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Home My WebLink About09-10-121505610140 REV-1500 Ex (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau oflndividual Taxes County Cade Year File Numtler PO BOx 280601 INHERITANCE TAX RETURN 2 1 1 2 0 9 2 7 Hardsburg, PA 1712&0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Securty Number Date of Death MMDDYYYY Date of Binh MMD~DYVYY 1 7 5 3 2 5 3 4 6 0 6 1 5 2 0 1 2 1 0 1 5 1 9 3 6 Decedent's Last Name Suffix Decedent's First Name MI J O H N S O N F R E D D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW O 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust _ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death poor to 72-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes i t . Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTgN NUST BE COMPLETED. ALL Name M A R C U S A First line of address I R W I N & Second line of address 6 0 W E S T City or Post Office C A R L I S L E M c K N I G H T, ID CONFIDENTIAL TAX INFORNATN)N SHOULD BE DIRECTED T0: Daytime Telephone Number ,..> I I I 7 1 7 4 9 2`~ 5 ,~ M c K N I G H T P C P O M F R E T S T R E E T State ZIP Code P A 1 7 0 1 3 O N ~ ;~ usE r , ~ <.~ l c~ ~ = ~ ' ~ Ci `- 1; (~ . - r`n ~ ~ '-~ y cn ~~ r- DATE FILED Correspondence e-mail address: Under penalties of perjury, I declare that I have examined this return, indutling accompanying schedules and statemenN, and to the best of my knowledge and belief, it is ,correct and . Declaration of preparer other roan the personal represematlve is based on ell information of which preparcr has arty knowledge. R N ESPONSIBLE FOR FILINO RETURN DATE OF PREPARER OTHER THAN REPRESENTATNE DATE 6D WEST POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 ~ (~! ~,. _ ._. 1505610240 REV-1500 EX p~ Socis~ Security Number Decedents Name: FRED D• JOHNSON 1 7 5 3 2 5 3 4 6 RECAPITULATION 1. Real Estate (Sonedu~ A) ........................................... 1. 1 1 6 6 0 0. 0 0 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) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous N~Probate Property (Schedule G) U Separate Billing Requested ....... 7. 8. Total Grose Assets (total Lines 1 through 7) ........................... 8. 1 1 6 6 0 0. 0 0 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9• 8 2 3 . 5 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. • 11. Total Deductions (total Lines 9 and 10) ............................... 11. 8 2 3 . 5 0 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 1 1 5 7 7 6. 5 0 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. 1 1 5 7 7 6. 5 0 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.o _ 1 1 5 7 7 6. 5 0 15. O. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0 • 0 0 16. 0. 0 0 17. Amount of Line 14 taxable 0 0 0 17 0 0 0 at sibling rate X .12 . . . 18. Amount of Line 14 taxable 0 0 0 0 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 1505610240 Side 2 1505610240 0. 0 0 REV-1500 EX Page 3 Decedent's Complete Address: Flle Number 21 12 0927 D CEDENT'S NAME SON _ _ FRED D.JOHN _ STREET ADDRESS 87 B STREET _ cln CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: t. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 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, 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. (,) o.oo Total Credits (A+E!) (2) 0.00 (3) (4) 0.00 (5) 0.00 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 : ................................................................ . ^ ^X 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, benefts or care? .................................................. ..... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideralion? ................................................................................. ...... ^ 0 3. Did decedent own an "intrust for" or payable-upontiealh 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? ............................................................................................ ...... ^ ^X IF THE ANSWER TO ANY OF THE A80VE 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 Vansfers 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 Vansfers 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(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 decedent's siblings is 12 percent X72 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-1502 EX+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAx RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: FRED D.JOHNSON 21 12 0927 All real property oxmed salety or 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 Jolntlyowned vdth right of survivorship must lx disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 87 B STREET, CARLISLE, PENNSYLVANIA 116,600.00 TAX ASSESSMENT TOTAL (Also enter on Line i, Recapitulation.) ~ S If more space u 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 FRED D.JOHNSON 21 12 0927 DecedenCs debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP p. AttomeyFees: IRWIN 8 McKNIGHT, P.C. 3, Family Exemption: (If decedents address b not the same as claimants, attach explanation.) ( laimanf 4. Sfreet Address Ciry State Relationship of Claimant to Decedent Probate Fees: REGISTER OF WILLS 5. I Accountant Fees: 6. 7 Taz Retum Preparer Fees: REGISTER OF WILLS -FILING FEE ZIP 500.00 293.50 30.00 TOTAL (Also enter on Line 9, Recapitulation) S If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+t01-10) pennsylvania SCHEDULE J DEPARTMENT OP REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER: FRED D. JOHNSON n tc uau RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do NM List Trustee(s) OF ESTATE [ TAXABLE DISTRIBUTIONS [Include ouNpht spousal distributions and Vansfers under Sec. 9116 (a)(1.2).] 1. RUTH M. JOHNSON Spousal 115,776.50 87 B STREET REMAINDER CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16 OF RE'V-1500 COVER S HEET, AS APPROPRIATE. -I. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAN;EN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART [I -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E If more space is needed, use additional sheets of paper of the same size. Ta~c Mapper Cumberland County, PA FERRY C~7UiJT`! nr/; w'' YlJ 1- LYM ~f1, ~r ~y},` ~~~`~~+U,ky'~1 ~~ mi ~ ~ ~ Copyright 2011 Esri. All rights reserved. Wed Sep 5 2012 10:11:27 AM. 87 B STREET PIN:06-20-1798-0528 Deed book: 0036K-00945 Owner: JOHNSON, FRED D SR Land Use Code: 101 Property Type: R Acreage: 0.09 Square Feet: 1163 Taxable Status: T Clean & Green Status: Land Assessed Value $: 14300 Building Assessed Value $: 102300 Total Assessed Value $: 116600 Sale Price $: 57900 Sale Date: Tue Jul 27 1993 08:00:00 PM Year Built: 1991 Municipality: CARLISLE BORO 5TH WRD Height in Stories: 1 Type of Dwelling: MODULR Primary Exterior: Vinyl Basement Percentage: CRL Air Conditioning: NO Total Rooms: 5 Bedrooms: 3 Full Bath: 1 Half Bath: c> Y Z' AA JV< o~ai' QUALIFIED DISCLAIMER In accordance with Internal Revenue Code Section 2518 (b) andi pursuant to Section 6201 of the Pennsylvania Probate Estate and Fiduciaries Code, (20 PA.C.S.A. Section 6201), this Qualified Disclaimer is being executed by the undersigned heir, FRED D. JOHNSON, JR in order to disclaim and renounce his individual capacity as a residuary heir of the ESTATE OF FRED D. JOHNSON, SR, and hereby transfers his interest to RUTH M. JOHNSON, specifically the real estate located at 87 B Street, Carlisle, Pennsylvania.. This disclaimer is executed as of this ~ day of August, 2012, the same being effective as of the date of death of the decedent, Fred D. Johnson, Sr. on June 15, 2012. SS COUNTY OF On this, the ~~ n- day of 2012, before me, the undersigned officer, personally appeazed FRED D. JOHNSON, JR., kno to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal. ~7H t7F p®iN . KaraAaFSsd Karen 5. Noe4 -~Y AA9e odwleeae, e~mis NEt~PENNSri~ [Pe Ap56pW7Wn OF NOTAWFB SEAL) ~O a7 p ••' m ~; m ~T~ ~ G~J ~ ~ ~ r ~ ~a N ~ ~ ; G " ^ O >,- ~ c ~ a _r .~, -, v = c~J c p ~ ~{, 'T STATE OF