HomeMy WebLinkAbout10-02-121505610105
REV- i ~oo EX (o2-ii) (FI) ~ OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes ~ ' `~' County Code Year file Number
PO BOX 28D6ot ~ pINHERITANCE TAX RETURN 1
Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT +~r I ~-- /~~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDWYY
264-52-2430 01 /14/2012 02/16/1937
Decedent's Last Name Suffix Decedent's First Name MI
Wine Gaylord 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
O~ 1. Original Retum 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
no
.r.;-f
Suzanne S. Friday, Esq. (717) 236-301~r.,~ ;:~;
First Line of Address
Nauman Smith
Second Line of Address
200 N 3rd 18th floor
City or Post Office
Harrisburg
Correspondent's a-mail address:
State ZIP Code
PA 17101
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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, co ct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU OF PERSON RESPONS E F FILI~iG~,4~ ETURN DATE
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SIGNATURE OF PREPARER O1~HER THAN REPRESENTATIVE ~ ~ DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
264-52-2430
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 and Notes Receivable (Schedule D) ......................... .. 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5.
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 100,285.16
7. Inter-vivos Transfers & Miscellaneous Non-Probate Property
7
765
85
63
(Schedule G) O Separate Billing Requested...... .
.. ,
.
8.
9 ) ...........................
Total Gross Assets (total Lines 1 throu h 7 8.
.. 186,050.79
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 6,807.72
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 34,926.89
11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 41,734.61
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 144,316.18
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. 144,316.18
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 - 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17~
18. Amount of Line 14 taxable 21
647
43
,
.
at collateral rate X .15 18.
19. TAX DUE ....................................................... ..19. 21,647.43
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~
Side 2
1505610205 1505610205 J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
DECEDENT'S NAME
Gaylord R. Wine
STREET ADDRESS
2123 Wentworth Drive
CITY
Camp Hill STATE i ZIP
PA ~ 17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
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.
(1)
Total Credits (A + B) (2)
(3)
(4)
(5)
21,647.43
21, 647.43
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 "intrust 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)].
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)]. 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-i5og EX+ (oi-io)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
Gaylord R. Wine
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A• Paul W. Austin 2123 Wentworth Drive Camp Hill, PA. 17011
B.
C.
JOINTLY OWNED PROPERTY:
Domestic Partner
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTIRJTION 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. 06124199 2123 Wentworth Drive Camp Hill, PA. 17011 117,136.00 50 58,568.00
2 A 06124199 Metro Bank 0616266913 67,796.15 50 33,898.08
3 A 06/24199 Metro Bank 0616266939 610.08 50 305.04
4 A 06/24/99 MIT Bank 3740923788 11,997.71 50 5,998.86
5 A 06124/99 MIT Bank 3740923317 3,030.35 50 1,515.18
TOTAL (Also enter on Line 6, Recapitulation) $ 100,285.16
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
~ pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gaylord R. Wine
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.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT ANO
THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1• Vanguard IRA 9842952375 31,109.64 100 31,109.6
2 Prudential IRA E0148097 28,250.17 100 28,250.1 i
3 Prudential Alliance 4353002048571 26,405.82 100 26,405.8:
TOTAL (Also enter on Line 7, Recapitulation) ~ I 85,765.63
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Gaylord R. Wine
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Neill Funeral Home 6,807.72
B.
1
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
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
ZIP
4.
5.
6.
7.
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
State ZIP
TOTAL (Also enter on Line 9, Recapitulation) I $ 6,807.72
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
~ Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gaylord R. Wine
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 ]
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Gaylord R. Wine
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• Paul W. Austin 2123 Wentworth Drive Camp Hill, PA. 17011 Domestic partner 100%
2 Paul W. Austin 2123 Wentworth Drive Camp Hill, PA. 17011 Domestic partner 100%
3 Paul W. Austin 2123 Wentworth Drive Camp Hill, PA. 17011 Domestic Partner 100%
II
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
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.
2,~(,90~
~~ig ~ee~
TAX PARCEL NO. 13-23-0549-211
MADE 7HE v~ ~ ~ daKy of ~`> ^ 2.
in the year ont thousand nine hundred nipety-nine (1999}
R, Wfli'fE and SUSAN WHITE, his wife. of Camp Ijsll, Pennsylvania.
B Oraators,
AND
PAUL W. AUS'CIN, s€tsglt men, and 4AYiARD RALPH WINE , siagic man,
As Joint Tettanis with the Right of Survivorship. Grantees
WI77flC~8Sr~ that is ponsidrratian of ONE HUNDRED THREE THOUSAND-------------------- -------
in hand paid, the receipt whereof is hereby adrnowledged, the said grantors do hereby grant and
convey to the said granter, heirs and assigns,
ALL THAT CERTAIN tract o£ land situate c Love rvt~y ~ MiChad C. D'Angtlo Registered Surveyor,
vania, bounded and described according
dated October 22, 1975, as follows:
BEGINNING at a pin on the southern line of Wentworth Drive (50 feet wide}, said pin being located
152.10 feet in a wtsterlq direction from the intersection of the western ~said2 is also being atlthe
southern line of Wentworth Drive (both hnes were pctcnded to intersect), P
~~ line between Lot Nos• 35 and 3~ N~ and 36 has showa~onsaidnPiaa, South IO
thence slang the dividing litre between thence along the dividing line between Lot Nos. 28 and
degi'ees 30 minutes Eaai, 120 feet to a pin: thence along the
35 as shown on sand Plan, South 79 degrees 30 minutes West, 60 £eet to a pin; 30 minutes
dividia8 line between Lot Nos. 34 and 35 as shown on said Plan. North 10 degrees
West, 120 feet to ~ qq9 a; 30 zn~'snutes F~as~ fip f Dt to pin, the plat of BEG G~ of
Wentworth Drive,
BEING Lot No. 35 as shown ea the Plan of Lots of Highland Estates, Additions No. 2, said Plan
being recorded in Cumberland County Plan Book 5. Page 51.
IIAVINO .tHEl?EpN ggEGTED a one story framt dwelling house known and numbered as 2123
Wentworth Drive. Camp Hill, pennsyhrania.
The shave mentioned survey modifiq and cocrecta a survey by Roy M. H. Benjaatin, Proftasional
Engineer. dated April 21, 1970, which said aurvel/ was erroneous and resulted in an incarrect
description in prior deeds.
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pu~1~RT~~ 1O3 P~ ~ aP~Q )a aap~g ayi )o x~~p acN u; SLbt 'Le ~R~O PaP~ Puce
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pua >PtuswsaKS "I ~N dq n~ou 'aea~ "I ,S~ucaN ~nt~° S3StTR32Id 3NIYS '.3HS ~Ni3S
Axtd the said grantors do hereby Wsrtxat 8paoially the Property hereby convoyed.
~ WlTNBSS 1Ytp; said grantors have hereunto set their hands and scale tha day
and year first above written.
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STATE OF T
C'4F ~}
On Lhis, the dr'*"~ ~y °f ~+~-- . 199 ., before me. the undersigriad
o8icer, petsonallY app~rad JEi'+FREY R. WHITE & SUSAN WHITE. his wife,
looowa to me (or astisfaMOrily provenl to be the persons whose names are subscribed to the within
inatrumrnt, and aclssiowledged that they eicecuted same for the purposes therein contained.
~r WfT1+)Egg WflERffiOl ; I hereunto xt my hand and official seal•
5nu~i~et S~J-~ I _._.~.r~ ,
~~~/~iotary lie
~Mii~ 4
STATE OF ~+`~•L:s ;.
COITNTY OF
On this, the day of , 199__, before me, the underaigncct
officer, personally appeared
known to me (or satisfactorily proven) to be the person whose name subscribed to the within
inatsvinent, and aclmovrledged that executed same for the purposes thereia contained.
~ ~q.~ggg tpggrt80l; I hereunto set my head and official seal.
(SEAL(
Notary Public
oonx 202 racF 338
Gs~rn~tcaTS of x~sm~lvt:E
I do hereby cerLifY chat the precise residence and counplete post ofbce address of the within
o71~ ~ ca0 ~ !~' ~. ~..
. ~ 70 IL__.- Attorney/Agent f ~ l W
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~+~ day of___~~--- A. D. 19~
RSfaURDED on this ~~~--=--
~ the gecorder'a office at tha sa2id County, in Daad Book-~
Vol. ~/.~-~ ~Ba 7~.1~_
1~4~;i~•.,• ;. Given under nsy hand end/the seal of the said office, the date above written.
• ~ ~ y~~~~_Y~'~t.~v Recorder.
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' PAGE 339
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PAUL W AUSTIN ESTATES 327
5356 HOLIDAY RD t 7-7000/2910 59
MINNETONKA, MN 55345 1852726498
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