HomeMy WebLinkAbout08-16-12 (2)J 1505610140
REV-1500 Ex j°'-'°'
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
Po Box 2aosot INHERITANCE TAX RETURN 2 1 1 2 0 6 6 9
Harrisburg PA'17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Secudy Number Date of Death MMDDYYYY Date Of Birth MMDDYYYY
1 8 8 1 2 3 5 1 7 0 5 2 3 2 0 1 2 ~ 8 l1 3 1 9 2 U
Decedent's Last Name Suffx Decedent's First Nalne MI
B I R D R U T H V
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Lasl 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
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (dale of death
pdor to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
Q 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trus[ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9713(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TIU(INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4„6 5 0
~,
a~a
REGISTERy3F'~LLS USE ~Y 7 , ~~
StZ7 -gy=p C' ~ i __ 7
First line of address ~ I I_ ~ - ~ ~'~
r~ n r
u m ~ ~.
5 4 E M A I N S T R E E T n O`~ ~' ~ _.' ~-n
Second line of address QK_. ~ _' ~ }
w ~rn
-_r N In~j
City or Post Office State ZIP Code DATE FILED J
M E C H A N I C S B U R G P A 1 7 0 5 5
Correspondent's a-mail address:
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.
SIGr~ATUy~ OF PERSON RESP NSIB E FOR FILING RETURN DAT
SIGNATURE OF PFjE~REFXjOTl~R TF~1V REPRESENTATIVE D~//4 // Z
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140
:L505610140
J~
155610240
REV-1500 EX Decedent's Social Security Number
Decedent's Name: RUTH V• BIRD 1 8 8 1 2 3 5 1 7
RECAPITULATION
~ ~ 0
1. ( ) .....................................
Real Estate Schedule A .... .. 1.
2 5 8 6 7 9 . 2 0
2. Stocks and Bonds (Schedule B) ................................ .... .
..
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3.
4. Mortgages and Notes Receivable (Schedule D) .................... .... .. 4.
1 5 1 6 1 4 . 7 1
S. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .... .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6.
7. Inter-Vivos Transfers & Miscellaneous N -Probate Property
(Schedule G) ~ Separate Billing Requested . .... .. 7. •
8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 2 1 ~ 2 9 3 . 9 1
9.
............
Funeral Expenses and Administrative Costs (Schedule H)
.... 9.
.. 6 8 6 3 . 5 0
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 1 8 7 D . 5 4
11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 8 7 3 4 . ~ 4
12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. 2 0 1 5 5 9 . 8 7
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. 2 ~ 1 5 5 9 . 8 7
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable
at lineal rate X .0 _ 16. 0 . ~ 0
17. Amount of Line 14 taxable
2 0 1 5 5 9
8
7
17
2
4
1
8
7
1
8
.
at sibling rate x .12 . .
18. Amount of Line 14 taxable
0 ~
~
~
~
0
at collateral rate X .15 18. •
19. TAX DUE ...................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
2 4 1 8 7. 1 8
Side 2
1505610240 1505610240
REV-1500 EX Page 3
Qecedent's Complete Address:
DECEDENT'S NAME
RUTH V. BIRD
__
STREET ADDRESS
712 CHARLES STREET __
CITY
MECHANICSBURG STATE
PA ZIP
17055
Tax Payments and Credits:
t. Tax Due (Page 2, Line 19)
2. CreditslPayments
A, Prior Payments
B. Discount
3. Interest
File Number
21 12 0669
(1) 24,187.18
1,209.35
Total Credits (A+E3) (2) 1,209.35
4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT.
Fiil in oval on Page 2, Line 20 to request a refund.
(3)
(4) 0.00
5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 22,977.83
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 lransferred : ................................................................. ..... ^
b. retain the right to designate who shall use the property transferred or its income : ......................... ..... ^ O
c. retain a reversionary interest; or ..................................................... ^ X
d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................................................................. ...... ^ 0
3. Did decedent own an "in tmst tor' orpayable-upon-death bank account or security at his or her death? ... ...... ^ Q
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ............................................................................................ ...... ^ 0
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) (t.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
fling a tax return are still applicable even if the surviving spouse is the only benefciary.
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 far the use of the decedent's lineal bene0ciaries is 4.5 percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)j.
• The tax rate imposed on the net value of transfers to or far the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defned, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
RUTH V. BIRD 21 12 0669
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM I VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SAVINGS BONDS 58,679.20
8 EE
NET REDEMPTION VALUE
TOTAL (Also enter on line 2, Recapitulation) ~ $
(If more space is needed, insert additional sheets of the same size)
REV-1508 FJC+ (11-10)
pennsylvania SCHEDULE E
DEPARTMENT OE REVENUE
CASH, BANK DEPOSITS, & MISC.
INRERNANCE rAx RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RUTH V. BIRD 21 12 0669
Include the proceeds of litigation and the date the proceeds were received by the a<tate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CITIZENS BANK 5,643.53
CHECKING
2. CITIZENS BANK 42,252.18
MONEY MARKET
3. WELLS FARGO 500.04
CHECKING
4. WELLS FARGO 48,309.65
SAVINGS
5 CASH 300.00
6. HIGHMARK 167.20
MEDICAL INSURANCE REFUND
7. PNC BANK 2,150.39
CHECKING
8. PNC BANK 52,291.72
MONEY MARKET
TOTAL (Also enter on Lina 5, Recapitulation) ~ $
If more space is needed, insert additional sheets of paper of the same size
REV-1511 EX+(10-09) ~ I
pennsylvania SCHEDULE H
oEPARrMeNroF RevanluE FUNERAL EXPENSES AND
INHERITANCE TAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
FILF: NUMBER
RUTH V. BIRD 21 12 0669
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. AUER FUNERAL HOME, HARRISBURG, PA (PREPAID)
2. TOMBSTONE 2,000.00
3. CEMETARY GRAVE OPENING-ST JOHNS CHURCH, DANVILLE, PA '100.00
4. FURNERAL LUNCHEON-ST JOHNS CHURCH, DANVILLE, PA 125.00
5. ROOM RENTAL LUNCHEON-ST JOHNS CHURCH, DANVILLE, PA 50.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) THELMA B. FISSEL
Street Address 712 CHARLES STREET
City MECHANICSBURG State PA ZIP
Year(s)CommissionPaid: (RENOUNCED)
2, I Attorney Fees: MURREL R. WALTERS, III
3, Family Exemption: (If decedents address is not the same as claimant's, attach explanation.)
(:laimant
Sueet Address
City State _
Relationship of Claimant to Decedent
4. ~ Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS
5. I Acwuntant Fees:
6. I Tax Retum Preparer Fees:
7
4,200.00
388.50
TOTAL (Also enter on Line 9, Recapitulation) ~ $
ZIP
if more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-De)
pennsylvania SCHEDULE I
oEanRTMer+TOFREVeNUr: DEBTS OF DECEDENT,
wHERIrANCE TAx REruRN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
RUTH V. BIRD 21 12 0669
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, Including unreimbursed medlcai expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MESSIAH VILLAGE 1,617.65
RESIDENTIAL CARE
2. ALERT PHARMACY 52.89
MEDICAL
3. PINNACLE HEALTH 200.00
MEDICAL
TOTAL (Also enter on Line 10, Recapitulation) I $
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(nbr^_)
pennsylvania I SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
RUTH V. BIRD [T i[ uuoa
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List T'rustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS pnclude ouMght spousal distdbutions and Vansfers under
Sec. 9116 (a) (1.2).]
1. THELMA B. FISSEL Sibling 33.00
712 CHARLES STREET
MECHANICSBURG,PA17055
2. DAVID E. BIRD Sibling 33.00
68 WONDERVIEW ROAD
CATAWISSA, PA 17820
3. JANE B. BRANDY Sibling 33.00
301 JADE AVENUE
DANVILLE, PA 17821
ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
i. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAI(EN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.