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HomeMy WebLinkAbout09-20-121,50561,01,05 REV-1500 Ex ~oz_~~, ~F>, OFFICIAL USE ONLY PA Department of Revenue Pennsylvania ° ~>~rME"r °` aE~E""F Coun Code Yea File Number Bureau of Individual Taxes ~' PO BOX 28o6oi INHERITANCE TAX RETURN k Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ~/~~ ~ ~ ~ L. ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 204-28-0972 01 /15/2012 03/09/1935 Decedent's Last Name Suffix Decedent's First Name MI 'Koonce Mary R (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 IN APPROPRIATE OVALS BELOW C>~ 1. Original Return p 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) ~ 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 T0: Name _ Daytime Telephone Number !Adam R. Deluca, Esq First Line of Address 61 West Louther Street Second Line of Address City or Post„Office ............. State ZIP Code REGISTERILLS USE ORtL'Y ~.a . Cn n ~ S_s ~ ` ~• © . C7 C:' O ~ ~ -~ _ -AILED t T •• , -w r~ w Carlisle PA 17013 ' ~'' Correspondent's a-mail address: ardelUCa85Cc~aOI.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. S_IG~NATURE OF PERSONS RESPONSIBLE FOR FILING RETURN DATE 'i .~, i> ~°~~'Irf~~'L,~'`~ ~ ,~ ~~7 is ~~_ ADDRES 18 Valley Road, Newville, PA 17241 SIGNATURE OF PRE,P.~R -OTHER T~iAN REPRESENTATIVE D TE .~ .~,-yam, // ~,r ADDRESS r 61 West Louther Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 150561D105 J ~l'I ."Tl f ; "~ t --; . _.i,., ~~ i _r _._'_~ r~r~ h~J J REV-1500 EX (FI) Decedent's Name: Mary ROSe KoOr1C@ 1,505610205 Decedent's Social Security Number 204-28-0972 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 28,500.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 1,841.25 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 30,341.25 9. Funeral Expenses and Administrative Costs (Schedule H) ............. ...... 9. 2,142.83 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ......... ...... 10. 206.86 11. Total Deductions (total Lines 9 and 10} ........................... ...... 11. ' 2,349.69 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12 27,991.56 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. 27,991.56 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. 16. Amount of Line 14 taxable at lineal rate X .0 45 27,991.56 16. 1,259.62 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. TAX DUE ...................................................... ... 19. 1,259.62 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 1,50561,0205 150561,0205 REV-1500 EX {FI) Page 3 Deceden#'s Complete Address: File Number DECEDENT'S NAME Mary Rose Koonce STREETADDRESS -- 18Valley Road CITY Newville STATE ZIP PA 17241 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 64.13 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. Total Credits (A + B) (2) (3) (4) (5) 1,259.62 1,346.63 87.01 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 tlesignation? .................................................................................................................. .... ^ 1F 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 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(x)(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(x)(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(x)(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. 1,282.50 REV-1502 EX+ {11-08) e pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF MARY ROSE KOONCE FILE NUMBER 2012-00149 ~., , «~ Ni vNci ay uw~~cu ,u~niy ur as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is iointly-owned with right of c~~r~~~~r~h~n mncf ho rl~c~t~.ce.l ,,., c..w..a..~., r If more space is needed, insert additional sheets of the same size. REV-iso8 EX+ (li-so) r Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FYLE NUMSER: Mary Rose Koonce 2012-00149 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-1511 EX+ {10-G9) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Mary Rose Koonce 2012-00149 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Names} of Personal Representative(s) Rickey L. Moffitt Street Address 18 Valley Road city Newville state PA zIP 17241 Year(s) Commission Paid: 1,800.00 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, 5. b. 7, s. 9. ZIP Probate Fees: Accountant Fees: Tax Return Preparer Fees: Advertise Estate in Cumberland Law Journal Advertise Estate in Patriot News Paper File Inheritance Tax Return TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 153.50 75.00 99.66 15.00 2,142.83 REV-151? EY+ (12-OS) II r Pennsylvania SCH E DU LE I !, DEPARTMENT OF REVENUE DEBTS OF DECEDENT INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY ROSE KOONCE 2o~?-~n~aA 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) ~ pennsylvania SCHEDULE J DEPARTMENT OF REVENUE - BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Mary Rose Koonce 2012-00149 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• Rickey L. Moffitt 18 Valley Road, Newville, PA 17241 son 30941.25 2. Roger E. Moffitt 12 Valley Road, Newville, PA 17241 son 200.00 3. Ruby Martin 165 Mohawk Road, Newville, PA 17241 daughter 100.00 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. Gary L. Foster, Realtor SPENCER & SPENCER REALTY 1325 N. West Street, # 1 Carlisle, PA 17013 717-386-9221 Apri12, 2012 To Whom It May Concern: On March 15, 2012, I completed a walk through inspection of the property at 18 Valley Road, Newville, PA 17241. The purpose of the inspection was to determine the value of the property for the Estate of Mary Rose Koonce. Through the Market Analysis process, I have determined the value of the property to be $28,500.00. I do not have any interest in the property except to determine the market value. Sincerely, '~ ~; . ~.: Gary L. Foster, Realtor Spencer & Spencer Realty THIS ANALYSIS HAS NOT BEEN PERFORMED IN ACCORDANCE WITH THE UNIFORM STANDARDS OF PROFESSIONAL APPRAISAL PRACTICE WHICH REQUIRES EVALUATORS TO ACT AS UNBIASED, DISINTERESTED THIRD PARTIES WITH IMPARTIALITY, OBJECTIVES AND INDEPENDENCE AND WITHOUT ACCOMMODATION OF PERSONAL INTEREST. IT IS NOT TO BE CONSTRUED AS AN APPRAISAL AND MAY NOT BE USED AS SUCH FOR ANY PURPOSE.