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HomeMy WebLinkAbout10-31-12 (2)150561fl1fl~ REV-1500 °`~°'-'°' 1~! OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Coun Code Year File Number OEMNTNENT OF NEVENVE Bureau of Individual Taxes INHERITANCE TAX RETURN --• PO BOX 280601 - ~ ':~ ~ . Harrisburg, PA 1'Ji28-D6oi RESIDENT DECEDENT ~ ~ ~ ~. ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~ f Decedents Last Name Suffix Decedent's First Name MI 5 ~'~'~ '~~ IiG Nii A~L.~ ~~~ ~ ~ '~y,/ (If Applicable) Enter Surviving Spouse's Information Below Spouses 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 IN APPROPRIATE OVALS BELOW ~ 1. Original Return p 2. Supplemental Return p 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise (date of p 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate p 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) p 9. Litigation Proceeds Received p 10. Spousal Poverty Credit (date of death p 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 TO: Name Daytime Telephone Number REGISTER OF WILLS U~_ ONLY ~~ _n ~- ~ ~ 1, ~ ~ C7 First line of address rn CO ~ C? , Second line of address ~ c~' `, ~ ~" - - d _ ~• ~} , . '`r- City or Post Office State ZIP Code ~ D/il~ FILED Q ~i~sP~E~S'~~ ~G P~ 17a5'`7~1a~ ~ -~ Correspondent's a-mail address: ©~ C O n~~ Y1c~''ry~q ~ l~ ~` U 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. SIGNATU PERS RESPQNSjBLE F FILING RE RN DATE G!//'Y/ ~0 3e aola AD3~j eRgzG si BEET S1~Pi°E/USt3~RG ~p~ ~~~~7 alai SIGN/ATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J J REV-1500 EX Decedent's Name: RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1 Decedent's Social Security Number 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 9 9 ( ) ........................... 4. Mort a es and Notes Receivable Schedule D 4• 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. a~'~'8-O U~;O~© ~; x::. ~ __.:~ ,.~?. .. r. .,5,~3fa`,3f~~ ~d 5`7 .' 'C5 •'~ , 'l 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. . 10. r; 11 ,: .~ . _._. ^-.77. a~ ~ ~ ~ f~ 11. Total Deductions (total Lines 9 and 10) ................................ . . ' ,. = ~:., . _.,,.,~., .x :. ,b, , .~. .: ~ ~ ~ ~ ?~ 12 Net Value of Estate (Line 8 minus Line 11) ............................. . 12. . 13. Charitable and Governmental BequestslSec 9113 Trusts for which v. . T" ~`~'~~~yi~. '' an election to tax has not been made (Schedule J) ....................... . 13. 14 ~~ ~ 1 ~ ~ ~ : +1 ~~ 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . . . TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 n ~ ~ 15. ~ 16. Y ~`" Amount of Line 14 x ble " `"~ ~"'~' ""~"'"` ~`O' ~ ~ ~ ~ ~ 16 ` + x, i~ ~ , ~* R at lineal rate X .0 '.,.. '~~' ~ ~,`~ ? ~~~ ~ ,: _f~LL -. ,., ~' 17. Amount of Line 14 taxable 12 17. . _ at sibling rate X . °" ~ ~" - ~ ~;:~x~4~°-~~.~ { bl 14 t 18. axa e Amount of Line ? ~' 18 ~ c t at collateral rate X .15 , ~ " 19. TAX DUE ........................................................ . 19. ~ .. ,;, ., ~.:~': 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O 1505610105 Side 2 1505610105 1505610105 ,J REV-1500 EX Page 3 Decedent's Complete Address: File Number a t ~, ~ ~~~ (~~ DECEDENT'S NAME c~lRRt-ks V~ 5T'Zt~L STREET ADDRESS - -- - - 30~ Ct~P~Z.C~ STREET CITY s~+rP~~Ns~ ~ R~ ~ Sp~ Zt`1 a5'1- `ot ~ ~ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ ©~ ~ ~ B. Discount j ~ 3 ,, 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. (1) 36 O'7$ 0 1~ Total Credits (A+ B) (2) '~ U ~ 3 ~ 9 1 (3) (4) O ~17V 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3 ~ `02 ~ ~ • ~' 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 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? ........................................................................................................ ...... ^ ,~t, 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(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-1502 EX+ (01-10) Pennsylvania ~.~J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: ~ ~ `- r S , ~~ ~ FILE NUMBER: c~1 ~ ~ s Yv ~" ~l 1 ~ oc~g08 nu real property owned solely 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 jointly-owned with right of survivorship must be 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. LQrI~~ -~ 1wki~vS~ L4GI~T~~ ~T ~ 1~~8Q~•v~ 301 C.R~ZG sTREE"~ stirs- P'~ Eu s T3 U CZ G (' ~ 1`l a5 ~1 a, LARt~7 a- G{~~~c~I ~,ocPr~E- R-~' ~ 6n,ooo.v~ l a g ~'~ 1C t ~~ E~R (~~ P~~ UPPER ST~R~~v~t6'~ PR 1h~,C~~ TOTAL (Also enter on Line 1, Recapitulation.) I $ p't~l-~ ~~©. ~~ If more space is needed, use additional sheets of paper of the same size. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER c~r~~~~s ~ s-~~~~E a~ ~a oc~o~ All property jointly-owned with right of survivorship must be disclosed on Schedule F. tir more space is needed, insert additional sheets of the same size) • REV-7508 EX+(1-97( SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHRESIDENTDECEDENTRN PERSONAL PROPERTY ESTATE OF ~ FILE NUMBER ~>~ R R L~~ vJ s ~ ~,~ ~ a~ ~a r~~ ~ o S Include the proceeds of litgation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. HotSStF}ol~ Cso~~ ~ '~©o4E 3. rg9~ -SF~~ ~~~'(1ou~~ Cc~3NT~y ysofp.©a -}, lit RTrC~~.l V3~~ ~ PLtf~T 'V '~ R,A CLO N \ t~tflK-Z~ orl ~ o ,53~t8 ~ ~ 57 38~ $~ 5~ GAIN c~ ~~N~ ~ a~, g 6 6. P~6tiu opsN~oN N~v~tsP~~tR R~f~~~ -~ ~~,do '1• E~n1cRoFT P~Rso~gt cA6~''E ~l~c.~.>.~Tf R~~vN~ 351`'x. 69 8, N~T2~'Nv~~°~E ~rto~~awN~~Zs R~f~N9 t ~ do ~G 9, F~LLSTF~"T~c V{~~EoWn~E RS R~F~~~ ~ ~d~53ap~ 80o v~ ~~f NL ~~~ Nur _- ~ C~~°sN~~a~Sbo~ SAvz+~GS(o~ c~'~~~1~~3, ~~,s~ ~a. O~nS~b~N ~~NK ~ 1g3 91 ~. a8 h~ ~~s~ K~K~ s-SR~~ i - . ~ Sil1Z~'~PC~s ~VY~~, P~A 1'ta.~'1 (1~ 888~~`7'7- ~8b°1> ~l~~cKS~G AcCo~~-s~6~5oa~6~ ~-oNE'Y ~f'~At~1;r~'(~~3~a ~j7s(~ooo0'`~i188~ ~~oooy'~'~.3~ '~®©bo ~a~°la~ yooo~y~--~(~~ 4~ooc~o 36~ ~1 ~ J t3. CT.-r ~ ~~ ~s C3f~~~c ~ a~~ 3~ o.,~s 1 >,~y3 ~,,tisi oR~i~c:~c STf~F~' - ~~~, s~zPPEris'4vr~~, Pit ~7a.~ L53a- 2~~1~ uEcac~rlG Acc~rJN ~ 610o8o~~go~ rnoN~'`f 'rnRnXti ~ C86a~ ~ 9 as~~~' 69 b o o 0 o©~b 68 Ib6~~ ~s ~$9 ~ 39 ~ 3 ~16 3~ \ ~ y- ~ ~~a8 ~~ TOTAL (Also enter on line 5, Recapitulation) 13 53Q~ 3, 7 (If more space is needed, insert additional sheets of the same size) „ REV-1510 EX+ (08-09) Pennsylvania °EPARTMENT DFREVENUEDEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER c~~t R~Ltis vet s~'z t~~ al-1a-- ~Uq ~S 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 (IF APPLICABLE) TAXABLE VALUE 1. ~~~.~NUI=~F P ~(~'~ ~ ~ nFt ~-~ N~JzT W5a>>9 ~oo~ ~~a1 q ~coNT~i~cT ~ v~ ~o~;~ 3 (~6~~ , TOTAL (Also enter on Line 7, Recapitulation) $ I °~ ~J vZ~ ~ q ~" If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCFIEDULE M FUNERAL EXPENSES 8r ADMINISTRATIVE COSTS ESTATE OF ~ FILE NUMBER c,~~~LE s ~~ s-r~ ~v ~ a~ ~a ~~~ ~ Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ ~ ~. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2• Attorney Fees 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address .City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5• Accountant's Fees 6• Tax Return PrepaTrer's Fees 7. u's z ~~- l ~. t5 (YI~"a-c ft~'~ 'P~EY~sv ~ TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) ~ o, ~ o p-(~a ~ b 33 . ~ d d~ d ~ `~ s t7 ~ ~ X19, g`7 ~ a°~~9~ 6.v REV-1513 EX+ (i1-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF FILE NUMBER c1~1~~tES ~1 sT~~E a1 ~~ o~qo~ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under 1, Sec. 2116 (a) (1.2).] CNlARL~ ~ ~ sT sly lac 'S~ so ~ ,~O~j~ 30 ~ C b~ R~ G 5T6t'EF'S' 5H-~ ~ P C ni s ~3 u~~- (~ R l~l a 5 ~? ~ a 12, 5_ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 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. # Ir more space is needed, insert additional sheets of the same size. ~, ~_;, LAST WILL AND TESTAMENT OF CHARLES W. STINE I, CHARLES W. STINE, of Shippensburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking any and all wills and codicils thereto by me at any time heretofore made. FIRST I direct the payment of my debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefor funds from my estate, in such amount as he shall consider necessary and desirable, and I authorize my personal representative to cause title ^~ to or ownership of such lot so purchased to be vested in such pe a ~ rn r- : ~ ~+.7 r, ~-- as my personal representative shall designate. ~~~' - -''~_-~ Further, in this connection, I authorize my personal C~= } ~~~~ ~~ _~ T -, o = ~~~, representative to expend funds from my estate, in such amount ~ ,_ ca~ N my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all my property, real, personal ~R ~ ' ~ ~ or mixed, together with all insurance policies thereon unto my wife, Beulah M. Stine, if she shall survive me by thirty (30) days. In the event she fails to survive me by thirty (30) days, I then give, devise and bequeath said property unto my son, Charles W. Stine, Jr., per stirpes. THIRD I give, devise and bequeath all the rest, residue and remainder of my estate whether real, personal or mixed, unto my wife, Beulah M. Stine, if she shall survive me by thirty (30) days. In the event she fails to survive me by thirty (30) days, I then give, devise and bequeath all the rest, residue and remainder of my estate unto my son, Charles W. Stine, Jr. , per stirpes. FOURTH I direct that any and all Inheritance, Estate and Transfer Taxes imposed upon my estate passing under my will or otherwise shall be paid out of the principal of my residuary estate. FIFTH All shares of principal and income herein given shall be free from anticipation, assignment, pledge or obligations of any beneficiary, and shall not be subject. to any attachment or execution. SIXT H I nominate, constitute and appoint my wife, Beulah M. Stine Executrix of this my Last Will and Testament. In the event of the renunciation, resignation, death or inability to serve for any reason whatsoever of my said Executrix, I nominate, constitute and::appoint my son, Charles W. Stine, Jr. Executor of this my Last Will and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties as such in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for da of ~ C C 19 74. the purpose of identification this ~f Y _~ fl. / ~~~~ (SEAL) SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testator, Charles W. Stineat his re nes and in his sight 4 Testament, in the presence of us, who, and presence and in the sight and presence of each other have hereunto subscribed our names as witnesses. ~---~_ ~ I residing at 10~~~1 C • ~C.~^}~ ~ •'~ S N~~ p~-rf~'~P+' r~ ~ , residing at G~/ r 1t~~ -1'-~'~"~~