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HomeMy WebLinkAbout12-04-12~ 1505610105 REV-1500 EX (02-11) (FI) OFFICIAL USE ONLY PA Department of Revenue Pennsylvania DEPAfiTMEYT OF PEVENL~E Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year •`" ~ File Num r ~ e PO BOX 280601 IDENT DECEDENT l.- ~ Harrisbur , PA 1y128-o6oi RES ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 175-01-3178 07/02/2012 03/14/1913 Decedent's Last Name Suffix Decedent's First Name MI Rankin Elizabeth A (If Applicable) Enter Surviving Spouse's Information Below Spouse's 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 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) ~ 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 TO: Name Daytime Telephone Number Law Office of John C Oszu (717) 243-7437 ~,_, ~.__.. First Line of Address 104 S Hanover St Second Line of Address City or Post Office State ZIP Code n ~_. RE~T~2 OF WILLS -~- SE gNf~Y~ ~ ~ ~ ~? ~ r~~ ~ ~ ~~ tir to ~a;.:~ ~~,,,a '- :: ~ '"DATE FILED z. n '~ ~` i'1 PA 17013 ~ Carlisle Correspondent's a-mail address: 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 beliet, 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. SIG OF PERSON RESPONSIBL R FILING RETURN DAT ADDRESS 1114 Hillside Dr., Carlisle, PA 17013 SIGNATURE`O P~2EP OTHER THAN REPRESENTATIVE DATE i.... , ~ ~- L Z- ADDRESS 104 S `Hover St., Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY L 1505610105 Side 1 1505610105 J ~~~ J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedents Name: Elizabeth A Rankin 175-01-3178 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 68.40 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. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 118,246.01 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. 118,314.41 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 5,632.41 !, 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 6,441.52 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12,073.93 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 106,240.48 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. 106,240.48 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 106,240.48. 16. 4,780.82 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 4,780.82 19. TAX DUE ......................................................... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Elizabeth A Rankin _ _ STREET ADDRESS 442 Walnut Bottom Rd --- - - - - - CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 4,780.82 2. CreditslPayments A. Prior Payments 4,520.00 -- - - - - - - B. Discount 237.89 Total Credits (A + B) (2) 4,757. 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) 22.93 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 .............................................................................................................................. ^ 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(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-i5o3 EX+ (8-iz) i pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS -- ESTATE OF FILE NUMBER Elizabeth A. Rankin 21-12-0802 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-1508 EX+ (08-12) i pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Elizabeth A Rankin 21-12-0802 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. (2.V-35] i ~X~- ti]t~-C9} ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS -- - ESTATE OF FILE NUMBER Elizabeth A. Rankin 21-12-0802 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Hoffman Roth Funeral Home 503.26 2 Brian Rotz -pianist 150.00 3 Mc Colly Memorials -engraving 150.00 4 Thornwald Home - refreshements 75.00 s Georges' Flowers 12.46 s Office Max -guest book 4.23 ~ Teddy's Restaurant -Funeral Meal 298.76 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) ___ _ _ __ __ ___ _ ___ Street Address City __ _ State _ ZIP Year(s) Commission Paid; 2. 3. 4. 5. 6. ~. 8 Attorney Fees: 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 __ __ Probate Fees; Accountant Fees; Tax Return Preparer Fees; The Sentinel -Legal Advertising Cumberland County Law Journal -Legal Advertising TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 3,890.00 358.50 115.20 75.00 5,632.41 f~W'J-1.517 C"h+ ;17-08) ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAx RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Elizabeth A. Rankin 21-12-0802 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• Thornwald Home 4,929.09 2 RiteAid Pharmacy 11.23 3 Millenium Pharmacy 21.45 4 Centurylink - 2 months 50.66 5 Blue Mountain Anesthesia 2.47 6 Three Springs Family Practice 12.69 7 Mobilex USA -medical bill 32.74 8 Carlisle Medical Center 231.19 9 PA Dept of Revenue - 2012 Estimated Tax Payment 1,000.00 10 M&T Bank Check # 2518 -Birthday gift to Wendy Plummer 50.00 11 M&T Bank Check # 2519 -Birthday gift to Brian Plummer 50.00 12 M&T Bank Check # 2515 -Birthday gift to Leslie Rankin 50.00 TOTAL (Also enter on Line 10, Recapitulation) ($ 6,441.52 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) ~ pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Elizabeth A Rankin 21-12-0802 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. Larry Rankin 1114 Hillside Dr.Carlisle, PA 17013 Step-son 1 /3 2 Wendy Plummer 51 Jenks St., Amherst, MA 01002 Granddaughter 1 /3 of 2/3 3 Leslie Rankin 620 Broadview Ct., Columbia, MO 65201 Granddaughter 1/3 of 2/3 4 Kimberly Rankin 263 River Rd. South #3, Putney, VT 05346 Granddaughter 1/3 of 2/3 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: 1 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.