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Home My WebLink About12-14-12 (2)J 1505610105 REV-1500`°~-"'iR' OFFICULL USE ONLY PA Department of Revenue pennsylvarria Bureau of Individual Taxes '" INHE RITANCE TAX RETURN County Code Year File Number PO BOX Z8o6ot ~ ~ , ~ 2 ~ ~~ Harrisburg, PA i71z8-o6ot RESIDENT DECEDENT J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDriri Date of Birth MMDDYYYY 10/08/2012 12/31 /1928 Decedent's Last Name Suffix Decedent's First Name MI DePuy Theresa M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Secudty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ t. 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) m 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Wili) (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 CONFIDENTU\L TAX INFORMATION SHOULD SF.pIRECTED TO: Name DaytirlQTelephone N~er ~ .Z7 John A. DePu CC rn y (71'f~`/~-9423 o cm~ o First Line of Address 835 South Humer Street Second Line of Address City or Post Office Enota Correspondent's e-mail address State ZIP Cade PA 17025 ~~Sr~ of ~s um ~ z nf ~ s ~n „ z . ~ o 0 C:J n Q -~ -rt _O ~ .. rv "" rn Y. ti f~? G) O t'-' -r9 Untler penalties of perjury, I deGare that I have examined this return, including arxampanying acheduks and statements, and to the best of my knowledge antl belief, it is We, correct and mmplek. Declaration of preparer other than the personal representatlve is based on all infomwtion of which praparer has any knowledge. SIGN RE PERSON R NSIBL R FILI G RETURN PATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Secudty Number Decedents Name: DePuy, Theresa M. 193-24-0951 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. Cash, Bank Deposits and Miscellaneous Personal Properly (Schedule E)..... .. 5. 1,208.43 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 99,242.73 7. Inter-Yvos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 100,4$1.16 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 2,405.75 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 1,606.06 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. 4,011,81 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 96,439.35 13. Chadtable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value SubJed to Tax (Line 12 minus Line 13) ...................... .. 14. 96,439.3$ 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. Amounl of Line 14 taxable at lineal rate X.045 96,439.35 1g, 4,339.77 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. 4,339.77 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 15U5610205 15[75610205 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME DePuy, Theresa M. STREETADDRESS 835 South Humer Street CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: t. Taz Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments _ _ . B. Discount 3. Interest 216.99_ 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Lirre 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A+B) (2) (5) (t) 4,339.77 (3) (41 216.99 122.78 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS i. 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 oxumed after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "intrust for" or payable-upon~eath 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 'rf 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)]. e 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 Vansfers 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-iSoR Ex+ (os-iz) `'. ~ , pennsytvania DEPARTMENT OF REVENUE. INHERITANCE TA% RETVRN RESIDENT DECEDENT SCNEDIlLE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: DePuy, Theresa M. 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 NUM6ER DESCRIPTION OF DEATH 1. Highmark Direct Pay Centrel Region -Premium Refund 158.43 2, Richardson funeral Home, Enola, PA -Prepaid Funeral Account 1,050.00 TOTAL (Also enter on Line 5, Recapitulation) $ 1,208.43 [f more space is needed, use additional sheets of paper of the same size REV-J,SDg EX+ (ot-LO) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TA% RETURN RESIDENT DECEDENT SClIEp11LE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: DePuy, Theresa M. It an asset became jointly owned within one year of the decedent's date of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. John A. DePuy 835 South Humer Street, Enola, PA 17025 son e' Janice M. Stoner C. JOINTLY OWNED PROPERTY: 26 Oak Avenue, Enola, PA 17025 daughter ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JDIXi DESCRIPTION aF MtOPERTY INCWDE NAME OF FlNANCGL [NSInUf10N AND BANK gCCWNi NUMBER OR SIMRAR IDENTIFYING NUMBER. ATTACH DEED FOR JOIMRY HELD REAL ESTATE. DATE OF DEATH VAWE OF ASSET % OF DECEDaRS INTEREST DATE OF DEATH VAWE OF DECEDENTS INTEREST 1. A. 04/01/04 Real Estate - 835 South Humer Street, Erala, PA 17025 188,201.00 50% 94,100.50 2. A. 03IO6I08 Bank Account-MemlN:rslst FCU-#263538 2,977.94 50% 1,488.97 3. A. 03/06/08 Bank At:count -Members 1st FCU -#263538 973.88 50% 486.94 4. B. 09/16/02 Bank Account -Members 1st FCU -#222440 2,507.42 50% 1,253.71 5. 8. 09/16/02 BankAxount-MembeTSistFCU-#222440 2,938.44 50% 1,469.22 6. B. 09/16/02 Bank Account -Members 1st FCU - #222440 886.78 50% 443.39 TOTAL (Also enter on Line 6, Recapitulation) I; 99,242.73 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) Pennsylvania ^EPARTMENT OF REVENUE MHERITANCE TAX RETU0.N RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DePuy, Theresa M. Decedent's debts moat be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Richardson Funeral Home, Enola, PA 1,862.76 2. Pamela's Flowers, Enola, PA 252.23 a. Funeral Luncheon Food/Paper Products 290.76 B. 1. 2. 3. 4. 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address _ City __. ____.._ -.. _ State ZIP Year(s) Commission Paid: 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: TOTAL (Also enter on Line 9, Recapitulation) I; 2,405.75 If more space is needed, use additional sheets of paper of the same size. 0.EV-1512 EX+ (12-ORJ j ~ pennsylvania DEPARTMENT OF REVENUE INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER DePuy, Theresa M. Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unrcimbursed medical ezoenses. tr more space is needed, Insert additional sheets of the same size. R`cV-]513 EX+ (O1-10) ~j,` pennsylvania Ry ^EP4HT?1fNT OF FfVENII[ INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE Of: FILE NUMBER: DePuy, Theresa M. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DO Not Llat Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outdgh[ spousal distributions and transfers Under Sec. 9116 (a) (1.2).] 1. John A. DePuy - 835 South Humer Street, Enola, PA 17025 `son 96076.41 2. Janice M. Stoner - 26 Oak Avenue, Enola, PA 17025 daughter 3166.32 ENTER DOLLAR AMOUNTS fOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH IB OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX [S 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 n~/CO n3n G _ G O eN uw+atl uolyls°tlslp i wpuawtl'E4 7/ / ~ v//v/ y ,\~ ~~ (U Ae0 owl aiep all]+¢»zleaH'L6 / / G a+naeu +e»sl8atl'i9 >a w >sl >sl8atl'Ob nN>PP .,e] aC/ b ° ~ oeo~-ass-tit I+A/~ p'a6E I a - >elawoJ unx.aa /o apoJ tlrs pue xsa.peb vweN ~qfi£ ~j ~.agpyg~:,.9wnN axua>n ~~- aulvl~ngawrn .I>IYm>/o a+n>.uvrs pa>.,x.a,,,,e p elna. >ele P°-'a>ep'awp aY>3¢P=+.n>a°4>.ap-'e3,;.f~ziaae~zs~~xa&~aeasirape.., ;e, ay>u + ]o~/+.,. we, .> a I 31 Ip W o Paaeae+aau. we wla:ne> aw °a anp pue . 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