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Home My WebLink About10-26-12 (2)I 1505610190 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 280601 INHERITANCE TAX RETURN 2 1 1 2 0 2 0 3 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 2 0 5 1 6 4 0 8 9 0 2 0 4 2 0 1 2 0 2 2 2 1 9 2 5 Decedent's Last Name Suffix Decedent's First Name MI WARD DOROTHY M (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 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 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) Q 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 ANU cUlvflutN I IAL I Ax mrurcmA i wn ~n~uLU Est uirct~ ~ to ~ v: Name Daytime Telephone Number r-;~ ~:~ MURRE L WALT E RS I I I ESQ 7 1 7 6~ 45 Q~:-~~~ First line of address 54 EAST MAI N STREET Second line of address City or Post Office M E C H A N I C S B U R G Correspondent's a-mail address: State P A ZIP Code ~ 1 7 0 5 5 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. MATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS DONNA J. ~E 118 E. COOVER ST. MECHANICSBURG PA 17055 SIGNATURE ~,. RE O ER THAN REPRESENTATIVE DATE ADDRESS ,~ ~(> "/ ~" ' MUR . WALTERS, III, 54__E. MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY L 1505610140 Side 1 DATE FILED ~~ ~~ ~.___; .~ ~-- .'~ ,,r _; %-=E ;~-r~ c~ _~ 1505610140 J h~J J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: DOROTHY M. WARD 2 0 5 1 6 4 0 8 9 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 0 . 1 6 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 1 2 1 2 7 5 ' 0 4 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. • 8 1 2 1 3 2 5 2 0 8. Total Gross Assets (total Lines 1 through 7) ........................... . 9 3 7 3 9 • 5 5 9. Funeral Expenses and Administrative Costs (Schedule H) ............ ...... • 7 1 9 9 ' 7 3 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... ...... 10. 11. Total Deductions (total Lines 9 and 10) ......................... ...... 11. 1 0 9 3 9 . 2 8 12. Net Value of Estate (Line 8 minus Line 11) ...................... ...... 12• 1 1 0 3 8 5 9 2 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 0 3 8 5 • 9 2 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 15 0. 0 0 (a)(1.2) x.o . 16. Amount of Line 14 taxable 9 1 1 0 3 8 5 2 16 4 9 6 7. 3 7 . at lineal rate X .045 . 17. Amount of Line 14 taxable Q 0 Q 17 Q Q Q at sibling rate X .12 . 18. Amount of Line 14 taxable Q Q Q 18 Q Q Q at collateral rate X .15 . 19 4 9 6 7. 3 7 19. ............................................... TAX DUE ....... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610240 1505610240 J REV-1500 EX Page 3 Ilnrnrlc~nt'c ('_AmC11P_fP_ AclclrpSS' File Number 21 12 0203 ------- DECEDENT'S NAME DOROTHY M. WARD _ _ - - STREETADDRESS 1851 WARD LANE CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: ~. Tax Due (Page 2, Line 19) 2, CreditslPayments 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) (1) 4,967.37 0.00 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4,967.37 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Ditl 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; .......................... ..... ^ 0 c, retain a reversionary interest; or ........................................................................................... ..... ^ 0 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 ^ 0 without receiving adequate consideration? .................................................................................. h? " ..... ^ .... orpayable-upon-death bank account or security at his or her deat 3. Did decedent own an "intrust for ..... Did decedent own an individual retirement account, annuity or other non-probate property, which 4 . contains a beneficiary designation? ............................................................................................. ..... ^ ^X 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(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 CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DOROTHY M. WARD 21 12 0203 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC BANK 50.16 CHECKING TOTAL (Also enter on Line 5, Recapitulation) I $ 50.16 If more space is needed, insert additional sheets of paper of the same size REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN nrC`Inr~1T nC/`C nCAIT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: DOROTHY M. WARD 21 12 0203 If an asset was made 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) 118 E. COOVER STREET MECHANICSBURG, PA 17055 DAUGHTER ADDRESS RELATIONSHIP TO DECEDENT A. DONNA J. WEHLER B. WILLIAM L. WEHLER C JOINTLY-OWNED PROPERTY: 118 E. COOVER STREET MECHANICSBURG, PA 17055 SON-IN-LAW 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., B 1/30112 SUSQUEHANNA VALLEY FEDERAL CREDIT UNION 118,705.00 100. 118,705.00 SAVINGS 483 2. A, B 1/30/12 SUSQUEHANNA VALLEY FEDERAL CREDIT UNION 2,570.04 100. 2,570.04 CHECKING 483 0.00 TOTAL (Also enter on Line 6, Recapitulation) I $ 121,275.04 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 nOROTHY M_ WARD _ 21 12 0203 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, MYERS BUHRIG FUNERAL HOME & CREMATORY, MECHANICSBURG, PA 1,109.05 MOSTLY PREPAID -BALANCE B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) DONNA J. WEHLER Street Address 118 E. COOVER STREET City MECHANICSBURG State PA ZIP 17055 Year(s) Commission Paid: (RENOUNCED) 2 Attorney Fees: MURREL R. WALTERS, III 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) (`laimant 4 Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 5 Accountant Fees: 6, Tax Return Preparer Fees: 7. 2,300.00 330.50 TOTAL (Also enter on Line 9, Recapitulation) I $ 3,739.55 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY M. WARD 21 12 0203 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MANOR CARE 1,264.64 MEDICAL 2. PPL 120.04 ELECTRIC 3. COMMUNITY LIFE TEAM EMS 94.00 AMBULANCE 4. CHARLES & SCOTT SHREINER 456.40 PLUMBING 5. DILLSBURG EXCAVATING & SEPTIC, INC. 357.50 PUMP REPAIR 6. HANGER, INC. 103.85 PROSTHETIC 7. PA DEPARTMENT OF PUBLIC WELFARE 4,097.05 MEDICAL ASSISTANCE 8. JAN L. BROWN & ASSOCIATES 706.25 ASSET PROTECTION PLANNING TOTAL (Also enter on Line 10, Recapitulation) I $ 7,199.73 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DOROTHY M. WARD 21 12 0203 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. DONNA J. WEHLER Lineal 100.00 118 E. COOVER STREET MECHANICSBURG, PA 17055 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: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, I $ If more space is needed, use additional sheets of paper of the same size,