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HomeMy WebLinkAbout10-03-121505610105 REV-1500 °``°~11'«, OFFICIAL USE ONLY PA Department of Revenue P~Y~~a Bureau of Individual Taxes INHERITANCE TAX RETURN Cot>nty Code Y~r File Number PO Box 2806oa, c~ ~ ~ ~ -a ~o Harrisburg, PA i~iz8-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 11 /01 /2011 11 /19/1925 Decedent's Last Name Suffix Decedent's First Name MI Reith Jean q (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Soaal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return Q 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 0 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 1-1-95j (Attach Schedule O) CORRESPONDENT - THIS SECTN)N MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTU\L TAX INFORMATN)N SHOULD BE DIRECTED T0: Name Daytime Telephone Number Baebara J. Nelson (717) 975-2028 First Line of Address 829 Mandy Lane Second Line of Address City or Post Office Camp Hill State ZIP Code PA 17011 REGISTER OF WILLS USE ONLY N N CO ~ _~ i~~' re --I I G7%.., Q ~ ~-. ~~ ~ ~ D/ D D '-+ :: c[± ~;;_) C: ~n .~ , ~-F ~~ Yf ~~`i ~^ ." ~,l ..-~~~ .~~ ~; f-rt c~ correspondents e-maH address: bjnelson49@yahoo.COm Under penalties of perjury, I declare that I have examined this return, including acx:omparrying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparerpther than the personal representatNe is based on all information of which preparer has any knowledge. ADDRESS (? {~ C11 ~ -_C.t Ci t 11~'~ _ ~ ' ~*- I ~ V SIGNATURE OF PREPARER OTHER THAN R RESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 1505610205 REV-1500 EX (FI) Decedent's Social Security Number oecedenrsNarne: Jean A. Reith RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 37,089.33 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. 4,775.95 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 3,142.64 7. Inter-~fivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 69,886.62 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 140,659.06 9. Funeral Expenses and Administrative Cosis (Schedule H) ................... 9. 7,196.61 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 280.00 11. Total Deductions (total Lines 9 and 10) ................................. 11. 7,476.61 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 133,182.45 13. Charitable and Governmental BequestslSec 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. 133,182.45 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (au1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 133,182.45 16. 5,993.21 17. Amount of Line 14 taxable at sibling rate X .12 17, 18. Amount of Line 14 taxable at cdlateral rate X .15 18. 19. TAX DUE ...................................................... ... 19. 5,993.21 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 1505610205 1505610205 REV-1500 EX (Fp Page 3 Decedent's Complete Address: Flk Number DECEDENTS NAME Jean A. Reith STREETADDRESS 829 Mandy Lane CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments 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 ZO to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 5,993.21 (5) 5, 993.21 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 beneficary 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 aRer 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 disdosure 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 p2 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents lineal benefiaaries is 4.5 peroent, 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. Total Credits (A + B) (2) (3) (4) REV-1503 EX+(8az) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~ s STOCKS & BONDS ESTATE OF FILE NUMBER Jean A. Reith 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-iso8 EX+ (u-io) ~, pennsytvania SCMEOYI.E E i~ DEPARTMENT OF REVENUE CASH, gpNK DEPOSITS 8~ MISC. lNHERIfANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jean A. Reith 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. iT more space is needed, use additional sheets of paper of the same size. REV-1509 EX+ (OS-io) ~j Pennsylvania DEPARTMENT OF REVENUE MHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpYLE F 70INTLY-0WNED PROPERTY ESTATE OF: FILE NUMBER: Jean A. Reith If an asset became jointly owned within one year of the deoedenYs date of death, >t must be reporbTSd on Schedule G. SURVIVING ]DINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Barbara J. Nelson 829 Mandy Lane Camp Hill, PA 17011 daughter B. C. ]OINTLY OWNED PROPERTY: nEM NUMBER LETTER FOR ]DINT TENANT DA7E MADE IODIT DESCRIPTION OF PRDPERTY IN(]iIDE NAME OF FBWINCGL INSTRURON AND BANK ACCOUNT NIAABER OR SIMILAR IDENTIFYING NUMBER. AITAGTI DEED fDR 70INTLY HELD REAL ESTATE DATE OF DEATH VALUE OF ASSET 96 OF DECEDENT'S BdTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 01/01/95 PSECU 151165045 to PSECU 197407876 cash transfer 10/4/2011 6,285.27 50 3,142.64 TOTAL (Also enter on Line 6, Recapitulation) I $ 3,142.64 If more space is needed, use additional sheets of paper of the same sae. ~.E'd- ' J ~ x+ ~ , Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Jean A. Reith 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 IINIUDETFffNAME0FINETRANSF9IEE,TFIEDIRE4AT[aNSF4PTODECEDEifrAND TtiE DmE or IanNSra~. A7TACIi A 00M of TFE 0E~ FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET 96 OF DECD'S INTEREST EXCLUSION (Ir APPLIpIBIE) TAXABLE VALUE I• Annuity Barbara J. Nelson daughter 23,295.54 1/3 23,295.5< 2 Annuity Rath E. Nelson son 23,295.54 1/3 23,295.5< 3 Pamela J. Kutchman daughter 23,295.54 1 /3 23,295.5< TOTAL (Also enter on Line 7, Recapitulation) ; I 69,886.62 If more space is needed, use additional sheets of paper of the same size. ~' -_~'~ tX+ , Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ---- ESTATE OF FILE NUMBER Jean A. Reith Decedent's debts must be reported on Schedule I. ITEM ' NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I' Myers-Hamer Funeral Home 3,041.00 2 Estimated cost to bury ashes 200.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address State ZIP 175.50 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation.) 3,500.00 Claimant Barbara J. Nelson street address 829 Mandy Lane city Camp Hill state PA zIP 17011 Relationship of Claimant to Decedent daughter 4. Probate Fees: 83.50 5. Accountant Fees: 6. Tax Return Preparer Fees: ~• Cumberland LawJoumal estate notice 75.00 The Patriot News estate notice 95.66 Check book fee 25.95 City Year(s) Commission Paid: TOTAL (Also enter on Line 9, Recapitulation) I $ 7,196.61 If more space is needed, use additional sheets of paper of the same size. Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES Slt LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jean A. Reith 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.