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HomeMy WebLinkAbout11-13-12 (2) 1505610101 REV-1500 Ex(°~ _~°' ~ PA Department of Revenue OFFICIAL USE ONLY Pennsylvania Bureau of Individual Taxes PO BOX 28olioi DEPARTMENT OF REVENUE Coun Code Year File Number INHERITANCE TAX RETURN ' ~ ""'~°' Harrisburg, PA 1~i28-o6oi RESIDENT DECEDENT ~ , ~ ~ I~ t3 ',~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY a .~ ~:~~..~, 2 Decedent's Last Narne . Suffix Decedent's First Name MI p,.,, ~ f..r. ._, ~ - E.. ~.. ~ N (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI QED . .,. ,. II ~ ~ ~ ...E , ..E. y - ! Spouse's Social Security Number _. oa ~ ®.. ~. -.. ~'~~ - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ® REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return p 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate p 4a. Future Interest Com romise date of P ( O 5. Federal Estate Tax Return Required death after 12-12-82) O 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 Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 7~e~~ r a:~~ Weav es 7 f 7 73/ &~~~ First line of address rr, ~~ (ti ~ ~ Cry v e ~_ K / ~ ~ ~J ~ ~~ Second line of address City or Post Office State ZIP Code REGISTER OF WILLS USE ONLY ~ t•. ~ Q ~ a' Ev ' AP ' ~ m ? c ., S c~ } ,.._1 ~- r- 'r: ,~ ~ to .: ~v:~ C7~-. ~- : { CJ :~ _ ~ r _ `' "~ ' D,~ FILED - ~ ~ ~~ C 7 r J -'l -T-1 rn Correspondent's a-mail address: (~ LAf' (~P,y 2~,~, ~ (/'Q~Vi ZQ ~ (/(.~ 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 of er than the personal representative is based on all information of which preparer has any knowledge. SIGNATUR_ wE pA PERSq~I R ON BLE FOR FILI RETURN DATE Ess N 655 L'r~e-1cv ~~c.w Ro 'c b P><1- J?OS v SIGN RE OF PREPARER OTHE THAN REPRE ENTATIVE DAT ADDRESS , ~~5 _Cre P l~. y ~ e i_•~ h~o a d Me h n ~ c.S b~ ~ c, ~~!- f ~ Aso PLEASE USE ORIGINAL R~ONLY Side 1 1505610101 1505610101 J J 1505610105 REV-1500 EX Decedent's Social Security Number ' ~F t ~ ' ~ ~ © ~~ ~~ ~ I x s Name: Decedent RECAPITULATION 5 t~ ~~ ~ ~ ~ ~ 3, ~- • • ,__ ~ _, , = : .; .. ., ~ - U' ~ ~U ~° 1. 8 . . • • • • • • • • • • • • Real Estate (Schedule A)........... _ . - 'i-'. ~~ Irk 'd+.., 2. Stocks and Bonds (Schedule B) ..... ~~.. (~.'F~C I't ~.~*~• ............... 2.. '2 P 2 to ,+Z = ~ Z 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. ~ = U ti:- , ~ . s "7 ~ w .~ - 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 2 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.. ~ ! ~ 4 3 ~ " 4 ~. -. ~! ~~.a 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. ~ '© • ~ M1 } ~ 7. P rtY Inter-Vivos Transfers 8~ Miscellaneous Non-PSe atrate Bilfn R nested........ (Schedule G) O P 9 eq 7. ~.~ b=(7 0 b '~" 8 - ~~ 2 ~ ~^ ~ ~ 3 7 8. Total Gross Assets (total Lines 1 through 7) ............................. . . . le H) d S h t C 9 7 L/ ~ ~ ' 9 3 , ~1 9. ............. u c e os s ( Funeral Expenses and Administrative . ...... , 10 Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........ ...... 10. .. . ~ .' t F ~}~ D .O / . ~~ ~} y . 11 ,~r.~ ~ ~ ~ ~j ~ 7 fJ 11. Total Deductions (total Lines 9 and 10) ........................... . ...... 12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. /~ !f ~ ~t ~ ~ ;~; ~j ;,. G 3 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. ..... . y,, ~ ~ 5 ~.3 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 "~~ "~ ' 4 7, '"~` ~ ~ (a)(1.2) X .0_ ~ 4 15. 16. Amount of Line 14 taxable s ~ "~' `" ''~`"~'~' 1 ' y~ ~ 3 ~ 5 16 at lineal rate X .0 ~ !~ : . bl 14 t f Li `'~~'„ 17. e axa ne Amount o at sibling rate X .12 ~ ~ 17. 18. Amount of Line 14 taxable ~ at collateral rate X .15 ~ ~ 18. 19. TAX DUE .............. ........................................ ...19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 O REV-1502 EX+ (11-08) ~ ~pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITAN~ TAX RETURN REAL ESTATE RESIDENT DE(~DB~IT ca ~ w ~ c yr FILE NUMBER R S ~',~ e r 1 ~ (~t ~E ,~ r'-€ G~ ~. t' ~ Yi 2 I - 12. - D3~? 3 AN real property owned solely or ~ a tenant in common must be reported at lair market value. fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing suer, neither being compelled to buy or sell, both having reasonable knowh~je of the relevant facts. Real property that is jointlyrowned with right of survivorship must be d~closed on Sd~eduk F. Attach a copy of the settlement sheet if the property has been sold. ITEM Indude a copy of the deed showing decedent`s interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION t ~ 1. ~ t ntj f e ~~ 6'<": , :.' ~5 !G~ ey1-~-r ~ ~ ~`7"U rY1f'i : .~„'""_ Udtva~`r~~ ~,er Ot l?~r~Q1SQ ~ U~/ ~~~'~~~r~ ~. ~O~~ .a~ ~~~~ (,'umb~rEr~ rod G~ ter: ~- 2. a"} 2 ~ ~~r~ tea rc2 ~ oX ~n~ ~Ir ~ (,l-1 ~ n hab~~`~tvt~- ~..~}~ ~ 2 ~~ ~ r `~~ ~D/~ D~`~..'• `~ _~ . ' ` ~'A- I ~ 0 5 3 f ~~r r ~ Ce u r€~~' Cop i es a ~a~c 1'1e~ TOTAL (Also enter on Line i, Recapitulation.} I # Z ?j ~~ ~,~ {'~ :.' ~` If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (6-98) scNEOU~ s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS iNHERffANCE TAX RETURN RESIDENT DECEDENT t,IATE pF ,., i r FlLE NUMBER ~~` l?fir ~~!`~P . f4.~~?(~t?r' 21- ~~ o~~ ~ ProPenfl jofoW~wned wttlt right of survivnrshio muxt hn die..l.+.e.+ nn s..~.a. c ~.......... .,I.ow ..~ ..waaw, n~ao~~ nuwuU~~~,IxitllS UI UlB S3IflB SIZQ) REV•1508IX~ (tA7) SCHEDULE E CAk9~lONIMEALTHaFPENttSYLVANIA CASH, BANK DEPOSITS, ~ MiSC. (" ~ `nr~c~ PERSONAL PROPERTY ESTATE OF FILE NUIYIBER ~~E l't2i' lyld2 ~t~'4(~~~~~tr ~ I - 1 Z-Q~O~ Include the prod of litigation and the date the proceeds were received by the estate. A9 propsriy J~lr-~ed r~ the right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. ,A' 1= r~rst ~ 2.6.2 ,Q.GG1- ~ ~S3 of z!o - O t ( 5ovo LouF s~ iir~ vn.. ~o- C'x~x 40 ~~GFtrt.vs i c$ fvvr~ Pier i ~ Qj5 Z~ SASIi ~~5 - N4ernb~r ~~ rat ~'~`-~ ,~.00 ~:oG-f'-~ ~ S' 3q 2lp - 0 ~d t? O. t~07~- ~ c`~ TOTAL (Also enter on line 5, Recapitulation) + ; { -] (~~ f 3 { . ~. (if mare space (s needed, Insert additional sheets of the sarrre sip) REV-1510 EX+ (08-04) ~'~~i "~~ Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND `""~""`~ TAX `~'~'~" MISC. NON-PROBATE PROPERTY RESIDENr DECEDENT ESTATE OF FILE NUMBER S+~I e Y /'~~ a e ~:-r~~ ~'.~~ rte, r Z. ! - f Z - f~ 3G 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 ves. ITEM NUMBER DESCRIPTION OF PROPERTY u+a1mE TFf NAME aF ~ TAANSFMtE£, trff7e RHAnowsi+tr To oECmerr AND of oeTE ~ Krrea~ A cow of ~ uE~ RRt RFAL ~. DATE OF DEATH VALUE OF ASSET 96 OF DECD'S INTEREST EXCLUSION ~ ~ TAXABLE VALUE 1. t,, ~~~rS c~,h S fL r`~ ~~t,YY'<~...~ :''. ~~ 2` ~i'.i,., `t~ fJJY' ~% ~ ~ ~~ - ~ 3,oor~. 3ooO. ~ t7 ~3D~' ~_~T ~" ~e~, i3,Zc~a~ , TOTAL (Also enter on Line 7, Recapitulation) ; I ~ 3 i ~~~ If more space is needed, use additional sheets of paper of the same size. REV-1511• D(+ (10-06) SCMEp1~LE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $c INHERITANCE TAX RETURN ADMINISTRATNE COSTS RESIDENT DECEDENT ..~~ nv.~.v~n Debts of decedent mast be reported on Schedule L ffEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Nli~Ylae(~hct~cn.~~ ~U/terQs 't-~rrt~'Pro.(rss~~~a Servie:~ -> Z. Gr-ief5 ~ot~~ cer~te'-C'Y/ 3saaa ,,. 3 JU~'~e Y`GtyM ~,~I'c~~j~~ 0.nd `/A mari+er-;-,;'!<<~o~n~r_-- c~ASC).Ob 1i B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ' Name of Personal Representative(s) Street Address Cm` State ~P --- --- Year(s) Commissi~ Paid: 2. 3. 4. 5. 6. 7. Attorney Fees - ~. ~q d I {l}41`:' c. ~ e h q r G ~ ~ Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address Gty State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Zip - __ .-- Z~S.~ a D TOTAL. (Also enter on lire 9, Recapitulation) ~ ; ~~y ~ ~ ~ ~~ (if more space is needed, insert additional sheets of the same size) REV-1512F_X+ (12.03) coMrTti of a~svivarllA INHERITANCE TAX RETURN RESIDENT oECEOENT SCNEpYLE 1 DEBTS OF DECEDENT, MCIRTGAGE LIABILITIES, ~ LIENS ESTATE OF ~{ ~ FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death. inciudina unreimku~reQrt .~.it~~~ e,...e..~~ ~~~ ~~nnc syatx ~s neeaea, insert aoOFOOna~ meets Of fie same Size) REY-1513 EX+ (11-08) ~ Pennsylvania DEPARTMENT OF REVENUE INIiERirANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES CJIAIC VF NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY I TAXABLI_ DISTRIBUTIONS [Indude outright spousal distributions and transfers under Sec. 2116 (a) (1.Z).) i. Jar>r-~s ~. ~~de~sbn 565'5 Cry e~ ~; e..cj R o a d ~e cln a. ~"~ i c ~ J u t ~ ~I~; e "1 ~ ~#..~ v FILE NUMBER 2! - !Z-~3Q3 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE ~ N~ ~ TM(s) OF ESTATE Son iav% 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 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 I'f If more space is needed, insert additional sheets of the same size. _ - ~- APPRAISAL OF Rev - ~ soo E Sher Mae ~4>rl.dersa ~t 21 - I Z -G° 3a 3 A SINGLE FAMILY RESIDENTIAL HOME LOCATED AT: 708 FRONT STREET WEST FAIRVIEW, PA 17025-3156 CLIENT: JAMES A ANDERSON 5655 CREEIMEW ROAD MECHANICSBURG, PA 17050 AS OF: MAY 18, 2012 APPRAISED VALUE: s125,o00 BY: REYNOLD R WOOF JR PENNSYLVANIA CERTIFIED GENERAL REAL ESTATE APPRAISER APPRAISAL OF Rev - i5~~0 ~s~er Nlct~ A~-n.d ersrr~-a A 25 ACRE PARCEL OF LAND WITH UNINHABITABLE IMPROVEMENTS . LOCATED AT: VILLAGE DRIVE MARYSVILLE, PA 17053 CLIENT: ` JAMES A. ANDERSON 5655 CREEKVIEW ROAD MECHANICSBURG, PA 17050 AS OF: OCTOBER 6, 2010 APPRAISED VALUE: s1o5,o00 - BY: REYNOLD R. WOOF, JR. IFAS PA CERTIFIED GENERAL REAL ESTATE APPRAISER J'= Z 21-IZ-03o3 Ica .. ~ _~ - - .~. __ . {~=:x.23 i . 73'?8 -r.1Eg . >4~d0ERS«P E~Ei;~JT~' +i~Ei~y ::1(v , ESTA~~ E '-E~=EE'T; 04%701 12 V~I ~T. F31~1 L(J~ S£ T~i~ : ;;244 Comment for C;-±EL~ING ~~' ~~=! and wedempt; ~ ~ _; . ;', I:: _ 1:828.08 ie;:,ls;t t0 ~=~iEi;~;ING Iu .:? PRr',' BAL 0.00 ~'AN AMOUNT ~' .128.08 ~~E~,' Bu± ANCE `..128.08 =~EO ~ 1173794 v`iL - 5.39 Ben. L" ; ~a ~?~ 18.75 Bc:~~c _ :ar}~~Q 115.3° - ~:: •.eari;~~ 18.75 ~;,-;z~ 115.39 _ .`_~ ;;.4 18,75 :, _,.., ° • 113.82 Belt) ,:7C_~r~ny 18.75 P~; d ~,5ar 1.;J 119,85 -'`-~F`~ '~~c~''~~= - 18,75 _r. ~~ =r•,. _ 118.61 -- ~ =_- ._ 1$.75 _^~' ;..~ar~r~a 120.61 .~ ,~a~~•ir~u 18.75 La= i,~~~~ "20.94 _ , as .._ 4 18.75 ,a. , ^.~ 1,)7.79 - . -. _ t 8.75 t..: ~.:.--_ '13.01 _ ~::~;: 18.75 1 ~: ,.. ;YQ ~ 1J9,73 - ,-,~ ari-'~ 18.75 - ..-t;~,,,,-; '~~ ,13.01 _ _,~ _ ! 8.75 _ -- - _ 111.45 1$.75 _ '10.81 - - 18,75 -~ - 111.14 .: ~_ ~.,~ - 18.75 -- 111.'4 18. 'S www. ~ssecu.com 800.237.7328 ESTATE OF ESTHER M ;4NDERSON Accost 8376xxxKXX ANDERSON,ESTATE EFFECT: 11/01/12 POST: 1]/O1/12 TLR: 0249 Comment for C K NG and Redemption 18.75 Int 115.39 Deposit to CHECKING ID 04 PREV BAL 2,129.20 IRAN AMOUNT 134.14 NEW BALANCE- 2,263.34 SEQ: 2276050 ----------------------------------------- Bond Clearing 115.39 Bond Clearing 18.75 REV-1500 EX Page 3 File Number Decedent's Complete Address: ~ i i ~ _ n -~ ,~, ~ - - - .~,~ DECEDENTS NAME STREET ADDRESS _ ~~ ~ ~ ~ r~~ CITY Wes ~ Fa ~ r vi ew - sTATEP~ ZI j a2 s Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments 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. (3) (4) r~ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) / 8 ~ Z 3, •~(p 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? .............................................................................................................. 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. (1) l ~. /~ 2 3 ~~ Total Credits (A + B) (2)