The URL can be used to link to this page

Home My WebLink About12-21-12 (2) 1505610143 Ex laz-n ~ OFFICIAL USE ONLY -~ REV-1500 PA Department of Revenue Pennsylvania county code vear Fue NumOer Bureau of Individual Taxes °` °°`"`"'°`"`°`"°` PO 80X.280601 INHERITANCE TAX RETURN 21 12 0871 Ha«isburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Date of Birth Social Security Number Date of Death Decedent's Last Name NORRIS (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW i 1. Original Return ' _ 4. Limited Estate B Oacetlent Oled Testate XJ (Attach Gopy of WJp '. 9. Litigation Proceetls Received Suffix Decedent's First Name MI JOHN W Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS C 3. Remaintler Return (Date of Death 2 Supplemental Return prior to 12-13-82j FWUre Interest Compromise ~ 5. Federal Estate Tax Return Required U 4a' (date orpptleath after 12-12A2) 1 ~' ~Att3Ch eopy icn~Tned e Living Trust _ 8. Total Number O( $afe DepOSit Boxes ^ 10'btween123~-9l antltitDa95~f Death I, JI 11'~Ae atCh Schedule Oj Sec. 9113(A) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CO BE DIRECTED T0: NFIDENTIA D F CORRESPONDENT - mbe Telephone Nu Dayt e Name 610 3 2 3 41,Q~0 LEE F MAUGER ESQ n ~' ~ ~ 0 REG~TEti OF WI~USLGO f ~ y,. r- nT t,T m First Line of Address ~ ~' M f"' A V~ ~ 240 KING STREET ~ ~ ~";~ ~ ~ ~ -,~ _~ y^} 1.-: -'r{ ~ ....- Second Line of Address ," C:: = C7 :: :::1 F-~ P.. _ I f i PO BOX 698 City or Post Office POTTSTOWN "O BATE Stale ZIP Code PA 19464 Correspondent's a-mail address: Untler penalties of perjury, I tledare that I have examined this return, including accompanying schetlules and statements, and to the best of my knowledge and belief, rt is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer home y knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ->/' _ . ~ _ a ~ ~~n ~ ~, ~,L~/ Virginia S. Norris ~.~'d d -`~~ rco oua c ~-.-.. --- DATE SIGNATURE OP PR ER/ Q~r~R T RE S ; ATIVE / ~ ~ `~~ ~// Lee F. Mauger Esq. 240 V Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number oeoeae~r~Name Norris, John W. _._ _._- RECAPITULATION 116 , 216.10 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 & Notes Receivable (Schedule D) .. _...._- ~--~~ ~~~ 4. 11.53 5. Cash., Bank Deposits & Miscellaneous Personal Property (Schedule E)............ _. 5 6. Jointly Owned Property (Schedule F) IL; Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8 Miscellaneous ion,-PSepa aterBPllinq Requested............ LJ 7. (Schedule G) s 116,227.63 g. _ ................_ Total Gross Assets (total Lines 1 through 7)............_....... -._ __ . ___ ___ -. 9. - - ___- Funeral Expenses and Administrative Costs (Schedule H)..._ ........... ........... 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I)......... _........... _.... 10. 11. Total Deductions (total Lines 9 and 10) .............................._..................... _..__... 11. i2 116,227.63 12. _...._ Net Value of Estate (Line 8 minus Line 11)... _.. _ .......................... . 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)......... -.~--~ 1a. 116,227.63 TA X COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or 0.00 transfers under Sec. 9t t6 116 227.63 15 , (a)(1.2) X .00 0 ' 00 16. Amount of Line 14 taxable 0 , 0 0 16. at lineal rate X .045 0 0 0 17 . Amount of Line 14 taxable 0.00 17. . at sibling rate X 12 00 0 18 . Amount of Line 14 taxable 0 _ 00 18. ' at collateral rate X .15 0.00 1s 19 . TAX DUE........... .............. ..__....... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 1505610243 Side 2 1505610243 J REV-1500 EX Page 3 norarfent's Complete Address: File Number 21-12-0871 DECEDENT'S NAME Norris, John W. _ _ -- __-. __--__ - - STREETADDRESS 128 Strayer Drive -- -- CITY _ ___-.__ __.--- __-__. ~-STATE _ __._- ZIP ^ _- _-_ pA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 0.00 q, If Line 2 is greater than Llne 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2, Line 20 to request a refund 5_ If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) (5) ~.~0 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and'. I LJ a. retain the use or income of the property transferre ;_..... -~~~-- b. retain the right to designate who shall use the property transferred or its income;.... , ........ _ ~ I-I c. retain a reversionary interest; or .......... -~.-~~~-~~ ~~~~~~-~ ' d. receive the promise for life of eRher payments, benefits or care?........ .~-~~~ ~-- - - 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without -_ r~ _...._. _. 1. i .. _. _..... _ I.-' receiving adequate consideration?.. ~~~~~-~--~~~ ~~~~~~~~~' -- 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death L. - - 4. Did decedent own an individual retirement account, annuity, or other non-probate property whit i J __.. - -. _ ........... 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 RETUR 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 [o orfor the use of the surviving spouse is 3 percent [72 PB. §9116 (a) (1.1) (i)]. For dates of death on or after January 1 1995, the tax rate imposed on the net value of transfers to orfor the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) Qi)]. 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 orfor the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S- §9116 (a) (L2)). . The tax rate imposed on the net value of transfers to orfor 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 orfor the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling 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) _ _0..00 Total Credits (A + B) (2) - -__. 0.00 Rev4soz ex+lof-to) " ~e COMMON WEALTX OF PENNSYLVANIA INHERITANCE TAS RETURN RESIDENT DECEDENT ESTATE OF I..Mn \A/ FILE NUMBER 21-12-0871 All real property ownetl solely or as a tenant in common must be raportetl at fair market value. Fav market value is defined as the pace at wFich property would ca exchanged between ewilR alb ~o ertdthat is ~ointly~ownedw[h 9ighl of survivorship must be dlscbsedson schedule Fge or the relevem facts. P P Y 1 Attach a copy of [he settlement sheet if the property has been sold Include a copy of the tleed showing decetlent's interest if ownetl as tenant in common. ITEM DESCRIPTION NUMBER 1 50°/, Ownership in Real Estate situate in Pike Township, Clearfield County -Map Number: 126 - 110 - 000 - 00086 Control No. 126036304 $6,500 x 4.95 Common Level Ratio 2 50% Ownership in Real Estate situate Pike Township, Clearfield County -Map Number: 126 - 110 - 000 - 00085 Value: $297 x 4.95 Common Level Ratio 3 50°/a Ownership in Real Estate situate Pike Township, Clearfield County -Map Number: 126 - 110 - 000 - 00053 $1,550 x 4.95 Common Level Ratio 4 50% Ownership of Certain Mineral Rights in BeII Township, Clearfield County -Map Number: 102 - B09 - 000- 04133 MN Control No. 102.0-30257 $1,386 z 4.95 Common Level Ratio 5 50% Ownership of Certain Mineral Rights in Bloom Township, Clearfield County -Map Number: 104 - E08 - 000 - 00055 MN Control No. 104.0-30382 $1,034 x 4.95 Common Level Ratio 6 50°/a Ownership of Certain Mineral Rights in Penn Township, Clearfield County -Map Number: 125 - G11 - 000 - 00009 MN Control No. 125.0-30242 $5,040 x 4.95 Common Level Ratio 7 50%Ownership of Certain Mineral Rights in Pike Township, Clearfield County -Map Numbe 126 - 110 - 000 - 00022 MN Control No. 126.0-29951 $2,106 x 4.95 Common Level Ratio Total of Continuation Schedule TOTAL (Also enter on line 1, Recapitulation) VALUE AT DATE OF DEATH 32,175.00 1,470.15 7,672.50 6,860.70 5,118.30 24,948.00 10,424.70 See attached page 116.216.10 (If more space is neetled, adtlitional pages of the same size) Copyright (c) 2010 form software only The Lackner Group, Inc. SCHEDULE A REAL ESTATE Form PA-1500 Schedule A (Rev. Ot-10) Rev4502 E%+10140) gCHEDULE A REAL ESTATE ~° continued COMMONWEALTH OF PENNSYLVANIA NMERITANCE TA%RETURN nccin~ui nc,'.Gf1FNT ESTATE OF John ILE NUMBER 21-12-0871 ITEM DESCRIPTION NUMBER 8 50% Ownership of Certain Mineral Rights in Pike Township, Clearfield County -Map Number: 126 - H08 - 000 - 00007 MN Control No. 126.0-30239 790 x 4.95 Common Level Ratio g 50% Ownership of Certain Mineral Rights in Pike Township, Clearfield County -Map Number: 126 -110 - 000- 00005 Control No. 126.0-93275 $2,132 x 4.95 Common Level Ratio 10 50%Ownership of Certain Mineral Rights in Pike Township, Clearfield County -Map Number 126 -110 - 000-00005 MN Control No. 126.0.30232 $1,853 x 4.95 Common Level Ratio 11 50% Ownership of Certain Mineral Rights in Pike Township, Clearfield County -Map Number 126 - HOS - 000 - 00017 MN Control No. 126.0-30236 $790 x 4.95 Common Level Ratio TOTAL (Also enter on Line 1, Recapitulation) VALUE AT DATE OF DEATH 3,910.50 10,553.40 9,172.35 3,910.50 116,216.10 Form PA-1500 Schedule A (Rev. Oi-10) Copyright (c) 2010 form software only The Lackner Group, Inc. REV-1515 E%+10110) '~. SCHEDULE) oMMONwEA}rHOEaENNSVwANIA BENEFICIARIES ~~ IN R 91~ENT DECEDENTRN ESTATE OF Norris, John W. NAME AND ADDRESS OF NUMBER PERSON(Sl RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spc distributions, and to under Sec. 9116(a Virginia S. Norris 128 Strayer Drive Carlisle, PA 17013 FILE NUMBER 21-12-0871 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT lWords) (5$S) Wife 116,227.63 Total I 116,227.63 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAK 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINt 13 ~r rcw- "..~ Form PA-1500 Schedule J (Rev. Ot-10) Copyright (c) 2010 form software only The Lackner Group, Inc.