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HomeMy WebLinkAbout10-18-12 (2)1505610105 REV-15 00 EX (oz-u) (FI)j ~i PA Department of Revenue enns lvania OFFICIAL USE ONLY ~E1=Af~i MF'u' OF ~L'eENI'~!: p y County Code Year File Number Bureau of Individual Taxes PO BOX 28o6oi INHERITANCE TAX RETURN ~ ` ~- ~ f ~~ ~~.-- Harrisburg, PA 1'7128-o6oi RESIDENT DECEDENT I ~ ,.;~; , ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 192-18-2177 03/ 19/2012 03/24/1923 Decedent's Last Name Suffix Decedent's First Name MI Johnston III James R (If Applicable) Enter Surviving Spouse's Infor mation Below Spouse's Last Name Suffix Spouse's First Name MI Johnston Marion N Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 280-20-1946 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~ 1. Original Return O 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) Cl~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 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 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TQ: Name Daytime Telephor~e~Vumber ~;~~, _L} John C Oszustowicz '~ ~-~ r~.~ (717) 243-743 ~~ ~ ~ ~T-.., ~-R-~, ;~_~_ REGISTER -111!l1CL~S USE ONa.Y ~ , -.;~' ,~ „=- ` G*7 ' - ~v ~ ~ •: ~ First Line of Address ~ ~'`~ ~ , ~v: ; - f .; ~ 104 S Hanover St = .~ r -,:- ~ ~~ ~' ` Second Line of Address ~ ~ t City or Post Office State ZIP Code ~ DATE FILED Carlisle PA 17013 Correspondent's a-mail address: john0 carlislepalaw.com 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, c ect an complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU F [~E SQN,R~SPONSIBLj=~OR,FILING RETURN DATE p ~_. a ~' ~~/~' et ~. ADDRESS - ~ 104 S H over St., Carlisle, PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 1505610105 Side 1 1505610105 ~. ;:.. J 150561,0205 REV-1500 EX (FI) Decedent's Social Security Number 192-18-2177 Decedent's Name: RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 2. ..................................... Stocks and Bonds (Schedule B) 2. .. 1,007.50 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. 9 9 ( ) ......................... Mort a es and Notes Receivable Schedule D 4. .. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 3,264.68 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 4,341.73 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 810.67 387 (Schedule G) O Separate Billing Requested...... .. 7. , 8. ( g ) ................ Total Gross Assets total Lines 1 throu h 7 ........... .. 8. 396,424.58 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 396,424.58 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. 396,424.58 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 395,474.86 (a)(1.2) x .0 00 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 45 949.72 16. 42.74 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19 42.74 19. TAX DUE ...................................................... . ... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1,50561,0205 150561,0205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME James R Johnston, III STREET ADDRESS 629 Belvedere St. CITY .STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 42.74 2. Credits/Payments A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 42.74 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 ........................................................................................................................ ...... ^ tl. 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-i5o3 EX+ (~-u) pennsylvania !~3 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER James R Johnston, III 21-12-0552 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-i5o8 EX+ (ii-io) ~ , pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT --- ESTATE OF: FILE NUMBER: Johnston, James R, III 21-12-0552 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-i5og EX+ (oi-io) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN nCrTn CnIT nCrCn CHIT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Johnston, James R, III 21-12-0552 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A, Marion N Johnston g' Lucille JJohnston-Walsh C. ~nTnrr~ v f1WNFl1 DRf1PFRTY~ 629 Belvedere St. Carlisle, PA 17013 I Spouse 28 Sheeley Lane, Boiling Springs, PA 17007 I Daughter ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 1 AB 08113107 Orrstown Bank Checking Account 106004451 5,698.20 33. 1,899.40 2 A 06/08105 Vanguard 500 Index Fund Account 0040-09933383099 4,884.66 50 2,442.33 TOTAL (Also enter on Line 6, Recapitulation) I $ 4,341.73 If more space is needed, use additional sheets of paper of the same size. ~ pennsylvania SCHEDULE G DEPARTMENT of REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER James R Johnston, III 21-12-0552 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 INCLUDE THE NAME Of THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE of TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION QF APPLICABLE) TAXABLE VALUE 1• Morgan Stanley IRA transferred to Marion Johnston wife on 4/27/12 , 387,810.67 100 387,810.6 TOTAL (Also enter on Line 7, Recapitulation) $ ~ 387,810.67 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: Johnston, James III 21-12-0552 If more space is needed, use additional sheets of paper of the same size.