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)j.
. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.;i 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 decedenPs 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.
Rev4808 EX. (8-eel
SCHEDULE E
CASH, BANK DEPOSfTS, & MISC.
PERSONAL PROPERTY
COMMWIW FAITHOF PENNariVAN1A
INHERITANCE TAX RETURN
RESI~EM OFCEDENI
ESTATE OF IFI~E NUMBER
Fnuuht_ Mildred J 21
InGUde the proceeds a litigation antl the ears the proceatlawara receivod by ore estate
All property jolMlY~ow^ad wIN tM right or wrvlvonhlP mwt Oe abelased on acheaWa P.
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
lX more space is needeq additional pages M me same size)
Rev-1818 EX+(e-98)
I SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWFALTHOF PENN6YLVANIA
I NHERITANCE TA% RETURN
RESIDENT DECEDENT
ESTATE OF
J
FILE NUMBER
This schetlula mull be campletetl antl filetl if the answer to any of puastions 1 through 4 on Na reverse sitle Of the REV-1580 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
THE DATE OF~TRCANSFER SATTACH A COPY OFTTHE DEED FCOREREAL ESTATE. DATE OF DEATH
VALUE OF ASSET %OF DECD'S
INTEREST EKCLElSION
(IF APPLICAEtLE) TAXABLE
VALUE
1 Monetary Gift to an Irrevocable Trust that has 5 adult 36,274.10 100.000°~ 15,000.00 21.274.10
children as beneficiaries on July 11, 2011 - amount of
gift 37,294.08
TOTAL (Also enter on Line 7, Recapitulation) I 21,274.10
(If more space is neetleq adtlitlonal pages of the same sire)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form pA-7500 Schedule G (Rev. 6-98)
REV-1157 Ex~(10-06) CI{E gxp~gry~r.7~p
COM~T DECEDENT ~ANIA
SCHEDULE H
FUNERAL EXPENSES &
1DMINISTRATIVE COST;
ESTATE OF FILE NUMBER
Fought, Mildred J _ 21
Debts of decedent must be reported on Schedule I.
ITEM
J`IUMBER DESCRIPTION AMOUNT
q, FUNERAL EXPENSES:
See continuation schedule(s) attached
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State
Year(s) Commission oaid
2. I ANornev's Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio _
Relationshio of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparers Fees
7. Other Administrative Costs
384.98
TOTAL (Also enter on line 9, Recapitulation) I 364.98
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule N (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINfSTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Fought Mildred J 21
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Egpenses
Sullivan Funeral Home 364.96
H-A 364.96
Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-1600 Schedule H (Rev. 6-98)
Rev-1512 E%~ f12-0el
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
coeuwaNwEA~moFaENNSnvpNIA
INHERITANCE TAX RETURN
RESIDENTOECEDENT
ESTATE OF FILE NUMBER
Fought Mildred J 21
Report debts Incurred M the decedent pdor to death Mat remslned unpaW attha date o[ death, including unrelmEursed medical ezpenaes.
ITEM VALUE AT DATE
HUMBER DESCRIPTION OF DEATH
1 Commonwealth of Pennsylvania- DPW Division of 3rd party liability estate recovery 3,407.02
2 Commonwealth of Pennsylvania- Repaying for Medicaid for medical expenses 20,433.42
3 Onsight Health Care LLC -medical bill 176.00
TOTAL (Also enter on Line 10, Recapitulation) I 24,016.44
(If more space is neetled, atldidonal pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1900 Schedule 1 (Rev. 12-OS)
REV 1613 EXn (H~161
SCHEDULE J
cor~l ~a~R~vANiA BENEFICIARIES
ESTATE OF FILE NUMBER
Fou ht, Mildred J 21
NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON/Sl RECEIVING PROPERTY (yyords) ($$$)
1 TAXABLE DISTRIBUTIONS [include outright spousal
• distributions, and transfers
under Sec. 9116 a 1.2
1 Denise A Erb Daughter 4,254.82
162 Lee Ann Court
Enola, PA 17025
2 Lloyd M Fought, Jr. Son 4,254.82
259 White Dogwood Drive
Fliers, PA 17319
3 Deborah J. Miller Daughter 4.254.82
1054 Temperance Hill Road
Lititz, PA 17543
4 Darla S Putt Daughter 4,254.82
3326 Turnpike Road
Elizabethtown, PA 17022
5 Dawn E Rothrock Daughter 4,254.82
68 Pleasant View Drive
Mechanicsburg, PA 17050
Total 21,27x.10
Enter dollar amounts for distributions shown above on lines 15 throw h t8 on Rev 15 00 cover sheet as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE71 _ _
Copyright (c) 2009 form soitware only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)