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HomeMy WebLinkAbout10-18-12 (2)1505610140 REV-1500 EX (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 1 2 9 4 8 _ Harrisbur PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 5 2 0 1 2 0 5 1 2 1 9 4 8 Decedent's Last Name Suffix Decedent's First Name MI F e a s t e r D o n n a M (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 INAPPROPRIATE OVALS BELOW 0 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) ^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ._ 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. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number S t e p h e n J- H o g g E s q- 7 1 7 2 4 5 2 6 9 8 r•a First line of address S t r e e t ~.:~ REGISTE FILLS US~ILY Z ~ ~ ~ !_.> . j ~D >. ~ . " ~' r 1 CI' - _ ~ ~ . , , fly, ~. ~~ ., ~" -, . ? ~t ~ ..D --+ is ~TE FILED U'1 ~ t_.,-3 r': z ,~--; C': rn 1 9 S- H a n o v e r Second line of address S t e 1 0 1 City or Post Office C a r l i s l e Correspondent's a-mail address: State ZIP Code P A 1 7 0 1 3 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. SIGNATUR~ OF PERSON RESPONSIBLE FO LING RETURN DATE ADDRESS 4259 Nantu~l'cet Drive Mechanicsburg PA 17050 SIGNATURE OF a,T, or~~,TREyy~,,,~. REPRESENTATIVE ~.~ _ 19 S- Hanover/~t~eet, Ste- 101 Carlisle PA 17013 rLt_asE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: Donna M• Feaster 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 1 7 3 . 4 7 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Nqn-Probate Property (Schedule G) U Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1 through 7) .............. .......... ... s. 6 1 7 3. 4 7 9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9. 6 0 3 0 . 0 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .......... ... 10. 1 1 1 . 7 4 11. Total Deductions (total Lines 9 and 10) ............................ ... 11. 6 1 4 ], . 7 B 12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 3 1 . 6 9 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) ......... ........... .. 1a. 3 1 . 6 9 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 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0 . 0 0 16. D , 0 0 17. Amount of Line 14 taxable at sibling rate X .12 3 1. 6 9 17. 3. 8 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 1 g. 0. 0 0 19. TAX DUE .................................................... ..19. 3 . 8 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 15D5610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 12 948 DECEDENT'S NAME Donna M. Feaster __ STREET ADDRESS cITY Tax Payments and Credits: ~• 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 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. STATE ZIP (1) 3.80 Total Credits (A + B) (2) 0.00 (3) (4) 0 00 (5) 3.80 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; or ................... ....................................................................... ..... d. receive the promise for life of either a ments, benefits or care P y ... .. ............................. ..... : D O 2. If death occurred after December 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 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)J. 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(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 [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-1508 EX+ (11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE INHERITANCE TAX RETURN CASH, BANK DEPOSITS & MISC. RESIDENT DECEDENT PERSONAL PROPERTY FILE NUMBER: Donna M. Feaster 21 12 948 Include the proceeds of INigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~• M&T Bank checking account #9849713509 OF DEATH 57.97 2• Maranatha-Carlisle Financial Management Service -Client Account 5,102.44 3. 1988 Pontiac Sedan VIN#1 G2AF51 R7JT251955 400.00 4. Comcast Refund 5. Kemper Insurance Refund 6. East Gate Apartment Refund 7. Brethren Mutual Insurance Refund TOTAL (Also enter on Line 5, Recapitulation) ~ If more space is needed, insert additional sheets of paper of the same size 31.56 131.00 429.50 21.00 7 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 Donna M. Feaster 21 12 948 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1• Myers-Harper Funeral Home, Inc. 2. Letort Cemetery Association B. ADMINISTRATIVE COSTS: 1 • Personal Representative Commissions: Names} of Personal Representative(s) Vlfglrlla B810g street Address 4259 Nantucket Drive city Mechanicsburg State FA zIP 17050 Year(s) Commission Paid: 2. Attorney Fees: Stephen J. Hogg, Esquire 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4• Probate Fees: AMOUNT 3,005.00 500.00 1, 000.00 1, 000.00 100.50 5. Accountant Fees: 6• Tax Return Preparer Fees: ~• Advertising: Law Journal The Sentinel 8. Tax Return and Inventory Filing Fee 9. Accounting (Estimated) 75.00 189.54 30.00 130.00 TOTAL (Also enter on Line 9, Recapitulation) ~ 3 If more space is needed, use additional sheets of paper of the same size. REV-1512 l'_X+ (12.08) ' pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8 LIENS c~~r~i~vr FILE NUMBER Donna M. Feaster 21 12 948 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1~ West Shore EMS -BLS 111.74 TOTAL (Also enter on Line 10 Recapitulation) I S If more space is needed, insert additional sheets of the same size. 111 74 REV-1513 EXt(01-10) ~° ^pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES ~~ i r{ i ~ ter: Donna M. Feaster NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outn' ht spousal distributions and transfers under Sec. 91 f6 (a) (1.2).] 1. Virginia Balog 4259 Nantucket Drive Mechanicsburg, PA 17050 21 12 948 RELATIONSHIP TO DECEDENT Do Not List Trustee(s1 Sibling AMOUNT OR SH OF ESTATE I 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 addltlonal sheets of paper of the same size.