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HomeMy WebLinkAbout10-22-12 (2)1505611180 REV-1500 EX (02-11) (FI) pennsylvania OFFICIAL USE ONLY PA Department of Revenue DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box 28oso1 ~l _.~r~ `_~~;'~2 ~l Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1?7-24-5011 09202010 05251932 Decedent's Last Name Suffix Decedent's First Name MI CLEVER HARRY P (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 BOXES BELOW Q 1. Original Return 4. Limited Estate Ox 6. Decedent Died Testate (Attach Copy of Will) 0 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 0 4a. Future Interest Compromise (date of death after 12-12-82) ~x 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 0 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number STEPHEN D. TILEY 717-243-5838 First Line of Address 5 SOUTH HANOVER STREE Second Line of Address City or Post Office CARLISLE Correspondent's a-mail address: State ZIP Code PA 17013 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. SIGNATURE OF PERSON RESPONSIB E FOR FILING RETURN DATE d ~-12 -' e ADDRESS DONNA RIPPLE CLEVER, 1202 CREEK ROAD CARLISLE, PA 17015 SIGNATU OF ARER OTHE THAN REPRESENTATIVE DATE ADDRESS STEPHEN D. TILEY_ 5 SOUTH HANOVER STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505611180 1505611180 3. Remainder Return (Date of Death Prior to 12-13-82) 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) REGISTER OF WILLS USE ONLY -. `+ C7 ,._._. -„ ~ : ~.> `~ _ ~ - --t -r _ y.; N _ F D`ART- E:FILfD - ~ !.._. ! ~ '1'? ~~ ~- r^ r~= ---' r' ,, ~.:,t .` ~__ -~ ~ + ~ TY !'i-i ~ .~ `~ p ~.... -T i J n[~ J 150561128D REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: HARRY P CLEVER 177-24-5011 RECAPITULATION 1. Real Estate (Schedule A) .............. . .......................... 1. N 0 N E 2. Stocks and Bonds (Schedule B) .................................... 2. 7 311 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. N 0 N E 4. Mortgages and Notes Receivable (Schedule D) ........................ 4. N 0 N E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... 5. 7 0 9 . 0 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. N 0 N E 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ....... 7. 0 . O O 8. Total Gross Assets (total Lines 1 through 7) .......................... 8. 8 0 2 O • O 0 9. Funeral Expenses and Administrative Costs (Schedule H) ................ 9. 15 • 0 D 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ 10. NON E 11. Total Deductions (total Lines 9 and 10) ............................. 11. 15 • D 0 12. Net Value of Estate (Line 8 minus Line 11) ........................... 12. 8 0 0 5 • 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... 14. 8 O 0 5 . 0 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 0 2668.33 15. 0.00 16. Amount of Line 14 taxable at linealrateX.O 45 5335.67 16. 240.11 17. Amount of Line 14 taxable at sibling rate X # # #l 17. 0 • 0 D 18. Amount of Line 14 taxable at collateral rate X # # #I 18. 0 • 0 0 19. TAX DUE ....................................................... 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 240.11 L 1505611280 1505611280 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number 177-24-5011 DECEDENT'S NAME HARRY P CLEVER STREET ADDRESS CITY CARLISLE STATE PA ZIP 17015 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest Total Credits (A + B ) (1) 240.11 (2) 0.00 (3) (4) 0.00 (5) 240.11 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box 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. 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 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)]. A sibling 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-1503 EX+ (7-11) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Harry P Clever 21-10-01028 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-1508 EX+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. NHERITANCE TOAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Harry P Clever 21-10-01028 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. 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 Harry P Clever ~ I "T ~~ "-~~~~~ Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address 2 3 City Year(s) Commission Paid: Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4. 5. 6. 7. Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Recorder of Deeds -Filing Fee Supplemental Inheritance Tax Return State ZIP 15 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 15 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+ (01-10) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Har P Clever 21-10-01028 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] Donna Hippie Clever 1 ~ 1202 Creek Road Spouse 1/3 Estate Per Agreement Carlisle, PA 17015 2 Sherry Lee Miller 5 South Stoner Avenue Daughter 1/3 Estate Per Agreement Shiremanstown, PA 17011 Barry Gene Clever 3. 4144 Enola Road Son 1/3 Estate Per Agreement Newville, PA 17241 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 ~ 0.00 If more space is needed, use additional sheets of paper of the same size. w n _~~ 0 n n 3 'v z~z a to rn ~ ~ ~ O O r-t ~? rt . r-r ~ ~ ~ ~ -t Q. - cn ~ : ~ :~. ~ ~ ~'' r~ n- ~- ~ -~, ~ :o ~. o ~ ~ ~ ~. '~ ~ ~ ~_ ~ .~ ~ ~ ~ O ~ . _ : ~..r . ~ ~ .. rr . ~ . lD ~ (D . ~ cn r--r ,~ O' O N N N N i-~` ~-' ~-' ~-` u~ u~ -P -P -P -P -P : ~ ~ : ~-` .~] ~ W W W W -P cn O O W W lO CO lO 10 0~,-P N N O O l0 0 ~ 10 10 ~ r+ : F-+ ~~ W W W W F-+ N U'I U'I .... N W O l0 00 ~l ~1 N ~1 00 rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn:rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn rn -~ -{~ : ~ ~ t-s --~ N N N N O O (!1 CJl :.: O O O O O'.O O:O O O O O O O O : 0: 0: 0 0 O ;;`;: A.~ fD ..::r ~, Sxf ~..:: 0 -„ 0 1 0 O N O o• o 0 o `.. Eft s V W ~+ N '- O ... ~:: ~~ w .... :. ~-. N` O F-+ V ~ :. O n n _ n _ rt ~ ~ (~ C ~ r* ~f "t ~ O ~ ~ . ~ ~ 0 C N ' O ~ ~ ~ O (/~ O \j I ~; '~~t \.~ ~3 q w r N r+ O F-+ r~ D FREY &TILEY ATTORNEYS-AT-LAW 5 SOUTH HANOVER STREET CARLISLE, PENNSYLVANIA 17013-3385 Telephone: (717) 243-5838 Facsimile: (717) 243-6441 Of Counsel: ROBERT M. FREY STEPHEN D. TILEY ROBERT G. FREY MEMORANDUM TO: Pennsylvania Department of Revenue Inheritance Tax Division ~,~ ~ FROM: Stephen D. Tile , Es uire Y q DATE: October 22, 2012 RE: Estate of Harry P. Clever, Jr., Deceased File: No. 21-10-1028 This memorandum accompanies the Su~~lemental Inheritance tax Return being filed in the above referenced estate. Please note the reference to the original return and the Memorandum which accompanied that original return. The original return was filed on September 15th of last year, 2011. We ask that you waive any interest or penalty in connection with the assets reported on this supplemental return as the assets were not discovered until this year. Should you have any questions, please do not hesitate to contact me. S DT/tl Encls.