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Home My WebLink About01-11-13 (2)~ REV-1500 Ex,°'-'°' _ PA Department of Revenue Pennsylvania Bureau of Individual Taxes °°•°^*^^^^^°~^^~E^^• PO Box.zsosol INH Harrisburg, PA 17128-0601 F 1505610143 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 196 48 4873 06 it 2012 Decedent's Last Name Suffix WAY (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS X_j 1. Original Return ~ 2. Supplemental Return 4. Limited Estate ~ qa. Future Interest Compromise (tlate of tleath after 12-12-92) r -'i L~ g Necetlent Oietl Testate ~ (Attach CopyM Will) ~ 7 pecer~erlt Maint ~nedaLiving Tmst lAttac Gopy ofTrusQ 9. Litigation Proceeds Received ~ 10. Sppaural P0~55rt~~reaitf(aata of aeatn b9tween 12-J1- antl -1 -95) U 3. Remainder Return (date of death prior to 12-13-82) `, ~ 5. Federal Estate lax Return Required -._..... e. Total Number of Sate Deposit Boxes 11.Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL Name HEATHER L MOORE First line of address 7 EAST FRONT STREET Second line of address Ciry or Post Office SHIREMANSTOWN e-mail address: AND CONFIDENTIAL TAX INFORMATION-6HOULD BE DIRECTED TO: Dayelne Telephorr~Num~r m C O r'% C'? rn _]! State ZIP Code PA 17011 -cr - Cll ,.n R~.I~E~2,.QF V~LS 113E ~LY ~'~' Cf1 ,.AJ r,-,r r, r-~ -1 -vt .;. - ti.1 .,. ~l a~ l';1 -...1 ._~ n, Crn Cr DATE FILED under penalues or peryury, I declare tnat I nave examined this return, inGuding accompanying schedules antl statements, and to the best of my knowledge and belief, it is true,_ correct antl complete. Declaration of preparer other than the personal representative i5 based on all information of which preparer has any knowledge. Heather L THAN REPRESENTATIVE Healther L Moore GATE 7 East Front Street, Shiremanstown, PA 17011 Side 1 1505610143 1505610143 OFFICIAL USE ONLY County Cotle Year File Number CE TAX RETURN 21 12 01083 IT DECEDENT Date of Birth 03 28 1958 Decedent's First Name MI KELLEY A 1505610243 REV-1500 EX necetlenfs Name- Way, Kell@yA RECAPITULATION 1. Real Estate (Schedule A) ...................................................................................... . 1. 2. Stocks and Bonds (Schedule B) ........................................................................... .. 2. 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)........ . 3. 4. Mortgages 8 Notes Receivable (Schedule D) ....................................................... . 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) .............. . 5. 6. Jointly Owned Property (Schedule F) ~~ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8 Miscellaneous h{oq-Probate Property (Schedule G) I,J Separate Billing Requested............ 7. 6. Total Gross Assets (total Lines 1-7) ................................................................... .. g. 9. Funeral Expenses 8 Administrative Costs (Schedule H) ...................................... . 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............................. . 10. 11. Total Detluctions (total Lines 9 8 10) .................................................................. . 11. 12. Net Value of Estate (Line 6 minus Line 11) ......................................................... . 12. 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) .............................................. . 1q. - - TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9i i6 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable 0 00 16 - at lineal rate X .045 . 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 16. Amount of Line 14 taxable at collateral rate X .15 0.00 16. 19. Tax Due ............................_._.................._............................._............................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 196 48 4873 10,250.95 10,250.95 4,205.50 6,757.49 10,962.99 -712.04 -712.04 Side 2 L 1505610243 1505610243 0.00 0.00 0.00 0.00 0.00 REV-1500 EX Page 3 File Number 21-1 2-01 0 8 3 Decedent's Complete Address: DECEDENT'S NAME Way, Kelley A - --_ STREET ADDRESS 433 Garden Drive CITY ~ ''. STATE '~ ZIP Mechanicsburg PA ~ 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits (A + g) (2) 0.00 3. Interest (3) q. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) 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. (5) Q ~0 Make Check Pa able to: REGISTER OF WILLS, AGENT. I PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes N o a. retain the use or income of the property transferred;........_ ..................................................................... !~ ~ I x I b. retain the right to designate who shall use the property transferred or its income;..._._._.._.... _._.......... ] _ u c. retain a reversionary interest; or ..................................................................._.__..................................... _ '..~ C' d. receive the promise for life of either payments, benefits or care?........_ ................................. _............._ ^ ~~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration........... `] x 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death?....._ I L~ I xl 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 January 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 it 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)]. A sibling is defined under Section 9102, as an individual who has al least one parent in common with the decedent, whether by blood or adoption. Rev-1506 EX+ (6-9a) COMMONWEALTHOF GENNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8r MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Way, Kelley A 27-12-01083 Inclutle the proceetls of litigation antl the tlate the proceetls were receivetl by the estate. All properly jointlyawnM with tha dghl of survivorship moat be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 PNC Bank -Checking Account # 51129890341 142.01 2 PNC Bank -Savings Account # 5112803732 25.00 3 2005 Honda Civic -Wells Fargo Dealer Services -vehicle demolished in accident that killed 10,083.94 decedent TOTAL (Also enter on Line 5, Recapitulation) I 10,250.95 (If more space is neetled atlditional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn PA-7500 Schedule E (Rev. 6-98) REV-1151E%110-081 q~ NEN COMfylQ~W EAINT~DECEDEN~RN ANIA ESTATE OF FILE NUMBER Way, Kelley A 21-12-01083 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission paid 2. Attorney's Fees 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio _ Relationshio of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 3,892.00 313.50 TOTAL (Also enter on line 9, Recapitulation) I 4,205.50 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Copyright (c) 2009 form software only The Lackner Group, Inc. Forth PA-1500 Schedule H (Rev. 10-06) Rev-1512 E%+ (12-Dal COMMONWEALTH OF GENNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8r LIENS ESTATE OF FILE NUMBER Way, Kelley A 21-12-01083 Report debts incurred by the decedent prior to death that remained unpaid at the data ar tleath, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Ascension Point Recovery Services, LLC -The Limited, credit card 1,136.19 2 Camp Hill Emergency Physicians -Emergency Medical Care 1,186.00 3 Comcast - Cable/Telephone Service 259.64 4 Credit One Bank -Credit Card 559.02 5 Holy Spirit Hospital -Physician Services 2,072.40 6 HSBC Card Services -Credit Card 600.51 7 PPL Electric Utlities 293.54 8 Seventh Avenue -Credit Card 15.90 9 The Hetrick Center -Middletown, PA 78.39 10 United Water 81.08 11 US Postal Service -Thank you cards for memorial donations 33.75 12 Wells Fargo Dealer Servlces -Outstanding balance after insurance proceeds paid of loan on 441.07 2005 Honda Civic which was demolished in decedent's accidente TOTAL (Also enter on Line 10, Recapitulation) I 6,757.49 (If more space is needed additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) <~ ~M o ~~ s .~ ~_