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HomeMy WebLinkAbout11-30-12 (2)1505610101 REV-1500 Fxt°1.1°) ~ PA Department of Revenue Pennsylvarria Bureau of Individual Taxes ~E~~pjME~f ~F INHERITANCE TAX RETURN PO BOX z8o6ot Harrisburg, PA iy1z8-06oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number ~'/ o'~ d a...~l 3 3. MMDDYYYY Date of Birth MMDDYYYY o a!z ~ s 3 a 5 ~, o3',Z:g ~ oo S 'i ! 9 i 9 z~ Decedent's Last Name u Q ~ ~ rr (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name N~ ~-- Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 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) i 6. Decedent Died Testate O 7. Decedent Maintained a Livin Trust 0 Attach Co g 8. Total Number of Safe Deposit Boxes ( py 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 ~ECTED TO• Name Daytime ~ephone Nurr{~g} ~ ~ G H ~4- R ~ `E 5 ~~ i'Y l E L A S I~~ ~" ~`' ~~ ~~;~0`~~9 First line of address w CLD,(~5~~ _~20~-~ Second line of address ~/ City or Post Office ~r~eN~~i c s8 u,e~ Correspondent's a-mail address: Crud/ l t I/I~S R~S'JIER~ WIL(.CNSEI9~IU1tT p, ~ ~ O ~ 'J ~ ~ 7C ~ C? F ~: rrl n j•1 ~ <J State ZIP Code DATE FILED I~A'' l 7 D 'S ~ 9i 7'' 3 s easf; ~~~~r~ pnnmues °i penury, i °eaare mat I nave examinetl this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of Breparer other than the personal representative is based on all information of which preparer has any knowledge SIGNATURE 9F P~FRSON Fj~SPQNSIBL~ R~FILING RETURN ,,,,rte ADDRESS C l/~n LES Q. Q u n ACTT rS~t ~'~ib/~y DATE ADDRESS CHIFRLES ~ c.JNlE~DS C OUS'~-- A i1`leellaritc5 burry, Pfd 17DS ,~ PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J _J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~ I H~ ~ ~Y( /St/ / T ~ Q p Z ~ 01 ~.: '~ S..lo RECAPITULATION _ ~ - 1. Real Estate (Schedule A) ................... .. ...... i. © d 2. Stocks and Bonds (Schedule B) ............. _ .. _ 2. . D ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 1± ~;~ 4. Mortgages and Notes Receivable (Schedule D) .. ...... .. 4. • 5 Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... 5 I '~ ~ s O lp 6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6. ., 0',~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule GJ ~ Separate Billing Requested_ 7. Q ~ 8. Total Gross Assets (total Lines 1 through 7) 8. ~~ J . ~ /„ 9 Funeral Expenses and Administrative Costs (Schedule H) 9 / D [~~ I D D 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. . ~ Q 11. Total Deductions (total Lines 9 and 10) _ 71- ~ 0 LI ~ _L Q d 12. Net Value of Estate (Line 8 minus Lire 11` i2 ~ ~yi 13 Charitable and Governmental Bequests/Sec 9113 Trusts far wricti an election to tax has not been made (Schedule J) 13. ; ~~rd i4. Net Value Subject to Tax (Line 12 minus Line 13j 14. 6 ' TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 911 f, (a)(1.2)X.Op~ . OD 15- 16. Amount of Line 14 tayabie at lineal rate X 0 ~ ~ 7 «; ~ ~Q 16. 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. TAX DUE ........... 19 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p v 3 ~ o*S a' t~ O O ~ O ~ °~,,4~ r~~;. ,3~ O O Side 2 1505610105 1505610105 J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME ~sTi~/E;~ 7 Bu~e~/ ~T TREETADDRESS a ~ 5 w/[sow/ L.4~J~ _ - __ - _ ---- - ,STATE -- - - CITY ~~-~-/~1f~///CS,QI.I,~(r I P~ i zIP /~Q3'~ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments D A. Prior Payments _-_ _ __ __ B. Discount --- -- _- Total Credits (A + B) (2) 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (q) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. ... ;»,r, 't4. e.Y....w~ i"M~M«S: ~ dia'L+,~iu. 1 ,.....~~.. ,.3"' a~~um~:am~ m., .e~a,wn,vmrnv,Y...M. ,,, ,,,..a......,..,..... (,) 3.05 O y7 . S~ 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" orpayable-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 benefciary 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. ~, .~ ,.~ . > r, .,, , ... t ~` 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. ~.,s~ ~,,,~n SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RESIDENT DECEDENURN PERSONAL PROPERTY ESTATE OF ~s ref X12 T, QGf /Z D ~ rT FILE NUMBER a/ o~ -Y33 Indude the proceeds of litigation and the date the proceeds were received by fhe estate. All property jointly-owned with the right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t Mare of C,*as5 ctr.~,'on roc.eeds /~ I ~' vt e~ ~ ~ Ma.>7 r ~ w a o TOTAL (Also enter on line 5, Recapitulation) I ; ~ '] ~, ~~ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~(~~e0~7~~ ESI~/~Z~i. X191-y3~ Debts of decedent must be reported on Schedule L ITEM IUMBER A. FUNERAL EXPENSES: 1. B. I ADMINISTRATIVE COSTS 1. Personal Representative's Commissions Name of Personal Representative(s) ~~q r-~ gL3 B $4 ,-~- ,~~j Q~ StreetAddre/~-s~"s /~~ ~ _ S~k.C~~Q/~L ~(jQ,g~ n City (.uI-~i S~G State p`"/¢ Zip / ?D /,~ Year(s) C~~orm~~mission Paid: y L+TtrlcS ~. ~i~~s rTi ~ 2. Attorne Fees .r. sp, 00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City ____ State _Lp Relationship of Claimant to Decedent 4. Probate Fees 5 Accountant's Fees 6. Tax Retum Preparer's Fees ~. SiIW/'t e~/,~'~,~ F $-s.oo SCHEDULE. H FUNERAL EXPENSES & ADMINISTRATIVE COSTS TOTAL (Also enter on line 9, Recapitulation) I $ ' D ~ ~ ~ (If rnore space is needed, insert additional sheets of the same size) I REV•1513 EX+ (9-00) _. SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETl1RN RESIDENT DECEDENT ESTATE OF QuRD/~ ESTy~~ / - FILE NUMBER ~ ~ _ 0~ _ Y33 RE[ATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not ListTrusiee{s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers antler _ Sec. 9116 (a) (5.2)) t CHStr2cE3 ,ES. ,D1lR-alT?' ~~/ ~.3 jY50 SH[tGH~-2T ~D. ~- G p,eDod GEE /~uRD! T T 50~ ! 3 r ~..ot~ ~u~NE QEN6r~ao,~, ~~a-~s ~~/a6 ~. G et~~nl .~ztbv f3~reQ~TT lrlr.P~~zc. ~/I-~fGHr~ t~3 33A F'i4/2/nDUN'r DR. ~~DC~EWAT~-72, IYIb. 2103`7 1 ENTER DOLLAR AMOUNTS FOR DISTA16UTIONS SHOWN A80VE ON LINES 75 TH ROUGH t8, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9753 FOR WHICH AN ELECTION TO TAX 1S NOT BEING MADE t. i B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. f I 5 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET __ _ } S {!f mare space is nestled, insert addRional sheets of the same size) LAST WILL AND TESTA1~tFNT OF ESTHER T B RDITT I, ESTHER T. BURDITT, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my last Will and Testament, hereby revolting and making void any and all prior Wills by me at any time heretofore made. ]. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done- 2. All [he rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath in equal shares [o my beloved children, ~ t~ 1TQP~; CORDON LEE BURDP["I', GWEN ELLEN BURDITT PURCELL, and CHARLES A. BURDITT to shier own use and benefit absolutely. 3. 1 nominate, constiute and appoint my son, CHARLES B. BURDITT, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter, G WEN ELLEN BURDITT PURCELL, to be Executrix in his place and stead. I funher direct that they shall no[ be required m file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. ~//jj iN WITNESS WHEREOF, I have hereunto set my hand and seal this __~~~ day of _" / -_-, A.D. 1994. ~ST~^~~e ~~t"'d4-@~ ___ (SEAL) ESTHER T. BURDITT - Signed, sealed, published and declared by the above-named ESTHER T. BURDITT as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our natrtes as witnesses. ~G, ~~ j ~~ X - i ~GL~,L~_ /(!ur¢ ~~ ~ ~ ~ L' optc!(_ c~-~,a~Z~ u-,,~an.l /J,e~~~q~ 3 svb~c<e, ere~~~ov ~o ptOytcB~L ~i.,t~ ~hcy .a-vi~, GozAON LEE Bir~U/T% , >/ /s~ a.~2r2t~.+~~ ~etsv~-°L, ~cco ~pzJO~c..u-.m ~ ~fsu/ 2t'P~'torl~r ~ /~C Q~JOLSC~Eic~ ~Gk >~e ,P~laz«' ~ : C~v~-~, Gn~U~N, u„~ Gw~n/. 9-~-t y CHARLF,S E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG. PA 17055 GEORGE M.HOUCK (1912-1991) November 30, 2012 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Esther T. Burdett No. 21-08-0433 Dear Register of Wills: TELEPHONE (717) 76fi-0209 FAX (717) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Esther T. Burditt Estate as well as a Check in the amount of $15.00 for the filing fee and a Check in the amount of $3.52 for the Supplemental Inheritance Tax due. Thank you for your kind attention to this matter. Very truly yours, ~~ C" ?~ ~ 2~G~- ~ ~fj~~'r~'~ 1 ~ Charles E. Shields, III Attorney-At-Law CES/mjj c o ,-.., ^~ ~ ~ Enclosure ~ ~ W ii °"' c_~ ~? ~ m ~ ~ ~_. en :.~ ~ ~.~ ~ N ~ a ~ ~ . ,~ a o .-~ o -:, ~ ~ ~ . , ,w `n W~ n .~ ~ ,_... ~._} ~ rrr d a CJl t--+ ~ - ry